Studying

Studying is a very simple concept right!?! Yes it is, but it also takes some dedication and a heck of a lot of keeping focused and keeping on track. It is so important that we study, in order to get the results that we want. And if we don’t want better results than we don’t study. In order to get good grades in class, we must apply ourselves, focus on what we are doing, and make sure that we are directly connected to what we are doing.

It is so simple, yet sometimes we will become complacent and that isn’t good for us. We need to do the very best that we can in whatever we are doing. One thing that I have noticed here lately is that it takes a lot more than just to show up for a class. It takes involvement in that class also. We must participate in what we are doing in order for whatever we are studying to become very effective. Now this concept isn’t knew to us, yet it is like a God Shot to someone such as myself.

I have been in recovery for quite sometime now. However even with the time that I have in, I have not participated too much in my recovery, nor have I even studied that much in order to get the results that I would like to have. I suppose a guy would even say that I have pretty much just rested on my morals, if in fact I even had any to begin with. So I come up with the conclusion that we need to get back to the basics. And what are the basics of studying.

First thing is to show up on time. We can not be late for class because there are consequences for being late, or tardy if you remember. And if you get too many of them than you can get suspended and than if that happens you are going to be missing out on a lot of things from the class that you will probably end up failing. So showing up on time is very important.

Now in class we have to also pay attention to the teacher. That being said, if you are in Recovery, the teacher can be a lot of different things. I know many will automatically go into the Sponsor, God stuff, etc. but there are other teachers such as just friends, maybe your partner, books, literature, Forums sites that have a whole lot of Resources and things of the such. These things are all teachers and if we are paying attention to it than we are off to a wonderful start.

Now usually during class, when the teacher is teaching, most of us have used what we know as taking notes. Now as far as the notes are concerned, that is pretty much the same as journalism. Now if you go to most websites that are used for recovery they or most of them have journal forums in them so you are able post and most of the Internet world are not able to see them unless they are members of that Forum so that is a good way to express yourself and to be able to take note so to speak.

Than when all is said and done, once we have commensed this way of life, we than are ready to take the test. The test in recovery and being able to pass the test is to learn how to live life without the use of using. To put into action the things that we are taught by all the process above and to score on that test so to speak. The score depends on how well we follow the directions and how well we have listened throughout sessions. That my friends is Studying to this addict.

Thanks for allowing me to share.

Sleeping Is Healthy

Finally got a decent night sleep in almost 4 weeks of being in Lincoln.

Sleeping isn’t easy for me. Most of my lack of sleeping is caused from my drug use during my life. But when I am able to get a good night sleep it feels really good I am glad that I finally was able to get a good nights rest! Sometimes I think that has a lot to do with my recovery as well. They talk a lot about the H.A.L.T.S. (Hungry, Angry, Lonely, Tired, Sick) part in the rooms of AA/NA and I am sure that it has a lot to do with relapse. I get most of those quite a bit, maybe I should pay more attention to that little check list.

I woke up earlier and did my postings on the server for the meditations for the day. That was a good thing around 3 or 4am and than I went back to bed. But let us get back to the topic at hand. Sleeping is Healthy.

Most of us don’t realize how important it is to have a good night sleep. It is very important to be well rested. It helps us through out the day to be able to function in a healthy manner and I also believe that it helps us to react to situations in a much healthier manner as well. Without having a good nights rest and having those nights build up into weeks without a good nights rest, we tend to be on the edge more with our attitude, and not only with our attitude but on dealing with issues that may arise. So it is important in so many aspects to have a healthy sleeping schedule.

Now I am not one for the use of aids, however if you need a sleeping pill to help you get that nights rest, than by all means get in touch with your Doctor and talk it over with him/her. I know that you can by those things over the counter, however with alkies/addicts it isn’t a good thing to start going to the local drug store and just prescribing yourself medications without first talking it over with a Doctor. Now that is just my own opinion and you can take it or leave it. But I only know from my own experience that it isn’t best for me to start playing Doctor again, I have been down that road too many times and it always leads to other things which are not healthy.

Here are some tips that might help you out

Here are some Tips that may help.

• Sleep is as important as food and air. Quantity and quality are very important. Most adults need between 7.5 to 8.5 hours of uninterrupted sleep. If you press the snooze button on the alarm in the morning you are not getting enough sleep. This could be due to not enough time in bed, external disturbances, or a sleep disorder.
• Keep regular hours. Try to go to bed at the same time and get up at the same time every day. Getting up at the same time is most important. Getting bright light, like the sun, when you get up will also help. Try to go to bed only when you are sleepy. Bright light in the morning at a regular time should help you feel sleepy at the same time every night.
• Stay away from stimulants like caffeine. This will help you get deep sleep which is most refreshing. If you take any caffeine, take it in the morning. Avoid all stimulants in the evening, including chocolate, caffeinated sodas, and caffeinated teas. They will delay sleep and increase arousals during the night.
• Use the bed for sleeping. Avoid watching TV or using laptop computers. Know that reading in bed can be a problem if the material is very stimulation and you read with a bright light. If it helps to read before sleep make sure you use a very small wattage bulb to read. A 15 watt bulb should be enough. Bright light from these activities may inhibit sleep.
• Avoid bright light around the house before bed. Using dimmer switches in living rooms and bathrooms before bed can be helpful. (Dimmer switches can be set to maximum brightness for morning routines.)
• Don’t stress if you feel you are not getting enough sleep. It will just make matters worse. Know you will sleep eventually.
• Avoid exercise near bedtime. No exercise at least 3 hours before bed.
• Don’t go to bed hungry. Have a light snack, avoid a heavy meal before bed.
• Bedtime routines are helpful for good sleep. Keep routines on your normal schedule. A cup of herbal tea an hour before bed can begin a routine.
• Avoid looking at the clock if you wake up in the middle of the night. It can cause anxiety. This is very difficult for most of us, so turn the clock away from your eyes so you would have to turn it to see the time. You may decide not to make the effort and go right back to sleep.
• If you can’t get to sleep for over 30 minutes, get out of bed and do something boring in dim light till you are sleepy.
• Keep your bedroom at comfortable temperature. Not too warm and not too cold. Cooler is better than warmer.
• If you have problems with noise in your environment you can use a white noise generator. A old fan will work or you can buy noise machies from many sources.
• Know that the “night cap” has a price. Alcohol may help you to get to sleep but it will cause you to wake up throughout the night. You may not notice it. (It is worse if you have sleep apnea because the alcohol makes the apnea worse.) Sometimes people snore only if they have had some alcohol or may snore worse if they already snore.)
• If you have a sleeping partner, ask them if they notice any snoring, leg movements and/or pauses in breathing . Take this information and try the sleep test. You may have a sleep disorder or you may just need to increase your awareness about your own sleep need. If you have any concerns see your doctor.

What Are Substance Abuse and Addiction?

The difference between substance abuse and addiction is very slight. Substance abuse means using an illegal substance or using a legal substance in the wrong way. Addiction begins as abuse, or using a substance like marijuana or cocaine. You can abuse a drug (or alcohol) without having an addiction. For example, just because Sara smoked weed a few times doesn't mean that she has an addiction, but it does mean that she's abusing a drug — and that could lead to an addiction.

People can get addicted to all sorts of substances. When we think of addiction, we usually think of alcohol or illegal drugs. But people become addicted to medications, cigarettes, even glue! And some substances are more addictive than others: Drugs like crack or heroin are so addictive that they might only be used once or twice before the user loses control.

Addiction means a person has no control over whether he or she uses a drug or drinks. Someone who's addicted to cocaine has grown so used to the drug that he or she has to have it. Addiction can be physical, psychological, or both.

Physical addiction is when a person's body actually becomes dependent on a particular substance (even smoking is physically addictive). It also means building tolerance to that substance, so that a person needs a larger dose than ever before to get the same effects. Someone who is physically addicted and stops using a substance like drugs, alcohol, or cigarettes may experience withdrawal symptoms. Common symptoms of withdrawal are diarrhea, shaking, and generally feeling awful.

Psychological addiction happens when the cravings for a drug are psychological or emotional. People who are psychologically addicted feel overcome by the desire to have a drug. They may lie or steal to get it.

A person crosses the line between abuse and addiction when he or she is no longer trying the drug to have fun or get high, but has come to depend on it. His or her whole life centers around the need for the drug. An addicted person — whether it's a physical or psychological addiction or both — no longer feels like there is a choice in taking a substance.

Recovery and Relapse inventory worksheet

Recovery and Relapse inventory worksheet

I have worked with a great many folks that have utilized teh swinging door. I have found the following to be very helpful in preventing the next relapse.

The instructions that were given to me when I found the worksheet were only that the person be encouraged to be thoroughly honest and willing to make changes. Those that have done the worksheet remain clean and sober. So I know it owrks…..and as the promises say..”if we work it”
I hope this will be helpful

Recovery and Relapse inventory worksheet

1) what fear did your relaps create?

2) what guilt did it bring?

3) what regret did it create?

4) what harm did you do to yourself?

5) what harm did you do to others?

6) what financial harm was done?

7) what relationship damage was done?

what did it do to your self esteem?

9) what damage was done to your relationship with God?

10) what other problems did your using create?

Read recovery and relapse every day for a month.

The chapter says a relapse means we are holding on to

Reservations.

11) what parts of the program are you not willing to trust?Can

you identify any reservations?

Often we find that our surrender only scratches the surface.Only

A full surrender works with this disease.Use this chapter as a guideline

The whole point of this worksheet is to look back and identify and discover in what areas you failed to work your program of recovery. If we don’t learn from our relapses…..and become aware of what not to do again…..we are destined to repeat those same mistakes.

If you are willing to at least look at your thinking, feelings, and behavior that led up to the relapse…..you are moving towards recovery, not away from it.

It is just as important to look at assets, as well as liabilities. We look at what was working as opposed to what didn’t work and identify problem areas. These are the areas we want to bring into our awareness this time….so they won’t slip below the radar again.

In what ways was I actively working my program? (explain/describe, include feelings)
Meetings?
Sponsor?
Steps?
Higher power?
Service?

In what areas did I let my program slide or become complacent? (explain/describe, include feelings)
Meetings?
Sponsor?
Steps?
Higher power?
Service?

In what ways was my life manageable?(explain/describe, include feelings)
Mentally?
Emotionally?
Physically?
Spiritually?

In what ways was my life unmanageable? (explain/describe – be specific, include feelings)
Mentally?
Emotionally?
Physically?
Spiritually?

What events/situations affected my life negatively? (people, places, things, relationships, work)
How did I handle those events? (positive/negative)
What choices (self-will) do I think led me back into unmanageability?
Were these choices well thought out or impulsive reactions? Did you choose by default and ignore the warning signs)
In what ways was I in denial of the direction I was heading?
What circumstances could I have handled differently? In what way?

How was my emotional life unmanageable without the use of drugs? (in what ways – describe feelings and over what).

What were my thinking processes? (describe) Was I lying to myself? Did I justify my actions?

How did my behavior change? In what ways?

In what areas did I lack faith or not use my Higher Powers Guidance?

In what ways did my character defects come into play? (explain/describe all areas)
Denial?
Dishonesty?
Selfishness?
Stealing? Emotional stealing others trust?
Emotional, physical, sexual, financial manipulation of others?
Distrust of self and others?
Resentments? How they affected me and what actions did I take / or not take?
Self reliance/isolation?
Blame? Who did I blame for my feelings and why?
Did I abandon myself?

In what ways did I depend on others to meet my needs?
Where did I not take responsibility for myself and my program?
In what ways did I give my power to others?

Now looking at the answers to all these questions – Identify the problem areas?

List them:

What do I need to work on?
What do I need to watch for? Warning signs? Triggers?

In my best thinking…..How could I actively stay aware and work my program differently this time? (explain/describe).

What active actions can I take to promote my recovery?

How does my behavior need to change?

How will I rely on my Higher power to help me make these changes?

How can I align my will with my Higher powers guidance?

What can I do this time that I did not do last time to ensure a stronger program.

What does a complete surrender mean to me?

Nebraska Drug News

Nebraska Drug News

Volunteers and maintenance crews who clean up roadside litter are being urged to watch for potentially toxic debris discarded from methamphetamine labs.

Transportation agencies in several states and organizations that promote highway cleanups are creating brochures and DVDs to educate workers about dangers from materials used to make the drug, also known as meth or speed.

“We felt it was important to notify the public that the trash you might as a Good Samaritan be out picking up on the side of the road could possibly be dangerous to you,” says Lt. John Eichkorn of the Kansas Highway Patrol. The agency issued a news release in March that warned volunteers and highway cleanup crews.
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Bystanders who come across materials used to make the drug can be burned or their lungs damaged from inhaling fumes. Clues indicating a dumpsite include empty bottles attached to a rubber hose, the smell of ammonia and coffee filters stained red or containing a white powder residue.

Meth is a highly addictive stimulant that can be made using household chemicals and equipment and common cold remedies containing ephedrine or pseudoephedrine.

To combat the drug’s spread, most states have passed laws restricting access to those medicines, including limiting how much a customer can buy and having buyers sign a log, says Blake Harrison of the National Conference of State Legislatures. President Bush in March signed a federal law that imposes similar restrictions.

Such legislation has dramatically reduced the number of illegal meth labs found inside homes, says Ashley Cradduck, spokeswoman for Gov. Dave Heineman of Nebraska, where a law was passed last year.

Among actions:

� Keep Nebraska Beautiful, a civic group, launched an education campaign last year and created a DVD on meth litter for the thousands of 4-H clubs, Scout troops and Rotary clubs involved in cleanup efforts. “We recommend to every single group to view that video before they go out so they know how to respond,” says Jane Polson, the group’s executive director.

� Colorado’s Department of Transportation offers an instructional video warning that meth litter is “a deadly threat to all Adopt-A-Highway volunteers.” The video urges group leaders to scout areas before volunteers begin work.

“There was a need for a higher level of attention to it because I don’t think the crews really realized the risk they were in,” says Stacey Stegman, a department spokeswoman. A maintenance worker was overwhelmed two years ago by fumes from meth materials tossed in a rest stop trash bin, she says. “It burned his lungs,” she says. “He was off work for close to a month.”

Managing alcoholism as a disease

The debate on whether alcoholism is a disease or a personal conduct problem has continued for over 200 years. In the United States, Benjamin Rush, MD, has been credited with first identifying alcoholism as a "disease" in 1784. He asserted that alcohol was the causal agent, loss of control over drinking behavior being the characteristic symptom, and total abstinence the only effective cure. His belief in this concept was so strong that he spearheaded a public education campaign in the United States to reduce public drunkenness.

The 1800s gave rise to the temperance movement in the United States. Alcohol was perceived as evil, the root cause of America’s problems. Accepting the disease concept of alcoholism, people believed that liquor could enslave a person against his or her will. Temperance proponents propagated the view that drinking was so dangerous that people should not even sample liquor or else they would likely embark on the path toward alcoholism. This ideology maintained that alcohol is inevitably dangerous and inexorably addictive for everyone. Today, we know that strong genetic influences exist, but not everyone becomes addicted to alcohol.

The temperance movement picked up steam in the late 1800s and evolved into a movement advocating the prohibition of alcohol nationally. Banning alcohol would preserve the family and eliminate sloth and moral dissolution in the United States, according to supporters. Backed by strong political forces, legislation was passed and prohibition went into effect in 1920. Paradoxically, the era of prohibition also marked the death of Victorian standards. According to A. Sinclair in his book, Prohibition: The Era of Excess, a code of liberated personal behavior grew and with it the idea that drinking should accompany a full life. Drunkenness represented personal freedom. Due to public outcry, prohibition was repealed in 1933.

Soon after prohibition ended, Alcoholics Anonymous (AA) was born. Formed in 1935 by stockbroker Bill Wilson and a physician, Robert Smith, AA supported the proposition that an alcoholic is unable to control his or her drinking and recovery is possible only with total abstinence and peer support. The chief innovation in the AA philosophy was that it proposed a biological explanation for alcoholism. Alcoholics constituted a special group who are unable to control their drinking from birth. Initially, AA described this as "an allergy to alcohol."

Although AA was instrumental in again emphasizing the "disease concept" of alcoholism, the defining work was done by Elvin Jellinek, M.D., of the Yale Center of Alcohol Studies. In his book, The Disease Concept of Alcoholism, published in 1960, Jellinek described alcoholics as individuals with tolerance, withdrawal symptoms, and either "loss of control" or "inability to abstain" from alcohol. He asserted that these individuals could not drink in moderation, and, with continued drinking, the disease was progressive and life-threatening. Jellinek also recognized that some features of the disease (e.g., inability to abstain and loss of control) were shaped by cultural factors.

During the past 35 years, numerous studies by behavioral and social scientists have supported Jellinek’s contentions about alcoholism as a disease. The American Medical Association endorsed the concept in 1957. The American Psychiatric Association, the American Hospital Association, the American Public Health Association, the National Association of Social Workers, the World Health Organization and the American College of Physicians have also classified alcoholism as a disease. In addition, the findings of investigators in the late 1970s led to explicit criteria for an "alcohol dependence syndrome" which are now listed in the DSM IIR, DSM IV, and the ICD manual. In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic."

Despite the numerous studies validating the disease model of alcoholism, controversy still exists. In his 1989 book, Diseasing of America, social psychologist Stanton Peele, Ph.D., argues that AA and for-profit alcohol treatment centers promote the "myth" of alcoholism as a lifelong disease. He contends that the disease concept "excuses alcoholics for their past, present, and future irresponsibility" and points out that most people can overcome addiction on their own. He concludes that the only effective response to alcoholism and other addictions is "to recreate living communities that nurture the human capacity to lead constructive lives."

Surprisingly, Dr. Peele’s view that alcoholism is a personal conduct problem, rather than a disease, seems to be more prevalent among medical practitioners than among the public. A recent Gallop poll found that almost 90 percent of Americans believe that alcoholism is a disease. In contrast, physicians’ views of alcoholism were reviewed at an August 1997 conference held by the International Doctors of Alcoholics Anonymous (IDAA). A survey of physicians reported at that conference found that 80 percent of responding doctors perceived alcoholism as simply bad behavior.

Dr. Raoul Walsh in an article published in the November 1995 issue of Lancet supports the contention that physicians have negative views about alcoholics. He cites empirical data showing physicians continue to have stereotypical attitudes about alcoholics and that non-psychiatrists tend to view alcohol problems as principally the concern of psychiatrists. He also contends that many doctors have negative attitudes towards patients with alcohol problems because the bulk of their clinical exposure is with late-stage alcohol dependence.

Based on my experiences working in the addiction field for the past 10 years, I believe many, if not most, health professionals still view alcohol addiction as a willpower or conduct problem and are resistant to look at it as a disease. Part of the problem is that medical schools provide little time to study alcoholism or addiction and post-graduate training usually deals only with the end result of addiction or alcohol/drug-related diseases. Several studies conducted in the late 1980s give evidence that medical students and practitioners have inadequate knowledge about alcohol and alcohol problems. Also, recent studies published in the Journal of Studies on Alcoholism indicate that physicians perform poorly in the detection, prevention and treatment of alcohol abuse.

The single most important step to overcoming these obstacles is education. Education must begin at the undergraduate level and continue throughout the training of most if not all specialties. This is especially true for those in primary care where most problems of alcoholism will first be seen. In recent years, promotion of alcohol education programs in medical schools and at the post graduate level has improved. In Pennsylvania, for example, several medical schools now offer at least one curriculum block on substance abuse. Medical specialty organizations, such as the American Society of Addiction Medicine, are focusing on increasing addiction training programs for residents, practicing physicians and students.

Also, an increasing number of hospitals have an addiction medicine specialist on staff who is available for student and resident teaching, as well as being available for in-house consultations.

The American Medical Association estimates that 25-40 percent of patients occupying general hospital beds are there for treatment of ailments that result from alcoholism. In the United States, the economic costs of alcohol abuse exceed $115 billion a year. Physicians in general practice, hospitals and specialty medicine have considerable potential to reduce the large burden of illness associated with alcohol abuse. For example, several randomized, controlled trials conducted in recent years demonstrate that brief interventions by physicians can significantly reduce the proportion of patients drinking at hazardous levels. But first, we as physicians must adjust our attitudes.

Alcoholism should not be judged as a problem of willpower, misconduct, or any other unscientific diagnosis. The problem must be accepted for what it is—a biopsychosocial disease with a strong genetic influence, obvious signs and symptoms, a natural progression and a fatal outcome if not treated. In the past 10 years, the medical profession’s and the public’s acceptance of smoking as an addictive disease has resulted in reducing nicotine use in the United States. I feel that similar strides can be made with alcohol abuse. We must begin, as we did with nicotine, by educating and convincing our own colleagues that alcoholism is a disease. We must also emphasize that physicians have played a significant role in reducing the mortality and morbidity from nicotine use through patient education. Through strong physician intervention, I believe that we can achieve similar results with alcohol abuse.

Heroin Addiction

Heroin is a highly addictive drug, and Heroin Addiction is a serious problem in America. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction.

Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for heroin include “smack,” “H,” “skag,” and “junk.” Other names may refer to types of heroin produced in a specific geographical area, such as “Mexican black tar.”

What is Heroin?

Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as “black tar heroin.”

Although less diluted heroin is becoming more common, most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.

How is Heroin Used?

Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a “rush” as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

Injection continues to be the predominant method of heroin use among addicted users seeking treatment; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now the most widely reported means of taking heroin among users admitted for drug treatment in Newark, Chicago, and New York.

With the shift in heroin abuse patterns comes an even more diverse group of users. Older users (over 30) continue to be one of the largest user groups in most national data. However, the increase continues in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been appearing in more affluent communities.

Consequences of Heroin Use

Short-Term Effects

• “Rush”
• Depressed respiration
• Clouded mental functioning
• Nausea and vomiting
• Suppression of pain
• Spontaneous abortion

Long-Term Effects

• Addiction
• Infectious diseases, for example, HIV/AIDS and hepatitis B and C
• Collapsed veins
• Bacterial infections
• Abscesses
• Infection of heart lining and valves
• Arthritis and other rheumatologic problems

Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin’s depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

Of course, sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse-infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.

Heroin abuse can cause serious complications during pregnancy, including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome), as well. Pregnant women should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery; rather, treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely in the nursery. Research has demonstrated also that the effects of in utero exposure to methadone are relatively benign.

What are the Treatments for Heroin Addiction?

A variety of effective treatments are available for heroin addiction. Treatment tends to be more effective when heroin abuse is identified early. The treatments that follow vary depending on the individual, but methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has a proven record of success for people addicted to heroin. Other pharmaceutical approaches, like LAAM (levo-alpha-acetyl-methadol) and buprenorphine, and many behavioral therapies also are used for treating heroin addiction.

Detoxification

The primary objective of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free state. Not in itself a treatment for addiction, detoxification is a useful step only when it leads into long-term treatment that is either drug-free (residential or outpatient) or uses medications as part of the treatment. The best documented drug-free treatments are the therapeutic community residential programs lasting at least 3 to 6 months.

Methadone programs

Methadone treatment has been used effectively and safely to treat opioid addiction for more than 30 years. Properly prescribed methadone is not intoxicating or sedating, and its effects do not interfere with ordinary activities such as driving a car. The medication is taken orally and it suppresses narcotic withdrawal for 24 to 36 hours. Patients are able to perceive pain and have emotional reactions. Most important, methadone relieves the craving associated with heroin addiction; craving is a major reason for relapse. Among methadone patients, it has been found that normal street doses of heroin are ineffective at producing euphoria, thus making the use of heroin more easily extinguishable.

Methadone’s effects last for about 24 hours - four to six times as long as those of heroin - so people in treatment need to take it only once a day. Also, methadone is medically safe even when used continuously for 10 years or more. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives.

Methadone dosages must be carefully monitored in patients who are receiving antiviral therapy for HIV infection, to avoid potential medication interactions.

LAAM and other medications

LAAM, like methadone, is a synthetic opiate that can be used to treat heroin addiction. LAAM can block the effects of heroin for up to 72 hours with minimal side effects when taken orally. In 1993 the Food and Drug Administration approved the use of LAAM for treating patients addicted to heroin. Its long duration of action permits dosing just three times per week, thereby eliminating the need for daily dosing and take-home doses for weekends. LAAM will be increasingly available in clinics that already dispense methadone. Naloxone and naltrexone are medications that also block the effects of morphine, heroin, and other opiates. As antagonists, they are especially useful as antidotes. Naltrexone has long-lasting effects, ranging from 1 to 3 days, depending on the dose. Naltrexone blocks the pleasurable effects of heroin and is useful in treating some highly motivated individuals. Naltrexone has also been found to be successful in preventing relapse by former opiate addicts released from prison on probation.

Another medication to treat heroin addiction, buprenorphine, may already be available by the time this Research Report appears. Buprenorphine is a particularly attractive treatment because, compared to other medications, such as methadone, it causes weaker opiate effects and is less likely to cause overdose problems. Buprenorphine also produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than do those who stop taking methadone. Because of these advantages, buprenorphine may be appropriate for use in a wider variety of treatment settings than the currently available medications. Several other medications with potential for treating heroin overdose or addiction are currently under investigation by NIDA.

Behavioral therapies

Although behavioral and pharmacologic treatments can be extremely useful when employed alone, science has taught us that integrating both types of treatments will ultimately be the most effective approach. There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. An important task is to match the best treatment approach to meet the particular needs of the patient. Moreover, several new behavioral therapies, such as contingency management therapy and cognitive-behavioral interventions, show particular promise as treatments for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn ÒpointsÓ based on negative drug tests, which they can exchange for items that encourage healthy living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Both behavioral and pharmacological treatments help to restore a degree of normalcy to brain function and behavior, with increased employment rates and lower risk of HIV and other diseases and criminal behavior.

What are the Opioid Analogs and their Dangers?

Drug analogs are chemical compounds that are similar to other drugs in their effects but differ slightly in their chemical structure. Some analogs are produced by pharmaceutical companies for legitimate medical reasons. Other analogs, sometimes referred to as “designer” drugs, can be produced in illegal laboratories and are often more dangerous and potent than the original drug. Two of the most commonly known opioid analogs are fentanyl and meperidine (marketed under the brand name Demerol, for example).

Fentanyl was introduced in 1968 by a Belgian pharmaceutical company as a synthetic narcotic to be used as an analgesic in surgical procedures because of its minimal effects on the heart. Fentanyl is particularly dangerous because it is 50 times more potent than heroin and can rapidly stop respiration. This is not a problem during surgical procedures because machines are used to help patients breathe. On the street, however, users have been found dead with the needle used to inject the drug still in their arms.