Fetal Alcohol Syndrome

When my mom was having kids (3 of us), her standard for prenatal care came from a book written by Johns Hopkins University in 1949, entitled, "Expectant Motherhood." This book stipulates "safe" levels of cigarette smoking and alcohol consumption during pregnancy. Sixty plus years ago the prevailing medical wisdom was that a pregnant woman shouldn't smoke more than 10 cigarettes a day (remember these were non filtered in the late '40s) and she shouldn't drink more than two alcoholic drinks per day.

I'm sure that my mom smoked a little and she drank in moderation during all of her pregnancies, although I did ask her once about her level of use and she replied that she cut down from her usual moderate levels during pregnancy, just to make sure. Anyway, my brother, sister, and I are in our 50s and so far it appears that we are doing OK. So, what's all the buzz about women smoking, drinking, and using certain drugs during pregnancy?

Since the 1940s, our knowledge about what is safe and unsafe for an unborn child has increased exponentially. We've known for a long time that pregnant women shouldn't smoke cigarettes at all. And the standard for drinking is, "There are no safe levels of alcohol during pregnancy."

That last statement is a little puzzling because I'm sure my mom drank a little during all of her pregnancies. Is there something missing here? Can't a pregnant woman just drink a little and not worry about it?

Answering that question requires an understanding of what alcohol does and when it does it during the pregnancy. You see, the unborn child is affected by the alcohol in relation to the precise development that he/she is going through at the time the alcohol is ingested. So, if a woman drinks a few drinks a night during the time that certain organs are being formed, then it is possible that those organs may be impacted by that drinking. Related to that is the fact that no one really knows how much alcohol is too much during pregnancy so it's proper and safe to say, "Don't drink at all during pregnancy."

Another issue is the woman who is addicted. What should she do? Well, I hope that everyone that is addicted gets help and gets into recovery. In the case of an addicted woman who is pregnant, the best advise is, "Quit immediately, get help for your addiction problem, and seek prenatal care!"

This cannot be stated plainly enough. Fetal Alcohol Syndrome and all of the Fetal Alcohol Spectrum Disorders are totally preventable if a woman doesn't use alcohol or other drugs while pregnant. If she uses a chemical substance and finds out she's pregnant, then quitting immediately is the next best thing.

There's a lot to say on this topic and I'll return to it later in the year. But suffice it to say that often pregnant women don't get the help they need because they are embarrassed, ashamed, or just don't understand. We need to take time to engage these women in any way we can for their sake and for the sake of their children.

Children of Alcoholics Week

What do you think it's like growing up in a home in which one or both parents have an alcohol or other drug problem? These are homes that may look fine from an outsider's perspective but for those children living in it that home can be a living inferno.

Alcohol andor other drug abuse adds a dimension to a family in which the mom, the dad, the kids, and anyone else living there learns to live by certain rules. These "dysfunctional" rules have been written about and analyzed by a number of authors but none so succinctly (in my opinion) as by therapist and author Claudia Black.

Dr. Black says that the rules of an addicted household boil down to three. These are 1) don't talk, 2) don't trust, 3) don't feel.

"Don't talk" means, "Don't talk about the problem." Don't bring up anything that might make the family look bad or that might divulge the family secret. So, the children carry on the charade that everything is just fine and dandy when it's not. Mom gets drunk while you're all out to dinner one night and the kids know not to talk about it, not to describe it, not to ask about it. "What was wrong with Mom last night?" is not a permissible question. Keep the family secret!

"Don't trust" means that you learn not to trust what you see, hear, and experience. For example,when Dad is intoxicated, he promises his son a fishing and camping trip but when sober, he either doesn't remember or just breaks the promise. The son learns over time to disengage from Dad's empty promises and sees his father as an unreliable person not worthy of trust. Over time, this lack of trust is really about learning not to depend on anyone, not to share, not to feel safe. It can be very isolating.

"Don't feel" means that you learn to deny or shut off your feelings in the midst of turmoil and trouble. A 12 year old girl drives her intoxicated mother home from the bar every Saturday night. When the girl protests, her mother says, "Do it and just get over it." In time, the girl learns to "stuff" her feelings so she can accommodate her mother's unreasonable requirement. Over time this rule of "don't feel" can develop to the point that this person may not even know how she feels when hurt,angered, or even joyous.

Don't talk, don't trust, don't feel are rules that evolve in an addicted household. These rules can be debilitating and damaging to those children that live under them. But they can be countered. Just like the addicted person, the people living with that person can benefit from counseling and treatment.

February is Children of Alcoholic's Month in recognition of the fact that those that grow up in an addicted family are at risk for being harmed in many ways,especially emotionally. This month is also a celebration of the fact that children that grow up in an addicted family need help and will benefit from help. If you'd like to know more, contact us at JTNN at 775-324-7557 or call the Crisis Call Center at 775-825-HELP.

What's So Funny About That?

As the 2009 Holiday Season wraps up we are reminded of many wonderful things: family, friendship, community, giving, faith, and more. But we are also reminded of the role that alcohol plays in our society. Even if you don't drink, could you imagine Christmas and New Years without the mention of alcohol? There's the football games with all of the beer commercials. There are the alcohol industry sponsored television ads exhorting us to enjoy the holidays and to drink responsibly. There are numerous events and get togethers that would seem not quite "right" if there wasn't a little (or a lot of) alcohol included in the festivities. Of course, locally, there is the Santa Crawl that includes people dressed like Santa going from bar to bar in downtown Reno spreading as well as imbibing Christmas Cheer. In fact, the picture of thousands of Santas "crawling" drunk around Reno in a snowstorm even strikes many as kind of humorous. I have to admit that it strikes me as a little funny.

So what's so funny about a drunk Santa? What's so funny about a drunk person in any situation? Is it that we enjoy someone else acting a fool? Is it that we enjoy seeing someone falling down, getting up and then falling down again? Is it we think that if a person is foolish enough to be in that condition they deserve to be the object of laughter and scorn? Or maybe we just chalk it up to a good time and wish we could be doing what that person is doing.

Not to spoil anyone's good mood at the outset of the good year, but whether you find the intoxicated person funny or not, there's a whole lot to take the edge off of the laughter that drunk person may provide.

First, alcohol is a toxic (i.e. poisonous) substance and while most people can drink safely and without harming themselves, intoxication is technically an overdose from consuming too much alcohol. That means that what was a safe activity in moderation could turn into alcohol poisoning that could range anywhere from throwing up to even death by lethal overdose.

Second, most people can drink safely and without incident but one of 10 drinkers become addicted to alcohol. There are many factors that contribute to this, including genetic, peer group, and more. Estimates are that there are somewhere between 18 and 22 million alcohol dependent people in America.

Third, even at small levels of alcohol, most people are impaired. Impairment begins with the higher brain functions such as reasoning, judgment, and memory. Then impairments continues to fine motor skills such as writing with a pen or typing. Next, impairment continues to gross motor skills such as walking. Finally, if a person drinks enough, basic functions such as breathing and heart beat can be suppressed by the alcohol, resulting in serious medical complications and even death. So many issues such as drunk driving, many family problems, fights, and more are related to over drinking.

Drunk people often say and do funny, even hilarious things. But, for me, it's not all that entertaining because of the wreckage that intoxication can cause in all of our lives. I wish everyone a happy, prosperous, and sober New Year!

Therefore But by the Grace of God Go I

What do you see when you picture an alcoholic? Maybe a white haired public inebriate? What do you see when you picture a drug addict? Maybe a greasy haired, pock marked faced, skinny addict with bad teeth? I know you all don't have those pictures in your mind but when I ask a classroom full of college students, those are some of the images I get. But more than just the picture, what do you think of a person like that? Weak willed? Beyond hope? Criminal? Pathetic? How about, "I'd never do that. I'd never let my life get that way. I don't understand how anyone would." This is not self righteousness as much as it is just not knowing.

You see, most of us think that people who struggle with alcohol and/or other drugs can just fix themselves. But that is not the case any more than a diabetic can will herself to become non diabetic. Part of the thinking that addicted people can fix themselves lies in the belief that they brought it on themselves, as well.

That kind of makes sense. But there is a plethora of good science that shows us chemical addiction can be hereditary. In fact it changes the brain in such a way that the person who could have said, "No" before they became addicted virtually can't say that word in relation to their drug of choice. We just can't view addiction as a bunch of bad choices. It's way more than that.

Does that make the person with what we call a substance use disorder not responsible? The answer lies in two parts. The first part is that we don't hold that person responsible for having the problem. But we do hold that person responsible to eventually do something about it. Kind of like the diabetic. We don't blame him for being diabetic but we consider it his responsibility to manage that disease.

What I'm really talking about here is stigma. Addicted people are often stigmatized or considered "less than" others. This results in several myths. Here are just three of those myths:

1. Addicted people are weak willed individuals and of poor moral fiber. Of course, there are some who fit that description but in general addicted people are people that are a lot like you and me. Regular people with hopes and dreams, who work hard and love their families.

2. Addicted people don't respond well to treatment. As I've mentioned before in another blog, everyone has an Uncle Bob who went to treatment six times and is still "running and gunning." Judging treatment by one person or even several people that you know doesn't really tell the story. In reality, substance abuse treatment outcomes are among the most studied health care outcomes in our country and the news is good. People that go to treatment do well. Not everyone, of course, but on the average.

3. Addicted people who keep using don't really love their family because if they did, they'd stop. Addicted people, especially those in the later stages of their disease, may have substantial or total emotional distance between themselves and their families and it's certainly true that many of those people are estranged from their families. But it has to be said that the addicted brain is a hijacked brain in that the addicted person has little ability to connect their addicted behavior to the the consequences that follow. This is not an excuse but it is a plea for understanding and a plea for treatment services to be available as people need them.

At this point I'm aware that I'm opening up the proverbial can of worms because it sounds like I'm saying, "Oh poor addict, it's not really their fault and they are so misunderstood!" I AM saying that they are misunderstood, but the message I want to get across is that those of us who deal with that person in our family or our work or wherever we are need to be able to do everything we can to understand the addiction process so we can be ready to respond in an effective manner. If we can all remember that the addicted person is NOT weak willed, has the capacity to respond to treatment, and that he or she doesn't stop because they are on a roller coaster going 200 miles an hour and can't stop without help, then we can approach that person in an effective and compassionate manner.

Alcoholics Anonymous has a saying that helps me view the addicted person in the right light and it also helps me keep my thoughts, beliefs, and bias in perspective. It goes like this, "Therefore but by the Grace of God go I." That is said in reference to anyone that I am liable to judge or to think of as being less than me. If we all repeat that saying whenever we are prone to judge that person with a substance use disorder, that will be a great start.

Where'd All Those Drugs Come From?

On October 17th a number of agencies came together to hold the community's first "Prescription Drug Round Up." The event, in response to a growing prescription drug abuse problem in the community, was held at 5 sites in Reno and Sparks and invited anyone to bring in prescription and over the counter drugs to one of our sites. Once there the drugs were counted by Reno Police Department officers and bagged. Then they were taken back to the Reno PD where they were destroyed by incineration.

The point of the Round Up was to highlight the prescription drug problem in our community, to keep potentially harmful prescription drugs out of the hands of those that they are not prescribed for, and to keep people for flushing them into our water system as a way of disposal. We believe that the event was a success and we plan to repeat it with all of our partners.

But I have a concern......

We gathered close to 40,000 pills, many of which are drugs that could be abused. I was staggered by the amount of drugs that came to the one site where I volunteered. As I watched the two officers document and identify the drugs that came in, I couldn't believe the sheer amount of pills and wondered, "What would happen if the wrong people had access to only a fraction of these drugs?"

40,000 pills!

Being raised by parents who grew up during the depression and who didn't waste anything, I am appalled at the sheer monetary value of these drugs and the waste of throwing them away. How much are they worth? How much would they be worth on the street? One woman chastised us for not using some of the drugs for poor people who can't afford medication. Doing what she suggested is out of the question for lots of reasons but I share her concern. What a waste! In our day and age of accelerating medical costs, especially prescription drug costs, it seems like we are aren't doing a very good job of keep these kinds of costs down!

40,000 pills!

Many of the people that came to us said that they had used one or two of the painkillers they had been prescribed but didn't want to take the rest. What happens when a patient doesn't need pain medication but it is prescribed anyway? Is there a reason that patients who don't seem to want or need this kind of medication should have it anyway?

40,000 pills!

Overall, my thoughts after it is all over is that I wasn't aware before of the sheer amount of psychoactive drugs in people's medicine cabinets. I have been thinking that 40,000 pills are just the proverbial tip of the ice berg that indicates something much more dangerous is below the surface, something we need to be aware of and be willing to take action on. While most of these drugs will never be abused, I have heard enough stories of homes burglarized for drugs or visitors rifling through their unsuspecting host's medicine cabinet that I believe some of these drugs could find their way into the wrong hands.

The drugs that were turned in last Saturday by responsible citizens will never be abused by anyone because they will be destroyed. But what about the other pills and otherwise legitimate prescription drugs? That is what the Round Up and other activities that we are planning are intended to address.

Stick around and we'll keep you posted on next steps. Better yet, why don't you get involved in helping us with this important and timely work?

You Really Have to Want it to Get Better

Over the years I have found myself becoming increasingly careful in how I answer the question, "What do you do for a living?" That may seem like a simple question that carries with it an equally simple answer, but for me, the answer to that question is full of possible trip wires and booby traps. You see, when I tell someone, "I work with people who have alcohol and drug problems," I get back everything from an awkward, "Oh, that's nice" to "My mother died of alcoholism last year." Others try to defend why they drink or use certain drugs. Some launch into the "I know this guy..." scenario.

In reality, everyone has been exposed to alcoholism and/or drug addiction through a family member, friend, co-worker, or neighbor. Because of that, everyone has experiences, thoughts, and usually opinions about the issue. Probably the most common response I get is, "Isn't it true that a person has to really want it in order to get better?" Of course, that's not really a question as much as it is a declarative statement. Then the "you-have-to-want-it-to-get-better" comment is followed up with something like, "I have an uncle that's been to treatment six times and he's still drinking and using drugs. He just isn't motivated."

These comments and questions are all understandable because each person that has an experience with someone else's addiction has often had a heartbreaking and emotionally painful time with that person. It seems as if that person struggling with alcohol or other drugs should just be able to quit. "Come on, if you love your kids, you'll quit. I would."

That last phrase is really the key. Unless you've had a substance use problem it's difficult to understand how this condition defies logic. A normally intelligent, motivated, skilled, well brought up, successful person shouldn't have this problem and if she does, she should be able to climb out whenever she wants. Right? Wrong.

To quote a cliche, "This is an equal opportunity disease" and anyone can get it. In addition, for those that do get it, making it back to sobriety and recovery is often a long road full of frustration and relapse. But it's not because the addicted person is weak. It's because the addicted person, if truly addicted, has a brain disease. That means that the drug "hijacks" the brain by changing the brain chemistry. In other words, that altered brain is in some ways not the same brain that started using years or even months ago. The addicted brain says, "You don't have a problem." It says, "You don't need help." It says, "You need more drugs."

This is why an addicted person can't just stop by force of their own will. That's not an excuse but it is a reason that must be understood in order to better understand the addictive process and how people get better.

The War on Drugs

In 1989, the first President Bush declared "war" on drugs. It didn't require Congressional approval but everyone seemed to agree that declaring a state of war on a drug was the right thing to do. We were facing a very ugly cocaine epidemic (not that any drug epidemic is pleasant) and the popular opinion of the day was that we needed to take decisive action against this enemy that was attacking our very way of life and taking hostage many that we know and love. Good reason for a war.

Unfortunately, when we are feeling threatened and upset, a declaration of"war" actually feels kind of empowering and that it will solve the issues at hand. In fact, if you listen to people talk about our society's ever constant problem with drugs you hear language that is spoken like a combat leader who wants to rally the troops to the cause. We talk about "beating"drugs or the drug problem. We talk about "deploying" agents and delivering a "significant blow" to "the bad guys." We talk about drugs as a "scourge"that needs to be eliminated.

It's not that this language is totally off the mark but it's the "war room"mentality behind it that is at issue here. Here are my reasons for not wanting to call our effort to address drugs and addiction a "war."

1. This isn't a real war. Last time I checked, a war has a beginning, a number of battles, and an outcome that usually has a winner and a loser. Other than the 100 Years War several centuries ago, most declared wars don't last more than 4 or 5 years because nobody can last that long. This one has been going on for 20 years and with no end in sight.

2. Using the term "war" makes people who use drugs the enemy. We already have enough trouble trying to figure out who's who in this mess. The addicted people in our country may do crime and sometimes they deserve to be punished by society but the majority of those who are addicted need to be treated for their condition so they can get the help they need and not re-offend. Those addicted people who are locked up, only, have a very high rate of re-offending while those that get help have a more positive outcome.

3. Prevention and treatment work. Study after study have shown that for every dollar spent on prevention and every dollar spent on treatment saves many times that amount in savings to society. We can't arrest or fight our way out of this "war" but we can make significant progress through prevention and treatment, in concert with the juvenile and criminal justice systems.

4. Finally, science has shown us in the last 10 or so years that chemical addiction (including alcoholism) is a brain disease. Simply stated, this means that those who are addicted have a disease that requires treatment and that leaving that condition to run its course is about as effective as telling a diabetic that needs medical care to try harder next time.

Instead of waging war on drugs and, ultimately, on the drug user, let's develop a full approach that includes treatment, education, prevention, and law enforcement. The time for emotional responses that follows our intuition and our need to "attack" the problem is over. We need to combine all efforts to address strategically and intelligently the ever present problem of drug abuse and addiction in our country and in our society.