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Living with Allergies
Living with Anxiety Disorders
Living with Asthma
Living with Cancer
Living with Depression
Living with Diabetes
Living with Eating Disorders
Living with Alcoholism and Drug Addiction

2009 by Nicholas R. Lessa

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Library of Congress Cataloging-in-Publication Data
Lessa, Nicholas, 1957
Living with alcoholism and drug addiction / by Nicholas R. Lessa with Sara
Dulaney Gilbert.
p. cm. (Teens guides series)
Includes bibliographical references and index.
ISBN-13: 978-0-8160-7326-9 (hardcover : alk. paper)
ISBN-10: 0-8160-7326-0 (hardcover : alk. paper)
1. Drug abuse. 2. Alcoholism. I. Gilbert, Sara D. II. Title.
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1 What Are Alcoholism and Addiction? 1
Z Substances of Abuse 14
3 Causes of Alcoholism and Drug Addiction 32
4 Recognizing Alcoholism and Drug Addiction 44
5 Dangers of Alcoholism and Drug Addiction 54
6 Getting Support and Help 65
7 Approaches to Treatment 77
8 Managing Alcoholism and Drug Addiction:
Life After Treatment 92
9 Helping a Friend or Relative 104
10 Paying for Care 115
11 What More Can You Do? 123
Appendix: Associations and Support Groups 132
Glossary 140
Read More About It 147
Index 151
Alcoholism and addiction are more widespread among
teensand even preteensthan many realize. Were not just talking
about the kind of beer parties that sometimes make the news, but
also about situations like these:
Tommy keeps a bottle of cough syrup in his middle-school
locker. He sips from it between classesbut he doesnt think
about being a drug addict.
Mary Annes parents let herand sometimes her friends
drink beer and wine at their home. They are happy its just
Lisas parents are alcoholics, and her grandparents too. At 14,
Lisa is determined to never be like them. She busies herself
with positive activities such as cheerleading and service clubs.
But one evening at a party, she is offered some pot. She takes a
couple of puffs and fnds she likes the effectsand she knows
it wont make her a sloppy drunk like some of her family
Jasons junior high class learned about the dangers of hard
drugs, and they all hated smoking, but pills from his moms
medicine cabinet seemed safeand fun.
Putting aside questions of illegality, each of these stories might
sound like mild examples of kids who have substance use under
What Are Alcoholism
and Addiction?
Z Living with Alcoholism and Drug Addiction
control. Unfortunately, they are all-too-common scenarios of teens
and preteenssome 8 million of themon the road to alcoholism
and other kinds of drug addiction, which science now says causes
permanent changes in the developing brain. Many still think of alco-
holics as drunks sleeping in the gutter, or addicts as junkies nodding
out with needles in their arms, but here are some basic facts about
alcohol and drug addictions.
A drug addict is not necessarily a strung-out street junkieyet.
Addiction can begin with repetitive and inappropriate use of
something as seemingly innocuous as cough syrup.
Theres no such thing as just alcohol. Alcohol, in addition
to being a dangerous substance on its own, is a potentially
addicting drug. Alcoholism is an addiction.
Addiction runs in families, whether from socially learned pat-
terns, from genetic inheritance, or both.
Alcoholism is not solely an adult problem. It doesnt necessar-
ily take a long time to become an alcoholic or an addict, and
it can mean trouble for kids as young as 12.
The abuse of prescription medications is increasing, and it is
potentially one of the more dangerous addictions.
Another fact thats only recently gaining acceptance is that addic-
tion starts at a much younger age than was once thought. By high
school, its often already time for treatment. According to a survey by
the National Institute on Alcohol Abuse and Alcoholism, more than a
ffth of all eighth-graders have used illegal drugs; more than a quarter
have used alcohol; and a quarter report having been drunk at least
The long-term dangers and effects of addiction are revealed by
recent research, as youll learn in detail in this book. The impact of
early use of alcohol and other drugs on the brain is more serious and
long-lasting than once thought.
The federal government tracks substance use among young people
and reports that for almost all types of drugs, use by eighth-, 10th-, and
12th-graders was down during the frst few years of the 21st century.
Though surveys show that fewer teens are using drugs, large numbers
are still using. The numbers show that use increases with age: Twice
as many 12th-graders as eighth-graders use drugs. Twelve million
teens are regular substance users, and as many as 3 million qualify
as substance abusers or full-blown addicts.
Chances are, you know at least one person your age (in addition to
one or more substance-using adults in your life) who is dealing with
What Are Alcoholism and Addiction? 3
a drug or alcohol problem. Each of these teens has parents, siblings,
and friends who are signifcantly affected by their problem.
Youve probably already been confronted with literature and lec-
tures designed to scare young people away from drinking and drug-
ging. The bad effects of alcohol and drugs are indeed something to be
scared of, but as you probably also know, using fright to keep young
people away from substance abuse often has the opposite effectit
makes danger seem attractive.
Instead, this book presents facts about these widespread, serious
disorders to help you fgure out the best way to deal with them,
whether you experience them in yourself, in a friend, or in a family
Youre also surrounded by opportunities and even encouragement
to at least try alcohol or another chemical substance. Even if your
friends dont use, TV shows, ads, and movies all make drugs and
alcohol seem like a natural part of life.
The more you know about alcoholism and addiction, the better you
will be able to cope with them, whether they affect you directly or
indirectly. In the frst half of this book, youll learn about addiction
and how it works. The second half of the book shows ways to deal
with alcoholism and addiction, including, at the end of the book,
resources for further support and information.
Mary Anne, whose family let her drink at home, wouldnt ever think of
using drugs. Lisa, who chose pot at that party, believed it was much
less messy than booze. They share the common misconception that
alcohol is not a drug. In fact, alcohol is one of many psychoactive
drugssubstances that affect the brain in very specifc ways, includ-
ing causing addiction. People can become addicted to alcohol just as
they can become addicted to the whole range of other drugsfrom
pot to heroin to nicotine or even caffeine. Substances like some cough
syrups or prescription medications contain a variety of ingredients
that create an addictive reaction. Addictive substances may differ, but
addictions themselves have so much in common that members of the
medical profession use the term substance use disorder (SUD) to refer
to any kind of dependence on an external chemical substance. The
most common types of SUD are alcoholism and drug addiction.
Addiction is a physical, mental, and emotional dependence on
chemicals known as psychoactive drugs. Alcoholism, for example, is
an addiction to alcohol. Addiction is a disease that includes the fol-
lowing four symptoms:
4 Living with Alcoholism and Drug Addiction
cravinga strong and often overpowering urge to use a psy-
choactive drug
loss of controlnot being able to stop using once a drug has
been introduced to the body
physical dependencethe need to maintain the level of drugs
in the body in order to avoid withdrawal symptoms, such as
nausea, sweating, shakiness, and anxiety
tolerancethe need to use increasingly large quantities of a
drug to get the same sensation
Alcoholism and addiction are considered biopsychosocial dis-
orders, in which biological (physical), psychological (mental), and
social (interpersonal) factors are intertwined. Physical dependency on
a chemical can lead to behavior that is extremely painful to the sub-
stance abusers and to all those connected to them. In some cases, a
preexisting mental or psychological problem can cause an individual
to self-medicate with an addictive drug. A social aspect of the dis-
order can refer to the impact of family on addiction, and vice versa.
Since in todays world society extends way beyond ones home, a
wide range of infuences, including the media, have an impact on
attitudes and addictionand substance abusers can affect a wide
range of social groups.
A unique characteristic of both alcoholism and addiction is a
process called denial. Denial is an inability on the part of substance
abusers (as well as, often, their family and friends) to admit that the
addiction exists. It adds to the puzzle of living with addiction, so well
be going into that important aspect of the disease in depth further
along in the book.
Addiction and alcoholism were once thought to be moral failings.
People thought that an alcoholic or addict simply had a weak will
or a bad character and that punishment or moral improvement was
the best way to handle them. Even today, despite the fact that sub-
stance abuse is a widely researched illness, many people continue to
believe that people who struggle with alcohol or drugs are weak,
evil, or sinful.
Research into body chemistry and the brain itself has revealed
scientifc facts that show that addiction is, in simplest terms, a brain
disease. Alcohol and drugs have a major impact on nerves controlled
by the brain, for example. One area that heavy drinking affects is our
ability to manage stress. Alcohol, often taken to relieve stress, can
What Are Alcoholism and Addiction? 5
actually make the brain feel more stress. Other drugs create changes
in the brains centers for pleasure and other emotions, as well as for
memory and motivation, and can create a need for more drugs, lead-
ing to addiction. Different types of drugs have different effects on the
chemistry of the brain, and over time repeated use alters brain struc-
ture and activity, so that effects last long after use has stopped.
Chapter 2 describes these brain connections and explains much
more about this exciting new feld of research. The knowledge of
how alcohol and drugs act on the brain will help improve treatment
of the disease of addiction. More importantly, this brain research has
also shown that young people are especially affected by addiction:
Whats the Problem?
At 14, Jamie tried marijuana at a party, since his friends told him
smoking cigarettes was not cool. Now, at 16, Jamie smokes marijuana
every day, because he needs it to chill from his problems, including
his Dads drinking and his own dropping grades. He says he cant be
an addict because marijuana isnt a real drug. Besides, he (almost)
always smokes with his friends, which makes it social. So whats the
1. Jamie is under legal age, so any drug use (including tobacco)
is illegal.
2. A daily need for a substance to ease problems is a clear sign
of addiction.
3. Marijuana is a real drug, which is addictive, and his use has
4. Jamies family history of alcohol problems is a sign of likely
5. Jamies drug use is causing problems, not solving them.
6. Calling drug use social is a form of denialnding an excuse
to use a substance.
Not seeing theres a problem is a good clue that there is a problem.
6 Living with Alcoholism and Drug Addiction
Since your brain is still developing and will continue to until youre
about 21, the addiction to any foreign substance can alter your brains
healthy development and result in serious and long-term changes in
how it works.
Harry, 16, needs to smoke a joint before school and during lunch,
and Angela, 17, needs a beer at breakfast, at mid-morning, and at
lunch. The two of them have the same problemand its not just
that both substances are illegal. Angela might not think of smok-
ing, and Harry cant stand the idea of beer. But both are displaying
addictive behavior, and as the previous section noted, addiction and
alcoholism are two versions of the same diseasesubstance use
Its not hard to see that these teens are in trouble, and that it
doesnt matter whether its drugs or alcohol causing the problem.
But the idea that they have a disease is not always easy for some
to accept. The National Institutes of Health considers alcoholism and
addiction diseases, as does the American Medical Association and
the insurance companies that pay for their treatment. But to many it
may still seem like a cop-out to say, I have a disease. According
to a dictionary defnition of disease, its a condition of the living ani-
mal . . . that impairs normal functioning and is typically manifested
By the Numbers
The federal government keeps track of substance use among young
people and reports that for almost all types of drugs, use by eighth-,
10th-, and 12th-graders is down over the past few years. But 65 per-
cent of all 12th-graders have smoked cigarettes, and almost a quarter
smoke every day. Other drugs on the rise are steroids, prescription
drugs, and nonprescription cough medicine. For the whole picture,
check out, a service provided by
the University of Michigan and funded by the National Institute on Drug
Abuse (NIDA).
What Are Alcoholism and Addiction? 7
by distinguishing signs and symptoms. Government health experts
agree that alcoholism and addiction are brain diseases.
Drug addiction is a complex brain disease. It is characterized by
compulsive and at times uncontrollable drug craving, seeking, and
use that persists even in the face of extremely negative consequences.
Drug-seeking becomes compulsive, in large part as a result of the
effects of prolonged drug use on brain functioning and on behavior.
For many people, drug addiction becomes chronic.
Alcoholism is a chronic disease with genetic, psychosocial, and envi-
ronmental factors infuencing its development and manifestations. The
disease is often progressive and fatal. It is characterized by continuous
or periodically impaired control over drinking, preoccupation with the
drug alcohol, and use of alcohol despite adverse consequences.
So why is it hard for some people to call them diseases? Perhaps
its because it seems to be something that people choose to infict
on themselves. It may be that the bad behavior that alcoholism and
addiction can trigger makes people so angry that its hard to take a
clear look at the illness. Also, studies show what many nonprofes-
sionals have observedthat there is an element of mental illness that
runs through addiction, and that frightens some.
Alcoholics and addicts feel a compulsion to ingest chemicals known
to be dangerous despite experiencing progressively more negative
and painful results. A compulsion is an overwhelming urge to take
an action that makes no sense. For example, Angela and Harry need
those daytime hitsthey dont necessary want them. A fundamen-
tal element of this compulsion is the fact that users use despite the
adverse consequences. They keep using even though they know that
it will lead to problems in physical health, psychological function-
ing, relationships, the workplace, and fnance. Few people who are
addicted to alcohol and drugs want to admit that they are mentally
ill, but the American Psychiatric Association considers addiction a
mental illness that causes signifcant impairments in a persons abil-
ity to function.
Another key feature of substance use disorders is denial, which
the National Council on Alcoholism and Drug Dependence defnes
as a defense mechanism disavowing the signifcance of events, and
a range of psychological maneuvers designed to reduce awareness of
the fact that alcohol use is the cause of an individuals problems. In
other words, an alcoholic or addict knowingly hurts him or herself
but then is unable to see or admit the problem.
8 Living with Alcoholism and Drug Addiction
The 21st century has an additional way of looking at substance use
disorders, thanks to breakthroughs in the scientifc study of the brain.
Today, addiction is seen as a chronic but treatable brain disorder,
according to NIDA. People who are addicted cannot control their need
for alcohol or other drugs, NIDA explains, even in the face of negative
health, social, or legal consequences. This lack of control is the result
of alcohol- or drug-induced changes in the brain. Those changes, in
turn, cause behavior changes, especially those related to motivation,
decision-making, and pleasure-seeking. In other words, the source of
a lot of the behavior that addicts, alcoholics, and their friends and
family have observed over many years can be seen inside the brain.
Whatever the label, alcoholism, addiction, or any kind of sub-
stance abuse is not something people choose. Whats key is to realize
that people like Harry or Angela, who need to use a drug during
their day at school, are not troublemakers or slackers who are simply
making bad choices. They are troubled and suffering from forces they
cant control.
Some people dont like the idea that they may have a disease
because they may think of diseases as being dirty or catching. For
them the term disorder may be more acceptable. A disorder implies
a system that just doesnt work rightdiabetes, for example, or high
blood pressure. These are conditions in which an internal system is
out of order, through no fault of the sufferer. The source may be
inherited, and the condition may be worsened by lifestylejust as
in addiction and alcoholism. Like diabetes or high blood pressure,
alcoholism is chronic, meaning that it lasts a persons lifetime, usu-
ally follows a predictable course, and has symptoms. The risk for
developing alcoholism is infuenced both by a persons genes and by
his or her lifestyle.
Alcoholism and addiction also can be considered a disability. Federal
law, under the Americans with Disabilities Act, includes alcoholism
and addiction as disabilities. It defnes a disability as a physical or
mental impairment that substantially limits or restricts the condition,
manner, or duration under which an average person in the population
can perform a major life activity, such as walking, seeing, hearing,
speaking, breathing, learning, working, or taking care of oneself.
Does this mean that if you drink too much you get federal fnancial
support? Of course notbut the long-term effects of substance abuse
can cripple people.
What Are Alcoholism and Addiction? 9
Some who treat those suffering addiction report fnding a sense of
spiritual impairment or a search for spirituality among addicts.
They are observing what some alcoholics and addicts refer to as a
hole in their soul, a sense of a gaping inner space that must be flled
with something. William C. Moyers, a recovering crack addict and
alcoholic who leads the nationally recognized Hazelden treatment
center, explained to scientists at a brain-study conference, I have an
illness with origins in the brain . . . but I also suffered with the other
component of this illness. I was born with what I like to call a hole in
my soul . . . A pain that came from the reality that I just wasnt good
enough. That I wasnt deserving enough.
Some people are also at higher risk of addiction than others, includ-
ing children of alcoholics or addicts, due possibly to genes, diffcult
upbringing, or both; young people with psychological problems,
such as conduct disorders, who self-medicate to feel better; people
with attention-defcit/hyperactivity disorder or other learning dis-
abilities, and others who fnd it diffcult to ft in to school or social
settings; and children of poverty who lack access to opportunities to
succeed and to resources when theyre in trouble. But if youre not in
one of these vulnerable groups, why should substance use disorders
matter to you?
Gaining a solid understanding of substance use disorders is important
for you, no matter what your circumstances, because even casual use
of alcohol and other drugs can cause special problems for teens. The
best way to treat SUDs is to prevent them. Anyone has the potential
for suffering from substance use disorders, directly or indirectly, and
almost everyone in the country is affected by substance use disorders,
whether they realize it or not.
Even casual use of alcohol and other drugs can cause spe-
cial problems for teens. Weve outlined the negative effects
of chemical substances on brain development, but there are more
reasons why their use matters especially to adolescents. Alcohol
and other drugs impair judgment, and brain studies show that the
10 Living with Alcoholism and Drug Addiction
judgment center of adolescents is still not fully developed, so that
teens are in extra trouble when it comes to making decisions after
using even a small quantity. This may explain why alcohol is a fac-
tor in the three leading causes of death among persons ages 10 to
24: car and other accidents, homicide, and suicide. In less deadly
situations, when combined with teens developmental drive to rebel
against family, this judgment impairment can also make for extra
painful conficts. And for those many teens who struggle to ft in,
alcohol and various other drugs are often used to make that situa-
tion feel better.
Some drug use leads to more: Its no myth that so-called soft
drugs can lead to hard drugs. It has been found that more than
67 percent of young people who start drinking before the age of 15
will try an illicit drug. Young people who drink are 7.5 times more
likely to use any illicit drug, more than 22 times more likely to use
marijuana, and 50 times more likely to use cocaine than young people
who never drank.
The best way to treat SUDs is to prevent them. Perhaps the
biggest reason for understanding addiction and alcoholism has to do
with prevention. Columbia University research shows that a person
who reaches age 21 without abusing alcohol or using drugs is virtu-
ally certain never to do so. Remember those statistics about the use
of many drugs by teens going down? Thats because studies show
what you knowkids are smart. When they have information about
potential harm, many of them tend to avoid it. The more you know
about alcohol and other drugs, the more likely you are to use caution
when approaching them.
Anyone has the potential for sufering from substance use
disorders. No one plans to be an addict or alcoholic, but some
people are at higher risk for addiction, and for others, repeated use
of chemical substances can create nerve links in the brain that cause
addiction. According to research by the National Institute on Alcohol
Abuse and Alcoholism, adolescents who begin drinking before age 15
are four times more likely to develop alcohol dependence than those
who begin drinking in adulthood.
Addiction also causes suffering in those around the addict: Living
with someone who is afficted with an SUD can be extremely painful
and requires special guidance for living. Whatever your situation,
the more facts you have, the more ammunition you have against
the kind of denial that fools people into thinking they dont have a
What Are Alcoholism and Addiction? 11
True or False?
People have a lot of misconceptions about substance abuse. The more
facts you have, the fewer false claims you will believe. Which are true
and which are false?
1. You have to use an illegal drug to be addicted. T / F
2. You have to drink in the morning to be an alcoholic. T / F
3. If youve just used alcohol or drugs for a short time,
you cant be addicted. T / F
4. Only addicts get in trouble for using. T / F
5. Some drugs are safer than others. T / F
6. Its normal for kids to party during their teens. T / F
7. Alcoholism and addiction cant be cured. T / F
8. My best friend would tell me if he was hooked. T / F
1. False. Nicotine, prescription medications, and alcohol are legal
for adults and can cause addiction.
2. False. Wake-up drinking can be a sign of alcoholism but is not
a requirement.
3. False. Addiction can take hold very quickly.
4. False. All teen use of all substances is illegal; and behavior
while high even for a short time can bring on trouble.
5. False. You cant count on a safe reaction from any drug, espe-
cially as a teen.
6. False. Teens have fun, of course, but kids who use drugs to
party are a tiny and shrinking minority.
7. True. There is no cure yet, though they can be treated and managed.
8. False. Probably not: Secrecy, denial, and dishonesty are char-
acteristics of the disease.
1Z Living with Alcoholism and Drug Addiction
Almost everyone in the country is afected by substance use
disorders, whether they realize it or not. According to govern-
ment statistics, abuse and addiction to alcohol, nicotine, and illegal
substances cost Americans upwards of half a trillion dollars a year, in
terms of combined medical, economic, criminal, and social impact.
Every year, abuse of illicit drugs and alcohol contributes to the death
of more than 100,000 Americans, while tobacco is linked to an esti-
mated 440,000 deaths per year.
People of all ages suffer the harmful consequences of drug abuse
and addiction.
Babies born to addicted mothers tend to be premature and
underweight and slow to develop.
Adolescent drug abusers act out, do poorly academically, and
risk violence and disease.
Adult addicts have problems thinking clearly, remembering,
and performing well socially and on the job.
Parents drug abuse makes for stress-flled homes and child
abuse and neglect, harming the next generation.
Its estimated that every alcoholic or addict directly affects the lives of
at least four other people. The simple arithmetic says that if one par-
ent is an addict, the other parent and the kids are emotionally dam-
aged. It gets more complex: If your Dads boss is an alcoholic, he can
make your Dads life miserableand that can affect you. If Grandma
was a secret drinker, she raised her children with some emotional
weaknesses, which get passed to you because your mother missed
out emotionally. This is one reason that addiction is called a family
diseaseand why understanding it matters to every family member.
Its not just that kids with a family history of alcohol dependence have
four times the risk of becoming alcoholics, but the roles that children
must play in those families change the way they live their own lives.
Knowledge can protect you from the side effects of such family
situations. But you dont have to literally live with them. In your
own home you may get the do as I say and not as I do order about
substance use. The same goes for outside the home, too, where our
society has very mixed feelings about the use of chemical substances.
This only complicates an understanding of the facts. We see shows
daily detailing family dysfunction and hear news every week about
yet another famous name going to rehab or falling off the wagon.
There are other ways that the media makes substance use matter
to everyone. Reporting the dangers of drug use while commercials cel-
ebrate the use of alcohol sends mixed messages at best, and its tough
What Are Alcoholism and Addiction? 13
for teens not to get sucked into the media hype thats trying to make you
the next big market for alcohol. Nicotine is more strictly regulated than
ever and cant legally even be advertised let alone sold to minorsyet
65 percent of teens report smoking. Since its been shown that the
younger people start drinking and smoking, the more likely they are to
become chronic drinkers and smokers, its to the producers advantage
to encourage young drinking and smoking. Corporate spokespeople
will deny any such unattractive motivations, but their promotions con-
tinue to glamorize alcohol and cigarettes for the young.
However, the media also helps to open up some truths about addic-
tion. By now, thanks to popular information in the news, on TV, and
on the Internet, most people know that addiction has many faces. The
addict can be a 12-year-old prep school student, a 35-year-old female
teacher, or a 60-year-old homeless veteran. There is no set profle.
This kind of knowledge can help you break through the denial that
blocks people from getting treatment.
Science, psychology, biology, society, family, the media: The
many and connected aspects of substance use disorders make them
especially hard to live with. Substance use disorders are not simple
diseases, so dealing with them, in oneself or in others, is not simple
either. Understanding how these substances work is the frst step
toward learning to manage them.
Alcoholism and addiction are two versions of the same disease
substance use disorders.
Kids as young as eight are drinking or using other drugs. One-
ffth of all eighth-graders have used drugs, and by the end of
high school over three million teens are alcoholics or addicts.
The misuse of alcohol and other addictive substances is espe-
cially dangerous for teens and preteens. Its not just about
short-term consequences like accidents and legal trouble, but
more importantly, the impact of chemical substances on the
developing brain can cause lifelong damage.
Alcoholism and addiction are chronic, progressive diseases,
characterized by mental obsession and physical compulsion.
They affect the body, mind, and spirit and are characterized by
a feature called denial, which slows or prevents treatment.
Alcoholism and addiction indirectly affect many people who
dont use alcohol or drugs themselves.
Addiction cannot yet be cured, but it can be treated and man-
aged. Prevention is the most effective known treatment.
Drugs are categorized according to the eects they
have: stimulants, depressants, narcotics, and hallucinogens. Stimu-
lants speed up the activities of the brain, producing feelings of well-
being and alertness. Depressants slow down activities of the brain,
producing a sedating effect. Narcotics alleviate pain and affect the
brains pleasure-control center, causing feelings of well-being. Hal-
lucinogens cause hallucinations, or distortions in the perception of
reality, and produce a sense of detachment from reality. Different as
their specifc effects are, all substances of abuse share one charac-
teristic in common, in addition to their addictive nature: Almost any
drug taken for one effect will end up having the opposite. Its like
backlashyou use cocaine [a stimulant] to get high and then you get
depressed, as one addict puts it. And as addictive substances, each of
those drugs requires increasing amounts to achieve the same result.
Is addiction new? No. Its thought that one of our ancestors may have
discovered the effects of fermented fruit or grain by accident, or inad-
vertently inhaled smoke from herb leaves tossed on a fre. As a result,
getting high or intoxicatedgetting out of oneself in an artifcial
wayhas been a goal or at least part of every culture. Drunkenness
has been seen as a problem in various societies for a long time, and
when it gets out of hand, it has been punished. Until fairly recently,
Substances of Abuse
Substances of Abuse 15
however, most psychoactive drugs were legal. Nineteenth-century
America has been called a dope fends paradise, and it was only
in the early 20th century that drugs began to be seen as sources of
abuse that needed to be regulated by laws. Even alcohol was out-
lawed in the United States in the early 20th century. But laws have
not stopped people from using alcohol or drugs.
When these substances were declared illegal, the whole process
went underground and got otherwise complicated, with, for example,
more people pointing fngers at the evils of drink and fewer poten-
tial professional hands available to help. In the second half of the
20th century, the drug scene got even more dramatic. In the 1960s,
due partly to the hippie culture and partly to addictions fostered
overseas during the Vietnam War, the use of drugs became more
socially acceptable or at least widespread. During the same period,
the pharmaceutical industry developed increasingly sophisticated
prescription drugs, which started to be abused. Those scared away
from criminally connected illegal drugs devised creative ways to use
prescription drugs and other substances to alter their consciousness.
Statistics show that teens use of such substances has grown as use
of other substances has declined, but pharmaceuticals are potentially
just as dangerous as other drugs.
Though potions for curing drunkenness were on the market hun-
dreds of years ago, the primary approach to dealing with alcoholism
and addiction has historically been to make it illegal or shameful or
both. Even with the advent of serious research in the 1930s, people
addicted to drugs were thought to have a moral failing rather than
a health problem, so approaches stressed punishment rather than
prevention or therapy. The idea that alcoholism might be a disease
spread in this country only around 1940, in part because of the popu-
larization of Alcoholics Anonymous, and later by the acceptance of
the disease concept by the American Medical Association. Today,
thanks to scientifc breakthroughs in brain studies, the approach to
addiction has changed dramatically, showing that it is a disease that
affects both the brain and behavior.
The path of nicotine illustrates the process by which substances
move from popular fad to social outcast. Cigarettes were once used
just by a small segment of society, but then they were marketed as
a sign of sophistication and reached a wider slice of the population.
As time passed, the facts about nicotine came to light, and people of
all ages found ways to stop lighting up. The same can be true of any
substance of abuse.
16 Living with Alcoholism and Drug Addiction
With new knowledge of how addiction works, you and your gen-
eration have the power to change the future, to take actions that will
stop the history of addiction and alcoholism from repeating itself.
Because the good news about substance use disorders is that they
can be successfully treated, and the more that is known about the
addictive properties of each substance, the more effectively they can
be treated.
The process of addiction is quite similar for most kinds of addictive
drugs, but each type has its own characteristics. Though substances
of abuse act on the dopamine pathway in the brain, alcohol and drugs
can each affect different neurological circuits. Abuse of alcohol, for
instance, may create changes in the brain that result in increased
feelings of stress that may trigger further compulsive drinking. Other
drugs affect the parts of the brain that control pleasure, motivation,
emotion, and memory, which can lead to addiction.
Here are some basic facts about how drugs work, according to the
effects they have: stimulants, depressants, narcotics, and hallucino-
gens. As the most commonly abused drugs, alcohol and marijuana
receive special attention.
Probably the oldest psychoactive substance around, with evidence of
use for at least 10,000 years, starting in the Stone Age, alcohol is also
available in the widest variety of forms. A chemical called ethanol is
the basis of alcoholic substances, which is made through simple pro-
cesses of fermenting or distilling sugar-based products. Strength and
favors depend on the process and the products used. Fermentation, or
the chemical breakdown of agricultural products like grains, fruits, and
vegetables, produces wine and beer. Distillationthe purifcation by
evaporation and condensationof those products makes hard liquor.
Beer, wine, liquor, coolers, and malt liquor are all forms of alcohol.
Even some nonalcoholic products actually contain small percentages
of alcohol, such as ice cream. Ethanol is also present in a wide variety
of products, including mouthwash, toothpaste, cough syrup, prescrip-
tion drugs, and many foods.
Taken orally, alcohol is characterized as a depressant, although
it may seem to have stimulant or upper qualities. Users feel high
because the inhibitions and judgment sections of the brain are
depressed. Alcohol also seems to stimulate blood fow, causing fush-
ing, because it relaxes the passages of the circulatory system. After
an initial high, users often experience depression. Other short-term
effects include dizziness, slurred speech, disturbed sleep, impaired
Substances of Abuse 17
motor skills, nausea, and sometimes violence. High doses can lead to
respiratory depression and death. Blackouts frequently occur during
drinking episodesa kind of amnesia during which drinkers may act
normal but not be conscious of their behavior. Hangoverssick feel-
ings following drinking episodesare common. Over the long term,
alcohol ingestion can lead to learning impairments and addiction
Marijuana, or cannabis, has been used as a psychoactive substance
since prehistoric times, whether smoked, eaten, or used as tea. It is
considered a quasi-psychedelic because it is not strictly a halluci-
nogen but provides hallucinatory effects to some users. Because of
those cases, it has often been made part of spiritual practices. The
main active chemical is delta-9-tetrahydrocannabinol, abbreviated
THC, which triggers brain cells to release the chemical dopamine.
Marijuana is the dried leaves and fower tops of the cannabis hemp
plant, grown throughout the world.
Pot is a common nickname for marijuana. In fact, there are hun-
dreds of slang terms for marijuana, including ganja, weed, grass, herb,
Mary Jane, gangster, and sinsemilla. Hashish is a stronger version of
marijuana, made from concentrated resins of the cannabis plant and
smoked as cigarettes or in pipes called bongs. While widely used, it
is an illegal controlled substance in most parts of the world.
Marijuana makes people feel high because of its effect on dopa-
mine levels, but the drug is characterized more as a hallucinogen
because it can create varieties of hallucinations. Marijuanas effects
on the user depend on its strength, related to the amount of THC it
contains. The THC content of marijuana has been increasing since the
1970s, so what was once considered a mild substance now has more
potentially ill effects. Short-term effects include euphoria, slowed
thinking and reaction time, confusion, and impaired balance and
coordination. Longer-term effects can include memory and learning
problems, distorted perception, and diffculty thinking. Cannabis can
cause physical dependence and withdrawal symptoms.
Stimulants are a group of drugs that excite the neurons in the brain,
speeding up activities of the brain and many organs controlled by the
brain. Some stimulants are very addictive, such as cocaine and nico-
tine; others, like caffeine, are less dangerous.
18 Living with Alcoholism and Drug Addiction
Amphetamines. Stimulants take many forms. Dexedrine and meth-
amphetamine, also known as crystal, crank, and speed, increase
alertness and physical activity and so are called uppers. Heart and
breathing rates and blood pressure go up, as does a sense of energy.
Pupils dilate and appetite decreases. They have nicknames such as
ups, hearts, black beauties, pep pills, copilots, and bumble bees. Taken
orally, injected, snorted, or smoked, stimulants are also often in
the form of pills, sometimes prescribed (see Prescription Drugs sec-
tion below). Uppers can cause sweating, dry mouth, blurred vision,
insomnia, loss of appetite, and dizziness. Users can feel restless, anx-
ious, and have a false sense of power. Uppers also cause increased
blood pressure and convulsions, and over a longer term they can
cause overaggressive behavior, depression, and paranoia. They are
highly addictive, and if injected, raise the risk of exposure to HIV,
hepatitis, and other infectious diseases.
Methamphetamine is the most commonly abused amphetamine,
in part because it is so easy to manufacture that its off-the-shelf
ingredients have now been restricted. Called, among other nick-
names, speed, meth, crank, crystal ice, fre, croak, crypto, white cross,
or glass, it is taken orally, injected, snorted, or smoked. Meth has
effects similar to any other amphetamine, but usually more intense.
The addiction can be more powerful too. Chronic use can cause vio-
lent behavior, anxiety, confusion, insomnia, auditory hallucinations,
mood disturbances, delusions, and paranoia. Delusions include for-
mication, the feeling that the skin is crawling with bugs. Damage
to the brain caused by meth usage is similar to Alzheimers disease,
stroke, and epilepsy.
Cocaine and crack. Cocaine and crack are stimulants that are
extremely addictive and produce intense euphoria. A powerfully
addictive stimulant, cocaine directly affects the brain, causing quick
highs and triggering intense cravings. Since the high these drugs
produce is short-lived, users typically use repeatedly. They are often
taken to level off the effects of downers, and to allow drinkers to
consume increased quantities for long periods. One of the oldest
known drugs, pure cocaine is extracted from the leaves of the coca
plant, the Erythroxylon bush, which grows primarily in Peru and
Bolivia. It is powdered and usually mixed with other substances.
Coca leaves have been ingested for thousands of years, and the pure
chemicalcocaine hydrochloridehas been an abused substance for
more than a century.
The hydrochloride salt, or powdered form of cocaine, can be taken
intranasally, or through the nose (snorted), or when dissolved
Substances of Abuse 19
in water can be injected. Cocaine is generally sold on the street
as a fne white crystalline powder, known as coke, C, snow, fake,
or blow, among more than 100 nicknames. On the street it may be
diluted with such substances as cornstarch, talcum powder, sugar, or
with such active drugs as the anesthetic procaine or stimulants like
Short-term effects include increased heart rate, blood pressure, and
metabolism; feelings of exhilaration, energy, increased mental alert-
ness, and increased temperature. Once used widely as medication,
it is still used as specialized anesthetic and high-altitude remedy in
mountainous countries. Its abuse or continued use produces insom-
nia, hyperactivity, anxiousness, agitation, and malnutrition. Over-
doses can be lethal, often from heart attacks.
Freebase refers to a compound that has not been neutralized by an
acid to make the hydrochloride salt. Crack is the street name given to
the freebase form of cocaine that has been processed into a smokable
substance. The term crack refers to the crackling sound heard when
the mixture is smoked. Because crack is smoked, the user experiences
an immediate high. This fact and the relatively low cost of the drug
made it popular, but addiction is extremely powerful and triggers
almost constant use, so long-term costs are high and withdrawal dif-
fcult. Smoking crack cocaine can produce a particularly aggressive
paranoid behavior in users. In addition, it carries the same risks as
any kind of smoking.
The duration of cocaines immediate upper effects is short, and
the faster the absorption, the more intense the high. Snorting it may
create a 30-minute high; smoking, a fve- or 10-minute one. Long-term
effects include rapid or irregular heartbeat, reduced appetite, weight
loss, heart failure, chest pain, respiratory failure, nausea, abdominal
pain, stroke, seizure, headache, and malnutrition. Physical effects
of cocaine use include constricted peripheral blood vessels, dilated
pupils, and increased temperature, heart rate, and blood pressure.
Because it can severely inhibit the brains production of dopamine,
long-term cocaine use can cause serious depression.
Nicotine. According to NIDA, nicotine is one of the most heavily
used addictive drugs in the United States. Cigarette smoking has been
the most popular method of taking nicotine since the beginning of the
20th century. In 1998, 60 million Americans were current cigarette
smokers (28 percent of all Americans aged 12 and older), and 4.1 mil-
lion were between the ages of 12 and 17 (18 percent of youth in this
age bracket). Prior to that, it was more often smoked in pipes, taken
orally as chewing tobacco, or snorted as snuff.
Z0 Living with Alcoholism and Drug Addiction
Nicotine is found in tobacco leaves, which are dried, processed,
and cut up to roll into cigarettes or bag for pipe and chewed tobacco,
or powdered for snuff. Whether tobacco is smoked, chewed, or
sniffed, it delivers nicotine to the brainabout one to two milligrams
of nicotine from each cigarette. Note that nicotine is used in farming
as a pesticide, and a drop of pure nicotine can kill a person. In addi-
tion to that dangerous substance, cigarettes contain as many as seven
types of glue, as well as other chemicals used in the growing of the
tobacco and the treating of the paper and flters. Tobacco smoke itself
contains more dangerous chemicals, including tar and carbon mon-
oxide, which cause lung and heart disease.
Nicotine is the most highly addictive substance in tobacco. Nico-
tine is so addictive because its molecules are shaped like those of the
The Hit Parade
Alcohol is the most abused drug in the United States, and marijuana
is the most abused illegal drug, according to the 2006 National
Survey on Drug Use and Health reported by the Substance Abuse
and Mental Health Services Administration (SAMHSA). Four million
people received some kind of treatment in 2006 for substance abuse
2.5 million received treatment for alcohol
1.2 million received treatment for marijuana
928,000 received treatment for cocaine
547,000 received treatment for pain relievers
535,000 received treatment for stimulants
466,000 received treatment for heroin
442,000 received treatment for hallucinogens
Of those who were classied by SAMHSA as needing treatment, about
15.6 million needed treatment for alcohol disorders only; 3.8 million
needed treatment for drug abuse only.
Substances of Abuse Z1
natural brain chemical acetylcholine, a neurotransmitter that carries
signals. Nicotine easily locks into the receptors of brain-cell neurons,
and then can cause rapid changes in the body and brain, raising the
heart and breathing rate, and causing more glucose, or blood sugar, to
be released into the blood and creating a sense of alertness. Nicotine
also attaches to neurons (brain cells) that release a neurotransmitter
called dopamine. Nicotine stimulates neurons to release unusually
large amounts of dopamine, which stimulates the brains pleasure
and reward circuit, creating a sense of well-being. These multiple
effects last about 40 minutes in most brains, so smokers soon crave
more, and repeated intake increases craving, as the brain structure
changes and can produce less of its own dopamine (just like the long-
term effects of heroin and cocaine).
Because early use of tobacco leads to long-term addiction and can
permanently affect a young persons brain, tobacco use is offcially
illegal for teens. Still, more than 3.5 million people between the ages
of 12 and 17 use tobaccothats about 15 percent of teens that age.
Of those, just over 3 million, or 13 percent, smoke cigarettes. In the
United States, 66.5 million people, or about 29 percent of the popula-
tion, use tobacco.
Depressants are a group of drugs that slow down activity in brain
and body. They are also known as CNS depressants, as they slow
the normal function of the central nervous system. They can impair
thinking and memory and repeated use can lead to addiction. Alco-
hol is the most common. As medicines, depressants are drugs that
relieve anxiety and produce sleep when safely used as prescribed in
medical and psychiatric treatments. They are dangerous only when
abused. In higher doses, some CNS depressants can become general
anesthetics. There are many CNS depressants, all of which affect the
neurotransmitter gamma-aminobutyric acid (GABA), which slows
brain activity and results in a sense of calm or drowsiness. Medica-
tions that are CNS depressants can be divided into two groups, based
on their pharmacology. Barbiturates, also known as tranquilizers
and sedatives, include mephobarbital (Mebaral) and pentobarbital
(Nembutal), and are used to treat anxiety, tension, and sleep disor-
ders. Benzodiazepines, such as diazepam (Valium), chlordiazepoxide
(Librium), and alprazolam (Xanax), treat anxiety, acute stress reac-
tions, and panic attacks. Some that have a more sedating effect, such
as estazolam (ProSom), may be prescribed for short-term treatment
of sleep disorders.
ZZ Living with Alcoholism and Drug Addiction
Despite these benefcial effects for people suffering from anxiety
or sleep disorders, barbiturates and benzodiazepines should be used
only as prescribed. CNS depressants are addictive and discontinu-
ing them can lead to withdrawal. Because they work by slowing the
brains activity, withdrawal can lead to seizures.
Narcotics are drugs that, when taken exactly as prescribed, can be
used to manage pain effectively. When these compounds attach to
certain receptors in the brain and spinal cord, they can effectively
change the way a person experiences pain. They are abused for this
very painkilling quality. Narcotics include opiates, which can be
compounds derived from natural substances like the opium poppy or
man-made substances that have similar effects. The body produces
its own internal painkilling substances, labeled opioids, and external
opiates attach to the receptors intended for those internal chemicals.
Opiate compounds include morphine, codeine, oxycodone (Oxy-
Continan oral, controlled-release form of the drug), propoxyphene
(Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), and
meperidine (Demerol).
Opiates affect regions of the brain that mediate pleasure, resulting
in the initial euphoria that opioids produce. They can also produce
drowsiness, cause constipation, and, depending upon the amount
taken, depress breathing. Taking a large single dose could cause
severe respiratory depression or death. Long-term use also can lead
to physical dependenceall narcotics are extremely physically and
psychologically addictive. Medical complications can include con-
gested lungs, liver disease, tetanus, infection of the heart valves,
skin abscesses, anemia, and pneumonia. Death can occur from
Heroin. Heroin is a highly addictive narcotic derived from morphine.
It can be injected, but recently many users are snorting or smoking it
because of concerns regarding injections risk and the misconception
that these forms of use will not lead to addiction.
The short-term effects of heroin abuse include a surge of euphoria
(rush) accompanied by a warm fushing of the skin. Then the user
goes on the nod, an alternately wakeful and drowsy state. Mental
functioning becomes clouded due to the depression of the central
nervous system. Even though its a depressant or downer, it can
make people feel high because of the experience of nodding out.
Long-term heroin abuse is associated with serious health conditions
Substances of Abuse Z3
including spontaneous abortion, collapsed veins, infectious diseases
including HIV/AIDS and hepatitis, and fatal overdose.
Hallucinogen is a word coined to describe a substance that creates the
imaginary visions or hallucinations. Hallucinogens disrupt the inter-
action of nerve cells and the neurotransmitter serotonin. Marijuana
can be considered a hallucinogen, and hallucinations are often expe-
rienced by alcoholics or addicts in withdrawal. The major hallucino-
genic drugs are psychedelics. Psychedelic comes from a combination
of Greek words meaning to show the mind, because of the sense
that these drugs reveal psychic truths. Psychedelics may be natural
substances like certain mushrooms, as well as chemically produced
substances including LSD, PCP, and various club drugs.
LSD (lysergic acid diethylamide) is one of the major hallucinogens.
LSD was discovered in 1938 and is manufactured from lysergic acid,
which is found in ergot, a fungus that grows on rye and other grains.
LSD is called purple fats, Lucy in the sky with diamonds, peace
tablets, and yellow dimples, among many other nicknames. A very
small amount of LSD can cause huge distortions in the perception of
Under the infuence of hallucinogens, people see images, hear
sounds, and feel sensations that seem real but do not exist. Some hal-
lucinogens also produce rapid, intense emotional swings. Users refer
to their experience with LSD as a trip and to acute adverse reactions
as a bad trip. These experiences are longtypically they begin to
clear after about 12 hours. Effects also include nausea; increased body
temperature, heart rate, and blood pressure; sleeplessness; numbness;
weakness; tremors; and loss of appetite. Over the long term, LSD can
lead to chronic mental disorders such as persisting perception dis-
order (fashbacks). LSD is not considered an addictive drug since it
does not produce compulsive drug-seeking behavior, but it produces
tolerance, so some users who take the drug repeatedly must take pro-
gressively higher doses. This is extremely dangerous since the drug is
unpredictable. While there are technically no withdrawal symptoms,
fashbacks are a long-term problem.
PCP, or phencyclidine, another hallucinogen, is illegally manufac-
tured in labs and sold as tablets, capsules, or colored powder. Devel-
oped in the 1950s as an anesthetic, PCP was never approved for human
use because of problems revealed in testing, including intensely
negative psychological effects. But it can be easily produced and is
used for those same characteristics, causing highs, hallucinations, and
Z4 Living with Alcoholism and Drug Addiction
intense physiological experiences. PCPalso called angel dust, ozone,
wack, rocket fuel, and many others namesis snorted, smoked, or
taken orally.
Club drugs, typically used by teenagers and young adults at bars, clubs,
concerts, and parties, are a form of designer drugs, so called because
they are man-made. Club drugs include ecstasy (MDMA or methylene-
dioxymethamphetamine), Rohypnol (funitrazepam), GHB, ketamine,
and methamphetamine (see Amphetamines section above).
Ecstasy. Ecstasy, one nickname for MDMA, a synthetic, psychoactive
drug chemically similar to the stimulant methamphetamine and the
hallucinogen mescaline, acts as both a stimulant and a psychedelic.
Among the other nicknames for MDMA are street, as well as hug and
love drug, due to its effect of providing what NIDA calls enhanced
enjoyment from tactile experiences. MDMA acts primarily on neu-
rons that use the chemical serotonin, which is key in regulating
mood, aggression, sexual activity, sleep, and pain sensitivity.
MDMA can be addictive: A survey of young adult and adolescent
MDMA users found that 43 percent of those who reported ecstasy use
met the criteria for dependence, and 60 percent experienced with-
drawal. Its harmful effects include memory loss and a lessened ability
to regulate body temperature, which can damage organs and in some
cases be fatal. Harm can occur quickly because MDMA is diffcult
for the body to break down, so dangerous levels can build up in a
short time. Other side effects include increases in heart rate and blood
pressure, teeth clenching, nausea, and blurred vision. Psychological
reactions such as confusion, depression, sleep problems, drug crav-
ing, and severe anxiety can occur both while and sometimes days or
weeks after taking MDMA.
Rohypnol. Rohypnol is a central nervous system depressant,
designed as a prescription painkiller but banned for use in the United
States because of its potential hazards. A trade name for funitraz-
epam, Rohypnol, nicknamed roofes, belongs to a class of drugs
known as benzodiazepines. When mixed with alcohol, Rohypnol can
incapacitate victims and prevent them from resisting sexual assault.
It can produce anterograde amnesia, which means individuals may
not remember events they experienced while under the effects of the
drug. Also, Rohypnol may be lethal when mixed with alcohol or other
Substances of Abuse Z5
GHB. GHB (gamma hydroxybutyrate) has been used in the United
States for its euphoric, sedative, and anabolic (bodybuilding) effects.
It is a central nervous system depressant that was widely available
over the counter in health-food stores during the 1980s and until
1992. It was purchased largely by bodybuilders to aid in fat reduction
and muscle building. Street names include liquid ecstasy, soap, easy
lay, vita-G, and Georgia home boy.
Coma and seizures can occur following use of GHB. Combining
use with other drugs such as alcohol can result in nausea and breath-
ing diffculties. GHB may also produce withdrawal effects, including
insomnia, anxiety, tremors, and sweating.
Because they are often colorless, tasteless, and odorless, both
Rohypnol and GHB can be secretly added to beverages, so these drugs
emerged as date rape drugs. In 1996 Congress passed the Drug-
Induced Rape Prevention and Punishment Act, which increased federal
penalties for use of any controlled substance to aid in sexual assault.
Ketamine. Ketamine is an anesthetic that has been approved for
both human and animal use in medical settings since 1970; about 90
percent of the ketamine legally sold is intended for veterinary use.
However, it is rarely used as an anesthetic because of its dangerous
side effects. As a club drug, ketamine is also known as special K or
vitamin K. Injected or snorted, ketamine can cause dreamlike states
and hallucinations. In high doses, ketamine can cause delirium,
amnesia, impaired motor function, high blood pressure, depression,
and potentially fatal respiratory problems.
Most club drugs are stimulants, hallucinogens, dissociative drugs
(which cause a person to temporarily separate from reality), or amne-
siacs (which make a person forget what happened while on the sub-
stance). Partyers may experience a cheap and easy high, but chronic
use of club drugs has long-term effects. For instance, MDMA may lead
to changes in brain function. GHB abuse can cause coma and sei-
zures. High doses of ketamine can cause delirium, amnesia, and other
problems. Mixed with alcohol, Rohypnol can incapacitate users and
cause amnesia. One potential hazard of all club or designer drugs
is that, because they are often made in haphazard laboratories, the
quality of the chemicals is often poor, and the resulting drug impuri-
ties can pose serious dangers.
Use of prescription drugs is on the increase among young people.
They are viewed as safe and legal, but they arent unless they are
Z6 Living with Alcoholism and Drug Addiction
prescribed by a medical professional and used only as prescribed.
Pills can be uppers or downers and can be dangerous if misused.
They are diffcult and often dangerous to detox from. They can be
stimulants, depressants, or narcotics.
Stimulants. Historically, stimulants were used to treat asthma and
other respiratory problems, obesity, neurological disorders, and a
variety of other ailments. As their potential for abuse and addiction
became apparent, the use of stimulants was restricted, and they are
now prescribed for only a few health conditions, including ADHD
and some respiratory problems. When taken as prescribed, they dont
appear to be addictive. Substance abusers misuse prescribed stimu-
lants such as dextroamphetamine (Dexedrine) and methylphenidate
(Ritalin) for the sense of euphoria that comes from overstimulating
the production of norepinephrine and dopamine. The consequences of
stimulant abuse can be extremely dangerous. Taking high doses of a
stimulant can result in an irregular heartbeat, dangerously high body
temperatures, and the potential for cardiovascular failure or seizures.
Sedatives. Sedatives like Valium or Xanax are also abused. They are
prescribed for anxiety, stress, and insomnia and when overused can
produce over-sedation.
Narcotics. Prescription pain relievers, a form of narcotic, have also
become widely misused. For example, OxyContin (a controlled-release
form of oxycodone), Vicodin (hydrocodone), and Percocet are highly
useful drugs when used as prescribed but can cause severe health
problems and serious addiction if abused. OxyContin alone has been
used without prescription by about 10 percent of high school seniors.
Its important to remember that just because a doctor prescribes
these medicationsor theyre advertised on TVdoes not make them
safe, and they are often dangerous when not used as indicated. For
more information, go to
Nonprescription drugs can be used for coughs, colds, sleep, and weight
loss. They are frequently abused, and many now have restricted sales.
Other products like glues and aerosol-spray products can be misused
by inhaling them, and they are just as dangerous as many of the
harder drugs. Finally, there is nicotine: Cigarette smoking is one of
the most dangerously addictive drug habits. Since this drug is easily
accessible, if illegally, to young people, it is a major health threat.
Substances of Abuse Z7
Nicotine addiction is also an example of how young people have
been able to resist the use of a dangerous drug, as smoking rates are
sharply down among teens since anti-nicotine campaigns began.
Many addicts are like chemists, who know exactly what they need
for what result. Others just take anything for thrills. Some very
deliberately combine substances to maximize results: They use an
upper so they can drink more, or use pot or alcohol to come down
from uppers without crashing. When people mix two or more drugs,
they compound the danger each drug poses. For instance, mixing
cocaine and alcohol forms a complex chemical compound in the
liver, cocaethylene, which intensifes cocaines euphoric effects,
while possibly increasing the risk of sudden death. Narcotics, too,
may interact dangerously with other medications. They should not
be used with substances such as alcohol, antihistamines, barbitu-
rates, or benzodiazepines. Since these substances slow breathing,
their combined effects could lead to coma or death from respiratory
Finally, its not just substances that are addictivegambling,
spending, and sex can also be practiced compulsively and have been
found to have brain effects similar to the substances that directly
affect neurons. For some people, these are primary addictions. For
others, they become substitutes for substance addictions. Many fnd
that when they put down a drug, for example, they eat compulsively.
If you want to know more about these types of addictions, check the
lists at the back of the book.
Addiction does start off as just a beer or only pot. Many people
can drink just a beer every now and then, and its not the start of
addiction. For others, though, a drink or a drugalcohol or substances
in other forms like pillstriggers a craving for more. As time goes on,
it takes a greater amount of the substance to achieve the same level of
pleasurable response, so the amount used increases. Ashley starts with
one cigarette, and if she becomes addicted to the nicotine, sooner or
later she is smoking a pack a day. Robert sniffs a little heroin, and if
he is an addict, he will most likely end up injecting it.
This is called progressiona moving onward from the frst use to
the full-blown addictive compulsion. Veteran members of Alcoholics
Anonymous put it dramatically: The frst drink will take me to the
Z8 Living with Alcoholism and Drug Addiction
jailhouse, the nuthouse, or the morgue. Today scientists understand
why initial use causes many bodies to demand more, no matter how
bad the consequences. The frst time someone uses a drug of abuse,
he or she experiences unnaturally intense feelings of pleasure. The
limbic system is fooded with dopamine. Of course, drugs have other
effects too; a frst-time smoker may also cough and feel nauseated
from the toxic chemicals in a tobacco or marijuana cigarette. But the
brain starts changing right away as a result of the unnatural food of
No one knows how many times a person can use a drug without
changing his or her brain and becoming addicted. A persons genetic
makeup probably plays a role. But after enough doses, an addicted
teens limbic system craves the drug as it craves food, water, or
friends. Without a dose of the drug, dopamine levels in the drug
abusers brain are low. The abuser feels fat, lifeless, depressed. Now
the abuser needs larger amounts of drugs just to bring dopamine lev-
els up to normal levelsan effect known as tolerance.
Drugs also change the way the addicted brain works. Drug abuse
and addiction lead to long-term changes in the brain. These changes
cause addicted drug users to lose the ability to control their drug use.
Teens who frst use drugsand the initial uses are by choice
never believe it can happen to me. But when they frst pick up, they
become a statistic. NIDA researchers have found, for instance, that
frst use of marijuana occurs on average at age 18, and roughly 9 per-
cent of users will become dependent on the drug, most likely before
age 25. For cocaine, frst use is most likely at age 20, and progres-
sion to dependence is more rapidthe peak incidence of dependence
occurs between ages 23 and 25. Roughly 21 percent of persons who
use cocaine at least once will become dependent, most likely by age
45. Further, researchers fnd that among cocaine users, more than 5
percent develop dependence during their frst year of using the drug.
Marijuana dependence develops less dramatically, but the likelihood
is greatest in the frst years of use.
The progression of use is evident. One young alcoholic tells his
story as follows:
I had my frst drink at age eleven. I had seen drinking as a kid. I
noticed before people started drinking they were quiet. But after a
few drinks, they seemed to be happy. I wanted what they had. So
a friend and I raided his mothers liquor cabinet one night. I had a
little bit of everything. And then it happened! For the frst time in
my life, I felt okay. The fear was gone. I knew then that I was going
to drink whenever I could. I always fgured since I was a kid it didnt
Substances of Abuse Z9
really matter. But when I hit 16 I began to get in trouble about driv-
ing. So I switched. I smoked pot because I fgured it wouldnt show
on a Breathalyzer. Then after a while that just wasnt enough. My
life just felt emptyand I was really bummed when I got rejected
by college. I started drinking again and tried to stay out of my car.
First it was a beer with a joint, then a sixpack. Then Id get a whole
case for a weekend and it would be gone by Saturday.
What Does Addiction Look Like?
How can you tell if someone is suffering fromor headed towardan
addictive disease? Here are some of the signs to watch for:
frequent illnesses, accidents, ghts, school absences
declining school performance
the ability (and desire) to use more than anyone else
near-constant use or talk of use
always using to the point of intoxication
getting drunk or high when its not appropriate
tendency to isolate and withdraw from usual friends and
irritation at comments about drinking or drug use
increasing secrecy about habits
apparent memory lapses
increasingly extreme mood swings
changes in health: coughing, eye or nose problems, sleep or
weight changes
If you notice changes like these in your friend, you may or may not be
able to talk with or help him or her, but you do need to be aware of their
problem and protect yourself from the effects of his or her condition.
30 Living with Alcoholism and Drug Addiction
Some may scoff at the idea of a fatal glass of beerthat a deathly
addiction can arise from a single use of a substance many people
enjoy. But brain science now shows that it is true in some cases.
Not all drinkers and userseven habitually frequent onesare
alcoholics or addicts. Science separates abuse, which is unhealthy
use that nevertheless can be stopped, from dependence, which
is the stage at which it takes more and more of the substance to
achieve the original result, and stopping triggers a withdrawal (with
the withdrawal becoming increasingly diffcult each time it is tried).
NIDA research describes what recovering addicts and alcoholics have
described for many years: As their illness deepens, addicted people
need more alcohol or other drugs. They may use more often, and use
in situations they never imagined they would when they frst began to
drink or take drugs. They may or may not end up living on the streets,
but they put themselves into a wide variety of dangerous situations,
and they truly suffer.
But theres good newsthe more we know about these diseases,
the more we understand how to turn them around.
When a parent promises again and again to stop drinking and be
there for a sons game and never follows through, its natural to be
angry and hurtnot to think about addiction as a disease. Do you
know any kids who seem to keep partying after everyone else has
gone home? When you see them cutting class, laughing and smoking
pot when youre stuck in school, you probably dont think, they have
a disease. But those who feel compelled to use alcohol or drugs in
increasing amountsthose whose use of substances is disordered
do have a disease. As researchers note, the craving that an alcoholic
feels for alcohol can be as strong as the need for food or water. An
alcoholic will continue to drink despite serious family, health, or legal
The good news is that increasing amounts of serious research
efforts are being directed at alcoholism and drug addiction, which
once were simply disdained. More good news is that as a disease,
addiction is highly treatable. At this point substance use disorders
are not curable, but the more that science learns, the closer we are to
more effective treatments.
We can look at the conditions from two angles: Addiction is a pro-
gressive, incurable, potentially fatal disorder or Addiction is a chronic,
but treatable, brain disorder. Drug addiction therapy is a program of
behavior change or modifcation that slowly retrains the brain. Like
Substances of Abuse 31
people with diabetes or heart disease, people in treatment for drug
addiction learn behavioral changes and often take medications as
part of their treatment regimen. Treatment may vary for each person
depending on the type of drug(s) being used and the individuals
specifc circumstances. In many cases, more than one effort may be
needed. But the more facts are revealed, the more accurate the treat-
ment can be.
The progression of addictionand the chaos it can cause for those
close to the substance abusercan be stopped. As you can tell from
the facts presented so far, the disease of addiction is tough and com-
plicated to deal with. Perhaps youve observed on your own how
destructive addictions can be. But millions do recover from them. The
frst step toward treating any disease is to understand its causesso
thats where we begin in the next chapter.
Alcohol and other drugs have been a part of human life for
thousands of years.
Stimulants (uppers) and depressants (downers) come in
a wide variety of forms and have useful value in medical and
psychiatric treatment.
Alcohol and other drugs become substances of abuse when
they are used for purposes and in quantities other than those
for which they were designed.
Addicts crave the use of more and more psychoactive sub-
stances, requiring increasing amounts to attain a similar result,
and experiencing withdrawal when substances are absent.
Addiction takes control of an addicts brain and body, but its
hold can be broken through various forms of treatment.
disorders because science is learning a whole lot about them and
their causes. And its a great time for anyone considering treatment
for alcoholism or addiction, because science is leading the way
to new treatment approaches. The government, which for many
decades focused mainly on fnding ways to limit or punish addiction,
is now supporting research into and sharing scientifc information
about how addiction happens.
Much of the recent research focuses on how the brain becomes
addicted. Our brains are far more complex and sophisticated than any
computer ever devised. Made up of several specialized sections, the
brain runs the whole showeverything that goes on in our bodies,
including everything we think and feel. The brain sends messages to
the body through a system of nerves and fuids. A message gets
sent along a nerve, then jumps to the next nerve ending through an
intersection flled with chemicals called neurotransmitters. One of
the most important neurotransmitters is dopamine, which is found
in regions of the brain that regulate movement, emotion, motivation,
and pleasure.
Various parts or lobes of the brain process information from your
sense organs: the occipital lobe receives information from your eyes,
for example. And the cerebral cortex, on top of the whole brain, is the
thinking part of you. Thats where you store and process language,
math, and strategies: Its the thinking center. Buried deep within the
Causes of Alcoholism
and Drug Addiction
Causes of Alcoholism and Drug Addiction 33
cerebral cortex is the limbic system, which is responsible for survival
it remembers and creates an appetite for the things that keep you alive,
such as good food and the company of other human beings.
Neurons in your brain release many different neurotransmitters
as you go about your day thinking, feeling, reacting, breathing, and
digesting. When you learn new information or a new skill, your
brain builds more axons and dendrites frst, as a tree grows roots and
branches. With more branches, neurons can communicate and send
their messages more effciently.
Some drugs work in the brain because they have a similar molecular
size and shape as natural neurotransmitters. In the right amount or
dose, these drugs lock into brain receptors and start an unnatural
chain reaction of electrical charges, causing neurons to release large
amounts of their own neurotransmitter. Some drugs lock onto the
neuron and act like a pump, so the neuron releases more neurotrans-
mitter. Other drugs block reabsorption or reuptake and cause unnatu-
ral foods of neurotransmitter.
All drugs of abuse, such as nicotine, cocaine, and marijuana,
primarily affect the brains limbic system. Scientists call this the
reward system. Normally, the limbic system responds to pleasur-
able experiences by releasing the neurotransmitter dopamine, which
creates feelings of pleasure. Think about how you feel when some-
thing good happensmaybe your team wins a game, youre praised
for something youve done well, or you drink a cold lemonade on a
hot dayand thats your limbic system at work. Because natural plea-
sures in our lives are necessary for survival, the limbic system creates
an appetite that drives you to seek those things.
The frst time someone uses a drug of abuse, he or she experi-
ences unnaturally intense feelings of pleasure. The limbic system is
fooded with dopamine. Of course, drugs have other effects too; a
frst-time smoker may also cough and feel sick from toxic chemicals
in a tobacco or marijuana cigarette. But the brain starts changing right
away as a result of the unnatural food of neurotransmitters. Because
they sense the presence of more than enough dopamine, for example,
neurons begin to reduce the number of dopamine receptors. Neurons
may also make less dopamine. The result is less dopamine in the
brain: This is called down regulation. Because some drugs are toxic,
some neurons may also die.
34 Living with Alcoholism and Drug Addiction
The limbic system, sometimes called the pleasure pathway,
is the route along which drugs of abuse travelat frst triggering
the brain to send out a big feel good message. The brain then
senses that it has enough of its own feel good neurotransmitter
and causes less dopamine to be produced. As a result, the outside
chemical becomes needed to complete the necessary nerve connec-
tions, and an addiction is born. The brain comes to count on the
substance the user puts into it, and the user keeps looking for that
big feel-good rush. An added factor is that brains are equipped with
a certain number of D2 dopamine receptors. Some people seem
to have fewer than others, which means they have to add extra
substance to get the same result as other userswhich may have
something to do with why some users become addicts and others
do not.
Researchers descriptions of the process echo the way addicts and
alcoholics themselves recount the experiences of their addictions: The
initial rush, the craving for more, and an inability to recapture the
initial euphoric experience all are connected to the activity of dopa-
mine receptors in the brain. These areas of the brain also infuence
the ability to make decisions and judgments, which may be part of
the reason that a substance user cant decide to resist the urge to use
once drugs are in the system.
The idea that addiction and alcoholism are character faws or
weak-willed choices is disproved by the scientifc research. Whats
less clear is what causes the frst use of a drug.
Science has a lot of news about how addiction happens, reinforc-
ing the idea that substance use disorders are not the result of bad
character or weak wills. But we still face the question of why some
people become addicted and others do not. Researchers for the lead-
ing government studies say that some people may be naturally better
protected against addiction than others. But they note that almost
anyone can become addicted with enough practice. As well see,
some users, probably no more than half, are genetically prone to
addiction. Then there are factors in individuals backgrounds. Scien-
tists have done studies on rats in labs to connect stress and trauma
with addictive behavior, and research has begun on large numbers of
humans to look for connections. Researchers are seeing that growing
up in a safe and caring setting, without much stress, can protect a
person from addictiondirectly perhaps, but also because we learn
in our families how to handle stress, and if our parents couldnt do it
Causes of Alcoholism and Drug Addiction 35
Quiz: The Brain and Addiction
The National Institute on Drug Abuse, part of the governments National
Institutes of Health, is one of the best sources for information on all
aspects of addiction. See their site at They
make material like this to help nonexperts understand the complicated
topics of substance abuse.
1. When you do something you enjoy, like watch a good movie,
your _______ system rewards you.
a) limbic
b) digestive
c) nervous
2. When someone uses drugs repeatedly, his or her brain is
a) trained to crave the drug
b) smaller than before
c) not changed
3. After a prolonged period of drug abuse, the brain _______.
a) needs less drug to get the same effect
b) needs more drug to get the same effect
c) experiences increasing amounts of dopamine
4. Drugs work in the brain because they have similar _______.
a) electrical charges as brain cells
b) sizes and shapes as natural brain chemicals
c) nerve cells as the brain
5. Drugs of abuse create intense feelings because they _______.
a) depress the nervous system
b) shut off receptors in the occipital lobe
c) cause a ood of dopamine in the limbic system
36 Living with Alcoholism and Drug Addiction
well, then were more likely to turn to chemical supports when under
Brain studies alone dont explain why we choose one particular sub-
stance of addiction over another. Why do some of us become addicted
to cocaine, while others are hooked on alcohol or addicted to gambling?
Our choices may depend on family background or whats available.
And it would make sense that people whose personalities tend to be
depressed would not want depressants, for instance, but researchers
dont know for sure, especially because many addicts are addicted to
more than one thing. A dopamine imbalance can have various causes
(including those related to mental or emotional illnesses) and addiction
to multiple substances can be a response to those imbalances.
Answer Key: The Brain and Addiction Quiz
1. a) The reward system of the brain is called the limbic sys-
tem. It rewards you by releasing a brain chemical called dopa-
mine, which produces feelings of pleasure.
2. a) The brain is wired to remember feelings of pleasure, includ-
ing those produced by drugs unnaturally. The brain then strives
to repeat those feelings, which the drug user feels/experiences
as a craving for the drug.
3. b) At rst, drug use may cause oods of dopamine. But
prolonged drug abuse causes the brains dopamine levels to
decrease. That means the brain will need more of the drug just
to get the dopamine levels back to normal and even more to
produce the high that it craves.
4. b) Drugs fool the brain because they are similar in size and
shape as the natural brain chemicals called neurotransmitters.
5. c) Drugs of abuse cause dopamine, the neurotransmitter that
produces feelings of pleasure, to be released by the brains
limbic system.
Causes of Alcoholism and Drug Addiction 37
If Lisas parents and grandparents were alcoholics, and she is too,
it would seem that alcoholism is an inherited genetic trait, right?
Maybe. This is one of the big questions scientists are working on.
Heredity might be a factor in the development of the D2 brain recep-
tors that seem to act as protection against addiction. But when they
study families, scientists fnd that only half of the people with addic-
tion in their family background seem to develop substance abuse
issues on their own, so DNA studies may offer other clues. In a recent
What Do You Think?
Janice started smoking cigarettes when she was 13 and drinking when
she was 14. By 16, she was a daily drinker and a regular heroin user.
Three of her grandparents had been alcoholics. Her father was a drug
addict who died young, leaving Janices mom to raise three kids and hold
two jobs. They couldnt afford to live in a very good neighborhoodtheir
apartment was above a barand drug deals happened on their corner.
Janices mother tried to control her, to keep her grounded and punish
her, but it didnt work.
What do you think? Is Janice an addict because of
(1) her heredity?
(2) her psychological losses?
(3) her confusing home life?
(4) her use of drugs?
(5) her bad neighborhood?
(6) her bad nature?
(7) all of the above?
(8) none of the above?
The best answers are 1, 2, 3, 4, and 5. No single explanation
accounts for most addictions.
38 Living with Alcoholism and Drug Addiction
large-scale genetic study, National Institute on Drug Abuse research-
ers used new genomic technology to identify genes in people most
at risk for developing alcoholism and other substance abuse. DNA
research is one of the great medical frontiers of the 21st century, and
it may be that developments in that area will bring hope for effective
So much research is being done about causes of alcoholism that
the results come with great frequency. All individuals with a fam-
ily history of alcoholism are at risk for developing alcohol abuse
disorders, but males who also have behavioral disinhibition are at
the greatest risk, according to research at the Behavioral Sciences
Laboratories. Parental alcoholism is a risk factor for children to
become alcoholics themselves, but that risk increases signifcantly
if the children, especially boys, have novelty-seeking personalities,
with risk-taking, thrill-seeking, and impulsive characteristics. Indi-
viduals with a family history of alcoholism tend to have a biological
dysfunction in their response to stress before they develop drink-
ing problems that others exhibit only after alcohol problems arise.
Scientists have also uncovered genetic evidence linked to alcohol-
dependent persons that could lead to the development of medication
to treat alcoholism.
How alcohol makes a person feel can play a part in whether or not
that drinker develops alcohol problems, and now researchers believe
they have found the gene that is directly linked to a drinkers level of
response to alcohol.
According to NIDA, family factors do infuence alcoholism. Chil-
dren of alcoholics are about four times more likely than the general
population to develop alcohol problems. Children of alcoholics also
have a higher risk for many other behavioral and emotional problems.
Your risk for addiction increases if you are from a family with the
following diffculties: an alcoholic parent is depressed or has other
psychological problems; both parents abuse alcohol and other drugs;
the parents alcohol abuse is severe; and conficts lead to aggression
and violence in the family.
The good news is that many children of alcoholics from even the
most troubled families do not develop drinking problems. Just as a
family history of alcoholism does not guarantee that you will become
an alcoholic, neither does growing up in a very troubled household
with alcoholic parents.
If you are worried that your familys history of alcohol problems
or your troubled family life puts you at risk, you can take steps to
protect yourself.
Causes of Alcoholism and Drug Addiction 39
Dont drink when youre young. Not only is it illegal, but
research also shows that the younger you start, the greater
your risk for addiction.
Drink cautiously as an adult. Even those adults without
a family history of alcoholism do well to be moderate. U.S.
guidelines suggest no more than one drink a day for most
women, and no more than two a day for most men, but you
would do well to not drink daily. If you feel that you need a
drink, that should be a signal to back off alcohol or drugs.
Discuss your concerns with a doctor, nurse, nurse practi-
tioner, or other health care provider. They can recommend
groups or organizations that could help you avoid alcohol
problems or can assess your drinking habits and offer advice.
If you are reluctant to talk about your drinking, that can be a
warning sign (see the next chapter for clues).
The American Psychiatric Association (APA) classifes substance
abuse as a mental illness. The APA also recognizes the mental prob-
lems that result from substance abuse, and mental illness itself is a
recognized cause of substance abuse. For instance, its found that chil-
dren diagnosed with attention-defcit/hyperactivity disorder (ADHD)
are at risk for developing alcohol and other substance abuserelated
disorders, especially if they have an alcoholic parent or otherwise
stressful families. Children diagnosed with anxiety or depression are
also more likely to become substance abusers. As researchers learn
more about post-traumatic stress disorder (PTSD), they are fnding
that it is often linked to substance abuse. PTSD can stem from violent
experiences in the past or from something as simple as the early or
sudden loss of a loved one. Patients with a variety of personal histo-
ries describe the relief from painful memories and stress that alcohol
or drugs offer. In people of all ages, self-medicating for emotional
or mental problems can lead to addiction.
Some frequently occurring mental illnesses have especially close
connections with substance abuse. Those experiencing anxiety or
depression fnd that alcohol or other drugs can improve their mood,
at least at frst. Young people with a history of major depression have
been shown to be more prone to alcohol abuse, and people with
schizophrenia sometimes fnd that alcohol brings some relief from
the mental voices or auditory hallucinations that they often expe-
rience. These various connections between substances and mental
40 Living with Alcoholism and Drug Addiction
problems can make treatment complicated. When addiction and a
separate mental illness are present, a patient is diagnosed with co-
occurring or co-morbid conditions. Shorthand for these diagnoses
is CAMI, for chemically addicted and also mentally ill, or MICA,
where the mental illness may be more dominant than the chemical
addiction. In any of these cases, both the mental illness and the sub-
stance use disorder need to be diagnosed and treated. The fact that
both types of disorders are conditions that people often conceal or
deny makes effective care diffcult. Some people with both disorders
seem to feel comfortable with being called addicts and are afraid
of being labeled crazy. Others would rather be considered mentally
ill, because the idea of having to give up using their drugs of choice
is too overwhelming.
As one MICA patient describes his life, Ever since I was a little
kid, people punished me for acting crazy. No matter what I did, I
couldnt control my behavior. When I found beer and pot, I learned I
could deal with it. Those substances helped me to be both calm and
cheerful. I got along better until the beer and pot got me in trouble!
It wasnt till a judge sent me for a psych exam that I learned I had
some mental problems. I was given medications for those problems
and was sent to rehab for my substance use. Now, as long as I keep
taking my meds, I can stay pretty much okay.
Mental and emotional illnesses like depression and anxiety can
also be the result of substance abuse, as the drug-dangers information
in chapter 5 will detail.
Alcoholics and other addicts have been said to be on a spiritual search
to fll a hole in their soul. As a cause for addiction, this can be hard
to understand for those who have not experienced it. Its also hard to
discuss because the very idea of what is spiritual is hard to grasp.
The simplest dictionary defnition of it as incorporeal, meaning not
related to the body, separates it from those physical cravings addicts
experience. Spirit comes from old Latin words meaning breath,
and theres a connection between that sense we have of feeling
spirit and feeling alive. Various cultures have used substances in
religious ceremonies as a way to achieve out-of-body experiences,
and the fact that alcohol is also called spirits may demonstrate a
connection between alcohol and spirit.
A British report on medical research actually refers to a Hole in
the Nations Soul, and enough alcoholics and addicts have described
a need to fll an inner hunger or emptiness that increasing numbers
Causes of Alcoholism and Drug Addiction 41
of professionals in the addiction and health felds are making seri-
ous efforts to understand and explain the spiritual connection to
addiction. They are working on everything from clearly defning
spirituality to the power of prayer. This is not an easy topic for sci-
entifc research, but surveys have shown that a spiritual component
does improve the success rates in the treatment of addiction, giving a
sense of meaning and purpose in life. In other words, it may be that
the absence of a sense of meaning and purpose could contribute to
substance abuse.
Teens concerned about developing substance use disorders may be
especially interested in a study reported in the Journal of the Ameri-
can Academy of Child and Adolescent Psychiatry that showed that
adolescents with strong religious or spiritual beliefs are half as likely
to become alcoholics or drug addicts or even try illegal drugs than
those who have no religious beliefs or training.
Peer pressure is often identifed as the source of all sorts of teen
behavior. As adolescents are separating from their families and
exploring new ways of living life on their own, they rely heavily on
connections with people their own age. Hanging with a bad crowd
is blamed as the cause of many teens problems with substances and
other unhealthy habits. Or they may fnd themselves in places like
concerts and sports events where everybody seems to be drink-
ing or smoking. As weve noted, the judgment center of the brain is
one of the later parts to develop, so teens are more likely to make
bad decisions in such circumstances. In the 21st century, social
infuences are not just down on the corner or at the malltheyre
in the media and on the Internet, and messages there can have a
big impact.
The Center for Media Literacy ( focuses
on the impact of the mediatelevision, radio, magazines, advertis-
ingon the lives of young people. Some of its research shows the
special power that mass communication has on teens. It also shows
ways that advertisers plan to target teens. Its been shown that when
companies can sell teens on their products, theyre likely to have
those people as customers for life. One of the many studies the cen-
ter supports shows how misleading messages about alcohol can be,
making it look as though drinking is only fun and sociable. Until
recently, television voluntarily avoided ads for hard liquor. Then hard-
liquor advertisers joined the beer-brewers on televisioncombining
scenes of great fun and excitement with the advice, Please drink
4Z Living with Alcoholism and Drug Addiction
responsibly. Which is more appealingexcitement or responsibility?
Studies have shown that alcohol advertising has increased rapidly,
especially in the promotion of low-alcohol, fun beverages with
teens as targets.
Concerns over young people and smoking were a big factor lead-
ing to laws regulating cigarette advertising and to later discussions
about giving movies with smoking in them an R rating. The power
Take a Look
What inuences you most? Rate the power of the factors in your life
contributing to alcoholism/addiction or to your feelings about it:
No Some Very
Inuence Inuence Powerful
Family substance abuse
Peer pressure
Spiritual seeking
Physical problems
Mental/emotional problems
Home life
School life
Music, movies, TV
Think about ways to counteract inuences that may be making up your
mind for you!
Causes of Alcoholism and Drug Addiction 43
of these infuences is widely recognized, and even though society
has worked to limit them, corporations connected with alcohol and
cigarettes seem able to work around them. Try this sometime: Keep a
journal for one day noting all the references to alcohol, cigarettes, or
other drugs you observe on TV, radio, magazines, and outside adver-
tisements. The Center for Media Literacy offers a number of other
exercises to help make you aware of the power of what you see and
hear 24/7 from sources that want to infuence you.
Beyond these traditional forms of communication today is, of
course, the Internet. This is the source of more misinformation, deliv-
ered faster, than any previous form of communication. It can also
link people up to sources of drugs that cant be tracked or regulated.
But can we really say that media infuence causes addiction? Perhaps
not directly. But it can encourage young people to pick up their frst
psychoactive substance. And as current brain research shows, its
the frst use of a substance than can start the process that leads to
In some cases, addiction is inherited through family genes; in
others, it may arise from frequent and repeated use of sub-
stances that create new pathways in the brain.
Addiction occurs in the brain, where substances interfere
with dopamine production and can create dependence on the
Mental illness is a factor in addiction and alcoholism.
Substance use disorders are also social conditions, triggered by
media and other social and cultural infuences.
kids. When they were both at the same college for a while, Larry
noticed Lynn was harder to talk with. Hed leave messages for her
and sometimes she called back or sometimes she would disappear
for a long time, but then shed be really friendly. He was confused
by this until he noticed that when they got together for a beer, Lynn
always drank until she got drunk. She didnt drink all the time, but
once she started she didnt stop.
Larry had family members who drank a lot. He also knew that
when she was home Lynn sometimes smoked pot with her family.
The drinking scared him, and he tried to talk with his friend about it.
Lynn just acted angry and backed away from him. As time went by,
whenever he saw her in a social situation, he noticed she put her beer
down and came over to him drinking a soda. After a while she stayed
away from him, and he heard that she dropped out of school.
This story contains each of these characteristics of substance abuse:
denial, deceit, secrecy, loss, and obsession. A simple way of defning a
substance use problem is that it causes problems in your relationships,
school and social activities, or affects how you think and feel.
I have a disease that tells me I dont have a disease, is how one
longtime recovering alcoholic puts it. Dishonesty is a hallmark of sub-
stance abuse. Addicts and alcoholics often lie to themselves, wanting to
Recognizing Alcoholism
and Drug Addiction
Recognizing Alcoholism and Drug Addiction 45
believe Its not that bad. This type of dishonesty is denial on the
part of the user. Psychiatrists explain denial as a range of psychologi-
cal maneuvers designed to reduce awareness of the fact that alcohol
or drug use is the cause of an individuals problems rather than a
solution to those problems. Alcoholics Anonymous and Narcotics
Anonymous members say the letters in denial stand for Dont
Even kNow I Am Lying. Thats a good description of the process,
because people who practice denial have often convinced themselves
that theyre telling the truth. To someone trying to deal with a sub-
stance abuser, this kind of dishonesty can be troubling: Most people
fnd it hurtful to be lied to and hard to understand that the liar isnt
quite doing it on purpose.
Many will hide how much they use by lying about or downplaying
their use. Young users keep secret the extent of their use because it is
illegal, and because theres a part of them that wants to protect their
habit from those who would try to make them stop. Others will go to
great lengths if they need money to feed their habit, including lying,
cheating, and stealing. Its not that they dont know that these things
are wrong, but rather that the obsession and compulsion are overpow-
ering. Since illegal drugs usually take more effort to get than alcohol,
an addicts dishonesty can be more devious than an alcoholics.
Does this mean that theyre bad people? No. It means that the
substance use disorder drives them to bad behavior. Secrecy and
deceit keep the disease goingbut the best way to manage life with
substance use disorders, in ones self or in those we live with, is to
face facts, so we need to fnd ways to break through that secrecy. One
way to do that is to put aside what addicts and alcoholics say to us
and make our own observations.
Bad behavior is one sign of a substance abuser. But since users are
not likely to be forthright about their condition, anyone who wants to
fnd out if someone is an alcoholic or addict may have to sort through
the secrecy for clues. Here are some clues to possible substance abuse
among young people:
changes in school performance: falling grades, skipping school,
changes in peer group: hanging out with drug-using, antiso-
cial, older friends
breaking rules at home or school or in the community
46 Living with Alcoholism and Drug Addiction
extreme mood swings, depression, irritability, anger, negative
sudden increases or decreases in activity level
withdrawal from the family; keeping secrets
changes in physical appearance: weight loss, lack of cleanli-
ness, strange smells
red, watery, glassy eyes or runny nose not due to allergies or
changes in eating or sleeping habits
lack of motivation or interest in things other teenagers enjoy
(hobbies, sports)
lying, stealing, hiding things
using street or drug language or possession of drug-use items
cigarette smoking
We began this chapter talking about the dishonesty that is a core
feature of addiction and alcoholism. Dishonesty kills by keeping peo-
ple hooked. Honesty can save lives. A multitude of simple tests have
been devised to profle alcoholics and addicts. You have a chance now
to answer some questions privately to fnd out if you or a loved one
has a drinking or drug problem.
Have you ever felt you should cut down on your drinking/
Have people annoyed you by criticizing your drinking/
Have you ever felt bad or guilty about your drinking/
Have you ever had a drink frst thing in the morning to steady
your nerves or to get rid of a hangover?
One yes answer suggests a possible problem. More than one
yes answer means it is highly likely that a problem exists. If you
think that you or someone you know might have an alcohol or drug
problem, it is important to see a doctor or other health care provider
right away. They can help you determine if a drinking/drugging prob-
lem exists and plan the best course of action.
Here are some other ways of looking at the situation:
Do you sometimes drink or use more than you mean to?
Have you tried to cut back on your drinking/drugging and
Recognizing Alcoholism and Drug Addiction 47
Do you black out (have trouble remembering things that hap-
pened) while drinking/drugging?
Have your problems at school, work, or with your relation-
ships gotten worse since you started drinking/drugging?
Do you keep drinking/drugging even though you know its
causing problems?
Do you drink or use when you feel stressed?
Do you drink or use alone?
Can you drink or drug much more now than you used to be
able to?
Do you ever feel uncomfortable when you havent had a drink?
Do you drink even when its important to stay sober?
What about your situation? How do you think it compares to
normal? Have you progressed to the point of having a real
problem that needs to be addressed?
Here are some surveys that health professionals use in evaluating alco-
hol or drug problems. Note that they have nicknamesCAGE and
TACE. Thats an indication of how common these problems are.
C: Have you ever felt you should cut down on your drinking/
A: Have people annoyed you by criticizing your drinking/drugging?
G: Have you ever felt bad or guilty about your drinking/drugging?
E: Eye-opener: Have you ever had a drink rst thing in the morn-
ing to steady your nerves or to get rid of a hangover?
T: Does it take more than three drinks to make you feel high?
A: Have you ever been annoyed by peoples criticism of your
C: Are you trying to cut down on drinking?
E: Have you ever used alcohol as an eye-opener in the morning?
48 Living with Alcoholism and Drug Addiction
How can one recognize the signs and symptoms of the disease?
Here are some examples:
Tommy didnt drink often but every time he did, he got
Alice had a hollow leg and could drink so much more than
her classmates that she was usually the one with a clear
enough head to drive home.
Howard could stop drinking for long periods of timeas long
as he had marijuana as a substitute.
It is said that alcoholics are either drinking, or thinking about
drinking, or thinking about not drinkingso that even if they arent
intoxicated all the time, they can still be under the control of the
mental obsession.
A common explanation for why I cant be an alcoholic offered by
young people goes like this: I only drink on Saturdays or at par-
ties or with the guys. You dont have to drink regularly for alcohol
to cause problems. In fact, binge drinkingdrinking a lot at one
timecan be particularly dangerous. Its just as illegal as any other
kind of drinking for underage drinkers, of course, but its one of the
most popular drinking patterns among young people, especially by
people in the 18- to 21-year-old age range. Researchers often defne
binge drinking as the consumption of fve or more drinks at one sit-
ting for males and three or more drinks at one sitting for females.
Binge drinkers on college campuses are more likely to get into trouble
and cause trouble for others than other types of drinkers. Another
defnition for binge drinking is simply drinking to get drunk. It is the
most common drinking problem for people under age 21.
Physical side efects of alcohol abuse. Hangovers are another
aspect of drinking that movies, comedians, and frat-house partyers
make into a joke. When you think about what alcohol does to your
brain, its no surprise it can leave you with a headache. But hangovers
are also common signs of withdrawal from the substance. Not every-
one experiences hangovers, but when drinkers who do have reached
a serious stage of alcohol dependence, they keep drinking to avoid
the withdrawal symptoms.
Blackouts are usually thought of as a typical sign of fairly advanced
alcohol abuse. This is not just a state of being foggy while in a buzzed
condition. A blackout is a lack of memory for events that occur dur-
ing a night of heavy drinking without a loss of consciousness. The
drinker looks as though he or she is functioning but has no awareness
Recognizing Alcoholism and Drug Addiction 49
of whats going on. Blackouts were once thought to be a symptom of
advanced adult alcoholism, but researchers have recently discovered
just how frequent they are among teenagers as well, with over half
of college-age drinkers reporting at least one blackout in their drink-
ing lifetimes; they reported an average of three blackouts apiece.
Researchers have found that theyre likely caused by a shutdown of
key cells in the brain. This cant be good for the brainbut of more
signifcance is the behavior that happens during blackouts (more on
that in the next chapter.)
Physical side efects of drug abuse. Note that the side effects
of drug-withdrawal are different from alcoholic ones. Depending on
the drug, they can be more or less painful, but they often include a
greater pull toward using more drugs.
Since for many users its possible to stop before serious addiction
occurs, its important to recognize what each stage of substance abuse
looks like. For instance, alcohol abuse may be categorized as follows:
Alcohol abuse can cause problems, like missing school or lying
to friends, but it is not yet a full-blown addiction.
Alcohol dependence is what people commonly call alcoholism:
a disease that is chronic, or persistent, and often progressive,
meaning that it gets worse over time. Health care professionals
consider it alcoholism when the sufferer experiences at least
three of seven symptoms within one year. These symptoms
include repeated unsuccessful attempts to stop or cut down,
physical craving for alcohol, a persistent pattern of drink-
ing despite known negative consequences, an unreasonable
amount of time and effort spent on obtaining alcohol, the orga-
nization of ones social or work life to accommodate drink-
ing, need for increased amounts of alcohol (tolerance), and
symptoms of withdrawal upon cessation of drinking (physical
dependence). People who promise to never drink again and
then get drunk are at this stage.
Likewise, not everyone who uses drugs becomes addicted, but
substance abuse can cause problems for individuals whether they are
technically addicted or not. There are different levels of substance
abuse, and all of them can be dangerous, so its important to be aware
of different behavior at different stages.
50 Living with Alcoholism and Drug Addiction
Substance abuse disorder: Using drugs or other substances
becomes a disorder when the use begins to cause continuing
or growing problems in the users life. A friend may seem to
turn away as he is pulled away by the obsession.
Chemical dependency: Dependency usually becomes notice-
able in substance abusers when they continue their pattern
of drug use in spite of incurring signifcant problems in their
lives. Theyve gotten to the stage where they need the sub-
stance, even though its stopped being fun.
Chemical addiction: Addiction can best be described as a com-
pulsive continued use of a drug or substance and a complete
inability to stop despite negative consequences. This is when
people start looking the way we might expect junkies to look.
Recovering addicts in Narcotics Anonymous developed this question-
naire based on their own experience. They urge you to answer them
as honestly as you can.
Do you ever use alone?
Have you ever substituted one drug for another, thinking that
one particular drug was the problem?
Have you ever manipulated or lied to a doctor to obtain pre-
scription drugs?
Have you ever stolen drugs or stolen to obtain drugs?
Do you regularly use a drug when you wake up or when you
go to bed?
Have you ever taken one drug to overcome the effects of
Do you avoid people or places that do not approve of you
using drugs?
Have you ever used a drug without knowing what it was or
what it would do?
Has your job or school performance ever suffered from the
effects of your drug use?
Have you ever been arrested as a result of using drugs?
Have you ever lied about what or how much you use?
Do you put the purchase of drugs ahead of your fnancial
Have you ever tried to stop or control your using?
Have you ever been in a jail, hospital, or drug rehabilitation
center because of your using?
Recognizing Alcoholism and Drug Addiction 51
Does using interfere with your sleeping or eating?
Does the thought of running out of drugs terrify you?
Do you feel it is impossible for you to live without drugs?
Do you ever question your own sanity?
Is your drug use making life at home unhappy?
Have you ever thought you couldnt ft in or have a good time
without drugs?
Have you ever felt defensive, guilty, or ashamed about your
Do you think a lot about drugs?
Have you had irrational or indefnable fears?
Has using affected your sexual relationships?
1. Getting high on drugs or getting drunk when its not a party.
2. Always using more drugs or alcohol than other kids.
3. Lying about things, or about the amount of drugs or alcohol
being used.
4. Having to use more alcohol or other illicit drugs to get the
same effects.
5. Believing that in order to have fun they need to drink or use
marijuana or other drugs.
6. Pressuring others to use drugs or drink.
7. Getting into trouble with the law.
8. Taking risks, including sexual risks and driving under the
inuence of alcohol and/or drugs.
9. Not showing upfor work, school, or friendship.
10. Unexplained mood swings, including irritability.
10 Ways to Tell When Drinking
or Getting High Has Become
Addictive Behavior
5Z Living with Alcoholism and Drug Addiction
Have you ever taken drugs you didnt prefer?
Have you ever used drugs because of emotional pain or stress?
Have you ever overdosed on any drugs?
Do you continue to use despite negative consequences?
Do you think you might have a drug problem?
Heres how Alcoholics Anonymous poses the questions when it
addresses teenagers with possible problems:
Do you drink because you have problems? To relax?
Do you drink when you get mad at other people, your friends
or parents?
Do you prefer to drink alone rather than with others?
Are your grades starting to slip? Are you goofng off on your
Did you ever try to stop drinking/drugging or drink lessand
Old Connections
In studying alcoholism and addictions, researchers have come up with
some perhaps unexpected connections. For instance:
When you were a child, did you have a sweet toothdid you
crave and eat a lot of sugary foods?
Were you diagnosed with attention-decit/hyperactivity
disorder (ADHD)? Whether or not you were diagnosed, were
you a restless child who got bored easily?
Was the home you grew up in chaotic and confusing rather
than calm and organized?
If the answer to any of those is yes, especially along with some yeses
to the other questions in this chapter, you may be at risk for addiction.
Sugar cravings, restlessness, and early turmoil seem connected to later
substance abuse.
Recognizing Alcoholism and Drug Addiction 53
Have you begun to drink in the morning, before school or
Do you gulp your drinks?
Do you ever have loss of memory due to your drinking/
Do you lie about your drinking/drugging?
Do you ever get into trouble when youre drinking/drugging?
Do you get drunk when you drink, even when you dont mean
Do you think its cool to be able to hold your liquor?
Only you can answer these questions for yourself, and being honest
about them is crucial. If even a few answers to all of those questions
is a yes, chances are good that you have a problem that should cause
you some concern. To learn more about the symptoms of substance
abuse disorders, go online or consult a health professional. Read
More About It at the back of this book provides some Web sites that
may be helpful.
People with substance use disorders often do not tell the truth
about how much they use, because that is the nature of the
For young people, the use of any chemical substance is illegal,
making lies and concealment essential to survival.
Symptoms are different at different stages of addiction/
You can evaluate your own need for managing your own or
anothers SUD by answering questions honestly for yourself.
Before you skip this chapter thinking its going to be
the same old preaching against the evils of drink and drugs, hang
on: Recent brain research shows that teens face special dangers from
substance abuse. Read on for these facts you need to knowits
your brain! But frst this important reminder about the dangers of
substance use: Its illegal. If youre under a legal age in your state
for use of alcohol or tobacco, youre breaking the lawand that has
consequences. Plenty of other drugsincluding misuse of prescrip-
tion drugsare illegal no matter what your age, but until youre of
legal age, one big danger is that you could be arrested.
One result of the current brain-research projects are fndings suggest-
ing that alcohol causes more damage to the developing brains of teen-
agers than was previously thought. It can injure them much more than
it does adult brains, and it has long-lasting effects. Alcohol affects the
very parts of the brain that develop during adolescence, where teens
learn adult decision-making skills, like the ability to focus, to discrimi-
nate, to decide between right and wrong. Researchers say that early
drinking also affects a developing brain in a way that promotes the
progression to addiction. The research even suggests that early heavy
drinking may undermine the precise brain links needed to protect one-
self from alcoholism, which may be why the younger that people start
drinking, the more likely they are to become alcoholics.
Dangers of Alcoholism
and Drug Addiction
Dangers of Alcoholism and Drug Addiction 55
It has long been known that adults brains shrink with extended
alcohol use, but recent research shows that youth drinking also
affects brain size, shrinking the important prefrontal cortex. Research-
ers used magnetic resonance imaging to measure prefrontal cortex,
thalamic, and cerebellar volumes in 14 subjects (8 males, 6 females)
with alcohol use disorders, and in 28 (16 males, 12 females) sociode-
mographically similar individuals without alcohol use disorders,
known as controls.
This is the frst study to examine the sizes of these brain struc-
tures in adolescents and young adults, said Michael D. De Bellis,
M.D., professor of psychiatry and behavioral sciences and director
of the Healthy Childhood Brain Development Research Program at
Duke University Medical Center, as well as corresponding author for
the study.
Studies on adults with alcoholism have generally shown smaller
brain sizes, but this is after many years of very heavy drinking,
added Susan Tapert, Ph.D., associate professor of psychiatry at the
University of California at San Diego. Before this study, it really
wasnt clear that adolescents, with briefer drinking histories, would
show any differences in brain size. However, with nearly one in three
high school seniors binge drinking at least once per month, it is criti-
cal that we understand precisely how drinking affects the brains of
these young people.
And its not just alcohol. Other research shows that drugs may
cause similar brain changes in dopamine signaling, which may play
a role in addiction. Researchers have also found that heavy abuse of
drugs by young people, whose brains are still developing, can cause
damage usually seen only in much older people and similar to the
early stages of Alzheimers disease.
Alcohol and drugs infict plenty of other long-term damage to parts of
the body in addition to the brain. Both alcohol and drugs can result in
cirrhosis of the liver, pancreatitis, diabetes, hepatitis, heart problems,
seizures, and strokes. These can make you very sick and can kill you.
Such ailments, howeverand even death itselfare often distant and
vague concepts for young people.
If death doesnt seem real, how about acne? Alcohol will make
you gain weight and feel sick, give you bad breath, and make your
skin break out. Drug use isnt conducive to nice skin or general good
looks either. And both alcohol and drugs interfere seriously with sleep
56 Living with Alcoholism and Drug Addiction
functions, so even though substance users may feel as though theyre
functioning well, they are not.
There are other alcohol-related problems that affect young people
more than others: Binge drinking is most common among teens and
young adults and is probably the most dangerous form of drinking. It
can result in serious damage to the teenage brain and increasing mem-
ory loss later in adulthood, according to research. In the short term,
its important to remember that binge drinkers are much more likely
to hurt themselves than other kinds of drinkers. The rush of a large
quantity of alcohol is just more than the brain or body can handle.
Its not just sudden heavy drinking can cause often forgotten haz-
ards of drinking. Remember that the sense frst impaired by alcohol
is the sense of judgmentso people tend to make decisions and take
actions that they wouldnt when sober. Unintended pregnancy can
result from poor judgment while intoxicatedand so can HIV/AIDS.
According to the National Institutes of Health, injection of drugs such
as heroin, cocaine, and methamphetamine accounts for more than a
third of new AIDS cases. Injection drug use is also a major factor in
the spread of hepatitis C, a potentially fatal liver disease. Its easy to
believe that just intravenous drug users can get AIDS through drug
use, but we tend to forget that, under the infuence of alcohol or
drugs, people engage in unsafe activities they may not even remem-
ber. Drinking or drug use doubles the risk of sexually transmitted dis-
eases (STDs) among young people, and drinking combined with drug
use increases the risk even more, especially for females. STDs carry
long-term consequences, including cancer and infertility.
Drinkers are three times as likely to die from injuries of all kinds
as are nondrinkers. Yet many kids and their parents continue to con-
sider drugs more of a threat than drinking. The fact is, whether or
not teen use of alcohol marks the onset of a lifelong problem, it is a
danger in itself. Anyone who underestimates the drinking epidemic
needs to consider these facts:
According to the U.S. Centers for Disease Control, the three
leading causes of death for 15- to 24-year-olds are automobile
crashes, homicides, and suicides. Alcohol is a key factor in all
Early-age drinking is associated with alcohol-related violence.
This is particularly true for people under 21. But those who
do begin early also tend to be more violent in their later adult
The vast majority of all criminal convictions in the United
States for all age groups are alcohol or drug-related. This is not
Dangers of Alcoholism and Drug Addiction 57
just about stealing for drug money; its about crimes commit-
ted while under the infuence, sometimes when in blackouts.
Teens and their families tend to down play alcohol and soft
drugs like marijuana. But both alcohol and marijuana have
been shown to be gateway drugsones that lead to other
use. Illegal use of any substance (underage drinking included)
makes it easier for teens to get accustomed to using illegal
Whats your most prized possession? For most teens, its their drivers
license. And of all the losses that alcohol and drugs can cause, it may
well be that the drivers license is the frst thing to go. It used to be that
drunk driving was brushed off as a minor offense. No more! In most
states and communities throughout the country, a zero-tolerance rule
for teen drivers applies. This means that if you are found to have any
drugs or alcohol in your system while driving, you lose your license.
Short-term effect: grounded! Longer term effect: insurance cost.
Teens have much higher rates for car insurance than any other group.
A DUI (driving under the infuence) conviction can cause those rates
to go up for at least three years. Scarier effect: You can kill yourself,
your friends, or total strangers in an instant. But think about this:
Most people in car accidents dont dietheyre more likely to be
Interactions with Medications
Another drug-related danger we tend to forget about: interactions with
medications. Alcohol interacts negatively with more than 150 medica-
tions. For example, if you are taking antihistamines for a cold or allergy
and drink alcohol, the alcohol will increase the drowsiness that the
medication alone can cause, making driving or operating machinery
even more hazardous. And if you are taking large doses of the pain-
killer acetaminophen and drinking alcohol, you are risking serious liver
damage. How often do you remember to check with your doctor or
pharmacist before drinking any amount of alcohol if you are taking any
over-the-counter or prescription medications?
58 Living with Alcoholism and Drug Addiction
permanently crippled. Its kind of like diving into a swimming pool
without checking to see if theres any water in it: You may not die but
youll probably be paralyzed for life.
And in case you think you can get around that zero tolerance
rule by acting sober, consider this fact from the National Institutes
of Health: You dont need to drink much alcohol before your ability
to drive becomes impaired. For example, certain driving skillssuch
as steering a car while, at the same time, responding to changes in
traffccan be impaired by blood alcohol concentrations (BACs) as
low as 0.02 percent. A 160-pound man will have a BAC of about 0.04
percent one hour after consuming two 12-ounce beers or two other
standard drinks on an empty stomach.
Alcohol has been called the great remover. It causes the removal and
disappearance of things that mattermoney, freedom, and health, for
a few. But another painful side effect of addiction and alcoholism is
the loss of people and values we care about.
Ruined relationships. If youre like most people, you began drink-
ing or drugging in some kind of social setting, and you did it to feel a
part of the crowd, to get along with people more easily. After some use,
however, people get to feel apart from others. In fact, the more heav-
ily you drink, the greater the potential for problems at home, at work,
with friends, and even with strangers. These problems may include
arguments with or estrangement from family and friends, who
over time dont want to deal with the kind of behavior that
substance use brings on
the forming of relationships based mainly on substance use,
which can leave you pretty lonely when the drugs or money
run out
committing or being the victim of violence: The rates of
involvement in violence soar for young addicts and alcohol-
icsdue to dangerous acts being committed under the infu-
ence or over the possession of substances of abuse
A young addict sums it up: I didnt get into trouble every time I
drankbut every time I had trouble, I had been drinking.
Failing grades. Want to do well in school? Stay away from SUDs:
Research shows that even mild to moderate drinking can adversely
Dangers of Alcoholism and Drug Addiction 59
affect cognitive functioningmental activities that involve acquir-
ing, storing, retrieving, and using information. In other words, forget
about test-success if you choose drug use. Alcoholic teenagers per-
formed poorly on tests of verbal and nonverbal memory, attention
focusing, and exercising spatial skills. Long-term studies reported by
the National Clearinghouse for Alcohol and Drug Information of sub-
stance-using teens found that those who had relapsed and who con-
tinued to get drunk frequently performed the worst on tests requiring
focused attention, while those who reported the most hangovers
performed the worst on spatial tasks.
On the other hand, the teenagers and young adults in the group
who stayed sober28 percent of the totalperformed almost as well
at both the four-year and the eight-year mark as other teenagers who
had rarely, if ever, had a drink. Further, the study found that 15- to 16-
year-olds who said they had been drunk at least 100 times performed
signifcantly more poorly than their matched nondrinking peers on
tests of verbal and nonverbal memory. These teenagers, who were
sober during the testing, had been drunk an average of 750 times in
the course of their young lives. Heavy alcohol involvement during
adolescence is associated with cognitive defcits that worsen as drink-
ing continues into late adolescence and young adulthood, the study
Why do tests seem easier to those who get high? Researchers fgure
its because we feel less anxious or tense, but bottom-line results are
worse, and its the grade that matters. Long term, the distractions of
drug use combine with the brain effects to produce really poor school
and work performance.
Mental illness. Many, if not most, of the substances that people use
to get high, feel happy, or go mellow can end up having the opposite
effect. Alcohol is a depressant, so even if it offers an initial giddy
rush, it can lead to depression. Cocaine, crack, and other uppers can
lead to chronic depression because they destroy the brains ability to
produce naturally the chemicals that make humans feel happy. Hal-
lucinogens and similar substances can create brain patterns that per-
manently distort reality, in ways similar to schizophrenia. Sometimes
these conditions can be reversed once the substance use is stopped,
but not always. It sometimes happens, too, that doctors who are not
aware of the extent of a patients use of alcohol or other drugs may
use the symptoms that the drugs cause to diagnose conditions like
bipolar disorder, depression, or even schizophrenia. Pharmaceuticals
prescribed for those disorders can make the effects of the secret drug-
taking even more harmful.
60 Living with Alcoholism and Drug Addiction
These are the hazards of some of the most commonly used drugs,
according to the National Clearinghouse for Alcohol and Drug Infor-
mation, part of the U.S. Department of Health.
Marijuana. Marijuana is the most widely used illicit drug in the
United States and tends to be the frst illegal drug teens use. The
physical effects of marijuana use, particularly on developing adoles-
cents, can be acute. Short-term effects of use include
diffculty keeping track of time; impaired or reduced short-
term memory
reduced ability to perform tasks requiring concentration and
coordination, such as driving a car
increased heart rate
potential cardiac dangers for those with preexisting heart
bloodshot eyes
dry mouth and throat
decreased social inhibitions
paranoia, hallucinations
Long-term effects of marijuana use include
enhanced cancer risk
decrease in testosterone levels for men; also lower sperm
counts and diffculty having children
increase in testosterone levels for women; also increased risk
of infertility
diminished or extinguished sexual pleasure
psychological dependence requiring more of the drug to get
the same effect
Marijuana blocks the messages going to your brain and alters your
perceptions and emotions, vision, hearing, and coordination. A recent
study of 1,023 trauma patients admitted to a shock trauma unit found
that one-third had marijuana in their blood.
Cigarette smoking. Although many people smoke because they
believe cigarettes calm their nerves, smoking releases epinephrine, a
hormone that creates physiological stress in the smoker, rather than
relaxation. The use of tobacco is addictive. Most users develop tolerance
Dangers of Alcoholism and Drug Addiction 61
for nicotine and need greater amounts to produce a desired effect.
Smokers become physically and psychologically dependent and will
suffer withdrawal symptoms including changes in body temperature,
heart rate, digestion, muscle tone, and appetite. Psychological symp-
toms include irritability, anxiety, sleep disturbances, nervousness,
headaches, fatigue, nausea, and cravings for tobacco that can last
days, weeks, months, years, or an entire lifetime. Risks associated
with smoking cigarettes include diminished or extinguished sense of
smell and taste; smokers cough; gastric ulcers; chronic bronchitis;
increase in heart rate and blood pressure; premature and more abun-
dant facial wrinkles; emphysema; heart disease; stroke; and cancer
of the mouth, larynx, pharynx, esophagus, lungs, pancreas, cervix,
uterus, and bladder.
Cigarette smoking is perhaps the most devastating preventable
cause of disease and premature death. Smoking is particularly danger-
ous for teens because their bodies are still developing and changing,
and the 4,000 chemicals (including 200 known poisons) in cigarette
smoke can adversely affect this process. Cigarettes are highly addic-
tive. One-third of young people who are just experimenting end up
being addicted by the time they are 20.
Alcohol. Alcohol abuse is a pattern of problem drinking that results
in health consequences, social problems, or both. However, alcohol
dependence, or alcoholism, refers to a disease that is characterized
by abnormal alcohol-seeking behavior that leads to impaired control
over drinking. Short-term effects of alcohol use include distorted
vision, hearing, and coordination; altered perceptions and emotions;
impaired judgment; bad breath; and hangovers. Long-term effects
of heavy alcohol use include loss of appetite, vitamin defciencies,
stomach ailments, skin problems, sexual impotence, liver damage,
and heart and central nervous system damage.
Methamphetamine. Methamphetamine is a stimulant drug chemi-
cally related to amphetamine but with stronger effects on the central
nervous system. Street names for the drug include speed, meth, and
crank. Methamphetamine is used in pill form or in powdered form by
snorting or injecting. Crystallized methamphetamine known as ice,
crystal, or glass is a smokable and more powerful form of the drug.
The effects of methamphetamine use include increased heart rate and
blood pressure; increased wakefulness; insomnia; increased physical
activity; decreased appetite; respiratory problems; extreme anorexia;
hypothermia, convulsions, and cardiovascular problems, which can
lead to death; euphoria; irritability; confusion; tremors; and anxiety,
6Z Living with Alcoholism and Drug Addiction
paranoia, or violent behavior. Meth can also cause irreversible dam-
age to blood vessels in the brain, producing strokes.
Methamphetamine users who inject the drug and share needles
are at risk for acquiring HIV/AIDS. Methamphetamine is an increas-
ingly popular drug at raves (all-night dancing parties) and as part of a
number of drugs used by college-aged students. Marijuana and alcohol
are commonly listed as additional drugs of abuse among methamphet-
amine treatment admissions. Most of the methamphetamine-related
deaths (92 percent) reported in 1994 involved methamphetamine in
combination with at least one other drug, most often alcohol (30 per-
cent), heroin (23 percent), or cocaine (21 percent). Researchers con-
tinue to study the long-term effects of methamphetamine use.
Cocaine and crack cocaine. Cocaine is a white powder that
comes from the leaves of the South American coca plant. Cocaine is
either snorted through the nasal passages or injected intravenously.
Cocaine belongs to a class of drugs known as stimulants, which tend
to give a temporary illusion of limitless power and energy that leave
the user feeling depressed, edgy, and craving more. Crack is a smok-
able form of cocaine that has been chemically altered. Cocaine and
crack are highly addictive. This addiction can erode physical and
mental health and can become so strong that these drugs dominate
all aspects of an addicts life. Physical risks associated with using
any amount of cocaine and crack include increases in blood pres-
sure, heart rate, breathing rate, and body temperature; heart attacks,
strokes, and respiratory failure; hepatitis or AIDS through shared nee-
dles; brain seizures; and reduction of the bodys ability to resist and
combat infection. Psychological risks of cocaine and crack use include
violent, erratic, or paranoid behavior; hallucinations and coke bugs
(a sensation of imaginary insects crawling over the skin); confusion,
anxiety and depression; loss of interest in food or sex; and cocaine
psychosis (losing touch with reality, loss of interest in friends, fam-
ily, sports, hobbies, and other activities).
Some users spend hundreds or thousands of dollars on cocaine and
crack each week and will do anything to support their habit. Many
turn to drug selling, prostitution, or other crimes. Cocaine and crack
use has been a contributing factor in a number of drownings, car
crashes, falls, burns, and suicides. Cocaine and crack addicts often
become unable to function sexually. Even frst-time users may experi-
ence seizures or heart attacks, which can be fatal.
Hallucinogens. Hallucinogenic drugs are substances that distort the
perception of objective reality. The most well-known hallucinogens
Dangers of Alcoholism and Drug Addiction 63
include phencyclidine, otherwise known as PCP, angel dust, or love-
boat; lysergic acid diethylamide, commonly known as LSD or acid;
mescaline and peyote; and psilocybin, or magic mushrooms. Under
the infuence of hallucinogens, the senses of direction, distance, and
time become disoriented. These drugs can produce unpredictable,
erratic, and violent behavior in users that sometimes leads to serious
injuries and death. The effect of hallucinogens can last for 12 hours.
LSD produces tolerance, so that users who take the drug repeatedly
must take higher and higher doses in order to achieve the same state
of intoxication. This is extremely dangerous, given the unpredictabil-
ity of the drug, and can result in increased risk of convulsions, coma,
heart and lung failure, and even death.
Physical risks associated with using hallucinogens include increased
heart rate and blood pressure; sleeplessness and tremors; lack of
muscular coordination; sparse, mangled, and incoherent speech;
decreased awareness of touch and pain that can result in self-inficted
injuries; convulsions; coma; and heart and lung failure. Psychological
risks associated with using hallucinogens include a sense of distance
and estrangement; depression, anxiety, and paranoia; violent behav-
ior; confusion, suspicion, and loss of control; fashbacks; behavior
similar to schizophrenic psychosis; and catatonic syndrome, whereby
the user becomes mute, lethargic, disoriented, and makes meaning-
less repetitive movements. Everyone reacts differently to hallucino-
genstheres no way to predict if you can avoid a bad trip.
Inhalants. Inhalants refer to substances that are sniffed or huffed
to give the user an immediate head rush or high. They include a
diverse group of chemicals that are found in consumer products such
as aerosols and cleaning solvents. Inhalant use can cause a number
of physical and emotional problems, and even one-time use can result
in death.
Using inhalants even one time can put you at risk for sudden
death; suffocation; visual hallucinations and severe mood swings;
and numbness and tingling of the hands and feet. Short-term effects
of inhalants include heart palpitations, breathing diffculty, dizzi-
ness, and headaches. Prolonged use can result in headache; muscle
weakness; abdominal pain; decrease or loss of sense of smell; nausea
and nosebleeds; hepatitis; violent behaviors; irregular heartbeat; irre-
versible brain damage; nervous system damage; dangerous chemical
imbalances in the body; involuntary passing of urine and feces; and
liver, lung, and kidney impairment.
Remember, using inhalants, even one time, can kill you. According
to medical experts, death can occur in at least fve ways:
64 Living with Alcoholism and Drug Addiction
1. asphyxiasolvent gases can signifcantly limit available
oxygen in the air, causing breathing to stop
2. suffocationtypically seen with inhalant users who use
3. choking on vomit
4. careless behaviors in potentially dangerous settings
5. sudden sniffng death syndrome, presumably from cardiac
While dangers associated with substance use disorders vary from
short- to long-term and practical to fatal, theres a common solution to
all the problems: The best treatment is prevention. Think its tough?
Take a look at cigarette smoking: Once the dangers were promoted
and the access was limited, cigarette use dropped sharply. If that can
happen, so can the use of other drugs.
The use of any psychoactive substance (other than caffeine),
including nicotine, is illegal for any underaged person.
Brain research shows special damage to adolescent brains.
The frst part of the brain to be affected relates to judgment
and short-term memory.
Harmful effects may be direct, like physical damage to your
body, or indirect, like poor grades.
The substances most often abused by teens are not street
drugs but those available in neighborhood storestobacco
and alcohol.
lf you have ever thought you might need help with a
drinking, drug, or other addiction problem, you may have found the
very thought of dealing with it frightening. If so, youre not alone:
Most people resist the idea of treatment at frst. Some 23.6 million
people over the age of 12 in the United States met the criteria for
substance abuse or dependence in the previous year, according to
the federal governments 2006 National Survey on Drug Use and
Health (NSDUH). But of that 23.6 million, only about 4 million
people received treatment for their disorder. Teens, too, are going
untreated: Among youths aged 12 to 17, an estimated 1.4 million
needed treatment for an illicit drug use problem in 2004, but only
134,000 received treatment at a specialty facility. In 2004, there were
1.6 million youths aged 12 to 17 who needed treatment for an alco-
hol use problem. Of this group, only 126,000, or 8 percent, received
treatment at a specialty facility.
The process of getting into treatment is so diffcult and so impor-
tant that this chapter will focus on just that, while the next will detail
treatment itself.
Recovery from addiction is not just about treating a disease. It is really
about making a major life change, and social scientists observe com-
mon patterns in making such changes. The specifc process of getting
Getting Support and Help
66 Living with Alcoholism and Drug Addiction
to treatment is so similar among so many people that the steps toward
it can be labeled.
Precontemplation: Not yet acknowledging a behavior problem
that needs to be changed
Contemplation: Acknowledging that there may be a problem
but not yet ready or sure of wanting to make a change
Preparation: Getting ready to change
Action: Taking steps to change behavior
Maintenance: Continuing the new behavior
Relapse: Returning to older behaviors and abandoning changes,
at least for a time
Note that the precontemplation, contemplation, and preparation
steps carry more weight than the action steps, because those are the
crucial stages where someone is just moving into awareness that he
or she may have a problem that needs solving. In fact, a perhaps
more familiar way of labeling the stages necessary to reach recovery
is the following:
Awareness: Admitting one has a problem
Attitude: Acknowledging the possibility of change
Action: Making the decision to change
Most people with SUDs arent even aware that they have a problem
or are not ready to admit or acknowledge it. Its estimated that only
a small percentage of all who need SUD treatment acknowledge that
they need help. According to the NSDUH survey, of the 23.6 million
people in 2006 over the age of 12 identifed as needing specialized
treatment and did not receive it, only 940,000 reported that they felt
they could beneft from it. In other words, the vast majority of people
each year who need treatment are still in the precontemplation stage.
Entering the contemplation stage means people may be aware of
the need but dont pursue it: Of that 940,000 people who said they
needed treatment in a specialty facility, only 314,000 made an effort to
get treatment, while 625,000 made no effort, according to the NSDUH
How is it possible to be unaware of having an alcohol or drug prob-
lem? Denial is a form of self-deception that keeps someone from
seeing the problem. For instance, teens who dont see cough syrup
Getting Support and Help 67
or pills as a real problem are in denial. Lets look at some of the
individuals introduced in chapter 1 and see how they approach treat-
ment. Each one of these teens is an addict or a potential addict:
Tommy, who kept a bottle of cough syrup in his middle-school
locker and sipped from it between classesbut didnt think
about being a drug addict.
Mary Anne, whose parents let her drink beer and wine at
home (since it was just alcohol), did a lot of partying there
with her friends.
Lisa, from an alcoholic family, resisted drinking but fnally
started smoking pot.
Jason, who was afraid of hard drugs and smoking, but who
used pills from his moms medicine cabinet to get high.
Like millions of other teens, none of these individuals was able to
admit at frst that drugs were a problem. So what will it take to get
them to the frst stage toward treatment?
Tommy started using real drugs and got in enough trouble to
be forced into treatment.
Mary Anne almost funked out of college because her partying
didnt stop.
Lisas pot smoking opened the way to using other drugs, and her
family, despite their own alcoholism, turned their back on her.
Are You Aware?
Have you been drunk or high at least once in the past month?
Have you ever taken prescription drugs not meant for you?
Think about ve times in your life when you were in trouble.
Were drugs or alcohol connected with any of those times?
If you answered yes to any of those questions, its likely that drugs or
alcohol is causing a problem for you.
68 Living with Alcoholism and Drug Addiction
Jason went in and out of several emergency rooms before his
family fnally pressured him to enter more serious treatment.
Why did it take such an effort to get to the frst stage of recovery?
Sometimes it takes a lot to get someones attention to make them aware.
When a person has a problem with alcohol or drugs, getting ready to
get clean and sober is almost as big a process as actually doing it.
People fght recovery. Why? The addiction itself resists recovery.
Some Alcoholics Anonymous members refer to addiction as the
disease, as though it were a real creature inside of the addict or
alcoholic. When they hear people making excuses for using deadly
substances, they may comment, Thats your disease talking.
Recent brain research into the mechanism of addiction shows that,
in a way, the AA members may be right. Those receptors in the
pleasure centers of the brain have become used to being stimulated
by artifcial chemicals, which are more powerful than the natural
substances the body produces for itself, so theres at least a strong
recollection of pleasureand thats hard to give up, even though its
a dangerous process.
The disease remembers only the fun parts. This is why people
in recovery are urged to remember how bad it got, not how good it
wasand one reason why people who are still sick from their last
drug or alcohol use are the most likely candidates for treatment.
The disease keeps you unaware. Many people, like Jason above,
truly dont believe they have a problemthey feel theyre too young,
perhaps. Or maybe they live in an environment where everybody
drinks or uses drugs, so they consider it normal.
The frst step in chipping away at resistance to recovery is to be
aware of the problem. This applies to any situationyou wouldnt
fx something until you knew it was broken, right? Lack of awareness
is one form of denial. Someone who manages to stay unaware of a
problem can deny that there is a problem.
Denial has many voices. People use denial to deceive themselves
by minimizing the effects of substance abuse. They also minimize the
substance itself, just as Lisa didnt acknowledge a problem because it
was only pot, not liquor. Or how about, Its only beer or Im too
young to have a problem? Have you ever heard any of those? Have
you heard families say them too? Family members often arent willing
or able to see their kids addiction problems clearly. It takes a lot of
Getting Support and Help 69
courage to be honest about these conditionsand an honest appraisal
of the situation is needed in order to deal with it.
The disease of addiction uses denial in many ways to create an
anti-treatment negative attitude. How about, Im an alcoholic, my
whole family says Im an alcoholic, so why fght it? Or even, Whats
the point of treatment if they cant cure it?
The disease triggers fear. Fear may be open or hidden. Fear often
drives the addiction itself as the addict uses an external substance
to relieve fearful feelings; fear is almost as powerful as denial in
blocking treatment. Theres also fear about what its like to give up
a substance that, at least at the beginning, may have seemed such a
powerful and positive force.
Fear of withdrawal symptoms also keeps people using. The physi-
cal and emotional reactions that occur when the drug level in the
body is reduced can be so unpleasant that they frighten an addict
or alcoholic into maintaining the status quo. Withdrawal is a major
sign of addiction to most substances, and withdrawal can be dif-
fcult. Once the pleasure is gone, addicts keep using. They keep up
their habits to avoid the pain of withdrawal, which happens when-
ever they wait too long for the next hit. (Withdrawal refers to that
period during which somebody addicted to a drug or other addictive
substance stops taking it. As the next chapter details, it can cause
painful or uncomfortable symptoms, which do pass when treated
Sometimes what holds a person back is a fear of what the recovery
process is like. The next chapters of this book will talk about what
happens along various treatment paths. Some young addicts or alco-
holics have a hidden fear that it wont work for me. They may want
to get better but are frightened that they will fail. Perhaps they have
relatives who never got clean and maybe died from addiction. Or they
may see those celebrities who cant seem to get it.
Fear and denial is often also fueled by shame. It might be too
embarrassing to admit the path that addiction has taken a person
downso out of fear they close their eyes to whats really happen-
ing. Someone like Mary Anne once had fun with alcohol, and when
it almost tore her life apart, she might blame her teachers for being
unfair or blame school for being too hard, because she was at frst too
embarrassed to take responsibility for her own actions.
Its also hard to admit we have a problem to which there is still a
stigma attached: In a 2005 report on its national survey of drug use,
the U.S. Department of Health and Human Services stated that two-
thirds of the general public say they believe that a stigma, or mark of
70 Living with Alcoholism and Drug Addiction
shame, exists for people in recovery from addiction. However, the very
forces that may prevent someone from getting help for addiction may
fnally push them into recovery. Mary Annes shame at almost failing
at school became a wake-up call to get help. Tommys big trouble cre-
ated enough fear to get him into a program. This kind of alarm bell can
drown out denial and kick in a willingness to explore recovery.
The old myth that you have to hit bottom before getting help is just
thata myth. Instead, if you begin to think you may have a problem
with alcohol or drugs, you can check it out. The idea that you have to
plunge immediately into rehab is one that may have developed from
celebrity-watching, but one that has little basis in real life. Instead,
take a clear look at yourself and keep it simple.
Check your answers to self-tests like those in the earlier chapters of
the book or on sites like or http://www.
Think of someone you really trusta good friend, a doctor, a mem-
ber of the clergy, or coachand ask what he or she thinks about your
drug use. Be aware that your close family members may not be the
best source of an evaluation, because they may have their own level
of denial. And double-check yourself: Are you looking for advice from
someone whos likely to reinforce your denial?
You may want to go to some open meetings of Alcoholics Anony-
mous or Narcotics Anonymous. Find them online or in your phone
book. Anyone is welcome at open meetings, and no one will ask you
anythingjust listen and see if the stories you hear apply to your own
life. Family members of people dealing with addiction can also learn a
great deal about the disease and the process of recovery by checking
out similar support groups, where they can gain some perspective on
the effects of the problem.
Increasing numbers of middle schools and high schools have sup-
port groups related to addiction, and a guidance counselor or school
nurse can be a good resource.
Professionals trained in substance use disorders can give you and
family members a clear evaluation and may be covered by insurance.
Ask a physician or psychotherapist for references to these specialists,
or search the Web or even the Yellow Pages for chemical dependency
counselors in your area. Therapists and counselors that are certifed
or licensed by a state or a professional organization, or both, are more
likely to be reliable than others. Some of the associations that certify
counseling professionals are listed in the appendix of this book.
Getting Support and Help 71
Anyone taking those suggested steps toward exploring the recovery
process is at the stage of preparing for treatment. But sometimes,
especially if the alcoholic/addict is endangering him or herself, it
takes an energetic push to get them there. This is where interven-
tion is an option.
In an intervention, family and friends, sometimes with the aid of
a professional, confront the addict or alcoholic with how his or her
chemical abuse causes a problem in his or her life. It sometimes can
backfre into negative results, so a modifed version has been devel-
oped to make it a more positive experience.
Further details about interventions and their costs and benefts are
in chapter 9, but as part of preparing for treatment its important
to decide on the best type of treatment program. Since the purpose of
any type of formal or informal intervention is to get the addict/alco-
holic to go into treatment, its especially critical to have a program
lined up. Here are the factors to consider in choosing one.
Finding a Guide
In considering treatment for substance abuse, many seek expert advice
as part of the decision-making process. These practitionersespecially
when they have had special training in substance use disorderscan
help most.
Psychiatrists, psychologists
Social workers
Family therapists
Certied addictions counselors
The best choice at this point is someone who has special training in
substance abuse treatment. A religious counselor with appropriate
training may also help. A substance abuse hotline may be of use too.
7Z Living with Alcoholism and Drug Addiction
Does the program accept your insurance? Or will they help you
fnd a way to pay, such as helping you to sign on for Medicaid
or apply for any grants or other supplements available?
Is the program licensed and accredited by state agencies? Is
it staffed by credentialed professionals to provide a full range
of social, psychological, medical, and vocational services that
meet the coverage criteria of your insurance?
Does it have a good reputation in the local medical community
and recovery communities?
Does it provide for follow-up treatment or aftercare?
Is there a family education or support program? How strong is
the family-involvement program? Parents participation is key
in the success of a teens ongoing recovery.
Does it offer the specifc treatments needed? For instance,
MICA treatments for those who are Mentally Ill and Chemi-
cally Addicted, appropriate approaches to the specifc drugs in
question, and, if necessary, special attention to the needs of
Does the facility work with the legal system? This is important
because often a teens substance abuse problems come to light
when they have gotten into some kind of behavioral trouble,
and often they are linked to issues of family abuse that may
require legal intervention.
As a teen, you have special needs and circumstances related to
addiction, given adolescent developmental patterns and your need to
continue your education as well. So in searching for a treatment, some
special approaches are needed. In a program specifcally designed for
teens, social and educational issues need attention. Motivational
enhancement therapy and cognitive behavioral therapy have proven
especially effective with adolescents, so a program for teens should
include this kind of treatment along with group counseling.
Outpatient services are especially important for adolescents. Many
teens are treated, at least initially, in an outpatient setting, going into
residential treatment if they have physical or mental complications or
repeated relapses. Outpatient services should include regular urine
and Breathalyzer tests.
Structured follow-up is especially important for teens, and thor-
ough programs will help them connect with adolescent-oriented
self-help groups, substance-free structured activities, and recovery-
oriented schools.
Whether youre seeking the best center for yourself or are part of
an intervention for a friend or loved one, the more you know about
Getting Support and Help 73
possible programs, the better prepared youll be. Within the limits of
your insurance coverage, you may choose:
to attempt recovery in a self-help setting rather than a treat-
ment program
to start out with a substance abuse counselor
to try the approach of medication plus psychotherapy
to go into a residential setting or try outpatient frst
Families, schools, doctors, the legal systemall may pressure a
young person into treatment, but its important that the young person
participate in the decision. The more choice a young person has, the
better his or her attitude for recovery.
Whether by choice, by intervention, or by persuasion, when a per-
sons attitude has changed from denial to Ill try it, he or she has
moved from the state of awareness of a problem to being ready to
The governments Substance Abuse and Mental Health Services
Administration (SAMHSA) suggests guidelines for teen treatment facili-
ties and offers a Substance Abuse Treatment Facility Locator at its
Web site (, which shows the location of facili-
ties around the country that treat alcoholism, alcohol abuse, and drug
abuse problems. The locator includes more than 10,000 addiction treat-
ment programs, including residential treatment centers, outpatient treat-
ment programs, and hospital inpatient programs for drug addiction and
alcoholism. Listings include treatment programs for marijuana, cocaine,
and heroin addiction, as well as drug and alcohol treatment programs
for adolescents and adults. New facilities are added monthly. Updates
to facility names, addresses, telephone numbers, and services are made
weekly. Information is also available at (800) 662-HELP [4357].
Free Help in Finding a
Treatment Program
74 Living with Alcoholism and Drug Addiction
consider change. He or she is at the turning point at which he or she
is preparing to change. He or she is getting ready to take action.
A positive attitude around addiction treatment can simply be a
mental position that says, I just might check this outa some-
Stages of Change
These are the stages a person goes through before deciding on
A. Precontemplation: Not yet acknowledging a behavior problem
that needs to be changed
B. Contemplation: Acknowledging that there may be a problem
but not yet ready or sure of wanting to make a change
C. Preparation: Getting ready to change
Which stage are these examples at?
1. A teen who thinks prescription drugs arent real drugs
2. A girl who has decided she doesnt want to drink like her alco-
holic parents
3. A family blaming a teens mood swings on hormones
4. A pot-smoking guy phoning a friend whos in NA
5. An eighth-grader who makes a point of not drinking before
1. (A) She doesnt yet acknowledge a problem
2. (B) Shes beginning to see a problem but not the whole
3. (A) In full denial about the possibility of drug use
4. (C) Hes getting ready, through his friend, to change
5. (B) Aware that drinking is a problem but not ready to stop
Getting Support and Help 75
times brief opening of willingness to try recovery. So its important
that an action plan be ready when preparing for treatment. Some
people are able to take themselves to treatment; for others, its wise
to take them, since that opening of willingness may shut down
quickly and someone may change his or her mind about treatment
before arriving.
Making a decision to enter treatment for a substance use disorder can
be the most important action you take in your life. The decision to
look toward treatment rather than to fnd ways to hold onto addiction
is a sign that an addict is ready for the next stage of recovery.
Ideally, when someone enters treatment, it should be by choice.
One element that can make treatment for young people more diffcult
is that if they are under 18, they can be forced into treatment by their
family, and so they may begin with a negative attitude. Professionals
in the feld of adolescent treatment need special skills in involving
teens in their own process of decision-making.
If you are considering treatment for yourself, pat yourself on the
back because youve moved one step closer to helping yourself. Your
family may wish you would move faster and may be pressuring
youand maybe you can consider that.
On the other hand, though, those closest to an addict or alcoholic
can sometimes resist treatment even more than the patientsbecause
they have their own denial and other issues to deal with. Families may
have strong feelings of shame or fear that fuel denial about addiction
in one of their kids. It may take involvement of another adultdoctor,
teacher, counselorto get them on board.
You will need your familys support to enter treatment, especially if
you are still a minor. They will need to give permission for treatment,
and their insurance is likely to be needed to pay for it.
Theyand youcan likely handle the idea of treatment with less
fear and resistance if you take it one step at a time. Unless addiction
has progressed so far that outside authorities are forcing treatment
decisions, you can choose how to proceed. Treatment can begin
with individual counseling, or with outpatient programs, or with an
inpatient program at a residential facility. The more you understand
the process, the easier it may be to enter, so the next chapter pro-
vides details about treatment. Most people are not happy to enter
a treatment program or facility, but many describe a sense of relief.
Many express anxiety and fear, which is natural when entering the
unknown. But the willingness to try is what matters.
76 Living with Alcoholism and Drug Addiction
Most people who need treatment for SUDs are not aware of it.
Most people who know they need treatment do not seek it.
People with addictions may resist treatment.
The process of getting to treatment moves through standard
Many types and formats of treatment are available, and the
more someone knows about them, the more likely he or she is
to seek treatment.
be treated. Until fairly recently, the best that could be done for suf-
ferers was to take the substance away: to send the alcoholic to a
drying-out farm, or to lock an addict up to go cold turkey, with
only a bit of dubious medication to ease the process. That kind
of treatment was better than the punishment that earlier society
inficted on drunks, who were often locked up in jails or insane
Unfortunately, many people still believe that addiction is not a
disease but a choice of behavior. According to a survey conducted by
the National Council on Alcoholism and Drug Dependence in 2005,
half of the U.S. population considers addiction a personal weak-
ness. Among those who did feel it is a disease, the majority labeled
it part of a special group of illnesses caused by people making poor
choices. This kind of public opinion makes it that much harder for
an addict or alcoholic (and their families) to develop a positive atti-
tude of their own about recovery. In fact, the same survey showed
that more than 20 percent of those who did not seek treatment chose
not to because of the stigma attached to it. Anyone feeling uncom-
fortable about going into treatment should know that he or she isnt
unique: 2.5 million people received treatment in 2006 in facilities spe-
cializing in substance abuse treatment. Add those who sought help
from nonprofessional support groups, and the total receiving some
form of treatment in 2006 was 4 million.
Approaches to Treatment
78 Living with Alcoholism and Drug Addiction
Recent brain research confrms that alcoholism and addiction are physi-
ologically identifable conditions, and the more they are understood by
medicine, the faster effective treatments are being developed for them.
As with most serious disease, the earlier treatment is started, the
better. Treatment proceeds from detoxifcation, or acute care, through
treatment using multiple approaches including pharmaceutical drugs
and continuing with follow-up care. If there is any difference, its the
frequent addition of spiritual work to the medical and psychological
ingredientsbut it still remains a step-by-step process.
Treatment can be in a hospital, a rehabilitation center, a therapeutic
community, an outpatient program, with a therapist or counselor, or
in the rooms of a support groupor a combination of some or all of
them. Wherever it happens, it begins with a separation from the sub-
stanceor detox, works through a learning phase, and looks toward
long-term maintenance of health.
The frst step in treatment for any substance abuse is detoxifcation, or
detox. Most physical addictions require this removal of the substance
from the body. While people do manage this on their own, cold
turkey, it can be extremely dangerous. It can also make treatment
diffcult to begin, because the cravings triggered by withdrawal can
cause an addict or alcoholic to give up before detoxing is complete.
Some drugs, like cocaine, dont require a physical detoxifcation but
may require early care due to intense psychological dependence.
Opening the Door
The rst step, for both outpatient and inpatient programs, is an intake
process during which professional staff will take information about
medical and personal details. For many people this is the rst time they
have seen their condition as part of a whole. And as one young addict
commented, It felt like kind of a relief to be open about stuff I always
lied about, with someone who didnt seem to judge me.
Approaches to Treatment 79
During detoxifcation, health care practitioners physically stabilize
an addicted person and get alcohol or other drugs out of his or her
system so that cravings can be lessened and treatment can begin.
Detox is almost always covered by insurance, so many consider it
a good way to begin treatment for alcoholism and addiction. (Chapter
10 details issues of paying for treatment.) In most areas, if you live
within the hospitals catchment area or service zone, you must be
admitted even without insurance. Or, if you are endangered by any
drug, you can go to the nearest emergency room, where medical staff
can evaluate your condition and if need be refer you to treatment.
Anyone concerned about anothers condition after drinking or drug-
ging should not hesitate to take him or her to a hospital or to call an
ambulance for help.
Many hospitals offer medical detoxifcation, so their services can
be widely available. To be accepted into detox a patient needs to be
drunk or actively high on another drug that requires detoxifcation.
Someone with only a cocaine or crack habit does not qualify, so if
they want help in the initial stages of recovery there must be another
drug involved to begin treatment through a detox.
Withdrawal is one of the signs of addiction: If the body overre-
acts to the removal of a substance, that shows the body has become
dependent on the substance. Since addiction is progressive, requiring
more and more to maintain a normal condition, each time an addict
or alcoholic tries to withdraw the process may be more painful. Not
only is unsupervised detoxing dangerous, but detox under medical
supervisionincluding close monitoring of vital signs, supportive
care, and medicationsis more likely to result in a successful recov-
ery because treatment can make withdrawal less painful.
Alcohol detox, which lasts from three days to two weeks, can
cause tremors (the shakes), headaches, vomiting, perspiration,
restlessness, loss of appetite, and insomnia, and, more severely,
delirium tremens (D.T.s) and seizures (convulsions). One-quarter
of detoxing alcoholics suffer seizures if not treated medically. Dur-
ing medical detox a patients vital signs are monitored regularly and
medications are administered, including Buprenex, certain benzodi-
azepines (tranquilizers such as Valium, Librium, Ativan, or Serax),
and anticonvulsants.
Drug withdrawal is caused by stopping or sharply reducing drug
intake after intense use. Reactions include sweating, tremors, head-
ache, drug craving, nausea, abdominal cramping, diarrhea, muscle
aches, and insomnia, as well as confusion, agitation, depression,
or anxiety, and other behavioral changes. Not all drugs require a
medical detox. Opiates, including heroin and methadone, do require
80 Living with Alcoholism and Drug Addiction
detox, using anticonvulsant and anti-craving prescriptions. Other
illegal drugs, such as marijuana, crystal meth, and cocaine (crack)
do not, although the psychological dependence on these substances
call for structured stabilization. Prescription drugs such as OxyCon-
tin, Xanax, Vicodin, and Lortab all require medically supervised
Rehabilitation (rehab) is the stage of treatment that offers the oppor-
tunity to develop positive motivation for recovery; stabilize health
status through longer-term withdrawal symptoms, using medications
if needed; learn skills for stopping drug and alcohol use and avoiding
relapse; gain positive incentives to encourage participation in both
treatment and follow-up programs; and learn new ways of dealing
with family and friends.
All programsresidential and outpatienthave group and indi-
vidual counseling. Many now offer medications for addiction and
Warning Signs
If you or someone you know displays the following symptoms, you
should nd immediate treatment at a detox center or emergency room,
by ambulance if necessary:
intense agitation; irrational behavior
chills or profuse sweating
Source: National Institutes of Health
Approaches to Treatment 81
psychiatric problems and help patients become aware of Post Acute
Withdrawal Syndrome (PAWS) that may disturb patients during the
frst year or so of recovery. The programs are designed to provide
structure in their curriculum, trained and supervised therapists and
counselors, individualized treatment planning, and monitoring for
any alcohol and drug use during treatment. Treatment programs
arrange for continuing and follow-up care after discharge (many state
agencies require rehabilitation programs to do this). The more thor-
ough programs offer social services to help gain better employment,
deal with pending legal problems, improve parenting and marital
relationships, and even obtain drug-free housing.
Rehabilitation centers may be residential, outpatient, therapeutic
communities, long- or short-term, or support groups. A recent study
of alcohol treatment by the National Institutes of Health found that
treatment with the medication naltrexone, when combined with
brief counseling from a doctor or nurse, was as effective as up to
20 sessions of specialized alcohol counseling. Detoxifcation from
many drugs can be accomplished fairly quickly, and with the help of
medication, but the psychological dependence is so strong that longer
treatment is needed for lasting recovery.
Virtually all current research shows that a combination of treat-
ments, with pharmaceutical support as necessary and professional
counseling plus follow-up connection with support groups, works the
best and for the longest time. Remember how the disease is described
as mental, physical, and spiritual? The treatments have to cover all
those aspects: physical detox alone, medication alone, psychotherapy
alone, or spiritual energy gained from religious experiences or sup-
port-group fellowships alone arent as effective as the interaction of
all those ingredients.
Research sponsored by agencies of the National Institutes of
Health fnds that most inpatient treatment and longer-term inten-
sive outpatient programs, which include regular monitoring against
alcohol or drug use, work equally well. Combining medication use
with professional counseling followed up by specialized support
groups like NA or AA or the non12-step groups fosters the longest
periods of recovery. Youll fnd an inclusive list of follow-up groups
on page 135.
The elements of the treatment process are similar for any setting,
including detox. Whether rehab is inpatient or outpatient, in a facility
or with a counselor, the basics should be the same.
8Z Living with Alcoholism and Drug Addiction
Treatment planning. A frst step in any effective rehab program is
to make an individualized plan and goals for each patient. The plan
is devised to address any special circumstances, including physical
or mental conditions, personal background, and the special charac-
teristics of various drugs (for instance, cocaine/crack addiction may
need to be addressed differently from heroin or alcohol addiction). In
a general way, most approaches share similar ingredients, which are
listed below.
Counseling and psychotherapy. Earlier approaches using psy-
chotherapy for substance use disorders stressed long-term approaches
to fnding the cause of the drinking or drugging behavior in the per-
sons psyche, then eliminating that cause and thus the habit. While
that approach may be practiced somewhat today, much more effective
in both individual therapy and treatment facilities are techniques of
behavioral therapy, which address recovery from the disease of addic-
tion rather than from a specifc drug.
Cognitive-behavioral therapy (CBT) works from the idea that feel-
ings and behaviors are caused by a persons thoughts rather than out-
side infuences. People may not be able to change their circumstances,
but they can change how they think about them and, therefore,
change how they feel and behave, according to cognitive-behavioral
therapists. The goal of CBT is to teach the person to recognize situ-
ations in which he or she is most likely to drink or use drugs, avoid
these circumstances if possible, and cope with other problems and
behaviors that may lead to his or her substance abuse problemsand
to learn or relearn better coping skills.
Motivational interviewing (MI) is a client-centered approach to help-
ing people move through the stages of change. Motivational enhance-
ment therapy (MET) is a technique based on MI that was developed
specifcally for addiction treatment, with the assumption that the
responsibility and capacity for change lie within the client. The thera-
pist works with the client to set and achieve treatment goals.
Combined medications and behavioral therapy. Research shows
that this combination works best for treatment of addictions, and today
increasing numbers of facilities and programs employ this multifaceted
approach. The process is usually short-term. Although other forms of
therapy and psychoanalysis can take years, cognitive-behavioral ther-
apy is usually completed in 12 to 16 sessions with the therapist.
As with other treatments for alcoholism and drug abuse, cognitive-
behavioral therapy works best when combined with other recovery
efforts, such as participation in support groups.
Approaches to Treatment 83
Socialization. An important part of treatment is the enhancement of
social skills that have usually been ignored or undeveloped during a
life of addiction. Group therapy and the promotion of group activities
are central to inpatient and outpatient programs, which focus on the
lifestyle changes necessary for preventing the return of the problems.
Old-fashioned potions and powders were part of treatment for
chronic drunkenness for hundreds of years, without much effect.
Twentieth-century medications included formaldehyde and vitamin
shots, and later Antabuse, which makes people violently ill when
they drink. Until quite recently, most so-called drunks were just
dried out or sent away to a so-called farm to separate them from
the alcohol for a time. Given the lack of chemical treatments, counseling
became the leading technique, especially after it was realized that jail-
ing alcoholics did little, and support did a lot. More recently, perhaps
Treatment by the Numbers
According to the National Survey on Drug Use and Health, of the 4
million people aged 12 or over who received some kind of treatment
in 2006:
2.2 million received treatment at a self-help group.
1.6 million received outpatient treatment at a rehabilitation
1.1 million received outpatient treatment at a mental health
934,000 received inpatient treatment at a rehabilitation facility.
816,000 received inpatient treatment at a hospital.
610,000 received treatment at a private doctors ofce.
420,000 received treatment at a prison or jail.
297,000 received treatment at an emergency room.
84 Living with Alcoholism and Drug Addiction
because of the rise in drug addiction late in the 20th century, alcohol-
ism and addiction have become the subjects of serious research, with
new drugs resulting from some of that study. In addition to medi-
cations to ease the process of detoxifcation, medications for treat-
ment of opiate addictionlevo-alpha-acetylmethadol (LAAM) and
naltrexoneare available, and an increasing variety of preparations
have been developed to help nicotine addicts. In some cases, medica-
tions developed for one addiction have proven useful for another. For
example, naltrexone, which blocks the high from heroin to help users
stay clean, is now also proving to be effective in treating alcoholism.
For multiple addictions. Since most people seek treatment for
both alcohol and drug addiction to more than one drug, some com-
bined approaches to treatment are effective, using medication and
therapy to deal with all of a patients addictions.
The Prescription Connection
Some drugs can help addicts and alcoholics deal with their symptoms
and cravings.
Antabuse (disulram) causes intense nausea and vomiting
when a patient drinks, intended to act as a deterrent.
Naltrexone was designed to lessen opiate dependency and
has been found to reduce alcohol dependence and opioid
addiction. Naltrexone is sold under the brand names ReVia,
Depade, and Vivitrol. For those who are addicted to opioids,
naltrexone works by blocking the effects of drugs like heroin
in the brain. It is not fully understood how naltrexone works
to reduce the craving for alcohol, but it is thought to affect
dopamine levels.
Campral (acamprosate) is the most recent medication
approved for the treatment of alcohol dependence or
alcoholism in the United States. It works by reducing the
physical distress and emotional discomfort people usually
experience when they quit drinking.
Methadone and LAAM, used in maintenance treatment for
heroin addiction, are heroin substitutes that are deemed
safe and effective medications for opiate addiction when
administered by mouth in regular, xed doses.
Acupuncture, an ancient form of treatment developed in China
that makes use of small needles, has been shown to reduce
drug and alcohol cravings when administered properly. It is
offered in some states treatment centers.
You may see claims about other, less well-recognized alternatives to
medical treatments for alcoholism and addiction. Beware of any big prom-
ises. The treatments that are in use have taken a long time to develop.
Be wary of medications offered for the treatment of cocaine, marijuana,
tranquilizer, or methamphetamine dependence; the U.S. Food and Drug
Administration has not approved any medications for these problems.
Ask to see the evidence for the effectiveness of these medications.
No matter how good the medications and other treatments may be,
people must be willing to use them appropriatelyno treatment works
by itself.
Approaches to Treatment 85
Increasing numbers of patients come in with comorbid or co-occur-
ring conditions, meaning that they have emotional or serious physical
problems as well as their addictions. Alcoholism and addiction can
cause various medical and psychiatric conditions or increase their
severity, including liver disease and heart trouble. These need treat-
ment. Alcoholics and addicts tend not to eat properly, so nutrition
needs to be improved.
HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious
diseases are all commonly associated with alcohol and drug abuse,
so counseling is needed to help patients modify or change behaviors
that place themselves or others at risk of infection.
Addiction and alcoholism themselves are categorized as mental
illnesses, and health care practitioners traditionally may not look
beyond the substance-abuse symptoms. That is changing in many
Some drugs can help addicts and alcoholics deal with their symptoms
and cravings.
Antabuse (disulram) causes intense nausea and vomiting
when a patient drinks, intended to act as a deterrent.
Naltrexone was designed to lessen opiate dependency and
has been found to reduce alcohol dependence and opioid
addiction. Naltrexone is sold under the brand names ReVia,
Depade, and Vivitrol. For those who are addicted to opioids,
naltrexone works by blocking the effects of drugs like heroin
in the brain. It is not fully understood how naltrexone works
to reduce the craving for alcohol, but it is thought to affect
dopamine levels.
Campral (acamprosate) is the most recent medication
approved for the treatment of alcohol dependence or
alcoholism in the United States. It works by reducing the
physical distress and emotional discomfort people usually
experience when they quit drinking.
Methadone and LAAM, used in maintenance treatment for
heroin addiction, are heroin substitutes that are deemed
safe and effective medications for opiate addiction when
administered by mouth in regular, xed doses.
Acupuncture, an ancient form of treatment developed in China
that makes use of small needles, has been shown to reduce
drug and alcohol cravings when administered properly. It is
offered in some states treatment centers.
You may see claims about other, less well-recognized alternatives to
medical treatments for alcoholism and addiction. Beware of any big prom-
ises. The treatments that are in use have taken a long time to develop.
Be wary of medications offered for the treatment of cocaine, marijuana,
tranquilizer, or methamphetamine dependence; the U.S. Food and Drug
Administration has not approved any medications for these problems.
Ask to see the evidence for the effectiveness of these medications.
No matter how good the medications and other treatments may be,
people must be willing to use them appropriatelyno treatment works
by itself.
86 Living with Alcoholism and Drug Addiction
settings, and today psychiatric issues are looked for more frequently.
In some instances, patients may use alcohol or drugs in an attempt
to medicate their psychiatric or emotional problems, making the
substance that much harder to give up. In some cases, the emotional
problem is a cause of the addiction; in other cases, addiction triggers
psychiatric illness. Both types need treatment, yet in many rehab
settings, patients are not even screened for psychiatric problems.
Psychiatric disorders that are associated with alcoholism and
addiction include
antisocial personality disorder
bulimia, an eating disorder
anxiety and panic disorders
bipolar disorder
Whether these conditions are causes or results of substance use
disorders, they need to be treated along with the SUD. Medications
like antidepressants and mood stabilizers may be critical for treat-
ment success when patients have co-occurring mental disorders.
As you know by now, alcoholism and addiction are not simple to
explain or easy to treat using cookie-cutter treatment plans. So it
should be no surprise that some of the approaches to managing them
are also less scientifc in their defnitions. Despite all the research
and new developments in scientifcally sound treatment for addiction
and alcoholism, the success of a recovery program comes down to
two simple factors: attitude and time.
Attitude. To beneft from treatment, a patient has to want it, and
be willing to participate in the recovery program. Many teenagers
are pressured into treatment before they are fully ready. Effective
programs and therapists use intervention and behavioral therapy to
increase motivation. Nonprofessional recovery programs urge new
participants to keep the negative aspects of their substance use fresh
in their minds and to work to care about themselves enough to stay
clean. But if you are entering treatment it all comes down to this: Do
you want to stay clean more than you want to get high?
Time. Whatever treatment you receive, the longer you stay in treat-
ment, the more likely you are to succeed. This commonsense obser-
Approaches to Treatment 87
vation is supported by research funded by the National Institute on
Drug Abuse (NIDA). Those studies showed that alcohol treatment
for 90 days or drug-use treatment for up to 18 months is the most
Funding for such long stays can be diffcult to fnd, which is
another reason why combining multiple approaches is effective. For
instance, a few days in detox followed by a relatively short stay in
residential treatment (long enough to stabilize an addict or alcoholic
and determine what medications might be needed), followed then
by outpatient sessions and an introduction into an ongoing support
I had been in trouble with drugs and booze since I started drinking
when I was 12 years old. I had a lot of stepfathers, and we moved a lot,
so I didnt do very well in school. So, of course, I had a lot of people to
blame my troubles on. I was mad all the time and made my mother even
madder. I got sent to reform school, put in boot-camp programs, sent
to a mental hospital. All I ever wanted to do was get out. They made
me go to rehab a couple of times too, and Id just leave as soon as I
began feeling better. When I turned 18, things got more serious and I
was given a choice between jail and rehab. It was a hard choice, really.
But what that did was to force me to stay in the rehab a little longer
than before. A therapist there decided I had Post-Traumatic Stress Dis-
order because of a lot of bad stuff in my past, and they gave me some
medication that seemed to keep me calmer and clearer. I was able to be
still and listen more, and I heard people talk about stuff they had gone
through and how drugs helped and then hurt themand what they were
doing about it anyway. I got to see older people who were in really bad
shape from drinking their whole lives. And that made me begin to think
maybe I wanted to choose a better life for myself. I tried doing what the
rehab people asked me to do, and I began talking about my own stuff. I
felt better and began getting hopeful about going back to school when
I got out. Thats what Im doing. And I keep taking those meds and am
going to support groups. So far, so good!
Sandras Story: Honesty,
Open-Mindedness, and Willingness
88 Living with Alcoholism and Drug Addiction
group can add up to as much time as the extra-long-term treatment
that was once commonplace.
The benefts of early focused professional or nonprofessional treat-
ment are backed up by research that shows physiological realignments
in the brain require three months. And data on PAWS (Post Acute
Withdrawal Syndrome) indicate it can last at least one year. Alcoholics
Anonymous and Narcotics Anonymous have customarily urged their
new members to attend meetings daily for 90 days and to stay espe-
cially close to program activities for the frst year of recoveryrecom-
mendations that now are supported by professional research fndings.
Addiction is called a mental, physical, and spiritual disorder, and its
treatment needs to include all three aspects. The idea of spirit con-
fuses some people and turns others off. As the next chapter will explore,
spiritual in the sense it is used here refers to those intangible qualities
that make a person unique and is an important part of treatment.
There are those who can abate their drinking and drugging by active
participation in a religious organization, but church dogma is not what
others identify as spiritual. Psychiatrist Carl Jung called alcoholism
a low-level spiritual search: perhaps because the physical and emo-
tional sensations produced by alcohol and drugs are similar to those
of spiritual experiences, or perhaps because of what addicts describe
as a hole in the soulthe big empty that needs flling up. Some
identify a spiritual experience as getting them into recovery: a radical
and inexplicable change in ones life that comes on suddenly.
Spirit comes from a Latin word for breath, and spirituality can be
something as simple as taking a deep breath of relief at letting go of
Stage of Change
Entering treatment represents the Action stage of change in the path
to recovery. HOW does it work? Recovery groups say it takes Hon-
esty, Open-mindedness, and Willingness. Whatever specic actions
are taken at this stage, a person who can be honest, open-minded, and
willing to change and learn stands a good chance for success.
Approaches to Treatment 89
destructive habits. Or it can be the act of opening up to the caring
support of another person (which means it happens even in non-
spiritual support groups).
However its defned or experienced, it has to do with beginning a
new lifeas a newborn breathes in air for the frst time. Many in recov-
ery fnd spiritual explorations to be an exciting and rewarding part of
life as recovery proceeds. Whatever it is, it is not a concept that should
discourage someone from seeking help. In fact, many treatment facili-
ties include spiritual guidance in their programs, and some research
shows that it is not about a belief in God or participation in a specifc
religion but a sense of being open to connection with a larger reality.
An important part of treatment, whether in a professional or a sup-
port-group setting, can be to help addicts get in touch with their inner
selves, to break down the barriers with others. Simply being open to
the possibility of a better life can be a spiritual experienceand the
sense of well-being that addicts or alcoholics feel as a result of being
able to stay clean can also be seen as a spiritual reward.
No matter how much pressure is on you to get into treatment, you
do have some choices, and the more input you make in the decision,
Harm Reduction
Harm reduction is a phrase used to describe approaches to alcoholism
and addiction with the goal of helping people stay reasonably safe even
if they arent able to totally stop using. For addicts, this may include
promoting needle exchange programs, for instance. For people with
moderate alcohol abuse problems who want to reduce their drinking,
this approach may be effective.
While most treatment calls for total abstinence, there are approaches
to reduce harm from drugs and alcohol by techniques like moderation
management. This calls for reduction and control of intake, which
sounds appealing to many who fear letting go of the substance but
tends to work only for people who have only recently become depen-
dent on a chemical.
90 Living with Alcoholism and Drug Addiction
the more commitment youre likely to have to it. For those who do
not go into a professional treatment program, whether by choice or
for fnancial reasons, there are alternatives. In any setting, though,
the process of recovery is similar: an initial period of withdrawal fol-
lowed by stages of stabilizing the body and learning new behavior.
Course of Treatments
Choose the word that best ts the facts in each sentence.
1. A crack addict does/doesnt need detox.
2. Someone who cant afford rehab can/cant be treated.
3. An 18-year-old alcoholic must/neednt enter a residential pro-
gram for treatment.
4. To benet from treatment an addict must/neednt hit bottom.
5. You do/dont have to believe in God to recover.
6. All drugs, including alcohol, are/arent equal.
1. Theres no detox for cocaine. Crack addicts need drug rehab.
2. Public and private insurance plans cover some treatment;
individual counseling costs less than hospitalization; support
groups work and cost nothing.
3. Unless he or she is mandated by some legal authority, he or
she can nd treatment in a variety of formats.
4. With current medical and psychiatric approaches, anyone will-
ing to get better can.
5. While effective treatments often have a spiritual component, spe-
cic beliefs or nonbeliefs dont matter. Even the Twelve Steps
power greater than ourselves doesnt need to mean God.
6. Treatment deals with the disease of addiction and needs to
take different approaches for different substances because of
differences in their causes of addiction and effects.
Approaches to Treatment 91
Try seeing a private practice psychiatrist, psychologist, or
counselorone who is trained and licensed to deal with addic-
tive issues.
Try medication under a doctors supervision, with counseling.
Try AA or other types of groups. Many people get clean and
sober just by going to group-support meetings. Research shows
they work even better in combination with other treatment
efforts. Try moderation management. If the abuse disorder
is fairly new or mild, it may be possible to turn it around.
Start with an outpatient program: If more independent efforts
dont work, outpatient is the next step. Its the most common
approach for teens, and the approach most likely to be covered
by insurance.
Unless a persons state of health is dangerously critical due to addic-
tion, trying out different types of treatment can be a good learning
experience: One less intense form of treatment may work, or the sub-
stance abuser can learn frsthand how much extra help is needed.
Whatever form of treatment is chosen, it is a new beginningjust
a beginning. As a director of a well-respected treatment program says,
We get people ready to begin recovery.
Treatment of alcoholism and addiction is more effective than it
ever has been, and the earlier in the stages of substance abuse
treatment begins, the better.
Outdated attitudes still make the public want to punish or
cover up the disease.
Treatment does not have to be voluntary to be effective, and a
patient does not need to hit bottom to beneft.
There are effective medications for the treatment of nicotine,
opiate, and alcohol addiction. There are effective individual
psychotherapies for the treatment of virtually all addictions.
Medical detoxifcation is only the frst stage of addiction treat-
ment and by itself does little to change long-term drug use.
The most effective treatmentsthe ones that result in the lon-
gest periods of sobrietyare those that combine professional
counseling and medical attention with ongoing participation in
support programs.
that Theres no cure, so whats the point? Meanwhile, Mary Annes
family and friends thought that after rehab shed be a normal
drinker, and they couldnt understand why she still wouldnt drink.
Embarking on the path to recovery from a substance use disorder
marks a turning point for anyone. Whether by entering treatment or
by joining a support group, recovering alcoholics and addicts fnd
that life is not the same, either for them or for those around them.
Once the initial phase of separation from the substance is over, many
people feel a sense of relief. While they were using, withdrawal for
even a short time was painful, so theyre happy to get through what
seems like the hard part. But as noted earlier, SUD treatment is really
about making a major life change. The action phase of change
began upon entering treatment. It continues after treatment, when a
person in recovery enters the maintenance stage, focusing on con-
tinuing the new behavior.
Addiction can be treated, but, with no cure currently available, it
must be managed over the long term. In this respect, its like diabe-
tes, hypertension, or many other disorders. For instance, anyone who
has to have a gall bladder removed will need to watch his or her diet
for the rest of his or her life. Even a broken leg can affect the way
Managing Alcoholism
and Drug Addiction:
Life After Treatment
Managing Alcoholism and Drug Addiction: Life after Treatment 93
you manage your body for the long term. Its the same for long-term
management of a substance use disorder.
In the case of SUD recovery, follow-up is an essential part of treat-
ment. Planning for continuing careincluding ongoing participation
in a support groupis a necessary part of professional treatment
programs. Those who begin recovery without professional help
are strongly encouraged to get involved in their support groups on
a daily basis for at least a few months, to get a good start. In the
early months, the addicted brain is still reworking the electrochemi-
cal connections that were the basis for addiction, so newcomers to
recovery need to work hard to keep moving away from the addic-
tion. They need to learn new patterns of behavior as well, while at
the same time taking care of their physical and medical needs. So
the more support they can get, from therapists, peers, and family,
the better! As they move on to further stages of recovery, the inten-
sity of need decreases, but theyve learned through early practice
how to make use of a variety of assistance to stay on an even keel
while navigating life.
Whatever the format of treatment used to begin recovery, a combi-
nation of efforts can be used to maintain it. Continuing all the good
youre doing for yourself is the best way to keep life moving in a posi-
tive direction. Does that mean going to those meetings?
Support groups. Recovery experts are in almost universal agree-
ment that becoming part of a focused support group is a critical aspect
of staying clean and sober. To avoid any misconceptions, though, be
clear: those meetings are not just Alcoholics Anonymous (AA). A
huge number of support groups, in the AA model as well as others,
are available.
Being able to connect with people who have experience similar
to yours can help you get from one stage to another in the process
of moving away from substance abuse. When cravings or a desire to
get high kick in, a fellow addict is the most likely to understand. But
those meetings are not just about maintaining recovery. When you
fnd the group thats right for you, youll fnd tremendous support and
companionship for all aspects of life, and youll enjoy the kind of fun
that is only possible among people who share a deep understanding
of each other.
Managing Alcoholism and Drug Addiction: Life After Treatment 93
94 Living with Alcoholism and Drug Addiction
References to 12-Step support groups can cause some confusion.
The Twelve Steps were conceived during the early years of Alcohol-
ics Anonymous as a pattern of recovery based in part on principles of
older personal development groups.
1. We admitted we were powerless over alcoholthat our
lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could
restore us to sanity.
3. Made a decision to turn our will and our lives over to the
care of God as we understood Him.
4. Made a searching and fearless moral inventory of
5. Admitted to God, to ourselves and to another human being
the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects
of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became
willing to make amends to them all.
9. Made direct amends to such people wherever possible,
except when to do so would injure them or others.
10. Continued to take personal inventory and when we were
wrong promptly admitted it.
11. Sought through prayer and meditation to improve our
conscious contact with God, as we understood Him,
Teens in Recovery
Young people were once a tiny minority in recovery meetings, and old-
timers were known to make fun of them. More recently, support groups
have tended to welcome them, and they have found and created groups
among their peers.
A 23-year-old celebrating four years of sobriety comments, Instead
of thinking that being young is a handicap, Im glad I have my whole life
ahead of me, and its already an adventure.
Managing Alcoholism and Drug Addiction: Life after Treatment 95
praying only for knowledge of His will for us and the
power to carry that out.
12. Having had a spiritual awakening as the result of these
steps, we tried to carry this message to alcoholics, and to
practice these principles in all our affairs.
They have been adopted and adapted by hundreds of other orga-
nizations with the goal of helping members overcome addictions and
other serious diffculties. For these groups, the process outlined in the
steps has been successful as a means to separate from self-destruc-
tive behaviors. It begins with the admission of an awareness that a
serious problem exists that the sufferer cant solve alone. A willing-
ness to seek help then opens the way to a process of major personal
change. The God referred to is a concept that varies from individual
to individual and can be a deity as taught by a formal religion or a
less well-defned spiritual force.
This combination of structure with fexibility probably helps people
of all backgrounds to use the steps as a pathway to change. Groups
based on the 12-step approach also use the mutual self-help pat-
tern, which means that members help each other as a way of fnding
strength themselves. They do not make use of facilitators or other
professionals but are self-organized. Organized support groups have
proven to be of great value in helping people through personal crises,
including addiction.
Psychotherapy. Support groups do notand are not supposed to
provide psychotherapy or medical advice. Many people, especially in
early recovery, fnd therapy useful. Once the mind is clear of alco-
hol and drugs, they fnd that psychotherapy can provide important
insights as well as guidance toward healthy recovery.
Medication. Physicians or psychiatrists can prescribe the medica-
tions that many people in recovery fnd necessary or helpful. Some-
times when people begin to feel better, they stop taking their meds,
and that can lead to relapse or worse. Sometimes even support-group
members discourage the use of prescriptions, as if their special method
is the only way that works. Watch out! Its important to continue with
medications as long as a doctor considers them necessary.
Moderation. Often people in early recovery go overboard in their get-
ting better activities, just as they did in their drug use. For instance,
some exercise is good to stimulate the brain chemicals that lift your
mood and help your body feel better, but too much can actually stir up
Managing Alcoholism and Drug Addiction: Life After Treatment 95
96 Living with Alcoholism and Drug Addiction
more stress hormones than is good for you, and overexercise can lead
to unhealthy over-fatigue. Likewise, improving nutrition is important,
but going on radical diets when the body is still trying to get back in
balance is not a good idea. People in early recovery are advised to treat
themselves as they would a friend who is just getting over a bad case
of fueat well, rest well, and be good to themselves.
Whats fun? If recovery were about only meds, meetings, modera-
tion, and maintenance, it would get pretty boring pretty fast. And if
its boring, who wants it? Not many peopleespecially young people
who have gotten used to a regular dose of more than a little excite-
ment. So making plans for having a good time is important. Think
about taking some of the money you would have spent on getting
high and using it for high-tech or travel or whatever gets you excited.
As one teen in recovery says, As long as I dont drink, I can do any-
thing legal I want.
Most Likely to Succeed
Which new recovery addicts are the most likely to stay clean and
1. Tony hangs out with his old friends, drinking soda. He says
theyre cool with his recovery.
2. Marisa blames her family for her pain but has begun family
therapy with them.
3. Alex has gone back to school, started a new job, and joined
the gym. He doesnt have much time for meetings.
4. Chandra took a leave of absence from school and decided to
stay in her outpatient program for a while.
5. Ken says he really doesnt like having to go to the NA meetings
that the court mandates, but hes beginning to make friends.
6. Stephanies family is so happy shes sober that theyre plan-
ning a homecoming party for her and have bought tickets for a
Walt Disney World trip.
7. Craigs new support group has told him that the medications
hes on mean hes not clean, so hes weaning himself off them.
Answers: Each example has something positive and something less
so. The most likely to stay clean would be numbers 4 and 5: Chandra
may need to lighten up a little, and Ken should stick with meetings till
he wants to go to them and so see those friends. As for the others:
Its good that number 1, Tony, is drinking soda, but hanging with his
old friends can lead to trouble. Marisa, number 2, has negative feel-
ings but is dealing with them in a positive way. Its good to be ener-
getic, as in example 3, but Alex needs to keep his priorities in order.
Stephanie, number 6, is lucky to have a supportive family, but they
need to be aware of the more basic needs of early recoverypartying
may not be what she needs at rst. Finally, its good that Craig, num-
ber 7, is attending meetingsbut no support group can tell anyone
to go off medications that a doctor deems necessary. Prescription
drugs taken as prescribed maintain the balance of many in recovery;
they are not relapses.
Managing Alcoholism and Drug Addiction: Life after Treatment 97
Attitude counts. Someone who thinks in terms of giving up his
favorite substance and feeling sorry for himself is not going to enjoy
life after treatmentand if hes not enjoying life, hes likely to pick up
again. Someone who is constantly envying others who can drug has
lost the focus on what she can do, and even if she doesnt pick up again
can make herself miserable. People in recovery who are enjoying their
lives are the ones who manage to be grateful for being free from their
addictions and can focus on what they have rather than on what they
dont have.
People in early recovery are cautioned about staying away from the
people, places, and things that are associated with their substance
abuse. Alcoholics need to stay out of bars and liquor stores. Addicts
need to stay away from the drug spot. Its also a good idea to take a
Which new recovery addicts are the most likely to stay clean and
1. Tony hangs out with his old friends, drinking soda. He says
theyre cool with his recovery.
2. Marisa blames her family for her pain but has begun family
therapy with them.
3. Alex has gone back to school, started a new job, and joined
the gym. He doesnt have much time for meetings.
4. Chandra took a leave of absence from school and decided to
stay in her outpatient program for a while.
5. Ken says he really doesnt like having to go to the NA meetings
that the court mandates, but hes beginning to make friends.
6. Stephanies family is so happy shes sober that theyre plan-
ning a homecoming party for her and have bought tickets for a
Walt Disney World trip.
7. Craigs new support group has told him that the medications
hes on mean hes not clean, so hes weaning himself off them.
Answers: Each example has something positive and something less
so. The most likely to stay clean would be numbers 4 and 5: Chandra
may need to lighten up a little, and Ken should stick with meetings till
he wants to go to them and so see those friends. As for the others:
Its good that number 1, Tony, is drinking soda, but hanging with his
old friends can lead to trouble. Marisa, number 2, has negative feel-
ings but is dealing with them in a positive way. Its good to be ener-
getic, as in example 3, but Alex needs to keep his priorities in order.
Stephanie, number 6, is lucky to have a supportive family, but they
need to be aware of the more basic needs of early recoverypartying
may not be what she needs at rst. Finally, its good that Craig, num-
ber 7, is attending meetingsbut no support group can tell anyone
to go off medications that a doctor deems necessary. Prescription
drugs taken as prescribed maintain the balance of many in recovery;
they are not relapses.
Managing Alcoholism and Drug Addiction: Life After Treatment 97
98 Living with Alcoholism and Drug Addiction
look at friendships: Which friends are supportive of recovery and which
are pals from using? Does this mean locking yourself up away from the
world? No. It means taking a new look at friends, parties, entertain-
ment, and hobbies and fnding ways to enjoy them, substance-free.
Dream a little. What do you really want to do with your life?
Once past the demands of maintaining a drinking or drugging habit,
teens in recovery fnd they can reach almost any goal they set for
themselves. Sean is a writer who had to fnd other work to support
his habit, then had to fnd some recovery before he could return to
his writing career, but he persisted and has seen success. For Rita
whose dreams of being a musician had to wait till shed been clean
for a whilethe experience of getting clean has helped her work and
her career. Harold is a good enough pool player to go professional,
he saysbut hes willing to wait till he feels comfortable going into a
pool hall without drinking. Whats your dream?
What about spirituality? Research has shown that spiritual expe-
riences increase the time away from a drink or a drug. For many in
recovery, it becomes an adventure in itself. As one young woman in
recovery observes, Today I dont need alcohol or drugs to fee from
their shadows. My recovery journey continues to deepen my experi-
ence of self and my fullness of living. I wouldnt miss this adventure
for the world!
Though some equate spirituality with religion (which is one reason
people who object to religious ritual organize their own groups), others
note the spiritual aspects of addiction. They note a similarity between
the experiences of getting high, which has been called a counterfeit
spirituality, and spiritual transcendence. Part of recovery is fnding new
ways to achieve those experiences. Some may fnd that new experiences
with music take them out of themselves; others turn to art or hikes in
the woods. Spirit comes from the Latin word for breath, one recover-
ing alcoholic explains, and I look for experiences that take my breath
away. A spiritual journey also contributes to a sense of purpose in life,
which can be exciting, and also keeps people in recovery. Researchers
found that this spiritual adventure is not about religion, not connected
with AA or its like, and not necessarily a matter of believing in one
interpretation of God or even belief in a God of any kind. Rather, they
found, it is about a pursuit of new and unique experiences.
There are highs and lows in recovery, a recovering addict com-
ments, but so far I havent had to fall back on my drug of choice.
Managing Alcoholism and Drug Addiction: Life after Treatment 99
Is relapse failure? Relapsea returning to older behaviors and
abandoning changes, at least for a timeis one of the recognized
stages of change. This doesnt mean everyone has to temporarily
return to old behavior as part of recovery, but it happens often. By
some estimates, approximately 90 percent of alcoholics are likely to
experience at least one relapse over the four-year period following
treatment. People with other chronic diseases also relapse frequently,
so its not unusual, but it remains a major challenge in treatment.
Early in sobriety, news articles, TV commercials, smells, and songs
play on the brains uncertain state, but that trigger mechanism fades
over time. People with long periods of recovery note that the triggers
fade, and brain studies confrm that: Cues that stimulate the addictive
regions of the brain in early recovery get little or no response in brains
of people with long-term recovery. NIDA researchers report that the
brain remains sensitive to triggers, and until a way is found to change
that, what is needed is to train the other parts of the brain to out-
weigh the addictive messages.
With other chronic diseases, relapse serves as a signal for returning
to treatment. The same response is just as necessary with drug addic-
tion. As a chronic, recurring illness, addiction may require repeated
treatments until abstinence is achieved.
Relapse can be viewed as a learning experience, if only as a way
of showing that a particular person cant be a controlled or moderate
userbut a return to drug or alcohol use can also be dangerous.
How Recovery Works in the Brain
When the brains limbic system is deprived of the drugs that have given
it extra boosts, it begins to retrain itself to produce more dopamine on
its own. Neural connections in the parts of the brain that exert judg-
ment also need time away from addictive drugs to reestablish. So the
suggestions for forming new habits and behaviors in early sobriety have
the effect of giving the brain time to reestablish normal connections.
Research continues on whether some changes in the brain from addic-
tion are permanentespecially when addiction has begun during early
Managing Alcoholism and Drug Addiction: Life After Treatment 99
100 Living with Alcoholism and Drug Addiction
Tools that exist to postpone or prevent relapse and to counter those
triggers include:
drugs like acamprosate and naltrexone, used to prevent relapse
desensitization programs help people learn to be calm around
avoidanceearly on, staying away from triggering situations is
timecravings along with the risk of relapse lessen greatly
over time, apparently as new brain patterns are established
What is success? If relapse is not about failure, then what is
success in recovery? Some research would say one year without
the use of a chemical substance; other research would say fve
years. Experts describe three levels of sobriety: earlyfrom one to
12 months of abstinence; sustainedone to fve years of abstinence;
One Denition of Recovery
A voluntarily maintained lifestyle characterized by sobriety, personal
health, and citizenship. This is the working denition of recovery agreed
upon by a panel of interested researchers, treatment providers, recov-
ery advocates, and policymakers convened by the Betty Ford Institute,
an addiction recovery center. Many people are able to quit drinking or
taking drugs and feel that this is all that is required to achieve recov-
ery. The Betty Ford panel of experts believes, however, that more is
required to achieve a sustained, stable recovery from alcohol or drugs.
Achieving the other components of recoverypersonal health and
citizenshipaffects not only the person trying to recover, but his or her
family, friends, and society as a whole. Personal health refers not only
to physical and mental health, but also to what they call social health,
or active participation in family and social roles.
Source: The Betty Ford Institute Consensus Panel. What Is Recovery? A
Working Denition from the Betty Ford Institute. Journal of Substance Abuse
Treatment, October 2007.
Managing Alcoholism and Drug Addiction: Life after Treatment 101
and stablemore than fve years of sobriety. The longer one stays
safe from destructive chemicals, the better, but rather than put a time
limit on the absence of drugs, many people in recovery look to the
enhanced quality of life they experience as the mark of success. If
treatment is about dealing with the disease, recovery is about a lot
more: Its about recovering life. Someone who can see sobriety as the
opportunity to do new things has a chance to start a new and excit-
ing life. Over time, it is the comparison of the positive quality of life
to the negative experiences during active addiction that reinforces an
addicts ability to maintain recovery.
When you take the big life-changing step into recovery, it may seem
that your whole world should shake. Usually, life goes on and the
recovering alcoholic or addict needs to adapt to that. The new life
may be complicated by old patterns of family and friends.
Rocking the boat. Its useful to think of your life as a rowboat. It
may have gone through some choppy seas and not been the easiest
of rides, but everyone you know has a seat in that boat. When you
get out, to go into treatment, you set the boat off balance. Now that
youre back, family and friends may be looking to you to get back in
that same seat. But its important that you let them get that boat back
in balanceyou dont need to take up your old patterns.
On the other hand, recently treated substance abusers would be
unrealistic to think that family and friends are guaranteed to meet all
their needs. After treatment and during early recovery, the body is
still going through changes and needs to be treated with care, and in
early recovery stress should be avoided. If youre lucky your family
and friends will be supportive but laid-back about your new way of
life. But its understandable that they may resent having to go out of
their way to make life easy for someone who may not have made their
lives easy during active addiction.
Family and friends. A new study by the State University of New
York reports that offering understanding and encouragement to
those with drinking problems is the best approach family members
can take in dealing with the problem. That may be the ideal, but
many newcomers to recovery fnd that those around them respond to
their new status not so positively. Family and friends may relate to
newly recovering young people in a range of styles, from walking on
eggshells to healthy support to sabotage that can result in relapse for
Managing Alcoholism and Drug Addiction: Life After Treatment 101
10Z Living with Alcoholism and Drug Addiction
the addict or alcoholic. Says Don M., My family just didnt under-
stand why I had to go to meetings! They said they saw less of me
than when I was using. They made it tough for meespecially since
I needed rides to meetingsuntil four relapses convinced them that
taking that time for myself was worth it!
The next chapter goes into more detail about the family dynamics
of recovery, but anyone wondering why his family isnt welcoming
him back with open arms after treatment might learn from some of
those surveyed by USA Today and HBO in 2006.
Seven out of 10 U.S. adults who have a family member suf-
fering from the disease of drug or alcohol addiction say that a
family members addiction has had a major or minor effect on
their emotional or mental health.
Almost one in 10 of those who say a family members addic-
tion has had a major negative impact on their fnancial situa-
tion say they have had to take out a loan or run up credit card
bills as a direct result of this addiction.
About a ffth of those who say a family members addiction
has had a major negative impact on their marriage, family
relationships, or emotional health say they sought professional
New connections. The need to pull away from old relationships
provides another argument for connecting with support groups. More
than 1 million Americans seek recovery only from support groups
each year, and research sponsored by the National Institute on Alco-
hol Abuse and Alcoholism attributes their benefcial effects in part to
the replacement of the participants social network of drinking friends
with a fellowship that can provide motivation and support for main-
taining abstinence.
There are also online groups and meetings. Check out http://www. or for an example of
12-steps in cyberspace. Youll fnd e-mail meetings, live-chat rooms,
and support and processes similar to face-to-face meetings. Online
support groups are handy for people with disabilities, and theyre a
good way to show family and friends what groups are like. They may
also be especially attractive to teens.
Luckily people in recovery have a lot of new friends with whom to
spend time. Those whove been around a while can tell you that life
Managing Alcoholism and Drug Addiction: Life after Treatment 103
is richer, more rewarding, easier, and more fun than it was while
chained to their drug of choice.
One of the big fears that keep people out of treatment is fear of
life without the substance. While addicted, separation from the sub-
stance for even a short time can be painful, so its hard to imagine a
happy life without it. But those who take the chance say its worth
the effort.
Substance abuse was for most addicts and alcoholics a 24-7 activ-
ity, so their recovery needs to mean more than just staying clean and
going to meetings. Luckily, young people will always fnd ways to
have funand there are those who say clean and sober fun is better
than the other kind. It can be more intense, they say, and it has no
downsides of hangovers or arrests.
Young people in AA began networking not long after the organi-
zation was founded in 1935, and today there are Young People in
Alcoholics Anonymous groups socializing throughout the United
States. Their international organization says it provides visible evi-
dence that large numbers of young people are achieving a lasting and
comfortable sobriety in Alcoholics Anonymous. Other examples of
clean and sober fun include sober cruises, retreats, and matchup sites.
Old friends may be among those you have to stay away from, or they
just may not quite understand your new outlook. So it becomes even
more important to be open to forming new friendships.
Recovery is an ongoing process.
Family and friends may or may not be of help, but support
groups are needed.
Fun, adventure, and dreams are important to life in recovery.
Relapse is common and is not the end of recovery.
Spirituality in various forms is part of the recovery adventure
for many.
Recovery is about more than not using; its about recovering
Managing Alcoholism and Drug Addiction: Life After Treatment 103
Alcoholics and addicts need a lot of help. As youve
read, they often need more help than they realize. They need help
before they get treatment, and they need help after. Whats interest-
ing is no matter how diffcult their disease can make them, there are
always plenty of people ready to help themand a lot of those people
need support too.
This story may seem familiar: Rachel and Andy had done a lot
of partying togetherand it was often fun, if not the kind of thing
theyd tell mom and dad about. Rachel still managed to go on with
her straight lifedoing pretty well in school and making plans to go
to college. But Andy was having a hard time. He was in trouble at
school for not showing up, in trouble at home for failing at school,
and in trouble with his old friends for being in trouble, and into a lot
of drugs Rachel hadnt even heard of. Rachel wanted to help him.
Whether its a friend or family member, helping an addict or alco-
holic can sometimes be a tricky business. If an addict is not ready
for recovery, theres little anyone else can do to force it. Even helping
another to inch closer to treatment can require a careful balancing act
to be sure you arent hurting yourself more than youre helping the
other person.
Helpers usually take approaches that range from enabling to
intervention, with the most effective being support. If theres an
addict or alcoholic in your life, whether one needs treatment or has
completed treatment, you may well want to seek help for yourself.
Helping a Friend or Relative
Helping a Friend or Relative 105
If there is an alcoholic or addict in your life, you are not alone: Its
estimated that each substance abuser directly affects four other
peoplefamily, friends, coworkersand each of those affects a wider
circle of people. Think about it: How many people feel direct impact
from the behavior of alcoholics and addicts that you know? In the
2006 USA Today/HBO survey of family members of alcoholics, many
respondents say the effects of the addiction are emotional and
Enabling. Given that description of the effects of addiction, it seems
especially puzzling that so many people will bend over backwards to
help the addict or cover up his or her behavior. If Rachel, in wanting
to help Andy, goes out of her way to cover up his addiction and even
Finding Bottom
It was once thoughtand is still widely believedthat an addict or
alcoholic had to hit bottom (lose everything) before seeking help.
People do have to be ready to benet from treatment, but they can be
persuaded to move closer toward it.
In a poll conducted in 2006 by Gallup for USA Today and HBO,
just over half of the respondents say the addicted family member has
admitted their addiction to them, while just under half say they have not.
Seven out of 10 of the respondents say they have personally confronted
the family member about the addiction. Family support/pressure was
most often cited as the primary reason the family member was able to
overcome addiction.
As a teen, you may have even more inuence: According to the
White House Ofce of National Drug Control Policy (ONDCP), 68 per-
cent of teens said they would turn to a friend or sibling about a serious
problem related to substance abuse. This means that when you talk,
your friends will listen.
106 Living with Alcoholism and Drug Addiction
help him get drugs, she is said to be enabling him. She means to
be helping, but in fact she is hurting him by allowing his addiction
to continue.
Enabling isnt limited to providing someone with a substance or
a cover-up. Family and friends of addicts and alcoholics take on a
variety of unhealthy and unhelpful roles.
The Rescuer cleans up after and covers up for the substance
abuser, denies there is a problem, and takes on extra responsi-
bilities, so the substance abuser has no incentive to get better.
The Provoker scolds, ridicules, belittles, and nags. The con-
stant stream of anger seems to bring its own kind of energy,
though the provoker threatens to leaveand it helps neither
The Martyr is ashamed of the addict/alcoholics behavior and
lets everyone know it but makes no move to correct it or to
leave, as though enjoying the suffering. (The Gallup survey
showed that almost half of U.S. adults who have a family
member suffering from the disease of drug or alcohol addic-
tion say they have felt a sense of shame about that family
members addiction.)
Those roles just help the addict feel worse and less able to get
helpand the enabler can feel miserable but powerful. Do you know
any of these types? Have you had encounters with them yourself?
Supporting. Someone like Rachel learns that its possible to care
about a person and hate the disease or the substance that is mak-
ing him sick. So she can be supportive without going overboard. For
example, she can be direct about her feelings, letting Andy know that
she wants him to get help but wont get pulled into his troubles.
Experts in dealing with teens substance abuse at the U.S. Public
Health Service offer some suggestions. When discussing diffcult sub-
jects with a friend or sibling, it is just as important to consider how
you say something as it is to decide what to say. Words are powerful,
and a supportive, caring tone usually goes much further than the
judgmental approach. They would suggest that Rachel do the follow-
ing in talking with Andy:
Talk in a private place where no one is likely to overhear the
details of their conversation.
Speak in a positive manner, in the context of I care about
Helping a Friend or Relative 107
Speak with some knowledge of the subjectRachel might go
online to learn about the drugs Andy uses (good sources are
listed at the back of this book in Read More about It).
Be prepared with some solutions to suggesteven if the sug-
gestion is only the idea of talking to a professional.
This approach may work. Or it may not. Not everyone wants help.
He or she might be in denial or might not be ready to approach recov-
ery. If this is the case, what should you do next?
Dos and Donts for Helping
The U.S. Ofce of National Drug Control Policy offers this advice to
teens concerned about a friend.
Helping a friend with a drug or alcohol problem is hard work
and can be a very difcult experience for you as well as your
friend. You may feel a great deal of pressure to get your friend
to stop drinking or doing drugs. Or you may get discouraged
if your efforts to convince your friend to stop using drugs or
alcohol dont work. But it is important to know that your friends
drug or alcohol use is not your fault. Remember that its ulti-
mately up to your friend to make that change and you cant do
that for him. Sometimes, as much as you may try to get your
friend to quit or seek help, you just cant seem to make it hap-
pen. If this becomes the situation you are in, you should do one
of the following:
Seek support from other friends or trusted adultsyour
friend is not the only one who needs help in this situation.
Limit the time you spend with your drug- or alcohol-using
friend. Remember, your friends use may also be putting you
at risk.
Start thinking about yourselfget out and participate in
activities that you enjoy to take your mind off of the situation.
108 Living with Alcoholism and Drug Addiction
Detach with love. Al-Anon, the organization for people whose
lives are affected by alcoholism, was started shortly after the found-
ing of Alcoholics Anonymous. When alcoholics began getting sober,
the people who had cleaned up after them realized they had issues
of their own to deal with. Today Al-Anon helps people detach with
love from the active addict or alcoholic in their lives. This means
to continue to care about the person while hating the disease. They
suggest that people with alcoholic/addict friends and family members
keep the focus on themselves and do the following:
Stop suffering because of the actions and reaction of others.
Stop being used or abused by others.
Stop doing for others what they could do for themselves.
Stop manipulating situations so others will get through a day
and not use.
Stop covering up for anyones mistakes or misdeeds.
Once you start focusing on yourself instead of the addict, the sub-
stance abuser may feel forced to seek helpbut in the meantime, you
have helped yourself.
Try Alateen. Alateen is Al-Anons recovery program for young
people. Alateen groups are sponsored by Al-Anon members. It is a
free program open to any young person who has an alcoholic in their
life. Alateen explains the ripple effect of substance abuse this way:
The disease affects all those who have a relationship with a problem
drinker. Those of us closest to the alcoholic suffer the most, and those
who care the most can easily get caught up in the behavior of another
person. We react to their behavior. We focus on them, what they do,
where they are, how much they drink. We try to control them. We
take on the blame, guilt, and shame that really belong to them. We
can become as addicted to the addict or alcoholic as they are to the
substance. In Alateen meetings you will meet others who share your
feelings and frustrations, if not your exact situation. Members share
experiences about what they can change in their lives and what they
cant, and how they can live a better life.
Interventions. One way that people living with an alcoholic or addict
can take action against the disease is when an addiction becomes life-
threatening and an intervention may be used. You may have seen
the television program called Intervention, which is a clear depiction
of how it works. Its worth watching, if only as a reminder that many
people go through painful times with those close to them.
Helping a Friend or Relative 109
In an intervention, an alcoholics or addicts family, friends, and
employers say in their own words how his or her drinking or drugging
has been a problem in their lives. Interventions need to be carefully
planned with the aid of experienced professionals, and they some-
times cause more harm than good. Another method called CRAFT
(Community Reinforcement and Family Training) has proven to be
especially effective with adolescents. Research reported in the March
2007 issue of the Journal of Substance Abuse Treatment showed that
71 percent of parents trained in using CRAFT techniques were suc-
cessful in engaging their youths in treatment. When this less confron-
tational method is used, patients enter treatment with less resentment
and are more likely to beneft. If you have drug problems yourself,
you may be the focus on an intervention. You may be asked to be part
of one for a friend or relative. They can be very successful, once the
addict realizes that the most important people in his life are meeting
about his problem and that they care. And if it doesnt work? Then
its healthiest to let go and move on.
Been There . . .
Heres what one Al-Anon member says about learning to live with addic-
tion in the family:
When someone I love drinks and drugs too much, I get lost in it
all. I dont know what to do, I think I caused the problem, I think
I can control the problem, and I do my best to x my loved one.
What I have learned in Al-Anon is that I cant do anything for the
one who suffers from alcoholism, I can only help myself. I can
learn about the disease, educate myself in that area, keeping the
focus on me and what Im doing. I also found others in Al-Anon
just like me. I learn there is hope, I can take care of me, and my
needs, get healthy and strong within myself, then the rest of the
world and all of my problems in it and with it seem to get better.
For more experiences from people who have been there, check out
110 Living with Alcoholism and Drug Addiction
Letting go. At least as much recent study has been done of those
affected by addicts as of the addicts and alcoholics themselves
youve probably heard the phrases co-dependency or rescuing,
concepts that relate to conditions that arise when another persons
life becomes more important than your own. Al-Anon and related
counseling techniques focus on helping people live their own lives.
No individual is responsible for another persons disease or recovery
from it. Once youve done what you can, you need to let it go. For
the friends and family of the alcoholic/addict, the key is learning the
difference between what they can and cannot change. As they say in
Al-Anon, Its simple, but it isnt easy.
Treatment opens the way to recovery. It is just the beginning of a
long-term process. Family, friends, and substance abusers alike need
to realize that this is a major life change that takes regular attention.
On the one hand, expectations may be very high that everything
will be okay now. Its easy to think of rehab as a fx-it program. If an
addict was like someone with a bad appendix, he would go to the
hospital have the appendix removed, and the family could count on
him to be all better almost immediately. Recovery from addiction isnt
that short or simple.
On the other hand, some of the bad memories of active addiction
can cause continuing resentments. Though recovery is a process, at
some point its healthier to be able to let go of past problems and
move forward.
Its important to remember that recovery is primarily the substance
abusers responsibility. Family members can fnd out what continuing
care programs have been planned and support the recovering persons
involvement in aftercare treatment meetings and recovery support
It will be helpful if you educate yourself on the recovery process
for individuals and families, and if your family member is living with
you, to provide a sober environment to support that recovery. But
its not your responsibility to save anyone, so you may want to seek
professional and peer support (from a group like Al-Anon) for your
own physical and emotional health.
Families have tendencies either to try to micromanage recovery
and meeting attendance or to express resentment and resistance on
the lines of, We saw you more before you stopped using. This is
especially true for parents who try to overmanage their teens recov-
Helping a Friend or Relative 111
ery. Its useful to set out ground rules right after treatment: What the
family will do (fnd housing? provide transportation? pay expenses?
or not?) and what is expected of the recovering person (help out at
home? fnd a job? not miss recovery programs?). That way, boundar-
ies are established and tensions can be reduced.
One situation in which a family needs to intervene is in the case of
relapsebut its best without anger or accusations, realizing that
relapse can be part of the recovery process. The 2006 USA Today/
HBO survey confrmed what recovery specialists know: Over half
of the respondents whose family member sought treatment say the
family member had to repeat treatment. Almost four out of 10 of the
respondents whose family member sought treatment say their family
member completely recovered, but about six out of 10 say their fam-
ily member either showed no improvement or got better but did not
completely recover.
So try not to be discouraged or accusatory. Remember that research
also indicates that treatment for addictive diseases has approximately the
ongoing success rate as the management of other chronic disorders.
When a substance abuser gets help and begins a new life in recovery,
one would think the family would be happy and relieved. But remem-
ber the rowboat described in the last chapter? Family and friends
of alcoholism and addicts have investments in continuing the same
relationship patterns.
Someone who feels powerful because the addict is weak needs
to fnd power elsewhere.
Someone whose emotional life has been flled by caring for the
alcoholic needs a new source of satisfaction.
Someone who may have a substance problem himself may not
like having to look at his own abuse.
A parent who has tried to get a child cured may resent the
fact that someone else was able to accomplish it.
In addition, built-up feelings about all the years of pain and anger
caused by the addict dont just go away by themselves: Old anger and
resentment continue to build and may be used against the recovering
person as shame or guilt.
11Z Living with Alcoholism and Drug Addiction
One of the best ways to help a recovering alcoholic or addict is for
family members to get help for themselves. They may need to work
on issues like low self-esteem, abandonment issues, a need to be
needed, control issues, no boundaries, addiction to excitement, or a
martyr complex.
Recovering from an unhealthy dependency on a substance abuser
follows the same steps as recovery from the addictive disease:
Rachel and Andy
Rachels relationship with Andy, described at the beginning of this
chapter, can have several outcomes.
He might convince her into a more intimate relationship so he
can keep a caretaker (thats called taking someone hostage).
She might be so worried about his feelings that she provides
him with drugs or money for drugs.
He might accuse her of abandoning him by going away to
school (addicts often prefer to blame others for their problems,
not wanting to look at themselves).
She might start using drugs herself to keep him company
(people whose self-esteem is low will cling to even bad
relationships in desperation).
She might get so angry and hurt that she calls him names and
ends their friendship badly.
She might tell him how his self-destructive behavior hurts her
and nd support for herself.
She might give him information about treatment programs and
offer to help him get started.
The last two scenarios represent the healthiest responses, both for
Rachel and for Andy. The next scene would have to be that Andy
responds or notand Rachel moves on with her life.
Helping a Friend or Relative 113
Awareness that theres a problem, then attitude about what you can
and cant change, and actions to improve your own life.
As you can see, there is a process for helping the alcoholic, just as
there is one for recovering from the disease. But in some ways the pro-
cess of helping another is at least as hard as detox and rehab. It sounds
sensible, but it can be tough. And it can be especially hard when the
alcoholic or addict youre dealing with is a family membereven
more so if its a parent. An estimated 6.6 million children under the
age of 18 years live in households with at least one alcoholic parent.
Kids in these homes have special problems in living with the dis-
ease. According to the National Institute of Alcohol Abuse and Addic-
tion, current research fndings suggest that children of alcoholics are
at risk for a range of cognitive, emotional, and behavioral problems.
The ripple effects of alcoholism can be particularly rough for children
of alcoholics and addicts. Psychologists see patterns of problems in
children of alcoholics as they grow upnegative patterns that last
a lifetime and can affect their own children. Yet some investigators
Its Not Your Fault
The National Association for Children of Alcoholics suggests that chil-
dren dealing with family addiction learn and use the following 7 Cs of
I didnt cause it.
I cant cure it.
I cant control it.
I can care for myself
by communicating my feelings,
making healthy choices, and
by celebrating myself.
114 Living with Alcoholism and Drug Addiction
also report that many children from alcoholic homes develop neither
psychopathology nor alcoholism.
What may make the difference is fnding extra support and help
outside the home. If youre in this situation, turn to more stable fam-
ily members or for special help and support try Al-Anon or Alateen
or go to a school counselor or spiritual adviser. Remember that the
addicted family member may not want the truth told, and thats one
of the patterns youll get help with from people and organizations
who have knowledge and experience with situations like this. Check
out the National Association for Children of Alcoholics (NACoA) at They can help you learn how alcohol and
other drugs hurt everyone in a family and fnd new ways to deal with
it, even if your parents dont change.
Alcohol and drug dependency is an illness. It is not your fault that
your parent drinks too much or uses drugs, and you are not respon-
sible for correcting it. It is a parents responsibility to seek treatment.
You can take care of yourself by talking with a trusted person and
making healthy choices in your own life.
There are healthy and unhealthy ways to help an addict or
The best goal is to help him or her decide to get treatment.
An intervention is one way to help him or her do that.
People close to substance abusers have issues of their own that
need addressing.
Support groups exist to provide guidance and strength to those
with alcoholics and addicts in their lives.
Children of alcoholics need special help, and it is available.
If you have an alcoholic or addict in your life, the most impor-
tant thing you can do is to live your own life.
First, a person has to become aware of having a
substance abuse problem. Then the addict or alcoholic must
become willing to seek treatment. Then decisions about what kind
of treatment must be carefully made. And then things can get
complicated, because fnding ways to pay for addiction treatment,
either through private or public funds, can be a tricky matter.
On the one hand, research demonstrates that remaining in treat-
ment for an extended time has benefcial outcomes for people in
residential or outpatient drug treatment programs. On the other hand,
insurers are actually reducing the length of stay theyll pay for. After
all the effort to convince someone to go to treatment, its an extra
pain to fnd out the cost cant be covered.
Some fnancial facts about paying for substance abuse treatment:
Among people who needed, felt they needed, but did not
receive illicit drug use treatment (based on 200304 combined
data), the most often reported reasons (38.8 percent) for not
receiving treatment were cost or insurance barriers.
Slightly less than half of the respondents in the 2006 USA
Today/HBO poll say their addicted family member currently
has health insurance.
Almost every U.S. state requires insurers to cover addictions
and mental illness, but actually benefting from that require-
ment is often diffcult.
Paying for Care
116 Living with Alcoholism and Drug Addiction
Like a lot of other aspects of this disease, payment policies for it
often dont make sense. But in another quirk, treatment for substance
use disorders can also be absolutely free. (Only three out of 10 respon-
dents to that 2006 USA Today/HBO survey say their addicted family
member consulted with a medical doctor or other medical profes-
sional specializing in the treatment of addiction.)
Children are covered by parents insurance policies until they
turn 19, or older if they are full-time students. What those insur-
ance policies cover varies from state to state, company to company,
and even according to the individual contracts an insurer may have
with an employer or with the insured. For individuals or families
with no insurance, public fundingsuch as Medicaid or the State
Childrens Health Insurance Program (SCHIP)is available for
young people.
The average cost for treatment of alcohol or drug abuse in out-
patient facilities was an estimated $1,433 per course of treatment
in 2002, according to a report released by the Substance Abuse and
Mental Health Services Administration (SAMHSA). Although you may
have to fght hard to gain coverage, insurance companies will usually
support at least part of the costabout $100 to $200 per week.
The report, Alcohol and Drug Services Cost Study, found that
residential treatment for alcohol or drug abuse cost $3,840 per admis-
sion, and outpatient methadone treatment cost $7,415 per admission
in 2002, the most recent date available. Nonhospital residential care
What It Costs to Not Treat Addiction
When treatment is compared to expenditures for jails, foster care for
children, and health complications that often accompany addiction,
treatment of substance abuse is a bargain, returning at least $2 in
social benet for every $1 spent.
On an individual level, the nancial and physical costs of liver dis-
ease, car accidents, brain damage, and all the other physical damages
from addiction are much higher than the cost of care for substance
abuse at its earliest point. Theres rarely a question about insurers cov-
ering those medical problems.
Paying for Care 117
had the highest mean cost per enrolled client day ($76.13). Costs for
this treatment, like that for all health care, have increased sharply
since then. Costs for inpatient care in a specialty facility can be as
much as $25,000 to $30,000.
Forty-four states require private health insurance plans to cover sub-
stance abuse treatment in some fashion, with some laws requiring
wider coverage than others. If companies choose to self-insure, or
administer their own health plans, they are exempt from state insur-
ance laws. Just under half of all workers who have health insurance
through their jobs are covered by self-insured plans, which means the
rules dont apply to them.
According to a recent report from the National Governors Asso-
ciation, Private insurers traditionally have been reluctant to provide
coverage for substance abuse treatment, mainly because of its per-
ceived costs and the availability of government-supported services.
Many health plans provide fewer benefts for alcohol treatment than
for other chronic diseases. Higher co-payments and deductibles make
it harder for even those with insurance to get the help they need.
On the other hand, coverage by private and public agencies for both
individual and inpatient treatment may be more forthcoming if there
is a psychiatric problem in addition to the substance abuse.
Details of the extent of coverage varies widely too. Increasingly,
insurersincluding Medicaidare more likely to pay only for detox,
or for medical treatments and outpatient care or for a limited and
closely monitored inpatient stay. Depending on the state and the pol-
icy, coverage is more likelyfor both individual therapy and inpatient
staysif there is a co-occurring psychiatric or medical problem. Try-
ing to make sense of the payment process gets even tougher as public
and private rules about coverage keep changing. Efforts at develop-
ing federal laws requiring addiction and mental health coverage may
result in more sensible approaches to paying for these diseases.
For now, your family can get some kind of coverage for addiction
treatment, whether through private or public sources. The benefts
or employee assistance program offce at your parents workplace, a
funding expert at the treatment facility, or a caseworker at a public or
private agency can help make the most of coverage.
Here are some resources that can be tapped:
State and local governments are picking up the largest portion
of the public tab19.2 percent, not including Medicaid.
118 Living with Alcoholism and Drug Addiction
Federal government programsblock grants, entitlements and
categorical grantsalso provide some support.
Individuals pay almost 8 percent of the cost of alcohol treat-
ment services themselves, out of pocket.
Private health coverage and other insurance make up 34.5
percent of the funding for alcohol treatment services.
As of early 2008, proposals may be close to enactment that would
make insurance coverage for alcoholism and addiction easier to
obtain: The Paul Wellstone Mental Health and Addiction Equity Act
of 2007 was passed by the U.S. House of Representatives for consid-
eration by the U.S. Senate. As of this writing, it has not been signed
into law. If it is, it will assure equal coverage for mental health issues
as for other medical problems. Anyone concerned with paying for
addictive care would do well to pay attention.
On the other hand, the provisions for coverage by Medicaid are
becoming increasingly tight: This public coverage varies by state,
and anyone seeking payment by public funds for addiction treatment
should check his or her states rules.
Have insurance but cant get paid? Though almost every state in
the country requires insurers to cover these conditions, sometimes peo-
ple have to fght for that coverage. One reason for that is, once again,
the stigma of alcoholism or addiction causes people not to reveal their
need for coverage. So theyre not as likely as people with other health
problems to go for help to their employer or a government agency. The
organization Faces and Voices of Recovery, a recovery advocacy group,
can be of help in speaking up for insurance coverage.
Pick care thats covered. Youre more likely to get better coverage
if you pick a facility that uses evidence-based treatments. These
services are grounded in medical science rather than hunches and
can demonstrate progress in a way that insurers can measure. Profes-
sionals in the feld note that one of the reasons good treatment is so
diffcult to fnd is that there have not been published standards for
effective addiction treatment. Thus, virtually any therapist, pro-
gram, or service can claim expertise and effectiveness. Increasingly,
insurers are demanding to see results and will monitor a patients stay
to see if progress is being made.
So when choosing a treatment program, ask specifc questions to
fnd out if the program uses practices supported by research. Find out
if the program follows the latest scientifc knowledge, uses creden-
tialed mental health/addiction professionals, and prescribes medica-
tion, when available, to assist in the recovery process.
Paying for Care 119
If the program follows evidence-based practices, you will have
a better chance of having effective care and improved chances for
recovery. Now, care providers have begun to establish standards of
treatment. In 2007 more than 350 American health care organiza-
tions announced that they had endorsed a set of voluntary stan-
dards for the treatment of substance use conditions. Adoption of
these standards by health care providers will dramatically improve
the diagnosis and treatment of substance use conditions in the
United States.
SUD treatment organizations that use the following guidelines are
more likely to meet demands by insurers:
Brief intervention, by a health care practitioner trained in this
technique, for patients identifed with SUDs (both drug and
A written treatment prescription for needed services for all
patients assessed and diagnosed with SUD
Initiation of effective psychosocial interventions for all patients
referred for specialty SUD treatment
Consideration of addiction-focused pharmacotherapy for
patients with alcohol or opioid dependence
Systematic activities to promote patient engagement and reten-
tion in treatment by specialty SUD providers
Processes for engaging SUD patients in long-term monitor-
ing/management through collaboration between specialty and
primary care providers
Parents should go to their employers human-resources department
for clarication of their coverage. Rehab facilities have specialists
who are expert in interpreting insurance policies. Every state has an
insurance department that can provide information and compliance.
A caseworker or advocate with your local social-services agency can
help unravel the rules.
Where to Find Help with
Insurance Issues
1Z0 Living with Alcoholism and Drug Addiction
If you have no insurance coverage for substance abuse treatment,
and you dont qualify for Medicaid, there are still ways to get treat-
ment. All states have designated a lead agency to plan and admin-
ister drug and alcohol abuse prevention and addiction treatment
services. This lead agency has some limited funding to provide
addiction treatment services for people with no insurance or inad-
equate insurance coverage. Go to your states Web site to fnd the
insurance-regulating offce, and call or click to fnd out how you
qualify for help. States also have special coverage for young people.
Coverage and age limits vary, but some is available for substance
Some nonproft organizations have developed specialties in sub-
stance abuse treatment. Among the leaders are Catholic Chari-
ties ( and the Salvation Army
( Most of their local agencies offer
substance abuse treatment at little or no cost. Check their Web sites
for a nearby offce. Also, look in your local telephone Yellow Pages
under Alcoholism Treatment and its cross-references to fnd local-
area nonprofts that might help.
The federal government provides a system to reimburse hospitals
for uncompensated caretreatment of those who cant pay. The
Hill-Burton Free Care Act provides that hospitals that receive certain
federal funds are required to, in turn, offer free care to those in need.
Not all hospitals or health facilities subscribe to this program, but
most do. When looking for care, fnd out if the local hospitals that
provide rehab services are covered by the Hill-Burton plan. On admis-
sion to those facilities, a patient routinely flls out an application for
To Get Help in a Hurry
In case of acute need for medical care for a substance abuser, go to
your local emergency room! Emergency care must be given. An ER may
refer an addict or alcoholic for detoxication. In many localities, if you
are a resident of the detox units county or catchment area, you must
be admitted to detox for treatment, insurance or no insurance.
Paying for Care 1Z1
Hill-Burton funding, and the hospital can then be repaid for treatment
costs. Go to for details.
Finally, if you have no other options, most addiction treatment
programs do provide some free services on a case-by-case basis. Its
worth asking to see if an individual scholarship can be arranged
for treatment.
Now that more medications are available to treat alcoholism and
drug addiction and more co-occurring conditions are recognized that
require medications, the need has grown to stick with prescription
drug treatment. As the cost of those medications has risen, the chal-
lenge of fnding affordable pharmaceuticals is great.
Pharmaceutical companies have developed ways to provide their
products at a lowered cost via various sources, and many other organi-
zations provide access as well. The National Alliance on Mental Illness
reports that the Partnership for Prescription Assistance brings together
Americas pharmaceutical companies, doctors and other health care
providers, patient advocacy organizations, and community groups
to help qualifying patients who lack prescription coverage get the
medicines they needincluding those for substance recovery and other
mental-health issuesthrough the public or private program thats right
for them. The Partnership for Prescription Assistance offers a single
point of access to more than 475 public and private patient assistance
programs, including more than 180 programs offered by pharmaceuti-
cal companies. To access the Partnership for Prescription Assistance by
phone, you can call toll-free, (888) 4PPA-NOW [477-2669].
In order to fnd out what patient assistance programs you may qual-
ify for, all you have to do is answer a few short eligibility questions. The
Partnership for Prescription Assistance Web site (http://www.pparx.
org) will help supply you with the information you need to get involved
in a program and even allow you to download applications online. You
can then follow the instructions on the application to apply.
Many individual companies offer assistance as well. If you prefer
to contact the manufacturer of your particular medications, you can
fnd listings at these sites: and http://www.
For many years effective medical treatment for alcoholism and addic-
tion didnt exist. Increasingly during the 20th century, people turned
1ZZ Living with Alcoholism and Drug Addiction
to free support groups like AA. That remains one piece of good news
about treating substance use disorders: They are one disease (perhaps
the only one) that can be treated without medical care.
Today, you have many choices in nonmedical settingsfree
approaches. Following the programs that most of them lay out, you
can move, with strong group support, from the early days of with-
drawal and stabilization through the post acute fuzzy stages to
learning about how to live happily without substances. Information
is available for free too, by phone or online, about AA and NA and
other groups listed in the Appendix.
The recovery rate from attending 12-step meetings alone is close
to that for treatment plans alone, since they are purely voluntary and
have less structure than a formal program, and persistence requires
a great deal of willingness and self-discipline. But those are require-
ments for any kind of recovery program: They work for those who
want them to work.
One and a half million Americans seek recovery only from sup-
port groups each year, and many of them are successful, clean,
and sober. Research sponsored by NIAAA notes that AAs and NAs
approach often results in the development of coping skills, many of
which are similar to those taught in more structured psychosocial
treatment settings, thereby leading to reductions in alcohol and drug
Financing for addiction and alcohol treatment is available from
private and public sources.
Rules governing coverage are changing and often diffcult to
interpret, but expert information is available.
Patients or their families may have to push and explore to get
the maximum amount of coverage.
The more scientifcally based the treatment, the more likely
the extensive coverage.
Emergency treatment is always available for acute symptoms
of addiction or withdrawal.
Nonprofessionally led recovery through 12-step and other pro-
grams is available to anyone for free.
lt can be frustrating to feel that you want to do
something about addiction and keep being told theres nothing to
do but let someone fnd recoverythat there is not even a cure. The
only true cure for substance use disorders is prevention, according
to reports by, among others, the National Center on Addiction and
Substance Abuse at Columbia University. You may know from per-
sonal experience how diffcult it is to prevent these insidious and
widespread conditions. Maybe youre dealing with your own addic-
tion, or youre living with family or friends who are struggling with
it. Prevention may seem impossible, especially when you think about
some of the prevention campaigns that badly miss the mark. For
instance, its only recently that antidrug programs were introduced
that aimed at audiences young enough to make a difference.
The fact is prevention programs do work, as demonstrated by the
reduction in hard drug use and cigarette smoking among young
people. You can be part of that prevention effort. Teens can work to
prevent SUDs in themselves, in others, and in society at large.
Use the knowledge you gain through books like this and from orga-
nizations listed at the back of this book as guides to behavior that
makes sense for you. The quick take on how to prevent problems in
yourself, from the U.S. Offce of National Drug Control Policy, goes a
step beyond just say no. If someone is pressuring you to do anything
What More Can You Do?
1Z4 Living with Alcoholism and Drug Addiction
thats not right or good for you, you have the right to resist. You have
the right to say no, the right not to give a reason why, and the right
to just walk away from a situation. Resisting pressure can be hard for
some people, those experts note. Why? They may be afraid of being
rejected by others, or they want to be liked and dont want to lose a
friend. They dont want to be made fun of. Perhaps they dont want
to hurt someones feelings, or arent sure of what they really want, or
dont know how to get out of the situation. Sometimes resisting isnt
easy, but you can do it with practice and a little know-how. Keep try-
ing, even if you dont get it right at frst.
Get all the facts you can about drug use and its dangers. Begin with
the information youve read here and follow up all the facts on the
links included. A great place to start is and
www.drugabuse.govboth well-researched sites. They focus on the
facts and not the morality of underage drug use.
Learn about your own family history. The NIAAA offers recom-
mendations if you are among the millions of people in this country
who have a parent, grandparent, or other close relative with alcohol-
ism. Are you worried about what your familys history of alcoholism
Turning Points
Here are some life events that can make the difference between addic-
tion and nonaddiction.
A 12-year-old does not have access to his mothers
A 14-year-olds big brother refuses to buy beer for him.
A 16-year-old turns down drugs because he plays sports and
doesnt want to get kicked off the team.
An 18-year-old getting ready for exams has no neighborhood
drug dealers to buy from.
These are examples of results that you can help create by taking
actions in your community.
What More Can You Do? 1Z5
means for you? Is your risk for becoming an alcoholic greater than for
people who do not have a family history of alcoholism? If so, what
can you do to lower your risk?
The good news is that many children of alcoholics from even the
most troubled families do not develop drinking problems. As a fam-
ily history of alcoholism does not guarantee that you will become an
alcoholic, neither does growing up in a very troubled household with
alcoholic parents. Just because alcoholism tends to run in families
does not mean that the child of an alcoholic parent will automatically
become an alcoholic too. The risk is higher, but it does not have to
Awareness is the frst step, and if you are worried that your familys
history of alcohol problems or your troubled family life puts you at
risk for becoming alcoholic, here is some commonsense advice to
help you.
Avoid underage drinking. First, underage drinking is illegal.
Second, research shows that the risk for alcoholism is higher
among people who begin to drink at an early age, perhaps as
a result of both environmental and genetic factors.
Drink moderately as an adult. Adults who choose to drink
alcohol should do so in moderation. People with a family
history of alcoholism, who have a higher risk for becoming
dependent on alcohol, should approach even moderate drink-
ing carefully.
Talk to a health care professional. Discuss your concerns about
your risks with a doctor, nurse, nurse practitioner, or other
health care provider.
Watch out for drugs. People with family histories of alcoholism
may assume other substances are safe. In some cases there
may be an addictive personality involved. In any case, drugs
not only cause problems of their own, they can lower anyones
ability to resist drinking.
Be aware and especially careful around times of stress: According
to NIDA, the key risk periods for drug abuse are during major transi-
tions in kids lives. The frst big transition for children is when they
leave the security of the family and enter school. Later, when they
advance from elementary school to middle school, they often expe-
rience new academic and social situations, such as learning to get
along with a wider group of peers. This can be quite stressful, and it is
at this stageearly adolescencethat children are likely to encounter
drugs for the frst time.
1Z6 Living with Alcoholism and Drug Addiction
When they enter high school, adolescents face additional social,
emotional, and educational challenges. At the same time, they may be
exposed to greater availability of drugs, to drug abusers, and to social
activities involving drugs. These challenges can increase the risk that
they will abuse alcohol, tobacco, and other substances.
When young adults leave home for college or work and are on their
own for the frst time, their risk for drug and alcohol abuse is very
high. Consequently, young adult interventions are needed as well.
If other stressful events happen around the times of these transition
periodsanything from a friend moving away to a family illness
or divorcea young person can be that much more vulnerable. Be
aware and take care.
Another good way to check on your own tendencies to alcohol-
ism or addictions is to attend open meetings of AA and NA and hear
Joes Story: Breaking the Cycle
Joes dad was an alcoholic. From a very early age, Joe lived through
the kind of chaos that an alcoholic parent can stir up in the house-
hold: excitement, ghts, disappearances. Over time, this grew worse,
and soon Joes parents separated. His dads drinking escalated, and
caused him to slip in and out of Joes life. It was scary and upsetting for
little Joe, and by the time he was growing into adolescence, his dads
behavior and lack of support made him very angry. He saw the pain it
caused his mother. He made up his mind that he would never drink.
Since his mother came from an alcoholic family too, she supported him
and stayed away from alcohol herself. Many people have similar experi-
ences, and they stay angry but become addicted themselves. Joe could
have let his life be negatively fueled by his anger and his determination
to be a nondrinker. Instead, he opted to go into therapy, and he got
help in guring out what positive paths he wanted to follow in his own
life. He was able to come to terms with his father before the man died
from his alcoholism. Joe made some highly personalized choices about
school and career. As a young man, he became a father himself, and
rather than reenacting his own childhood, he is being a careful parent
to his children. He is living his own life.
What More Can You Do? 1Z7
stories of peoples experiences with substance abuse. Or go online
and sit in on meetings there. Since the meetings are open to all
and anonymous, your concern stays private. But if you hear anything
that you identify with, you might want to look further into your own
Youve probably gotten a lot of education over the years about drugs,
but you can be a part of the education process yourself and that might
be more effective.
Research proved years ago that young people who drink before
age 15 are four times more likely to develop serious alcohol problems
than those who abstain until their 21st birthday, and school systems
began to teach alcohol and other drug-prevention lessons. However,
though such lessons were mandated, national surveys have shown
that teachers dont always have time for them, and theyre often
offered too late anyway, since kids start using as young as eight. Drug
education doesnt happen at home eithera NIDA survey showed
that only 12 percent of parents of 12th-graders thought their children
had tried drugs, while 45 percent guessed they had used alcohol.
Although schools can and should play a role in prevention educa-
tion, they should not be relied upon to act as the principal provider
of general prevention programs, according to Join Together, a non-
proft group focused on alcohol and drug abuse. Jim Together has
studied the situation and concluded that what works best is a com-
prehensive community prevention strategy that includes parents and
other social institutions.
Communities can help prevention efforts by implementing strate-
gies that help reduce underage drinking, such as raising alcohol taxes
(the fve states with the highest beer taxes have much lower rates of
teen binge drinking); tightening the age and terms of drivers licenses
for adolescents; adopting social-host laws where adults who serve
alcohol to minors are held accountable; controlling the number of
alcohol outlets in a particular area; and doing frequent compliance
checks to deter sales to minors. You can get involved with that kind
of education program and feel that youre really learning something
and sharing the news too.
One approach is sponsored by the White House Offce of National
Drug Control Policy. It has created the Freevibe Web site as part of
a national effort to prevent or reduce the use of drugs among young
people and fnds that the ads and interactive communications they
sponsor have an impact. Check it out at
1Z8 Living with Alcoholism and Drug Addiction
More effective education comes from teens themselves. Sixty-
eight percent of addicts or potential addicts say they would turn to a
peer for help, so who better to help with drug problems than teens
themselves? Thats what the peer program is about. A peer helper
program is a team of teens trained by a certifed peer program edu-
cator to provide services to others. Peer helping groups may focus
on one issue, such as drugs or suicide, or focus on many issues. If
you think youre a great listener and could be a great peer helper
and are willing to take the time to train, you might want to consider
joining or starting a peer helping program in your community or at
your school.
Service has always been an important part of recovery group mem-
bership. In your support group youll fnd that the more that you
can do to help another in recovery, the better you can feel about
yourself. You can provide that kind of rewarding service on a wider
scale as well. One important way to prevent substance use disor-
dersin others as well as in yourself or those close to youis to
work against them. (And the more active one is in working against
the problem, the greater the possibility of avoiding addiction in
The National Center for Alcohol and Substance Abuse at Columbia
University notes that you dont have to be an adult to make a real
impact. Although many conficting messages about drug and alcohol
use may compete for your attention, you can empower yourself by
getting informed and getting active. By making your voice heard, you
can make your community a healthier place for your neighbors, your
friends, and yourself.
Be a role model for your peers by making healthy lifestyle deci-
sions about drug and alcohol use.
Help your school to organize after-school activities.
Voice your concern to friends if you think they are having a
problem with alcohol or drugs.
Get involved in a community coalition or advocacy group. It is
important that the youth in the community have a voice.
Volunteer your time at a local family shelter or treatment cen-
ter. This is not just about caring for someone who may be in
trouble as the result of a substance use problemit can show
you what can happenand it can show them that someone
cares. You never know whom you might inspire.
What More Can You Do? 1Z9
You might start or join a chapter of Students Against Destruc-
tive Decisions (SADD). Originally the mission of SADD was to help
young people say no to drinking and driving. Today, the mission
has expanded. Students have explained that positive peer pressure,
role models, and other strategies can help them say no to more than
drinking and driving. And that is why SADD has become a peer lead-
ership organization dedicated to preventing destructive decisions,
particularly underage drinking, other drug use, impaired driving, teen
violence, and teen depression and suicide.
Other associations are listed at the back of this book. There are
enough to choose from that you can fnd a group that fts you. As a
teen you have an advantage in helping other young people because
Here are a couple of the many practical recovery-related issues that any
teen can help with. Go to Figure out
the effects of young substance abuse in your area. Let people know
how serious things are in their own neighborhood.
Calculate how many kids in your state have serious alcohol
Calculate how many kids in your community have serious alcohol
problems and calculate how much it costs society at large.
Write a story about it for your school or local newspaper, or use it as
the topic of a school report. Or, think about what you can do with this
kind of news: CASAs 2007 Teen Survey Reveals Americas Schools
Infested with Drugs; Popular Kids at Drug-Infested Schools Much
Likelier to Get Drunk and Use Drugs. You might join with a local group
of teens to check out the conditions of their own schools or organize
recovery groups for school-aged friends. Look around your neighbor-
hood and see how you could prevent someone from getting hooked.
Contact CASA (The National Center for Alcohol and Substance
Abuse) at for more ideas.
Check out the Web site http://www.facesandvoicesofrecovery.
org for a lot of action-ideas for bringing help and attention to people
affected by the disease of addiction.
130 Living with Alcoholism and Drug Addiction
they are more likely to accept a message that is not judgmental or
A fairly new group that promotes issues that matter to people
in recovery, including fair insurance coverage, is Faces and Voices
of Recovery. Go to This
energetic non-anonymous group is one of the frst signs that people
affected by addictive diseases are not hiding in shame but speaking
up for themselves and their own interests and concerns.
The more you think and observe for yourself, the more reason youll
fnd not to use and to encourage others not to. For instance, now that
you know more, how differently would you answer this quiz from
earlier in the book?
True or False?
Which are true and which are false?
1. You have to use an illegal drug to be addicted. T / F
2. You have to drink in the morning to be an alcoholic. T / F
3. If youve just used alcohol or drugs for a short time,
you cant be addicted. T / F
4. Only addicts get in trouble for using. T / F
5. Some drugs are safer than others. T / F
6. Its normal for kids to party during their teens. T / F
7. Alcoholism and addiction cant be cured. T / F
8. My best friend would tell me if he was hooked. T / F
And how do you think your friends would answer those questions?
If you want to know one big source for all the wrong ideas about
SUDs, play close attention to what you hear and see. Next time you
see or hear messages in ads, TV shows, online, or wherever, think
about it a little. And talk about it with whoever youre with. Keep
your eyes and ears open, and you can stay independent.
Be smart about the Internet too. Some sites spread misinformation
about how drugs really work or spread peoples stories about their so-
called adventures in the world of drugs. Youre smart enough to know
that not everything you see online is true. But you can fnd sources of
positive information online too. To keep up with real trends related to
What More Can You Do? 131
addiction and recovery, check out or any of
the other sites listed throughout this book and in the sections at the
back. Look for sites where you can tell your own story too. When you
fnd recovery from your own addiction or fnd ways to get involved
in helping prevent addiction, your story becomes a powerful tool to
help others.
Young people can take effective action against addiction and
They can educate themselves about drugs and about their own
They can learn ways to work with other teens at risk.
They can join with others to work toward better prevention
and treatment programs.
They can become media aware so that they can help them-
selves and their peers to make their own responsible decisions
about substances of abuse.
The groups and organizations listed here are good sources to con-
sider for aid or information. Note that addresses and Web site URLs
are subject to change, but an Internet search of an associations
name or key related terms can turn up new Web sites and additional
resources. For some groups that emphasize their online presence,
only Web site URLs are listed. For quick and reliable information
and referral to drug and alcohol treatment centers, use this toll-free
number to reach the U.S. Department of Health and Human Services
Center for Substance Abuse Treatment Referrals: (800) 662-HELP
[4357]. (For immediate emergencies, dial 911.) These are the most
thorough and reliable sources for information on all aspects of addic-
tion and alcoholism. They can provide up-to-date facts via phone,
mail, and e-mail.
Center for Substance Abuse Prevention (CSAP)
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane, Rockwall II Building, Suite 900
Rockville, MD 20857
(301) 443-0365
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
P.O. Box 2345
Rockville, MD 20847-2345
(800) 662-HELP [4357]
Associations and Support Groups
Associations and Support Groups 133
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
(800) 311-3435
Drug Enforcement Administration
U.S. Department of Justice
2401 Jefferson Davis Highway
Alexandria, VA 22301
(202) 307-1000
Mental Health America
2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
(800) 969-6642
(800) 273-TALK [8255] (hotline)
National Alliance on Mental Illness
Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22201-3042
(800) 950-6264
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
(800) 729-6686
National Council on Alcoholism and Drug Dependence
12 West 21st Street, 7th Floor
New York, NY 10010
(800) NCA-CALL [622-2255]
National Institute of Mental Health
6001 Executive Boulevard, Room 8184, MSC 9663
134 Living with Alcoholism and Drug Addiction
Bethesda, MD 20892-9663
(866) 615-6464
(866) 415-8051 (TTY)
National Institute on Alcohol Abuse and Alcoholism
5635 Fishers Lane, MSC 9304
Bethesda, MD 20892-9304
(301) 443-3860
National Institute on Drug Abuse
5600 Fishers Lane
Rockville, MD 20857
(301) 443-1124
Offce of National Drug Control Policy
Drug Policy Information Clearinghouse
P.O. Box 6000
Rockville, MD 20849-6000
(800) 666-3332
Substance Abuse and Mental Health Services Administration/
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
(800) SAY-NOTO [729-6686]
American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Avenue NW
Washington, DC 20016-3007
(202) 966-7300
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007
Associations and Support Groups 135
(847) 434-4000
American Psychological Association
750 First Street NE
Washington, DC 20002-4242
(800) 374-2121
American Society of Addiction Medicine
4601 N. Park Avenue, Upper Arcade #101
Chevy Chase, MD 20815
(301) 656-3920
Center on Addiction and Substance Abuse
Columbia University
633 Third Avenue, 19th Floor
New York, NY 10017-6706
(212) 841-5200
These groups provide free mutual emotional and personal support for
people dealing with virtually every aspect of substance abuse. Most
have local or regional meetings, and many offer connections via the
Internet and telephone. They provide informational literature as well
as interpersonal interaction. Some (mostly, those with anonymous
in their name) take the 12-step approach; others do not.
Adult Children of Alcoholics
P.O. Box 3216
Torrance, CA 90510
(310) 534-1815
Family Group Headquarters, Inc.
P.O. Box 862
Midtown Station
New York, NY 10018-0862
136 Living with Alcoholism and Drug Addiction
(888) 4AL-ANON [425-2666]
Alcoholics Anonymous
World Services, Inc.
475 Riverside Drive
New York, NY 10115
(212) 870-3400 (for online AA groups)
Children of Alcoholics Foundation, Inc.
555 Madison Avenue, 20th Floor
New York, NY 10022
(800) 359-COAF [2623]
Cocaine Anonymous
World Service Offce
3740 Overland Avenue, Suite C
Los Angeles, CA 90034
(800) 347-8998
Families Anonymous
P.O. Box 35475
Culver City, CA 90231
(800) 736-9805
Marijuana Anonymous
World Services
P.O. Box 2912
Van Nuys, CA 91404
(800) 766-6779
Nar-Anon Family Group Headquarters, Inc.
P.O. Box 2562
Palos Verdes Peninsula, CA 90274
(310) 547-5800
Associations and Support Groups 137
Narcotics Anonymous
P.O. Box 9999
Van Nuys, CA 91409
(818) 773-9999
National Association for Children of Alcoholics
11426 Rockville Pike, Suite 301
Rockville, MD 20852
(301) 468-0985
Rational Recovery Systems
P.O. Box 800
Lotus, CA 95651
(800) 303-CURE [2873]
Secular Organizations for Sobriety
P.O. Box 5
Buffalo, NY 14215
(310) 821-8430
Women for Sobriety
P.O. Box 618
Quakertown, PA 18951
(800) 333-1606
These groups are organized to be more active in working against
addictions than those whose purpose is information or support. All
offer Web sites for information or opportunities for involvement.
Community Anti-Drug Coalitions of America
625 Slaters Lane, Suite 300
Alexandria, VA 22314
(800) 542-2322
138 Living with Alcoholism and Drug Addiction
Drug Strategies, Inc.
1616 P Street NW, Suite 220
Washington, DC 20036
(202) 289-9070
Faces and Voices of Recovery
1010 Vermont Avenue, Suite 708
Washington, DC 20005
(202) 737-0690
Join Together
715 Albany Street, Suite 580
Boston, MA 02118
(617) 437-1500
Latino Behavioral Health Institute
P.O. Box 1008
Thousand Oaks, CA 91360
(818) 831-3395
Mothers Against Drunk Driving
511 E. John Carpenter Freeway, Suite 700
Irving, TX 75062
(214) 744-6233
(800) GET-MADD [438-6233] (victim hotline)
National Asian Pacifc American Families Against Substance
340 East 2nd Street, Suite 409
Los Angeles, CA 90012
(213) 625-5795
National Families in Action
2957 Clairmont Road NE, Suite 150
Atlanta, GA 30329
(404) 248-9676
Associations and Support Groups 139
National Hispanic/Latino Community Prevention Network
P.O. Box 33800
Los Angeles, CA 90033
(916) 442-3760
National Prevention Network
National Association of State Alcohol/Drug Abuse Directors
1025 Connecticut Avenue NW, Suite 605
Washington, DC 20036
(202) 293-0090
National PTA Drug and Alcohol Abuse Prevention Project
330 North Wabash Avenue, Suite 2100
Chicago, IL 60611-3690
(800) 307-4782
Offce of Safe and Drug-Free Schools
U.S. Department of Education (DoE)
(800) 872-5327
Parent to Parent
Partnership for a Drug-Free America
405 Lexington Avenue, Suite 1601
New York, NY 10174
(212) 922-1560
PRIDE Youth Programs
3610 DeKalb Technology Parkway, Suite 105
Atlanta, GA 30340
(800) 853-7867
Students Against Destructive Decisions
SADD National
255 Main Street
Marlborough, MA 01752
(877) SADD-INC [723-3462]
absorption The process by which elements move from outside
of the body into the blood and other tissues. Food is absorbed
through the stomach and intestines. When tobacco is smoked,
nicotine is absorbed through the lungs.
acute Refers to a disease or condition that has a relatively rapid
onset, marked intensity, and a short duration.
addiction A chronic brain disorder characterized by the loss of
control of drug-taking behavior, despite adverse health, social,
or legal consequences to continued drug use. Addiction is
characterized by relapses during recovery and by long-lasting
chemical changes in the brain.
adolescence The period of human maturation between about
ages 12 and 20, during which the brain and the bodys
reproductive organs are undergoing critical development
AIDS(AcquiredImmunodefciencySyndrome) A condition
characterized by a potentially fatal defect in the bodys natural
immunity to diseases.
alcohol A complex psychoactive drug found in beverages such
as beer, wine, and whiskey. Alcohol is a depressant drug with
potential for abuse and addiction.
alcoholism A primary, chronic disease with genetic, psychosocial,
and environmental factors infuencing its development and
manifestations. The disease is often progressive and fatal. It is
characterized by continuous or periodic impaired control over
drinking, preoccupation with the drug alcohol, and use of alcohol
despite adverse consequences.
amphetamine Stimulant drug whose effects are very similar to
amylnitrite A yellowish oily volatile liquid used in certain
diagnostic procedures and prescribed to some patients for
heart pain. Illegally diverted ampules of amyl nitrite are called
poppers or snappers on the street.
analgesics A group of medications that reduce pain.
Glossary 141
anesthetic An agent that causes insensitivity to pain and is used
for surgeries and other medical procedures.
barbiturates Depressant drugs that produce relaxation and sleep.
Sleeping pills such as pentobarbital and secobarbital are barbiturates.
blackouts A kind of amnesia during which drinkers may act
normal but not be conscious of their behavior.
blood-brainbarrier A network of tightly packed cells in the walls
of capillaries in the brain that prevents many molecules, including
poisons, from entering the brain. Psychoactive substances are
capable of penetrating the barrier.
brainstem The major route by which the forebrain sends
information to, and receives information from, the spinal cord
and peripheral nerves.
buprenorphine A long-lasting opiate analgesic that has both opiate
agonist and antagonist properties. Buprenorphine may be useful
for treating heroin addiction.
caffeine A mild stimulant found in coffee and kola nuts. Caffeine
is the most widely used drug in the world.
cannabis The botanical name for the plant from which marijuana
carcinogen Any substance that causes cancer.
cardiovascularsystem The heart and blood vessels.
centralnervoussystem The brain and spinal cord.
cerebellum A portion of the brain that helps regulate posture,
balance, and coordination.
cerebralcortex The outer layer of the cerebral hemispheres that
controls conscious experience, including perception, emotion,
thought, and planning.
cerebralhemispheres The two specialized halves of the brain.
The left hemisphere is specialized for speech, writing, language,
and calculation; the right hemisphere is specialized for spatial
abilities, face recognition in vision, and some aspects of music
perception and production.
cerebrum The upper part of the brain consisting of the left and
right hemispheres.
chemicaldependency The stage of substance abuse when
substance users continue their pattern of drug use in spite of
incurring signifcant problems in their lives.
chronic Refers to a disease or condition that persists over a long
period of time.
coca The plant Erythroxylon, from which cocaine is derived. Also
refers to the leaves of this plant.
14Z Living with Alcoholism and Drug Addiction
cocaethylene A substance created in the body when cocaine and
alcohol are used together; chemically similar to cocaine.
cocaine A highly addictive stimulant drug derived from the coca
plant that produces profound feelings of pleasure.
cognitive-behavioraltherapy(CBT) A form of interpersonal
psychotherapy used in treating addictions, based on the idea that
feelings and behaviors are caused by a persons thoughts rather
than outside infuences. The goal of cognitive-behavioral therapy
is to get the person to learn or relearn better coping skills.
crack Slang term for a smokeable form of cocaine.
craving A powerful, often uncontrollable desire for drugs, caused
by drug-induced changes that arise from a need of the brain to
maintain a condition created by the presence of the drug.
dendrite The specialized branches that extend from a neurons cell
body and function to receive messages from other neurons.
depressants Drugs that relieve anxiety and produce sleep.
Depressants include barbiturates, benzodiazepines, and alcohol.
dopamine A brain chemical, classifed as a neurotransmitter,
found in regions of the brain that regulate movement, emotion,
motivation, and when released by the brain-reward system,
feelings of pleasure.
drug A chemical compound or substance that can alter the
structure and function of the body.
drugabuse The repeated use of illegal drugs or the inappropriate
use of legal drugs, to change mood or alter perceptions of reality.
drugaddiction The continued compulsive use of drugs in spite
of adverse health or social consequences. Drug addiction is a
complex brain disease. It is characterized by compulsive, at times
uncontrollable drug craving, seeking, and use that persists even
in the face of extremely negative consequences.
ecstasy(MDMA) A chemically modifed amphetamine that has
hallucinogenic as well as stimulant properties.
electroencephalogram(EEG) A graphic record of the electrical
activity of the brain made by attaching electrodes to the scalp.
emphysema A lung disease in which tissue deterioration results in
increased air retention and reduced exchange of gases. The result
is diffcult breathing and shortness of breath. It is often caused by
endorphins Brain chemicals with opiatelike effects that bind to
opiate receptors. Endorphins are made by neurons and used as
enzyme A large molecule that living organisms use to catalyze
chemical reactions. Enzymes are used to build, modify, or break
Glossary 143
down different molecules without themselves being permanently
altered or destroyed.
ether A volatile liquid with a characteristic odor. Used as a
medical anesthetic gas.
euphoria A feeling of extreme well-being or elation.
forebrain The largest division of the brain, which includes the
cerebral cortex and basal ganglia. It is credited with the highest
intellectual functions.
frontallobe One of the four divisions of each cerebral hemisphere.
The frontal lobe is important for controlling movement and
associating the functions of other cortical areas.
hallucinations Perceptions of something (such as a visual image
or a sound) that does not really exist. Hallucinations usually arise
from a disorder of the nervous system or in response to drugs
(such as LSD).
hallucinogens A diverse group of drugs that alter perceptions,
thoughts, and feelings. Hallucinogenic drugs include LSD,
mescaline, MDMA (ecstasy), PCP, and psilocybin (magic
hangover Sick feelings following a drinking episode.
hepatitis Infammation of the liver.
heroin The potent, widely abused opiate that produces addiction.
It consists of two morphine molecules linked together chemically.
hippocampus A brain structure that is involved in emotions,
motivation, learning, and memory.
HIV(humanimmunodefciencyvirus) The virus that causes AIDS
(acquired immunodefciency syndrome).
hormone A chemical substance formed in glands in the body and
carried in the blood to organs and tissues, where it infuences
function, structure, and behavior.
hypothalamus The part of the brain that controls many bodily
functions, including feeding, drinking, and the release of many
ingestion The act of taking in food or other material into the body
through the mouth.
inhalant Any drug administered by breathing in its vapors.
Inhalants commonly are organic solvents, such as glue and paint
thinner, or anesthetic gases, such as ether and nitrous oxide.
inhalation The act of administering a drug or combination of drugs
by nasal or oral respiration.
injection A method of administering a substance such as a drug
into the skin, subcutaneous tissue, muscle, blood vessels, or body
cavities, usually by means of a needle.
144 Living with Alcoholism and Drug Addiction
limbicsystem A set of brain structures that generates our feelings,
emotions, and motivations. It is also important in learning and
LSD(lysergicaciddiethylamide) A hallucinogenic drug that acts on
the serotonin receptor.
magneticresonanceimaging(MRI) An imaging technique that
uses magnetic felds to take pictures of the structure of the brain.
marijuana A drug, usually smoked but sometimes eaten, that
is made from the leaves of the cannabis plant. The main
psychoactive ingredient is THC.
medication A drug that is used to treat an illness or disease
according to established medical guidelines.
metabolism The processes by which the body breaks things down
or alters them so they can be eliminated.
methadone A synthetic opiate used to treat cancer pain and heroin
methamphetamine A commonly abused, potent stimulant drug
that is part of a larger family of amphetamines.
morphine The most potent natural opiate compound produced
by the opium poppy. Morphine is a very effective medicine for
treating pain.
naltrexone An opiate antagonist used to treat heroin addiction and
more recently for the treatment of alcohol addiction.
neuron(nervecell) A unique type of cell found in the brain and
body that is specialized to process and transmit information.
neurotransmission The process that occurs when a neuron
releases neurotransmitters to communicate with another neuron
across the synapse.
neurotransmitter A chemical produced by neurons to carry
messages to other neurons.
nicotine The addictive drug in tobacco. Nicotine activates a
specifc type of acetylcholine receptor.
nitrousoxide Medical anesthetic gas, especially used in dentistry.
Also called laughing gas. Found in whipped-cream dispensers
and gas cylinders.
noradrenaline A chemical neurotransmitter that is made in the
brain and can affect the heart.
norepinephrine A neurotransmitter and a hormone. It is
released by the sympathetic nervous system onto the heart,
blood vessels, and other organs, and by the adrenal gland
into the bloodstream as part of the fght-or-fight response.
Norepinephrine in the brain is used as a neurotransmitter in
normal brain processes.
Glossary 145
occipitallobe The lobe of the cerebral cortex at the back of the
head that includes the visual cortex.
opiatereceptors Receptors that recognize both opiates and
endogenous opioids. When activated, they slow down or inhibit
the activity of neurons on which they reside.
opiates Any of the psychoactive drugs that originate from the
opium poppy or that have a man-made chemical structure like
the drugs derived from opium.
opioid Any chemical that has opiatelike effects; commonly used to
refer to endogenous neurochemicals that activate opiate receptors.
parietallobe One of the four subdivisions of the cerebral cortex; it
is involved in sensory processes, attention, and language.
physicaldependence An adaptive physiological state that occurs
with regular drug use and results in a withdrawal syndrome
when drug use is stopped.
pituitarygland An endocrine organ closely linked with the
hypothalamus. The pituitary secretes a number of hormones
that regulate the activity of other endocrine organs in the human
polyneuropathy Permanent change or malfunction of nerves. Can
lead to sudden sniffng deaththis can occur when inhaled
fumes fll up the cells in the lungs with poisonous chemicals,
leaving no room for the oxygen needed to breathe. This lack of
oxygen can lead to suffocation, respiratory failure, and death.
progression A characteristic of addictive diseases, which are
marked by the increasing need (tolerance) for a drug to maintain
a comfortable level, despite the deterioration of the users
psychedelicdrug A drug (like LSD or PCP) that dramatically
distorts perception, thought, and feeling.
psychoactivedrug A drug that changes the way the brain works.
psychosocialtherapy Therapy that uses a combination of
individual psychotherapy and group (social) therapy approaches
to rehabilitate or provide the interpersonal and intrapersonal
skills an addict needs to live without drugs.
receptor A large molecule that recognizes specifc chemicals
(like neurotransmitters or hormones) and transmits the message
carried by the chemical into a cell.
relapse In drug abuse, relapse is the resumption of drug use after
trying to stop taking drugs.
rewardsystem(orbrainrewardsystem) A brain circuit that,
when activated, reinforces behaviors. The circuit includes the
dopamine-containing neurons of the ventral tegmental area and
146 Living with Alcoholism and Drug Addiction
part of the prefrontal cortex. The activation of this circuit causes
feelings of pleasure.
rush A surge of pleasure that rapidly follows administration of
some drugs.
sensitization An increased response to a drug caused by repeated
administration. Sensitization is most commonly seen in some
responses to stimulants.
serotonin A neurotransmitter that regulates many functions,
including mood, appetite, and sensory perception.
stimulants A class of drugs that has a powerful effect on the
reward system, elevating mood, increasing feelings of well-
being, energy, and alertness. Stimulants include cocaine,
methamphetamine, and methylphenidate (Ritalin).
synapse The site between neurons across which the nerve cells
communicate with each other.
temporallobe One of the four major subdivisions of each
hemisphere of the cerebral cortex. It functions in auditory
perception, speech, and visual perceptions.
tetrahydrocannabinol(THC) The active ingredient in marijuana
that is primarily responsible for producing the drugs
psychoactive effects.
tobacco A plant widely cultivated for its leaves, which are used
primarily for smoking.
tolerance A condition in which higher doses of a drug are
required to produce the same effect as during initial use; often
leads to physical dependence.
toluene A light, colorless liquid solvent found in many commonly
abused inhalants, including airplane glue, paint sprays, and paint
and nail polish removers.
transporter A large protein on the cell membrane of the axon
terminals. It removes neurotransmitter molecules from the
synapse by carrying them back into the axon terminal that
released them.
ventraltegmentalarea(VTA) The group of dopamine-containing
neurons that make up a key part of the brain reward system.
vertigo The sensation of dizziness.
withdrawal Symptoms that occur after chronic use of a drug is
reduced or stopped.
Defnitions were adapted from a variety of sources, including NIDA
(, the National Institutes of Health, and
the Society for Neuroscience.
These are additional resources for detailed information about aspects
of alcoholism and addiction.
Bellenic, Karen, ed. Tobacco Information for Teens. Detroit, Mich.: Omni-
graphics, 2007.
Borchert, William. The Lois Wilson Story: When Love Is Not Enough:
The Authorized Biography of the Co-Founder of Al-Anon. Center City,
Minn.: Hazelden, 2005.
Cheever, Susan. My Name Is Bill: Bill WilsonHis Life and the Creation
of Alcoholics Anonymous. New York: Simon & Schuster, 2004.
Colvin, Rod. Prescription Drug Addiction: The Hidden Epidemic. Omaha,
Nebr.: Addicus Books, 2002.
DiClemente, Carlo C. Addiction and Change: How Addictions Develop and
Addicted People Recover. Center City, Minn.: Hazelden, 1996.
Friel, John, and Linda Friel. Adult Children: The Secrets of Dysfunctional
Families. Deerfeld Beach, Ill.: Health Communications, 1990.
Gerdes, Louse L., ed. Addiction. Farmington Hills, Mich.: Gale Publish-
ing, 2004.
Johnson, Marlys C., and Phyllis Alberici. Cross-Addiction: The Hidden
Risk of Multiple Addictions. New York: Rosen, 1998.
Lessa, Nicholas R., and Walter F. Scanlon. Substance Use Disorders.
Hoboken, N.J.: John Wiley & Sons, 2006.
Nagle, Jeanne M. Everything You Need to Know about Drug Addiction.
New York: Rosen, 1998.
Nakken, Craig. The Addictive Personality: Understanding the Addictive
Process. New York: HarperCollins, 1988.
Rebman, Rene C. Addictions and Risky Behaviors: Cutting, Bingeing,
Snorting, and Other Dangers. Berkeley Heights, N.J.: Enslow, 2006.
Woititz, Janey G. Adult Children of Alcoholics. Deerfeld Beach, Ill.:
Health Communications Inc., 1990.
148 Living with Alcoholism and Drug Addiction
These are reliable guides to fnding your way through problems
related to addiction and alcoholism.
Alateen. A Day at a Time. New York: Al-Anon Family Group Headquar-
ters, Inc., 1983.
Alcoholics Anonymous World Services. Alcoholics Anonymous: The Story
of How Many Thousands of Men and Women Have Recovered from
Alcoholism. 4th ed. New York: AAWS, 2001.
Covey, Sean. The 6 Most Important Decisions Youll Ever Make: A Guide
for Teens. New York: Simon & Schuster, 2006.
Drews, Toby Rice. Getting Them Sober: An Introduction to Al-Anon and
Alateen. Baltimore, Md.: Recovery Communications Inc., 1998.
Gilbert, Sara D. Trouble at Home. New York: Lothrop, l981.
. What Happens in Therapy. New York: Lothrop, 1982.
. Get Help. New York: Morrow Jr. Books, 1989.
Hazelden. How Teens Help Friends with Alcohol. Center City, Minn.:
Hazelden/Wisconsin Clearinghouse, 1999.
Kettlehack, Guy. First-Year Sobriety: When All That Changes Is Every-
thing. New York: Harper Sobriety Series, 1998.
. Sober and Free: Making Your Recovery Work for You. New York:
Simon and Schuster, 1996.
Narcotics Anonymous Worldwide. Narcotics Anonymous. Van Nuys,
Calif.: NAWS, 1988.
Roos, Stephen. A Young Persons Guide to the Twelve Steps. Center City,
Minn.: Hazelden, 1992.
The books listed here refect more individual approaches to
AA Grapevine. In Our Own Words: Stories of Young AAs in Recovery. New
York: AA Grapevine Inc., 2007.
Anonymous. Go Ask Alice. New York: Simon & Schuster, 1971.
Beckman, Chris. Clean: A New Generation in Recovery Speaks Out. Center
City, Minn.: Hazelden, 2005.
Black, Claudia. My Dad Loves Me, My Dad Has a Disease: A Childs View:
Living with Addiction. San Francisco: MAC Publishing, 1997.
D., Lisa. Stepping Stones to Recovery for Young People: Experience the
Miracle of 12 Step Recovery. Center City, Minn.: Hazelden, 1991.
Read More about It 149
Ketcham, Katherine, and William C. Moyers. Broken: My Story of Addic-
tion and Redemption. Center City, Minn.: Hazelden, 2006.
Marshall, Shelly. Young Sober and Free. 2nd ed. Center City, Minn.:
Hazelden, 2003.
McGinnis, Sheryl Letzgus, and Heiko Ganzer. I Am Your Disease: The
Many Faces of Addiction. Parker, Colo.: Outskirts Press, 2006.
Roper, Dr. Charles N., Ph.D. High Bottom Drunk: A Novel . . . and the
Truth about Addiction & Recovery. Buda, Tex.: Small Change Publish-
ing, 2000.
Volkmann, Chris, and Toren Volkmann. From Binge to Blackout: A
Mother and Son Struggle with Teen Drinking. New York: Penguin,
White, W. Lets Go Make Some History: Chronicles of the New Addiction
Recovery Advocacy Movement. Washington, D.C.: Johnson Institute
and Faces and Voices of Recovery, 2006.
Zailckas, Koren. Smashed: Story of a Drunken Girlhood. New York:
Viking/Penguin, 2006.
These are some of the most useful informational and support Web
sites on alcoholism and addiction. You will fnd many more as you surf
the Web. Take care, as always when getting information from the Inter-
net, that the source material is reliable. Government and recognized
professional associations are your best resources on these topics. Alcoholism is an excellent resource for information on a variety of
topics. The alcoholism section at this site offers information, news
updates, and reliable links on all aspects of addiction.
Gives teens anonymous access to accurate information about drugs,
from Drug Strategies, a nonproft research institute.
Faces and Voices of Recovery
An advocacy group for people in all aspects of recovery.
Read More About It 149
150 Living with Alcoholism and Drug Addiction
An interactive site with helpful information on all aspects of
addiction and recovery, from the National Youth Anti-Drug Media
Campaign of the White House Offce of Drug Control Policy.
National Institute on Drug Abuse
A division of the National Institutes of Health, NIDAs Web site
provides information on all aspects of drug abuse, particularly
the effects of drugs on the brain and body, in easy-to-use format.
NIDA also has a site specially designed for teens: http://teens.
National Mental Health Information Center
A useful site of the Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Straight talk on all health topics from the Nemours Foundation.
AA. See Alcoholics Anonymous
absorption 19, 23
acamprosate 84, 100
acetaminophen 57
acne 55
action stage of change 66, 113
acupuncture 85
addiction. See also specific addictions
age of addiction 2, 10, 13, 28, 56
awareness 6668
causes of 3243
chemical 50
chronic nature of 7
dangers of 5464
defined 3
disability 8
disease of 67, 8, 13, 15, 3031,
4445, 6869
education and prevention
family/friend, helping with
family history 2, 38, 124125
fear in 69
long-term dangers 2
multiple, treatment of 84
paying for care 115122
perceptions of addicts 2
prevention 123130
progression 16, 2731
recovery, resisting 6870
research 8, 3031
shame of 6970
signs/symptoms of 29, 4453
stages of 4950
stages of change 6566, 74
substance use disorders 36
symptoms 34
treatable brain disorder 8, 13
ADHD. See attention-deficit/
hyperactivity disorder
adolescence period 54, 94, 125126
advertising 42. See also media
age of addiction. See addiction, age of
AIDS 23, 56
Al-Anon 108, 109, 110, 114
Alateen 108, 114
alcohol 1617
abuse 49
addiction. See addiction
affect on brain 46, 5455
age of addiction. See addiction,
age of
age of first use 2829
alcoholism 2, 45. See also
avoidance using scare tactics 3
children of alcoholics 113114
dangers of 5657, 61
dependence 49
family influences 38
genetics and use 3739
impact on daily life 5859
interaction with drugs 57
legal issues 54, 64, 127
mental illness 59
parental use 38
physical side effects 4849
15Z Index
research 3031
stages of abuse. See addiction,
stages of
treatment 79. See also treatment
use statistics 10, 20
Alcohol and Drug Services Cost
Study 116
Alcoholics Anonymous (AA) 45, 52,
68, 70, 81, 88, 91, 9394, 103, 108,
115, 122, 126127
alcoholism. See alcohol, alcoholism
alprazolam 21, 26. See also
American Medical Association 6, 15
American Psychiatric Association 7,
Americans with Disabilities Act 8
amphetamines 18
angel dust. See PCP
Antabuse 83, 84
antisocial personality disorder 86
anxiety disorder 86
associations, listing of 132139
Ativan 79. See also benzodiazepines
disorder (ADHD) 39, 52
attitude in recovery/treatment 66,
86, 97, 113
automobile crashes 56
awareness stage of recovery 6668,
113, 125
BAC. See blood alcohol concentration
bad behavior 4546
barbiturates 21. See also depressants
behavioral therapy treatment element
benzodiazepines 21, 24, 79. See also
binge drinking 56
biopsychosocial disorder 4
bipolar disorder 59, 86
black beauties. See amphetamines
blackouts 17, 4849
blood alcohol concentration (BAC) 58
blow. See cocaine/crack
body, long-term damage 5557
addiction and 3536
addiction as treatable disorder
of 8
cerebral cortex 3233
damage 5455
depressants and activity of 21
dopamine production. See dopa-
drug addiction as complex dis-
ease of 7, 13
drugs and activity of 3334
effects from alcoholism 45
judgment center 910, 64
lobes 3233
nicotine and 21
occipital lobe 32
recovery and 99
research on adolescent 54, 64
size 55
Breathalyzer tests 72
bulimia 86
bumble bees. See amphetamines
Buprenex 79
C. See cocaine/crack
caffeine 3
CAGE survey 47
CAMI. See chemically addicted and
also mentally ill (CAMI)
Campral 84
cancer 56
cannabis. See marijuana
CASA (Center for Alcohol and
Substance Abuse) 123, 128, 129
catchment area 120
Index 153
Catholic Charities 120
CBT. See cognitive behavioral therapy
Center for Alcohol and Substance
Abuse. See CASA
Center for Medical Literacy 41
Centers for Disease Control and
Prevention, U.S. 56
central nervous system (CNS) 21
cerebral cortex 3233
chemical addiction 50
chemical dependency (symptom of
addiction) 50
chemical dependency counselors 70
chemically addicted and also
mentally ill (CAMI) 40
chewing tobacco 19. See also
chlordiazepoxide 21. See also
cigarettes. See nicotine
cirrhosis 55
club drugs 2325. See also
CNS. See central nervous system
coaethylene 27
cocaine/crack 10, 1819, 28, 59, 62,
cocaine psychosis 62
coca plant 18
codeine 22
co-dependency concepts 110
cognitive behavioral therapy (CBT)
72, 82
coke. See cocaine/crack
coke bugs 62
cold turkey 77, 78. See also
treatment programs
Columbia University 10, 123, 128
Community Reinforcement and
Family Training. See CRAFT
comorbid 85
contemplation stage of change 66, 74
control, loss of (symptom of
addiction) 4
copilots. See amphetamines
cough syrup 3
counseling/psychotherapy treatment
element 82
counselors. See therapists/counselors
crack. See cocaine/crack
CRAFT (Community Reinforcement
and Family Training) 109
crank. See methamphetamines
craving (symptom of addiction) 4
criminal convictions 5657
croak. See methamphetamines
crypto. See methamphetamines
crystal. See amphetamines
crystal ice. See methamphetamines
crystallized methamphetamine 61,
80. See also methamphetamines
Darvon. See propoxyphene
date rape drugs 25
De Bellis, Michael D. 55
delirium tremens (D.T.s) 79
delta-9-tetrahydrocannabinol (THC)
delusions 18
Demerol. See meperidine
dendrites 33
denial 4, 7, 13, 45, 6869
Depade 84
depressants 14, 2122, 31, 59
depression 59, 86
designer drugs 24. See also club
detox. See detoxification
detoxification 7880
Dexedrine. See dextroamphetamine
dextroamphetamine 26. See also
diabetes 55
diazepam 21, 26. See also
Dilaudid. See hydromorphone
154 Index
disability considerations 8
disease. See addiction, disease of
dishonesty (characteristic of
substance abuse) 4445, 46, 53
dopamine 16, 26, 28, 33, 43, 55, 99
downers. See depressants
down regulation 33
DNA research 3738
drivers license 57, 127
driving under the influence (DUI) 57
Drug-Induced Rape Prevention and
Punishment Act 25
drug interaction 57
drugs, categories of 1627
drug use
abuse, stages of. See addiction,
stages of
addiction. See addiction
avoidance using scare tactics 3
brain activity and 3334
dangers of 5657
history of 1416
impact on daily life 5859
injection 56
legal issues 15, 54, 64
mental illness 59
physical side effects 49
research 3031
treatment 7980. See also treat-
ment programs
drying-out farm 77, 83. See also
treatment programs
D.T.s. See delirium tremens (D.T.s)
DUI. See driving under the influence
Duke University Medical Center 5
easy lay. See GHB
ecstasy 24. See also club drugs
education and prevention of
addiction 127128
emphysema 61
enabling characteristics 105106
epinephrine 60
estazolam. See also benzodiazepines
ethanol 16
euphoria 17
evidence-based treatments 118119
Faces and Voices of Recovery 118,
family and addiction 101102, 104114
family history. See addiction, family
fear in addiction 69
fire. See methamphetamines
flake. See cocaine/crack
flashbacks 23
flunitrazepam. See Rohypnol
Food and Drug Administration, U.S.
Ford, Betty 100
formication 18
freebase 19
Freevibe Web 127
friendships and addiction 9798,
GABA. See gamma-aminobutyric acid
Gallup poll 105
gamma-aminobutyric acid (GABA)
gangster. See marijuana
ganja. See marijuana
gateway drugs 57
genetic inheritance. See genetics
genetics 2, 3739, 43
Georgia home boy. See GHB
GHB 25. See also club drugs
glass. See methamphetamines
grades, failing 5859
grass. See marijuana
Index 155
hallucinogens 14, 2324, 59, 6263
hangovers 17, 59
hard drugs 10
harm reduction 89
hashish. See marijuana
Hazelden treatment center 9
HBO 102, 105, 111, 115, 116
heart problems 55
hearts. See amphetamines
Health, U.S. Department of 60, 69
health insurance coverage, rules of
Healthy Childhood Brain
Development Research Program 55
hepatitis 18, 23, 55, 56
hepatitis B 85
hepatitis C 56, 85
herb. See marijuana
heroin 3, 2223, 7980
Hill-Burton Free Care Act 120121
hippie culture 15
HIV 18, 23, 56, 85
Hole in the Nations Soul 4041
homicides 56
honesty in treatment success 87, 88
hydrocodone 22, 26
hydromorphone 22
ice. See methamphetamines
infectious diseases 23
infertility 56
inhalants 6364
injection drug use 56
insurance coverage. See health
insurance coverage, rules of
interaction (drug) 57
intervention 71, 108109
Join Together 127
Journal of Substance Abuse Treatment
Journal of the American Academy of
Child and Adolescent Psychiatry 41
judgment impairment 910, 64
Jung, Carl 88
Just Say No campaign 123124
ketamine 25. See also club drugs
LAAM. See levo-alpha-acetylmethadol
levo-alpha-acetylmethadol (LAAM)
84, 85
Librium 79. See also chlordiazepoxide
lifestyle changes 9596, 100
limbic system 28, 3334
liquid ecstasy. See GHB
liver damage 55, 56, 57
Lortab 80
loveboat. See PCP
LSD 23. See also hallucinogens
Lucy in the sky with diamonds. See
lysergic acid diethylamide. See LSD
magic mushrooms. See PCP
magnetic resonance imaging 55
maintenance stage of change 66
marijuana 3, 5, 10, 17, 20, 28, 57,
60, 80
Martyr role in enabling 106
Mary Jane. See marijuana
MDMA. See ecstasy
Mebaral. See mephobarbital
media influences 4142, 43, 130
Medicaid 116, 117
medications. See prescription drugs
156 Index
memory 64
mental illness 7, 13, 3940, 43, 59
mentally ill and chemically addicted
(MICA) 40
meperidine 22
mephobarbital. See also barbiturates
mescaline. See PCP
MET. See motivational enhancement
metabolism 19
meth. See methamphetamines
methadone 79, 85
methamphetamines 18, 6162. See
also amphetamines
See ecstasy
methylphenidate 26. See also
MI. See motivational interviewing
MICA. See mentally ill and
chemically addicted
moderation management 89
morphine 22
motivational enhancement therapy
(MET) 72, 82
motivational interviewing (MI) 82
Moyers, William C. 9
NACoA. See National Association for
Children of Alcoholics
naltrexone 81, 84, 100
narcotics 2223, 26
Narcotics Anonymous 45, 5052,
70, 81, 88, 122, 126127
National Alliance on Mental Illness
National Association for Children of
Alcoholics (NACoA) 113114
National Center on Addiction and
Substance Abuse. See CASA
National Clearinghouse for Alcohol
and Drug Information 59, 60
National Council on Alcoholism and
Drug Dependence 7, 77
National Governors Association 117
National Institute on Alcohol Abuse
and Alcoholism (NIAAA) 2, 10, 102,
113, 122, 124125
National Institute on Drug Abuse
(NIDA) 6, 8, 19, 28, 38, 87, 99,
125126, 127
National Institutes of Health 6, 35,
56, 58, 81
National Survey on Drug Use and
Health (NSDUH) 20, 65, 66, 83
Nembutal. See phenobarbital
neuron 33
neurotransmitter 21, 3334
NIAAA. See National Institute on
Alcohol Abuse and Alcoholism
addiction to 3, 1516
dangers of 6061
described 1921
effects of 6061
legal issues 54, 64
teens smoking patterns 42
NIDA. See National Institute on Drug
norepinephrine 26
NSDUH. See National Survey on Drug
Use and Health
occipital lobe 32
Office of National Drug Control
Policy. See White House Office of
National Drug Control Policy
ONDCP. See White House Office of
National Drug Control Policy
online support groups 102
open-mindedness in treatment
success 87, 88
opiates 22, 79
opioids 22
Index 157
opium poppy 22
outpatient services 72, 80, 91
overdose 22, 23, 80
over-the-counter drugs and products
oxycodone 22, 26
OxyContin 80. See also oxycodone
ozone. See PCP
pancreatitis 55
panic disorder 86
parental alcoholism 38
Partnership for Prescription
Assistance 121
PAWS. See Post Acute Withdrawal
paying for care 115222
PCP 2324, 63. See also hallucinogens
peace tablets. See LSD
peer pressure 41
peer program educational program
pep pills. See amphetamines
Percocet 26
peyote. See PCP
phencyclidine. See PCP
phenobarbital. See also barbiturates
physical dependency (symptom of
addiction) 4, 13, 4849
pleasure pathway 34
Post Acute Withdrawal Syndrome
(PAWS) 81, 88
post-traumatic stress disorder (PTSD)
39, 87
pot. See marijuana
precontemplation stage of change
66, 74
pregnancy 56
preparation stage of change 66, 74
prescription drugs 2526
abuse of 2
addictive ingredients 3
treatment element 82
legal issues 54
narcotics 26
paying for 121
sedatives 26
stimulants 26
in treatment programs 79, 80,
8386, 95
prevention of addiction 123130
progression of addiction. See
addiction, progression
propoxyphene 22
ProSom. See estazolam
Provider role in enabling 106
psilocybin. See PCP
psychedelic drugs 23. See also
psychoactive drugs 3
psychotherapy, 95. See also
treatment element
PTSD. See post-traumatic stress
Public Health Service, U.S. 106
purple flats. See LSD
questionnaires (symptom) 47, 5053
raves 62
receptors 21
attitude toward 7375
brain and 99
deciding on 75
defined 100
exploring 70
free 121122
issues 98101
maintaining 9397
preparing for 7173
158 Index
resisting 6870
self-tests 70
stages of 66
rehab. See rehabilitation
rehabilitation 8081
relapse stage of change 66, 99100,
relationships, impact of addiction and
alcoholism 58
Rescuer role in enabling 106
rescuing concepts 110
residential treatment 72, 80
ReVia 84
reward system 33
Ritalin. See methylphenidate
rocket fuel. See PCP
Rohypnol 24. See also
benzodiazepines; club drugs
roofies. See Rohypnol
rush 22
SADD. See Students Against
Destructive Decisions
Salvation Army 120
SAMHSA. See Substance Abuse
and Mental Health Services
SCHIP. See State Childrens Health
Insurance Program
schizophrenia 59
sedatives 21, 26. See also
barbiturates; prescription drugs
seizures 55, 79
self-medication risks 9, 39
Serax 79. See also benzodiazepines
serotonin 23
7 Cs of Addiction 113
sexually transmitted disease (STD)
shame of addiction 69
signs/symptoms of addiction 29,
sinsemilla. See marijuana
sleep functions 5556
snorted drug 18, 19
snow. See cocaine/crack
snuff 19. See also nicotine
soap. See GHB
social-host laws 127
social influences 2, 4143
socialization treatment element 83
soft drugs 10, 57
special K. See ketamine
speed. See methamphetamines
spirituality, search for 9, 4041,
8889, 98
stages of addiction 4950
State Childrens Health Insurance
Program (SCHIP) 116
State University of New York 101
STD. See sexually transmitted
stimulants 14, 1721, 26, 31, 59
stress 45
strokes 55
Students Against Destructive
Decisions (SADD) 129
substance abuse. See addiction
Substance Abuse and Mental Health
Services Administration (SAMHSA)
20, 73, 116
substance use disorder (SUD) 36,
913, 50
SUD. See substance use disorder
suicide 56
support for family/friend 106107
support groups, 9395, 102, 132
139. See also Al-Anon; Alateen;
Alcoholics Anonymous; Narcotics
surveys. See questionnaires
symptom questionnaires. See
questionnaires (symptom)
symptoms of addiction. See signs/
symptoms of addiction
Index 159
TACE survey 47
Tapert, Susan 55
THC. See delta-9-
therapists/counselors 70, 71
therapy. See treatment programs
time in treatment success 8687, 100
tobacco. See nicotine
tolerance (symptom of addiction) 4,
tranquilizers 79. See also
treatment management 92114
treatment programs 6591
tremors 79
trip 23
tuberculosis 85
12-step groups 81, 9495, 102, 122
underage drinking, reducing 127
University of CaliforniaSan Diego
University of Michigan, substance
use statistics 6
uppers. See stimulants
ups. See amphetamines
urine tests 72
USA Today 102, 105, 111, 115, 116
Valium 79. See also diazepam
veins, collapsed 23
Vicodin 80. See also hydrocodone
Vietnam War 15
violence 56
vita-G. See GHB
vitamin K. See ketamine
Vivitrol 84
wack. See PCP
weed. See marijuana
weight gain 55
Wellstone Mental Health and
Addiction Equity Act, Paul 118
white cross. See methamphetamines
White House Office of National Drug
Control Policy (ONDCP) 105, 107,
willingness in treatment success 87,
withdrawal symptoms 69, 79, 81
Xanax 80. See also alprazolam
yellow dimples. See LSD
Young People in Alcoholics
Anonymous 103
zero tolerance rule 5758