BANGOR, Me. — The mother got the call in the middle of the night: her 3-day-old baby was going through opiate withdrawal in a hospital here and had to start taking methadone, a drug best known for treating heroin addiction, to ease his suffering.
The mother had abused prescription painkillers like OxyContin for the first 12 weeks of her pregnancy, buying them on the street in rural northern Maine, and then tried to quit cold turkey — a dangerous course, doctors say, that could have ended in miscarriage. The baby had seizures in utero as a result, and his mother, Tonya, turned to methadone treatment, with daily doses to keep her cravings and withdrawal symptoms at bay.
As prescription drug abuse ravages communities across the country, doctors are confronting an emerging challenge: newborns dependent on painkillers. While methadone may have saved Tonya’s pregnancy, her son, Matthew, needed to be painstakingly weaned from it. Infants like him may cry excessively and have stiff limbs, tremors, diarrhea and other problems that make their first days of life excruciating. Many have to stay in the hospital for weeks while they are weaned off the drugs, taxing neonatal units and driving the cost of their medical care into the tens of thousands of dollars.
Like the cocaine-exposed babies of the 1980s, those born dependent on prescription opiates — narcotics that contain opium or its derivatives — are entering a world in which little is known about the long-term effects on their development. Few doctors are even willing to treat pregnant opiate addicts, and there is no universally accepted standard of care for their babies, partly because of the difficulty of conducting research on pregnant women and newborns.
Those who do treat pregnant addicts face a jarring ethical quandary: they must weigh whether the harm inflicted by exposing a fetus to powerful drugs, albeit under medical supervision, is justifiable. “I’ve had pharmacies that have just called back and said: ‘This lady’s pregnant. Why do you want me to fill this scrip? I can’t do that,’ ” said Dr. Craig Smith, a family practitioner in Bridgton, Me. “But when you stop and think about what actually happens during withdrawal and how violent it can be, that would certainly be not in the baby’s best interest.”
Still, even doctors who advocate treating pregnant addicts have had moments of doubt. “At first I was going, ‘Gosh, what am I doing?’ ” said Dr. Thomas Meek, a primary care physician in Auburn, Me. “ ‘Am I really helping these people?’ ”
There are no national figures that document the extent of the problem, but interviews with doctors, researchers, social workers and women who abused painkillers while pregnant suggest that it has grown rapidly, especially in rural regions, where officials say such abuse is most common.
In Maine, which has been especially plagued by prescription drug abuse, the number of newborns treated or watched for opiate withdrawal, known as neonatal abstinence syndrome, at the state’s two largest hospitals climbed to 276 in 2010 from about 70 in 2005. Hospitals in states including Florida and Ohio reported similar increases, and experts said the numbers were probably higher since pregnant women are rarely tested for drug use and many mothers do not admit to abusing opiates.
Tonya, 24, said she was introduced to painkillers like OxyContin, Percocet and Vicodin while working the overnight shift at an industrial bakery an hour from her home. Everyone — including co-workers, the boyfriend she met on the job and their manager — was taking pills, she said. “It was a lot easier to get through life and have energy,” Tonya said at Eastern Maine Medical Center here in January, holding Matthew a month after his birth. He was still being weaned off methadone.
Before she was pregnant, Tonya said, she quickly became addicted, spending all of her money on pills bought on the street. She and her boyfriend, Josh, needed to stave off withdrawal and get through the day, she said. Now that she is in treatment, Tonya, who like most mothers interviewed for this article did not want her last name used, said her focus was on Matthew. “We put him in this situation,” she said, “and we have to help him out of it.”
‘How Little We Know’
Rigorous studies on treating infant withdrawal are scarce, and the American Academy of Pediatrics has not published guidelines since 1998. “It’s really remarkable how little we know about the effect of prescription drugs and even nonprescription drugs on the fetus,” said Dr. Nora D. Volkow, director of the National Institute for Drug Abuse. “There are real roadblocks in terms of helping us advance the field.”
Dr. Mark L. Hudak, a neonatologist in Jacksonville, Fla., is helping to revise the pediatrics academy’s guidelines. “There are commonalities, but it’s not like you can go to a Web site that says, ‘This is what should be used by everyone,’ ” Dr. Hudak said. “No one knows what the best approach is.”
Within states, every hospital that delivers babies exposed to painkillers may have its own approach. Eastern Maine treats affected newborns with tiny doses of methadone, while Maine Medical Center in Portland uses morphine combined with phenobarbital, a barbiturate that prevents seizures. Some hospitals are also experimenting with clonidine, a mild sedative that can relieve withdrawal symptoms.
There is growing debate over treatment for pregnant women addicted to prescription drugs, in light of concerns over the effects on their babies. Many are slowly weaned from their dependence with methadone, the standard of care for decades. Methadone, when taken in prescribed doses, keeps a steady amount of opiate in the body, preventing withdrawal and drug cravings that occur when levels dip. But it, too, can be addictive and cause nagging side effects like drowsiness. And for addiction treatment, it can be obtained only at federally licensed clinics where most users have to report for a daily dose.
A growing number of addicts are instead taking buprenorphine, another drug used to treat addiction that some studies suggest staves off drug cravings as effectively as methadone but is less likely to cause withdrawal in newborns. In rural areas of the nation, where methadone clinics are few, buprenorphine is considered a promising alternative because it can be prescribed by primary care doctors and taken at home. But buprenorphine also appears not to work for some addicts.
Still, a study published in December in The New England Journal of Medicine showed that babies whose mothers had taken buprenorphine required significantly less medication after birth and less time in the hospital than did babies whose mothers were treated with methadone. But researchers cautioned that exposure to buprenorphine in utero can still cause withdrawal symptoms and that further study was needed. “We don’t want it misconstrued that buprenorphine is a miracle drug,” said Hendrée E. Jones, a Johns Hopkins University researcher and the study’s lead author.
Even less is known about longer-term effects on babies exposed to painkillers, though in a second leg of their study, Dr. Jones and her fellow researchers plan to follow the 131 babies in the cohort until they turn 3. A recent study by the Centers for Disease Control and Prevention found that babies exposed to opiates in utero, in this case legally prescribed painkillers, had slightly higher rates of birth defects, including congenital heart defects, glaucoma and spina bifida.
Experts say that since many drug users also smoke and abuse alcohol, not to mention that they face extenuating circumstances like poverty, it is difficult to tease out the effects of each substance on their offspring. “Most of the literature suggests consistently that the drug exposure itself is not the primary concern,” said Karol Kaltenbach, a professor at Jefferson Medical College in Philadelphia who studies addiction in pregnant women. “It’s the cumulative effect of the drug-using lifestyle — poverty, chaos in the home, domestic violence. All those things affect development.”
Not all newborns exposed to opiates have severe enough withdrawal to need medicine; at Maine Medical Center since 2003, about 55 percent of babies exposed to buprenorphine and 80 percent of those exposed to methadone have needed treatment. But it is hard to predict which ones will need it: a newborn whose mother was on a high dose of either drug might need none, while a baby whose mother took a low dose might experience acute withdrawal. Babies known to have been exposed to drugs are often kept in the hospital for at least five days because withdrawal symptoms usually do not set in immediately. Nurses examine them for a checklist of symptoms every few hours, assigning each baby a score that, if high enough, calls for treatment.
“They don’t stop crying, they can’t settle down, they don’t relax,” said Geraldine Tamborelli, nursing director of the birthing unit at Maine Medical Center, which in 2010 diagnosed opiate withdrawal in 121 newborns. “They’re struggling in your arms instead of snuggling into you like a baby that is totally fine.”
In the neonatal intensive care unit at Eastern Maine, Kendra, 3 days old, was sleeping in a dark, silent room one morning, away from the bustle and bright lights that can be especially irritating to babies going through withdrawal. Nurses frequently crept in to observe her, though, and by the afternoon her limbs had stiffened and she was crying excessively and having tremors; it was enough to begin treatment. “This seems to be ramping up fairly quickly for her,” said Dr. Mark Brown, the hospital’s chief of pediatrics, “so the decision was to start treatment more quickly.”
On the pediatric ward, Matthew started fussing while his mother, Tonya, talked to reporters that afternoon in January; his cry had a strange, reedy pitch that nurses say is common to babies with his condition. The small dose of methadone he had received gave him gas and heartburn, for which he was given two stomach medications. He also was on clonazepam, a muscle relaxant and anti-anxiety drug that helped him metabolize the methadone more slowly.
Tonya said that at first she “didn’t believe in” methadone treatment during pregnancy and that doctors had to persuade her that it would not hurt her fetus. She had experienced wrenching withdrawal when she stopped using painkillers after learning she was pregnant, she said, and the doctors had warned her that “when I was feeling that bad, he was feeling 1,000 times worse.” Tonya said that in a previous pregnancy, she quit using drugs altogether and miscarried a month later. “That was the last thing I wanted to happen this time,” she said.
Avoiding Addicts, and Liability
Treating drug-dependent mothers and babies is often lonely work, with little communication among the doctors who take it on. As Dr. Brown said, “My network for people who do this is really very small.”
Dr. Mark R. Publicker, an addiction medicine specialist at Mercy Recovery Center in Westbrook, Me., is on a mission to get more of the state’s doctors to treat pregnant prescription drug abusers and more hospitals to deliver their babies. Only a handful of doctors here treat pregnant women with buprenorphine, Dr. Publicker said, partly because they fear liability and do not want to deal with addicts. The fact that most hospitals will not deliver the babies makes doctors even less likely to treat the women. “It’s mostly ignorance,” Dr. Publicker said. “It’s a concern that it’s a risky proposition and that they’re going to wind up with an ill baby.”
In February, Dr. Smith persuaded Bridgton Hospital, which has only 25 beds, to deliver the babies of women on buprenorphine — a major victory, he said, because until then women in rural southwestern Maine had to drive an hour or more to Maine Medical to deliver. Courtney, a patient of Dr. Smith’s who discovered she was pregnant while in jail for stealing OxyContin from her landlord, said buprenorphine treatment seemed the best of her bleak options. “I just don’t want to mess up,” she said.
Tonya, too, said she was determined to make things right for Matthew, who was five weeks old when she took him home to a trailer outside Bangor. He is off the methadone now and appears healthy, but Tonya still has to go to a methadone clinic in Bangor every day for her dose and resist the pressures to return to illicit drug use. Her boyfriend began using opiates as a young teenager, she said, and his father and grandmother abused OxyContin along with him. “I’m proud that I changed my life,” Tonya said. “But at the same time, when you see your child in pain and you know your child is in pain because of a life decision you made, it’s the hardest thing in the world.”

Source: New York Times April 9th 2011

Source: http://brainblogger.com/2009/07/03/why-do-schizophrenics-smoke-cigarettes/
3rd July 2009

By MARK SCHOOFS

Source: WallStreetJournal online. Sept. 27th 2006

The young wrestler was sitting on the kitchen floor, his bloody face illuminated by the early-morning light that streamed through a nearby window. In other parts of the world, the shadow of the moon was edging across the rising sun, marking the beginning of a dramatic and well-publicized total eclipse. Will Hollingsworth had talked of little else for the past four days: the last eclipse of the millennium and the apocalypse some believed would follow. He had not slept in more than 100 hours, holed up in his room, paging restlessly through a Bible, his television tuned to news of the eclipse. It was a peculiar obsession for a 20-year-old college student who spent most of his time training to be a world-class athlete.
Will didn’t appear intoxicated. To the contrary, he was alert, engaging and philosophical, though strangely fixated on current events.

Now this.

On any other day, he would have been out the door — running for miles along eastern Hillsborough County’s busiest roads, pumping iron at the gym, working out with his old high school wrestling team.

But on this August morning in 1999, there was only the inexplicable blood and the vacant stare that greeted me when I came to make breakfast. “What happened?” I asked my only son. “I’ve been fighting demons,” he replied.

Demons?

“It’s true,” he insisted, gesturing to his bloody face and filthy shirt. “I’ve been fighting demons all night. And I won.”

I followed his gaze through the window into the back yard. There, the torn sod and blood-stained patio marked the spot where he had pounded his face into the ground as his father and I slept, oblivious to the war we were about to wage with an invisible enemy. Will would battle his demons for the next three years. But he would never exorcise them. GHB already had laid claim to his sanity, and there was no one who could tell us how to retrieve it.

Dying To Win

Trinka Porrata is all too familiar with the phenomenon of young men who speak of mortal conflict with demons — men who pound their heads on concrete as they experience the unique and little-known psychosis that accompanies GHB withdrawal. “I can’t tell you how many times I’ve heard about that,” said the retired Los Angeles narcotics detective. “Some of them try to put their heads through plate-glass windows.” Some succeed.

Porrata, founder of Project GHB, has spent seven years throwing a lifeline into cyberspace for addicts desperate to escape the grip of a nutritional supplement promoted as a safe, non-habit-forming sleep aid that claimed to build lean muscle mass. Most have been athletes or bodybuilders, but GHB use cuts across all demographics. “It’s the most unique drug,” she said. “We have a lot of senior citizens hooked on it thinking it’s antiaging. It’s big in the gay community, big in the gym scene, big in the club scene. Yet it’s invisible.”

Porrata said she has had more than 1,800 inquiries from GHB users and their family members since Project GHB went online in December 1999. “We were getting: ‘I thought I was the only person in the world with this problem,’” she said.

Before the debut of Project GHB, anyone looking for information on the chemical discovered a nest of Internet sites featuring glowing testimonials, mail-order supplies and recipes for cooking it at home. Central Florida, with its fitness culture, was a watershed for the craze during the 1990s, before GHB-related products were outlawed.

Tampa had its own cottage industry in the form of Body Life Sciences, a now-defunct company that produced and marketed the supplement under the brand names Revivarant and Revivarant G. GHB seemed to offer something for everyone, depending on the dosage: sedation, exhilaration, sexual stimulation, weight loss and the unsubstantiated promise of massive muscles. It was readily available at health food stores and gyms, where it entered the marketplace as an ostensibly safe, legal alternative to steroids.

In recent years, its ability to induce mild euphoria and amnesia attracted a new kind of customer who employed it as a party drug associated with overdoses and sexual assaults. GHB’s link to “date rapes” and all-night raves quickly overshadowed its widespread use in the athletic community. Yet it is the athletes and bodybuilders, who incorporate it into a daily regimen, who are most at risk of becoming addicted.

“It’s really the frequency of the dose as opposed to the amount of the dose that leads to this very striking psychosis,” said David Kershaw, a psychologist for Hillsborough County’s Mobile Crisis Unit. Kershaw has seen his share of GHB addicts in withdrawal — beginning in late 1999, when the county’s mental health center saw a rash of cases involving muscular young men suffering from hallucinations and paranoia.

One believed he had an invisible tape recorder fastened to his leg. Another saw a swarm of flies covering his body. All were regular users of GHB. “The irony is that despite the fact that they wouldn’t deliberately pollute their bodies like that, they get sucked into using it,” Kershaw said. “The people I see are all athletes, all concerned with being as healthy as they can be.”

One of them was Will.

The Runner Stumbles

Will’s descent into madness was swift and seemingly irreversible.

The first sign that something was amiss came one night in the spring of 1999, when he called to ask his father to come help him change a flat tire. It turned out the tire was flat because Will had drifted off an exit ramp on Interstate 75 and into a tree. Weeks later, another late-night call — this one from an ex-girlfriend, who said she had received an urgent message from Will asking her to pick him up at a gas station near the University of South Florida.

When she arrived, she found the car, with the engine still running, the driver’s door ajar, but no sign of Will. He turned up at another nearby gas station — incoherent, with no memory of how he got there. His father and I were mystified. Will seemed as bewildered as we were. “I keep making mistakes, and I don’t know why,” he said.

He never made the connection between the potion he bought at the local health food store and the bizarre things that happened when he stopped using it. We didn’t know he was using GHB. There were a lot of things we didn’t know.

The Will we knew was exceptionally bright, responsible, hardworking and honest. A good student, a loyal friend and — most striking — a gifted athlete with a passionate dream to be the best of the best — at something.

He was, at one time, the fastest boy in Hillsborough County — sprinting and jumping his way through a medley of track-and-field titles during his middle school years. There was a charisma about the sturdy blond boy whose blistering speed brought stadium crowds to their feet as he entered the homestretch.

When he earned a place on the Brandon High School wrestling team — one of the premiere prep athletic programs in the nation — he told a sports reporter what it meant to soar with the Eagles. “I feel there is no limit to where I can go,” he said in a 1997 newspaper interview. “It is a great team and I don’t think my life will ever be the same.”

Death And Detox

About the time the young wrestler was beginning to unravel in Florida, bodybuilder Mike Scarcella, a former Mr. America, was arrested in Texas, charged with felony possession with intent to distribute GHB.

The U.S. Food and Drug Administration had banned the supplement in 1990 but left loopholes that allowed its analogues — chemical cousins that turn into GHB after ingestion — to be sold for another decade. By all accounts, including his own, Scarcella had been using the supplement for years — first as a muscle-building nightcap, then as a morning pick-me-up. Eventually he was sipping capfuls throughout the day, a classic pattern among athletic users that can lead to physical dependence in a matter of weeks or months. Scarcella was hooked. His May 1999 arrest, which resulted in 10 years’ probation, was not enough to pry him from the grip of GHB.

The 1992 Mr. America continued to use and sell the drug, even as he tried to kick the habit — first on his own, then in hospitals, where doctors had no experience with the bizarre hallucinations and raging psychosis of GHB withdrawal.

Even with a doctor’s help, withdrawal can be deadly. Stroke, heart attack and suicide are among the consequences for addicts in withdrawal, which can start within one to three hours of a missed dose.

Anxiety, restlessness and insomnia can quickly progress to delirium, muscle tremors and delusions.

“They think they’re on fire. They’re moving, thrashing, screaming,” said Karen Miotto, a University of California-Los Angeles addiction psychiatrist who helped develop a GHB detox protocol. “I think GHB is probably harder to get addicted to than some other drugs,” she added. “But once people get addicted, it is far harder to get off than any drug I’ve seen.”

Scarcella’s battle ended in August 2003, when the 39-year-old bodybuilder was admitted to a Texas hospital feeling the first effects of GHB withdrawal. By the 10th day, he had become delusional and suffered what the medical examiner termed “sudden cardiac death.”

Doctors and psychiatrists have been slow to recognize GHB withdrawal. Most know little beyond its reputation as a date-rape or club drug with the potential to deliver a swift, deadly knockout punch. Emergency room physicians have become familiar with the unconscious overdose patients — generally youthful partiers — who are often treated and released.

But they rarely consider GHB use in the muscular, hallucinating patients who are delivered in four-point restraints. “ER doctors don’t really know what to look for,” Kershaw said. Most physicians and mental health professionals also fail to recognize the early stages of withdrawal, when careful detoxification using the right medications might head off a spiral into psychosis. “It really means that the only time they’re going to get help is when they’ve reached the state of hallucinating,” said San Francisco addiction specialist Alex Stalcup. By then, their condition may be far less treatable.
“It’s just heartbreaking.”

Jesus’ Son

The angels appeared in September 1999, shortly after the eclipse that marked the end of life as we knew it.
These were not benevolent guardians, but mute, shadowy creatures only Will could see. What was their purpose? I asked him. “They’re here to watch us,” he said. Not as protectors but observers. They were neither dangerous nor benign. They just WERE, he said. Six weeks had passed since the morning of Will’s bloody battle with the backyard demons.

His father and I had spent the first week taking turns staying home from work with him as he slept round-the-clock, sedated by a physician.

The sleep deprivation that preceded the incident was enough to cause hallucinations, according to a psychologist friend. Perhaps sleep would bring him out of it, she suggested. We knew by this time that GHB had played some role. Will had acknowledged taking the supplement in the week before the eclipse. But he had stopped about three days before, he insisted. When Will finally woke up by week’s end, the crisis seemed to have passed.

He returned to his part-time job as a waiter at a Brandon restaurant and began his junior year at USF. With his sights set on the Olympics since high school, he resumed his regular workouts — and, according to his off-campus roommates, resumed his GHB use. “It takes you to a place you never want to come back from,” Will said.

On Labor Day, he was back home, reading the Bible around the clock. He stopped attending classes, didn’t report for work and did not return to the apartment he shared with three other students. He had stopped taking GHB.
He also had ceased his workouts and stopped eating. He claimed he was going to fast for two weeks — “like Jesus.”

Once again, his father and I took turns working from home, watching, waiting. He was, by law, an adult and could not be forced into an evaluation unless he proved to be a danger to himself or others. He didn’t meet that criterion — not yet. His father took his car keys, just in case. Sept. 17, 1999. It was my turn to watch over Will.

I worked on a news story from my laptop on the dining room table, just outside his bedroom. Each time I checked on him, he was sitting on his couch, reading his Bible. He had not eaten since Sept. 6. Shortly before 6 p.m., Will wandered out of his room and pulled up a chair across from me. My fingers froze on the keyboard as I met his gaze. “What are you working on?” he asked. I knew he couldn’t possibly be interested, but it was the first time in weeks he had made any effort to engage in conversation. I began to explain the story I was writing. Then I saw it, so plainly that for a moment I thought I was the one losing touch with reality.

Will’s gray-green eyes, the windows to his troubled soul, suddenly transformed into black pools of blazing madness. And for the first time, I understood the concept of possession. I was still answering his question when he cut me off in midsentence. “You don’t know who you’re dealing with, do you?” hissed the suddenly dark, dangerous creature.

“No,” I replied, cautiously. “Who AM I dealing with?” He rose from his chair and took a step toward me, his fist clenched, his face contorted with rage. “I am the Lord Jesus Christ, and I want my car keys.” I glanced at the clock. His father was due home any time now.

Will’s lips smiled, but his eyes still glittered with that dark madness. “He’s not going to save you,” he said, as though he had read my mind. The phone rang. Will answered. “Yeah, Dad. She’s right here,” he said, handing me the phone, still smiling that frightening smile. Whatever I had seen in Will’s eyes, his father heard in his voice. “Can you talk?” he asked me. “No.”

“Something is wrong?”

“Yes.”

“Get out of the house,” Will’s father told me. “Get out NOW.” Clearly the time for watching and waiting was over. His father dialed 9-1-1.

That night, the angels made their first appearance as Kershaw and his mobile crisis unit came to commit Will for 72 hours of psychiatric observation under Florida’s Baker Act — the first of nearly a dozen hospitalizations over the next 30 months. It wasn’t a tough call. Will was in “florid psychosis” and claimed alternately to be God, Jesus and Jesus’ son.

Then there were the angels, who would, in time, become Will’s constant companions. Kershaw was among the few professionals we encountered over three years who took serious note when we told him of the GHB link.

“Will’s case prompted me to educate myself on this,” he said. “If I have someone who’s got psychotic symptoms, and they’ve got a history of being a fairly well-functioning athlete with no history of mental illness, one of the first things I think of now is GHB.”

Spontaneous Combustion

GHB was the last thing David Johnson thought of as he searched the Internet for information about “Enliven,” a supplement his 28-year-old son, Tyler, purchased at a health food store near his home in Beebe, Ark.

Tyler, who had graduated weeks before from the University of Arkansas, became restless and “fidgety” on the night of July 15, 2000. His pulse raced, and he began to say things that didn’t make sense, Johnson said. Unknown to Johnson, the young bodybuilder had been taking Enliven for about a year. Now, engaged to be married and about to begin law school, Tyler had decided to stop taking it. That night, he showed his father a bottle of the supplement, labeled as a “100% Pure Cellular Recovery System” that “Renews the Body Naturally.”

What it didn’t say was the active ingredient — 1,4 butanediol, better known as BD — is a solvent that converts into GHB once ingested.

GETTING OFF ‘G’
Withdrawal from GHB is among the most prolonged and severe of any drug and should not be undertaken without medical supervision.

Cardiovascular distress is significant, posing the risk of stroke or heart attack. Spikes in blood pressure from repeated bouts of withdrawal can result in arterial damage and an enlarged heart. Withdrawal grows more severe with each subsequent attempt, “kindling” the nervous system to the point of inducing delirium or seizures.

Patients treated before they reach this stage stand a better chance of successful recovery. Detox begun in early stages of withdrawal, with onset of restlessness and anxiety, works best. Detox generally takes at least two weeks, often requiring heavy doses of sedatives, accompanied by monitoring of blood oxygen levels. David Johnson didn’t know it, but Tyler was in GHB withdrawal.

“I wanted to take him to the hospital, but he told me he was all right and he went to bed,” Johnson said.

The next morning, shortly after dawn, a neighbor discovered Tyler’s body on the Johnsons’ front lawn. He had shot himself in the head. Suicide is an all-too-common outcome in cases of GHB addiction, though the true numbers will never be known. Porrata has seen it over and over.

“It’s like spontaneous combustion, not like they pondered it. They just shoot themselves in the head,” she said.
Detox from GHB can take at least two weeks.

“I think one of the most dangerous periods is after detox, where they are suffering depression, anxiety, and it becomes this protracted withdrawal state,” Miotto said. GHB anxiety is malignant — the frightening dreams at night, the terror during the day as the central nervous system tries to deal with the legacy of a little-understood chemical assault on the brain, Stalcup said. “If I had to go through what I see people going through, I don’t know if I could do it,” he said.

Perhaps the harshest irony, Porrata said, is the people who become addicted to GHB in the pursuit of health and fitness and end up turning to street drugs to counter the effects of withdrawal. Black-market Xanax, Valium and similar drugs tend to be the ones of choice. Alcohol, cocaine, Ecstasy and even crystal methamphetamine aren’t far behind.

Of Dreams And Nightmares

In the weeks and months that followed Will’s first Baker Act, life took on a rhythm of sorts — but not the sort we envisioned.

By day, Will continued to run, lift weights, wrestle and pursue his athletic dreams. By night, he battled the demons that invaded his sleep. The boy who once was a designated driver for friends retreated to his room, alone, to drown the delusions in rum and vodka.His circle of friends shifted from students and athletes to dropouts and drug dealers who could ensure a steady supply of sedatives and anything else that might quiet the voices and visions.

I purchased a dreamcatcher and hung it beside his bed, hoping the mystical Indian legend would offer some comfort.

But nothing could banish the nightmarish images that appeared when he closed his eyes. “You can’t imagine what is happening in the world,” he told me. “Yes, I can.” I had to look no further than the gaping hole in his soul.

Laced with antipsychotics prescribed by his doctors, supplemented by a pharmacopia of his own invention, Will struggled to hold down a job and tried, unsuccessfully, to complete his junior year.

He teetered for months on the brink of madness, alternately stabilizing, then disintegrating into a series of forced hospital stays. We didn’t know whether he continued to use GHB or whether the drug had permanently rewired his brain.

“With Will, when I saw him again and again, I wasn’t sure if the GHB had triggered more of a chronic process with him,” Kershaw said. Each time Will was committed, we asked the nurses and doctors to flag his chart to reflect his GHB use — a request that often was received with blank stares and dismissive waves. Will continued to slip from our grasp, trapped in a world inhabited by demons and angels, a world defined by the absence of light or joy.

We wondered how long he could survive in such a dark and hopeless place. It didn’t help that he had come to believe he possessed the gift of prophesy and claimed to have seen his own death many times. He wouldn’t tell us when this was to occur. All he would say was that it involved fire.

Drowning In Cases

In the beginning, the addicts who flocked to Project GHB for help tended to be young men in their late teens and early 20s. Today, Porrata is seeing older men who have been using for five to 10 years. Most are 30 to 55 years old.
“It’s not the party kids,” she said. “It’s the man in midlife crisis who starts going to the gym and wants to lose a few pounds, look a little better, rekindle things — and someone introduces him to ‘G.’”

But still it is the athletes who concern her the most. “Any place you see steroids, GHB is right in the shadows,” she said. “The sports world won’t admit this drug. It’s like their secret drug, and they won’t give it up.”

Unlike steroids, there is no evidence GHB enhances physique or performance. Still, users subscribe to the myth.

“What makes GHB so attractive to athletes is it’s very difficult to detect. They pass all the routine urine drug screens that you do,” said Tampa addiction specialist David Myers.

One of Myers’ patients — a Major League Baseball player — sipped GHB from a small mouthwash bottle during his games. He told Myers and his team managers that GHB use was widespread in pro sports, including among his teammates.

“He relapsed,” Myers said. “There was no support from team management, and it was clear they were not interested in tackling GHB issues.”

There is some speculation that stepped-up enforcement has limited the drug’s availability. But despite a major Drug Enforcement Administration sting that netted 115 Internet distributors in 84 North American cities in 2002, followed by a $7 million bust this year in Scotland, there is plenty of GHB to go around. With Project GHB and other Internet sources supplying information that wasn’t available to addicts six years ago, many users are taking matters into their own hands, Porrata said. “They’ll die from other drugs,” she said. “And we’ve had so many suicides — so many.”

The Three Demons

Will’s final Baker Act took place Jan. 18, 2002. His slide into psychosis began as it always did: He stopped eating.

This time he said he planned to fast until Easter. When he entered Memorial Hospital’s psychiatric unit that day, he had been fasting for two weeks and had lost nearly 30 pounds. A public defender assigned to Will’s case blocked every effort to give him intravenous fluids and nutrients. If he wanted to starve himself, it wasn’t our business, or his doctor’s, she said. By February, Will was still fasting and began walking into walls. He fell and hit his head.

Then something remarkable happened: After three years of inexplicable madness, someone finally decided to take a look at Will’s brain. A nurse requested a CT scan. It was then that we finally met his demons. There were three of them: inoperable brain lesions whose nature and origin doctor’s couldn’t even guess at. Will was transferred to the medical floor, and for the first time in nearly two months, he received IV fluids and nutrients. Too late.

The neurological collapse began with involuntary flickering of his eyelids, which grew more pronounced each day. His hearing began to fail. He started to lose the use of the right side of his body. Still he would not eat. “Don’t worry,” he said. “I’ll be fine.” “All you have to do is start eating, and they’ll let you out of here,” I pleaded. “Isn’t there someplace you’d rather be?” “Heaven,” he said. On Easter, Will broke his fast with a Cadbury egg. He was transferred to a physical therapy unit, then sent home.

The brain scan was sent to Johns Hopkins University in an attempt to identify the lesions. The young wrestler, once the fastest boy in Hillsborough County, could not get from the bedroom to the bathroom without a walker. His balance was gone, his hearing severely impaired. And his flickering eyes couldn’t focus on a television screen, much less a Bible.
But he could kneel, and he could pray. And that is what Will did each day. “Everything will be fine,” he kept saying. “I’ve seen the future, and I’ll be wrestling.”

One of the saddest things about GHB, Miotto said, is the way the drug affects the mind. “They don’t grasp the level of their impairment,” she said. But the saddest thing about Will’s experience was his ability to grasp just that.

Despite his irretrievably broken mind, he knew what he had lost. He knew it all along. Will had always felt a particular affinity for the homeless. In the years he struggled with GHB psychosis, he actively sought them out to give them money as they picked through garbage bins. “That could be me someday,” he said. Despite his intermittent delusions of grandeur, his goals were humble. “What do you want from life?” I asked him shortly before that last Baker Act.

“I just want to be able to take care of myself,” he said. “To drive a car. To have a place of my own.”
Weeks after Will’s release from the hospital, his doctor evaluated him. He checked his eyes, his ears, his balance. This, he told him, was as good as it was going to get. As for the three still-unidentified brain lesions — things could get worse, he added.

Four days later, on June 3, 2002, my son took a gas can from the garage to the back yard. He doused himself and lit a match. A young man approached me after the memorial service. He said his name was Brandon and that Will had persuaded him to seek treatment for cocaine addiction.

“I’m two years clean and sober now,” he said. “Will saved my life, and I just wanted you to know.”

Source: Researcher Mike Messano contributed to this project. Reporter Jan Hollingsworth can be reached at (813) 865-4436 or jhollingsworth@tampatrib.com.

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Renewtrient
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Weight Belt Cleaner

Source: Project GHB

The key question was whether growth in substance use was retarded in the media campaign communities. The answer was yes, most clearly for drinking and cannabis use and less clearly (but still substantially) for smoking.
In the two sets of communities, at the start roughly the same proportions of pupils had tried these substances. Over the next two years, half as many pupils in the campaign communities started to use each of the three.
An earlier analysis suggested that the school campaign had worked by fostering the perception that substance use was incompatible with the pupils’ aspirations.

In context

Its inexpensive strategy meant the project could afford repeated exposure in a way that would not have been possible with mass media ads. It also gave teachers and school counsellors (who often distributed the materials) a chance to amplify the effects through interaction with the pupils and for pupils to discuss the campaign among themselves. Possibly relevant too were the marketing and PR backgrounds of the leading researcher and campaign strategist, who co-opted strategies used by companies seeking to sell to young people. Effects were much larger than the norm, probably because the study incorporated principles of effective media campaigns including tailoring to the community, preparatory research with the intended audience, a theoretical foundation, targeting to relevant sub-groups (in this case, youngsters largely yet to try drugs), novel and appealing messages, and effective delivery channels.
However, a third of the pupils did not participate in the study (among whom are likely to have been those most prone to substance use) and larger conurbations were excluded. Nor we do not know whether frequent use was also retarded, though this seems likely.

Practice implications An expertly planned and adequately resourced media campaign systematically focused on preventing substance use in young people can make a difference. Localities which want to achieve this will need to maintain focus on this objective rather than the many others campaigns can explicitly or implicitly serve. Upbeat messages about the advantages of not using seem to have more effect and less potential to backfire than negative warnings. Despite the emergence of important principles ( Incontext), there is no formula which guarantees success. Especially since there are also no demonstrably successful UK examples, any campaign should be evaluated against its objectives or a close proxy. If they will cooperate, schools are an effective and inexpensive delivery mechanism, but such activities are not an alternative to drug education lessons or pastoral interventions for high-risk pupils.
Featured studies Slater M.D. et al. “Combining in-school and community-based media efforts: reducing marijuana and alcohol uptake among younger adolescents.”
Health Education Research: 2006, 21(1), p. 157–167 DS
Contacts Michael Slater, School of Communication, Ohio State University, 3022
Derby Hall, 154 North Oval Mall, Columbus, OH 43210, USA, slater.59@osu.edu.
Thanks to Neil McKeganey of the Centre for Drug Misuse Research at the University
of Glasgow for his comments.

Source: Findings.org.uk

Abstract
This review and guidance initiated by the UN Office on Drugs and Crime concerned the role of family skills training programmes in the prevention of substance use problems among children in families across the board (‘universal’), or families whose children are particularly at risk (‘selective’). Unless integrated with these types of interventions, the document did not include programmes aimed at individuals identified as at high risk or as already experiencing substance use problems (‘indicated’). A literature and website review identified 130 universal and selective programmes. Research articles and programme descriptions were solicited from the developers. Practitioners, managers, researchers and developers from these programmes throughout the world were invited to a technical consultation meeting. The guide was drafted on the basis of the discussions and the literature review. This account largely relies on its final chapter, which summarised the major points.
Families can act as powerful protective forces in healthy child development, in particular with regard to substance use. To bolster this process, universal and selective family skills training programmes generally aim at strengthening the protective factors in families, equipping parents with the skills to provide supportive parenting, supervision, monitoring and effective discipline, and giving entire families opportunities and skills to strengthen attachment between parents and children. These approaches are more intensive and differ from parent education, which typically limits itself to providing parents with information about substances and their effects and does not involve the children.
Such programmes have been extensively evaluated and found effective in preventing substance abuse and other risky behaviours – about three times more effective than life skills education programmes aimed only at children and young people, and with more long-lasting benefits. Conservative estimates indicate that for each pound spent, over the long term these programmes return a saving of nine pounds. They also form part of effective multi-component programmes which offer other interventions in other settings (such as schools, media and the community), and of tiered programmes which operate across several levels of prevention simultaneously according to the needs of the families (universal, selective and indicated).
Although the evidence is limited to few programmes in high-income countries, recommended principles for family skills training programmes can be identified. These include a solid theory of how the training will affect risk and protective factors based on research on factors related to substance abuse which can be addressed at the family level. Programmes should be matched to the target population, especially the age and developmental stage of the children and the level of risk or problems in the families. This makes accurate needs assessment vital. Programmes must be of sufficient intensity and duration to address the targeted outcomes. In general, universal programmes extend over four to eight sessions, selective programmes for higher risk families, 10 to 15. Sessions last about two to three hours and should be based on interactive techniques implemented in small groups of eight to 12 families. A typical and effective programme will provide parents with the skills and opportunities to strengthen positive family relationships, family supervision and monitoring, and improve the communication of family values and expectations.
Recruitment and retention of parents are significant barriers to the dissemination of such programmes. However, retention rates of over 80% can be achieved by addressing the practical (transportation, childcare) and psychological (fear of stigmatisation, feelings of hopelessness) barriers. Interventions are most effective if participants are ready for change, such as at major transition points like children starting school or a new school phase.
Often it most feasible and/or cost-effective to base a project on an evidence-based programme developed elsewhere for a similar target group, preferably one with the best prevention record. In this case, it is important to carefully and systematically adapt the programme to the cultural and socioeconomic needs of the target population. Such adaptations enhance recruitment and retention of families. However, during its initial use the programme should be implemented with only minimal local adaptations or changes. Feedback from participants and group facilitators on what worked or did not work so well can be used as the basis for further refinements. Experience with these and outcome evaluations should be used to assess whether a deeper adaptation is required.
As with other types of programmes, adequate training and ongoing support must be provided to carefully selected staff. Most evidence-based programmes require two to three days of training for 10 to 30 future group leaders. Training should give them the opportunity to practise their skills, but also discuss the theoretical foundations, evidence of effectiveness, and the values of the programme. Ongoing support by programme managers and supervisors (and, if possible and appropriate, from programme developers) is important, especially in the form of e-mail contacts and web-based networking of group facilitators across agencies. Site visits and debriefing sessions also enhance quality and fidelity of implementation, as well as the collection of monitoring data.
Programmes should include strong and systematic monitoring and evaluation components. This work contributes to the understanding of prevention strategies, indicating which programmes are effective, under which circumstances, and for which populations, and provides evidence of effectiveness which can be used to lobby policymakers and donors, potentially helping to sustain the programme.
There is no question that the family is a powerful influence on child development and on substance use and problems in particular, nor that interventions with families and parents can (see for example this demonstration from Sweden) help prevent substance use in various forms. What is questionable is whether the research, though sometimes promising, is sufficiently extensive and sound to warrant widespread implementation of these programmes. Searching for practical guidance, British reviewers found that research deficiencies mean that no clear choice could be made about what works best either for marginalised and vulnerable groups, or for families in general. The background notes focus on two of the best researched family skills interventions (the Strengthening Families Programme and the Family Check-Up) as a way of testing the adequacy of the evidence overall, and address the issue of engaging families of early adolescent children. For other relevant evidence run this search for pre-school and parenting interventions on the Findings site.
When in 2008 the US government analysed the costs and benefits of substance use prevention programmes, family skills training programmes were among those with the highest benefit to cost ratio, though they lagged behind some other school/community/family programmes, and also well behind some entirely different kinds of initiatives like enforcing laws on serving drunk customers in licensed premises. Estimates for the two relatively well researched family skills interventions focused on in the background notes rested on one or two studies, which in both cases provided a narrow and at best tentative basis for the calculations, casting doubt over the degree to which they can be relied on to guide prevention programme planning. Nevertheless, the same may be said of some of the other programmes included in the analysis. For the analysts, the major drawback of family training as a universal prevention modality was its higher cost relative to other types of initiatives, leading them to suggest that this approach be reserved for high risk schools, areas or families
A particular issue is whether by the time family skills training comes in to its own – from age six to 11, and in major studies not until the early years of secondary schooling – enough families can be involved to make these strategies a viable way of curbing youth substance use problems across the population as a whole. British experience so far suggests this is not the case, though high-risk families under pressure to attend and/or energetically and sensitively targeted can be engaged in and benefit from family skills training. As the featured review comments, one way cost and accessibility barriers are being addressed is through computerisation of such programmes so families can go though them at times convenient to them and in their own homes, a tactic trialled for example with some success among mothers and daughters in New Jersey.
Based on UK experience and the adequacy of the international evidence, family skills training programmes of the kind reviewed can be recommended for consideration for families who have come to attention because their children (age six upwards) are at risk of behavioural problems which may include risky substance use. Sensitive personal approaches from programme staff, perhaps preferably from the same communities, can recruit many to participate, stay in and benefit from the programmes. Universal application to all families seems at the moment to lack sufficient evidence (especially in the UK) to warrant the considerable investment required, a situation which may change if low-cost, accessible computer-based alternatives prove feasible, effective and capable of widespread implementation.

Source: K. Kumfer www.findings.org.uk 09 March 2010

Nick Davies is right about one thing; drug policy is typically surrounded by an absurd amount of disinformation and misinformation. The truth is not always easy to find.  Governments the world over are perennially advised by experts of the day and the scientific establishment. Science, like most human activities, has within it schools of different thought and is very subject to the winds of its own internal fashions.  Phrenology in the 1930’s was one glaring example and the recent man made global warming debate is another. Many of my friends in the UK and on the East coast of the US are desperate for a good dose of global warming to thaw out their cars, homes and driveways.  The dearth of quality information in this field, and in many cases its deliberate suppression implies that, to borrow another of Davies’ metaphors, the policy debate continues to impersonate a drunken man on a dark night.  The main thing I learnt from Davies’ polemic was that the political and social left dislike Margaret Thatcher – who would have guessed?

Davies dutifully recites the many alibis and mantras of the liberal drug left including principally that heroin itself is intrinsically benign, and it is the illegal status of the drug along with the high cost, the impurities with which it is mixed and injected, and the unknown purity of the drug which are responsible for its toxicity. 

Astonishingly Davies even manages to trivialize heroin overdose, and claims it is relatively rare.  Perhaps this extraordinary claim is due to the fact that his references are mainly to Wikipedia, advised by a few drug liberalization sites or other journalists.

It is well known that the rate of death amongst heroin addicts is about 16 times higher than that of non-addicts, with some estimates from Sweden placing it 55 times higher, and others 70 times higher.  Overdose is not rare amongst heroin addicts, and many studies show that it is a common feature of people who have been injecting it for several years, and more have overdosed than have not.  In some Australian studies about half overdose several times annually.  Rather than heroin being safe as suggested, the levels of opiates in the blood are often relatively low or in the therapeutic range at post-mortem.  Therefore the reason some addicts die is often not well understood, although in the overdose situation it may be mixed with other drugs.  This does not exonerate heroin as it is a depressant drug, and obviously depressant drugs can sum together, or even potentiate the effects of each other to have a super-additive effect to halt breathing.  Moreover opiate addiction, which includes methadone and heroin, likely changes the central appetite mechanism deep in the hypothalamus of the forebrain, so that the appetite for other drugs is increased.  Davies also fails to mention that many heroin programs are actually heroin and methadone programs.  Heroin works for such a short time, that the overnight doses have to be of methadone to keep patients comfortable during the night.  So heroin programs are more properly thought of as “heroin top up programs.”

Rather than heroin being benign for the brain, the scientific literature is replete with studies and claims that long term opiate use causes damage to the mood centres in the limbic system, and the extended limbic system which includes the hippocampus and hypothalamus, which it turns out are also responsible for memory formation, learning and hormone control.  There is no such thing as a drug addict with a good memory and this is not related to the legal status of the drug.  Similarly the majority of opiate addicted patients have psychological disorders with rates in various studies particularly of depression and anxiety at over 70-90%.  Similarly epilepsy is far more common in opiate dependent patients, and there are several reasons for this.  Opiates have been shown to impair the renewal of brain stem cells, particularly in the hippocampus.  As this area is in charge of memory formation and emotionality, and is frequently the site of origin of fits, disturbances in these functions are to be expected, and are in fact commonly observed.  Indeed opiates have been shown to impair the growth of all organs, likely by impairing stem cell growth and activity.  This likely accounts for the evidence of disease and dysfunction in virtually every organ system of the body in long term users.  Opiates have actually been shown to impair the ability of cells to divide by blocking the normal progression of stem cells through the cell cycle, right at the very beginning of these transitions.  This effect is exacerbated by the action of morphine and its derivates including heroin to trigger programmed cell death, which researchers refer to as “apoptosis”.  Clearly the increased cell death, and the relative inability to replace the lost cells can hardly be good either for the health of the body’s cells and organs individually, or the patient as a whole.

It has also been shown that – pure – opiates both suppress and stimulate the immune system.  Whilst some may find this dual action confusing, it is reminiscent of an old car struggling to keep up with the speed limit with a dying engine.  As the car goes up the highway it blows smoke everywhere, and gets pulled over by the police for failing to keep up to the speed limit!  It is also very noisy, as its engine rev’s hard to do its best.  It is clearly working both hard and weakly at the same time.  This seems to be the picture of the opiates saturated immune system.  It parallels other clinical disorders such as rheumatoid arthritis and lupus, where patients with an overactive immune system also display evidence of generalized immunosuppression.  This immune stimulation is particularly damaging for the body, and likely takes a big toll of all organ systems.  Such immunity has been found to be important in many diseases including dementia, atherosclerosis, diabetes, obesity, osteoporosis, chronic periodontitis, cancer development and the ageing process itself.  Opiates have been shown to directly stimulate many aspects of the innate immune system, an evolutionarily ancient and very powerful arm of the immune response which acts quickly and promptly to alert the body to danger signals, and to summon other yet more powerful components of the truly matching adaptive immune response.  Moreover components of the innate immune system have now been shown to be also involved in controlling brain formation, synapse formation between nerve cells, brain stem cell generation and differentiation, and controlling neuronal and dendrite growth in the brain.  The immunosuppressive action of opiates increases the infectivity of, and damage caused by HIV in the immune system and brain, and Hepatitis C damage in the liver.

In particular one of the most sensitive tissues are actually stem cells, as these fragile baby cells, which all carry opiate receptors, are unusually sensitive to the noxious effects both of opiate agents and immunity.  This means that opiates actually pack a triple punch on cells throughout the organism:  there is the devastating effect of opiates on cell growth, and particularly stem cell growth; there is the stimulating effects of opiates on the immune system which leads to damage to the body as a whole; and then there is the compounded interactive effect of the immune effects of opiates particularly on the stem cells, which is likely more severe than the effect of either action working alone. 

Evidence of damage to the vascular system has also been published, which has been linked with stroke and heart attack.  Evidence of widespread hormonal disruption has also been shown.  The dental disease is well known, and this in its turn has been shown to be linked with higher rates of systemic pathology including hardening of the arteries and the development of dementia, probably by further stimulating the immune system.  Opiates disrupt cellular barriers both in the gut, allowing increased access of highly toxic germs to the blood stream, and in the brain where the immune system gains increased access to the nerve cells of the critical centres of the brain through a leaky blood brain barrier.  Similarly bone healing and formation is disturbed by opiates, likely by both stem cell and immune stimulatory mechanisms.  90% of an American study of opiate dependent males, with a mean age of about 40 years, had evidence of measurable and clinically significant bone loss, called osteopaenia or osteoporosis.  This is very important as it integrates the effects of addiction over significant time.  The liberalists argue that opiates are without intrinsic harm themselves, whilst conservatives argue the obvious denigration of virtually all drug users with time.  In one sense both might be true.  If the net defect suffered is only minor – say 5% annually, then over 20 years, the total deficit suffered is 64%!  Over 40 years this is 87%!  This implies that studies which demonstrate short term efficacy, typically over 6-12 months, really have essentially nothing to say about the long term toxicity of the drugs, as none of them have the necessary sensitivity to assess damage at this high degree of precision.

In fact there are very few published studies which examine the effect on physiology over the very long term.  Those which are available all paint a very bleak picture, with one major American study recently calling for geriatricians to be appointed to those addicts who survive to the age of 50 years, as their health was essentially falling apart in many body systems with evidence of widespread physical and mental disease, disability, misery and – of course – death in those who had not survived to complete the survey.

As for giving heroin out, one must be very careful.  The recent report of the Canadian heroin trial showed that it had a primary failure rate over one year of 40%.  This makes it far from the panacea depicted in its marketing blurb.  Data from the Sydney injecting groom, a room where illegal heroin can be taken under the supervision of Government employed nurses, showed that the rate of overdose was over 30 times higher than that in the general community.  In other words, in the presence of support staff clients were more than happy to “go for the magic big hit”, with near fatal overdoses on many occasions only averted by prompt action from the attending professional staff.

Davies mentions the disrupted social networks characteristic of heroin users.  It is sad that people who are dearly loved by their families die alone.  The utter chaos surrounding the heroin addicts life is legendary.  So many patients have told me that while they are using they think they are only hurting themselves; however when they get clean they realize how destructive their drug abuse is on all their family, friends and social relationships.  Most of these patients tell me that the best thing they could do is to come upon a bag of free heroin, and when they are sick many admit praying for a free hit.  However they freely and universally admit that this is also the worst thing that could happen to their own children.  When I ask them which view is correct, their view for themselves or their view for their children, they start to see that they have been badly deceived, and wickedly seduced.  It also becomes very obvious to them that they will not be truly free from their addiction in their mind until the way they think about heroin for themselves is the same as the way they think about heroin for their children.  As much is likely also true of societies.

As to heroin use being normalized in Switzerland and Zurich, that is not what the many refugees from that city who have fled all the way to Australia have told me on many occasions, nor is it the story which is in the published medical press.  Many have fled the gross social degradation which have taken over the forced closure of the Swiss “Needlepark” [ “Platzspitz”], and the criminal explosion which accompanied it.  According to published reports the top 1 meter of soil had to be bulldozed out of the park to clean it up.  Its closure only saw it move over the road to the abandoned railway station. 

Davies’ claim that the introduction of methadone was a cunning move to push up the price of black market heroin betrays his obvious agenda.  The simple fact is that a wave of heroin abuse has taken the world since the 1960’s which the various programs were designed to allay.  I found his figures for the majority of property crime in the UK being related to heroin use interesting in that they are virtually identical to those from Australia. 

The arguments of the left are seductively simple, but they are best addressed by stating the obvious from everyday life, the social, physical and psychological nightmare of active addiction.  These are the hard lessons learnt in places such as Sweden in 1968 and in Zurich where liberal policies such as those presently advocated were tried on the basis of seductive supposedly compassionate advice such as that which Davies and his ideological colleagues presently so eloquently argue.  Whilst there is a superfluity of robust evidence available in the scientific literature to refute such claims, it is also clear that much more work in this area could be done.  Nor is it relevant only to addiction medicine.

The fact that opiate addicts notoriously suffer from exorbitant rates of atherosclerosis, dementia, psychological disorders, osteoporosis, dental disease, immune dysfunction, hormonal disturbances and disruption of their sleep-wake cycles and appetite drives, and a very high rate of some cancers, implies that if we understood more of this process we could treat these major disorders much better.  Moreover, collectively they demonstrate an acceleration of the ageing process, so we would likely begin to understand the ageing process much better, potentially developing treatments which might increase the human “healthspan”, or our number of disability free years, minimizing our risk of long term disablement and years spent in a nursing home.  And the deficit of detailed long term studies of these important issues is clearly a major gap in our understanding, which urgently needs to be addressed.  Whilst it is true that there exists enough data in the published science to effectively refute the raucous arguments for legalization of all presently proscribed drugs, it is equally true that much more could be done in the toxicological sciences to explore these issues in more detail.  That western societies allow mainstream science to continue to overlook such areas, whilst drugs pose so present and imminent a major social threat, is an international disgrace, and one which can only be overcome by the will of the people being felt by the policy makers, to properly protect the coming generations. 

For example cannabis has been shown to be linked with eight cancers, including congenital leukaemia and brain cancer, and has been shown to be mutagenic.  This may be related to its genotoxic effects mediated via AP-1 and MAP kinase pathway activation.  Opiates also stimulate these same pathways, and have also been shown to be linked with carcinogenesis.  Environment has been shown to impact gene regulation through epigenetic regulation including chromatin methylation confirming the Barker hypothesis that in utero and neonatal influences can permanently affect gene expression for decades to come.  There is no liberalization argument to address genotoxicity in this generation, and no liberalist defence of genetic mutagenicity in the next generation.  The demonstration in many studies that parental opiate use produces body and organ growth retardation, impairs brain growth, induces organ structural abnormalities, and intellectual and behavioural disabilities in affected offspring into their teenage years has no liberalist defence, and is in fact egregariously indefensible.  As developed nations we have much more to learn and much more to do

The author runs the largest heroin detox clinic in Queensland Australia, and has published many papers on heroin and drug addiction and its treatment.

Source: Stuart Reece Feb.2010

Dear Dr. Jacobs,

Re: Establishment of Needle and Syringe Programs

I understand that the state of New Jersey is considering a needle and syringe “exchange” program. I am also advised that New Jersey is a liberal democratic society whose members for the most part believe in freedom of the individual to pursue “life, liberty and happiness”. This of course is wonderful! And also provides a useful opportunity to note that no drug addict enjoys real freedom while their will, their lives, their relationships and their resources are largely dedicated to the service and slavery of their chemical addiction. This would make your lovely part of the world an excellent place in which to pursue those liberties which should be the birthright of every human being.

To introduce myself I am a family physician in Australia, and have pursued a special interest in the treatment of addiction especially for heroin, but also other drugs of addiction for the last ten years. Health department figures indicated last year that in the years 2001-2006 I single handedly registered 11,000 of the 14,000 registrations for opiate detoxification in the state of Queensland. I have also attained one of the three largest numbers of naltrexone based rapid opiate detoxifications in the country of Australia with over 1,800 procedures performed including 600 naltrexone implants. This was done with only two overnight hospital admissions which is a world safety record. I have also submitted evidence to several Government committees and leaders on the subject of drug policy.

As the so-called “needle “exchange” programmes” make little effort to exchange syringes, and as actual exchange makes little difference to the operation or mission of the programs, it is probably more accurate to refer to them as needle and syringe distribution programs, or NSP’s. It is important that your community appreciate this because syringe disposal is a real problem with these facilities. It has been so in this country. Our lovely and world famous Bondi beach in Sydney is now said to be one of the best places in the country to get a needle stick injury, due to the many syringes hidden in the sand. Clean up patrols have operated in King’s Cross twice daily for years to clean up the extreme public nuisance of hundreds of used syringes left dangerously in the streets and side walks, to protect the public . This is a well recognized problem with NSP’s which is generally covered up while such programs are in the planning phase.

Epidemiological Evidence

Since the NSP experts readily resort to discussion of “evidence based treatments”, and since the community decision to fully implement this program has such far reaching implications both in terms of needle disposal bins in all public toilets and for the time and direction of public health policy in the management of addiction, it is very appropriate that careful consideration be given to the quality of evidence which is typically cited in support of NSP’s. In particular the evidence based literature waxes lyrical about “levels of [reliability of] evidence.”

Self-report data is widely used in the addiction literature but it has been shown many times to be highly flawed and unreliable, and to fails to correlate with more objective and hard signs of HIV rates. As was pointed out to you by Dr. Fred Payne’s letter, and as was noted in the Institute of Medicine Report on this subject, it is well recognized that most of the literature on the subject of needle exchange is based on self report. This would clearly make it the least reliable form of evidence by their own criteria. Actually one would have to wonder if the evidence based gurus would accept such data at all.

Secondly we are aware of the “ecological” studies where they repeatedly report many cities with and without NSP’s. The work of Dr. Kirsten Kall’s group from the University of Linkoping shows clearly that in such an epidemic the rate of rise of the epidemic is related to the population at risk. Epidemics it is argued have a natural life history with a rise, fall and usually stabilization levels. Depending where in the natural history of the epidemic one takes one’s samples one will get a different picture of the efficacy of the NSP’s. It is for this reason that showing either a rise or a fall in HIV incidence or prevalence after NSP introduction is irrelevant if one is not informed of the natural history of the epidemic, and unless one can adduce by other means the likely outcome in its absence. This is a severe criticism, and one which effectively invalidates the whole of this genre of studies. I am also assured by epidemiologists familiar with such matters, that such studies are given no weight in epidemiological circles for this reason. That they have been foisted upon the rest of the world and even mentioned in major UN reports shows the degree to which such sloppy unscientific methods have been adopted within such agencies.

Indeed Dr. Alex Wodak, understood to be one of the primary authors of the relevant section of the 2006 UNAIDS report which eulogized NSP’s and the harm minimization addiction management paradigm, unequivocally stated in 1995 that formal proof of the methods of harm minimization would be impossible as it would not be possible to control in real life the many confounding factors which would be acting, and thereby prove that any particular intervention alone had been salient in controlling the target disorder .

Furthermore there is a clear conflict of interest by some of the leading proponents of NSP’s . Dr. Alex Wodak was for many years the President of the International Drug Law Reform Foundation and is the current president of the Australian Drug Reform Foundation which lobbies unceasingly for drug decriminalization. Dr. Don Jaralais in the USA is also understood to be of a similar ideology, and his advocacy for NSP’s is well known. I am of the understanding that such parallels could be made repeatedly for many of the most ardent advocates of NSP’s.

Dr. Payne’s letter mentions the very high rates of HIV in Vancouver at present despite the operation of an NSP, having risen from 1% to 35%. It was also shown long ago in Montréal that the HIV rate amongst NSP attendees was 2.5 times that amongst non-attendees (3.1 Vs. 7.9%) .

In terms of its control of other virus transmission NSP’s seem to substantially lack power. They failed to control Hepatitis B in Amsterdam , or Hepatitis C in Australia where rates of HCV carriage amongst IVDU who have been involved in the lifestyle for longer than six months exceed 80%.

Special Situations

Some situations are special and require special consideration. We are well aware that the apparent success of harm minimization techniques in this country is frequently cited overseas and in international fora as proof of principal of the efficacy of harm minimization epidemic management techniques. What is repeatedly overlooked in such discussions is our record rates of other infections such as Hepatitis B and C, and the venereally transmitted agents Herpes, Warts and Chlamydia. Indeed recently released data shows 30-100% growth in the last five years in Queensland in Gonorrhea, Hepatitis C, Chlamydia and Syphilis . Indeed it has been estimated that the Australian health care system has now to plan for over 100,000 liver transplants required for Hepatitis C alone in the next 20 years. One also notes that the outcome after transplantation for Hepatitis C is inferior to that for other infections due to the universal early graft re-infection which invariably occurs in the first few post-operative days, and the clash between anti-rejection immunosuppressive therapy and the anti-viral needs of fighting an aggressive viral infection in the context of the immuno-suppression and likely immuno-senescence induced by drug addiction, which is reversed to an unknown extent by abstinence.

In Australia our HIV rate amongst IVDU who do not share other risk factors is very low by international standards of the order of 1%. New cases of HIV nationally in all groups have risen from about 100 in 1991 to around 300 in 2005 . There appears to be significant variation in the estimates for the number of syringes distributed to addicts in this country with estimates varying from 20,000,000 to 200,000,000 – a level of inexactitude which in itself should give us pause. The former number was more than our total population at the time, and the latter number is substantially greater than the number of sheep here (which says a lot for a nation which for a long time was said to ride on the sheep’s back!) One important feature then facing the advocates of any NSP program is exactly how many syringes do they want to distribute? One for every man woman and child in the state?

However in the case of Australia we would do well to heed Wodak’s warnings about the inability to control for other confounders. From a modeling point of view the epidemic began in certain well known high risk groups. Its spread would then have been related to the population at risk, the activity of the various risk taking behaviours, and the intersection of these behaviors with the wider general community. Still today over half of all HIV infections in this country occur amongst men who have sex with men. It should also be added that the rate of IVDU in this group is 10-20 times higher than it is in the general community. Clearly then the spread of the disease into the wider community is related to the behaviour of this reservoir of infected people. One of the obvious confounding factors which has never been studied or quantified is what might be termed the homosexualization of the Australian culture with many laws, many bureaucracies, and schools of public health completely subsumed by the new ideology accompanying the public health impetus of the HIV epidemic. In that this likely instilled major good will in the primary target community, and is likely to have very positively influenced the relevant risk taking behaviours, it is clearly an intimate confound which confuses and likely dilutes any effects which might be attributable strictly to NSP’s.

Another important confounding factor was that Australia made treatment for HIV free to all patients who would have benefited from it from the outset of the epidemic. Assuming that the most at risk individuals were infected near the beginning of the epidemic, then those that survived their infection might reasonably be expected to have had a lower viral load for most of this time making them les infectious. This can be expected to have significantly slowed the rate of progression of the epidemic in this country.

Sweden is an important case in point which must be mentioned in any intelligent discussion of the NSP movement. Sweden has very limited methadone treatment availability, until recently no NSP activity, and no legal “shooting galleries” and a very low rate of HIV in IVDU. Hence the methods of harm minimization cannot strictly be said to be required for HIV control. Clearly HIV control can occur in a very effective manner in the absence of the model harm minimalist strategies.

The situation in prisons, or penitentiaries, is a special one and well worth at least some specific consideration. I was privileged to give evidence to the Inquiry into the Impact of Illicit Drug Use on Families before the Federal House of Representatives of the Australian Parliament on 3rd April 2007 . During that interview I stated that “my blood ran cold at the thought of 500 inmates all sharing the same syringe barrel” as was recounted to me by one of my HIV positive patients. However typical harm minimalist solutions such as methadone, syringe distribution and bleach use have been found to be impractical in the prison environment, and in this country have triggered strikes and industrial disputes by the prison warders due to the creation of unsafe workplaces. Since making those comments to the committee I have considered what might best be done about this appalling situation. One approach follows below (see “Other Treatment Modalities”).

In essence it is my belief that where the crime for which a person is committed is referable to opiate drugs, the standard of care will become naltrexone implant insertion on admission to the jail (after appropriate detoxification procedures), naltrexone implant maintenance during incarceration, and naltrexone implant prior to discharge to prevent the overdose which so often accompanies discharge (and the ritualistic “get a whack, get a woman” routine which is invariably followed). Indeed in Perth patients discharged from the prison are taken by volunteer escort from the prison gates to the clinic for implantation before the whole destructive cycle can re-commence. This seems the most sensible, responsible and compassionate management of this problem.

Other Treatment Modalities

Naltrexone was fist synthesized in the USA 1963 at Endo laboratory by Matossian acting under Blumberg’s instruction . Naltrexone implants and depot preparations have recently received a lot of attention from the international addiction management literature, and have been commercially introduced in the USA. American developed depot injections typically last 3-4 weeks. A preparation recently developed in this country lasts typically 4-6 months. The results of the first formal clinical trial conducted in Perth will soon be announced, probably in a leading medical journal such as JAMA or New England Medical Journal. They have been extensively used in this clinic where we have inserted over 600 USA (Wedgewood) and Australian (Perth “Go Medical”) implants. I was asked by the Preventative and Community Medicine Committee of the Queensland Faculty of the Royal Australian College of General Practitioners to evaluate naltrexone medicine including the Perth naltrexone program in 1998, and since 2001 I have been involved with the development in Perth of their naltrexone implant.

Unofficially the abstinence rate in terms of not returning to dependent heroin use at five months was well in excess of 50% in a study which set new standards international medical literature for patient follow-up. Only 11% of the 70- patients were lost to follow-up compared to over 90% in a similar (larger) study conducted in leading centres in the USA reported by Hollister in 1977 for NIDA at the NIH . Naltrexone is also a widely recognized and used technique for reducing problem drinking in alcoholics. It has also been used for gambling addiction, with positive results on some occasions. Moreover other results reported from the Perth clinic indicate that naltrexone is likely to have a controlling effect on other chemical addiction such as benzodiazepines, cannabis and stimulants such as amphetamines.

It is my personal view that they are excellent and will soon revolutionize the treatment of opiate addiction. Opiate dependence of course is the most addictive and refractory of all drug addictions, and the possibility of gaining control of such patients in a drug free context, as opposed to the usual medical model involving the indefinite maintenance of addiction, must be one of the most exciting opportunities ever to be offered to physicians in addiction medicine.

Another medical agent which has shown enormous promise in the control of multiple addictions is the cannabinoid antagonist rimonabant (“Accomplia”; SR141716A) which has been used with success against opiate, tobacco, alcohol, amphetamine food and cocaine addictions. This drug has attracted attention from NIDA and is undergoing further testing. I am not sure what its regulatory status is in the USA. It was available in eight European nations when I enquired with the pharmaceutical company (Sanofi-Synthelabo) about four months ago. The drug is still under patent, so this impedes its being re-formulated into an implant or depot preparation.

The combination of naltrexone and rimonabant has yet to be tested but would appear to show obvious promise, and it would be a priority in a rational testing program to investigate this further.

Future Research Directions

Many studies show increased evidence of drug use in young people.

All senior authorities in the world agree that there is far too little resources put towards investigating the toxicological effects of addictive drugs in general, and in adolescents in particular.

If we are ever going to do more than shut the door after the horse has bolted, clearly the issue of the true toxicity of addiction must be much better investigated, and the results of such studies broadcast far and wide to our young people, to de-glamourize the dreadfully seductive marketing program to which the rock music and popular culture misleadingly subjects them. If we are ever going to contain the monster of rampant destructive drug use in our younger people, then their dangers must be better emphasized.

Given the obvious multi-system damage of long term chemical addiction which is immediately apparently to even the untrained observer, one can only conclude which a Science which espouses the relative benignity of addiction must be grossly and egregariously deficient.

I have formulated a detailed plan by which such a strategy can be put in place, based around the accumulated ageing changes evident in the skin, teeth, hair, blood vessels, bones, immune system, stem cells and brains of addicts. It invites international collaboration and multi-system multilevel cooperation and the application of state of the art techniques to classical clinical problems. That however, is another story.

CONCLUSION

In summary NSP’s incur great social cost and are clearly part of the problem rather than part of the solution. Their scientific literature is remarkable for its lack of compelling evidence and methodological rigor, not to mention the prominence of adverse findings, when properly adjudicated. Rather the global penetration of NSP’s is an indicator of the strength of the marketing strategy of the ideology they enshrine. They are in any case about to be phased out like old dinosaurs by the cutting edge technologies which are moving ever closer to being a real market alternative, particularly the revolutionary long lasting Australian naltrexone implant.

I have been advised that now methadone is worth $150/week to dispensing hospitals in Federal hospital subsidies. As some of the most famous institutions in the USA have 10,000 – 20,000 patients enrolled on it, this income source forms a major stream of hospital funding. As such it is not likely to be disrupted. What the management of the Australian HIV epidemic does teach us is that it is best to get on and treat the HIV infection as soon as medically appropriate. In addiction medicine we have up until now largely done the reverse, for there we have deliberately continued indefinitely maintenance treatment designed to not to confront the addicted physiology, but rather to postpone indefinitely the definitive redress of that medical condition. The Australian success with HIV management tends to rather emphasize the reverse approach. This is the therapeutic route suggested by naltrexone implant maintenance. In all the discussion we would appear to have forgotten that in the early 1960’s New York was in urgent need of a treatment for addicted GI’s returning home from Vietnam. Methadone as the only medical solution then available was adopted and quickly came to command tremendous official support to the point where it became in time, the established industry. We have now a far more exciting opportunity to launch naltrexone implants and other new treatments in a similar and innovative manner. In would be my sincere hope that nations can move speedily to deliver proven and safe medical treatments to vulnerable populations without incurring undue, unnecessary and officious regulatory obstruction.

This would appear to be the visionary, drug free and health enhancing approach. As these concepts are more widely understood it is hoped that regulators and administrators will cooperate to mobilize international best medical practice on behalf of those with whose care they have been entrusted. I would invite the legislators of New Jersey to work with us on these issues of major cultural importance.

Yours Sincerely,

A. Stuart Reece, MBBS (Hons.), FRCS (Ed.), FRCS (Glas.), MD, FRACGP.
Family Physician, Highgate Hill Brisbane,
Senior Lecturer, Medical School, University of Queensland,
Fellow, Drug Watch International,
Fellow, Drug Free Australia,
Member, Society for Neuroscience,
Member, International Cannabinoid Research Society,
Attendee, College of the Problems of Drug Dependence Conferences 2002-2006.
Awardee, National Institute of Drug Abuse, International, 2003, 2004, 2006.

Key findings:
• Although some consider experimenting with marijuana normal behavior for adolescents, those adolescents who abstain are not maladjusted as others have reported.
• Young abstainers do better than experimenters into young adulthood.
• Even strict abstainers — youth who avoid all drugs — fare well in life.
• Solitary substance use is not uncommon among youth.
• Young solitary users are an overlooked at-risk group who face a wide range of psychosocial and behavioral difficulties as teens and young adults.

A lot of adolescents experiment with marijuana — the National Institute on Drug Abuse estimates that 46% of high school seniors have tried this drug at some time. Pushing boundaries is what young people do, and some researchers believe that trying marijuana is a normal part of growing up. Does that mean that young people who do not indulge are somehow maladjusted?

Jonathan Shedler and Jack Block[1] raised this possibility in a report in 1990. They suggested that adolescents who experimented with marijuana were better adjusted emotionally and socially than their counterparts who avoided all drugs. Specifically, abstainers were observed to be anxious, emotionally constricted, and lacking in social skills compared with experimenters. Not surprisingly, these findings caused widespread comment in the drug-prevention community.

Now, RAND Corporation researchers have revisited Shedler and Block’s classic study and have uncovered evidence that challenges those initial findings. Kids who abstained from marijuana through the last year of high school were not socially or emotionally troubled. And they had better outcomes as young adults.

A second study looked at a largely ignored group of adolescents: kids who go off by themselves to use marijuana and other harmful substances. The researchers documented a wide range of psychosocial and behavioral difficulties faced by youth who use harmful substances while alone, rather than only in social settings like parties. And the troubles followed them into young adulthood.

For policymakers, these two studies help clarify the picture of youthful marijuana use: Marijuana abstainers do well, solitary users do poorly, and kids who use marijuana only in social settings are in between.

Digging for Clues About Youthful Marijuana Use
To re-examine the provocative findings of Shedler and Block, the RAND researchers, led by Joan Tucker, a social psychologist, mined a wealth of data on youthful substance use accumulated since 1985 by the RAND Adolescent/Young Adult Panel Study. This database contains survey responses from thousands of individuals who answered questions about their use of harmful substances, about their social and emotional well-being and behavior, and about school. The survey was given in grades 7, 8, 9, 10, and 12, and again at ages 23 and 29. The database was used to evaluate the effectiveness of the Project ALERT drug use prevention program that RAND developed for middle-school students. For their study, the researchers examined responses to the surveys given in 12th grade and at age 23. They divided the responders into abstainer and experimenter categories, which replicate as closely as possible those used in the 1990 Shedler and Block study:

Abstainers — those who had never tried marijuana or any other illicit drug.

Experimenters — those who had used marijuana less than 10 times in the year before being surveyed and less than three times in the preceding month, and none or only one other illicit drug in their lifetime.

A different picture emerges of youth and marijuana
From their analyses of survey responses, the RAND researchers pieced together a picture of marijuana abstainers and experimenters as teens and as young adults that contradicts that painted by earlier studies. Their key findings, some of which are shown in the figure, include

Youth who stayed away from marijuana through their senior year of high school functioned better overall than did seniors who experimented with the drug. Compared with experimenters, abstainers

• had more parental support
• devoted more time to homework
• spent more time in extracurricular school activities
• earned better grades
• got into less trouble
• were emotionally better off.

Both groups were similar in that

• on average, they rarely felt lonely
• they reported similar levels of peer support and ease in interacting with the opposite sex.

The one exception was that,

• although abstainers were socially active, they went to parties and dances significantly less frequently than did experimenters.

By the time they turned 23, those who had avoided marijuana in high school functioned better overall as young adults than those who had experimented with it in their youth. Compared with experimenters, abstainers

• were better educated
• were happier with their friends
• were less involved in deviant behavior (stealing and drug selling).

Both groups were similar in that

• they showed no differences in their satisfaction with family life and with general mental health, or with limitations due to emotional problems.

The emotional and social well-being of strict marijuana abstainers — those who had tried neither marijuana nor cigarettes and had not used alcohol in the past year — was also compared with that of experimenters, both in high school and as young adults:

• Even this more-stringent subgroup of marijuana abstainers did not show the adjustment problems suggested by earlier studies.

Why did two different pictures emerge?
The conflicting findings may be due to methodological factors. For example, the RAND team examined longitudinal data for more than 3,000 individuals who were originally recruited from 30 California and Oregon schools. These schools were chosen to represent a wide range of community types, socioeconomic status, and racial/ethnic composition. Thus, the RAND sample was considerably larger and more diverse than the 100 or so youth from the San Francisco Bay area whom Shedler and Block followed.

Young Solitary Substance Users: An Overlooked, At-Risk Group
Surprisingly little research looks at the sizable minority of teens who use marijuana and other harmful substances when alone rather than only in social settings. In a second study, researchers again used the RAND Adolescent/Young Adult Panel Study database for clues about the extent of solitary substance use, as well as about the well-being, behavior, and future risks, of this largely ignored group. For this study, these youth are referred to as “solitary users,” even though they may also use marijuana, cigarettes, or alcohol in social settings with others. This time, the researchers analyzed responses to the surveys given in 8th grade and at age 23. They found that:

Although they constitute a small percentage, solitary users are an overlooked, at-risk group:

• In 8th grade, 4% of young people said they sometimes or often used marijuana alone rather than limiting its use to parties or other social occasions. This figure was 16% for cigarettes and 17% for alcohol.

By 8th grade, solitary substance users are worse off than classmates who use only in social settings. Compared with social-only users, solitary users

• engaged in heavier and more-frequent drug use
• got into more trouble (e.g., stealing, acting out at school)
• confided less in their parents about personal problems
• performed more poorly in school (had lower grades, spent less time on homework, participated less in extracurricular school activities).

Solitary users are not social outsiders. Contrary to what might be expected, these youth are not loners. They are socially active teens who spend more time hanging out with friends, going to parties, and dating than do youth who limit substance use to social settings. Popularity with peers may help compensate solitary users for their poorer academic track records and behavioral problems in the short term.

Solitary use foreshadows problems down the road. Compared with social-only substance users, teen solitary users faced more difficulties as young adults: They made fewer educational strides, had poorer health, and experienced more substance-use problems.

Solitary users perceive drug consequences differently than do social-only users. Solitary users more strongly believed that turning to marijuana, cigarettes, or alcohol helped them get away from their problems, relax, and have more fun — an optimistic bias that could lead them to underestimate the potential for serious negative consequences.

Implications for Drug-Prevention Programs
New insight into youthful substance use emerged from the RAND studies that can help improve drug-prevention programs for adolescents and teens.

Experimentation with drugs has sometimes been viewed as developmentally appropriate and adaptive. In contrast, the RAND results indicate that youth who experiment with marijuana are worse off in many respects than those who abstain throughout their teenage years. This insight helps the drug-prevention community put into perspective the conflicting conclusions from prior studies about marijuana use and its consequences.

The research also documented the wide range of psychosocial and behavioral difficulties that lone substance users, as opposed to strictly social users, face as teens and young adults. These findings suggest that drug-prevention programs should pay closer attention to this at-risk group of young people.

Source: http://www.rand.org/pubs/research_briefs/RB9265/index1.html 2007
—————————————————————————–

[1] Shedler J, and Block J, “Adolescent Drug Use and Psychological Health: A Longitudinal Inquiry,” American Psychologist, Vol. 45, No. 5, May 1990, pp. 612–630.
——————————————————————————–
This Highlight summarizes RAND Health research reported in the following publications:
Tucker JS, Ellickson PL, Collins RL, and Klein DJ, “Are Drug Experimenters Better Adjusted Than Abstainers and Users?: A Longitudinal Study of Adolescent Marijuana Use,” Journal of Adolescent Health, Vol. 39, No. 4, 2006, pp. 488–494.

Tucker JS, Ellickson PL, Collins RL, and Klein DJ, “Does Solitary Substance Use Increase Adolescents’ Risk for Poor Psychosocial and Behavioral Outcomes? A 9-Year Longitudinal Study Comparing Solitary and Social Users,” Psychology of Addictive Behaviors, Vol. 20, No. 4, 2006, pp. 363–372.

In the age group 16-24, 22% had used drugs in the previous year, 18% used cannabis in the previous year.

The report states that between l996 and 2008 the use of Class A drugs rose as follows:

25 – 29 years of age – 3.9% – 8.4%
30 – 34 “ “ “ – 1.9% – 5.2%
35 – 44 “ “ “ – 0.5% – 1.7%

And between 2007/8 to 2008/9 the rises were:

16 – 24 years of age – 6.9% – 8.1%
25 – 29 “ “ “ – 6.4% – 8.4%
30 – 34 “ “ “ – 3.8% – 5.2%

Note the differing age groups which make total comparisons difficult.
The report then makes a statement which is impossible to understand:

‘However, Class A drug use rose from 6.9% to 8.1% between 2007/08 and 2008/09; hence Class A drug use among young people is now stable over the long term’ ??

The most notable figure, repeated in the report in several places were:
7.9% of adults used cannabis in the past year (2008/9). This figure hardly agrees with media pronouncements and ‘accepted facts’ that cannabis use is endemic throughout the population. It might be very common in the younger age groups but this report suggests that over 92% of the adult population are non-users of cannabis. Ergo restrictive drug policies work.

Main findings:

Drug misuse among adults (16 – 59 years) In England and Wales:

• In 2008/09, 10.1% of adults had used one or more illicit drug within the last year,
compared with 9.6% in 2007/08. However, over the longer term this shows an overall
decrease from 11.1% in 1996.

• In 2008/09, 3.7% of adults had used Class A drugs in the last year, compared with 3.0% in 2007/08. Over the longer term this also shows an increase from 2.7% in 1996.

• Consistent with previous findings, cannabis is the type of drug most likely to be used by adults; 7.9% of 16-59 year olds used cannabis in the last year in 2008/09.

• There have been some decreases over the longer term in the use of non-Class A drugs; between 1996 and 2008/09 use of cannabis, amphetamines and anabolic steroids within the last year among adults declined.

Drug misuse among young adults (16 – 24 years) In England and Wales:

• In 2008/09, around 22.6% of young adults had used one or more illicit drug in the last year, which shows no change from 2007/08. This shows a long term decrease from 1996 when it was 29.7%.

• In 2008/09, 8.1% of young adults had used Class A drugs in the last year, compared with 6.9% in 2007/08. Over the long term, Class A drug use among young people has stabilised since 1996.

• Cannabis remains the drug most likely to be used by young people; 18.7% of
respondents aged 16-24 had used cannabis in the last year in 2008/09.

Drug misuse among children (11 – 15 years) In England:

• There has been an overall decrease in drug use reported by 11- 15 year olds since 2001. The prevalence of lifetime drug use fell from 29% in 2001 to 22% in 2008.

• There were also decreases in the proportion of pupils who reported taking drugs in the last year; from 20% in 2001 to 15% in 2008.

• Reported drug use was more common among older pupils; for example, 4% of 11 year olds said they had used drugs in the last year, compared with 29% of 15 year olds in 2008.

• Cannabis was the most widely used drug in 2008; 9.0% of pupils reported taking it in the last year, a long term decrease from 13.4% in 2001.

• Pupils who had truanted or been excluded from school were more likely to report taking drugs at least once a month than those who had not truanted or been excluded (11% and 1% respectively) in 2008
.
• There was an overall decrease in the proportion of pupils being offered drugs from 42% in 2001 to 33% in 2008. Cannabis was the most commonly offered drug followed by volatile substances and poppers.

• Older pupils were more likely to have been offered drugs, with 11% of 11 year olds
having been offered them compared with 57% of 15 year olds in 2008.

Health outcomes

Individuals who take illicit drugs face potential health risks, as the drugs are not controlled or supervised by medical professionals. As well as health risks, drugs can become addictive and lead to long term damage to the body. Illicit drug users are also at risk of being poisoned by drugs, and overdosing which can lead to a fatality.
In England (unless otherwise stated):

• In 2008/09, there were 5,668 admissions to hospital with a primary diagnosis of a drug-related mental health and behavioural disorder. This number is 15.1% less than in 2007/08 when there were 6,675 admissions. There were more male than female
admissions (3,997 and 1,671 respectively).

• Where primary or secondary diagnosis was recorded there were 42,170 admissions in 2008/09 compared with 40,421 in 2007/08, which shows an increase of 4.3%. There were more male than female admissions in 2008/09 (28,289 and 13,875 respectively).

• Where a primary diagnosis of poisoning by drugs was recorded, 11,090 admissions were reported during 2008/09, an increase of 47.2% from 1998/99 when the number of such admissions was 7,533. This has remained stable since 2007/08. There were more male than female admissions (6,076 and 5,014 respectively).

• The Strategic Health Authorities (SHAs) with the most admissions for drug related mental health and behaviour disorders as the primary or secondary diagnosis were North West SHA (155 admissions per 100,000 population) and Yorkshire and The Humber SHA (98 admissions per 100,000 population).

• During 2008/09, there were 207,580 people in contact with structured drug treatment services (those aged 18 and over). This is a 10.4% increase from the 2007/08 figures, where the number was 187,978.

• In 2008/09, a larger number of men accessed treatment services than women (151,064 men compared to 56,516 women aged 18 or over).

• Those taking opiates only (which includes heroin) was the main type of drug for which people received treatment (48% of all treatments), with a further 31% of treatments for those who have taken both opiates and crack in 2008/09.

• There were 60,386 discharged episodes of treatment by the end of 2008/09 and there were 24,656 (41%) of clients exiting treatment who were no longer dependent on the substances that brought them into treatment; a further 9,002 (15%) were referred on for further interventions outside of community-structured treatment.

• The total number of deaths related to drug misuse in England and Wales was 1,738 in 2008; 78% of those who died were male. The most popular underlying cause of death was from accidental poisoning for both males and females (597 and 166 respectively).

The key findings from Chapter 2 of the BCS (British Crime Survey) report show that:

• Around one in three (36.8%) had ever used illicit drugs, one in ten had used drugs in the last year (10.1%) and around one in 20 (5.9%) had done so in the last
month.

• Levels of Class A drug use were, unsurprisingly, lower than overall drug use, with 15.6% having used a Class A drug at least once in their lifetime, 3.7% having done so in the last year and 1.8% in the last month.

• Consistent with previous findings, cannabis is the type of drug most likely to be used; 7.9% of 16-59 year olds used cannabis in the last year.

• Use of any illicit drug during the last year has shown an overall decrease from 11.1% in 1996 to 10.1% in 2008/09, due in part to successive declines in the use of cannabis between 2003/04 and 2007/08.

• Despite this long-term overall decline, there has been an increase in the number 16-59 year olds who have used Class A drugs within the last year between 1996 (2.7%) and 2008/09 (3.7%).

• Class A drug usage has remained generally stable over this period: year-on-year changes were not statistically significant until most recently; however there was a slight underlying upward trend, which is now significant over the long term.

• The increase in Class A drug usage since 1996 can be understood in terms of an increase in the number of people who have used cocaine powder within the last year (from 0.6% to 3.0%), partly offset by a decrease over the same period in the use of LSD (from 1.0% to 0.2%).

• In 2008/09 methamphetamine was included for the first time but this has no visible impact on the overall prevalence of Class A drug use in that survey year.

• There have been some decreases over the longer term in the use of non-Class A drugs; between 1996 and 2008/09 use of cannabis, amphetamines and anabolic
steroids within the last year among 16-59 year olds declined. Looking at more recent years, key changes between 2007/08 and 2008/09 showed:

• The overall proportion of 16-59 year olds who have used any illicit drug within the last year remained stable (9.6% in 2007/08 compared with 10.1% in 2008/09) but there was an increase in Class A drug use within the last year (from 3.0% to 3.7%).

• For individual types of drug, increases were seen in the use within the previous year of cocaine powder, ecstasy, tranquillisers,anabolic steroids and ketamine.

1.3 Young people
Chapter 3 on pages 19-33 of the BCS report focuses on the use of illicit drugs by
young people aged 16-24 years old.

Figure 3.1 on page 20 shows the percentages of 16-24 year olds who have used Class A drugs either in the last year, the last month or ever for 2008/09. Related
information showing these percentages as a time series can be found in Tables 3.1-
3.3 on pages 27-29 and similar information showing actual numbers for 2008/09 can
be found in Tables 3.4- 3.6 on pages 30-32.
Figures 3.2-3.5 on pages 21-24 show the proportion of drugs used in the last year for 16-24 year olds by various drug breakdowns or as a time series. Figure 3.6 on page 25 shows the proportion of this age group classified as frequent drug users
as a time series. Related information on frequent drug use in the last year among
16-24 year olds can be found in Tables 3.7 and 3.8 on page 33 as a time series for any drug and by drug type for 2008/09.

The key findings from Chapter 3 of the BCS report show that:

• Around two in five young people(42.9%) have ever used illicit drugs, nearly one in four had used one or more illicit drugs in the previous year (22.6%) and around one in eight in the last month (13.1%).

• Levels of Class A drug use were, unsurprisingly, lower than overall drug use, with 16.9% of young people having ever used a Class A drug, 8.1% having done so within
the last year and 4.4% in the last month.

• Cannabis remains the drug most likely to be used by young people; 18.7% of respondents aged 16-24 had used cannabis in the previous year. Long and short-term trends for young people aged 16-24 show:

• The proportion of 16-24 year olds having used drugs in the last year fell from 29.7% in 1996 to 22.6% in 2008/09, due in large part to the gradual decline in cannabis use.
Latest figures show no change between 2007/08 and 2008/09.

• The general trend for having used Class A drugs in the last year for young people shows a slight decline since 1996.

• However, Class A drug use rose from 6.9% to 8.1% between 2007/08 and 2008/09; hence Class A drug use among young people is now stable over the long term. In
2008/09 methamphetamine was included for the first time but this has no visible impact on the overall prevalence of Class A drug use in that survey year. Recent trends in types of drugs used show that between 2007/08 and 2008/09:

• There was an increase in use of cocaine powder within the last year (from 5.1% to 6.6%) and ketamine (from 0.9% to 1.9%).

• Use of methadone within the last year, and hence opiates, fell (these figures are based on small numbers).

The key findings from Chapter 4 in the BCS report show that:

• The youngest age groups (16-19 and 20-24 year olds) reported the highest levels of drug use in the last year (22.2% and 22.9% respectively) compared with all older age groups.

• A broadly similar pattern can be seen for Class A drug use, but with the peak for drug use in the last year shifting slightly later to also include the 25-29 age group, with usage then decreasing with increasing age.

• Men continued to report higher levels (around twice as high) than women of drug use in the last year of any illicit drug or any Class A drug use. Looking at trends since the survey began, the self-report drug use data collection in 1996 shows there is a decrease in drug use in the last year for the 16-19 year olds which decreased from 31.7% in 1996 to 22.2% in 2008/09 and, for those aged 20- 24, fell from 28.1% to the latest figure of 22.9%. In general, between 1996 and 2008/09, year-on-year changes in levels of Class A drug use in the last year use were not statistically significant until most recently; however, there was a slight underlying upward trend which is now significant over the long term. There were increases in Class A drug use within the following age groups between 1996 and 2008/09: 25-29 year olds (3.9%
to 8.4%), 30-34 year olds (1.9% to 5.2%) and 35-44 year olds (0.5% to 1.7%).
Looking at change over the last year:

• There were no statistically significant changes in prevalence of any drug use overall in the last year between 2007/08 and 2008/09 for any age group.

• There was a statistically significant rise between 2007/08 and 2008/09 in the proportion of 16-24 (6.9% to 8.1%), 25-29 (6.4% to 8.4%) and 30-34 year olds (3.8% to 5.2%) who took Class A drugs in the last year.

Drug-related mental health and behavioural disorders

During 2008/09 more people aged 25-34 were admitted with a primary diagnosis of drug-related mental health and behaviour disorders than any other age group. This age group accounted for nearly 40% of all such admissions in that year.

Table 3.4 shows that there were 42,170 admissions where there was a primary or
secondary diagnosis of drug-related mental health and behavioural disorders in 2008/09, which is 4.3% higher than 40,421 admissions in 2007/08

England Numbers
Total Under 16 16-24 25-34 35-44 45-54 55-64 65-74 75+

1998/99 24,236 266 7,236 10,850 4,066 1,220 258 141 162
1999/00 24,974 273 7,028 11,027 4,634 1,363 271 144 196
2000/01 25,683 292 6,904 11,357 5,112 1,426 254 116 137
2001/02 28,063 329 7,136 12,355 6,034 1,543 290 151 146
2002/03 31,490 358 7,399 13,772 7,324 1,899 412 118 146
2003/04 34,957 374 7,861 15,061 8,670 2,137 418 156 194
2004/05 35,737 396 7,547 14,872 9,388 2,414 598 204 235
2005/06 38,005 445 7,495 15,752 10,314 2,817 688 181 197
2006/07 38,170 402 6,983 15,330 10,941 3,158 793 232 183
2007/08 40,421 350 7,348 15,540 11,792 3,664 924 270 191
2008/09 42,170 318 6,721 15,817 12,815 4,385 1,181 272 212

Table 3.10 NDTMS clients in treatment, by gender and age, 2008/09

England Numbers / percentages
Total Male Female

All clients 207,580 100 151,064 100 56,516 100
18-24 29,848 14 19,656 13 10,192 18
25-29 43,778 21 31,026 21 12,752 23
30-34 44,713 22 33,031 22 11,682 21
35-39 39,215 19 29,649 20 9,566 17
40+ 50,026 24 37,702 25 12,324 22

Source:

Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2008 – 31
March 2009. National Treatment Agency for Substance Misuse (NTA)
1. National Drug Treatment Monitoring System (NDTMS).
2. Percentages are rounded to the nearest per cent. Totals may not add up to 100 due to rounding

3. Age is calculated at year midpoint (30th September 2008).

Table 3.13 shows the reasons why clients were discharged from treatment. A discharge is classed as successful if an individual is said to have completed their course of treatment (whether drug free or otherwise), or if the individual is referred to another agency

Table 3.13 Treatment exit reasons for individuals not retained in treatment reported to NDTMS, 2008/09

Numbers %

Total (episodes discharged) 60,386 100
Total successful completions 24,656 41

Treatment completed free of dependency 15,676 26
Treatment completed drug free 8,980 15
Referred on 9,002 15
Dropped out/ left 14,822 25
Prison 4,383 7
Treatment declined 1,769 3
Treatment withdrawn 1,328 2
Moved away 1,870 3
Died 905 1
Other 980 2
Not known 159 0
No appropriate treatment 512 1

Source:
Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2008 – 31
March 2009. National Treatment Agency for Substance Misuse (NTA)
Copyright © 2009, re-used with the permission of the National Treatment Agency for Substance Misuse
Copyright © 2009. Health and Social Care Information Centre, Lifestyle Statistics. All rights
Reserved

Snippets

• Drug users aged 16-34 were more likely to have used three or more illicit
drugs in the last year com

The BCS report shows an overall prevalence rate of 4% for use of more than one illicit drug (polydrug use) in the last year amongst adults aged 16-59.

There was little difference between adult drug users who were single or cohabiting in terms of taking three or more illicit drugs in the last year (both 23%) and both groups were considerably more likely to take three or more illicit drugs than those who were married (married couples accounting for 8% of those who used three or more illicit drugs in the last year).

Reported drug use was more common among older pupils; for example, 4% of 11
year olds said they had used drugs in the last year, compared with 29% of 15 year
olds.

Regular smokers and pupils who have consumed more units of alcohol in the
previous week were very much more likely to have used drugs in the last year..

Deaths related to drug misuse. In 2008, there were1,738 deaths reported as being due to drug misuse. Of those who died, 78% were male. Compared to 1993 the number of male deaths has increased by around 136% in 2008 compared to a 48% increase for females. In recent years however no overall trend is apparent. The highest numbers of deaths due to drug misuse occurred in the 30 to 39 age group for both males and females (490 and 112 respectively).

The difference between the right word and the almost right word is the difference between lightning and the lightning bug.—Mark Twain

At every word a reputation dies.—Alexander Pope

By our silence, we let others define us.—Susan Rook (Missouri Recovery Network campaign slogan)

Addiction treatment organizations and a variety of policy-making, planning, and funding authorities are changing their historical focus on acute biopsychosocial stabilization to a broader vision of sustained long-term recovery for individuals and families. This shift can be seen in widespread discussions and practices that embrace “recovery management” and “recovery-oriented systems of care.” This change in organizing concepts and service practices will not be possible without the meaningful involvement of individuals and families in or seeking recovery in the planning and decision-making processes.
The word “consumer” is cropping up more frequently, with references to “our consumers,” “consumer representation,” ”consumer councils,” and “consumer-based” or “consumer-directed” services. This latest term joins a long list of terms—patients, clients, service users/recipients/participants, alumni—that have described people needing, receiving, or completing addiction treatment and recovery support services.
Historically, language applied to and chosen by historically disenfranchised groups evolves over time. People who were recovering from severe mental illness began their own recovery revolution in the 1970s and 1980s and chose to self-designate themselves as “consumers” and “survivors” as a less stigmatizing alternative to “mental patient.” The surge in “consumer” language was a positive development within the history of the mental health recovery advocacy movement—one that at the time was experienced as personally empowering. It is likely that this language will continue to evolve as the mental health recovery advocacy movement continues to evolve.
With the growing integration of addiction treatment and mental health treatment services, the introduction of new medications for the treatment of addiction, and expanded efforts to include coverage for addiction treatment and recovery support services as part of comprehensive health care reform, the use of the word “consumer” is gaining prominence within the addiction treatment and recovery support communities. This brief essay describes why this “consumer” terminology is counterproductive and suggests other ways to describe the critical role that people seeking or in long-term recovery, their families, and friends play in the design, delivery, and evaluation of addiction treatment and recovery support services.

Rejecting the “Consumer” Designation
There are nine reasons to reject the spread of “consumer” language when talking about addiction treatment and recovery support services.

1. The term “consumer” is ill-defined and as such, may create further misunderstanding by the general public and policymakers about people experiencing addiction or who are in long-term addiction recovery. There is no generally understood meaning of what exactly is being consumed, and members of the public may well think the term refers to people who continue to consume excessive amounts of alcohol and/or drugs.
“The ‘consumer’ language suggests that the person in treatment is a social ‘taker,’ that they suck up community resources and give nothing in return—a parasitic relationship to others.”
People in active addiction are often involved in a parasitic process of using (in the manipulative sense) family, friends, and community resources to sustain their alcohol and drug use. “Consumer” is a more apt description of someone in active addiction than of a person in long-term recovery. Furthermore, the most cursory search of “consumer” on the internet reveals meanings that include a person who drinks alcohol to excess (See http://www.thefreedictionary.com/consumer). A person in recovery is more aptly described as a person who ceases being a consumer.

2. The term “consumer” fails to provide an alternative identity for persons attempting to disengage from alcohol/drug-saturated lifestyles and subcultures. Addiction treatment can be a transitional bridge from a culture of addiction to a culture of recovery or a revolving door within a person’s active addiction career. The “consumer” identity tends to reinforce the latter; focusing on the repeated “consumption” of services as well as the “consumption” of alcohol and other drugs. “Person in recovery,” in contrast, builds a new identity for an individual moving forward to a new life. “Consumer” defines a person in terms of a part of the self while ignoring the whole. Participating in addiction treatment is an activity, not who a person is.
The term “consumer” had value at a particular point in time for persons recovering from mental illness. New language that had value within a particular historical context can become old language and stand as an obstacle to progress as contexts change. We need a different term to describe people seeking and in long-term recovery from addiction and people who participate in addiction treatment as part of that long-term journey. Does that mean that any alternative language we embrace today may need to be given up in the future? We need to be open to that possibility.

3. The term “consumer” ties an individual’s identity to a service delivery system, be it a treatment provider or a physician prescribing medications, and can be paternalistic and disempowering. There are words other than “consumer” that can be used to describe a relationship between a person receiving professional care and the caregiver. For example, in the HIV/AIDS community, people who receive medications from a physician often describe themselves as patients when talking about their relationship with their doctor. Similarly, many people using medications in their recovery describe themselves as a “person in long-term recovery using medication,” as a “patient” when describing their relationship with their physician, or as a “client” when describing their relationship with a clinic.
The problem is that when “consumer” is juxtaposed against “professional” or “provider,” as it often is, “consumer” conveys a person of less value and authority and implies that the individual has value only to the extent to which they consume professional services or products. This juxtaposition further creates the delusion that the “provider” is whole/well and the consumer is “broken/sick.” Both are dehumanized by this process, with one denied of weakness and the other denied of strength. The “consumer” designation reflects a hierarchical relational model that rests on twin propositions: 1) “the professional knows best” and 2) the role of the “patient/consumer is to listen and comply.”
“Consumer” also defines a person in terms of his or her problems. It relegates the person to being one, albeit critical, component of a system of care, rather than as the driver of that care and the person around whom all care is to be organized so that the person is able to get well. There is nothing in the term that conveys autonomy (or even healthy interdependence), competence, responsibility, or describes the assets that the person brings to others and the community. “Consumer” does not convey the status of, or hope for, recovery and seems alien when linked to words like liberation, journey, transformation, Higher Power, redemption, spirituality, and service, to name just a few of the words and concepts that are associated with recovery. If we need a name, then let’s use words that convey wholeness and wellness, words like “citizen,” “person in long-term recovery,” or “person seeking recovery.”

4. Using the term “consumer” to convey the involvement of people in recovery and their families in advisement or decision-making roles narrowly restricts the pool of people considered for such participation. For example, the term “consumer” would not include individuals/families in need of recovery who have never sought professional help, individuals who did not complete and may have had a “bad” experience in treatment, and individuals and families who achieve long-term recovery without the aid of professional treatment. Referring to such people as “consumers” (of addiction treatment services) is simply inaccurate. Individuals in treatment constitute only a small, unrepresentative sample of those who have experienced and/or have resolved alcohol and other drug problems. Too often, “consumer” represents an even smaller sample: individuals who have successfully “graduated” from treatment and, out of deep gratitude for their personal recovery, can offer testimony to a particular program’s effectiveness.
“Consumer” councils that guide federal, state, or local recovery-focused initiatives must include a wide range of voices as part of the advisory process. The term “consumer” does not adequately describe the scope of needed representative. Voices must be heard who represent diverse levels of problem severity/complexity, recovery capital, and pathways and styles of long-term recovery. The homogenous designation “consumer” ignores the distinct cultural histories and the enormous diversity of needs and circumstances people bring to the experiences of recovery initiation and recovery maintenance.

5. The “consumer” designation inadvertently serves as a mechanism of “outing.” To routinely introduce someone as a “consumer representative” or a member of “our consumer council” discloses the person’s status as a former treatment recipient or person in recovery and places the institution rather than the individual in control of when, where, to whom, and under what circumstances his or her recovery status is disclosed. For professional treatment institutions, such communications often constitute an inadvertent breach of ethics (confidentiality) and etiquette (respect, privacy, discretion). For the people serving in this role, the “consumer representative” designation diminishes and restricts how they are perceived by others and how they perceive themselves.

6. Terms such as “consumer,” “client,” “patient,” and “previously incarcerated person (PIP)” are inappropriate in the context of peer-based recovery support services. These terms imply a hierarchical service relationship model that is incongruent with peer-based recovery support. For example, when a recovery coach commented to a treatment professional that they did not refer to the people they served as “clients” or “consumers,” the professional asked, “Well then, what do you call them?” The simple response was, “Collectively, we call them people; individually, we call them by their names.” This response indicates a different relationship—not only one of mutual respect, but one that embraces the reciprocity that is at the core of peer recovery support relationships. The term “consumer” reflects the role dichotomy of helper (a producer of services) and helpee (a user of services); in the world of peer recovery support services, each person both gives and receives.

As more people return to communities from prison in search of sustained recovery, new acronyms are popping up. Unfortunately, these names and acronyms continue to objectify and turn individuals into an aggregate object, e.g., previously incarcerated persons (PIPs) and formerly incarcerated persons (FIPs). Such names and acronyms have no place in the world of addiction treatment and recovery support services.
( Referrals from the criminal justice system increased from 38% of total referrals in 1990 to 59% of referrals in 2004. During this same time period, referrals from welfare and child protection systems increased from 8% to 16%. McLellan, A.T. (2006). Addiction is changing: How changes in systems and customers may affect the Betty Ford Institute. Presentation to Betty Ford Institute Executive Council, February, Rancho Mirage, CA)
.
7. Embracing this term in the addiction treatment and addiction recovery support arenas may amplify stigma by pairing the stigma already attached to addiction with the stigma attached to mental illness.
Given the dominance of the term “consumer” within the mental health field over the past two decades and the existing Consumer Advisory Councils for people with mental illness in each state, “consumer” has become a code word for mental illness. Joint use of “consumer” by the two fields may compound social stigma by inadvertently signaling that all “consumers” have histories of both mental illness and alcohol/drug addiction.
The use of “consumer,” because of its association with the mental health field, may also reinforce the view that addiction is a symptom of mental illness and not a primary disorder. It is critical that people with co-occurring addiction and mental illness receive the specialized and integrated services that they need to achieve long-term recovery. However, it is imperative that addiction is recognized and treated as a primary disorder.

8. The term “consumer” used in the context of addiction treatment mistakenly conveys the image of a seller-buyer relationship, with an informed customer having substantial autonomy, power, and choice and rights of redress if the product or service is faulty. This is not an accurate depiction of most persons entering addiction treatment in the United States today. The growing percentages of people entering treatment via external coercion, the substantial power differential between addiction professionals and their “patients,” the limited choices available to those forced into treatment, the lack of knowledge about those choices, the absence of lobbyists and advocacy organizations representing individuals and families in addiction treatment, and the lack of any significant mechanisms of redress for ineffective or harmful treatment are all obscured by referring to those entering addiction treatment as “consumers.” The term “consumer” is used in few other contexts in which choice and redress are so limited.

9. The term “consumer” has a commercial/marketing/sales connotation that overemphasizes the business aspects of addiction treatment and is particularly ill-suited for people involved in volunteer, peer-based recovery support services provided by recovery community organizations.
The term “consumer,” perhaps not unexpectedly, came into prominence in the roaring “greed is good” days of the 1980s when addiction treatment organizations were told they needed to shift their identity from that of a service program to one of a business.
( Acker, C.J. (1993). Stigma or legitimation? A historical examination of the social potentials of addiction disease models. Journal of Psychoactive Drugs, 25(3), 193-205, quotation from page 203.
“Americans are urged through ubiquitous advertising to construct their identities through consumerism; they are expected to be positive economic actors through consumption.”)

The commodification of addiction treatment and its accompanying language has been a corrupting force within the treatment field and set the stage for calls to de-commercialize and re-humanize the service relationship. The “consumer” designation is incongruent with the sustained person-professional and peer-peer partnerships being advocated as the ideal models of long-term recovery support. The commercial/commodity aspects of the term “consumer” are also part of a value system that attributes personal value to the possession/consumption of goods and services. It conflicts with a recovery value system that defines personal identity in terms of humility, restitution (paying rather than incurring debt), service (an emphasis on giving rather than owning), and simplicity.

Final Reflection
The addictions field could learn much from the larger disabilities movement of recent decades. Some of the central ideas of this movement include the following:

• Language matters. It is far more than superficial concerns about political correctness.

• Language is imbedded with values and judgments of a culture; cultural change involves a transformation in language.

• The labels applied to individuals affect how they are perceived by others and how they perceive themselves.

• Language is a vehicle of social control and social isolation. Stigma and discrimination are couched in a language that reinforces stereotypes and elicits fear.

• Recovery and community integration require claiming one’s own language.

• Language that focuses on the person is more respectful and less stigmatizing than language that defines a person in terms of an illness.

It will be interesting to see how the language of addiction treatment and recovery evolves in tandem with the dramatic changes that are unfolding within these worlds. I hope we will not be talking much longer about “consumers” or “consumer councils” but will instead be talking about people in recovery and recovery (or citizen) advisory councils. I also hope that the paternalistic “our patients,” “our clients,” and “those we treat” will evolve in the near future to “people we serve.”

Words can elicit fear, contempt, anger, or pity, but they can also elicit understanding, compassion, and respect. Individuals and families in recovery are awakening culturally and politically. As they do, they will forge their own language to collectively convey their “experience, strength, and hope.” They will challenge the traditional language that has been used culturally and professionally to depict alcohol and other drug problems and their resolution. Most importantly, they will claim entitlement to select the words used to refer to those who have experienced addiction and recovery.

Source: Daily Dose 21st July 2009

Thus young people (aged 11-15), who drink, tend to do less frequently but at a higher intensity than adults.

In young people (aged 16-24), the latest NHS Information Statistics on Alcohol (2008) reported that 26% of males and 24% of females drink over the recommended weekly limits for low risk drinking in adults, which are 21 units for men and 14 units for women. Moreover it is shown that 9% of young males and 6% of young females drank over 50 units per week which is indicative of high risk drinking in adults . It is not clear whether current adult guidance on low risk drinking is pertinent to young people or if specific recommendations are required for individuals who are in the midst of ongoing physiological and emotional
development.

During the last 30 years the number of deaths due to chronic liver disease and cirrhosis has risen steadily in England and this trend is particularly marked in the 25-34 year group with the number rising from 16 in 1970 to 68 in 2000 for men and from 7 in 1970 to 60 in 2000 for women . The majority of liver disease in this country is due to heavy drinking . However, the most significant physical health risks associated with alcohol consumption in young people at the present moment are those relating to accidents and injuries. The ESPAD study reported that 13% of all 15-16 year olds had been involved in an accident or had an injury as a result of drinking .

In Scotland, it has been reported that on a daily basis, 15 children under the age of 17 attend Emergency Departments, intoxicated and in need of medical assistance or treatment .Indeed an audit of 21 emergency departments over a 6 week period showed that 648 children and young people under the age of 17 required medical treatment; 15 of these cases were below the age of 12 and one was as young as 8 years old. On average these young people had consumed 13 units of alcohol within the 24 hours leading up to their attendance . If this number were to be extrapolated for England it would give an estimate of around 1245 young people per week requiring medical assistance or treatment in England (64,750 per year).

In England some 35,472 young people aged 16-24 were admitted to hospital in 2005 with alcohol-related conditions . The largest proportion (19,533) were male and the figures increased with increasing age. Whilst it is clear from these figures that excessive drinking by young people is a significant concern in the UK, it is not clear what impact this alcohol misuse has on their health and well-being beyond the immediate hospital episode.

Heavy drinking by young people is more pronounced in areas with high social deprivation. The highest levels of alcohol consumption are reported by young people in the North-East of England and Yorkshire and Humberside where they are 1.5 times more likely to have drunk alcohol during the last week than young people living in the rest of England . In 2008, a survey of 1,250 young people living in deprived communities in Britain found that over a third did not know what a unit of alcohol was and did not understand the term binge drinking. Of
these young people, 39% drank up to 20 units per week and 15% drank over 20 units per week . Thus the adverse effects of social deprivation on young people may be compounded by possible health and social problems related to heavy drinking.

In a survey of school children aged 15 and 16 from the North West of England, participants reported that being aged 16, receiving a greater amount of income per week and not having a hobby or being a member of a club or sports team was associated with higher levels of alcohol . In addition, a higher percentage of girls reported drinking in public places whilst a higher percentage of binge drinkers were male . The 2005/2006 Health Behaviour in School-aged Children (HBSC) Survey (on patterns of health among young people in 41 countries and regions across Europe and North America) provides an international comparison . Notably, findings suggest that young people in the UK have some of the
highest rates of drunkenness internationally. England had the highest proportion of girls (24%) that reported that they had first been drunk at the age of 13 or younger. Rates for English boys were also high 23% reported they had been drunk at age 13 or younger .

Thus there are clear grounds for concern about alcohol consumption in young people in England and it seems that many aspects of young people’s drinking may be situational or culturally determined. Moreover, whilst there is some evidence that parents’ attitudes about alcohol may shape their children’s views (particularly in younger children) about drinking, it seems that other direct mechanisms such as access to pocket money and involvement in diversionary activities (or not) may also determine if, when and how much their children
drink. However, it is currently not clear to parents what risks arise for their children from early exposure to, or different levels of, alcohol consumption. Many parents may feel that early introduction to alcohol by them is preferable to its use in unsupervised experimentation.

However, there is currently insufficient information to base such decisions on.
In adults there are some health and social benefits associated with alcohol consumption. However, the health benefits are linked to cardio-protective effects of low to moderate consumption of alcohol which have generally been identified in older adults, that is men aged over 40 and post-menopausal women . The positive social effects of drinking are well known to the majority of the adult population that chooses to drink alcohol, although these effects are rarely studied in research terms. In young people, it is not clear whether there is any health benefits associated with drinking in early life. It is likely that young people will
perceive positive social effects of drinking . However, it is possible that these may be tempered by adverse consequences that may arise from drinking at an age before alcohol is legal.

On the basis of current epidemiological evidence on adverse consequences of drinking, particularly in young people who become intoxicated, the alcohol harm reduction strategy for England has highlighted that underage drinking is a major public health priority and outlined three objectives for tackling it:

• 1.Delaying the onset of regular drinking, primarily by changing the attitudes of 11-15 year olds and their parents about alcohol.
• 2. Reducing harm to young people who have already started to drink.
• 3. Creating a culture in which young people feel they can have fun without needing to drink.

Recent NICE guidelines on alcohol interventions in schools and the Government’s recent Youth Alcohol Action Plan also set out clear priorities concerning alcohol and young people under the age of 18. One of the actions in the Action Plan is to issue advice to parents about young people and alcohol, which will include guidelines for low risk drinking

This ‘guidance will also offer wider information on the health and social impacts of
drinking at young ages, sources of help and support for parents including evidence-based approaches for them to use with their children. Furthermore, the 2007 Chief Medical Officers Report recognised that young people’s health is the key to the nation’s future. He identified six priority risk-taking areas of which one was alcohol and drugs . In order to inform the proposed guidelines on alcohol and young people, this review was commissioned to identify published evidence on both the harms and benefits of drinking in early life. Given that there was a limited time-frame available for the work, the commissioning brief asked for a focus on existing reviews in this field. The purpose of this work was to provide an assessment of this evidence to an expert group of clinicians/researchers
convened by the Department for Children, Families and Schools to enable them to make recommendations to parents about their children’s drinking.

The aim of the study were to:

• produce a thorough review of the most up-to-date, robust and reliable evidence on the harms and benefits of alcohol consumption for children and young people;
• undertake a systematic search of existing reviews and weigh-up the quality of the evidence base;
• communicate and discuss the findings with the expert panel on alcohol and young people;
• support the Department in accurately and appropriately interpreting and using the evidence;
• ensure the guidance for parents is based on a firm evidence base; and
• identify evidence gaps that longer term research needs to address.

The following electronic databases were searched for relevant reviews:

• ETOH Alcohol and Alcohol Problems Science database (1972-2003)
• TRIP (May 2008)
• MEDLINE (1950-May 2008)
• EMBASE (1980-May 2008)
• CINAHL (1982-May 2008)
• PsycINFO (1806-May 2008)
• Social Science Citation Index (1970-May 2008)
• Science Citation Index (1970-May 2008)
• Scopus (1996-May 2008)

We also used key words (see below) to search the following websites

• Institute http://www.intute.ac.uk/
• Department for Children, Schools and Families http://www.dcsf.gov.uk/
• Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/index.htm
• Home office http://www.homeoffice.gov.uk/rds/alcohol1.html
• UK Statistics Authority http://www.statistics.gov.uk
• EU Statistics UK http://www.eustatistics.gov.uk/
• NHS Information Centre http://www.ic.nhs.uk/
• UK Data Archive http://www.data-archive.ac.uk/
• NICE http://www.nice.org.uk/
• WHO http://www.who.int/topics/alcohol_drinking/en/
• Alcohol Concern http://www.alcoholconcern.org.uk/
• Alcohol Education and Research Council http://www.aerc.org.uk/
• National Center on Addiction and Substance Abuse http://www.casacolumbia.org/
• Alcohol and Drug Abuse Institute http://depts.washington.edu/adai/
• Australian Drug Information Network http://www.adin.com.au/
• SoRAD http://www.sorad.su.se/
• Diversity Health Institute Clearinghouse

http://www.dhi.gov.au/clearinghouse/default.htm

• European Alcohol Policy Alliance http://www.eurocare.org/
• ADCA library http://tinyurl.com/4t8ds2
• DrinkandDrugs.net http://www.drinkanddrugs.net/
• Daily Dose http://www.dailydose.net/
• Google and Google Scholar http://www.google.co.uk
• NIAAA: http://www.niaaa.nih.gov/

Two-and-a-half-year-old, weakened by starvation, cold, deprivation, and physical abuse, paid the scapegoat price for
this careless society and gave up the fight to live. Scott was a victim of malignant neglect, not just by his drug-crazed parents, but
by the society into which he was born, where neglect, in various forms, has become commonplace. A parent’s’ right to choose, at any
cost, a pleasure-seeking lifestyle, rules, while laws change to allow drug-taking on an unprecedented scale. The silent sufferers are the children.

The long-term effect becomes all too clear, as children, unable to cope with the chaos in their lives, become aggressive and disruptive, serving an
apprenticeship for addiction. This Government’s answer is so-called “harm reduction.” This evil drug policy has been in place for 30 years or so. Its cornerstone is free choice for individuals to take drugs, and it promotes “safe use” – whatever that means. It focuses on the individual, never the family, the dependants, or the community. This policy promotes the lie that drugs are here to stay, and there is nothing we can do about it except “reduce harm.” Addicts are enabled to take drugs and are given, at the taxpayers’ expense, all necessary means.

“Harm reduction” adherents are fanatical about protecting this system,even though it has been responsible for the drug crisis in society. We have
built a gigantic business on the backs of drug addicts (called ‘clients’), and people grow fat on the proceeds. The tax-paying public remains in denial. Perhaps people believe this couldn’t be happening. It is. Parents of addicted children, exploited by the system, live the nightmare daily. The society we are creating through malignant neglect is not one we will want to live in. Scott Saunders is not the first to endure a living hell and prolonged death. Unless we act, the rot won’t stop.

Forty years ago, the Scandinavian countries looked at “harm reduction.” Their findings led them to scrap any notion of adopting such a policy.
Every government agency had to adopt a drug-free stance and promote drug prevention. It was made abundantly clear that drug addiction was not an acceptable way of living. Sweden set up European Cities Against Drugs, developing strategies for a safe, drug-free society, and proving that it can be done.

In Rutherglen, an outwardly respectable neighbourhood of Glasgow, Scott Saunders was subjected to appalling abuse and neglect. One hundred fifty wounds were found on his body; he had been systematically deprived of food, and his eventual death from starvation came after he had been left alone in the house for three days.

We must be brave enough to face up to our failures and to the treason yes, treason – which is undermining our way of life, canceling our workforce,and damaging, often terminally, our young people, while imperceptibly luring us into accepting the unacceptable. Don’t believe the lies, the platitudes,the excuses, the cover-up of so-called “harm reduction” drug policies. We are all responsible for the death of Scott through negligence.

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In Brief

• In 2004, an estimated 14% of youths aged 12 to 17, approximately 3.5 million youths, had experienced at least one major depressive episode (MDE) in their lifetime

• Over 7%, an estimated 1.8 million youths, had lifetime MDE and thought about killing themselves at the time of their worst or most recent episode

• An estimated 712,000 youths had tried to kill themselves during their worst or most recent MDE; this represents 2.9% of those aged 12 to 17

In 2003, suicide was the 11th leading cause of death among persons of all ages in the United States. However, among young people aged 15 to 24, suicide, or intentional self-harm, was the third leading cause of death, with 3,921 deaths, following accidents/unintentional injuries (14,966 deaths) and assaults/homicides (5,148 deaths).

The 2004 National Survey on Drug Use and Health (NSDUH) asked youths aged 12 to 17 about symptoms of depression, including thoughts about death or suicide. Major Depressive Episode (MDE) is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least five of the nine symptoms of depression as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The suicide-related questions asked youths if (during their worst or most recent episode of depression) they thought it would be better if they were dead, thought about killing themselves, and, if they had thought about killing themselves, whether they made a plan to kill themselves and whether they tried to kill themselves. This report presents estimates of the prevalence of lifetime MDE among youths. The report also presents the numbers and percentages of youths who had both lifetime MDE and suicidal thoughts.

Prevalence of MDE

An estimated 14% of youths aged 12 to 17, approximately 3.5 million youths, had experienced at least one MDE in their lifetime (Table 1). Almost 20% of females aged 12 to 17 and 8.5% of males had at least one of these depressive episodes. Rates of lifetime MDE were similar among racial/ethnic groups and increased with age.

MDE and Suicidal Thoughts

Among youths aged 12 to 17, about 9%, an estimated 2.3 million youths, had experienced MDE in their lifetime and thought, during their worst or most recent MDE, that it would be better if they were dead. Over 7%, an estimated 1.8 million youths, thought about killing themselves at the time of their worst or most recent MDE.

Females aged 12 to 17 were significantly more likely than their male peers to have had MDE and to report thinking about suicide and believing it would be better if they were dead (Figure 1).

Both 14 or 15 year olds and 16 or 17 year olds were significantly more likely than those aged 12 or 13 to have had MDE accompanied by thoughts that it would be better if they were dead and thoughts about committing suicide (Figure 2).

MDE with suicidal thoughts did not vary by urbanicity.4 Youths in large metropolitan areas, small metropolitan areas, and non-metropolitan areas were equally likely to have MDE with suicidal thoughts.

MDE and Suicide Attempts

An estimated 900,000 youths, or 3.6% of 12 to 17 year olds, made a plan to kill themselves at the time they were having their worst or most recent MDE. An estimated 712,000 youths had tried to kill themselves during such an episode; this represents 2.9% of those aged 12 to 17.

Female youths were more likely than male youths to have had MDE and made a plan to kill themselves (5.6% of females and 1.7% of males) or to have attempted suicide (4.7% of females and 1.1% of males).

INDEPENDENT TWO REPORTS Exclusive report reveals the crisis among teenagers caused by their growing addiction to drink and drugs.

Teen Britain: The shocking truth Exclusive report reveals the crisis among teenagers caused by their growing addiction to drink and drugs. Experts warn of ‘health time bomb’ as ministers consider forcing GPs to report under-age sex to police and social workers By Jonathan Thompson and Marie Woolf.

Teenagers are facing what medical experts warn is “a mental health time bomb” caused by the abuse of drugs and alcohol.

New figures show that the use of drink and drugs has become common among children as young as 13, with one expert saying alcohol, cocaine and marijuana are “as ubiquitous as traffic on the streets”.

Doctors and counsellors say that record numbers of stressed-out adolescents are becoming addicts as they struggle to cope with the trauma of family break-up, exam pressures and the ever-growing obsession with body image.

The use of drink and drugs is also fuelling a growing problem of sex among young teenagers. Ministers are now considering forcing doctors to breach confidentiality with young patients if they believe they are having under -age sex.

72% Alcohol

The proportion of 14-year-olds who have drunk alcohol. Almost half of all 13-year-olds have also tried it. Mental health experts say people drinking at that age are four times more likely to become alcoholics

36% Drugs

The proportion of 15-year-olds who have tried cocaine or cannabis. Addiction experts say there is clear evidence that young people using drugs are more likely to suffer from psychiatric disorders in later life

32% Sex

The proportion of 15-year-olds who have had sexual intercourse, with more than one in 10 saying they felt pressured into it by peers. Doctors say the trend is fuelling an explosion in sexually transmitted diseases

25% Suicide

The proportion of girls aged 15 who have considered killing themselves or indulged in significant attempts at self-harm. Almost one in 10 blamed bullying and violence for their low self-esteem and depression.

Teenagers are facing what medical experts warn is “a mental health time bomb” caused by the abuse of drugs and alcohol.

New figures show that the use of drink and drugs has become common among children as young as 13, with one expert saying alcohol, cocaine and marijuana are “as ubiquitous as traffic on the streets”.

Doctors and counsellors say that record numbers of stressed-out adolescents are becoming addicts as they struggle to cope with the trauma of family break-up, exam pressures and the ever-growing obsession with body image.

The use of drink and drugs is also fuelling a growing problem of sex among young teenagers. Ministers are now considering forcing doctors to breach confidentiality with young patients if they believe they are having under -age sex.

Dr Dylan Griffiths has spent more than 20 years healing the minds of troubled teenagers. But the psychiatrist is shocked by what he is now facing on a daily basis. He is treating record numbers of disturbed young patients, unable to cope with the pressures of modern life, who are hooked on drink, drugs and underage sex, or who are so desperate they even contemplate suicide.

The age of experimentation among Britain’s teenagers is dropping every year, he and other leading health workers warn, creating a mental health time bomb which will create a generation of dysfunctional adults.

“For today’s teens, marijuana, cocaine and alcohol are as ubiquitous as traffic on the street,” said Dr Griffiths, who is based at Ticehurst House Hospital in East Sussex.

“Adolescents who self-harmed were rare 30 years ago. Today, self-harming is a dramatic, addictive behaviour, a maladaptive way for growing numbers of youngsters to relieve their psychological distress.”

The shocking extent of teen angst among Britain’s youth is revealed tomorrow in one of the most comprehensive reports ever carried out into adolescent mental health. Backed by counsellors, drug experts and mental health charities including Sane, the independent study commissioned by the Priory Group paints a bleak picture of the growing mental-health crisis among 12- to 19-year-olds.

Family break-up, increasing pressure to achieve at school, a lack of tolerance in society and an “anything goes” attitude are all contributing to a rise in the number of young people pushed to the brink of suicide, with others driven to experiment with drugs, drink and underage sex as a way of coping with stress.

More than 900,000 adolescents have been so miserable they have considered suicide, the study says. A million have wanted to self-harm and more than half a million have experienced bullying or violence at home.

The Priory research is based on interviews with 1,000 girls and boys across the country as well as an analysis of figures provided by the Office of National Statistics. More than one in seven 14-year-olds and one in 25 young people of 13 said they had had sex. Around one in every 13 teenage boys and girls said they had gone through with sex because of peer pressure, not because they wanted to.

Ministers are discussing measures to make family doctors warn police and social workers about young patients who are having under-age sex.

Peer pressure was also to blame for many adolescents using alcohol or drugs – one in 20 teenagers of 13 and around one in six 15-year-olds had experimented with illegal substances in the belief that it would make them look “cool” and be better accepted at school.

Another worrying trend is the increase in teenagers who have such low self-esteem that they think they need radical surgery to make them look “normal”. Nearly one in five 15-year-old girls and boys and one in every 20 young people of 13 said they had considered plastic surgery.

Counsellors, drug experts and mental health charities agree that action is needed urgently to prevent a generation of young people growing up with serious mental health problems. Dr Angharad Rudkin, a children’s therapist, said that the internet and mobiles, which have given rise to text bullying, were factors.

“There is a lot more stress now in the education system and a pressure on teenagers to be thin, beautiful, successful and to have sex,” said the clinical psychologist, based in Basingstoke, Hampshire. “There’s less guidance for teenagers, less mentoring and fewer role models for positive behaviour.”

Marjorie Wallace, chief executive of Sane, said that increased availability of drugs was a huge factor in the rise in young people suffering from mental illness.

“Young people who may have symptoms of mental illness rumbling under the surface are being pushed to flashpoint very quickly because of binge drinking and the availability of drugs, particularly chemical hybrids,” she said. “Many of them will go on to develop lasting mental illness.”

Virginia Ironside, the agony aunt and writer, said that the “curse” of a wealthy society was that young people had too much choice, so were confused about their identity.

“Pressures are absolutely nothing compared with what they used to be – pressure used to be going up chimneys. But at least if you are going up a chimney you know where you are.”

Additional reporting by Ese Odetah, Rob Tolan and Laura Herring

DRINK: Emma East, 15

“My home life stresses me out as I often have fights with my family. It means I can’t concentrate in school and it affects my schoolwork. My family don’t get on at all. I got really badly drunk once and was sick in the pub, so I haven’t touched the stuff since last Christmas. I had a really bad experience and don’t want to touch the stuff any more. I’ve been to church for the past five years. My parents don’t go; I go by myself. You learn things there to help you in your everyday life. It’s a support network.”

72% of 14-year-olds have consumed alcohol

DRUGS: Sevim Hodge, 16

“It starts at secondary school, where there is a huge emphasis on status. Drugs offer an easy solution to these pressures. From the age of 13 I was smoking cannabis with my friends. It was only my own willpower that helped me stop, and what I saw happening to my friends. I’m still friends with people who take drugs and at least a third of them now are regular users, but it can easily spiral out of control. I’ve seen cocaine taken openly in the playground.”

53% of 16-year-olds have tried illegal substances such as marijuana or cocaine

BULLYING: Michael Licudi, 17

“I was targeted by homophobic bullies outside my school and ended up on anti-depressants. Being gay, I’ve struggled because US rap culture promotes masculine stereotypes in schools. The media, particularly programmes such as Little Britain and The Catherine Tate Show, also legitimise a certain way of saying and doing things. If you don’t match those stereotypes, then it makes acceptance much more difficult. There has always been a cool group, but media influence gives them an added legitimacy and power.”

28% of 13-year-olds are bullied at school

SELF HARM: Imogen Townley, 15

“It’s a bit weird, but a lot of girls in my year cut themselves. I think it’s supposed to be some kind of statement, because they roll their sleeves up in class to show the marks. It’s like they’re trying to say, ‘Look at me, I’m so stressed out, so messed up and misunderstood, so beautiful but lonely.’ But all they’re trying to do is get attention.”

19% of 15-year-olds have wanted to hurt themselves

SEX: Amari Nunesi, 14

“Of course teenagers are going to have sex. We like doing it, it’s as simple as that. We like it as much as adults do. Society can’t stop it. Nobody can stop it. The only thing that would stop it is if they made more ugly girls. Family-wise it’s more difficult for teenagers now, because a lot of people don’t have two parents, so they don’t know who to go to with their problems. Sometimes you want to speak to your mum about something, but if you’re staying with your dad you can’t.”

32% of 14-year-olds have had sexual intercourse

STRESS: Steph Ashcroft, 13

“There are people from my school who have anger management counselling, and others who have counselling for depression and abnormal behaviour. I guess about 10 people in my year are having therapy. There are some kids who have hit teachers over the head with chairs. Sometimes they just go ape and throw everything about. There are a lot of people at school with a lot of issues, unfortunately. I get tense myself sometimes. I got an after-school detention last week for calling one of the teachers a stroppy cow.”

15% of 14-year-olds have considered taking their own lives

BODY IMAGE: Sebastian Emin, 13

“I am happy with my body but I would definitely change my height. I used to get picked on because I’m only 4ft 6in. Everyone sees something they don’t like about themselves. If you take a photo, you look at your lips or your eyes and you think they look horrible. We always find something wrong with ourselves. I think Peter Andre has got the perfect body. He’s more popular because of his looks – particularly his muscles. Britney Spears has the perfect female figure. She’s so slim.”

15% of 14-year-olds have considered plastic surgery

Dr Dylan Griffiths has spent more than 20 years healing the minds of troubled teenagers. But the psychiatrist is shocked by what he is now facing on a daily basis. He is treating record numbers of disturbed young patients, unable to cope with the pressures of modern life, who are hooked on drink, drugs and underage sex, or who are so desperate they even contemplate suicide.

The age of experimentation among Britain’s teenagers is dropping every year, he and other leading health workers warn, creating a mental health time bomb which will create a generation of dysfunctional adults.

“For today’s teens, marijuana, cocaine and alcohol are as ubiquitous as traffic on the street,” said Dr Griffiths, who is based at Ticehurst House Hospital in East Sussex.

“Adolescents who self-harmed were rare 30 years ago. Today, self-harming is a dramatic, addictive behaviour, a maladaptive way for growing numbers of youngsters to relieve their psychological distress.”

The shocking extent of teen angst among Britain’s youth is revealed tomorrow in one of the most comprehensive reports ever carried out into adolescent mental health. Backed by counsellors, drug experts and mental health charities including Sane, the independent study commissioned by the Priory Group paints a bleak picture of the growing mental-health crisis among 12- to 19-year-olds.

Family break-up, increasing pressure to achieve at school, a lack of tolerance in society and an “anything goes” attitude are all contributing to a rise in the number of young people pushed to the brink of suicide, with others driven to experiment with drugs, drink and underage sex as a way of coping with stress.

More than 900,000 adolescents have been so miserable they have considered suicide, the study says. A million have wanted to self-harm and more than half a million have experienced bullying or violence at home.

The Priory research is based on interviews with 1,000 girls and boys across the country as well as an analysis of figures provided by the Office of National Statistics. More than one in seven 14-year-olds and one in 25 young people of 13 said they had had sex. Around one in every 13 teenage boys and girls said they had gone through with sex because of peer pressure, not because they wanted to.

Ministers are discussing measures to make family doctors warn police and social workers about young patients who are having under-age sex.

Peer pressure was also to blame for many adolescents using alcohol or drugs – one in 20 teenagers of 13 and around one in six 15-year-olds had experimented with illegal substances in the belief that it would make them look “cool” and be better accepted at school.

Another worrying trend is the increase in teenagers who have such low self-esteem that they think they need radical surgery to make them look “normal”. Nearly one in five 15-year-old girls and boys and one in every 20 young people of 13 said they had considered plastic surgery.

Counsellors, drug experts and mental health charities agree that action is needed urgently to prevent a generation of young people growing up with serious mental health problems. Dr Angharad Rudkin, a children’s therapist, said that the internet and mobiles, which have given rise to text bullying, were factors.

“There is a lot more stress now in the education system and a pressure on teenagers to be thin, beautiful, successful and to have sex,” said the clinical psychologist, based in Basingstoke, Hampshire. “There’s less guidance for teenagers, less mentoring and fewer role models for positive behaviour.”

Marjorie Wallace, chief executive of Sane, said that increased availability of drugs was a huge factor in the rise in young people suffering from mental illness.

“Young people who may have symptoms of mental illness rumbling under the surface are being pushed to flashpoint very quickly because of binge drinking and the availability of drugs, particularly chemical hybrids,” she said. “Many of them will go on to develop lasting mental illness.”

Virginia Ironside, the agony aunt and writer, said that the “curse” of a wealthy society was that young people had too much choice, so were confused about their identity.

“Pressures are absolutely nothing compared with what they used to be – pressure used to be going up chimneys. But at least if you are going up a chimney you know where you are.”

Additional reporting by Ese Odetah, Rob Tolan and Laura Herring