Addiction to drugs is a serious, chronic, and relapsing health problem for both women and men of all ages and backgrounds. Among women, however, drug abuse may present different challenges to health, may progress differently, and may require different treatment approaches.

Understanding Women Who Use Drugs
It is possible for drug-dependent women, of any age, to overcome the illness of drug addiction. Those that have been most successful have had the help and support of significant others, family members, friends, treatment providers, and the community. Women of all races and socioeconomic status suffer from the serious illness of drug addiction. And women of all races, income groups, levels of education, and types of communities need treatment for drug addiction, as they do for any other problem affecting their physical or mental health.

Many women who use drugs have faced serious challenges to their well-being during their lives. For example, research indicates that up to 70 percent of drug abusing women report histories of physical and sexual abuse. Data also indicate that women are far more likely than men to report a parental history of alcohol and drug abuse. Often, women who use drugs have low self-esteem and little self-confidence and may feel powerless. In addition, minority women may face additional cultural and language barriers that can affect or hinder their treatment and recovery.

Many drug-using women do not seek treatment because they are afraid: They fear not being able to take care of or keep their children, they fear reprisal from their spouses or boyfriends, and they fear punishment from authorities in the community. Many women report that their drug-using male sex partners initiated them into drug abuse. In addition, research indicates that drug-dependent women have great difficulty abstaining from drugs, when the lifestyle of their male partner is one that supports drug use.

Consequences of Drug Use for Women
Research suggests that women may become more quickly addicted than men to certain drugs, such as crack cocaine, even after casual or experimental use. Therefore, by the time a woman enters treatment, she may be severely addicted and consequently may require treatment that both identifies her specific needs and responds to them.

These needs will likely include addressing other serious health problems-sexually transmitted diseases (STDs) and mental health problems, for example. More specifically, health risks associated with drug abuse in women are:

Poor nutrition and below-average weight
Low self-esteem
Depression
Physical abuse
If pregnant, preterm labor or early delivery
Serious medical and infectious diseases (e.g., increased blood pressure and heart rate, STDs, HIV/AIDS)
Drug Abuse and HIV/AIDS
AIDS is now the fourth leading cause of death among women of childbearing age in the United States. Substance abuse compounds the risk of AIDS for women, especially for women who are injecting drug users and who share drug paraphernalia, because HIV/AIDS often is transmitted through shared needles, and other shared items, such as syringes, cotton swabs, rinse water, and cookers. In addition, under the influence of illicit drugs and alcohol, women may engage in unprotected sex, which also increases their risk for contracting or transmitting HIV/AIDS.

From 1993 to 1994, the number of new AIDS cases among women decreased 17 percent. Still, as of January 1997, the Centers for Disease Control and Prevention had documented almost 85,500 cases of AIDS among adolescent and adult women in the United States. Of these cases,

About 62 percent were related either to the woman's own injecting drug use or to her having sex with an injecting drug user.
About 37 percent were related to heterosexual contact, and almost half of these women acquired HIV/AIDS by having sex with an injecting drug user.
Treatment for Women
Research shows that women receive the most benefit from drug treatment programs that provide comprehensive services for meeting their basic needs, including access to the following:

Food, clothing, and shelter
Transportation
Job counseling and training
Legal assistance
Literacy training and educational opportunities
Parenting training
Family therapy
Couples counseling
Medical care
Child care
Social services
Social support
Psychological assessment and mental health care
Assertiveness training
Family planning services
Traditional drug treatment programs may not be appropriate for women because those programs may not provide these services. Research also indicates that, for women in particular, a continuing relationship with a treatment provider is an important factor throughout treatment. Any individual may experience lapses and relapses as expected steps of the treatment and recovery process; during these periods, women particularly need the support of the community and encouragement of those closest to them. After completing a drug treatment program, women also need services to assist them in sustaining their recovery and in rejoining the community.

Extent of Use
The National Household Survey on Drug Abuse (NHSDA)* provides yearly estimates of drug use prevalence among various demographic groups in the United States. Data are derived from a nationwide sample of household members aged 12 and older.

In 1996, 29.9 percent of U.S. women (females over age 12) had used an illicit drug at least once in their lives-33.3 million out of 111.1 million women. More than 4.7 million women had used an illicit drug at least once in the month preceding the survey.

The survey showed 30.5 million women had used marijuana at least once in their lifetimes. About 603,000 women had used cocaine in the preceding month; 241,000 had used crack cocaine. About 547,000 women had used hallucinogens (including LSD and PCP) in the preceding month.

In 1996, 56,000 women used a needle to inject drugs, and 856,000 had done so at some point in their lives.
In 1996, nearly 1.2 million females aged 12 and older had taken prescription drugs (sedatives, tranquilizers, or analgesics) for a nonmedical purpose during the preceding month.

In the month preceding the survey, more than 26 million women had smoked cigarettes, and more than 48.5 million had consumed alcohol.

Read More...

Many people view drug abuse and addiction as strictly a social problem. Parents, teens, older adults, and other members of the community tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs if they are willing to change their behavior.

These myths have not only stereotyped those with drug-related problems, but also their families, their communities, and the health care professionals who work with them. Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences. It is NIDA's goal to help the public replace its myths and long-held mistaken beliefs about drug abuse and addiction with scientific evidence that addiction is a chronic, relapsing, and treatable disease.

Addiction does begin with drug abuse when an individual makes a conscious choice to use drugs, but addiction is not just "a lot of drug use." Recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn drug abuse into addiction, a chronic, relapsing illness. Those addicted to drugs suffer from a compulsive drug craving and usage and cannot quit by themselves. Treatment is necessary to end this compulsive behavior.

A variety of approaches are used in treatment programs to help patients deal with these cravings and possibly avoid drug relapse. NIDA research shows that addiction is clearly treatable. Through treatment that is tailored to individual needs, patients can learn to control their condition and live relatively normal lives.

Treatment can have a profound effect not only on drug abusers, but on society as a whole by significantly improving social and psychological functioning, decreasing related criminality and violence, and reducing the spread of AIDS. It can also dramatically reduce the costs to society of drug abuse.

Understanding drug abuse also helps in understanding how to prevent use in the first place. Results from NIDA-funded prevention research have shown that comprehensive prevention programs that involve the family, schools, communities, and the media are effective in reducing drug abuse. It is necessary to keep sending the message that it is better to not start at all than to enter rehabilitation if addiction occurs.

A tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data. Overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" - the gap between the public perception of drug abuse and addiction and the scientific facts.

Be especially scrutinizing as you determine the drug rehab program that meets your specific needs. This site has listings of drug rehab programs and treatment centers, alcohol rehabilitation programs, teen rehabs, sober houses, drug detox and alcohol detox centers.

Please call (866) 762-3712 to find the right drug rehabilitation center for you or your loved one.

Read More...

Length of Detoxification

Because detoxification often entails a more intensive level of care than other types of AOD treatment, there is a practical value in defining a period during which a person is "in detoxification." There is no simple way to do this. Usually, the detoxification period is defined as the period during which the patient receives detoxification medications.

--------------------------------------------------------------------------------
Third-party payers often manage payment for AOD detoxification services separately from other phases of drug treatment, as though detoxification occurs in isolation from drug treatment. In clinical practice, this separation cannot exist. Detoxification is one component of a comprehensive treatment strategy.
--------------------------------------------------------------------------------

Another way of defining the detoxification period is by measuring the duration of withdrawal signs or symptoms. However, the duration of these symptoms may be difficult to determine in a correctly medicated patient because symptoms of withdrawal are largely suppressed by the medication. Chapter 3 describes the typical lengths of regimens for withdrawal.

The Role of Detoxification in AOD Abuse Treatment

For many AOD-dependent patients, detoxification is the beginning phase of treatment. It can entail more than a period of physical readjustment. It can also be a time when patients begin to make the psychological readjustments necessary for ongoing treatment. Offering detoxification alone, without followup to an appropriate level of care, is an inadequate use of limited resources. People who have severe problems that predate their AOD dependence or addiction -- such as family disintegration, lack of job skills, illiteracy, or psychiatric disorders -- may continue to have these problems after detoxification unless specific services are available to help them deal with these factors (Gerstein and Harwood, 1990).

Immediate Goals of Detoxification

To provide a safe withdrawal from the drug(s) of dependence and enable the patient to become drug free. Many risks are associated with withdrawal, some influenced by the setting. For persons who are severely dependent on alcohol, abrupt, unsupervised cessation of drinking may result in delirium tremens or death. Other sedative-hypnotics may produce life-threatening withdrawal syndromes. Withdrawal from opioids produces severe discomfort, but is not generally life threatening. However, risks to the patient and society are not limited to the severity of the patient's physical disturbance, particularly when the detoxification is conducted in an outpatient setting. Outpatients experiencing withdrawal symptoms may self-medicate with street drugs. The resulting interaction between prescribed medication and street drugs may result in an overdose. Less severe side effects include sedation or a drop in blood pressure.

To provide withdrawal that is humane and protects the patient's dignity. A caring staff, a supportive environment, sensitivity to cultural issues, confidentiality, and the selection of appropriate detoxification medication (if needed) are all important to providing humane withdrawal.

To prepare the patient for ongoing treatment of his or her AOD dependence. During detoxification, patients may form therapeutic relationships with treatment staff or other patients, and may become aware of alternatives to an AOD-abusing lifestyle. Detoxification is an opportunity to offer patients information and to motivate them for longer term treatment.

Repeated Detoxification

Alling discussed detoxification and treatment in a text published in 1992:

Those not familiar with the chronic nature of addictive disorders often characterize detoxification programs as 'revolving doors' through which patients come and go in an endless cycle, and which have little or no impact on the recovery process. Although it is true that many people undergo detoxification more than once -- and some do so many times -- the assumption that little or no progress has been made is often false. (Alling, 1992)

Alling(1992) described a pattern in individuals who return for several detoxification episodes, observing that young people with a history of AOD dependence of short duration (a year or less) "often are unrealistically optimistic about being able to remain drug free following detoxification." When recently AOD-dependent persons return after several months for repeat detoxification, it is usually with a more realistic expectation about what is needed to remain free from AODs. Individuals who subsequently relapse and return for detoxification a third time may have an even clearer understanding of what is required to sustain recovery (Alling, 1992).

During certain expected and predictable phases of recovery, addicted persons are at increased risk of relapse. However, relapse can occur at any point in recovery. Thus, relapse prevention is a legitimate area for patient education, and the relapsed patient is appropriate for clinical treatment. Treatment services designed precisely for this stage of the disease may facilitate the individual's return to abstinence.

Issues in Postdetoxification Treatment

Few addicted persons enter detoxification or seek further treatment with the idea of maintaining lifelong abstinence. They may still believe they can control their abuse of AODs. Some persons enter detoxification and other treatment to satisfy the demands of their families, employers, or the courts. They may be motivated to seek treatment because attempts to relieve pressure through other means have proved futile. Clinicians should consider patient motivation when deciding upon appropriate treatment placement.

Families suffer severe consequences from the AOD abuse of their loved ones. The consequences may include obvious problems such as lost income, domestic violence, or divorce. Less obvious consequences may also occur, such as issues concerning trust and children's mirroring maladaptive ways to deal with problems encountered in everyday living. Addiction is a family disease because of the seriousness of its effects on family members and family functioning. Just as the person who abuses AODs needs support, education, and counseling, so too does the family. It is appropriate and important for treatment providers to engage the family in treatment as early as possible, even while the individual is undergoing detoxification.

Effects of AOD Exposure and Withdrawal

Tolerance and Physical Dependence

Continued exposure to AODs induces adaptive changes in an individual's brain cells and neural functioning. The changes vary depending on the drug of abuse and are not completely understood. The term "neuroadaptation" is often used to refer to these changes. One result of neuroadaptation is drug tolerance; that is, increasing the amounts of the drug that are required to produce the same effect. A second consequence of neuroadaptation is physical dependence; the brain cells require the drug in order to function.

Drug Withdrawal

Sudden removal of alcohol or another drug of abuse from the system of a person who is physically dependent produces either an abstinence or withdrawal syndrome. The abstinence syndrome for each drug follows a predictable time course and has predictable signs and symptoms. Signs are defined by Webster's Medical Dictionary as "objective evidence of disease especially as observed and interpreted by the physician rather than by the patient or lay observer." Symptoms are defined in the same text as "subjective evidence of disease or physical disturbance observed by the patient."

--------------------------------------------------------------------------------

There are three immediate goals of detoxification:

• To provide a safe withdrawal from the drug(s) of dependence and enable the patient to become drug free
  
• To provide withdrawal that is humane and protects the patient's dignity
  
• To prepare the patient for ongoing treatment of his or her AOD dependence

--------------------------------------------------------------------------------

The signs and symptoms of drug withdrawal are usually the reverse of the direct pharmacological effects of the drug. Heroin use commonly produces elevation of mood (euphoria), a decrease in anxiety, insensitivity to pain (analgesia), and a decrease in the activity of the large intestine, often causing constipation. Heroin withdrawal, on the other hand, produces an unpleasant mood (dysphoria), pain, anxiety, and overactivity of the large intestine, often resulting in diarrhea. Alcohol usually reduces anxiety and causes sedation; large quantities may produce sleep, coma, or even death by respiratory depression. In a person who is physically dependent, cessation of alcohol use produces anxiety, insomnia, hallucinations, and seizures.

For short-acting drugs such as alcohol and heroin, the most severe signs and symptoms of withdrawal usually begin within hours of the individual's last use. With a long-acting drug or medication, such as diazepam (Valium), withdrawal symptoms may not begin for several days and usually reach peak intensity after 5 to 10 days. The most severe drug-withdrawal symptoms, during the initial stages of detoxification, constitute the acute abstinence syndrome. The adjective "acute" distinguishes the syndrome from a "chronic" or protracted abstinence syndrome, in which signs and symptoms of withdrawal may continue for weeks to months after cessation of use (Martin and Jasinski, 1969).

--------------------------------------------------------------------------------
The signs and symptoms of drug withdrawal are usually the reverse of the direct pharmacological effects of the drug.
--------------------------------------------------------------------------------

Protracted abstinence syndrome is the subject of considerable controversy. Providers often find it difficult to distinguish symptoms caused by drug withdrawal from those caused by a patient's underlying mental disorder, if one is present. The signs and symptoms of protracted withdrawal are not as predictable as those of acute withdrawal. Some patients may be predisposed to a protracted withdrawal. Acute withdrawal syndromes produce measurable signs that researchers can study in animals under controlled laboratory conditions; protracted withdrawal in patients, by contrast, is often confined to distress symptoms that cannot be studied in animals.

Source: U.S. Department of Health and Human Services

Be especially scrutinizing as you determine the drug rehab program that meets your specific needs. This site has listings of drug rehab detox programs and detox treatment centers, alcohol detox rehabilitation programs, teen drug rehab, sober houses, drug detox and alcohol detox centers.

Please call (866) 762-3712 to find the right drug rehabilitation center for you or your loved one.

Read More...

Cocaine's effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect.

The duration of cocaine's immediate euphoric effects depends upon the route of administration. The faster the absorption, the more intense the high. Also, the faster the absorption, the shorter the duration of action. The high from snorting is relatively slow in onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes.

The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

---

What are the long-term
effects of cocaine use?

---

Long-term effects of cocaine

Addiction Irritability and mood disturbances Restlessness Paranoia Auditory hallucinations

Cocaine is a powerfully addictive drug. Once having tried cocaine, an individual may have difficulty predicting or controlling the extent to which he or she will continue to use the drug. Cocaine's stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the brain's reward system, and is either directly or indirectly involved in the addictive properties of every major drug of abuse.

An appreciable tolerance to cocaine's high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitization) to cocaine's anesthetic and convulsant effects, without incre?g the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

---

What are the medical complications of cocaine abuse?

---

Medical consequences of cocaine abuse

Cardiovascular effects disturbances in heart rhythm heart attacks Respiratory effects chest pain respiratory failure Neurological effects strokes seizures and headaches Gastrointestinal complications abdominal pain nausea

There are enormous medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions and coma.

Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. And, persons who inject cocaine have puncture marks and "tracks," most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug, or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.

Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone. While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.

---

Are cocaine abusers at risk
for contracting HIV/AIDS
and hepatitis B and C?

---

Yes. Cocaine abusers, especially those who inject, are at increased risk for contracting such infectious diseases as human immunodeficiency virus (HIV/AIDS) and hepatitis. In fact, use and abuse of illicit drugs, including crack cocaine, have become the leading risk factors for new cases of HIV. Drug abuse-related spread of HIV can result from direct transmission of the virus through the sharing of contaminated needles and paraphernalia between injecting drug users. It can also result from indirect transmission, such as an HIV-infected mother transmitting the virus perinatally to her child. This is particularly alarming, given that more than 60 percent of new AIDS cases are women. Research has also shown that drug use can interfere with judgement about risk-taking behavior, and can potentially lead to reduced precautions about having sex, the sharing of needles and injection paraphernalia, and the trading of sex for drugs, by both men and women.

Additionally, hepatitis C is spreading rapidly among injection drug users; current estimates indicate infection rates of 65 to 90 percent in this population. At present, there is no vaccine for the hepatitis C virus, and the only treatment is expensive, often unsuccessful, and may have serious side effects.

---

What is the effect of
maternal cocaine use?

---

The full extent of the effects of prenatal drug exposure on a child is not completely known, but many scientific studies have documented that babies born to mothers who abuse cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are often shorter in length.

Estimating the full extent of the consequences of maternal drug abuse is difficult, and determining the specific hazard of a particular drug to the unborn child is even more problematic, given that, typically, more than one substance is abused. Such factors as the amount and number of all drugs abused; inadequate prenatal care; abuse and neglect of the children, due to the mother's lifestyle; socio-economic status; poor maternal nutrition; other health problems; and exposure to sexually transmitted diseases, are just some examples of the difficulty in determining the direct impact of perinatal cocaine use, for example, on maternal and fetal outcome.

Many may recall that "crack babies," or babies born to mothers who used cocaine while pregnant, were written off by many a decade ago as a lost generation. They were predicted to suffer from severe, irreversible damage, including reduced intelligence and social skills. It was later found that this was a gross exaggeration. Most crack-exposed babies appear to recover quite well. However, the fact that most of these children appear normal should not be over-interpreted as a positive sign. Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, but significant, deficits later, especially with behaviors that are crucial to success in the classroom, such as blocking out distractions and concentrating for long periods of time.

---

What treatments are effective
for cocaine abusers?

---

There has been an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be poly-drug users, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of problems. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient's drug abuse.

Pharmacological Approaches

There are no medications currently available to treat cocaine addiction specifically. Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine treatment medications. Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. For example, one of the most promising anti-cocaine drug medications to date, selegeline, is being taken into multi-site phase III clinical trials in 1999. These trials will evaluate two innovative routes of selegeline administration: a transdermal patch and a time-released pill, to determine which is most beneficial. Disulfiram, a medication that has been used to treat alcoholism, has also been shown, in clinical studies, to be effective in reducing cocaine abuse. Because of mood changes experienced during the early stages of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

Behavioral Interventions

Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction, for which there is, as yet, no viable medication. However, integration of both types of treatments is ultimately the most effective approach for treating addiction. It is important to match the best treatment regimen to the needs of the patient. This may include adding to or removing from an individual's treatment regimen a number of different components or elements. For example, if an individual is prone to relapses, a relapse component should be added to the program. A behavioral therapy component that is showing positive results in many cocaine-addicted populations, is contingency management. Contingency management uses a voucher-based system to give positive rewards for staying in treatment and remaining cocaine free. Based on drug-free urine tests, the patients earn points, which can be exchanged for items that encourage healthy living, such as joining a gym, or going to a movie and dinner. Cognitive-behavioral therapy is another approach. Cognitive-behavioral coping skills treatment, for example, is a short-term, focused approach to helping cocaine-addicted individuals become abstinent from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. The same learning processes can be employed to help individuals reduce drug use. This approach attempts to help patients to recognize, avoid, and cope; i.e., recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, such as pharmacotherapy.

Therapeutic communities, or residential programs with planned lengths of stay of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. Therapeutic communities are often comprehensive, in that they focus on the resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Therapeutic communities typically are used to treat patients with more severe problems, such as co-occurring mental health problems and criminal involvement.

Read More...

Buprenorphine, a derivative of thebaine, is an opiate that has been marketed in the United States as the Schedule V parenteral analgesic Buprenex®. In 2002, based on a re-evaluation of available evidence regarding the potential for abuse, diversion, dependence, and side effects, the DEA reclassified buprenorphine from a Schedule V to a Schedule III narcotic.

In October 2002, Reckitt Benckiser received FDA approval to market a buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in opioid addiction treatment. The combination product is designed to decrease the potential for abuse by injection. Subutex® and Suboxone® are currently the only medications to have received FDA approval for this indication. In January 2003, Reckitt Benckiser began shipments of Suboxone® to pharmacies in the United States.

The approval of these formulations does not affect the treatment standards of previously approved medication-assisted treatments, such as methadone and LAAM (levo-alpha-acetyl-methadol). As indicated in Title 42 Code of Federal Regulations Part 8 (42 CFR Part 8), these therapies can only be dispensed, and only in the context of an Opioid Treatment Program. Also, neither the approval of Subutex® and Suboxone®, nor the provisions of DATA 2000, affect the use of other Schedule III, IV, or V medications, such as morphine, that are not approved for the treatment of addiction. Lastly, note that other forms of buprenorphine besides Subutex® and Suboxone®, e.g., Buprenex®, are not approved for treatment of opioid addiction.

Applied Pharmacology

Buprenorphine is an opioid partial agonist. This means that, although buprenorphine is an opioid, and thus can produce typical opioid agonist effects and side effects, such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone. At low doses, buprenorphine produces sufficient agonist effect to enable opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symptoms. The agonist effects of buprenorphine increase linearly with increasing doses of the drug until at moderate doses they reach a plateau and no longer continue to increase with further increases in dose—the so-called “ceiling effect.” Thus, buprenorphine carries a lower risk of abuse, dependence, and side effects compared to full opioid agonists. In fact, in high doses and under certain circumstances, buprenorphine can actually block the effects of full opioid agonists and can precipitate withdrawal symptoms in an acutely opioid-intoxicated individual.

Buprenorphine has poor oral bioavailability and moderate sublingual bioavailability. Thus, formulations for opioid dependence treatment are in the form of sublingual tablets.

Buprenorphine is highly bound to plasma proteins. It is metabolized by the liver via the cytochrome P4503A4 enzyme system into norbuprenorphine and other metabolites. The half-life of buprenorphine is 24–60 hours.

Safety

Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16–32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects.

Respiratory depression from buprenorphine (or buprenorphine/naloxone) overdose is less likely than from other opioids. There is no evidence of organ damage with chronic use of buprenorphine, although increases in liver enzymes are sometimes seen. Likewise, there is no evidence of significant disruption of cognitive or psychomotor performance with buprenorphine maintenance dosing.

Information about the use of buprenorphine in pregnant, opioid-dependent women is limited; the few available case reports have not demonstrated any significant problems due to buprenorphine use during pregnancy. Suboxone® and Subutex® are classified by the FDA as Pregnancy Category C medications.

Side Effects

Side effects of buprenorphine are similar to those of other opioids and include nausea, vomiting, and constipation. Buprenorphine and buprenorphine/naloxone can precipitate the opioid withdrawal syndrome. Additionally, the withdrawal syndrome can be precipitated in individuals maintained on buprenorphine. Signs and symptoms of opioid withdrawal include:

Dysphoric mood
Nausea or vomiting
Muscle aches/cramps
Lacrimation
Rhinorrhea
Pupillary dilation
Sweating
Piloerection
Diarrhea
Yawning
Mild fever
Insomnia
Craving
Distress/irritability

Abuse Potential

Because of its opioid agonist effects, buprenorphine is abusable, particularly by individuals who are not physically dependent on opioids. Naloxone is added to buprenorphine to decrease the likelihood of diversion and abuse of the combination product. Sublingual buprenorphine has moderate bioavailability, while sublingual naloxone has poor bioavailability. Thus, when the buprenorphine/naloxone tablet is taken in sublingual form, the buprenorphine opioid agonist effect predominates, and the naloxone does not precipitate opioid withdrawal in the opioid-dependent user.

Naloxone via the parenteral route, however, has good bioavailability. If the sublingual buprenorphine/naloxone tablets are crushed and injected by an opioid-dependent individual, the naloxone effect predominates and can acutely precipitate the opioid withdrawal syndrome.

Under certain circumstances buprenorphine by itself can also precipitate withdrawal in opioid-dependent individuals. This is more likely to occur with higher levels of physical dependence, with short time intervals (e.g., less than 2 hours) between a dose of opioid agonist (e.g., methadone) and a dose of buprenorphine, and with higher doses of buprenorphine.

Evidence of Effectiveness

Studies have shown that buprenorphine is more effective than placebo and is equally as effective as moderate doses of methadone and LAAM in opioid maintenance therapy. Buprenorphine is unlikely to be as effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence.

Few studies have been reported on the efficacy of buprenorphine for completely withdrawing patients from opioids. In general, the results of studies of medically assisted withdrawal using opioids (e.g., methadone) have shown poor outcomes. Buprenorphine, however, is known to cause a milder withdrawal syndrome compared to methadone and for this reason may be the better choice if opioid withdrawal therapy is elected.

Non-pharmacological Therapies

Effective treatment of drug addiction requires comprehensive attention to all of an individual’s medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus Suboxone® and Subutex® treatment should be combined with concurrent behavioral therapies and with the provision of needed social services.

The choice of treatment setting in which to provide non-pharmacological therapies should be determined based on the intensity of intervention required for a patient. The continuum of treatment setting intensities ranges from episodic office-based therapy to intensive inpatient therapy.

Ideal candidates for opioid addiction treatment with buprenorphine are individuals who have been objectively diagnosed with opioid addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy, and who agree to buprenorphine treatment after a review of treatment options. There are three phases of buprenorphine maintenance therapy: induction, stabilization, and maintenance.

The induction phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opioid-dependent individual has abstained from using opioids for 12–24 hours and is in the early stages of opioid withdrawal. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could precipitate acute withdrawal.

Induction is typically initiated as observed therapy in the physician’s office and may be carried out using either Suboxone® or Subutex®, dependent upon the physician’s judgment. As noted above, Buprenex®, the parenteral analgesic form of buprenorphine, is not FDA-approved for use in opioid addiction treatment.

The stabilization phase has begun when the patients have discontinued or greatly reduced the use of their drug of abuse, no longer has cravings, and is experiencing few or no side effects. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved.

The maintenance phase is reached when the patient is doing well on a steady dose of buprenorphine (or buprenorphine/naloxone). The length of time of the maintenance phase is individualized for each patient and may be indefinite. The alternative to going into (or continuing) a maintenance phase, once stabilization has been achieved, is medically supervised withdrawal. This takes the place of what was formerly called “detoxification.”

Be especially scrutinizing as you determine the drug rehab program that meets your specific needs. This site has listings of drug rehab programs and treatment centers, alcohol rehabilitation programs, teen rehabs, sober houses, drug detox and alcohol detox centers.

Please call (866) 762-3712 to find the right drug rehabilitation center for you or your loved one.

Read More...

Being a teenager and raising a teenager are individually, and collectively, enormous challenges. For many teens, illicit substance use and abuse become part of the landscape of their teenage years. Although most adolescents who use drugs do not progress to become drug abusers, or drug addicts in adulthood, drug use in adolescence is a very risky proposition. Even small degrees of substance abuse (for example, alcohol, marijuana, and inhalants) can have negative consequences. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug use and abuse.

One of the most telling signs of a teen's increasing involvement with drugs is when drug use becomes part of the teen's daily life. Preoccupation with drugs can crowd out previously important activities, and the manner in which the teen views him or her self may change in unrealistic and inaccurate directions. Friendship groups may change, sometimes dramatically, and relationships with family members can become more distant or conflictual. Further bad signs include more frequent use or use of greater amounts of a certain drug, or use of more dangerous drugs, such as cocaine, amphetamines, or heroin. Persistent patterns of drug use in adolescence are a sign that problems in that teen's environment exist and need to be addressed immediately.

What causes adolescent substance abuse?
There is no single cause of adolescent drug problems. Drug abuse develops over time; it does not start as full-blown abuse or addiction. There are different pathways or routes to the development of a teen's drug problems. Some of the factors that may place teens at risk for developing drug problems include:

• insufficient parental supervision and monitoring
• lack of communication and interaction between parents and kids
• poorly defined and poorly communicated rules and expectations against drug use
• inconsistent and excessively severe discipline
• family conflict
• favorable parental attitudes toward adolescent alcohol and drug use, and parental alcoholism or drug use

It is important to also pay attention to individual risk factors. These include:

• high sensation seeking
• impulsiveness
• psychological distress
• difficulty maintaining emotional stability
• perceptions of extensive use by peers
• perceived low harmfulness to use

How do you know when to seek help?
The earlier one seeks help for their teen's behavioral or drug problems, the better. How is a parent to know if their teen is experimenting with or moving more deeply into the drug culture? Above all, a parent must be a good and careful observer, particularly of the little details that make up a teen's life. Overall signs of dramatic change in appearance, friends, or physical health may be signs of trouble. If a parent believes his or her child may be drinking or using drugs, here are some things to watch for:

• Physical evidence of drugs and drug paraphernalia
• Behavior problems and poor grades in school
• Emotional distancing, isolation, depression, or fatigue
• Change in friendships or extreme influence by peers
• Hostility, irritability, or change in level of cooperation around the house
• Lying or increased evasiveness about after school or weekend whereabouts
• Decrease in interest in personal appearance
• Physical changes such as bloodshot eyes, runny nose, frequent sore throats, rapid weight loss
• Changes in mood, eating, or sleeping patterns
• Dizziness and memory problems

Howard Liddle, Ed.D.

Read More...

What is Morphine?

Morphine is typically prescribed to patients for pain relief, it is one of the best drugs available to relieve severe pain and is considered as the yardstick against which new pain relief drugs are tested. Morphine is a narcotic, and has increased substantially during recent years. There are now many more morphine based products available on the market.

Morphine is available under different brand names in each country, in the US Morphine drugs are sold under the following brand names:
- MSIR
- Roxanol
- Kadian
- Oramorph SR
- RMS

Morphine can also be used to sedate patients before operations, instead of anesthetic and as a pain killer. This is one of the most widely used pain relief drugs for severe pain.

How is Morphine taken?

Morphine can be purchased in a number of different forms, including:

- Tablets and Capsules
- Suppositories
- Injections
- Oral Solutions

All of these forms of morphine are equally as addictive, it is actually very easy to get addicted to something like morphine. You can also get high concentration morphine products, some as high as 25mg injections which can be used to treat pain in patients which are tolerant to opiates.

What is Morphine Addiction?

A person can quite easily become addicted to morphine as a result of abusing it. Morphine is created from opium, it is a more refined drug and so it more powerful. This drug can be purchased in a number of different concentrations, from 4% up to 21%. Opium typically only has 10% morphine content, so you can see how powerful morphine is. In the United states very little opium is actually used in its raw form, only around 15 tons is used like this. The remaining 120 tons is processed into morphine and other similar products.

Morphine creates a sense of euphoria which is why it’s so addictive. It targets the reward centres of the brain which can make taking this drug to be very pleasurable. Your body will get used to morphine being in your system and so you might crave it if you stop using it. People suffering from Morphine Addiction will do almost anything to get the morphine that their body craves. Your body will start to build up a resistance to morphine which as in Opium Addiction will mean you have to take higher and higher doses to get the same feeling.

Morphine creates a state of euphonium which can lead to an addiction. It relieves pain, but it can also affect the mental and physical performance of the person. Morphine actually reduces anxiety and fear, and is well known to increase sex drive. Morphine can also affect a woman’s menstrual cycle, cause constipation and prevent someone being ale to cough. There are many reasons why people should not take morphine, however there are still many people that are addicted to it.

Read More...