14. March 2010 by stationmanager.

There was a time in our history—not so long ago—when smoking was cool, when seat belts were for sissies, and when AIDS was seen as a death sentence for gay sex. Today our attitudes are profoundly different—with powerful and beneficial consequences. Smoking has been cut sharply, and so have the related deaths from lung cancer and heart disease. Auto safety measures have curbed the highway death and injury rate. AIDS is recognized as a serious illness rather than
a social curse.In all three cases, we fundamentally changed our attitudes and, as a result, took actions that greatly improved the quality of life for millions of people.The time has come for a fundamental change in our attitude about the pervasive and pernicious role drug and alcohol abuse play in our society and a revolution in the way we deal with it.

Americans, comprising only four percent of the world’s population, consume two-thirds of the world’s illegal drugs. The number of illegal drug users, which had dropped from a high of 25.4 million in 1979 to a quarter century low of 12 million in 1992, rose to 20.4 million in 2006. The number of teen illegal drug users, which had dropped from its 1979 high of 3.3 million to a low of 1.1 million in 1992, more than doubled to 2.5 million in 2006.All the huffing and puffing in the current war on drugs has not been able to blow down the nation’s house of substance abuse and addiction:
• 61 million Americans are hooked on cigarettes.
• 16 to 20 million are addicted to alcohol or abuse it regularly.
• More than 15 million abuse prescription drugs.
• 15 million smoke marijuana.
• 2.4 million use cocaine; 600,000 use crack.
• Hundreds of thousands are hooked on heroin.
• More than 750,000 are methamphetamine users.
• 1 million use ecstasy and hallucinogens.
• Almost 2 million of our children have used steroids.
• 4.5 million teens abuse controlled prescription drugs like OxyContin, Ritalin, and Adderall to get high.The human misery that addiction and abuse cause can’t be calculated. The consequences of this
epidemic are severe.Almost a quarter of a trillion dollars of the nation’s yearly health-care bill is attributable to substance abuse and addiction.

Alcohol and other drug abuse is involved in most violent and property crimes, with 80 percent of the nation’s adult inmates and juvenile arrestees either committing their offenses while high, stealing to buy drugs, violating alcohol or drug laws, having a history of substance abuse/addiction, or sharing some mix of these characteristics.

Seventy percent of abused and neglected children have alcohol or drug abusing parents.

Ninety percent of homeless are alcoholics or alcohol abusers; 60 percent abuse other drugs.

Half of the nation’s college students binge drink and/or abuse illegal and prescription drugs. Nearly a quarter of them meet the medical criteria for alcohol and drug abuse and addiction. Cruel courtesy of excessive drinking, each year—700,000 students are injured, 100,000 are raped or sexually assaulted, and 1,700 are killed by alcohol poisoning or alcohol related injuries.Addiction and the Brain

Statistically we have known for some time that teens who abuse alcohol and smoke marijuana are likelier to use drugs like cocaine and heroin. Now biomedical research and the brain imaging work of Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), help explain why teens who play with the fire of cigarettes, alcohol, and marijuana increase the chance they will get burned by the flames of heroin, cocaine, and hallucinogens. All of these substances cause an increase in dopamine levels in the brain. As dopamine levels increase, an individual’s feeling of pleasure increases. A growing body of science is finding that all these substances affect dopamine levels in the brain through similar pathways, and dopamine becomes less active in the brains of addicts who use drugs to trigger its release, a condition which in turn reinforces the need for the drug.Studies by scientists in Italy reveal that marijuana affects levels of dopamine in the brain in a manner akin to heroin. Studies in the United States have found that nicotine and alcohol (as well as cocaine) have a similar effect on dopamine levels through common pathways to the brain. This may explain why some scientists believe that nicotine makes the brain more accommodating to other drugs.In essence, whatever the substance, the brains of addicts are “rewired,” becoming predisposed to
cravings. Dr. Joseph Frascella of NIDA points out that “in excessive behaviors such as compulsive drug abuse…the brain is changed, reward circuits are disrupted, and the behavior eventually becomes involuntary….”

These statistical and biological findings are underscored by the fact that most addicts are poly-drug abusers. Alcoholics are likely to abuse tranquilizers, sleeping pills, or other psychotropic drugs. Older teens who abuse prescription drugs are often found to be to be abusing other drugs as well. There are also social elements to the relationship among smoking, drinking, and using illegal and prescription drugs, as well as to polydrug use, particularly among children and teens. Kids who seek the high from marijuana may also want to look for “better” highs from other drugs. As kids start using drugs, they may tend to hang out and share experiences with others who use different drugs. In a sense, these teens end up encouraging each other to use various drugs.

Of special importance is the need to recognize that for many teens, smoking, drinking, or drug use is often a symptom of incipient depression, anxiety or some other (usually undiagnosed) mental illness that hikes the youngster’s risk of drug abuse.

Mental health problems go hand in hand with smoking, drinking, and drug use for children and adults, and these problems can lead individuals to self-medicate with a variety of substances. Our current approach to substance abuse does not
adequately recognize this.

Mounting a Revolution

We must recognize that substance abuse and addiction is a disease, not a moral failing or easily abandoned self-indulgence. We must recognize that it is a complex disease with neurological, physical, emotional, and spiritual components. We must recognize its impact on the most intractable domestic problems we confront. With such acceptance and recognition, we will appreciate the benefits of a revolution.

In the Health-care System—The National Institutes of Health spend $13 billion a year on research for cancer, strokes, cardiovascular, and respiratory diseases, and AIDS, but only one tenth of that amount to study substance abuse and addiction—the largest single cause and excacerbator of this quintet of killers and cripplers. It is time for a revolution in health-care: the creation of the National Institute on Addiction, with a budget of at least $3 billion a year to conduct a “Manhattan Project”-style research initiative identifying the causes and cures of substance abuse and addiction.

Courses in substance abuse and addiction should be a compulsory part of medical school curriculums. Physicians should be trained to diagnose the disease and refer patients for treatment. States and medical societies should establish professional standards for treatment counselors and accreditation systems to certify treatment facilities. Public and private health plans should cover substance abuse treatment and pay doctors to talk to patients.

Only through professionalizing the treatment system will we be able to bring it fully into the medical care system, which, in turn, is key to obtaining parity of coverage.

In the Justice System—Our nation’s prison system is as anachronistic as the debtor prisons in Charles Dickens’ day. Prosecutors, courts, and prisons must seize the opportunity to reclaim hundreds of thousands of addicts by using the criminal justice system to offer effective treatment for all who need it and incentives for them to achieve and maintain sobriety. Successfully treating and training inmates could deliver the greatest reduction in criminal activity in the nation’s history. Experts estimate that the number of crimes committed by a drug addict range from 89 to 191 annually.

In the Social Service System—Parental substance abuse accounts for $23 billion in the nation’s child welfare spending, and most domestic violence involves alcohol or other drugs. The time has come for a complete overhaul of family court, adoption, and foster care systems in order to better deal with alcohol and drug abusing parents and partners. The only way we will rehabilitate our nation’s homeless population is by investing in substance abuse and mental health treatment.

In the Education System—Schools, from elementary through college, should include age appropriate education about all substance abuse involving tobacco, alcohol, prescription, and illegal drugs as they do about other health matters from hygiene to STDs.

Prevention should be “laser beamed” on children. Sixteen years of research at The National Center on Addiction and Substance Abuse finds that a child who gets through age 21 without smoking, using illegal drugs, or abusing alcohol is
virtually certain never to do so. It is time to end the denial and stamp out the stigma associated with substance abuse and addiction, and to finally commit the energy and resources to confront a plague that has maimed and killed more Americans than all our wars, natural catastrophes, and traffic accidents combined.In his monumental study of history, the brilliant British historian Arnold Toynbee found that the great civilizations were destroyed not by an external enemy, but from within. “Civilizations,” he said, “die from suicide, not by murder.” Of all the internal dangers our nation faces, none possess a greater threat to our children and families and none is complicit in more domestic ills than substance abuse and addiction.This is our enemy within.

The judgment of history will be harsh if we fail to defeat that enemy—and deservedly so, when the stakes are our children and there is so much we can do to help them. 

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6. March 2010 by stationmanager.

Of the 2.3 million inmates in prison or jail in the United States, 1.5 million meet the DSM IV medical criteria for substance abuse or addiction. An additional 458,000 had histories of substance abuse; were under the influence of alcohol or other drugs at the time of their crime; committed their offense to get money to buy drugs; were incarcerated for an alcohol or drug law violation; or shared some combination of these characteristics, according to Behind Bars II: Substance Abuse and America’s Prison Population. Combined these two groups constitute 85 percent of the U.S. prison population.

The new 144-page report released on Friday by The National Center on Addiction and Substance Abuse (CASA) at Columbia University also reveals that alcohol and other drugs are significant factors in all crime. In 2006, alcohol and other drugs were involved in these inmate offenses:
78 percent of violent crimes;
83 percent of property crimes; and
77 percent of public order, immigration or weapon offenses; and probation/parole violations.

Despite these high rates, the CASA report found that only 11 percent of all inmates with substance abuse and addiction disorders receive any treatment during their incarceration. The report found that if all inmates who needed treatment and aftercare received such services, the nation would break even in a year if just over 10 percent remained substance and crime free and employed. Thereafter, for each inmate who remained sober, employed and crime free the nation would reap an economic benefit of $90,953 per year.

“States complain mightily about their rising prison costs; yet they continue to hemorrhage public funds that could be saved if they provided treatment to inmates with alcohol and other drug problems and stepped up use of drug courts and prosecutorial drug treatment alternative programs,” said Susan E. Foster, CASA’s Vice President and Director of Policy Research and Analysis.

The report also noted that in 2005, federal, state and local governments spent $74 billion on incarceration, court proceedings, probation and parole for substance-involved adult and juvenile offenders and less than one percent of that amount—$632 million—on prevention and treatment for them.

Twelve years ago, CASA released Behind Bars: Substance Abuse and America’s Prison Population. CASA prepared this report to see if any progress had been made in reducing the number of substance-involved offenders behind bars and to examine and identify promising practices for cost-effective investments. To conduct this study, CASA researchers analyzed data on inmates from 11 federal sources, reviewed more than 650 articles and other publications, examined best practices in prevention and treatment for substance-involved offenders, reviewed accreditation standards and analyzed costs and benefits of treatment.

The CASA report also found that compared to non-substance involved inmates, substance-involved inmates are not only likelier to be re-incarcerated, begin their criminal careers at an early age, and have more contacts with the criminal justice system, but they are also:
Four times likelier to receive income through illegal activity;
Twice as likely to have had at least one parent who abused alcohol or other drugs when they were children;
41 percent likelier to have some family criminal history;
29 percent less likely to have completed at least high school; and
20 percent likelier to be unemployed a month before incarceration.

Click here to read CASA’s full news release on the report.

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