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Archive for the ‘The Facts About Substance Abuse’ Category

More Women Than Ever Are Dying From Prescription Drug Abuse

Friday, July 5th, 2013

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Picture a drug addict who dies from an overdose of prescription medication.

What gender is the addict?

If you answered male, you’d be right, but new evidence suggests that more women are dying from drug overdoses than ever before. More women now die of overdoses from pain pills like OxyContin than from cervical cancer or homicide.  In fact, a new analysis of federal data has found that deaths in recent years have been rising far faster among women, quintupling since 1999.  The number of men who are dying also continues to increase, but at a much lower rate.

Another suprising fact is that older women are more at risk than younger ones.  And while in the past drug overdoses have been disproportionately an urban problem that afflicted minorities, more whites than blacks are dying from prescription drug overdoses.  Asians and Hispanics had the lowest rates.

Deaths among women have been rising for some time, but Dr. Thomas R. Frieden, the C.D.C. director, said the problem had gone virtually unrecognized. And for every woman that dies of an overdose, 30 go to the hospital for painkiller abuse.  While younger women in their 20s and 30s tend to have the highest rates of opioid abuse, the overdose death rate was highest among women ages 45 to 54. 130705 women opiate Clinicians surmised that the higher death rates indicate that at least some portion of the drugs may have been prescribed appropriately for pain.  If death rates were driven purely by abuse, then one would expect them to be highest among younger women who are the biggest abusers.

The study offered several theories for the increase. Women are more likely than men to be prescribed pain drugs, to use them chronically, and to get prescriptions for higher doses.  The study’s authors hypothesized that it might be because the most common forms of chronic pain, like fibromyalgia, are more common in women. A woman typically also has less body mass than a man, making it easier to overdose.

Women are also more likely to be given prescriptions of psychotropic drugs, like antidepressants and antianxiety medications, and those who overdose are much more likely to have been taking a combination of drugs.

I was interested in this report because I have seen the number of women addicted to prescription medicine increasing in my practice.  While the typical opiate addict is still a young male, women of all ages are finding themselves in trouble.  Men most often are identified when they end up arrested or fired from work.  However, painkiller addiction is most often discovered in women when child welfare is compromised and foster care investigators get involved.  Child neglect and abuse because of prescription drug addiction is growing at an alarming rate.

130704 suicide2Single-parent families, the poor economy and inadequate local housing also contribute to the vice in which women with children find themselves.  When drug abuse is added to the picture, children suffer.

Because the problems of women addicts are different, the treatment must also be different.  One size does not fit all in opiate addiction.  If you or a woman care about is in trouble with prescription drug abuse, find more information on how to help them here.


Alcohol and Suicide

Thursday, July 4th, 2013

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“It’s Larry,” said the nurse, handing me the phone.

No other introduction was needed.  Larry was a Viet Nam vet who was a frequent patient at the hospital where I worked. It was 8 p.m., I had a unit full of psychiatric patients and he wanted to be admitted. Larry was drunk, which he and I both knew would keep him from getting a bed here tonight.  I wasn’t entirely conscious of it at the time, but something was different.   “I feel lost,” he said.

Thirty minutes later Larry shot himself in the head with his military revolver.

This was almost twenty years ago, but it feels no less tragic  today than it did then.  Suicide is a therapist’s worst nightmare, perhaps because so little is really known about why people kill themselves.

One thing that we do know for sure is that alcohol plays a role in suicidal thought, ideation and attempt. In 2009, the Centers for Disease Control and Prevention measured blood alcohol levels post mortem and found that one in four suicide victims were legally drunk.

Dr. Alex Crosby, the author of the CDC report, described the nature of the connection.  “It leads to disinhibition, and it can enhance feelings of hopelessness and depression,” he said,  “Alcohol impairs judgment and can lead to much more impulsive behavior.  Any suicide prevention efforts must take that into account and address alcohol and substance abuse as well.”

So you can add this to the list of dangerous side effects of drinking to excess: Statistically, one in ten people in the U.S. abuse alcohol, yet alcohol is implicated in 40% of all suicides. If you abuse alcohol, you’re four times more likely to die from suicide.  

Depression is the culprit, but the chicken and the egg argument pops up here, and in my years of treating alcoholics I still can’t always figure it out, at least at first.   What’s clear is that depression is found at clinical levels in 30% to 50% of active alcoholics. (Anecdotally, I think it’s higher.)   Women are more likely to self-medicate with alcohol than men.

In some people, heavy drinking brings on depression: sober them up and the depression goes away.  Others – and this may be the majority – drink alcohol to excess to self-medicate an un- or undertreated depressive episode.

Either way, the danger can’t be overstated.  You’re more likely to commit suicide from heavy drinking than you are to die driving drunk.

There’s a brain chemistry feedback loop that keeps you trapped in the cycle of relief drinking, even when you want to stop.  How can you tell if your drinking has become a problem?  If you can’t stop when you want to.  If you’re in doubt, ask a social drinker if he or she has trouble stopping drinking.  They’ll look at you, like, “Do have trouble stopping hitting yourself on the head with a hammer?”

It’s not a willpower problem.  Willpower doesn’t work on the brain disease of alcoholism any better than it does on any other disease.  Try willing your blood sugar to go down.  Will away that pesky toenail fungus.

If you’re drinking too much and feeling like life’s not worth living, ask for help.

Now.  Your life may very well depend on it.



Cross My Heart: How To Tell When An Addict Is Lying

Sunday, June 23rd, 2013

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130622 Denial

One of these people is an addict and one isn’t.  Guess which one is lying:

“Are you an addict?”   “No.”

“Are you an addict?”  “No.”

It’s a trick question.  The answer is neither is lying.  The non-addict is telling the truth, and the addict is in denial.   (For sake of simplicity, the term “addict” will be used to refer to someone who abuses drugs and/or alcohol.)

Denial is closely associated with addiction, and we’ve all heard the old joke that ends “it’s not a river in Egypt.”  But what’s the difference between lying and denial? Lying is conscious, denial is subconscious.  Denial is one of the defense mechanisms codified by Sigmund Freud.  In Freudian psychoanalytic theory, a defense mechanism is a tool we use to keep painful truths from moving from the subconscious to the conscious.

Dysfunctional defense mechanisms can be pathological (delusional projection), immature (fantasy, passive aggression, acting out), or neurotic (intellectualization, displacement, repression).  There are also functional, or mature, defense mechanisms, like humor, sublimation and altruism.

How do defense mechanisms work?  Think of the ocean.  Above the water is consciousness – the things we’re aware of, that we can see.  Under the water is the subconscious – the things that we’re not aware of.  They’re in the dark.  They’re unknown.  They may or may not be dangerous.  They may eat us alive. They’re scary.

Now here’s the crazy part: both you and the addict are denying the addiction, and you don’t even know it.  If we hooked you up to a lie detector, both of you would pass.  The addict denies it because to acknowledge it would mean taking responsibility.  You deny it because if you don’t, you’ll have to admit your powerlessness.  Your challenge is to break through your denial so both you and the addict can survive the addiction.  Al-Anon and a good therapist – alone, or together – can dislodge your denial.

Denial often takes the form of minimization or blame.  Minimization is underestimating the effects of the dysfunctional behaviors. (“At least I don’t do crack.”  “I never drink liquor.)  Blame is just what it sounds like, but alcoholics raise it to an art form. (“If you were married to my wife, you’d drink too!”)

Now, it’s not all about denial; addicts are also masterful liars. Pop Quiz: If you ask her how much she had to drink, and she says “two drinks” when she had ten, is this denial?  No!  It’s lying!  (Denial would be, “Yeah, so I had ten drinks.  Everybody drinks like that.”)

Addicts lie about things big and small.  They lie so often, they often can’t keep their lies straight.  This is why you’re starting thinking maybe you’re the crazy one. Sometimes it seems that addicts lie when there’s no good reason to.  It’s as if they intentionally lie just to stay in practice.

 130622 liar1In the end, you can’t stop the addict from lying, but you can stop buying into it. Then you can stop enabling, and start healing.

As I said in the beginning, addiction refers to those who abuse alcohol or drugs, since alcohol is really a drug.  Both lie, and both deny. But how can you tell the difference between an alcoholic and an addict?  Here’s how:

An alcoholic will steal your wallet and lie to you about it.  An addict will steal your wallet and then help you look for it. 




How To Save An Addict’s Life

Wednesday, May 29th, 2013

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Opiate Addiction in Southwest Florida has reached epidemic levels.   The rate of emergency room admissions, overdose deaths and arrests  in the greater Sarasota area meets or exceeds statewide numbers.   If you’re reading this, I’m sure you know someone in your life who is suffering from Opiate Addiction.   There things that will work in getting them clean and things that wont – and it’s not always what it seems.

What you need to do: How do you help them?

  • First, decide if the person needs hospitalization   Do they show the physical signs of addiction/withdrawal or simply behavioral and psychological symptoms?  If they have physical signs (sweating, heart palpitations, falling, intoxication) they will probably need hospitalization.
  • Identify friends and relatives (parents, spouses, children) who will help the person get into recovery.  Codependency is an issue here: sometimes people who say they want to help are simply keeping the addict happy, enabling them to continue to use.
  • Third, who is supporting the addict in maintaining their addiction to opiates?   Roommate? Paramour? Dealer?  Remember the old adage: “Keep your friends close, and your enemies closer.”  This cannot be underestimated – I’ve had numerous interventions that have failed due to sabotage from the inside.
  • Don’t try this at home.  If you watch television or movies, you’ve probably seen an intervention staged for dramatic effect. My favorite was an episode of The Sopranos. Christopher Moltisanti is the subject, and when his girlfriend discloses a shameful act by Chris and the man mouths off in an impudent manner, Tony, et al, become enraged, kicking and punching Chris until he ends up in an emergency room.  We all know that this is NOT the way to do an intervention, but still, the process is not as easy as it looks.

What you DON’T do:

  • 130528 hopeDon’t make a threat you have no intention of following through with.  Are you really going to leave him?  Take away your daughter’s car keys? Kick your son to the curb? The addict has heard this from you many times before and knows this is just another empty threat.  Let’s face it: you’re not that convincing, but this is a complement, really.  You don’t lie with the cheerful alacrity of an addict.
  • Don’t let your emotions get the best of you.  Watching a family member ruining their life with alcohol, drugs or other process addictions is excruciating. This is one of the great tragedies of the disease of drug addiction: those who are closest to the alcoholic – those who love him or her the most – get hurt the worst. You’ve been lied to, cheated, manipulated and betrayed. You feel like a fool, and this makes you angry.  But when you lose it with the addict, you lose your credibility.  This is another reason for having a dispassionate third party to moderate the discussion. Another trick is to use “I” statements which keep you from entering the Blame Game which no one wins.  An example:  “When you lied about paying the electric bill, I felt deceived and unloved.”
  • Finally, and most importantly, don’t give up hope.  Addiction is a chronic, life-threatening illness that steals the will, the values and the soul of the addict and holds them hostage. It sometimes takes a long time for the alcoholic to make it to the finish line of recovery. Been to detox dozens of times?  Had repeated hospitalizations?  Been arrested, evicted, and in rehab more times than you care to count?  Talk to someone in recovery – most people travel a long and winding road on the way to peace.  Then, find a Certified Addictions Professional who specializes in intervention.  You are not alone.