Drug Abuse Treatment

If you’re like most people, you may try to avoid revealing anything about yourself that will make people think differently or negatively about you. Basically, you’re avoiding stigma—which is being marked by shame or disgrace.

But what if you have a drug problem and want to get help?

For a long time, our society has “stigmatized” drug use and addiction, judging people with drug or alcohol problems. Fear of being judged can be dangerous if it keeps someone from getting treatment.

One way to combat the stigma associated with drug addiction is to teach people the facts. NIDA science shows that addiction is a disease, just as cancer and asthma are diseases. It’s not just that the person chooses to take drugs. In fact, an addicted person no longer chooses to take drugs—rather, their brains have been altered by drugs to the point where free will has been cruelly “hijacked,” and the desire to seek and use drugs is beyond their control. Addiction is a disease of the brain that manifests itself in compulsive behaviors. Helping people understand this sad truth may lead to more support for those battling addiction.

It’s also important to stop labeling people as one thing or another. Try to avoid saying “addicts.” This label makes it easier to dismiss people as not worthy of help or notice. It’s better to say, people with “drug use problems” or “substance use disorders.” It may be a mouthful, but this phrase makes it clear that these are people who are facing challenges. They are more than just drug addicts.

Do you avoid certain hobbies, interests, or even potential new friends because you’re afraid of what your current friends will think? What would you say to someone who needs drug abuse treatment but isn’t getting it for fear of being judged?

My name is Sarah and before my high school senior year, I spent a summer at NIDA as an intern with the Center for Clinical Trials Network (CCTN). Never heard of it? Neither had I. I discovered that the goal of the CCTN is to improve the quality of drug abuse treatment throughout the whole country by doing safe and interesting scientific studies with humans. By the way, human studies are called “Clinical Trials.” These are trials or tests done to evaluate the effectiveness and safety of different medications or approaches by monitoring their effects on large groups of people, like a big “clinic” full of patients, but in a research setting.

As the name implies, the CCTN works as a network that includes scientific investigators all over the country. These investigators work together to develop and carry out clinical trials to evaluate behavioral and medical treatments for drug addiction, and to discover new ways to make existing treatments more effective.

So what did I learn about clinical trials? Clinical trials provide the best standard for demonstrating that a certain behavioral treatment or medicine really works and is also safe for humans. In the area of drug addiction, there is a great need for safe and effective treatments that are tailored to the specific addiction, such as heroin, cocaine, or marijuana.

I also learned that drug addiction is a chronic, relapsing condition. It may be easy to break one cycle of addiction, but it is very difficult to keep the patient from falling into another. One analogy is to think about the obese patient who can lose weight in the short run, but over time experiences many cycles of weight loss and gain, without really achieving an ideal body weight.

In a similar way, the addicted patient will receive successful treatment to break the addiction, but will continue to have cycles of relapse, requiring further treatments. The addicted patient might have a relapse towards the initial drug, but it can also be for a new substance or a combination of substances (e.g. initial addiction to marijuana, then addiction to opiates, then addiction to opiates and prescription drugs). Thus I discovered the true goal of the CCTN is to promote the development of treatments, or a combination of treatments, that will not only treat the addiction, but will also prevent future relapses.

More on clinical trials

While clinical trials are a way to develop new treatments and advance the scientific and clinical knowledge base from humans who volunteer to participate, I also learned that the volunteers themselves can benefit from their participation in clinical trials. For example, patients with difficult diseases like cancer can participate in a clinical trial in hopes of finding a cure, or at least a more effective treatment.

For more information on clinical trials, NIH maintains a clinical trials registry known as ClinicalTrials.gov, which contains information on trials supported by federal funds. There you can find information about a trial's purpose, who may participate, locations, and more.

Many of you probably heard that the European tour just launched by the talented Amy Winehouse has been canceled after fans watched the diva stumble under the lights in Serbia. Reports say audience members in Belgrade booed her off the stage Saturday night just a few songs into the first concert of the tour when she couldn’t even remember the lyrics to her own songs. The Grammy winner was scheduled for a dream tour—to Istanbul, Athens, Spain, Switzerland, Italy, Austria, Poland, Hungary and Romania—but those dates have all been cancelled. The Serbian media called the concert a "scandal," with Belgrade’s daily newspaper calling it "the worst performance in the history of Belgrade."

It is ironic that Amy Winehouse became famous for her song "Rehab," where she sang: "They tried to make me go to rehab. I said 'No, no, no.'" After the song became a hit, she actually said “yes” to drug and alcohol rehab in London, where she stayed for a month. If she has turned again to drugs, people will ask the same questions about if rehab works, and why big stars risk everything for drugs…

We’ve talked about rehab before, but Amy Winehouse’s struggle highlights what rehab is all about: addiction is a chronic disease, which means it has to be managed throughout your whole life. People relapse to drug addiction just like they do with other chronic illnesses like diabetes, hypertension, and asthma. To successfully treat a chronic disease, you have to change deeply imbedded behaviors—and that takes practice. For example, a diabetic has to learn how to manage a restricted diet, just as a person struggling with addiction has to learn how to manage cravings. Relapse does not mean treatment failure, but that treatment needs to be adjusted or changed altogether.

Sadly, many people are able to hide their addiction from the world and never get help. For famous people, every slip is recorded by fans and posted for millions to see. But famous or not, being successful in recovery takes a lot of support—which it sounds like Amy Winehouse has. Her representative put out this statement: "Everyone involved wishes to do everything they can to help her return to her best and she will be given as long as it takes for this to happen."

R.I.P Amy Winehouse 1983-2011

You might have heard the news that former first lady Betty Ford recently died at the age of 93. Many of you reading this might never have heard of Betty Ford; after all, she became First Lady way back in 1974. But maybe you’ve heard of the Betty Ford Center, a rehab center in Rancho Mirage, California, where many celebrities have gone to seek treatment for their addictions. You also may not know why she built the center.

Not long after Richard Nixon resigned from office during the Watergate scandal, Jerry Ford suddenly became President and the family got thrust into public life. Betty Ford wrote in her memoirs that her family never wanted that level of fame, but accepted it to help the country through difficult times.

Over the years, as the spotlight on Betty Ford and her family grew, she began to drink more heavily on top of a dependency on pain pills, which started in 1964 when she got a prescription to relieve constant pain from a neck injury and a pinched nerve. We now know that mixing pills and alcohol is a big mistake. Once she was First Lady, people began to notice that when she spoke she was slowly slurring her words and she seemed to have no energy. After her husband’s presidency was over, Betty Ford left public life and soon announced she was addicted to pills and alcohol. In her memoirs, she tells the story about how her family confronted her about her addiction, which at first she was not happy about. Later, she thanked them and became a champion for people struggling with the disease.

Her openness about her addiction was shocking to some people. Forty years ago, people tried to hide the fact they had an addiction problem, but she bravely brought it into the light, giving others the courage to ask for help with their own drug abuse and addiction problems. She entered rehab and, with treatment, learned to manage her addictions. A few years later she opened a rehab center in her name to help other people. Today the Betty Ford Center is a thriving treatment center, and because of its closeness to Los Angeles, it has become a rehab center for many famous people, including Drew Barrymore, Robert Downey, Jr., Johnny Cash, Elizabeth Taylor, and many others.

So SBB says thank you Betty Ford for having the courage to use your personal story to educate people about addiction, and for bringing it from the darkness into the light, from shame and despair to treatment and hope.

How did she have the courage to bring her addiction out in the open? She has been quoted as saying, “The public needed to know that this didn’t have to be swept under the rug anymore, that this needed to be open and discussed.”

While we are still not sure exactly what killed Amy Winehouse, many people are speculating that it had something to do with her admitted drug and alcohol abuse. As we blogged a few weeks ago, Winehouse was booed off the stage in her last concert. Now she may be among what some call the “27 Club”—famous people who died at the age of 27 from drug and alcohol abuse, including Kurt Cobain, Jimi Hendrix, Janis Joplin and Jim Morrison, all major music heroes of their times. Coincidence?

Not really. As their fame and wealth increased, so did their access to drugs and so maybe, too, their belief that they were outside the rules, invincible. But that wasn’t true. By the time they were in their mid-twenties it is likely their bodies started to rebel, screaming enough is enough!

Going to rehab is a smart move, even if it takes several tries. Rehab is hard. It calls for major changes in an addicted person’s life beyond stopping drug use—like a change of friendships (maybe even of a best friend or partner), not to mention a change of lifestyle and even where you live. When you’re “on top,” too much change might be harder to accept.

Still, the alternative is worse—just ask the people who loved Amy Winehouse. She was a great talent who could really have moved the world. To quote one of our 2010 GRAMMY winners from their video "Drug Free State of Mind," "…we all shootin’ stars basically waitin’ to be seen…"

What is your talent that is waiting to be seen? Make a plan not to waste it!

You may think you know what addiction is—lots of people have many different opinions about addiction and different ways of defining it. Here are some myths you may have heard:

• Getting over addiction to drugs is a choice.
• In order for treatment to work, the person has to hit “rock bottom.”
• People have to choose to get treatment or it won’t be effective, such as when a judge sends a person to treatment facility instead of jail.

The truth is that addiction is a complex brain disease that scientists are still figuring out. For instance, one person may use a drug once or many times and nothing bad happens, while others may overdose with the first use. Some people use drugs regularly and never become addicted, while others try drugs once or twice and do become addicted. There is no way of knowing in advance how a person may react to these dangerous substances. Whether or how quickly addiction takes hold in individuals depends on many factors, including:

• Genes: Research shows that some people’s genes may leave them more susceptible to addiction than other people’s.
• Environment: Kids who are exposed to drug use in their families or neighborhoods are at greater risk of engaging in drug abuse themselves.
• Age at first use: The younger a person uses drugs, the more vulnerable he or she is to addiction in adulthood. Since the brain continues to develop well into a person’s twenties, using drugs in the teen years can set a person up for later drug problems.

What scientists know for sure is that many drugs “turn on” the brain’s reward circuit, which is part of the limbic system. The person then learns to associate the drug with pleasure and starts to crave it more and more, leading to compulsive drug use and often to addiction. In an addicted person, the brain changes in ways that cause compulsive drug seeking and use, despite negative consequences, so even if they want to quit, they can’t without treatment and support. That’s why addiction is considered a brain disease. Other activities in life also activate the brain’s reward circuit and can cause “driven” behaviors, such as compulsive overeating or video game playing. However, scientists are still trying to figure out why this happens in non-drug contexts—it may be connected to dopamine levels in the brain. Learn more about the science behind drug addiction by visiting http://nida.nih.gov/scienceofaddiction/.