In 2009, Mainesaw 179 deaths due to overdose and 165 of those were related to prescription drugs. Many of the abused prescription drugs are respiratory depressants such as Oxycontin®, Vicodin ® and Oxycodone which slow down one’s breathing to dangerous levels, are addictive and can lead to death in overdose situations.

For many of these drugs, it does not take a large amount to have dangerous health effects. According to recent data, nearly 7 million Americans are abusing prescription drugs, more than those abusing cocaine, heroin, hallucinogens, Ecstasy, and inhalants combined.  That 7 million was just 3.8 million in 2000, an 80 percent increase in just six years.

Some teens are also abusing over-the-counter drugs, primarily cough and cold remedies that contain dextromethorphan (DXM), a cough suppressant.  Products with DXM include Nyquil, Coricidin and Robitussin, among others. Teens often have easy access to these products. The abuse of over-the-counter cough and cold remedies can cause blurred vision, nausea, vomiting, dizziness, coma and even death.

As a result of the increase in prescription drug abuse, many communities are seeing an increased need for health-care and law enforcement services. Robberies and burglaries have increased nearly 4 percent in Maine from 6,848 in 2008 to 7,109 in 2009, according to reports.

According to the Maine DEA, prescription drug-related arrests accounted for 41 percent of all drug arrests for the first six months of 2009. Maine’s unintentional poisoning deaths (most all related to prescription drug abuse and misuse), rose 210 percent from 1999 to 2004.

According to the Centers for Disease Control, unintentional poisoning deaths have become the second leading cause of unintentional death second only to motor vehicle accidents. Between 2004 and 2008, the number of visits to hospital emergency departments involving the non-medical use of narcotic painkillers increased 111 percent.

What can parents do to safeguard their kids from the dangers these medicines pose? 

Educate yourself a talk with your kids because your opinion really does count! Studies consistently show that parents are the No. 1 influence on their kids, yet the MIYHS student survey revealed that 58 percent of students admitted their parents had not talked to them about the dangers of alcohol and other drugs within the past year.

Feel like you don’t know enough about this issue to guide them?

Visit CASA’s website at www.midcoastcasa.org for resource materials

Safeguard. Measures to take at home include: monitor all drugs in your home by recording quantities and storing them in a secure location; set clear rules for your kids about all drug use, including not sharing medicine and always following prescriptions and dosages as they’re written; be a good role model by following these same rules with your own medications.

Source:  www.TimesRecord.com  22^nd Oct 2010

There has been much discussion in recent months about Canadian drug laws. Some favour liberalization because the current approach has been unsuccessful in reducing the harm caused by illegal drugs. Others claim that the strict enforcement of existing laws is necessary to control the spread of harmful, mind-altering drugs.

Interestingly, the starting point for both sides is that drugs cause “harm.” What logically flows from this single point of agreement is that drug-prevention education must be a key component in any national drug policy — to minimize the chance of “harm” ever arising.

There are two simple but key points to keep in mind when formulating drug prevention initiatives:

• It is about children. All parents know the importance of nurturing their very young children; we see their minds developing almost on an hourly basis. Recent research shows that the teen brain goes through similar major development, particularly in the prefrontal cortex area that controls reasoning and impulses, and this is the time when the brain is most open to outside influences. Negative influences that can lead to harmful behaviour and positive influences that can inspire the teen to make healthy choices

• It is about parents. Studies show that parents have a greater influence on their children than friends, TV, the Internet or celebrities, and studies show that teens of parents who have discussed the risk of drug use are 50-per-cent less likely to use drugs than teens in families who have not had this discussion.

The Partnership for a Drug Free Canada recently commissioned a national survey which shows that, although parents say it is important to have a conversation with their kids about the dangers of drugs, there is still a lack of meaningful dialogue.

While 92 per cent of parents of 11 to 19 year olds claim to have talked with their kids about drugs in the past year, 40 per cent of parents surveyed admitted that their conversation lasted a few minutes or less. That is not what we would consider a meaningful dialogue.

That’s why our current drug-prevention campaigns, which are targeting parents, put so much emphasis on the need to talk to their kids.  Parents need to educate themselves before they engage. Too many parents jump right in without preparation and the conversation can derail quite easily. My suggestion is: Learn as much as you can so you understand what your kids are facing in the schoolyard, on the street and at gatherings and parties.

In the survey, 97 per cent of parents agreed with the statement “It is important for parents to talk to their kids about drugs,” yet almost half (49 per cent) wished they knew better what to say to their kids about drugs.  Meanwhile, 40 per cent of teens said they “wished they knew better how to say ‘No’ when someone offers drugs.”

It is obvious that parents want to discuss “drugs” with their children but, as we have seen in many countries, they may be reluctant to do so, both because they fear that the kids know more about the subject than they do and because they are uncomfortable about how to enter the discussion.

Yes, we certainly must provide treatment services to those suffering from addiction, while recognizing that the most effective way to reduce the number of future sufferers is to provide the prevention education that can help reduce the number of people ever trying drugs in the first place.

Richard Pound is the founder and former president of the World Anti-doping Agency and the current chair of the Partnership for a Drug Free Canada. www.canadadrugfree.org

Source: www.thestar.com  28^th May 2012

The article “Reclassifying cannabis ‘would make no difference to young’ – Experts say that the vast majority of teenagers get the drug from their friends” by Jonathan Owen from U.K.’s The Independent, January 6, 2008, relates to basic concerns that need attention in the U. S. as well as the U.K. and probably other countries as well.     

As for the title of the article as implied reason against returning to the higher classification of cannabis in the U.K., there has long been awareness that teenagers in the U. S. are getting their cannabis mainly from friends or relatives (as older siblings) rather than directly from drug dealers, certainly in early stages of use, and that was probably also the case in the U.K. prior to its having lowered the classification.But some of the teens must surely get the drugs from for-profit dealers in order to have a supply to share with friends and relatives.  

The quoted report stated that young people need to be educated about the health risks, but that supposedly has been ongoing in schools for years.I have been a member of several grassroots volunteer drug prevention organizations since 1983, having become involved as a parent, and not one of those organizations has examined school drug curriculum.Yet, I have read complaints from several credible sources about the psychosocial approach that is dominantly used in school drug education/prevention in theUnited States (and perhaps other countries as well?).   

Those critiques point out that the psychosocial approach with its focus on teaching decision-making skills and on self-esteem implies to youth that they have the ability and maturity to make their own decisions regarding drug use.Furthermore, these decision-making activities often are not related to drug use, and indications are that there has been too little taught about the health and behavioral consequences of drug use.The psychosocial approach often uses classroom group discussions about drug use instead of focusing on teacher lecturing, thus students are indirectly encouraged to be influenced by their peers instead of adult authorities.School drug curriculum should be regularly reviewed by drug prevention organizations with more thorough information on what the complaints have been than in these several sentences.   

With cannabis use having become so prevalent among youth and so many cultural influences to use drugs, neither parents nor law enforcement should be expected to be the main detectors of youth drug use or of no-use enforcement.Experience has shown that is not realistic.  With technology of drug testing now available, schools and other youth organizations, such as sports teams, need to randomly drug test their students and participants and then provide graduated consequences for positive tests without involvement of law enforcement.Parents and law enforcement need that support and assistance from society.And most importantly, youth needs that adult-provided protection.

Nancy Starr
Pennsylvania

Source:  DrugWatch International   January 2008

Surveys of American and European teenagers have found dramatic differences between the two groups’ substance use. While American teens smoke and drink less than their European peers, they are more likely to use illegal drugs.
The results come from coordinated school surveys about substance use that include more than 100,000 students around Europe. They are largely modeled on the University of Michigan’s Monitoring the Future survey in the United States, making comparisons possible between the American and European results.
The United States had the second lowest proportion of students who used alcohol and tobacco, compared with teens in 36 European countries, HealthCanal reports. Among American students, 27 percent drank alcohol in the month before the survey.

The average rate in Europe was 57 percent. Twelve percent of American students smoked cigarettes in the month before the survey, compared with an average of 28 percent in Europe.
Eighteen percent of American teens reported using marijuana or hashish in the previous month, compared with an average of 7 percent among European teens. American teens reported the highest level of marijuana availability. The U.S. had the lowest proportion of teens who associated use of marijuana with great risk, according to Lloyd Johnston, the principal investigator of the American surveys.
American teens were more likely than European students to have tried any illicit drugs other than marijuana, including hallucinogens, Ecstasy and amphetamines.
“Clearly the U.S. has attained relatively low rates of use for cigarettes and alcohol, though not as low as we would like,” Johnston said in a news release. “But the level of illicit drug use by adolescents is still exceptional here.”
Source: Join Together weekly news 8th June 2012

Adolescent use of marijuana has become almost as acceptable as staying out a little past curfew. Most agree the latter shouldn’t happen, but it’s understandable and  as long as things don’t get worse  easy to address with a clock and threat of grounding. No big deal.

Not so with marijuana. If your child is smoking pot and it starts to get worse you won’t know when or why until you have a child for whom a grounding is a mere impediment to a dangerous new lifestyle. And more importantly you will have missed critical opportunities to help your child address his problems in a healthy, positive way.

I see a lot of adolescents in my practice, many of whom arrive after a lengthy relationship with pot.  But my first contact is usually with the anxious parents. “Something is going on,” they say. “His grades are going down; She’s spends all her time in her room; He’s moody and uncommunicative; she’s lost interest in her flute. ” “He’s different,” they say. “She’s like a stranger.”

How long has this been going on I ask? Around six months says mom. Closer to a year says dad.  Ask a few questions, a sort of psychological triage, looking for any recent changes or traumas that might offer a clue.

Then I put it out there. “Do you think your child is involved with drugs?”

Here is the answer I almost always receive. “No.  I don’t think so. Maybe just a little marijuana.”

So, let’s stop here. I want to say this loud and clear.

The correct answer to my questions is a simple “YES.”

I realize there is a battle afoot to legalize the stuff. I understand that most parents when asked if their child smokes marijuana will usually respond in a tone rife with defeatism, “Of course. They all do.” I get it. There is comfort in numbers. But unfortunately this beleaguered answer tends to end a conversation instead of inspire a look at the heart of the matter.

“Why does my child choose to do drugs?”

Certainly I know there are some teens who dabble with marijuana every so often at a party.  Maybe she wants to fit in.  Maybe the munchies and some frenzied laughter feel like a fun release.  But this same adolescent stays on top of her grades, enjoys long term friendships and converses typically peevishly with her parents on a regular basis.  I don’t meet these kids or their parents in my office. Obviously not every child who smokes marijuana is going to dance around the drain.

But from what I can see, more and more kids are doing just that . At this point you might be thinking, ” When I was young I smoked all the time. I was fine!.” Well, the truth is marijuana is more powerful now, 20 to 30 times according to some estimates, and is more often laced with other drugs.  The information age has also made it far easier to get it when you want it.  All of this makes a big difference.

I recently attended a lecture at a private Residential Treatment Center for adolescent drug addicts, at which the director made a point of saying there wasn’t a child there who hadn’t convinced their parents or themselves that a little marijuana was okay.

Adolescents are walking into my office in increasing numbers having grown alienated, unproductive and increasingly self-destructive. They are standing on a long road of marijuana use. These are unhappy kids and whether they are smoking a little on occasional weekends, every weekend, everyday or are already into heavier stuff, they need emotional help.

The sooner they get it the better. Which is why it is critical that every parent recognize that their pot smoking teenager, who may be doing what everyone else is doing, IS STILL DOING A DRUG and that it is a form of self-medication.

This is no time to seek comfort in numbers. It’s a time NOT TO PANIC, but to pay attention.

Marijuana helps kids hide from the painful and negative feelings with which so many teens struggle. By minimizing pot, parents may be neglecting to look around for the REASON their particular teen is needing to stifle his or her feelings. They are looking away from their child’s emotional health which may in fact be far more fragile than it seems. Most kids don’t connect hating life with identifiable painful feelings. They just think life stinks and drugs offer a vacation..

So how do you help open their eyes?

If you ask your child if she is depressed or anxious she will likely say “no.” This is because she doesn’t really know what the words mean and anyway believes she’s found a way to stop feeling “bad.” Ask anyway. It’s an opportunity to teach emotional vocabulary. For example, “You’ve been so quiet lately. Not laughing much and you’re not hanging out with your friends. You seem depressed, kind of sad to me.” Your teen will most certainly say you’re wrong, but that’s okay. Her education has begun.

As for how to ask your teen about drug use it’s really quite counterintuitive. Don’t ask when he is bleary eyed, or comes home laughing hysterically, or if you walk in his room and find yourself in a haze of AXE. Wait for a quiet moment when you’re child is not going to be highly defensive, or out of it and express the question with concern as opposed to accusation.

Point out what you noticed the other night, say you’re worried about drugs including marijuana, and then center on your concern for how she is FEELING. If she closes down just smile and invite her to talk when she’s ready. If she snaps that everyone smokes a little marijuana try, “I understand the way it is out there but it doesn’t make it right or healthy.” Then let it alone. Return to the subject when there are more clues or you can sense there’s an opening. The point is not to let her waste energy being angry at you. She needs that energy to just think.

When it comes to their well-being teens rarely do that. Which is why you have to.

Marijuana is a drug. For many kids it will become addictive. It could become the first step to the use of other drugs. Drugs that could ruin and even end lives.

So watch your child. If there’s a problem you’ll see it…because too many times just a little marijuana, despite what you are being told, is simply not okay.

And remember, “just a little” is dangerously subjective.

Source:  www.megfschneiderlcsw.com August 19, 2010

The number of people admitted to hospital in England with mental illnesses linked to use of illegal drugs has doubled in the past decade, official figures revealed yesterday. The NHS Information Centre said 38,170 adults and children were admitted with drug-related mental and behavioural disorders in 2006-7, an increase of 101% since 1996-97.

Admissions of people under 35 peaked in 2003-4, but there was a continuing surge in mental disorders among middle-aged users. In the 35-44 age group, admissions rose by 259% over the decade to a record 10,941 in 2006-7. Among those aged 45-54, there was a 256% increase to 3,158.

The centre said men were more than twice as likely as women to be admitted to hospital for mental and behavioural problems linked to drug use. Men also accounted for 79% of the 1,573 deaths from illicit drug use in England and Wales in 2006.

Tim Straughan, the centre’s chief executive, said: “This bulletin paints a picture of wide discrepancy between the number of men who take, are treated for, or even die from drug use compared to the number of women.

“The fact more than 1,500 people died due to drug use in 2006 is extremely saddening in itself, but the fact so many of these deaths are male raises many questions about gender and drug misuse.”

In 2006-7, 13.2% of men in England and Wales reported taking drugs during the last year, compared with 6.9% of women.

Marjorie Wallace, chief executive of the mental health charity Sane, said: “More than twice as many young men were admitted as young women, which suggests men may be more likely to self-medicate with illicit drugs to manage their emotional distress. Many of these admissions may be related to other, pre-existing mental health problems, such as depression or feelings of alienation, for which we need much earlier intervention and support when families express concerns.”

Admissions for treatment of drug poisoning in England also rose from 7,057 in 1996-7 to a record 10,047 in 2006-7. Men accounted for 55% of these cases.

The National Drug Treatment Monitoring System said there were 195,464 people in contact with structured drug treatment services in 2006-7, compared with about 85,000 in 1998-9. A Department of Health spokeswoman said: “More people than ever before are getting into and staying in treatment, drug-related deaths are down and the level of drug-fuelled crime has fallen substantially.

“The high-quality drug treatment that is being provided is the most effective way of reducing illegal drug misuse, improving the physical and mental health of drug users, as well as reducing the harm they cause to themselves and society.”

The percentage of 16- to 24-year-olds who admitted using cocaine in the past year rose to over 6% for the first time.

Andrew Lansley, the shadow health secretary, said: “Clearly too few people who misuse drugs are being identified and admitted to drug rehabilitation courses early on, which has contributed to this worrying rise in admissions to hospitals. As drugs get stronger, the harm they are doing to young people’s mental health is increasing. The government needs to wake up to the scale of the problem.”

Source: http://www.guardian.co.uk/society/2008/aug/15/drugsandalcohol.mentalhealth

Background & Aims:
Complications of HCV infection are primarily related to the development of advanced fibrosis and whether cannabis use is a risk factor for more severe fibrosis is controversial.

Methods: Baseline data from a prospective cohort study of 204 persons with chronic HCV infection were used for analysis.

The outcome was fibrosis score on biopsy, and the primary predictor evaluated was daily cannabis use.
Results: The median age of the cohort was 46.8 years, 69.1% were male, 49.0% were white, and the presumed route of infection was injection drug use in 70.1%.

The median lifetime duration and average daily use of alcohol were 29.1 years and 1.94 drink equivalents per day, respectively. Cannabis use frequency (within prior 12 months) was daily in 13.7%, occasional in 45.1%, and never in 41.2%. Fibrosis stage, assessed by the Ishak method, was F0, F1–2, and F3–6 in 27.5%, 55.4%, and 17.2% of subjects, respectively.

Daily compared with non-daily cannabis use was significantly associated with moderate to severe fibrosis (F3– 6 vs F1–2) in univariate (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.20 – 8.56, P _ .020) and multivariate analyses (OR, 6.78; 95% CI, 1.89 –24.31, P _ .003). Other independent predictors of F3–6 were >11 portal tracts (compared with <5, OR, 6.92; 95% CI, 1.34 –35.7, P _
.021) and lifetime duration of moderate to heavy alcohol use (OR per decade, 1.72; 95% CI, 1.02–2.90, P _ .044).
Conclusions:
Daily cannabis use is strongly associated with moderate to severe fibrosis, and HCV-infected individuals should be counseled to reduce or abstain from cannabis

Source: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:69–75*Departments of Medicine, ‡Epidemiology and Biostatistics, and §Pathology, University of California at San Francisco , San Francisco , California

Recreational users and hard-core addicts in the U.S. give little thought to the violence by Mexican cartels that is consuming our southern neighbor.

Illegal drugs by the tons are smuggled into California each year by sea, by land and by air. Cocaine, marijuana, methamphetamine and heroin are either produced in or pass through Mexico, where 50,000 people have been killed in the last six years in an escalating war among cartels. Some of the victims have been beheaded, mutilated or left hanging from bridges, not necessarily because of their involvement in the trade, but as a diabolical demonstration that the drug lords will stop at nothing to dominate the market.

Those drugs end up in every neighborhood in Southern California and every city in the United States, feeding a never-ending hunger. But few people north of the border seem to make the connection. The Mexican carnage is conveniently distant. It’s Mexico’s problem, not ours.
When a 24-year-old Echo Park illustrator and recreational drug user goes to a warehouse party or a dance club, she told me, cocaine, Ecstasy and other drugs are always available and often used openly. Given the horrific stories from Mexico, I wondered if the price of those drugs is ever a consideration.

“I do definitely realize that I have a connection to it, and it’s sad,” said the illustrator. “It’s one of those things I’ll try not to think about. It’ll cross my mind and I’ll push it out.”

In 2011, the Los Angeles Police Department seized 11,378 kilos of cocaine, 3,426 kilos of marijuana, nine kilos of heroin and 304 kilos of methamphetamine, along with $16.3 million in suspected drug money, according to the department.

When you walk through the terminals at LAX, not everyone is carrying toiletries, socks and underwear in their suitcases. Several million dollars in cash was seized last year, officials said, much of it stuffed into luggage carried by couriers who were transporting drug payments.

In April, yet another panga boat was spotted off the coast of Malibu, and the Coast Guard took custody of three men and 80 bales of marijuana, which were valued at $1.6 million. Immigration and Customs Enforcement officials said that bumped the stats, since last October, to 51 arrests, with 14 panga boats and 11,000 pounds of marijuana seized.

But those busts and others never seem to nick the operations of the staggeringly rich and powerful cartels, nor do they do much to stem the availability of drugs or the insatiable demand by everyone from occasional recreational users to hard-core, seriously diseased addicts.

The drugs pouring into California don’t all stay here, of course. Greater Los Angeles serves as a distribution point for drugs that get shipped through the nation. But we get our hands on a piece of the goods too.

“On the Southside, you’ll see them slinging it in the streets. In Hollywood, it’s in clubs or behind closed doors and you and I will never see it,” a ranking officer in the LAPD’s Gangs and Narcotics Division told me. “On the Westside it’s the same thing, and we can’t do any enforcement unless someone picks up the phone.”

In some places, like skid row, there are no mysteries as to where the drugs are. On countless occasions, I’ve seen people selling, buying and using, and once watched a woman die of a heroin overdose on her way to the hospital. In other neighborhoods, the action is only slightly less concealed.

“It’s ridiculously easy” to find drugs in the San Fernando Valley, a 48-year-old recovering cocaine addict named Josh told me. Find a motel or liquor store near a row of apartment buildings in a so-so neighborhood, he said, go into the nearest alley, and someone will appear, asking if you want anything.

Josh got clean 15 years ago, works in construction and now tries to help other addicts keep from losing jobs and driving away loved ones, as he once did. When I called the Cocaine Anonymous help line in the Valley, it was Josh who answered, and he offered suggestions on the many meetings I might attend to learn more.

“Every single walk of life you can imagine is covered in the meetings,” said Josh. “As a matter of fact, at one meeting I go to there’s a lawyer, a podiatrist, there’s another lady who’s a nurse…. All races, male, female, it doesn’t matter.” He sees lots of musicians, he said, as well as people in the entertainment business who work both behind and in front of the camera.

The cartels “wouldn’t be in business without us,” Josh said of drug addicts. But as for there being blood on the hands of those whose business is fought over by gangs that torture, kill and terrorize, he said he wouldn’t go that far. “Indirectly, yeah,” there’s a connection. “But directly, you’re talking about Mexican Mafia-type people. They’re going to do what they’re going to do, regardless.”

Maybe so, but I don’t think it’s that easy to wash our hands of any responsibility.
I recognize that any serious addict has a disease, and a chemical craving that can’t be cured by an appeal to conscience. But I’m appealing to the greater, collective conscience.

It’s time to examine why we’ve built such a culture of addiction — whether the devil is alcohol, tobacco, prescription drugs or illegal drugs. It’s time again to question every aspect of U.S. drug policy, and to consider a heavier reliance on prevention and treatment, with fewer resources thrown at the impossible task of cutting off the flow of drugs by land, sea and air.

Fifty thousand neighbors have been killed, many of them savagely. That’s almost equal to the number of U.S. soldiers killed in the Vietnam War. In Mexico, many of the dead were innocent victims of our cravings, and they are not done digging graves.

Source: steve.lopez@latimes.com

While negative influences abound, positive messages reinforcing a drug-free lifestyle seem scarcer all the time. More responsibility than ever falls on the parents of our teens to educate them of the pitfalls of marijuana — a gateway drug. New data suggests a connection between perceived risk and frequency of use, along with an increase in escalation to more dangerous drugs after experimenting with marijuana.

According to The Partnership Attitude Tracking Study (PATS), 2011, past-month marijuana use among teens was 27 percent — up a staggering 42 percent from 2008, and marking an upward trend in teen marijuana use the past three years. These disturbing statistics hint at a more relaxed opinion of the drug among teens, which leads to heavier use.

While the PATS data reflect that about half of teens seemingly disapprove of their peers using marijuana, the data also found among teens a decrease in perceived risk involved with smoking the dangerous drug. The still small voice of anti-drug messages is waning in the face of negative pressures from pot enthusiasts, causing more and more teens to use marijuana early and often.

We can assume from the findings in the study that if more teens are using marijuana more regularly, then more teens will experiment and transition to more dangerous drugs and substances. Regular and heavy teen marijuana users are significantly more likely to use substances like cocaine (30 times more likely), Ecstasy (20 times more likely), and abuse prescription pain relievers (15 times more likely), according to PATS data. Now, teens are not only at risk of becoming addicted to marijuana, they are more likely to develop an addiction to hard-core drugs as a result.

At the root of the alarming potential trends is the decrease in perceived risk. We are losing the war for our teens’ attention, and the cost will be dear if perceptions are not changed.

Still believe the myth that marijuana’s not a gateway drug? Not only are heavy pot users more likely to experiment with heavier drugs, they are also in as much risk of developing cancer as a heavy cigarette smoker. Marijuana smoke contains some of the same carcinogens found in cigarettes and often in higher concentrations. Studies have shown that someone who smokes five joints a week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.

Many people know the typical short-term effects of marijuana use — dry-mouth, anxiety or paranoia, decreased motor skills — but more disturbing are the long-term effects, which quickly can escalate into lifelong issues for abusers. The most common effect is “amotivational syndrome,” in which abusers suffer from a chronic lack of interest in their future and cease to care about things that used to be important to them. Also, as their tolerance for the narcotic agents in marijuana increase, the abuser needs larger and larger amounts of the drug to achieve the same high. This also contributes to the gateway process — once the user stops experiencing the high, he or she escalates use to other drugs to make up the difference.

Source: www.reporternews.com  3^rd June 2012

When we say that someone is “addicted” to a behavior like gambling or eating or playing video games, what does that mean? Are such compulsions really akin to dependencies like drug and alcohol addiction — or is that just loose talk?

This question arose recently after the committee writing the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses, announced updated definitions of substance abuse and addiction, including a new category of “behavioral addictions.” At the moment, the only disorder featured in this new category is pathological gambling, but the suggestion is that other behavioral disorders will be added in due course. Internet addiction, for instance, was initially considered for inclusion but was relegated to an appendix (as was sex addiction) pending further research.

Skeptics worry that such broad criteria for addiction will pathologize normal (if bad) behavior and lead to overdiagnosis and overtreatment. Allen J. Frances, a professor of psychiatry and behavioral sciences at Duke University who has worked on the D.S.M., has said that the new definitions amount to “the medicalization of everyday behavior” and will create “false epidemics.” Health insurance companies are fretting that the new diagnostic criteria may cost the health care system hundreds of millions of dollars annually, as addiction diagnoses multiply.

There is always potential for misuse when diagnostic criteria are expanded. But on the key scientific point, the D.S.M.’s critics are wrong. As anyone familiar with the history of the diagnosis of addiction can tell you, the D.S.M.’s changes accurately reflect our evolving understanding of what it means to be an addict.

The concept of addiction has been changing and expanding for centuries. Initially, it wasn’t even a medical notion. In ancient Rome, “addiction” referred to a legal dependency: the bond of slavery that lenders imposed upon delinquent debtors. From the second century A.D. well into the 1800s, “addiction” described a disposition toward any number of obsessive behaviors, like excessive reading and writing or slavish devotion to a hobby. The term often implied a weakness of character or a moral failing.

“Addiction” entered the medical lexicon only in the late 19th century, as a result of the over-prescription of opium and morphine by physicians. Here, the concept of addiction came to include the notion of an exogenous substance taken into the body. Starting in the early 20th century, another key factor in diagnosing addiction was the occurrence of physical withdrawal symptoms upon quitting the substance in question.

This definition of addiction was not always carefully applied (it took years for alcohol and nicotine to be classified as addictive, despite their fitting the bill), nor did it turn out to be accurate. Consider marijuana: in the 1980s, when I was training to become a doctor, marijuana was considered not to be addictive because the smoker rarely developed physical symptoms upon stopping. We now know that for some users marijuana can be terribly addictive, but because clearance of the drug from the body’s fat cells takes weeks (instead of hours or days), physical withdrawal rarely occurs, though psychological withdrawal certainly can.

Accordingly, most doctors have accepted changes to the definition of addiction, but many still maintain that only those people who compulsively consume an exogenous substance can be called addicts. Over the past several decades, however, a burgeoning body of scientific evidence has indicated that an exogenous substance is less important to addiction than is the disease process that the substance triggers in the brain — a process that disrupts the brain’s anatomical structure, chemical messaging system and other mechanisms responsible for governing thoughts and actions.

For example, since the early 1990s, the neuropsychologists Kent C. Berridge and Terry E. Robinson at the University of Michigan have studied the neurotransmitter dopamine, which gives rise to feelings of craving. They have found that when you repeatedly take a substance like cocaine, your dopamine system becomes hyper-responsive, making the drug extremely difficult for the addicted brain to ignore. Though the drug itself plays a crucial role in starting this process, the changes in the brain persist long after an addict goes through withdrawal: drug-using cues and memories continue to elicit cravings even in addicts who have abstained for years.

Furthermore, a team of scientists led by Nora Volkow at the National Institute on Drug Abuse have used positron emission tomography (PET) scans to show that even when cocaine addicts merely watch videos of people using cocaine, dopamine levels increase in the part of their brains associated with habit and learning. Dr. Volkow’s group and other scientists have used PET scans and functional magnetic resonance imaging to demonstrate similar dopamine receptor derangements in the brains of drug addicts, compulsive gamblers and overeaters who are markedly obese.

The conclusion to draw here is that though substances like cocaine are very effective at triggering changes in the brain that lead to addictive behavior and urges, they are not the only possible triggers: just about any deeply pleasurable activity — sex, eating, Internet use — has the potential to become addictive and destructive.

Disease definitions change over time because of new scientific evidence. This is what has happened with addiction. We should embrace the new D.S.M. criteria and attack all the substances and behaviors that inspire addiction with effective therapies and support.

Howard Markel, a physician and a professor of the history of medicine at the University of Michigan, is the author of “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”

Source: www.nytimes.com 5^th June 2012