Archive for June, 2014

Young-adult addiction

Jun. 30th 2014

College students hit the bottle, the bong, and sometimes the books

College is a time for young people to find themselves, experience the world on their own, expand their horizons and meet new people. You might think your college-age child is living in a safe and at least somewhat-controlled environment, but do you know what’s actually going on in your son or daughter’s dorm?

A recent report from SAMSA on young-adult substance use by college students should give every parent pause. And a study from the University of Michigan – Ann Arbor1 looks specifically at college students:

  • Nearly one in 10 college students are taking Adderall.  And handing extra pills out to friends “for studying.”
  • Five percent are smoking weed every day.
  • Four percent drink every day.
  • In the past two weeks, almost 40 percent binge-drank, having downed five or more alcoholic drinks in a row.

In just the past 30 days:

  • More than one in five college students have taken an illicit drug.
  • Two-thirds have consumed alcohol.
  • Forty percent have been drunk.
  • One in five have been high on marijuana.

While drug and alcohol “experimentation” comes with the territory, it seems to be way over the top for a group that is supposed to be learning advanced skills for future employment.

Virtually guaranteed

With over half of the college-aged population involved in at least some type of substance use or abuse, it’s virtually guaranteed that your own son or daughter has been affected by alcohol and drug use – whether they use, feel peer pressure to use, or have trouble studying due to nearby partying. Maybe your son is rooming with the daily pot-smoker. Maybe your daughter is dating the person with the Adderall script. Maybe your son’s frat parties are the best place to get blackout drunk on the weekends.

It doesn’t take long for someone who’s on the right track to get sidetracked. These tight-knit using groups form fast, and with hardly any effort at all. Getting occasionally wasted is expected and accepted in college, but what starts as casually getting high on Friday night to let loose can snowball and end up derailing even the most promising students.

Impossible to know

Is your child part of a heavy-use group? How would you know? Even for parents who are footing the hefty tuition bills, it’s nearly impossible to know exactly what’s going on. School records – including grades, attendance, academic probation notices, etc. – are all private. You only know what your child tells you and what your child lets you see when you visit.

It happens at even the top-rated colleges: Clever, using students find ways to get degrees by taking “gut” courses and maintaining a B average, which makes the slippery slope to addiction even slipperier and does little to prepare them for an employment environment where over the long run, their skill set is much more important than who they know.

Warning signs go unnoticed

Thus, the warning signs of addiction can go unnoticed. There are more addicted college students than you might think:

One-fifth of 18-to-25-year-olds are classified as needing treatment for alcohol or illicit drug use.2

 

And more expensive schools aren’t impervious to this problem. Quite the opposite! College students from well-off families are even more likely to abuse alcohol and drugs and need treatment. Compared to young adults in the bottom wealth quartile, those in the top wealth quartile are:

  • three times more likely to engage in heavy episodic drinking3;
  • almost 25 percent more likely to consume alcohol in general; and
  • almost twice as likely to use marijuana.

A self-perception problem

Unfortunately, on top of the substance use problem, there’s also a self-perception problem. A shockingly high percentage (96 percent!) of young adults who need treatment don’t believe they need it. So how are parents really to know when alcohol and drug use becomes a problem for their son or daughter? Dig in. Ask hard questions. Set high expectations. Ask to see transcripts and grades.

Your student may legally be an adult, but take advantage of their financial dependence to exert leverage to keep them on track – and course-correct when necessary.  Proof is in performance, not intentions, so if a pattern of academic failure and broken promises becomes common, seek professional advice and consider drug testing.

1 Johnston, L. D., O’Malley, P. M., Bachman, J. G., and Schulenberg, J. E., (2013). Monitoring the Future national survey results on drug use, 1975–2012: Volume 2, College students and adults ages 19–50. Ann Arbor: Institute for Social Research, The University of Michigan.
http://monitoringthefuture.org/pubs/monographs/mtf-vol2_2012.pdf

2 “Young Adults’ Need for and Receipt of Alcohol and Illicit Drug Use Treatment: 2007.” National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, 25 June 2009. Web. 24 June 2014.
http://www.samhsa.gov/data/2k9/157/YoungAdultsDrugTxt.htm

3 Patrick, Megan E., Ph.D, Patrick Wightman, Ph.D, Robert F. Schoeni, Ph.D, and John E. Schulenberg, Ph.D. “Socioeconomic Status and Substance Use Among Young Adults: A Comparison Across Constructs and Drugs.” Journal of Studies on Alcohol and Drugs 73.5 (2012): 772-82. PMC. Web. 23 June 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410945/

Pregnant women popping pills

Jun. 16th 2014

From Tylenol to Vicodin, an uptick in opioid prescriptions during pregnancy

To do pregnancy the “right” way, to follow all the rules and recommendations, requires sacrifice on the part of the expectant mother. The list of no-nos is long: caffeine, alcohol, ibuprofen, sushi, deli meat, soft-serve ice cream, runny egg yolks, skiing, stomach-sleeping . . . just to name a few.

One of the hardest parts for me when I was wading through my first pregnancy (besides forgoing the soft-serve and stomach-sleeping), was being limited to acetaminophen for the various and sundry aches and pains I encountered as my hips widened and my ligaments stretched. Having found Tylenol to be quite ineffective in my younger years, my M.O. was to grin and bear it. Advil or bust, was my attitude. But not all pregnant women have the same tough-it-out mentality. And when they complain to their physicians, they’re getting something a lot stronger than Tylenol.

An alarming rate

Despite a dearth of research regarding the impact of opioids on fetal health and safety, doctors are prescribing opioid narcotics to pregnant women at an alarming rate, primarily to treat back pain and abdominal pain.*

In both studies, the opioids most prescribed during pregnancy were codeine and hydrocodone. Oxycodone was among the top four.

There’s speculation as to whether these script-happy doctors have done their due diligence, as fewer than 10 percent of medications approved by the FDA since 1980 have sufficient data to determine fetal risk. In fact, opioid use in the first trimester may double the risk of fetal neural tube defects. The question of addiction in just-born infants is also an issue to be addressed, as prolonged use while pregnant can lead to dependence – in mother and child.

America’s pain-averse mentality

A miracle cure in pill form has come to be expected for whatever might ail us – and that mentality doesn’t simply disappear during pregnancy. After all, taking painkillers is certainly an easier solution than suffering through it or seeking more time-consuming alternative help, such as physical therapy or acupuncture. But it still boggles the mind how women who try to be so careful in so many ways will eagerly accept an opioid prescription. “If the doctor’s giving it to me, it must be safe . . . right?”

Recklessly over-prescribed

Ultimately, this seems to be merely another manifestation of the trend of opioid painkillers being recklessly over-prescribed – and to inappropriate patients. It’s a main contributor to pharmaceutical and opioid abuse and addiction in the U.S., and now there’s yet another subgroup to whom these pills are becoming more – and more easily – available.

*For more information, see Catherine Saint Louis’s April 13, 2014, article, “Surge in Narcotic Prescriptions for Pregnant Women,” in The New York Times.

Why heroin?

Jun. 9th 2014

Why do supposedly smart people become addicted to heroin? Why do they use it in the first place, when it has a reputation as a low-class, junkie drug? What’s the attraction? What’s the high?

With the recent death of Philip Seymour Hoffman, I asked myself those questions. As a person in recovery whose drug of choice was primarily alcohol, I experimented with cocaine, used Xanax occasionally to sleep, and smoked a joint now and then – but never, ever thought of heroin.

But it’s not just famous people who die of overdoses from the drug – it’s people I know in my circle of friends, my relatives and in our newspapers. As part of our efforts to make available an antidote to heroin overdoses to first responders (the Naloxone spray), family members came forward and told their stories of loved ones lost to the drug. Very sad. And these were middle-class young adults. It migrates into the best families, but why? Why use it when it has a reputation as a drug no one wants to mess with?

Understand the draw

First, to understand the draw of heroin, you have to understand what it does. According to Robert Aaron, the man who was arrested for providing dope to Hoffman, heroin has “good qualities”:
 

A lot of times you have a deadline and you to work for 24 hours. This lets you do it with no pain, no tiredness. If I have to write a book, get me high – I’ll have that book written in two weeks. You’re lucid. And emotions don’t affect you as much – your anger – it bottles up your feelings. It makes you more rational, or you think you are, anyway. I’m a lifelong insomniac. …. Everything has it good points and bad points. The bad point is the dependence.

 
So there you have it: the perfect study drug to pull an all-nighter on. Or to learn your lines and perform in front of the camera. Or to deliver a speech honoring a family member or friend, as a relative of mine did. It was a brilliant performance – everyone said so – but I could tell by his eyes he had used, which he confided to me while in treatment. And far too soon, he was gone.

I’ve also heard the first few times, it’s better than the perfect orgasm, better than any sex. But then, of course, the intensity lessens each time and the user begins to chase the high, hoping the next time will be like the first time. The irony is that heroin robs many users of the ability and desire to obtain an erection (see Amy Winehouse’s You Know I’m No Good, “Upstairs in bed with my ex boy / He’s in the place but I can’t get joy”).

The connection

As you probably already know, few drug users start out using heroin. In fact, many heroin users are first exposed and addicted to prescription pain medication. You may be wondering about the connection between pain medication use and heroin.

I’d always known that many people with injuries or post-surgical trauma become dependent on prescription pain medications such as oxycodone, hydrocodone and Percocet (oxycodone + acetaminophen). It’s a common phenomenon when taking these pills for only a few days, as I discovered after undergoing hip surgery. I was very aware of withdrawal symptoms when stopping after three weeks of use, and I was very conscientious about limiting the amount per day and the duration.

However, pills are different from heroin in that they numb you out, slow you down and allow you to withdraw from the world. Some people like these feelings because it helps them cope with other problems, they are pain-averse, or they can’t tolerate withdrawal symptoms. So when a pill person first touches heroin, there is a “WOW!” effect that is unlike any pills, which are all about dulling senses, not first focusing the mind and relaxing feelings and then withdrawing into the inner world of nothingness. That is the attraction of the drug, what makes it so popular, and what I never understood until Aaron came forward with his story.

Cheaper and more powerful

With increasing pressure on doctors to limit the number of prescriptions and number of pills prescribed, along with central registries for prescriptions, supply is becoming more limited. Also, copays can be high – higher, even, than the price of heroin. So users who want pills are increasingly buying over the Internet or from friends or dealers. Once they get into this illegal market, the movement to heroin is common.

Because users tend to associate with each other, word gets out that heroin is cheaper and more powerful than pills. More bang for less buck. People who use drugs encourage their friends to join them because it makes them feel better and it helps them justify their use. Dealers also will tout heroin as a better alternative, offering free samples (“One snort won’t hurt; you can control it.”).

Chasing the perfect high

All junkies believe they know how much to use without killing themselves because they successfully do it all the time. But, as we all know, this is a delusion because they are both chasing the perfect high – the one combination of drugs that will really make them feel like the first time they used – and ignoring the fact that due to increasing tolerance, they require higher-potency drugs to do so. Unfortunately, their belief is only valid until it doesn’t work. And then, they are dead.