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.

Methamphetamine - "Haven't we already dealt with that?

Methamphetamine or "Meth" as we more affectionately call it has been in our collective consciousness in northern Nevada for at least the last 5 or 6 years. We've been exposed to stories of thin, unkempt young people with scab and pock marked faces, dental issues that defy description (and that are a major gross out), and an insatiable compulsion to use the drug despite the inevitable consequences. We have been shown people who give up spouses, careers, and even their children to use this scourge of a drug.

Beginning in about 2005, the Washoe County community rose up in heroic fashion to face this menace to our children and to our very way of life. So much has been done, including millions of state dollars allocated by the Legislature in 2007 to increase prevention and treatment efforts, formation of the Washoe County based Meth Community Response Alliance in 2005, media campaigns such as "Crystal Darkness" beginning in early 2007, the "Break Free, Live Free" video produced by the Washoe County School District and shown to thousands of students in 2005 and 2006, the statewide "Most of Us" media campaign, a full spread in the Reno Gazette Journal in 2005, community trainings, and so much more. For quite some time, Meth was the "talk of the town." To our credit as a community, we rose up and met the challenge and, in my opinion, we have been successful.

We can see that lifetime use and use in the last 30 days of Meth by Washoe County students has gone down. Meth related admissions to treatment facilities skyrocketed in 2004-08 but now have evened out. Many youth report that they think of Meth as a "dirty" and dangerous drug. Meth labs, those iconic symbols of all that is wrong with Meth use, have all but disappeared in Washoe County and in Nevada. All of this is cause for celebration. I believe we could build a great case based on the information I just provided that the Meth problem has been significantly impacted by all of our efforts.

But has Meth really gone away? I think if you ask the average person, they'll say, "Sure, it's on the way out." In fact, I really think that many people not only think that Meth is becoming passe but they also are a little tired of talking about Meth as a topic. You might say that it's old
hat.

However, if you are of the opinion that Meth has been "whipped," consider this:

1. In January of this year, the Reno Police Department confiscated 15 pounds of Meth in one arrest. That's really a lot of dope! They've had at least one other large bust this year and others which I'm not aware. Check the police blotter in your local paper and see if Meth is mentioned in any of the arrests.
2. Treatment centers in Washoe County and northern Nevada are still treating people with a primary diagnosis of amphetamine abuse or amphetamine dependence, meaning that there are still people out there using the drug and having trouble with it.
3. Anecdotally, I still hear almost daily about people that have a current Meth problem.

Despite these facts, I still say that what we all have been doing to address Meth has helped but the real issue is not whether we are going to win this "War on Meth." I don't even like to call it a war because this is something that has been with us off and on since amphetamine was first developed in the 1880s. We aren't going to totally conquer it but we are going to cause use to go down and we are going to help people get the help they need to address their problems with the drug.

With the emerging prescription drug trend, it's easy to forget about Meth. It's easy to be tired of talking about it. "Haven't we already dealt with that?" But while we begin to address prescription drug use, we need to keep our eyes on Meth to make sure that the gains we've
made stay there and that we can make even more progress in that arena.

It's Just a Pill

As I look back on my career I think about some of the "drug epidemics" America has gone through. Some of these include heroin in the 1960s and 70s, LSD in the 70s, cocaine in the 80s, and more recently, methamphetamines. These are all drug trends that the media and popular culture have used to send shock waves through our collective consciousness by showing graphic details of illicit drug use, crime, babies affected by mother's drug use while pregnant, and more.

Today, we still face challenges with all of the drugs I've named. But as we speak, a "new" trend is coming upon us and it's one that at first glance doesn't look so threatening. That is, the illicit use and abuse of prescription drugs, particularly the Opioids, which include drugs such as Hydrocodone (Vicodin), Oxycontin, Oxycodone, Methadone, and more. These are all powerful painkillers that have great potential use in treating many ailments and controlling pain.

In fact, because these drugs are medically approved for use and because they often come in pill form, it's difficult for some people to think of them as dangerous. But the fact is that when used improperly, these drugs can be every bit as dangerous as any other drug of abuse on the street.

Briefly, Opioid based drugs are derived from the opium plant and are mainly designed to control pain. They also are effective in the control of coughing and stopping diarrhea. Used as prescribed, these drugs are normally safe but can be habit forming. That's why they are always to be used under doctor's orders and supervision.

However, this drug group can be dangerous when used and abused in ways that are outside of medical prescription. Some of the dangers include decreased respiration, overdose, increased tolerance, physical addiction, mental health problems and more.

To illustrate, recently, a 15-year-old high school athlete in Reno said goodnight to his parents, went into his room, took two methadone tablets and passed away in his sleep. This young man, whose name is Austin, was experimenting and didn't know what he was getting into. The prescription drug related deaths of celebrities such as Michael Jackson, Heath Ledger, and Anna Nicole Smith may have grabbed the headlines but the tragedy of a 15-year-old boy in Reno cries out even louder because this could be anyone and it could be anyone's child.

Austin's parents contacted JTNN when they learned of the cause of his death and we have been meeting with them to talk about what we can do to stop this from happening to anyone else. Interestingly, he told his parents once that he would never try "methamphetamine" because of its danger. But he tried methadone - with fatal and tragic results.

We are now working with Austin's parents, local law enforcement, the Washoe County School District, the Truckee Meadows Water Authority, and more to develop a community wide strategy to help us keep prescription drugs where they belong and out of the hands of those that may misuse them.

A little methadone pill may not look as scary as a "crack" pipe or a methamphetamine lab, but it can be just as dangerous. JTNN is committed to bringing all of the resources and energy that we have to address the problem of prescription drug abuse.