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PERCEPTION THERAPY® TREATMENT MODEL -eEnliven's innovative and successful therapeutic treatment model utilizes its own
MIND-BODY-SPIRIT-ENVIRONMENT® approach that "treats the whole person and the cause of the problem, not just the symptom".



WANT TO QUIT SMOKING? WE CAN HELP.

Tobacco use takes the lives of approximately 5.4 million individual each year. The "Quit Smoking" Program is specifically designed to assist current smokers to lead a healthier life while eradicating the desire, need or compulsion to smoke. Participants are exposed to an array of support mechanisms and practices provided for successful cessation of smoking. Education is provided to assist individuals to understand what to expect when the body begins to rid nicotine and other toxins during withdrawal and the changes that begin to occur with healing. This four week program includes the use of Perception Therapy combined with various alternative healing techniques such as Acupuncture, Visualization Exercises, Deep Meditation, Imbedded Suggestion, and Guided Imagery. For participants requesting additional support, supplemental stop smoking medications are also available. (Medication costs, if requested, are the participant's responsibility).


CLIENT TESTIMONIAL
"To all of the wonderful Staff at eEnliven,

I would like to thank you from the bottom of my heart for all the care and love you gave to my fiance. Your program has transformed his life and mine. Everything that I read about your program before he went there gave me a feeling of hope. But I am truly astounded by his happiness, wholeness and transformation. All I have ever wanted for him was to be happy and you have all guided him to that path. I would especially like to thank Charles and Erin for really helping him to find himself. Our life together is a journey and we are moving forward. He is becoming my teacher, helping me to love and discover myself as he has.

I hope someday to also reap the benefits of your program. Thank you for blessing our lives."

Sincerely, K.B.
B's. fiance. New Jersey

Read more about ATI Wellness Treatment Results and what clients from St. Petersburg, Florida are saying about their alcohol treatment. It is also interesting to read what the clients from Miami have said about their full recovery from an eating disorder and feelings of low self esteem that they resolved at ATI. Clients that presented problems of dual diagnosis from Florida cities such as Orlando, Tallahassee and Boca Raton participated in ATI's 30 day residential treatment and were able to attain lasting sobriety, and other clients from such areas as Ft. Lauderdale, Destin, Tampa, Naples, Ft. Myers and Palm Beach were able to uncover and resolve their substance abuse and addiction problems by increasing their length of stay in the residential and then IOP programs at ATI Wellness

"DRINKING AND DRIVING" It is obviously not good enough to say, "Don't Drink and Drive" Everyone knows this is a very bad choice, dangerous to the driver and other drivers, and against the law. The law is clear and everyone knows it, if you get caught driving while intoxicated, you could go to jail or worse, prison. So just saying it doesn't seem to stop people from participating in this dangerous behavior. The only time when drivers will not drink alcohol and drive their cars is when they make the conscious decision not to do it. The decision must come from the individual and their mindful choice, not from the threat of the outside consequences. Everyone is aware of the consequences, but only the mindful thought and decision will change the behavior.

OxyContin®: Prescription Drug Abuse

OxyContin® Frequently Asked Questions

Q: What is Oxycontin?

A: OxyContin is a semisynthetic opioid analgesic prescribed for chronic or long-lasting pain. The medication's active ingredient is oxycodone, which is also found in drugs like Percodan and Tylox. However, OxyContin contains between 10 and 160 milligrams of oxycodone in a timed-release tablet. Painkillers such as Tylox contain 5 milligrams of oxycodone and often require repeated doses to bring about pain relief because they lack the timed-release formulation.

Q: How Is OxyContin Used?

A: OxyContin, also referred to as "Oxy," "O.C.," and "killer" on the street, is legitimately prescribed as a timed-release tablet, providing as many as 12 hours of relief from chronic pain. It is often prescribed for cancer patients or those with chronic, long-lasting back pain. The benefit of the medication to chronic pain sufferers is that they generally need to take the pill only twice a day, whereas a dosage of another medication would require more frequent use to control the pain. The goal of chronic pain treatment is to decrease pain and improve function.

Q: How Is OxyContin Abused?

A: OxyContin abusers either crush the tablet and ingest or snort it or dilute it in water and inject it. Crushing or diluting the tablet disarms the timed-release action of the medication and causes a quick, powerful high. Abusers have compared this feeling to the euphoria they experience when taking heroin. In fact, in some areas, the use of heroin is overshadowed by the abuse of OxyContin.

Purdue Pharma, OxyContin's manufacturer, has taken steps to reduce the potential for abuse of the medication. Its Web site lists the following initiatives aimed at curbing the illicit use of OxyContin: providing physicians with tamper-proof prescription pads, developing and distributing more than 400,000 brochures to send to pharmacists and healthcare professionals to help educate them about how to prevent diversion, working with healthcare and law enforcement officials to address the problem of prescription drug abuse, and helping to fund a study of the best practices in Prescription Monitoring Programs. In addition, the company is attempting to research and develop other pain management products that will be less resistant to abuse and diversion. The company estimates that it will take significant time for such products to be brought to market. For more information, visit Purdue Pharma's Web site at www.purduepharma.com or call them at 203-588-8069.

Q: How Does OxyContin Abuse Differ From Abuse of Other Pain Prescriptions?

A: Abuse of prescription pain medications is not new. Two primary factors, however, set OxyContin abuse apart from other prescription drug abuse. First, OxyContin is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other prescription pain relievers. By crushing the tablet and either ingesting or snorting it, or by injecting diluted OxyContin, abusers feel the powerful effects of the opioid in a short time, rather than over a 12-hour span. Second, great profits are to be made in the illegal sale of OxyContin. A 40-milligram pill costs approximately $4 by prescription, yet it may sell for $20 to $40 on the street, depending on the area of the country in which the drug is sold.(1)

OxyContin can be comparatively inexpensive if it is legitimately prescribed and if its cost is covered by insurance. However, the National Drug Intelligence Center reports that OxyContin abusers may use heroin if their insurance will no longer pay for their OxyContin prescription, because heroin is less expensive than OxyContin that is purchased illegally.(2)

Q: Why Are So Many Crimes Reportedly Associated With OxyContin Abuse?

A: Many reports of OxyContin abuse have occurred in rural areas that have housed labor-intensive industries, such as logging or coal mining. These industries are often located in economically depressed areas, as well. Therefore, people for whom the drug may have been legitimately prescribed may be tempted to sell their prescriptions for profit. Substance abuse treatment providers say that the addiction is so strong that people will go to great lengths to get the drug, including robbing pharmacies and writing false prescriptions.

Q: What Is the Likelihood That a Person for Whom OxyContin Is Prescribed Will Become Addicted?

A: Most people who take OxyContin as prescribed do not become addicted. The National Institute on Drug Abuse (NIDA) reports: "With prolonged use of opiates and opioids, individuals become toleran...require larger doses, and can become physically dependent on the drugs.... Studies indicate that most patients who receive opioids for pain, even those undergoing long-term therapy, do not become addicted to these drugs."(3)

One NIDA-sponsored study found that "only four out of more than 12,000 patients who were given opioids for acute pain actually became addicted to the drugs.... In a study of 38 chronic pain patients, most of whom received opioids for 4 to 7 years, only 2 patients actually became addicted, and both had a history of drug abuse."(4)

In short, most individuals who are prescribed OxyContin, or any other opioid, will not become addicted, although they may become dependent on the drug and will need to be withdrawn by a qualified physician. Individuals who are taking the drug as prescribed should continue to do so, as long as they and their physician agree that taking the drug is a medically appropriate way for them to manage pain.

Q: How Can I Determine Whether a User Is Dependent on Rather Than Addicted to OxyContin?

A: When pain patients take a narcotic analgesic as directed, or to the point where their pain is adequately controlled, it is not abuse or addiction. Abuse occurs when patients take more than is needed for pain control, especially if they take it to get high. Patients who take their medication in a manner that grossly differs from a physician's directions are probably abusing that drug.

If a patient continues to seek excessive pain medication after pain management is achieved, the patient may be addicted. Addiction is characterized by the repeated, compulsive use of a substance despite adverse social, psychologic, and/or physical consequences. Addiction is often (but not always) accompanied by physical dependence, withdrawal syndrome, and tolerance. Physical dependence is defined as a physiologic state of adaptation to a substance. The absence of this substance produces symptoms and signs of withdrawal. Withdrawal syndrome is often characterized by overactivity of the physiologic functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. Opioids often cause sleepiness, calmness, and constipation, so opioid withdrawal often includes insomnia, anxiety, and diarrhea.

Pain patients, however, may sometimes develop a physical dependence during treatment with opioids. This is not an addiction. A gradual decrease of the medication dose over time, as the pain is resolving, brings the former pain patient to a drug-free state without any craving for repeated doses of the drug. This is the difference between the formerly dependent pain patient who has now been withdrawn from medication and the opioid-addicted patient: The patient addicted to diverted pharmaceutical opioids continues to have a severe and uncontrollable craving that almost always leads to eventual relapse in the absence of adequate treatment. It is this uncontrollable craving for another "rush" of the drug that differentiates the "detoxified" but opioid-addicted patient from the former pain patient. Theoretically, an opioid abuser might develop a physical dependence, but obtain treatment in the first few months of abuse, before becoming addicted. In this case, supervised withdrawal (detoxification) followed by a few months of abstinence-oriented treatment might be sufficient for the nonaddicted patient who abuses opioids. If, however, this patient subsequently relapses to opioid abuse, then that would support a diagnosis of opioid addiction. After several relapses to opioid abuse, it becomes clear that a patient will require long-term treatment for the opioid addiction. (Please see the section of this CSAT Advisory titled Treatment and Detoxification Protocols on page 2 to learn more about treatment options.)An American addiction treatment and rehabilitation clinic, Alternative Treatment International (A.T.I. Inc) offers the highest success rates for addiction recovery and mental health issues using holistic and alternative treatments and Non-12-Step, Non-AA, programs. Our dual diagnosis clinical treatment program in Clearwater, Florida provides a positive and successful alternative to 12-step/AA/NA treatment for individuals afflicted with addictions and psycho-emotional disorders. For alcoholism, prescription drug abuse, cocaine addiction, gambling, depression, eating disorders, anxiety, bi-polar disorder, A.T.I. offers a wellness program for recovery that doesn't just treat the symptoms of addictions, but treats the whole person and the cause of the problem. The philosophy at Alternative Treatment International, Inc. is to provide the highest quality individualized psychotherapy. Together we can resolve your psycho-emotional issues and help you to rebuild self-esteem and rediscover your true nature. Our corporate mission is to promote true patient self awareness. By formulating philosophies, treatments, healing techniques and protocols that address the whole individual, the highest level of self discovery can be achieved. As well as providing the life transformation tools that promote recovery and relapse prevention, part of A.T.I.'s goal is to examine the perceptions one has about Mind-Body-Spirit-Environment® and how those perceptions produce thinking. Perception Therapy® reviews those perceptions throughout the learning process and as those perceptions transform, we witness changes in thinking, which in turn brings hope and healing. When a change in thinking produces a new view, all things are possible including good health, positive lifestyle change, the prevention of addiction relapse, successful resolution to addictions and emotional problems, and happiness, peace and self-esteem.

Click on the Life Transformation/Relapse Prevention Icon to view a wide range of addiction recovery products, wellness aids and innovative therapy products available for purchase, for the use of patients receiving addiction treatment and for addiction treatment therapists. Used by clients and Alternative Treatment International wellness program therapists daily, the Perception Therapy® Wellness Guide, the Therapeutic 53 Card Deck and Journal are powerful tools in addiction recovery. The set can be used in addictions and mental health treatment programs and individual therapists will find them a valuable addition to their current treatment protocols. As well, these tools can be used at home to assist with relapse prevention and life transformation. Therapists and clients have found journaling to be a highly effective tool for self discovery. Journal entries allow for free expression, without judgment, as individuals record their private thoughts, ideas and concerns. The Full Set (including Perception Therapy® Wellness Guide, Therapeutic Card Deck, Journal, Inspirational Stones and Magnet, used together, either in addictions and mental health treatment programs by qualified individual therapists or by the recovering client at home, allowing greater personal insights and further advance mental wellness and addiction recovery. All Perception Therapy® products may be purchased individually or as a set, including the Perception Therapy® Wellness Guide, Journal, Therapeutic 53 Card Deck, Therapeutic 53 Card Deck on CD, Inspirational Stones, and Perception Therapy® Magnets.

Perception Therapy® In-House Training is available for addiction therapists, behavioral therapists and psychotherapy professionals. Learn the innovative and highly successful techniques of Perception Therapy developed by ALTERNATIVE TREATMENT INTERNATIONAL, INC. Help your clients with their addictions by treating the whole person and the cause of the problem and not simply the symptom. Compatible with all existing treatment models, Perception Therapy® Training techniques can be incorporated into a variety of treatment programs, individual practices, and may also be used by your clients at home as a self-help aid. In-house training is available at our Florida treatment facility. To learn and experience Perception Therapy® techniques, all training materials are included, as well as 8 CEU's each day. For those unable to attend our in-house training, the Perception Therapy® Training Set may be purchased. A competency test will be administered and a 2 CEU Perception Therapy® Certificate provided.

Perception Therapy® In-House Training, on location at our Florida addictions treatment center, will give health professionals an in-depth understanding of our unique non-12 step program and therapeutic treatment model that utilizes its own MIND-BODY-SPIRIT-ENVIRONMENT® approach to overcoming addictions and undesirable behaviors. Participants in the addiction therapy program will benefit from interacting in small groups and have the opportunity to participate in Art Therapy Integrating Perception Therapy® and daily offered Kai Chi Do. For those travelling to our Florida Treatment Centre from out-of town, housing can be arranged at an additional charge.

We believe that an educated consumer is a good consumer. Having as much information as possible is critical to making informed decisions, especially where one's health and wellness is concerned. This is particularly true for those seeking rehabilitation, therapy or treatment for an addiction, compulsion, physiological or emotional disorder. To this end, we have provided a wealth of pertinent health and wellness information, addiction case studies, informative articles from medical journals, drug research studies and questions and answers to a variety of topics, ranging from bipolar disorders to cocaine addiction. Continue to scroll down to learn more. We will add further information as it becomes available that will benefit our clients and be of interest to anyone dealing with a drug addiction or are concerned for a family member's mental health. We invite you to check back periodically.

Alternative Treatment International, Inc. offers a number of innovative and highly effective addiction treatments and services that treat the whole person, using a MIND-BODY-SPIRIT-ENVIRONMENT® approach to get to the root cause of the addiction. All of our patients receive exceptional specialized care that leads to addiction recovery. Some of ATI treatments include Individual Psychotherapy Treatments, Group Psychotherapy Treatment, Metaphor Therapy and Indirect Suggestion, Perception Therapy® , Family Programs, Detox and Medical Services. Our Extended Care Program provides an excellent opportunity for continuing care in a comfortable and therapeutic environment.

For clients living in the Clearwater, Florida and Tampa Bay, Florida region, ATI offers a variety of successful outpatient addiction treatments and outpatient addiction therapy. Over the years, we have welcomed countless in-house patients at our beautiful Clearwater Florida treatment facility, from all 50 states, including New York, New Jersey, Texas, North and South Carolina, Georgia, Illinois, Ohio, Louisiana, Connecticut, Arizona and California. As well, ATI Wellness has helped clients from Canada, Europe, Asia, Australia and the Middle East with our Non 12 Step treatment programs.

Our addiction treatment facility located in Clearwater Florida is a modern facility that includes our suite of clinical offices and is where most of our wellness therapy programs and addiction treatments take place. The treatment centre provides a calm and peaceful atmosphere that enables our clients to concentrate on their therapy in a non-stressful setting. Our suite of clinical offices is located approximately 15 minutes from the client living quarters allowing for a more normal separation of therapy and living environments.

Transportation and supervision are provided by our staff on a 24-hour basis. Our facility condominiums are situated approximately 5 minutes from the beautiful, white sand beaches of Dunedin and just minutes away from scenic Honeymoon and Caladesi Island. Every client has his or her own individual bedroom with water view. These beach cabana style condominium suites offer our clients accommodations that ensure privacy and comfort. Tastefully decorated with Key West or Tommy Bahama style furnishings, our client living quarters are two bedrooms and one bath units with queen size beds, granite counter top full size kitchen with dining area, washer/dryer, ceiling fans throughout, wireless Internet and cable television in the living room and in individual bedrooms.

What is prescription drug abuse?

Although most people take prescription medications responsibly, there has been an increase in the nonmedical use of or, as NIDA refers to it in this report, abuse1 of prescription drugs in the United States.

What are some of the commonly abused prescription drugs?

Although many prescription drugs can be abused, there are several classifications of medications that are commonly abused.

The three classes of prescription drugs that are most commonly abused are:

Opioids, which are most often prescribed to treat pain;

Central nervous system (CNS) depressants, which are used to treat anxiety and sleep disorders; and

Stimulants, which are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD).

Opioids What are opioids?

Opioids are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Medications that fall within this class-referred to as prescription narcotics-include morphine (e.g., Kadian, Avinza), codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), and related drugs. Morphine, for example, is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs-codeine and diphenoxylate (Lomotil) for example-can be used to relieve coughs and diarrhea.

How do opioids affect the brain and body?

Opioids act on the brain and body by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors, they can block the perception of pain. Opioids can produce drowsiness, nausea, constipation, and, depending upon the amount of drug taken, depress respiration. Opioid drugs also can induce euphoria by affecting the brain regions that mediate what we perceive as pleasure. This feeling is often intensified for those who abuse opioids when administered by routes other than those recommended. For example, OxyContin often is snorted or injected to enhance its euphoric effects, while at the same time increasing the risk for serious medical consequences, such as opioid overdose.

What are the possible consequences of opioid use and abuse

Taken as directed, opioids can be used to manage pain effectively. Many studies have shown that the properly managed, short-term medical use of opioid analgesic drugs is safe and rarely causes addiction-efined as the compulsive and uncontrollable use of drugs despite adverse consequences-or dependence, which occurs when the body adapts to the presence of a drug, and often results in withdrawal symptoms when that drug is reduced or stopped. Withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and involuntary leg movements. Long-term use of opioids can lead to physical dependence and addiction. Taking a large single dose of an opioid could cause severe respiratory depression that can lead to death.

Is it safe to use opioid drugs with other medications?

Only under a physician's supervision can opioids be used safely with other drugs. Typically, they should not be used with other substances that depress the CNS, such as alcohol, antihistamines, barbiturates, benzodiazepines, or general anesthetics, because these combinations increase the risk of life-threatening respiratory depression.

1 A common vocabulary has not been established in the field of prescription drug abuse. Because much of the data collected in this area focuses on nonmedical use of prescription drugs, the definition of abuse used in this report does not correspond to the definition of abuse/dependence listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

2 This does not apply only to opioids. Changes in routes of administration also contribute to the abuse of other prescription medications, and this practice can lead to serious medical consequences.

Alternative Treatment International Inc. provides a wonderful tropical setting for those dealing with alcohol abuse, drug addiction and various psychological disorders including depression, anxiety, trauma and eating disorders like bulimia.

Alternative Treatment offers a comfortable safe environment and we utilize rehabilitation programs that combine traditional medicine with spiritual healing and a healthy holistic approach to living.

Located in Clearwater Florida the clinic receives patients from throughout the USA, Canada and Europe. Emotional disorders and chemical addictions can be devastating and Alternative Treatment International has the therapists and medical staff that can help patients turn around their lives with a proven program that provides a path to recovery and a new beginning to a healthy lifestyle.

Alternative Treatment International specializes in identifying the underlying symptoms that often accompany addictions. Depression can often be associated with substance abuse by example.

Symptoms of depression are extremely common in society today. It has been stated that 10% of the population suffers from depression at one time or another. There is much controversy still about the causes of depression, with many leaning toward a chemical imbalance in the brain as a cause. This may or may not be true (perception). If one is taught to perceive oneself as having a chemical imbalance then their thinking would naturally lean towards taking a chemical to restore the diagnosed imbalance. The behavior would be to seek out anti-depressant medications to relieve the symptoms. For some, a symptomatic relief through medications would be indicated in order to allow the individual to explore the causes of the depressive feelings in a clinical setting.

Many types of depression are situational and transient, meaning that the symptoms such as hopelessness, helplessness and worthlessness have been produced by a particular life situation, and transient in that with intervention, these symptoms may lift and a return to normalcy may be experienced without medication.

Of the myriad of symptoms that are experienced by depressed individuals, the one thing that they all share in common is the sense of "loss of hope”. In the human condition, the concept of hope is probably the most important. Without hope (a spiritual concept), the depressive symptoms continue and may worsen.

The treatment of depression must include a restoration of the concept of hope for the individual, for the depressive symptoms to lift and for that person to find the sense of hope and peace that they seek.

Is it possible that depression can be treated successfully without medications? The answer is absolutely. One must take into consideration a number of factors including; the precipitating situation, physical condition, eating habits and nutrition, environment, psycho-emotional condition and of course, spiritual understanding and enlightenment. Understanding and resolving the underlying causes of depression whether consciously understood or hidden in the subconscious may produce a more positive result than simply perceiving chemical medications and their symptomatic relief as the only answer.

Depression and its causes are addressed and treated at Alternative Treatment International. Through a holistic approach, mind/body/spirit, the depressive symptoms begin to lift as the person recognizes a sense of inspiration with a proactive desire to move forward in their life and resolve their difficulties in a productive manner.

The Decision To Get Help

Accepting the fact that help is needed for an alcohol problem may not be easy. But keep in mind that the sooner you get help, the better are your chances for a successful recovery.

Any concerns you may have about discussing drinking-related problems with your health care provider may stem from common misconceptions about alcoholism and alcoholic people. In our society, the myth prevails that an alcohol problem is a sign of moral weakness. As a result, you may feel that to seek help is to admit some type of shameful defect in yourself. In fact, alcoholism is a disease that is no more a sign of weakness than is asthma. Moreover, taking steps to identify a possible drinking problem has an enormous payoff—a chance for a healthier, more rewarding life.

When you visit your health care provider, he or she will ask you a number of questions about your alcohol use to determine whether you are having problems related to your drinking. Try to answer these questions as fully and honestly as you can. You also will be given a physical examination. If your health care provider concludes that you may be dependent on alcohol, he or she may recommend that you see a specialist in treating alcoholism. You should be involved in any referral decisions and have all treatment choices explained to you.

Getting Well - Alcoholism Treatment

The type of treatment you receive depends on the severity of your alcoholism and the resources that are available in your community. Treatment may include detoxification (the process of safely getting alcohol out of your system); taking doctor-prescribed medications, such as disulfiram (Antabuse®) or naltrexone (ReVia™), to help prevent a return (or relapse) to drinking once drinking has stopped; and individual and/or group counseling. There are promising types of counseling that teach alcoholics to identify situations and feelings that trigger the urge to drink and to find new ways to cope that do not include alcohol use. These treatments are often provided on an outpatient basis.

Because the support of family members is important to the recovery process, many programs also offer brief marital counseling and family therapy as part of the treatment process. Programs may also link individuals with vital community resources, such as legal assistance, job training, childcare, and parenting classes.

Alcoholics Anonymous

Virtually all alcoholism treatment programs also include Alcoholics Anonymous (AA) meetings. AA describes itself as a "worldwide fellowship of men and women who help each other to stay sober.” Although AA is generally recognized as an effective mutual help program for recovering alcoholics, not everyone responds to AA’s style or message, and other recovery approaches are available. Even people who are helped by AA usually find that AA works best in combination with other forms of treatment, including counseling and medical care.

Can Alcoholism Be Cured?

Although alcoholism can be treated, a cure is not yet available. In other words, even if an alcoholic has been sober for a long time and has regained health, he or she remains susceptible to relapse and must continue to avoid all alcoholic beverages. "Cutting down” on drinking doesn’t work; cutting out alcohol is necessary for a successful recovery.

However, even individuals who are determined to stay sober may suffer one or several "slips,” or relapses, before achieving long-term sobriety. Relapses are very common and do not mean that a person has failed or cannot recover from alcoholism. Keep in mind, too, that every day that a recovering alcoholic has stayed sober prior to a relapse is extremely valuable time, both to the individual and to his or her family. If a relapse occurs, it is very important to try to stop drinking once again and to get whatever additional support you need to abstain from drinking.

Help for Alcohol Abuse

If your health care provider determines that you are not alcohol dependent but are nonetheless involved in a pattern of alcohol abuse, he or she can help you to: Some individuals who have stopped drinking after experiencing alcohol-related problems choose to attend AA meetings for information and support, even though they have not been diagnosed as alcoholic.

What Is Alcohol Abuse?

Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for alcohol, loss of control over drinking, or physical dependence. Alcohol abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period: Although alcohol abuse is basically different from alcoholism, many effects of alcohol abuse are also experienced by alcoholics.

What Are the Signs of a Problem?

How can you tell whether you may have a drinking problem? Answering the following four questions can help you find out: One "yes" answer suggests a possible alcohol problem. If you answered "yes" to more than one question, it is highly likely that a problem exists. In either case, it is important that you see your doctor or other health care provider right away to discuss your answers to these questions. He or she can help you determine whether you have a drinking problem and, if so, recommend the best course of action.

Even if you answered "no" to all of the above questions, if you encounter drinking-related problems with your job, relationships, health, or the law, you should seek professional help. The effects of alcohol abuse can be extremely serious—even fatal—both to you and to others.

Facts About Alcoholism

For many people, the facts about alcoholism are not clear. What is alcoholism, exactly? How does it differ from alcohol abuse? When should a person seek help for a problem related to his or her drinking? The following information explains both alcoholism and alcohol abuse, the symptoms of each, when and where to seek help, treatment choices, and additional helpful resources.

Alcoholism Information - A Widespread Problem

For most people who drink, alcohol is a pleasant accompaniment to social activities. Moderate alcohol use—up to two drinks per day for men and one drink per day for women and older people—is not harmful for most adults. (A standard drink is one 12-ounce bottle or can of either beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.) Nonetheless, a large number of people get into serious trouble because of their drinking. Currently, nearly 14 million Americans—1 in every 13 adults—abuse alcohol or are alcoholic. Several million more adults engage in risky drinking that could lead to alcohol problems. These patterns include binge drinking and heavy drinking on a regular basis. In addition, 53 percent of men and women in the United States report that one or more of their close relatives have a drinking problem.

The consequences of alcohol misuse are serious—in many cases, life threatening. Heavy drinking can increase the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx (voice box). Heavy drinking can also cause liver cirrhosis, immune system problems, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. Furthermore, both homicides and suicides are more likely to be committed by persons who have been drinking. In purely economic terms, alcohol-related problems cost society approximately $185 billion per year. In human terms, the costs cannot be calculated.

What Is Alcoholism?

Alcoholism, also known as "alcohol dependence," is a disease that includes four symptoms: People who are not alcoholic sometimes do not understand why an alcoholic can’t just "use a little willpower” to stop drinking. However, alcoholism has little to do with willpower. Alcoholics are in the grip of a powerful "craving,” or uncontrollable need, for alcohol that overrides their ability to stop drinking. This need can be as strong as the need for food or water.

Although some people are able to recover from alcoholism without help, the majority of alcoholics need assistance. With treatment and support, many individuals are able to stop drinking and rebuild their lives.

Many people wonder why some individuals can use alcohol without problems but others cannot. One important reason has to do with genetics. Scientists have found that having an alcoholic family member makes it more likely that if you choose to drink you too may develop alcoholism. Genes, however, are not the whole story. In fact, scientists now believe that certain factors in a person’s environment influence whether a person with a genetic risk for alcoholism ever develops the disease. A person’s risk for developing alcoholism can increase based on the person’s environment, including where and how he or she lives; family, friends, and culture; peer pressure; and even how easy it is to get alcohol.

How To Help The Unwilling Alcoholic

If an alcoholic is unwilling to get help, what can you do about it?

This can be a challenge. An alcoholic can't be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. But you don't have to wait for someone to "hit rock bottom" to act. Many alcoholism treatment specialists suggest the following steps to help an alcoholic get treatment:

Stop all "cover ups"

Family members often make excuses to others or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.

Time your intervention

The best time to talk to the drinker is shortly after an alcohol-related problem has occurred--like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.

Be specific

Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.

State the results

Explain to the drinker what you will do if he or she doesn't go for help--not to punish the drinker, but to protect yourself from his or her problems. What you say may range from refusing to go with the person to any social activity where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry out.

Get help

Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous meeting.

Call on a friend

If the family member still refuses to get help, ask a friend to talk with him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.

Find strength in numbers

With the help of a health care professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health care professional who is experienced in this kind of group intervention.

Get support

It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, which is geared to children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help.

Understanding Drug Abuse and Addiction

Many people view drug abuse and addiction as strictly a social problem. Parents, teens, older adults, and other members of the community tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs if they are willing to change their behavior.

These myths have not only stereotyped those with drug-related problems, but also their families, their communities, and the health care professionals who work with them. Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences. It is NIDA's goal to help the public replace its myths and long-held mistaken beliefs about drug abuse and addiction with scientific evidence that addiction is a chronic, relapsing, and treatable disease.

Addiction does begin with drug abuse when an individual makes a conscious choice to use drugs, but addiction is not just "a lot of drug use." Recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn drug abuse into addiction, a chronic, relapsing illness. Those addicted to drugs suffer from a compulsive drug craving and usage and cannot quit by themselves. Treatment is necessary to end this compulsive behavior.

A variety of approaches are used in treatment programs to help patients deal with these cravings and possibly avoid drug relapse. NIDA research shows that addiction is clearly treatable. Through treatment that is tailored to individual needs, patients can learn to control their condition and live relatively normal lives.

Treatment can have a profound effect not only on drug abusers, but on society as a whole by significantly improving social and psychological functioning, decreasing related criminality and violence, and reducing the spread of AIDS. It can also dramatically reduce the costs to society of drug abuse.

Understanding drug abuse also helps in understanding how to prevent use in the first place. Results from NIDA-funded prevention research have shown that comprehensive prevention programs that involve the family, schools, communities, and the media are effective in reducing drug abuse. It is necessary to keep sending the message that it is better to not start at all than to enter rehabilitation if addiction occurs.

A tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data NIDA has amassed. Overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" - the gap between the public perception of drug abuse and addiction and the scientific facts.

Prescription drug addiction

Years of research have shown us that addiction to any drug, illicit or prescribed, is a brain disease that can, like other chronic diseases, be effectively treated. But no single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used and the needs of the individual. To be successful, treatment may need to incorporate several components, such as counseling in conjunction with a prescribed medication, and multiple courses of treatment may be needed for the patient to make a full recovery.

The two main categories of drug addiction treatment are behavioral and pharmacological. Behavioral treatments teach people how to function without drugs, how to handle cravings, how to avoid drugs and situations that could lead to drug use, how to prevent relapse, and how to handle relapse should it occur. When delivered effectively, behavioral treatments - such as individual counseling, group or family counseling, contingency management, and cognitive-behavioral therapies - also can help patients improve their personal relationships and ability to function at work and in the community.

Some addictions, such as opioid addiction, can also be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior. Medications also can be used to relieve the symptoms of withdrawal, to treat an overdose, or to help overcome drug cravings. Although a behavioral or pharmacological approach alone may be effective for treating drug addiction, research shows that a combination of both, when available, is most effective.

Treating addiction to prescription opioids

Several options are available for effectively treating addiction to prescription opioids. These options are drawn from experience and research regarding the treatment of heroin addiction. They include medications, such as methadone and LAAM (levo-alpha-acetyl-methadol), and behavioral counseling approaches.

A useful precursor to long-term treatment of opioid addiction is detoxification. Detoxification in itself is not a treatment for opioid addiction. Rather, its primary objective is to relieve withdrawal symptoms while the patient adjusts to being drug free. To be effective, detoxification must precede long-term treatment that either requires complete abstinence or incorporates a medication, such as methadone, into the treatment plan.

Methadone is a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms, and relieves drug craving. It has been used successfully for more than 30 years to treat people addicted to opioids. Other medications include LAAM, an alternative to methadone that blocks the effects of opioids for up to 72 hours, and naltrexone, an opioid blocker that is often employed for highly motivated individuals in treatment programs promoting complete abstinence. Buprenorphine, another effective medication, is awaiting Food and Drug Administration (FDA) approval for treatment of opioid addiction. Finally, naloxone, which counteracts the effects of opioids, is used to treat overdoses.

Principles of Drug Addiction Treatment

Nearly three decades of scientific research has yielded 13 fundamental principles that characterize effective drug abuse treatment. These principles are detailed in NIDA's Principles of Drug Addiction Treatment: A Research-Based Guide.
  1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each patient's problems and needs is critical.

  2. Treatment needs to be readily available. Treatment applicants can be lost if treatment is not immediately available or readily accessible.

  3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. Treatment must address the individual's drug use and associated medical, psychological, social, vocational, and legal problems.

  4. At different times during treatment, a patient may develop a need for medical services, family therapy, vocational rehabilitation, and social and legal services.

  5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The time depends on an individual's needs. For most patients, the threshold of significant improvement is reached at about 3 months in treatment. Additional treatment can produce further progress. Programs should include strategies to prevent patients from leaving treatment prematurely.

  6. Individual and/or group counseling and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships.

  7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethodol (LAAM) help persons addicted to opiates stabilize their lives and reduce their drug use. Naltrexone is effective for some opiate addicts and some patients with co-occurring alcohol dependence. Nicotine patches or gum, or an oral medication, such as buproprion, can help persons addicted to nicotine.

  8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.

  9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification manages the acute physical symptoms of withdrawal. For some individuals it is a precursor to effective drug addiction treatment.

  10. Treatment does not need to be voluntary to be effective. Sanctions or enticements in the family, employment setting, or criminal justice system can significantly increase treatment entry, retention, and success.

  11. Possible drug use during treatment must be monitored continuously. Monitoring a patient's drug and alcohol use during treatment, such as through urinalysis, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that treatment can be adjusted.

  12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place them or others at risk of infection. Counseling can help patients avoid high-risk behavior and help people who are already infected manage their illness.

  13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Participation in self-help support programs during and following treatment often helps maintain abstinence.



Rehab Centers

Selecting a treatment center for alcoholism and drug abuse for yourself or someone you care about may be one of the most important decisions you will make in your lifetime. Most of us don't know what to look for in a quality program. Not all treatment centers are the same-they differ greatly in program options, staff qualifications, credentials, cost, and effectiveness.

You need to ask appropriate questions when you call a drug abuse treatment center for information and you should expect to receive clear answers.

Before you make any decisions-ask questions and get the facts!

Does the treatment center offer a variety of programs?

Alcohol and drug addiction is a disease that progresses through predictable stages. It takes a trained health professional, often a doctor specializing in addiction medicine, to make an accurate diagnosis and prescribe the most appropriate treatment.

Centers should offer a variety of treatment programs that meet individual needs. Programs may include inpatient, residential, outpatient, and/or short-stay options.

The difference between inpatient and residential treatment is that inpatient services are provided by a licensed hospital, while residential programs usually do not meet the same rigorous standards of medical care.

The length of stay depends on the severity and stage of the disease.

What is the cost of treatment?

"How much does it cost?" is often one of the first questions asked.

The price tag for drug abuse & alcoholism is presented in many different formats. You need to know what is included in the price, what will be added on to your bill as a fee-for-service program, and what services your health insurance will cover. This makes it extremely difficult to compare prices by simply asking the question - "What does it cost?"

If you are seeking the best value for your treatment dollar, remember: Price can be meaningful only in the context of quality and performance.

Is the treatment program medically based?

There is an advantage to including on-site medical care in a drug abuse treatment center. Physicians and nurses provide 24-hour hospital services to monitor and ensure a safe withdrawal from alcohol and other drugs. In addition, a medical staff specializing in addiction medicine can oversee the progress of each individual and make necessary adjustments to the treatment plan.

Medical credentials can also be important. For example, chemical dependency treatment centers that earn a JCAHO accreditation (Joint Commission on Accreditation of Healthcare Organizations) meet national standards for providing quality medical care. Appropriate state licensing is also an important consideration.

Be sure to ask which medical costs are included in the price of treatment.

What is the degree of family involvement in the recovery program?

Drug abuse and alcoholism affects the entire family, not just the alcoholic/addict. Quite often family members do not realize how deeply they have been affected by chemical dependency. Family involvement is an important component of recovery.

Treatment centers vary in the degree and quality of family involvement opportunities. Some offer just a few lectures and others offer family therapy. Ask if there is any time devoted to family programs and if group therapy is included.

Does treatment include a quality continuing care program?

There are no quick fixes for the diseases of drug abuse and alcoholism. Recovery is an ongoing process. The skills one learns during intensive treatment must be integrated into everyday life and this takes time.

Some treatment programs will offer a follow-up program but only in one location which may make it difficult to use.

Treatment programs should include a quality, continuing care program that supports and monitors recovery.

Principles of Effective Treatment
  1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

  2. Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.

  3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems.

  4. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture.

  5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

  6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community.

  7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM) are very effective in helping individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important.

  8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.

  9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.

  10. Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.

  11. Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring.

  12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients avoid high-risk behavior. Counseling also can help people who are already infected manage their illness.

  13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.
Source: National Institute on Drug Addiction

What are the street names/slang terms for Cocaine?
Big C, Blow, Coke, Flake, Freebase, Lady, Nose Candy, Rock, Snow, Snowbirds, White Crack.

What is Cocaine?
Cocaine is a drug extracted from the leaves of the coca plant. It is a potent brain stimulant and one of the most powerfully addictive drugs.

What does it look like?
Cocaine is distributed on the street in two main forms: cocaine hydrochloride is a white crystalline powder and "crack" is cocaine hydrochloride that has been processed with ammonia or sodium bicarbonate (baking soda) and water into a freebase cocaine - chips, chunks, or rocks.

How is it used?
Cocaine can be snorted or dissolved in water and injected. Crack can be smoked.

What are its short-term effects?
Short-term effects of cocaine include constricted peripheral blood vessels, dilated pupils, increased temperature, heart rate, blood pressure, insomnia, loss of appetite, feelings of restlessness, irritability, and anxiety. Duration of cocaine's immediate euphoric effects, which include energy, reduced fatigue, and mental clarity, depends on how it is used. The faster the absorption, the more intense the high. However, the faster the absorption, the shorter the high lasts.The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Cocaine's effects are short lived, and once the drug leaves the brain, the user experiences a "coke crash" that includes depression, irritability, and fatigue.

What are its long-term effects?
High doses of cocaine and/or prolonged use can trigger paranoia. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users. When addicted individuals stop using cocaine, they often become depressed. Prolonged cocaine snorting can result in ulceration of the mucous membrane of the nose.

What is its federal classification?
Schedule II

Source: National Institute on Drug Abuse (NIDA)

Eating Disorders: Facts About Eating Disorders and the Search for Solutions

Introduction

Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Treatment Strategies
Research Findings and Directions
For More Information
References

Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions. Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, at some point move beyond control in some people and develop into an eating disorder. Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity, but in the long run have the potential to lead to new pharmacologic treatments for eating disorders.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa.

1 A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis.

2 Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood.

3 Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders.1 In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia4 and an estimated 35 percent of those with binge-eating disorder5 are male.

Anorexia Nervosa

An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime.

1 Symptoms of anorexia nervosa include:

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.6 The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Bulimia Nervosa

An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime.1 Symptoms of bulimia nervosa include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise

The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months Self-evaluation is unduly influenced by body shape and weight Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Binge-Eating Disorder

Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.5,7 Symptoms of binge-eating disorder include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode The binge-eating episodes are associated with at least 3 of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating Marked distress about the binge-eating behavior The binge eating occurs, on average, at least 2 days a week for 6 months The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise)

People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

Treatment Strategies

1 Eating disorders can be treated and a healthy weight restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging; (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and (3) achieving long-term remission and rehabilitation, or full recovery. Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person's medical and nutritional needs. In some cases, intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often employed. Establishment of a pattern of regular, non-binge meals, improvement of attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse. The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long term.

Research Findings and Directions

Research is contributing to advances in the understanding and treatment of eating disorders.

NIMH-funded scientists and others continue to investigate the effectiveness of psychosocial interventions, medications, and the combination of these treatments with the goal of improving outcomes for people with eating disorders.8,9 Research on interrupting the binge-eating cycle has shown that once a structured pattern of eating is established, the person experiences less hunger, less deprivation, and a reduction in negative feelings about food and eating. The two factors that increase the likelihood of bingeing?hunger and negative feelings?are reduced, which decreases the frequency of binges.

10 Several family and twin studies are suggestive of a high heritability of anorexia and bulimia,11,12 and researchers are searching for genes that confer susceptibility to these disorders.13 Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses. Identification of susceptibility genes will permit the development of improved treatments for eating disorders.

Other studies are investigating the neurobiology of emotional and social behavior relevant to eating disorders and the neuroscience of feeding behavior.

Scientists have learned that both appetite and energy expenditure are regulated by a highly complex network of nerve cells and molecular messengers called neuropeptides.14,15 These and future discoveries will provide potential targets for the development of new pharmacologic treatments for eating disorders.

Further insight is likely to come from studying the role of gonadal steroids.16,17 Their relevance to eating disorders is suggested by the clear gender effect in the risk for these disorders, their emergence at puberty or soon after, and the increased risk for eating disorders among girls with early onset of menstruation.

The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services. 

Bipolar disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year, 1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

"Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide."

"I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do."

Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
(Reprinted with permission from Alfred A. Knopf, a division of Random House, Inc.)

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

The National Institute of Mental Health

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness-for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified physiologically-for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). 2

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it-memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.

Suicide

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

If you are feeling suicidal or know someone who is:

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder?

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment. http://www.termlifeinsurance.org/additional-resources/resources-for-bipolar-disorder/

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below-"How Is Bipolar Disorder Treated?"). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. 4  But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder?

Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. 5  Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.

For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Causes Bipolar Disorder?

Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder-rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes-the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow-passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling. 6

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. 7  It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses. 8 , 9  New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated?

Most people with bipolar disorder-even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.  10 , 11 , 12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications

Medications for bipolar disorder are prescribed by psychiatrists-medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder.10 Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

· Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.

· Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.

·Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.

· Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.

· Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13  Therefore, young female patients taking valproate should be monitored carefully by a physician.

·Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14 Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.

· Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18

·If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.

· Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.

·Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.

·To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function

People with bipolar disorder often have abnormal thyroid gland function. 19 Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects

Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.

Psychosocial Treatments

As an addition to medication, psychosocial treatments-including certain forms of psychotherapy (or "talk" therapy)-are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

· Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.

· Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.

·Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.

· Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.

·As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments

·In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19

·Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications.20  In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21

· Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated

Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.

Do Other Illnesses Co-occur with Bipolar Disorder?

Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23 Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25 Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment. For more information on anxiety disorders, contact NIMH (see below).

How Can Individuals and Families Get Help for Bipolar Disorder?

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:

What About Clinical Studies for Bipolar Disorder?

Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of "real-world" clinical studies. They are called "real-world" studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.

The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services.

Marijuana

Marijuana is the most commonly abused illicit drug in the United States. A dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis sativa, it usually is smoked as a cigarette (joint, nail), or in a pipe (bong). It also is smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug. It might also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-andsour odor. There are countless street terms for marijuana including pot, herb, weed, grass, widow, ganja, and hash, as well as terms derived from trademarked varieties of cannabis, such as Bubble Gum, Northern Lights, Fruity Juice, Afghani #1, and a number of Skunk varieties.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). The membranes of certain nerve cells in the brain contain protein receptors that bind to THC. Once securely in place, THC kicks off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana.

Extent of Use —

In 2004, 14.6 million Americans age 12 and older used marijuana at least once in the month prior to being surveyed. About 6,000 people a day in 2004 used marijuana for the first time—

2.1 million Americans. Of these, 63.8 percent were under age 18(1). In the last half of 2003, marijuana was the third most commonly abused drug mentioned in drug-related hospital emergency department (ED) visits in the continental United States, at 12.6 percent, following cocaine (20 percent) and alcohol (48.7 percent)(2). Percentage of 8th-Graders Who Have Used Marijuana Monitoring the Future Survey, 2005 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Lifetime 23.1% 22.6% 22.2% 22.0% 20.3% 20.4% 19.2% 17.5% 16.3% 16.5% Annual 18.3 17.7 16.9 16.5 15.6 15.4 14.6 12.8 11.8 12.2 30-day 11.3 10.2 9.7 9.7 9.1 9.2 8.3 7.5 6.4 6.6 Daily 1.5 1.1 1.1 1.4 1.3 1.3 1.2 1.0 0.8 1.0

Percentage of 10th-Graders Who Have Used Marijuana Monitoring the Future Survey, 2005 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Lifetime 39.8% 42.3% 39.6% 40.9% 40.3% 40.1% 38.7% 36.4% 35.1% 34.1% Annual 33.6 34.8 31.1 32.1 32.2 32.7 30.3 28.2 27.5 26.6 30-day 20.4 20.5 18.7 19.4 19.7 19.8 17.8 17.0 15.9 15.2 Daily 3.5 3.7 3.6 3.8 3.8 4.5 3.9 3.6 3.2 3.1

Percentage of 12th-Graders Who Have Used Marijuana Monitoring the Future Survey, 2005 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Lifetime 44.9% 49.6% 49.1% 49.7% 48.8% 49.0% 47.8% 46.1% 45.7% 44.8% Annual 35.8 38.5 37.5 37.8 36.5 37.0 36.2 34.9 34.3 33.6 30-day 21.9 23.7 22.8 23.1 21.6 22.4 21.5 21.2 19.9 19.8 Daily 4.9 5.8 5.6 6.0 6.0 5.8 6.0 6.0 5.6 5.0

*“Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to use at least once during the year preceding an individual’s response to the survey. “30-day” refers to use at least once during the 30 days preceding an individual’s response to the survey.

Prevalence of lifetime,* annual, and use within the last 30 days for marijuana remained stable among 10th- and 12thgraders surveyed between 2003 and 2004. However, 8th-graders reported a significant decline in 30-day use and a significant increase in perceived harmfulness of smoking marijuana once or twice and regularly(3). Trends in disapproval of using marijuana once or twice and occasionally rose among 8th-graders as well, and 10th-graders reported an increase in disapproval of occasional and regular use for the same period(3).

Effects on the Brain

Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to organs throughout the body, including the brain.

In the brain, THC connects to specific sites called cannabinoid receptors on nerve cells and influences the activity of those cells. Some brain areas have many cannabinoid receptors; others have few or none. Many cannabinoid receptors are found in the parts of the brain that influence pleasure, memory, thought, concentration, sensory and time perception, and coordinated movement(4).

The short-term effects of marijuana can include problems with memory and learning; distorted perception; difficulty in thinking and problem solving; loss of coordination; and increased heart rate. Research findings for long-term marijuana abuse indicate some changes in the brain similar to those seen after long- term abuse of other major drugs. For example, cannabinoid (THC or synthetic forms of THC) withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system(5) and changes in the activity of nerve cells containing dopamine(6). Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.

Effects on the Heart

One study has indicated that an abuser’s risk of heart attack more than quadruples in the first hour after smoking marijuana(7). The researchers suggest that such an effect might occur from marijuana’s effects on blood pressure and heart rate and reduced oxygen-carrying capacity of blood.

Effects on the Lungs

A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers(8). Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

Even infrequent abuse can cause burning and stinging of the mouth and throat, often accompanied by a heavy cough. Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers do, such as daily cough and phlegm production, more frequent acute chest illness, a heightened risk of lung infections, and a greater tendency to obstructed airways(9). Smoking marijuana possibly increases the likelihood of developing cancer of the head or neck. A study comparing 173 cancer patients and 176 healthy individuals produced evidence that marijuana smoking doubled or tripled the risk of these cancers(10).

Marijuana abuse also has the potential to promote cancer of the lungs and other parts of the respiratory tract because it contains irritants and carcinogens(9, 11). In fact, marijuana smoke contains 50 to 70 percent more carcinogenic hydrocarbons than does tobacco smoke(12). It also induces high levels of an enzyme that converts certain hydrocarbons into their carcinogenic form—levels that may accelerate the changes that ultimately produce malignant cells(13). Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which increases the lungs’ exposure to carcinogenic smoke. These facts suggest that, puff for puff, smoking marijuana may be more harmful to the lungs than smoking tobacco.

Other Health Effects

Some of marijuana’s adverse health effects may occur because THC impairs the immune system’s ability to fight disease. In laboratory experiments that exposed animal and human cells to THC or other marijuana ingredients, the normal disease-preventing reactions of many of the key types of immune cells were inhibited(14). In other studies, mice exposed to THC or related substances were more likely than unexposed mice to develop bacterial infections and tumors(15, 16).

Effects of Heavy Marijuana Use on Learning and Social Behavior

Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a person’s existing problems worse. Depression(17), anxiety(17), and personality disturbances(18) have been associated with chronic marijuana use. Because marijuana compromises the ability to learn and remember information, the more a person uses marijuana the more he or she is likely to fall behind in accumulating intellectual, job, or social skills. Moreover, research has shown that marijuana’s adverse impact on memory and learning can last for days or weeks after the acute effects of the drug wear off(19, 20, 25).

Students who smoke marijuana get lower grades and are less likely to graduate from high school, compared with their nonsmoking peers(21, 22, 23, 24). A study of 129 college students found that, among those who smoked the drug at least 27 of the 30 days prior to being surveyed, critical skills related to attention, memory, and learning were significantly impaired, even after the students had not taken the drug for at least 24 hours(20). These “heavy” marijuana abusers had more trouble sustaining and shifting their attention and in registering, organizing, and using information than did the study participants who had abused marijuana no more than 3 of the previous 30 days. As a result, someone who smokes marijuana every day may be functioning at a reduced intellectual level all of the time.

More recently, the same researchers showed that the ability of a group of long-term heavy marijuana abusers to recall words from a list remained impaired for a week after quitting, but returned to normal within 4 weeks(25). Thus, some cognitive abilities may be restored in individuals who quit smoking marijuana, even after long-term heavy use.

Workers who smoke marijuana are more likely than their coworkers to have problems on the job. Several studies associate workers’ marijuana smoking with increased absences, tardiness, accidents, workers’ compensation claims, and job turnover. A study among postal workers found that employees who tested positive for marijuana on a preemployment urine drug test had 55 percent more industrial accidents, 85 percent more injuries, and a 75-percent increase in absenteeism compared with those who tested negative for marijuana use(26). In another study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement including cognitive abilities, career status, social life, and physical and mental health(27).

Effects of Exposure During Pregnancy

Research has shown that some babies born to women who abused marijuana during their pregnancies display altered responses to visual stimuli(28), increased tremulousness, and a high-pitched cry, which may indicate neurological problems in development(29). During the preschool years, marijuana-exposed children have been observed to perform tasks involving sustained attention and memory more poorly than nonexposed children do(30, 31). In the school years, these children are more likely to exhibit deficits in problem-solving skills, memory, and the ability to remain attentive(30).

Addictive Potential

Long-term marijuana abuse can lead to addiction for some people; that is, they abuse the drug compulsively even though it interferes with family, school, work, and recreational activities. Drug craving and withdrawal symptoms can make it hard for long-term marijuana smokers to stop abusing the drug. People trying to quit report irritability, sleeplessness, and anxiety(32). They also display increased aggression on psychological tests, peaking approximately one week after the last use of the drug(33).

Genetic Vulnerability

Scientists have found that whether an individual has positive or negative sensations after smoking marijuana can be influenced by heredity. A 1997 study demonstrated that identical male twins were more likely than nonidentical male twins to report similar responses to marijuana abuse, indicating a genetic basis for their response to the drug(34). (Identical twins share all of their genes.)

It also was discovered that the twins’ shared or family environment before age 18 had no detectable influence on their response to marijuana. Certain environmental factors, however, such as the availability of marijuana, expectations about how the drug would affect them, the influence of friends and social contacts, and other factors that differentiate experiences of identical twins were found to have an important effect.(34)

Treating Marijuana Problems

The latest treatment data indicate that, in 2002, marijuana was the primary drug of abuse in about 15 percent (289,532) of all admissions to treatment facilities in the United States. Marijuana admissions were primarily male (75 percent), White (55 percent), and young (40 percent were in the 15–19 age range). Those in treatment for primary marijuana abuse had begun use at an early age; 56 percent had abused it by age 14 and 92 percent had abused it by 18(35).

One study of adult marijuana abusers found comparable benefits from a 14session cognitive-behavioral group treatment and a 2-session individual treatment that included motivational interviewing and advice on ways to reduce marijuana use. Participants were mostly men in their early thirties who had smoked marijuana daily for more than 10 years. By increasing patients’ awareness of what triggers their marijuana abuse, both treatments sought to help patients devise avoidance strategies. Abuse, dependence symptoms, and psychosocial problems decreased for at least 1 year following both treatments; about 30 percent of the patients were abstinent during the last 3-month followup period(36).

Another study suggests that giving patients vouchers that they can redeem for goods—such as movie passes, sporting equipment, or vocational training— may further improve outcomes(37).

Although no medications are currently available for treating marijuana abuse, recent discoveries about the workings of the THC receptors have raised the possibility of eventually developing a medication that will block the intoxicating effects of THC. Such a medication might be used to prevent relapse to marijuana abuse by lessening or eliminating its appeal.

References

1 Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H–27, DHHS Publication No. SMA 05–4061). Rockville, MD, 2004. NSDUH is an annual survey conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 800-729-6686.

2 These data are from the annual Drug Abuse Warning Network, funded by the Substance Abuse and Mental Health Services Administration, DHHS. The survey provides information about emergency department visits that are induced by or related to the use of an illicit drug or the nonmedical use of a legal drug. The latest data are available at 800729-6686 or online at www.samhsa.gov.

3 These data are from the 2005 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

4 Herkenham M, Lynn A, Little MD, Johnson MR, et al. Cannabinoid receptor localization in the brain. Proc Natl Acad Sci, USA 87(5):1932–1936, 1990.

5 Rodriguez de Fonseca F, et al. Activation of cortocotropin-releasing factor in the limbic system during cannabinoid withdrawal. Science 276(5321):2050–2054, 1997.

6 Diana M, Melis M, Muntoni AL, et al. Mesolimbic dopaminergic decline after cannabinoid withdrawal. Proc Natl Acad Sci 95(17):10269–10273, 1998.

7 Mittleman MA, Lewis RA, Maclure M, et al. Triggering myocardial infarction by marijuana. Circulation 103(23):2805–2809, 2001.

8 Polen MR, Sidney S, Tekawa IS, et al. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med 158(6):596–601, 1993.

9 Tashkin DP. Pulmonary complications of smoked substance abuse. West J Med 152(5):525–530, 1990.

10 Zhang ZF, Morgenstern H, Spitz MR, et al. Marijuana use and increased risk of squamous cell carcinoma of the head and neck. Cancer Epidemiology, Biomarkers & Prevention 8(12):1071–1078, 1999.

11 Sridhar KS, Raub WA, Weatherby, NL Jr., et al. Possible role of marijuana smoking as a carcinogen in the development of lung cancer at a young age. Journal of Psychoactive Drugs 26(3):285–288, 1994.

12 Hoffman D, Brunnemann KD, Gori GB, et al. On the carcinogenicity of marijuana smoke. In: VC Runeckles, ed, Recent Advances in Phytochemistry. New York. Plenum, 1975.

13 Cohen S. Adverse effects of marijuana: Selected issues. Annals of the New York Academy of Sciences 362:119–124, 1981.

14 Adams IB, Martin BR: Cannabis: pharmacology and toxicology in animals and humans. Addiction 91(11):1585–1614, 1996.

15 Friedman H, Newton C, Klein TW. Microbial infections, immunomodulation, and drugs of abuse. Clin Microbiol Rev 16(2):209–219, 2003.

16 Zhu LX, Sharma M, Stolina S, et al. Delta-9-tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor- mediated, cytokine-dependent pathway. J Immunology 165(1):373–380, 2000.

17 Brook JS, Rosen Z, Brook DW. The effect of early marijuana use on later anxiety and depressive symptoms. NYS Psychologist 35–39, January 2001.

18 Brook JS, Cohen P, Brook DW. Longitudinal study of co-occurring psychiatric disorders and substance use. J Acad Child and Adolescent Psych 37(3):322–330, 1998.

19 Pope HG, Yurgelun-Todd D. The residual cognitive effects of heavy marijuana use in college students. JAMA 275(7):521–527, 1996.

20 Block RI, Ghoneim MM. Effects of chronic marijuana use on human cognition. Psychopharmacology 100(1–2):219–228, 1993.

21 Lynskey M, Hall W. The effects of adolescent cannabis use on educational attainment: A review. Addiction 95(11):1621–1630, 2000.

22 Kandel DB, Davies M. High school students who use crack and other drugs. Arch Gen Psychiatry 53(1):71–80, 1996.

23 Rob M, Reynolds I, Finlayson PF. Adolescent marijuana use: Risk factors and implications. Aust NZ J Psychiatry 24(1):45–56, 1990.

24 Brook JS, Balka EB, Whiteman M. The risks for late adolescence of early adolescent marijuana use. Am J Public Health 89(10):1549–1554, 1999.

25 Pope HG, Gruber AJ, Hudson JI, et al. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58(10):909–915, 2001.

26 Zwerling C, Ryan J, Orav EJ. The efficacy of pre-employment drug screening for marijuana and cocaine in predicting employment outcome.

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27 Gruber AJ, Pope HG, Hudson JI, et al. Attributes of long-term heavy cannabis users: A case control study. Psychological Medicine 33(8):1415–1422, 2003.

28 Fried PA, Makin JE. Neonatal behavioural correlates of prenatal exposure to marihuana, cigarettes and alcohol in a low risk population. Neurotoxicology and Teratology 9(1):1–7, 1987.

29 Lester BM, Dreher M. Effects of marijuana use during pregnancy on newborn crying. Child Development 60(23/24):764–771, 1989.

30 Fried PA. The Ottawa prenatal prospective study (OPPS): Methodological issues and findings. It’s easy to throw the baby out with the bath water. Life Sciences 56(23–24):2159–2168, 1995.

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32 Kouri EM, Pope HG, Lukas SE. Changes in aggressive behavior during withdrawal from long-term marijuana use. Psychopharmacology 143(3):302–308, 1999.

33 Haney M, Ward AS, Comer SD, et al. Abstinence symptoms following smoked marijuana in humans. Psychopharmacology 141(4):395–404, 1999.

34 Lyons MJ, Toomey R, Meyer JM, et al. How do genes influence marijuana use? The role of subjective effects. Addiction 92(4):409–417, 1997.

35 These data from the Treatment Episode Data Set (TEDS) 2003: Substance Abuse Treatment Admissions by Primary Substance of Abuse, According to Sex, Age Group, Race, and Ethnicity, funded by the Substance Abuse and Mental Health Services Administration, DHHS. The latest data are available at 800-729-6686 or online at www.samhsa.gov.

36 Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. J Consult Clin Psychol 68(5):898–908, 2000.

37 Budney AJ, Higgins ST, Radonovich KJ, et al. Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. J Consult Clin Psychol 68(6):1051–1061, 2000.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.

Prescription Medications

Brief Description:
Prescription drugs that are abused or used for nonmedical reasons can alter brain activity and lead to dependence. Commonly abused classes of prescription drugs include opioids (often prescribed to treat pain), central nervous system depressants (often prescribed to treat anxiety and sleep disorders), and stimulants (prescribed to treat narcolepsy, ADHD, and obesity).

Street Names:
Commonly used opioids include oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil). Common central nervous system depressants include barbiturates such as pentobarbital sodium (Nembutal), and benzodiazepines such as diazepam (Valium) and alprazolam (Xanax). Stimulants include dextroamphetamine (Dexedrine) and methylphenidate (Ritalin).

Effects:

  Long-term use of opioids or central nervous system depressants can lead to physical dependence and addiction. Taken in high doses, stimulants can lead to compulsive use, paranoia, dangerously high body temperatures, and irregular heartbeat.

Statistics and Trends:

  According to NIDA's 2005 Monitoring the Future study, 9.5% of high school seniors used hydrocodone (Vicodin) in the past year. Source: NIDA Infofacts: High School and Youth Trends.

Methamphetamine is a very addictive stimulant drug that activates certain systems in the brain. It is chemically related to amphetamine but, at comparable doses, the effects of methamphetamine are much more potent, longer lasting, and more harmful to the central nervous system (CNS).

Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is available only through a prescription that cannot be refilled. It can be made in small, illegal laboratories, where its production endangers the people in the labs, neighbors, and the environment. Street methamphetamine is referred to by many names, such as ?speed,? ?meth,? and ?chalk.? Methamphetamine hydrochloride, clear chunky crystals resembling ice, which can be inhaled by smoking, is referred to as ?ice,? ?crystal,? ?glass,? and ?tina.? 1

Methamphetamine is taken orally, intranasally (snorting the powder), by needle injection, or by smoking. Abusers may become addicted quickly, needing higher doses and more often. At this time, the most effective treatments for methamphetamine addiction are behavioral therapies such as cognitive behavioral and contingency management interventions.

Health Hazards
Methamphetamine increases the release of very high levels of the neurotransmitter dopamine, which stimulates brain cells, enhancing mood and body movement. Chronic methamphetamine abuse significantly changes how the brain functions. Animal research going back more than 30 years shows that high doses of methamphetamine damage neuron cell endings. Dopamine- and serotonin-containing neurons do not die after methamphetamine use, but their nerve endings (?terminals?) are cut back, and regrowth appears to be limited. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system. These alterations are associated with reduced motor speed and impaired verbal learning. Recent studies in chronic methamphetamine abusers have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers.

Taking even small amounts of methamphetamine can result in increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and hyperthermia. Other effects of methamphetamine abuse may include irritability, anxiety, insomnia, confusion, tremors, convulsions, and cardiovascular collapse and death. Long-term effects may include paranoia, aggressiveness, extreme anorexia, memory loss, visual and auditory hallucinations, delusions, and severe dental problems.

Also, transmission of HIV and hepatitis B and C can be a consequence of methamphetamine abuse. Among abusers who inject the drug, infection with HIV and other infectious diseases is spread mainly through the re-use of contaminated syringes, needles, and other injection equipment by more than one person. The intoxicating effects of methamphetamine, however, whether it is injected or taken other ways, can alter judgment and inhibition and lead people to engage in unsafe behaviors. Methamphetamine abuse actually may worsen the progression of HIV and its consequences; studies with methamphetamine abusers who have HIV indicate that the HIV causes greater neuronal injury and cognitive impairment compared with HIV-positive people who do not use drugs.

Extent of Use
Monitoring the Future Study (MTF)*
Past year** methamphetamine use in 2006 was reported by 1.8 percent of 8th-graders, 1.8 percent of 10th-graders (which represents a statistically significant decline from 2.9 percent in 2005), and 2.5 percent of 12th-graders. Perceived risk of harm from trying crystal methamphetamine, collected only for 12th-graders, increased from 54.6 percent in 2005 to 59.1 percent in 2006.

Methamphetamine Prevalence of Abuse
Monitoring the Future Survey, 2006

8th Grade 10th Grade 12th Grade
Lifetime 2.7% 3.2% 4.4%
Past Year 1.8 1.8 2.5
Past Month 0.6 0.7 0.9

Community Epidemiology Work Group (CEWG)***
In eight areas with data available from 2002 to 2005, sizable increases in primary methamphetamine treatment admissions as a proportion of total treatment admission, excluding alcohol, occurred in six; the increases were greatest in Arizona, Minneapolis/St. Paul, Los Angeles County, Denver, and Atlanta. Trend data show decreases in lab incidents from 2002 to 2005 in all CEWG States except Florida (up from 157 to 273), Michigan (from 225 to 341), and Pennsylvania (up from 30 to 79).

In the 2005 reporting period, primary treatment admissions for methamphetamine abuse as a proportion of all admissions, excluding alcohol, continued to be highest in Hawaii (56.3 percent) and San Diego (49.4 percent). Trend data from 2004 to 2005 show increases in methamphetamine treatment admissions as a proportion of all admissions, excluding alcohol, of between 4.1 and 4.7 percentage points in Atlanta, Los Angeles, and San Diego. The proportion of primary methamphetamine treatment admissions declined 5 percentage points in Arizona.

Demographic data available from seven CEWG areas suggest that, compared with cocaine and heroin admissions, primary methamphetamine admissions are more likely to be female, White, and younger than 25.

Unweighted DAWN Live! data for 2005 show that methamphetamine emergency department reports exceeded those for all other illicit drugs, excluding alcohol, in Phoenix and San Diego, and accounted for the second highest number of reports in San Francisco.

National Survey on Drug Use and Health (NSDUH)****
According to the 2005 NSDUH, 10.4 million Americans age 12 and older had tried methamphetamine at least once in their lifetimes. The rates for past month and past year methamphetamine use did not change between 2004 and 2005, but the lifetime rate declined from 4.9 percent to 4.3 percent. From 2002 to 2005, decreases were seen in lifetime (5.3 percent to 4.3 percent) and past year (0.7 percent to 0.5 percent) use, but not past month use.

Rates of past year methamphetamine use among persons aged 12 or older were among the highest in Nevada (2.0 percent), Montana (1.5 percent), and Wyoming (1.5 percent). Young adults aged 18 to 25 were more likely to use methamphetamine in the past year than youths aged 12 or 17 and adults aged 26 or older.

Other Information Resources
For more information on the effects of methamphetamine abuse and addiction, visit www.drugabuse.gov/drugpages/methamphetamine.html.

To find publicly-funded treatment facilities by state, visit www.findtreatment.samhsa.gov.

Stress and Substance Abuse

In the aftermath of the terrorist attacks on New York City and Washington, D.C., people across the country and abroad are struggling with the emotional impact of large-scale damage and loss of life, as well as the uncertainty of what will happen next. These are stressful times for all and may be particularly difficult times for people who are more vulnerable to substance abuse or may be recovering from an addiction. For example, we know that stress is one of the most powerful triggers for relapse in addicted individuals, even after long periods of abstinence. NIDA-supported ethnographers are already reporting increases in street sales of various drugs. Given that individuals may turn to drugs to cope with life's stressors, it is more important than ever that NIDA supports a comprehensive research portfolio that better informs how we prevent and treat drug abuse and addiction.

Stress and Drug Abuse; Stress and Relapse to Drug Abuse
Many clinicians and addiction medicine specialists suggest that stress is the number one cause of relapse to drug abuse, including smoking. Now, research is elucidating a scientific basis for these clinical observations. In both people and animals, stress leads to an increase in the brain levels of a peptide known as corticotropin releasing factor (CRF). The increased CRF levels in turn triggers a cascade of biological responses. Animal and human research has implicated this cascade in the pathophysiology of both substance use disorders and Posttraumatic Stress Disorder (PTSD) (Jacobsen, et al. Am J Psychiatry 2001). Research also has shown that administering CRF or a chemical that mimics the action of CRF in animals produces increases in stress-related behaviors (Koob, Heinrichs. Brain Research 1999; Jones, et al. Psychopharmacology 1998). And, mice that lack a receptor for CRF (CRF1) have impaired stress responses and express less anxiety-related behavior (Smith, et al. Neuron 1998; Timpl, et al. Nature Genetics 1998). Furthermore, people subjected to chronic stress or those who show symptoms of PTSD often have hormonal responses that are not properly regulated and do not return to normal when the stress is over. This may make these individuals more prone to stress-related illnesses and may prompt patients to relapse to drug use.

Selected Research Findings on Stress and Drug Abuse; Stress and Relapse to Drug Abuse.
Studies have reported that individuals exposed to stress are more likely to abuse alcohol and other drugs or undergo relapse.

Kosten TR, Rounsaville BJ, Kleber HD: A 2.5 year follow-up of depressions, life crises, and treatment effects on abstinence among opioid addicts. Arch Gen Psychiatry 1986; 43:733-739.
Dawes MA, Antelman SM, Vanyukov MM, Giancola P, Tarter RE, Susman EJ, Mezzich A, Clark DB: Developmental sources of variation in liability to adolescent substance use disorders. Drug and Alcohol Dependence 2000; 61(1): 3-14.
Sinha R, Fuse T, Aubin LR, O'Malley SS: Psychological stress, drug-related cues, and cocaine craving. Psychopharmacology 2000; 152:140-148.

In an analysis of studies regarding factors that can lead to continued drug use among opiate addicts, high stress was found to predict continued drug use.

Brewer DD, Catalano RF, Haggerty K, Gainey RR, Fleming CB: A meta-analysis of predictors of continued drug use during and after treatment for opiate addiction. Addiction 1998; 93:73-92.

Research has shown that in animals not previously exposed to illicit substances, stressors increase vulnerability for drug self-administration.

Piazza PV, Deminiere JM, Le Moal M, Simon H: Stress- and pharmacologically-induced behavioral sensitization increases vulnerability to acquisition of amphetamine self-administration. Brain Research 1990; 514:22-26.

Acute stress can improve memory, whereas chronic stress can impair memory and may impair cognitive function.

McEwan BS, Sapolsky RM: Stress and Cognitive Function. Current Opinion in Neurobiology 1995; 5:205-216.

Research has shown that there is overlap between neurocircuits that respond to drugs and those that respond to stress.

Piazza PV, Le Moal M: Pathophysiological basis of vulnerability to drug abuse: role of an interaction between stress, glucocorticoids, and dopaminergic neurons. Annu Rev Pharmacol Toxicol 1996; 36:359-378.
Kreek MJ, Koob G: Drug dependence: Stress and dysregulation of brain reward pathways. Drug Alcohol Depend 1998; 51:23-47.
Piazza PV, Le Moal M: The role of stress in drug self-administration. Trends Pharmacol Sci 1998; 19(2):67-74.

Researchers have shown that, among drug-free cocaine abusers in treatment, exposure to personal stress situations led to consistent and significant increases in cocaine craving, along with activation of emotional stress and a physiological stress response. In another study of cocaine abusers in treatment, significant increases in cocaine and alcohol craving were observed with stress and drug cues imagery but not with neutral-relaxing imagery.

Sinha R, Catapano D, O'Malley S: Stress-induced craving and stress response in cocaine dependent individuals. Psychopharmacology 1999; 142:343-351.
Sinha R, Fuse T, Aubin LR, O'Malley SS: Psychological stress, drug-related cues, and cocaine craving. Psychopharmacology 2000; 152:140-148.

A follow-up study of smokers who had completed a national smoking cessation program showed that there is a strong relationship between stress coping resources and the ability to sustain abstinence.

Matheny KB, Weatherman KE: Predictors of Smoking Cessation and Maintenance. Journal of Clinical Psychology 1998; 54(2):223-235.

Animal studies have shown that stress induces relapse to heroin, cocaine, alcohol, and nicotine self-administration.

Shaham Y, Stewart J: Stress reinstates heroin-seeking in drug-free animals: an effect mimicking heroin, not withdrawal. Psychopharmacology 1995; 119:334-341.
Erb S, Shaham Y, Stewart J: Stress reinstates cocaine-seeking behavior after prolonged extinction and a drug-free period. Psychopharmacology 1996; 128:408-412.
Stewart J: Pathways to relapse: the neurobiology of drug- and stress-induced relapse to drug-taking. Journal of Psychiatry & Neuroscience 2000; 25:125-136
Ahmed SH, Koob GF: Cocaine- but not food-seeking behavior is reinstated by stress after extinction. Psychopharmacology 1997; 132:289-295.
Lê AD, Quan B, Juzytch W, Fletcher PJ, Joharchi N, Shaham Y: Reinstatement of alcohol-seeking by priming injections of alcohol and exposure to stress in rats. Psychopharmacology 1998; 135:169-174.
Y. Buczek, Lê AD, Wang A, Stewart J, Shaham Y: Stress reinstates nicotine seeking but not sucrose solution seeking in rats. Psychopharmacology 1999; 144:183-188.
Posttraumatic Stress Disorder (PTSD) and Substance Abuse
Research shows that Posttraumatic Stress Disorder (PTSD), a psychiatric disorder, may develop in people after they experience or witness life-threatening events such as terrorist incidents, military combat, natural disasters, serious accidents, or violent personal assaults like rape. Research also shows that PTSD is a risk factor for substance abuse and addiction. Because the events that occurred on September 11, 2001, were experienced by thousands of people, as well as rescue workers in and around the vicinity of the attacks, and were televised to millions across the world, it is likely that some individuals may develop behavioral and emotional re-adjustment problems. Symptoms of PTSD can include reexperiencing the trauma; avoidance of people, places, and thoughts connected to the event; and arousal, which may include trouble sleeping, exaggerated startle response, and hypervigilance. People who develop such symptoms may be more prone to escape from the realities of the day by self-medicating with drugs (Khantzian. Am J Psychiatry 1985). In fact, clinical observations suggest that PTSD patients may use psychoactive substances without a physician?s directions to relieve traumatic memories and other symptoms associated with PTSD (Brown. Drug Alcohol Dependence 1994).

Selected Research Findings on PTSD and Substance Use Disorders
High rates of comorbidity of PTSD and substance use disorders were first reported in war-related studies, in which as many as 75% of combat veterans with lifetime PTSD also met criteria for alcohol abuse or dependence.

Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS: Trauma and the Vietnam War Generation: Report of Findings From the National Vietnam Veterans Readjustment Study. New York, Brunner/Mazel, 1990.

In a general population study, the overall lifetime rate of PTSD was 7.8%. Among men with a lifetime history of PTSD, 34.5% reported drug abuse or dependence at some point in their lives versus 15.1% of men without PTSD. For women, 26.9% with a lifetime history of PTSD reported drug abuse or dependence during their lives versus 7.6% of women without PTSD.

Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52:1048-1060.

Among adolescents lifetime rates of PTSD have been found ranging from 6.3%, in a community sample of older adolescents, to 29.6%, in substance-dependent adolescents aged 15 to 19 receiving treatment. And, among the substance-dependent adolescents, 19.2% currently had PTSD.

Giaconia RM, Reinherz HZ, Silverman AB, Pakiz B, Frost AK, Cohen E: Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry 1995; 34:1369-1379.
Deykin EY, Buka SL: Prevalence and risk factors for posttraumatic stress disorder among chemically dependent adolescents. Am J Psychiatry 1997; 154:752-757

Persons with a lifetime history of PTSD have elevated rates of co-occurring disorders. Among men with PTSD during their lives, rates of co-occuring alcohol abuse or dependence are the highest, followed by depression, conduct disorder, and drug abuse or dependence. Among women with PTSD during their lives, rates of comorbid depression are highest, followed by some anxiety disorders, alcohol abuse or dependence, and drug abuse or dependence.

Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52:1048-1060.

Patients with PTSD commonly have substance use disorders, particularly abuse of and dependence on central nervous system depressants. This frequent co-occurrence of PTSD and substance use, suggests that the two are related.

Jacobsen LK, Southwick SM, Kosten TR: Substance Use Disorders in Patients with Posttraumatic Stress Disorder: A Review of the Literature. Am J Psychiatry 2001; 158(8):1184-1190.

The most recent thinking about the association between PTSD and substance use disorders suggests that for combat veterans (Bremner. Am J Psychiatry 1996) and civilians (Chilcoat. Arch Gen Psych 1998), the onset of PTSD typically precedes the onset of substance use disorders.

Saxon AJ, Davis TM, Sloan KL, McKnight KM, McFall ME, Kivlahan DR: Trauma, Symptoms of Posttraumatic Stress Disorder, and Associated Problems Among Incarcerated Veterans. Psychiatric Services 2001; 52(7):959-964.

In a study of 1007 young adults designed to look for a causal relationship between PTSD and substance use disorders, researchers found that when they reevaluated the participants at 3 and 5 years after an initial assessment, PTSD was associated with a more than 4-fold increased risk of drug abuse and dependence. The risk for abuse or dependence was highest for prescribed psychoactive drugs. The results suggest that drug abuse or dependence in persons with PTSD might be caused by efforts to self-medicate.

Chilcoat HD, Breslau N: Postraumatic Stress Disorder and Drug Disorders. Archives of General Psychiatry, 1998; 55:913-917.

Heroin-addicted patients who undergo so-called ultrarapid, anesthesia-assisted detoxification suffer withdrawal symptoms as severe as those endured by patients in detoxification by traditional methods, according to a NIDA-funded clinical trial. Researchers Dr. Eric Collins and colleagues at the College of Physicians and Surgeons of Columbia University concluded that there is no compelling reason to use general anesthesia in the treatment of opiate dependence, especially as it presents particular safety concerns. The new findings corroborate those of three international studies.

The ultrarapid detox technique, developed about 15 years ago by clinicians who hoped to mitigate the discomfort of withdrawal and speed the initiation of relapse prevention therapy, relies on a general anesthetic to sedate the patient for several hours while an opiate blocker precipitates withdrawal.The method is not covered by insurance, which makes it difficult to determine how many patients have received anesthesia-assisted detox.

To compare anesthesia-assisted detox with other approaches, Dr. Collins and colleagues enrolled 106 people seeking heroin detox at Columbia University Medical Center's Clinical Research Center. The patients, aged 21 through 50, had abused heroin every day during the past month. All spent 3 days as Center inpatients during detox, then were scheduled for twice-weekly outpatient relapse prevention psychotherapy and naltrexone maintenance (50 mg/day) for 12 weeks.

The investigators randomly assigned the participants to one of three detox methods (see chart). The goal of each method was to minimize patients' discomfort during withdrawal. In the ultrarapid approach, physicians put patients under anesthesia for 4 to 6 hours while administering naltrexone, a medication that precipitates withdrawal by blocking opioid molecules from their receptors in the brain. In the second method, patients remained awake and took a single dose of buprenorphine, a medication that eases withdrawal symptoms by moderating and smoothing the rate of opioid clearance from the brain. In the third approach, patients also remained awake and received clonidine and other nonopioid medications as needed to counter symptoms for all 3 inpatient days. These medications were available to all groups as needed for the duration of the inpatient phase. Throughout detox, the researchers closely monitored patients for complications, assessed physical indications of withdrawal, and asked the participants to rate their subjective experiences.