The ASAP Family was founded over twenty years ago by Dr. David Lewis. Since then the ASAP Family has been dedicated to serving the Southern California community with quality chemical dependency treatment and mental health programs, as well as educational and preventative programs.
WASHINGTON (AP) — Waiting to have sex is a nice idea, teenagers say, but they believe hardly anyone does it. Many teens, particularly boys, feel pressure to have sex, and they say drugs and alcohol often lead to sex — often without condoms.
The teen survey, released Monday by the Kaiser Family Foundation, paints a comprehensive portrait of youth attitudes about sex and the risk of pregnancy and sexually transmitted diseases.
Teen pregnancy and birth rates have been falling for a decade — a trend that other surveys have attributed to a drop in sexual activity and an increased use of condoms and other forms of birth control.
Still, the Kaiser survey spotlights areas of concern: Four in 10 sexually active teenagers have taken a pregnancy test or had a partner who did so. A significant minority of young people — about one in six — say having sex without a condom occasionally is not a big deal. And one in five say they have had unprotected sex after drinking or using drugs.
Other surveys have found that nearly two in three teens will have had sex by the time they graduate from high school. The Kaiser survey shows that many have intimate relationships before that, with more than half of 15-to-17-year-olds saying they have been with someone in a sexual way. Among teens who have not yet had sex, nearly a third say they have been “intimate” with a partner.
“Changing social norms and cultural expectations as well as delayed marriage means many young people have multiple sexual relationships in their lifetimes and need the information and tools to make healthy decisions and communicate with their partners,” the report said.
About one in three teens said they had been in a relationship where they felt things were moving too fast sexually.
Separately, the National Campaign to Prevent Teen Pregnancy was releasing its own study Tuesday examining sex among younger teens. It found that about one in five teens report having sex before they turn 15 years old.
That report, a compilation of data from earlier surveys, also found that younger teen girls who are sexually experienced were more likely than older teens to say they wish they had waited to have sex.
“Parents, program leaders, school officials, community leaders and others need to recognize that sex and dating are important issues for middle school age youth that cannot be ignored,” the campaign said.
The Kaiser survey found that boys face particular pressure to have sex, often from male friends — in contrast to the typical portrait of boys pressuring girls.
“There are a lot of expectations for boys to be sexually active,” said Julia Davis, senior program officer at the Kaiser Family Foundation, an independent group that studies health issues.
One in three boys ages 15-17 say they feel pressure to have sex, compared with 23 percent of girls. The pressure to drink alcohol was greater for both boys and girls; pressure to use drugs was about even with pressure to have sex.
Overall, 63 percent of all 15-17-year-olds agreed either strongly or somewhat that “waiting to have sex is a nice idea but nobody really does it,” with boys 6 percentage points more likely to say so.
The survey also found:
-More than eight in 10 teens say that a lot or some people their age drink or use drugs before having sex. Seven in 10 said their peers don’t use condoms when they are drinking or using drugs.
-About a quarter said that alcohol or drugs had influenced their decision to do something sexual at least once.
-More than half of teens believe oral sex is not as big a deal as sexual intercourse, with boys more likely to believe this. Four in 10 consider oral sex “safer sex,” although some diseases can be transmitted this way.
Although some people have only one episode of depression, many people have ongoing problems. Depression treatment does not stop once you start feeling better.
Maintenance treatment is usually advised if you are at high risk of recurrent depression. Maintenance treatment begins once you have been feeling good for about six months. The most common advice about maintenance treatment is to continue doing what keeps you feeling well. This is probably an extension of whatever treatment helped you in the first place. Drug treatment and psychotherapy may both play a role.
Because the treatment of depression often involves a few different providers (such as your primary-care physician, a psychiatrist, and/or a psychotherapist or counselor), you may want to use one of these providers as a consultant in your ongoing treatment. In the best circumstance, this person is available to discuss the pros and cons of different forms of maintenance treatment and can help you decide whether to keep using drug treatment or how long to continue psychotherapy.
Depression is often a life-long matter. It is beneficial to develop a long-term relationship with a provider whom you trust.
Ongoing Drug Treatment
Ask yourself the following two questions:
If you continue using drug treatment, how unpleasant are the side effects?
If you stop using drug treatment, what is the risk that your depression will return?
Weighing your options.
If you have had a good result from drug treatment, with few side effects, your health-care provider will probably suggest continuing drug treatment for at least six to nine months. At the end of this period, you may choose to continue drug treatment (because it was helpful and easy to take) or you may prefer to see what happens if you stop drug treatment. If you stop, there is a chance your depression will return. You should discuss the risks with your health-care provider.
Be aware that stopping any antidepressant abruptly may lead to uncomfortable symptoms. These symptoms are rarely, if ever, dangerous, but you can avoid them by working with your health-care provider to taper your dose. Restarting the drug (or a similar drug) can also reverse these symptoms.
The risk of recurrence.
As the risk of recurrence increases, more people decide to continue drug treatment. Depression is likely to recur when:
You have had more than one episode of depression in the past.
You experience a lot of stress.
You have lingering symptoms of depression, even though your depression has been treated.
You have other mental-health problems.
You have had a previous episode of severe depression, with suicidal thoughts, psychosis, or very poor functioning.
Other members of your family have been diagnosed with depression.
You drink alcohol excessively or use drugs.
If you decide to continue drug treatment, you should probably continue to take the same doses that worked for you at the start. Although it is a common practice to take a lower dose during maintenance treatment, reducing the dose may increase your chance of relapse. Only consider using a lower dose if you have troubling side effects; be aware that a lower dose may be less effective at controlling your symptoms. If your symptoms come back, you can increase your dose again. Or you can try another antidepressant to see if there is equal benefit with fewer side effects.
A final thought. When it comes to drug treatment, make the decision that is best for you. Do not underestimate the problems and dangers associated with depression, especially if you have had multiple episodes or if you have lingering symptoms. For those most affected by depression, maintenance treatment is highly desirable.
Ongoing Psychotherapy
If you have been using psychotherapy to treat your depression, ask yourself the following questions:
Are you feeling better?
Do you understand your problems or yourself better?
Have you made the changes you wanted to make?
Do you feel you can maintain these changes?
Have you met your goals?
Have you discovered other goals that you want to continue to pursue?
Is psychotherapy a useful tool for you to reach those goals?
Would other treatment options better help you reach these goals?
The frequency and duration of psychotherapy depend on your goals and on the type of psychotherapy used. You may have learned what you need to know to modify your behaviors. You may have better control over reactions to stress or triggers for your depression. However, maintenance visits may be useful if you slip back to old patterns. In some situations, ongoing support of the therapist is key to maintaining your progress or your self-esteem. Or maintenance therapy may lead to further growth, enabling you to respond more effectively to life’s challenges.
Decisions about stopping therapy are very often complicated. You may have developed a strong relationship with your therapist. Always realize that your therapist is a consultant who provides a service to you. You are free to decide whether or not the visits help you keep depression at bay.
The number of teens abusing illegal drugs dropped 11 percent in the past two years, according to reports from the U.S. Department of Health, but the celebration may be premature. Many kids are getting high on legal medications — from over-the-counter cough medicines containing DXM (dextromethoxpan) to painkillers such as Vicodin. (In another survey, 8 percent of 12- to 17-year-olds used prescription medicines for nonmedical use.) Scariest of all: “A parent’s prescription is the most likely source,” says M. David Lewis, MD, medical director of Visions Teen Treatment Program in Malibu, California. Dr. Lewis recommends that parents throw out outdated prescriptions and hide current ones, carefully monitoring the amounts. Symptoms to watch for in your teen: insomnia, weight loss, irritability, agitation, and mood swings. “Dumping an intensely psychoactive drug into a teenager’s developing brain is like a chemistry experiment,” says Dr. Lewis. “The damage can be devastating.”
–Caroline Stanley
Originally published in Ladies’ Home Journal magazine, April 2004.
Teens Are Abusing Over-the-Counter Cold Pills to Get High
By John Stossel | ABCNEWS.com
Parents have their hands full trying to keep kids away from alcohol, smoking and drugs. Now there’s yet another substance that teens are using to get high — legally. They’re taking big doses of ordinary cold medicine.
A group of kids who spoke to ABCNEWS said they were using Coricidin HBP Cough and Cold Pills to get stoned. The ingredient that gives kids a high is dextromethorphan, or DXM. It suppresses coughs safely, but in large amounts it produces a chemical imbalance in the brain that allows the kids to get high.
Dextromethorphan is in more than 100 cold medicines, not just Coricidin, but one type of Coricidin has the particular cocktail of ingredients that the kids prefer. This week, the American Association of Poison Control reported teen abuse of these types of over-the-counter cold medications has doubled in the last four years.
‘It Tastes Just Like Candy’
Molly, 17, described how taking a large dose of the pills made her feel, “You turn your head and everything went in slow motion. It was like you were in The Matrix or something.”
The abuse of Coricidin is so appealing, kids say, because it’s easy to get, it’s legal, and parents and teachers usually don’t have any idea they’re taking it.
“As far as drugs go, you don’t need to know a dealer, you know. If you can find a Walgreen’s or a grocery store, you’re set,” said Jeff Helgeson, a 20-year-old from Minneapolis. Helgeson says he’s been getting high on Coricidin for four years.
Some kids call the habit “skittling,” because the pills look like the popular candy Skittles. “It’s just like pot, except it’s better and it tastes just like candy and your parents won’t know if you get high cause your eyes won’t be red,” said Ashley, 16.
Jason, a 15-year-old from Seattle, said he liked the feeling so much he took the pills every day for five months. Another teen, Kevin, said he took Coricidin for a year and a half.
Parents, Teachers Often Unaware of Abuse
When parents see that their kids have cold pills, they don’t think twice. It’s just cold medicine, after all; it seems innocent enough.
School principal Judi Hanson says she’s finding that Coricidin is becoming kids’ drug of choice. It’s easier to conceal. There’s no smell, there’s no dealing with a dealer. It makes it hard to detect.
But Jason’s father, Pat, noticed his son seemed stoned when he came home with friends and he confronted him. Jason finally admitted to abusing the medicine. Like many parents, Pat didn’t know kids could get high on cold pills.
Often the kids don’t even buy the Coricidin — they steal it. Helgeson said he stole it. “I’d wear my coat in there or stuff it in my underwear.”
The shoplifting has led some stores to move that type of Coricidin behind the counter. James Holm, a pharmacist at a Hopkins, Minn., store, said they had no choice.
“These kids just seem to find it, zero in on it, and believe me, if you have it on the shelf, it’s going to be gone,” he said. “They’ll steal it right out from underneath your nose. … They just grab it and go.”
As the kids talked about getting stoned, there was a lot of laughter, even when they talked about accidents and injuries they suffered while taking the pills. Helgeson laughed as he talked about breaking his elbow and ankle while snowboarding and skateboarding when he was high on Coricidin.
Sometimes they laughed about not getting caught. Helgeson said he drag-raced a police car, and thought it was funny the officers couldn’t tell he was high when they pulled him over. “They gave me a Breathalyzer. I hadn’t been drinking. I didn’t have any drugs on me. So they didn’t know,” he said.
Helgeson was the oldest among the group of young people who talked with ABCNEWS about their experiences. As the younger kids continued to laugh about their experiences, we noticed that Helgeson seemed sort of separate from them.
Helgeson says it’s still fun when he takes Coricidin, but he says it’s wrecked his life. His mom has to drive him places because he’ll lose his license if he gets another ticket. He dropped out of school and now lives at home, spending most of his time playing his guitar or just sitting.
“Living in the household with Jeff the past few years has been like living with somebody who’s sick and they never get well,” said his mom, Merrilly Helgeson.
Jeff Helgeson has a twin brother, John, a junior at the University of Wisconsin, whose life is good. His mom says Jeff “always has a reminder right in front of him of where he would be right now if he were not doing Coricidin.”
And Jeff doesn’t seem happy with himself. “My brain has gone and I’m just wasted. It took all my friends away from me. I threw my life away.” Yet he keeps using.
Abuse on the Rise
Failing grades or a trip to the hospital is sometimes what it takes to alert kids and their parents to the danger. Doctors say they’re seeing more and more kids in emergency rooms who’ve taken too much Coricidin.
Over the last three years, there’s been approximately a 300 percent increase in calls to poison control centers about dextramethorphan, said Dr. Edward Boyer, an emergency room physician in Massachusetts.
Boyer says the kids who come in to the emergency room are agitated, difficult to control, sweating and unresponsive when you try to speak to them.
Molly and Ashley had a recent close call.
They told Ashley’s mom they were going to bed. Instead they took Coricidin, sneaked out of their house, and went to a party where they took more Coricidin.
“My fingers were so numb that I couldn’t open the package. So me and Molly were literally trying to rip the package open with our teeth,” Ashley said.
They went to a boy’s house where Ashley may have had sex, but she doesn’t know.
“He took me in a bedroom and I guess he tried to have sex with me. … He was on top of me. But I fell asleep.”
Later, a hospital test revealed she and the boy had not had sex. She and Molly did get home and later went to sleep. But by morning, they were still very high. The Coricidin high can last a day. Ashley’s mom called the poison control center and was told to get the girls to the hospital.
Sometimes Deadly Consequences
At least five people have died after taking Coricidin, but even death doesn’t seem to scare the kids. Jason had heard about a boy who died, but said he knows that the boy took the type of Coricidin that contains acetaminophen. And he knows not to take that type. “It tends to cause you to die,” he said.
He’s right, because acetaminophen can cause liver damage or death when taken in large doses.
Boyer said, “If you talk to kids, they know they should take the stuff that doesn’t have acetaminophen in it.”
It’s hard to believe the kids know which type of medicine is going to hurt them less.
But Boyer says he believes they do, and he says they can get a lot of information from an online drug encyclopedia called Erowid. While Erowid warns that high doses of acetaminophen can be fatal, the Web site appears to have been written by drug users. They describe first-time experiences, and suggest dosages — and in the case of Coricidin, warn of its dangers.
In fact, you can get more information from these than you get from the government’s drug-abuse Web site, Boyer said. “If I need information on a drug of abuse, I go to this Web site,” he said.
Easy Access Makes Drug a Greater Threat
Some parents say Coricidin, because it’s so accessible, is worse than other drugs. They want it taken off store shelves.
But the company that makes Coricidin, Schering-Plough HealthCare Products, said removing it from the shelves would deny cold sufferers access to a helpful medication.
“We want to minimize abuse by warning people and changing the package so it’s harder to shoplift, but Coricidin HBP is a valuable cold medicine, the safest and most effective product for patients with high blood pressure,” the company said in a statement.
It also said putting it behind the counter would deprive those who need it.
Wal-Mart’s policy is to sell it only to customers 18 or older, and the chain limits the number of boxes people can buy to three.
Still, kids who want to abuse the medicine can still find it in stores or buy it over the Internet. Ultimately, making the decision not to abuse the medicine will be up to the kids.
Ashley said it’s difficult to stop taking it once you get started. “It’s addictive,” she said. “here’s some ingredient in those pills that makes you want to take it again no matter what.”
That’s not correct. Dextromethorphan is not physically addictive. Ashley and Molly have now stopped taking it. People do quit. Jason has been clean since June, and Kevin for almost a year. But Jeff Helgeson still uses.
“I know that the right answer is for me to never do it again. Or drugs in general,” he said. “But once you’ve been down that road, it’s really difficult to get on a different path and stay on that path.”
Poison Control Information
1-800-222-1222 is the 24-hour emergency number to call to find a poison control center your area. Poison control centers have additional information concerning abuse and misuse of cold medicines containing dextromethorphan.
INDIANAPOLIS (AP) – Most serious head injuries in college football are never reported to team trainers or coaches because the players don’t think their symptoms are severe enough to indicate a concussion, according to a new Indiana State University study.
That lack of knowledge could be putting athletes at risk for more severe injury, or even death, researchers say.
“When your head is messed up, you may not know it yourself,” said JoEllen Sefton, a doctoral fellow in sports medicine who surveyed 457 players, 38 coaches and eight trainers from eight NCAA Division I-A, I-AA and II colleges.
Coaches, players, athletic administrators and medical personnel have long known the risks of injury to the brain. But Sefton’s 2002 survey, to be presented Saturday at the National Athletic Trainers Association meeting in Baltimore, indicates nearly three of every four concussions go unreported.
A concussion is a blow to the head that jostles the brain and can cause brain swelling, blood vessel damage and even death. Symptoms can include headache, confusion, loss of consciousness and nausea.
A study funded in part by the NCAA and published last November by the Journal of the American Medical Association found college players who suffer concussions are more prone to another one, especially if they return to the field too soon. They also become slower to recover from blows to the head, researchers said.
“There’s a condition called second impact syndrome,” said Mitchell Cordova, chairman of the athletic training department at Indiana State. “An athlete takes a subsequent hit that may be less severe than the first hit but receives a greater injury because the symptoms from the initial incident are not completely resolved.”
Several pro football players have ended their careers early after suffering multiple concussions, including quarterbacks Troy Aikman of the Dallas Cowboys and Steve Young of the San Francisco 49ers..
The Indiana State study, published in the April-June issue of the Journal of Athletic Training, gave players a list of symptoms and asked them to identify which were associated with concussions and which were not. It asked players how many of those symptoms they had experienced, and how often they had reported them, after a hit in the head.
Sefton said those surveyed suffered symptoms consistent with concussion 391 times – 21 percent of them more than once. But 72 percent of the symptoms were not reported, primarily because the athlete did not think the injury was serious, she said.
The study also indicated that many players had misconceptions about what signals a concussion.
For example, some players mistakenly thought they could not have suffered a concussion because they did not have a headache.
“If they had trouble sleeping at night or were depressed or had emotional outbursts – all symptoms of concussion – if they didn’t know those were symptoms, they might not connect that with the hit in the head they had that day,” Sefton said.
She said the more athletes know about concussions, the more likely they are to report them.
“We need to develop an education program for athletes for head injuries,” she said. “We have them for drug abuse, we have them for nutrition and eating disorders, for smoking, but we don’t have anything for head injuries.”
Johnson BA, Ait-Daoud N, Akhtar FZ, Ma JZ. Department of Psychiatry | The University of Texas Health Science Center at San Antonio
BACKGROUND: Topiramate, a fructopyranose derivative, was superior to placebo at improving the drinking outcomes of alcohol-dependent individuals.
OBJECTIVES: To determine whether topiramate, compared with placebo, improves psychosocial functioning in alcohol-dependent individuals and to discover how this improvement is related to heavy drinking behavior.
DESIGN: Double-blind, randomized, controlled, 12-week clinical trial comparing topiramate vs placebo for treating alcohol dependence (1998-2001).
PARTICIPANTS: One hundred fifty alcohol-dependent individuals, diagnosed using the DSM-IV.
INTERVENTIONS: Seventy-five participants received topiramate (escalating dose of 25 mg/d to 300 mg/d), and 75 had placebo and weekly standardized medication compliance management.
MAIN OUTCOME MEASURES: Three elements of psychosocial functioning were measured: clinical ratings of overall well-being and alcohol-dependence severity, quality of life, and harmful drinking consequences. Overall well-being and dependence severity and quality of life were analyzed as binary responses with a generalized estimating equation approach; harmful drinking consequences were analyzed as a continuous response using a mixed-effects, repeated-measures model.
RESULTS: Averaged over the course of double-blind treatment, topiramate, compared with placebo, improved the odds of overall well-being (odds ratio [OR] = 2.17; 95% confidence interval [CI], 1.16-2.60; P =.01); reported abstinence and not seeking alcohol (OR = 2.63; 95% CI, 1.52-4.53; P =.001); overall life satisfaction (OR = 2.28; 95% CI, 1.21-4.29; P =.01); and reduced harmful drinking consequences (OR = -0.07; 95% CI, -0.12 to -0.02, P =.01). There was a significant shift from higher to lower drinking quartiles on percentage of heavy drinking days, which was associated with improvements on all measures of psychosocial functioning.
CONCLUSIONS: As an adjunct to medication compliance enhancement treatment, topiramate (up to 300 mg/d) was superior to placebo at not only improving drinking outcomes but increasing overall well-being and quality of life and lessening dependence severity and its harmful consequences.
WASHINGTON (AP) — More than four million people younger under age 21 drove under the influence of drugs or alcohol last year, according to a government report released Wednesday. That’s one in five of all Americans aged 16 to 20.
“That’s an awful lot of kids if you think about it,” said Charlene Lewis, acting director of the Office of Applied Studies at the Substance Abuse and Mental Health Services Administration, which produced the report.
The report, based on a large household survey of drug use, found a small drop in driving under the influence of drugs or alcohol between 2002 and 2003. In 2002, 22 percent drove under the influence; last year, it was 20 percent.
Just four percent of these young people reported being arrested and booked for driving under the influence in the year before they were interviewed.
The report was released Wednesday in advance of New Year’s Eve in hopes of raising consciousness of the issue on a night when the risk of drinking and driving is high, federal officials said. Motor vehicle crashes are the leading cause of death among young people.
The data come from face-to-face interviews in the homes of people ages 12 and up, part of the National Survey on Drug Use and Health. People were asked to define for themselves what driving “under the influence” of drugs or alcohol means.
Young people were most likely to drink alcohol and then drive, with 17 percent admitting this. Fourteen percent said they had driven under the influence of illicit drugs, and eight percent reported driving after consuming a combination of alcohol and drugs.
The rates were highest among people who lived in the Midwest and among those who lived outside of metro areas.
Researchers did not have data to compare the 2002-03 rates to earlier years. But a similar survey of teen behavior found that drunken driving fell steadily between 1984 and the early 1990s, as media campaigns pleaded “friends don’t let friends drive drunk” and urged partygoers to choose a designated driver.
The rates remained level from 1992 to 1995 before jumping a bit in the late 1990s and then declining a little in 2003, said Lloyd Johnston, principal investigator for the University of Michigan’s Monitoring the Future survey of students.
“It’s not nearly as serious a problem as it was in the mid ’80s but it’s still a serious problem,” he said.
He said that his survey also found that a substantial number of teens rode in cars where drivers had been drinking, adding to the number of young people at risk.
Johnston added that while teens growing up in the 1980s were exposed to heavy media campaigns against drunken driving, that’s not true for today’s teens. He warned of “generational forgetting.”
“Each generation has to be reeducated about the dangers of any of these behaviors,” he said.
ST. PAUL, Minn. (American Academy of Neurology) — People who smoked marijuana had changes in the blood flow in their brains even after a month of not smoking, according to a study published in the February 8 issue of Neurology, the scientific journal of the American Academy of Neurology.
The findings could explain in part the problems with thinking or remembering found in other studies of marijuana users, according to study authors Ronald Herning, PhD, and Jean Lud Cadet, MD, of the National Institute on Drug Abuse in Baltimore, Md.
The study involved 54 marijuana users and 18 control subjects. The marijuana users volunteered to take part in a month-long inpatient program.
The blood flow velocity in brain arteries was tested with transcranial Doppler sonography in all participants at the beginning of the study and again at the end of the month for the marijuana users.
The blood flow velocity was significantly higher in the marijuana users than in the control subjects, both at the beginning of the study and after a month of abstinence from marijuana use.
The marijuana users also had higher values on the pulsatility index (PI), which measures the amount of resistance to blood flow. This is thought to be due to narrowing of the blood vessels that occurs when the circulation system’s ability to regulate itself is impaired.
“The marijuana users had PI values that were somewhat higher than those of people with chronic high blood pressure and diabetes,” Herning said.
“However, their values were lower than those of people with dementia. This suggests that marijuana use leads to abnormalities in the small blood vessels in the brain, because similar PI values have been seen in other diseases that affect the small blood vessels.”
The PI values for light and moderate marijuana users improved over the month of abstinence. There was no improvement for heavy marijuana users.
The light users smoked two to 15 joints per week. The moderate users smoked 17 to 70 joints per week, and the heavy users smoked 78 to 350 joints per week.
ANAHEIM, CA (AP) — [Name removed] of the Anaheim has voluntarily entered a substance abuse program, the NHL and the players’ union announced.
The 33 year-old player has been out since November 27 with a knee injury. He has one goal and three assists in 13 games.
Doctors Brian Shaw of the NHLPA and Dave Lewis of the NHL will oversee his care in the substance abuse and behavioral health program administered by the league and the union.
“The Might Ducks ownership, management, coaches and players are wholeheartedly behind [player] and his family during t his time and support his decision to seek professional help,” Anaheim general manager Brian Burke said in a statement.
Thirty days’ treatment is the norm, but more facilities are offering programs to patients that extend to 45 days, 90 days and even longer.
We love quick, tidy solutions in this country. With health problems, in particular, we’re impatient. Pills to ease each and every symptom? Great. Same-day surgery? Terrific. A scheduled cesarean section? Bring it on.
But in the case of drug and alcohol dependence, it’s becoming increasingly clear that there is no such thing as get-well-quick therapy. Instead, with scientific evidence showing that the longer the treatment, the better the chance of lasting sobriety, addiction centers nationwide are lengthening their programs and firmly discouraging patients from early checkouts.
For more than a year, the Betty Ford Center in Rancho Mirage has offered a 90-day residential treatment program, in addition to shorter programs, that attracts about one-third of all clients. Promises Treatment Center in Malibu now provides more than half of its clients with 45- to 90-day treatments and last year extended its young-adults program from 30 days to 90 days.
Visions, which provides adolescents with addiction treatment in Malibu, increased its program’s length from 30 days to 45. Hazelden, the legendary treatment program based in Minnesota, has added beds in nearly all of its facilities over the last two years to meet a growing demand for treatment programs of 90 days or more.
Addiction experts say that longer treatments — with the length of stay based on the client’s specific needs — will lead to fewer people cycling between 30-day hospitalizations and relapses for years on end. From 40% to 60% of people relapse after drug treatment, according to the National Institute on Drug Abuse.
“Treatment is dose-related,” says Dr. Harry Haroutunian, director of the licensed professional program at the Betty Ford Center. “More is often better, depending on what you do with the time.”
Treatment programs of 28 or 30 days are still common. But this template was never based on medical evidence, says Dr. David Lewis, Vision’s medical director. Lewis, who in the 1970s helped establish the first addiction treatment program in the U.S. Air Force, says 30-day stays were scheduled for bureaucratic reasons — men and women didn’t need to be reassigned if they were away from duty for no more than 30 days. Other treatment centers followed suit, and insurers adopted the standard of 28 or 30 days of inpatient care.
Today, addiction experts recognize that it’s foolish to treat every patient the same way.
“There was a belief that 30 days was the right number,” says Dr. David Sack, chief executive of Promises and an addiction psychiatrist. “But there was absolutely no data to say 30 days was the right number. . . . The programs were cookie cutters. What we’re seeing now is this much broader view for how to manage addiction. There isn’t this naive optimism that people will reach 30 days and they’ll be fine.”
Relapse rates
In fact, data suggest 30 days aren’t nearly enough.
* Research published in 1999 by Bennett Fletcher, a senior research psychologist at the National Institute on Drug Abuse, has shown that though 90 days isn’t a magic number, anything less than that tends to increase the chances of relapse. One study, of 1,605 cocaine users, looked at weekly cocaine use in the year after treatment. It found that 35% of people who were in treatment for 90 days or fewer reported drug use the following year compared with 17% of people who were in treatment for 90 days or longer. The study was published in the Archives of General Psychiatry.
* Another study, part of an NIDA-funded project called Drug Abuse Treatment Outcome Studies, followed 549 patients who had several problems in addition to their drug use and who entered a long-term residential program. Those who dropped out of treatment before 90 days had relapse rates similar to those who stayed in treatment only a day or two. After 90 days, however, relapse rates dropped steadily the longer a person stayed in treatment.
* Studies of youth also reflect the connection between longer care and a greater chance of recovery. A 2001 UCLA study of 1,167 adolescents receiving substance-abuse treatment found that those in treatment for 90 days or more had significantly lower relapse rates than teens in programs of 21 days.
Some of the earliest evidence emerged from high success rates in treatment of addicted health professionals, says Haroutunian: The Federation of State Physician Health Programs has long recommended 90-day treatments and continued follow-up care for doctors who abuse drugs.
Longer treatment reflects the fact that addiction is a chronic, relapsing disorder, says Lisa Onken, chief of NIDA’s behavioral and integrative treatment branch.
“The more you have a treatment that can help you become continuously abstinent, the better you do,” she says. “You have to figure out how to be abstinent. You still have cravings. You still have friends offering you drugs. You still have to figure out ways not to use. The longer you are able to do that, the more you are developing skills to help you stay abstinent.”
Additional time in treatment allows people to learn to handle stress, develop ways to cope with environmental cues that could trigger drug use and improve relationships that are needed to sustain recovery.
However, time alone isn’t a solution. Many addicts stop using for long periods of time while incarcerated but relapse after being released.
“There is no real evidence that just locking someone up, denying someone access to drugs alone, will cure an addiction,” Onken says. “It’s not just length of treatment that is important. It’s length of treatment that is working.”
28 days later
The first month of treatment is now viewed as a first step, Fletcher says. It often consists largely of coping with withdrawal symptoms and establishing a relationship with a therapist.
“People are often detoxifying for 28 days,” Haroutunian says. “Their mind is not right. Their temperament is not right. They have emotional instability, poor judgment, physical complaints, sleep problems — things that keep them in a very delicate state of vulnerability to coping with life stresses. If they are out there in the world after only 28 days and get flooded with these things, they are vulnerable to relapse.”
Brain scans of recovering addicts support the idea that changes are still taking place three months or more after treatment. Chronic drug use damages the brain, such as reducing the number of dopamine receptors, chemical pathways that allow for normal brain functioning. Changes in the brain during recovery correlate to clearer thinking and more honesty on the part of the patient, Haroutunian says. It’s often only at that point that therapists discover other problems, such as physical or mental-health problems, eating disorders, gambling issues, relationship problems or a history of abuse or molestation.
“If that is not identified and treated, it can easily bring someone back to their original drug of choice,” he says.
Haroutunian notes that Alcoholics Anonymous, founded more than 70 years ago, recommends: “90 meetings in 90 days.”
“I think the founders of the 12-step program were divinely inspired in their wisdom, which science and data are now supporting,” he says.
Trying to get clean
Drug abuse became a way of life for Steve Owens at age 11. After being molested as a child, he says, “I found drugs the only way to have comfort.”
Owens abused cocaine, alcohol and prescription drugs, and later, heroin. By age 21, after numerous arrests on drug-related charges, he entered a 30-day treatment program. It was the first of 34 hospital stays he would experience over the next two decades, each time relapsing after the monthlong treatment ended.
“They would clean me up and I would start to get back on my feet again, mentally, physically and spiritually,” he says. “Then I would get out and go right back where I came from — the same friends and the same places. With these rehabs, you just get started before they let you go.”
At one point, Owens, who is now 50, stayed clean for seven years. But after his brother died unexpectedly, he relapsed. He was living in Atlanta at the time and heard of Promises in Malibu. Twice he entered for 30-day stays — stints that were followed by relapses. When he flew to Los Angeles for a third try — about five years ago — he was so addled by drugs that he got on the wrong plane and ended up in restraints in a hospital psychiatric ward. He was released to Promises and told a therapist, “If you let me stay here, I’ll do anything you say.”
He agreed to 30 days of hospitalization followed by five months in a sober-living house from which he was free to come and go but where he also received daily counseling. After leaving the sober-living house, he attended a nine-month intensive outpatient group and completed a 12-step program.
The year he devoted to getting well “was the best thing that ever happened to me,” says Owens, who now lives in Los Angeles and runs a nonprofit group that supports rehab for people who are homeless, as well as women with children. “I got a chance to get on my feet the first 30 days and then I got a chance to get used to being clean and sober and staying away from the people I used to drink and use with. I was able to let go of the past and apologize to the people I’ve hurt. I became a free man.”
However, it’s tough to convince some addicts or their family members that three to six months of treatment offers the best chance of success. People argue that they can’t leave their jobs, school or families for that long, Sack says. They want to put the problem behind them as quickly as possible.
“They want to believe it will be fixed up very quickly and they can go back to normal and not have to talk about it,” he says.
Instead, he compares addiction to any chronic disease, such as heart disease or diabetes, in terms of the attention and perseverance needed to remain healthy.
Longer-duration treatment doesn’t necessarily mean a hospital or residential stay, experts say. Some treatment centers and hospitals offer transition to a sober-living residence, where residents are free to go about their lives but also receive daily counseling. The Betty Ford Center has about 15 houses, with six people to a home, to continue long-term care. The residences are designed to allow clients to return to more normal lives while offering support and advice in remaining drug-free.
“The supervision is light,” Haroutunian says. “They go into the community. But they more or less report in every day for their program.”
Coverage varies
Some people would like to commit to a longer period of treatment but can’t afford it.
Most states, including California, have laws mandating that group health insurance plans include addiction-treatment coverage, but insurance programs vary widely in the amount of inpatient care that is covered. Some plans cover 30 days of inpatient care per year, although other insurers will discontinue inpatient coverage after a week or two if a patient is physically stable. A few will pay for treatment that lasts more than 30 days.
Care is typically most expensive in the first month, Haroutunian says. At Betty Ford, the first month of inpatient treatment costs $24,000; the second and third months cost $8,000 each.
People without insurance coverage often pay out-of-pocket. The cost is overwhelming to most people, he acknowledges. “But we tell them it may save their life. Most people see the wisdom in that.”
Intensive outpatient programs are becoming more common for people who cannot afford the steep price of long inpatient or residential care, Fletcher says. Successful care of that nature, he says, “means, on average, at least every other day having contact with a group or therapist.”
In his counseling work, Owens says, he encounters resistance to the idea of spending three months or more devoted to nothing but recovery. People view it as a sacrifice, but he tries to reassure them they’ll gain more than they lose.
“Even if you have to lose a job, so be it,” Owens says. “You’re trying to save your life. And what comes next could be the best part of your life.”
Chemical dependency treatment and mental health programs: ASAP Family