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Smoke Signals: Why Are Cigarettes Such a Hot Commodity in Treatment?

Years ago, while I was in a nine-month substance abuse treatment program, I realized that everyone around me had one thing in common – they smoked.

In fact, their lives seemed to revolve around the next cigarette, so much so that they weren’t putting their focus on where it should have been: on their sobriety.

Could Smoking Negatively Affect Recovery?

As it turns out, people in rehab have higher rates of cigarette use than the rest of the general population. And according to two recent studies, these higher rates negatively affect substance abuse treatment success.

Let’s take a look at those studies now:

  • Study #1This research, led by Barbara K. Campbell, Ph.D. a clinical psychologist and associate professor at Oregon Health & Science University, discovered smoking rates among those in treatment facilities continue to be high, despite significant national declines in nicotine use. In the United States, for example, 40 percent of the population smoked in 1965, while only 17.8 percent reported smoking by 2013.

    “Although smoking rates have declined substantially in the general population, they remain very high among people with other addictions,” Campbell said. “This increases disease burden and mortality and may contribute to difficulty maintaining abstinence from other drugs.”

    Among the 1,113 participants surveyed, 159 (14.3 percent) smoked before treatment, and 87 (7.8 percent) were non-smokers before rehab. However, a whopping 867 (77.9 percent) of them reported smoking an average of 10 cigarettes a day upon completion of their stay in rehab.

  • Study #2Researchers at Vanderbilt University found that, out of the one million Americans in Alcoholics Anonymous (AA), approximately 56.9 percent were smokers. Among this group of smokers, 78.7 percent smoked at least half a pack a day and more than 60 percent considered themselves highly dependent on cigarettes.

The Bottom Line: Smoking is Bad For You

These results should cause an increase in concern, considering smoking led the participants to feel less depressed, anxious, and irritable – all feelings more likely to contribute to a return to substance use. Knowing that, researchers believe the reliance on cigarettes by people in recovery has a biological basis and may actually increase the chances of relapse.

So, how can the prevalence of smoking be reduced by those in recovery? Researchers emphasized the need for targeted efforts and individualized attention against smoking.

“Clients in substance use disorders treatment were more likely to quit smoking if it was part of their individualized treatment plan,” Campbell said. “People in these groups often want to quit smoking but face many barriers in doing so. Incorporating smoking cessation interventions into drug treatment is an important step.”

Image Source: iStock

Detox Types and Options

Formal detox is often the first and one of the most important steps in the drug addiction recovery process, as a person may better benefit from the efforts of counseling and therapy after first being physically stabilized. According to the National Institute on Drug Abuse (NIDA), detox involves getting rid of the foreign substances and managing withdrawal symptoms on an as-needed basis.

Just as there are different types of drug rehab, there are also various forms of drug detox, each one designed to meet the needs of a particular type of addiction and a specific type of individual. The following gives a glimpse into the options that an individual who is ready to break the addiction cycle has at his disposal.

What Is Drug Detoxification?

When an individual consistently or repeatedly uses a substance, it is likely that they will develop physical dependence over time. Physical dependence is the body’s natural adaptation to the presence of a drug and, once it is significantly established, the body requires the drug to function as normal.

When someone dependent on a substance abruptly discontinues or dramatically reduces use, withdrawal symptoms are likely to emerge. Withdrawal symptoms vary from substance to substance, and while some may be only mildly uncomfortable, some can be life-threatening. See below for symptoms of withdrawal for common substances.

Symptoms of Withdrawal

Alcohol:1

  • Nausea/vomiting
  • Anxiety
  • Insomnia
  • Excessive sweating
  • Rapid pulse
  • Repetitive, purposeless movements
  • Hand tremors
  • Hallucinations or illusions
  • Confusion
  • Seizures
  • Delirium tremens (DTs)

Opioids (e.g., heroin, prescription painkillers):1

  • Muscle aches
  • Goose bumps
  • Fever
  • Increased sweating
  • Nausea/vomiting
  • Diarrhea
  • Watery eyes and runny nose
  • Excessive yawning
  • Anxiety
  • Irritability
  • Insomnia
  • Depressed mood

Sedative, hypnotic, or anxiolytic drugs (e.g., Xanax, Ativan, Valium, Ambien):1

  • Anxiety
  • Insomnia
  • Increased pulse rate
  • Excess sweating
  • Nausea/vomiting
  • Unintentional and purposeless movements, such as pacing
  • Illusions or hallucinations
  • Tremors
  • Seizures

Stimulants (e.g., cocaine, meth, Ritalin, Adderall):1

  • Nightmares
  • Fatigue
  • Insomnia or hypersomnia
  • Increased appetite
  • Slowed movements and thought
  • Anhedonia, or an inability to feel pleasure
  • Depression
  • Suicidal ideation or behavior

How Long Does The Process Take?

The withdrawal timeline varies from drug to drug and even within drug classes. Generally, the emergence and resolution of withdrawal symptoms are impacted by the half-life of the substance (which influences the average duration of drug effects), the mode of administration, the frequency of use, and the average dose used.1 While you might feel symptoms right away for some drugs, others will not produce immediate withdrawal symptoms: 1

person checking their watch
  • For stimulant drugs, withdrawal symptoms typically appear within a few hours to a couple days after the last dose.
  • Sedative withdrawal symptoms may appear as quickly as a few hours after or as delayed as several days following last use. For someone who is addicted to Xanax, withdrawal symptoms may appear within 6-8 hours of the last dose and improve by the 4th or 5th day. Meanwhile, Valium may produce withdrawal symptoms a full week after the most recent dose and may not resolve for 3-4 weeks.
  • For opioid drugs, such as heroin and painkillers, symptoms typically emerge within 6-12 hours after the most recent dose and subside within 5-7 days.
  • Long-acting opioid drugs, such as methadone, may have a longer and more delayed timeline, with symptoms appearing 2-4 days after the last dose and taking longer to dissipate entirely.
  • Alcohol withdrawal symptoms tend to emerge within a few hours to several days after quitting or reducing consumption.

Withdrawal severity will vary among individuals. A person’s physiology, age, gender, and mental and physical health impact the severity and timeline of symptoms. Likewise, the different types of interventions may affect the duration of withdrawal symptoms, since the administration of medication in a medical detox setting could somewhat lengthen the process, while a social detox program doesn’t intervene medically.

Non-Medical or “Social” Detox

Social detox, which is a non-medical type of detox program, involves the individual stopping the use of the drugs entirely—essentially going “cold turkey” while under the care of treatment professionals. This social model of detox involves professionals providing the patient with emotional and psychological support throughout the withdrawal process but not administering medications to manage symptoms and complications.

While this method can help people successfully withdraw from psychoactive substances, it is not without its challenges. The potential for an unpleasant withdrawal syndrome presents perhaps the most prominent challenges associated with natural detox, as an individual must endure several potentially uncomfortable withdrawal symptoms as their body adjusts to a lack of drugs in their system. Depending on the specific drug, withdrawal symptoms can be severe, causing the individual great distress and even putting them in medical danger in some cases. As a result, individuals may relapse in an effort to relieve their symptoms and cravings for the drug.

One of the major risks associated with relapse is that of overdosing. During a significantly long period of abstinence, a person’s tolerance will markedly decrease, which means that they don’t require as much of the drug as they once did. Many people who relapse return to using the dose they previously abused, which can lead to an accidental, and potentially deadly, overdose.

Other risks associated with entering a natural detox program include the potential development of psychological issues over the course of withdrawal and, next, a decreased capacity to adequately manage such issues. Oftentimes, withdrawal syndromes from various substances—such as opioids, stimulants, and benzodiazepines—include mental health symptoms, such as depression, suicidal ideation or attempts, anxiety, delirium, emotional blunting, and insomnia.1

Medical complications may arise during withdrawal. Generally speaking, natural or social detox is not recommended for the management of withdrawal from alcohol, benzodiazepines, barbiturates, or opioids, due to humanitarian and safety concerns.2 The symptoms that emerge when an individual stops using these substances are often painful and, with the exception of those associated with opioids, potentially fatal.1,2

Medical Detox

Unlike the “natural” method, medical detox provides patients with medication and medical treatment in order to prevent and address complications. As previously mentioned, withdrawing from alcohol, benzodiazepines, and barbiturates can be dangerous to attempt alone, due to the risk of serious symptoms. Seizures may emerge that require immediate medical management, which may not be available in a social detox program. Further, withdrawal can lead to delirium, a confused, agitated state, in which the person may experience hallucinations and exhibit dangerous, unpredictable behaviors.1

Disturbances in consciousness and cognition can lead to accidents, erratic behavior, and even violence. If you are addicted to one of these substances, medical detox can help to ensure your safety while withdrawing. For example, to prevent some of the complications of alcohol withdrawal, medical intervention with drugs like benzodiazepines or anticonvulsants may be initiated.6

While withdrawal from opioids such as heroin is not generally medically dangerous, it can cause intense discomfort, so much so that many people return to using them to relieve the painful symptoms. For this reason, medical detox can also be beneficial for those addicted to these drugs. Medication-assisted treatment (MAT), which involves administering medications to alleviate withdrawal symptoms and cravings, is an important aspect of medical detox for opioids. The medications are used to minimize the distress caused by withdrawal, reduce cravings, and prevent medical complications. They include:3,4,5

different types of medications for addiction treatment
  • Methadone: This full opioid agonist attaches to and activates opioid receptors in the brain, which decreases cravings and reduces unpleasant withdrawal symptoms. For treatment of opioid dependence, methadone is administered as an orally disintegrating wafer, an oral concentrate liquid, or a pill. It can only be dispensed by opioid treatment programs (OTPs).
  • Buprenorphine: This partial opioid agonist produces a less pronounced opioid effect than a full agonist, like methadone. It can be prescribed by doctors who have been authorized to treat opioid dependence with buprenorphine. Suboxone is a formula containing a combination of buprenorphine and naloxone, a medication that blocks opioid effects. This combination formula helps to curb abuse of the medication.

Both methadone and buprenorphine may be used solely as detox medications or may be continued as part of maintenance management to prevent relapse. Another MAT drug used in a maintenance capacity is naltrexone. This opioid antagonist blocks the rewarding effects of opioids. If someone who is on naltrexone uses an opioid, they won’t experience any euphoria. It is available as a pill or an extended-release, intramuscular suspension known as Vivitrol. Combined with behavioral therapy, continued use of opioid dependence medications can help to prevent relapse and promote long-term sobriety.

Is Ultra Rapid Detox Safe?

Ultra rapid detox, which touts an ability to ease the process of opioid withdrawal, is a controversial method that can produce dangerous outcomes.

Someone who undergoes rapid detox is placed under general anesthesia and is administered medication (such as naltrexone) to initiate the withdrawal process. Under anesthesia, the individual theoretically won’t experience the full spectrum of painful symptoms associated with withdrawal. Rapid detox can seem appealing to those who are apprehensive about enduring these symptoms.7 However, one problem with this method is that the length of withdrawal is different for each person and is complicated by the combination of medications administered. For this reason, many people wake up still in the throes of withdrawal, experiencing intense symptoms for days after the procedure.8

Some patients may fail to disclose preexisting health issues during medical and psychiatric screenings in order to be approved for rapid detox, which can have dire consequences.

Researchers have posited that there is no evidence in support of anesthesia-assisted detox for the management of opioid withdrawal. Further, there are many risks associated with undergoing rapid detox. These risks include:7

  • Exacerbation of mental health problems, such as bipolar disorder, panic attacks, and depression.
  • Metabolic complications of diabetes.
  • Fluid accumulation in the lungs.

Individuals who are at particularly high risk of experiencing harmful effects include those who have preexisting conditions, such as AIDS, heart disease, hepatitis, prior pneumonia, elevated blood sugar, insulin-dependent diabetes, and psychiatric conditions. Some patients may fail to disclose preexisting health issues during medical and psychiatric screenings in order to be approved for rapid detox, which can have dire consequences.7 Case reports of people who underwent anesthesia-assisted rapid opioid detox (AAROD) showed patients experiencing complications ranging from cardiac arrhythmias to rhabdomyolysis. If your health is already in peril for one reason or another, AAROD can cause especially serious and even life-threatening problems.9

Where to Find a Suitable Program

If you’re interested in entering a detox program but aren’t sure where to begin, you can always ask your physician or therapist for recommendations on various centers in your area. Once you’ve received some recommendations, you will want to do your own research regarding the different types of detox services available. It’s important to determine your priorities when it comes to treatment so that you can find the program that is the best fit for you. Some questions you may want to ask when calling various detox programs include:

  • What detox method is utilized (social vs. medical)?
  • What is the typical length of the program?
  • What is the price of the program?
  • Does the program accept insurance? If so, which plans?
  • What are the credentials of the staff members?
  • What amenities and services are offered?
  • Are rooms private or shared?
  • Does the treatment team help patients transition into addiction treatment?

You are not limited to the above questions but they should help jumpstart your search for the appropriate detox program for your needs. Each program will have its advantages and disadvantages.

Know Your Options: Find the Right Environment for You

You have options for where you receive drug detox. They include:10

  • Medically managed inpatient detox: The most intensive level, which occurs in a hospital setting or psychiatric facility, you receive around-the-clock treatment and monitoring in this environment.
  • Medically monitored inpatient detox: You’ll receive 24-hour medical care in a location other than an acute care setting—typically a legitimate center.
  • Clinically managed residential detox: This option, also known as social or natural detox, offers around-the-clock supervision but lacks constant medical care, preferring to offer emotional and psychological support instead.
  • Ambulatory detox with extended onsite monitoring: Detox, as well as treatment, takes place at an outpatient facility in which you’ll spend several hours in treatment before returning home.
  • Ambulatory detox without extended onsite monitoring: As the least intensive level available, you’ll attend appointments at a physician’s office or through a home health care agency.

Oftentimes, people complete a detox program and subsequently, with help from their treatment team, transition into a comprehensive addiction treatment program, which can address the underlying issues driving drug abuse. The program may provide you with referrals or even help you to enroll into a program so that your transition into treatment is smooth.

If you haven’t completed a detox program and are looking for an addiction treatment program, you can ask any medical or mental health professional for guidance. If you have insurance, you may also want to call your insurance company to learn what your individual plan covers before making a decision. You can then acquire a list of treatment programs that accept your insurance in order to narrow down your search.

What Happens Next?

Once detoxification is complete, you’ll likely be considered stable enough to continue on with the remainder of drug rehab treatment. It is important to note that this is NOT addiction treatment in and of itself. Completing the process of detoxification means you have overcome your physical dependence on drugs, not your psychological dependence.

In order to maintain sobriety in the months and years to come, you must also address the thoughts, feelings, and behaviors that lead you to use substances; this is accomplished through drug addiction therapy.

Just as detox programs vary greatly, there are many different types of recovery programs available at varying levels of intensity. The most common types of addiction treatment programs include:

  • Inpatient: You reside at the treatment facility for the duration of the program, which is usually between 30 and 90 days, but may be longer if needed. Amenities, services, and policies vary amongst inpatient programs.
  • Outpatient: You live at home while receiving addiction treatment services. This option is appropriate for you if you have strong social support and need to continue living at home, for example to take care of your family, continue working, etc.
  • Holistic: Some inpatient programs utilize a mind-body-spirit approach to recovery and employ alternative and complementary methods, such as meditation, yoga, and creative arts therapy.
  • Luxury: More expensive inpatient options provide you with upscale amenities, such as gourmet meals, massage, and horseback riding.
  • Executive: These inpatient programs cater to working professionals who don’t want treatment to disrupt work or negatively impact their reputations. If you must continue working while addressing your addiction, this is a good option.
  • Faith-based: Select inpatient programs will integrate religious beliefs with traditional treatment methods, such as individual and group counseling.
  • Population-specific: Some facilities have experience in addressing the unique needs of certain populations, such as LGBT, veterans, teens, women, and men.

Detox can occur in a separate facility before transitioning into an addiction treatment program, or the substance abuse center may offer both detox and addiction treatment services. It all depends on the individual program.

Regardless of the type of treatment program offered, drug counseling is a major component. Drug counseling makes up the bulk of time most individuals will spend in a rehab center. There are many specific varieties of counseling but the primary types include individual, group, experiential, and family therapy.

people attending a group therapy session
  • Individual counseling. The patient meets in private with a therapist to discuss the underlying causes of their addiction. The patient and therapist work together to help the patient develop life strategies that will promote a lifetime of sobriety.
  • Group counseling. Group sessions are a chance for the individual to form a support network with other recovering individuals in the program. These meetings are, for many, the first time they ever talk openly and honestly about their addictions with other people. Most group counseling sessions are led by licensed therapists; however, 12-step meetings in the community are often led by others also recovering from an addiction.
  • Experiential therapy. Experiential therapy can take on many forms, such as adventure therapy, art therapy, drama therapy, music therapy, or animal-assisted therapy. These different forms of therapy focus on the experience rather than talking about it. Therapists guide the patient through activities where they may experience victories and learn to overcome obstacles. These lessons can then be applied to their thoughts and behaviors toward drugs or alcohol.
  • Family therapy. Addiction puts a great deal of strain on the family unit. Family therapy is a chance to heal damaged relationships and to learn how to communicate with one another in a more productive way that enhances the recovery efforts of the individual.

It’s never too late to start down the right path. If you need help, reach out today.


Sources:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment.
  3. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  4. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
  5. Substance Abuse and Mental Health Services Administration. (2011). Medication-Assisted Treatment for Opioid Addiction.
  6. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research, 9(9).
  7. National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.
  8. California Society of Addiction Medicine. (2011). Anesthesia-Assisted Rapid Opioid Detoxification.
  9. Centers for Disease Control and Prevention. (2013). Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012.
  10. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.

LSD Overdose

LSD is a hallucinogen drug capable of altering thoughts and perceptions in those who use it, including pseudo-hallucinations and synesthesias—a condition where they see and hear things that are not real, while others report being able to hear colors 1. People have experimented with hallucinogens for thousands of years, using plants or fungi found in nature, such as peyote or hallucinogenic mushrooms, but unlike these, LSD is synthesized in a lab from a chemical precursor isolated from a fungal source.

LSD—full name, D-lysergic acid diethylamide, and also known historically as acid, dots or microdot, windowpane, and Yellow Sunshine—is most frequently taken orally in liquid or pill form, or from a piece of LSD-impregnated gelatin or paper placed on the tongue 2,3.


Signs and Symptoms of LSD Overdose

When someone experiences an LSD “overdose,” likely they have experienced what is more commonly known as a “bad trip.”

When someone takes too much LSD, they may experience terrifying hallucinations, but technically a person cannot take so much LSD that it kills them. It is not like heroin, Xanax, or even alcohol in that there is no known lethal dose of LSD.

When someone experiences an LSD “overdose,” likely they have experienced what is more commonly known as a “bad trip.” This is not to say that LSD use is without its dose-dependent dangers, however. Severe injury and death has occurred as an indirect result of using LSD, in that accidents, self-mutilation, and suicide have occurred during these trips, when people are largely unaware of what they are doing 4.

Some commonly experienced side effects of LSD can include 4:

  • Sweating.
  • Nausea.
  • Dilated pupils.
  • Rapid heartbeat.
  • Dry mouth.
  • Tremors.
  • Insomnia.
  • Blurred vision.
  • Raised body temperature.
  • Weakness.
  • A distorted sense of time.
  • Visual hallucinations.
  • Mixed senses (for example, “seeing” sounds).
  • Intensified sense of smells and noises.
  • A sense of a mystical experience.


Recurrent LSD use is potentially dangerous and can seriously impact an individual’s thoughts, emotions, and behavior.
Learn how to get help.

In contrast to some of these relatively mild symptoms, when someone has a bad trip, the experience may be overwhelmingly unpleasant. LSD users may experience frightening alterations in their thoughts and moods, which places them at increased risk for associated injury and even fatal consequences.

Some of the potentially adverse outcomes include 4:

  • Extreme anxiety.
  • Feelings of lost identity, that they are ceasing to exist.
  • Panic.
  • Paranoia.
  • Rapid mood swings.
  • Aggression towards others, including homicide.
  • Self-mutilation.
  • Dying in an accident.
  • Committing suicide.
  • Features of psychosis that don’t immediately end when the LSD trip is over.


Risk Factors

LSD is such an unpredictable drug insofar as it is hard to know when a person might experience a so-called overdose. People who have used LSD many times before without any problem may unexpectedly have a bad trip.

One real danger with LSD is the way in which users quickly develop tolerance for the drug. When someone first uses LSD, they are likely to experience the hallucinogenic effects quickly and intensely. However, as time goes on, the body builds a tolerance to LSD, and a person who abuses it must use more and more of it to achieve the same high as before.

Given how unpredictable LSD is, taking higher doses is dangerous. If someone abuses LSD, it can also increase their tolerance to other hallucinogenic drugs, such as PCP, which results in the person taking more of other unpredictable drugs while attempting to have a “good” trip 2. This issue is further complicated by the fact that it is so difficult to control the dose of any illicit drug, particularly one like LSD, which has effective doses in the microgram range. The weights of its various delivery forms—such as tablets and blotter papers—can be significantly higher than the dry weight of an “average” LSD dose, so there is an exceptionally large margin for error. What this means in practical terms is that one blotter paper could easily carry multiple times the dose that another paper does, so a user can never be sure how much of the drug they are actually consuming, dramatically escalating their odds of overdosing.

However, it is not physically addictive. Users of LSD do not normally crave the drug, and stopping the use of LSD does not lead to symptoms of physical withdrawal (a symptom characteristic of addiction). There is not a substantial body of research on LSD dependence, tolerance, and withdrawal, so much remains unknown here 2.

What to Do If You Overdose on LSD

If you or a loved one uses LSD and experiences the symptoms of an overdose or bad trip, seek emergency medical treatment, which can help prevent harm through self-mutilation, suicide, or highly dangerous behavior, such as walking into traffic or jumping off buildings. It may also prevent someone from harming others in the setting of extreme paranoia and frightening hallucinations they may experience in one of these situations 5.


Preventing LSD Overdose

Girl being comforted by a doctor

The best way to avoid an overdose with LSD is to never take the drug in the first place. It is unpredictable and dangerous—a person can use LSD many times without serious problems, and then suddenly experience aggression, self-harm, psychosis, or other adverse side effects.

When someone seeks help for an adverse experience with LSD, immediate medical intervention is important. However, treatment shouldn’t stop there with someone who regularly abuses LSD and experiences these types of serious side effects—they may benefit from more extended treatment programs. Additionally, very often those who abuse LSD abuse other substances as well, which not only complicates the predictability of overdose, but further signals the need for comprehensive substance abuse treatment.

Drug abuse treatment is the best way for a person to stop putting themselves at risk of the dangerous outcomes of LSD abuse. After someone experiences a bad trip, they may be more willing to seek treatment, since the extremely frightening experience can serve as a wake-up call.

A substance abuse professional assesses numerous factors in determining the best treatment program for a person’s addiction, such as if they have a co-occurring mental health disorder (such as bipolar disorder or depression), or if the person has underlying medical issues (such as a heart problem or diabetes). In more complex cases, inpatient treatment may be necessary to provide the safest environment that includes around-the-clock supervision. The intensity of a person’s addiction, as well as the length of time that they have abused LSD and other drugs, will further help determine if inpatient or outpatient treatment is the best approach.

Inpatient treatment programs come in many styles so that people can find one that best fits their needs. These programs are more intensive than outpatient programs and require patients to live at the facility as part of the treatment protocol. Most programs rely heavily on group therapy, but a few offer larger amounts of individual counseling; most programs also offer family therapy as part of the treatment program. Inpatient programs typically last between 30 and 90 days, but can continue for longer durations, if necessary.

Outpatient treatment programs are also a viable option for someone abusing LSD. Depending on the evaluating clinician’s assessment, a person may attend treatment anywhere from 2-4 hours a day, 2 days a week, to 4-8 hours per day, 5 or 6 days per week. Patients continue to live at home while attending outpatient treatment at some point during the day, allowing them to tend to responsibilities with children, work, or school at the same time.

Many programs use the cognitive behavioral therapy (CBT) model to teach clients how to recognize faulty thoughts and replace them with more positive and productive ones. Out of these new thoughts come healthier behaviors that help clients effectively deal with urges to use it and other drugs and to develop new ways to cope with common stressors that trigger drug use. The approach also emphasizes examining the pros and cons of behavioral choices.

Motivational interviewing is an approach that helps people find internal motivation for positive change. This modality tends to be more effective in getting people to engage in treatment and stay in it.

Contingency management is yet another approach in which the patients receive actual rewards for staying clean from drugs. For instance, they might receive vouchers for items ranging from diapers to movie tickets.

The purpose of addiction treatment is to help people with addictions to stop using drugs, enhance their coping skills, and help them avoid relapse, as well as work on the underlying issues which started the drug abuse in the first place.6

If you or someone you love has a problem with LSD or has overdosed, call us today at 1-888-744-0069Who Answers? to learn about your treatment options.


References:

  1. National Institute on Drug Abuse. (2016). What are Hallucinogens?
  2. National Institute on Drug Abuse. (2014). Hallucinogens.
  3. Center for Substance Abuse Research. (2013). LSD.
  4. University of California, Santa Cruz. (2016). LSD.
  5. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.

Refusing to Give In: 8 Ways to Beat Cravings

Cravings are a normal part of addiction recovery. No matter whether you haven’t used in months or you just stopped using this week, you’re likely to experience an urge to use at some point.

Urges are relentless, finding you at your weakest point and trying to convince you that you don’t really want the change you’ve worked so hard to accomplish. Drug cravings can quickly lead to a relapse if not handled appropriately.

Here are 8 ways to stop the urge to use.

1. Self-Talk

When a craving arises, resist the urge to use by talking yourself out of it using logic and reason. Because a craving can often be “myopic” and prevent you from seeing the big picture outside the immediate moment, you can prepare a list ahead of time and have it handy to read to yourself when a drug craving comes on.

This list may contain all the reasons that you’ve chosen to quit in the first place as well as all of the negative consequences that could occur if you choose to use.

2. Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) provides a myriad of techniques to use to cope with cravings when they arise. These include redirection, distraction, and visualization.1

When a craving arises, you may choose to redirect your attention to something else or distract yourself until the craving inevitably passes. Visualization techniques can also help you relax during a craving as you may imagine yourself in a relaxing setting.

CBT techniques can help you to spot cognitive distortions in your thinking. A common cognitive distortion that occurs during a drug craving is called catastrophizing. When you are experiencing a drug craving, you may catastrophize the situation by thinking things like “I’m never going to be able to make it through this” or “This feeling will never go away if I don’t give in and take this drug.” CBT techniques can help you to decatastrophize the situation and see it more objectively.

3. Get a Hobby

Hobbies not only build character and encourage joy, but they can provide an excellent means of distraction during a drug craving. Many times cravings arise out of boredom as the mind tries to find a way to fill a “void” or empty space. A hobby provides something else to engage in other than drug use.

Some hobbies you might try taking up include sports, cooking, arts and crafts, dancing, hiking, fishing, or video games.

4. Surf the Urge

Rather than trying to stop the urge all together, surf the urge instead. Urge surfing is a mindfulness technique that rests on the principle of accepting a craving for what it is rather than resisting it and wanting it to go away.

To practice urge surfing, when you feel a craving coming on, stop and acknowledge it. Accept it completely for what it is and don’t try to make it go away. Sit down, close your eyes, and observe the thoughts in your mind and sensations within your body. It helps to verbally acknowledge the thoughts and feelings during the experience.

For example, you might say to yourself, “I feel uncomfortable and I am thinking about using drugs,” or “My palms are sweaty and my heart is beating fast.” Describe as many thoughts and sensations as possible until you no longer feel the craving. Urge surfing can help you realize that cravings come in waves and will eventually pass.

Basically, rather than trying to push them away, accept that they are there and ride them out.2,3

5. Self Care

Practicing good self-care such as eating healthy and exercising regularly can help promote physical health and emotional well-being, which will not only make you less likely to want to use drugs but will make you more resilient and better able to deny a craving when it does arise.

6. Know Your Triggers

During recovery, certain people, places, and things will inevitably make you want to use drugs. Knowing what your triggers are can help prepare you for the possibility of a craving and allow you to avoid it when possible.

Try making a list of your triggers and consider which ones you can honestly avoid. Recognize that there will be some triggers that are unavoidable, so come up with strategies for dealing with the cravings that may arise when you are triggered.

7. Reach Out to Others

If you feel a craving coming on, attend a support group where you can talk with other recovering addicts about your conflicting desire to use and commitment to stay sober. Consider calling your sponsor when the urge to use arises—he or she may be able to talk you out of it. If you don’t have a sponsor, check with your group leader about possibly getting one.

8. Remove Bad Memories

Many therapists offer what’s called memory reconsolidation, which helps treat cravings by consolidating and removing memories that are associated with drug use. By eliminating these memories, it can help you experience less cravings triggered by environmental cues that may be associated with memories of drug use.4

If you are dealing with cravings and need support to get through this challenging time, call 1-888-744-0069Who Answers? today and speak to one of our admissions navigators. They are available 24/7 to support you and help you find the best treatment plan.

Sources

  1. NIDA. (2012). Principles of Drug Addiction Treatment: A Research Based Guide.
  2. Nauman, E. (2014). Can Mindfulness Help Stop Substance Abuse? University of California, Berkeley. Greater Good: The Science of A Meaningful Life.
  3. Bowen, S. & Marlatt, A. (2009). Surfing the urge: brief mindfulness intervention for college student smokers. Psychology of Addictive Behavior, 23(4):666-71.
  4. Torregrossa, M. & Taylor, J. (2013). Learning to Forget: Manipulating Extinction and Reconsolidation Processes to Treat Addiction. Psychopharmacology (Berl), 226(4): 659-72.

Drug Arrests Across America

Drug Arrests Across America

The Current Drug Landscape

An estimated 24.6 million Americans aged 12 or over used an illicit drug in 2013. That’s 9.4% of the population.1 The number was similar in 2012 (9.2%), and in that year the FBI reports that there were 1.5 million drug law violations, 82% of which were for possession.2

These are broad, country-level numbers, of course. If you want more fine-grained statistics, you have to be patient and wait for the release of a report like the National Survey on Drug Use and Health, which is published once a year and provides fresh facts about drug and alcohol use across America at the state level. But even these figures leave a lot to be desired, considering what a culturally, politically and economically diverse country America is. The difference between two cities in the very same state can be like night and day. Miami and Jacksonville in Florida, for example, couldn’t be much less alike, despite being only a few hundred miles apart. The same holds true for Houston and Dallas, for example, or for Philadelphia and Pittsburgh.

To understand the current drug landscape across America it might therefore be wiser to zoom in on a selection of cities and dissect each one individually. In this first issue of Arrests Across America, we will focus on eight major U.S. cities and the drug violations that have occurred within their borders over the last few years.

Click a city below to jump to the appropriate section







If you think the eight locations we’ve chosen seem like a motley assortment, lacking of arguably more significant cities like Los Angeles and New York, it’s because strictly speaking we didn’t choose them. They volunteered themselves by virtue of their participation in Open Data programs: publicly accessible databases that provide up-to-date figures on key issues like building permits, food inspections and crimes. As of November 2014, the U.S. City Open Data Census reports that 74 U.S. cities have data portals, with 641 datasets available between them, about a quarter of which are totally open.3

Check out the complete list here and you’ll see that New York and Los Angeles do have data available to the public, but (as indicated by the red lines) it’s severely lacking in many regards. It’s not complete (only certain types of crimes are included, like murder and rape, not drugs and DUIs), and it’s not available to download in bulk. In contrast, the eight cities we are about to examine do have detailed data on drug crimes, including key pieces of information such as where violations occurred and for what type of drug. So let’s get started with the biggest among them: Chicago. A city of 2.7 million souls.

Chicago, IL

In 2013, Chicago had 34,000 drug law violations. Two-thirds involved marijuana, crack, heroin, or cocaine. It’s not hard to guess which of those drugs in particular was involved in the most arrests. The maps below show the locations of the two-thirds of violations that involved the aforementioned drug types. Each dot, representing a single event, is accurate to the block level.

The drug law violations mapped above are only those that occurred Jan-Oct 2014, and they total 20,851. It’s obvious from the sheer number of dots on the first map that most of the drug law infractions in Chicago this year have been for the possession or sale of marijuana. Here are the same maps again, simplified and placed side by side.

60% of drug law violations between January and October of 2014 were for marijuana, at an average of 42.7 a day. That’s a bit lower than the 50.5 per day that were made in 2013, and lower still than 2012’s 54.8. The number may be falling due to law enforcement officials shifting their focus from lower-level drug crimes to bigger and more violent drug operations.4

The map above of drug arrests sits alongside a poverty level map of Chicago, made using data from 2011. The correlation between the areas with high poverty and high numbers of drug arrests is unmistakable. However, it’s also worth considering the relative population sizes of Chicago’s neighborhoods. So let’s do that.

While the most densely populated areas of Chicago—and any city—are most likely to contain the highest number of drug arrests, in Chicago’s case, it goes a bit beyond that. The map above right shows drug violations by ward, per 1,000 residents—in effect, removing population size as a factor. If you squint, it looks almost identical to the poverty level and violation locations maps. Therefore, the top five wards in Chicago for drug incidents in 2014 are 28, 24, 27, 37 and 16. Which are, in case you don’t work for the Department of Zoning: Garfield Park, North Lawndale, Near Westside, Austin, and Englewood.

76% of drug law violations in Chicago in 2013 were made on the street or in an alley, with residences and vehicles in distant second and third (10% and 5%).

Meth arrests have stayed pretty steady over the last few years (averaging not much more than one a week, which seems curiously infrequent). Crack arrests have been falling since 2012, with an average of 7.8 a day this year, 9 in 2013, and 10.4 in 2012.

Cocaine arrests are about the same this year as in 2013: 2.8 and 2.7 per day respectively. There were 3.5 a day in 2012.

The line chart below gives a clearer picture.

Most drug arrests in Chicago are pretty evenly distributed across the week. Cocaine is the only drug for which arrests are noticeably more frequent on specific days, with most occurring on Saturdays (18%) and Fridays (16.5%). Cocaine arrest levels have been steady over the last decade, whereas total yearly heroin arrests have outnumbered crack arrests since about mid-2009. Marijuana arrests, as already mentioned, are on the decline.

There’s a lot more we could say about Chicago, and in a future issue we probably will, but we have seven other places to visit and tens of thousands more drug arrests to map. So let’s swap the streets of the Windy City for the rolling, foggy hills of The City by the Bay.

San Francisco, CA

In 2013, there were 4,470 marijuana, cocaine, meth, and heroin arrests/citations in San Francisco — reflecting little change from 2012, which saw 4,326. You have to go back a few more years to see big changes in the numbers.

As the graph above clearly shows, drug arrests in San Francisco have been falling year on year since the end of 2008, except where meth arrests are concerned, which have very gradually been rising. Last year they were higher than any other year since 2005. The explanation for the drop in all other drug arrests seems similar to the one mentioned earlier for Chicago: a change in priorities by law enforcement. For instance, a 2010 change in California state law made the possession of small amounts of marijuana an infraction rather than a misdemeanor. Overall, the California Department of Justice reports that drug arrests in San Francisco and the Bay Area have dropped 75% over the least five years.

Here is how the remaining arrests have been distributed across San Francisco over the last two years, beginning with marijuana.

There have been 4,118 marijuana arrests/citations in San Francisco between January 2012 and October 2014. That total doesn’t include arrests/citations for “drug paraphernalia,” which usually—but not always—are associated with marijuana in some way. There are three main clusters on the map above. One is around downtown, which is to be expected. Another is Bayview-Hunters Point, which has been plagued by gang and drug activity for many years. In 2011, The New York Times described the area as one of the city’s most violent neighborhoods.5 Another cluster of marijuana incidents can be seen around the Haight. SF Weekly reported in 2013 that neighborhood complaints about drug dealing in the Haight-Ashbury area have soared in recent years.6

It’s not just marijuana that can be found there, either.

The main clusters of meth arrests can be seen in the downtown area, especially on and around Market Street. This is where much of San Francisco’s homeless population could be found over the last decade, as well as the welfare and medical services that care for them7. More recently, there have been reports that the homeless population has been pushed by new tech companies in the Mid-Market district into nearby neighborhoods.8

If we arrange the drug arrest maps side by side, we can get a clear idea of which drug types have resulted in the most arrests since 2012.

The San Francisco poverty map once more correlates closely with the distribution and density of drug arrests. Marijuana was involved in the most incidents, but not by anywhere near as great a margin as we saw earlier for Chicago. To see the ratio between marijuana and the other three drugs drop even further, all you need to do is travel 1,200 miles from San Francisco to somewhere where marijuana is completely legal: Denver, Colorado.

Denver, CO

If we begin our look at Denver by comparing the total number of arrests for each drug type over the last four years, the situation is somewhat confusing.

Arrests for cocaine and its derivatives have been decreasing since 2009. That’s good. Meth and heroin have increased though. Not so good. But marijuana is on the rise as well, despite being legal to use and possess since December 2012 and legal to sell to anyone aged 21 or over since January 2014. So why are marijuana arrests higher in 2013 than 2009? And already higher by October 2014 than the whole of 2013? Well, on closer inspection, they aren’t. Marijuana citations are. At the 4/20 Rally in 2013, for example, five citations were issued.9 At the same rally this year, that number rose to 130 (92 of which were for public consumption of marijuana).10 It is, after all, still prohibited in Denver to smoke marijuana in public places.

If we map marijuana, cocaine, meth, and heroin drug incidents between January 2013 and October 2014, we can see that—despite there still being a relatively large number of marijuana citations—they are proportionally much less significant than arrests for the other three main drug types.

Only 14% of violations across the above four drug types were for marijuana-related offenses. Cocaine/crack arrests were much more prevalent. They accounted for just over half of drug arrests across the four main drug types. In our next city, where marijuana is still illegal, the ratio of marijuana arrests to heroin and cocaine is very different than what you see above.

Baltimore, MD

Baltimore has seen a lot more marijuana violations recently than Denver, even taking into consideration that possessing less than 10 grams of marijuana in Maryland is now considered a civil charge rather than a criminal one. From January 2013 to October 2014, there have been 14 police incidents on average per day involving marijuana in Baltimore, compared to 3.3 for cocaine and 3 for heroin.

Despite the variation in dot number across each of the maps above, their neighborhood distribution is extremely similar. Three or four main clusters of drug arrests can be seen in the heroin and cocaine arrests, near Upton, Hollins Market, Arlington and Broadway East. Unless you’re quite familiar with Baltimore’s geography, those names won’t mean much to you, but the main clusters of drug arrests once again overlap the areas of most extreme poverty in the city.

As in all cities, it’s men in Baltimore who are arrested for drug offenses most often. 88% of the people arrested or cited for marijuana-related charges were male, as were 85% and 84% of heroin and cocaine offenders respectively. The next city on our list is pretty similar to Baltimore, at least in terms of its population size and median age of residents. It’s 300 miles away as the crow flies, but only 72 pixels as the finger scrolls.

Raleigh, NC

Raleigh, North Carolina had 5,842 marijuana, cocaine/opium, and synthetic drug arrests and citations in 2013. We’ve grouped cocaine with opium because that’s how Raleigh’s database lists it. The graph below shows how arrests for each of those drug categories have changed in volume over the last eight years.

In 2010, law enforcement made 20,983 marijuana arrests in North Carolina, which placed the state in 10th place for the most in the nation. Marijuana is still illegal in North Carolina and police interventions for the possession of the drug are numerous—growing, in fact, since 2011.

Cocaine, crack and opium arrests (grouped together) mostly fell from 2005 to 2012, but have risen a bit since then. Here’s how the various drug incidents look when mapped.

The long streak of marijuana incidents you can see in the top left of the city is along Route 70, which passes right through Raleigh. 30% of the marijuana arrests and citations on the map above are concentrated in that big dark green blob around downtown. On the cocaine/crack/opium arrests map below, the density is even higher at 44%. Synthetic drug arrests were more evenly distributed around the city.

You can see below that a large majority of drug violations in Raleigh were for marijuana, a higher proportion than any of the other cities we’ve looked at so far: Raleigh (74%), Baltimore (67%), Chicago (60%), San Francisco (31%), and Denver (14%). It’s worth remembering though that those numbers should only be loosely compared—each city categorizes its drug arrests differently, and we’ve short-listed and shown a few of the “main drugs” on that basis.

The last three cities on our sightseeing tour across the American drug arrest landscape are Boston, Seattle, and Kansas City. These three fall together at the end of our list because, unlike the places we’ve covered so far, their data doesn’t distinguish arrests by drug type. Instead, they are simply described with a vague term like “drug/narcotics.”

Boston, MA

From January to October of 2014, there were 3,480 police incidents involving drugs in Boston. By year’s end, that figure looks like it’ll be a bit higher than the total from 2013, which was 3,875. It’s unlikely to reach 4,768 though, which was 2012’s grand total. It’s a safe bet that the vast majority of drug incidents (but not necessarily arrests) in Boston are marijuana-related, as the drug still isn’t legal in Massachusetts. Instead, possession of small quantities of the substance are punishable with a fine (but not a criminal record). Before this change to the law was made in 2009, offenders faced up to six months in jail and a $500 fine.11 The downtown Boston areas are responsible for the most drug incidents, especially South Boston. The dark cluster just above the South Boston label on the map below contains more than 650 events.

Kansas City, MO

There were 5,771 drug offenses in Kansas City between January 2014 and October 2014. Based on 2,400 of those events, 77% of the offenders were male and 33% were female—a relatively high proportion of women compared to some other cities.

The average age of those arrested or cited for a drug offense was 31; this average was the same for both genders.

Most drug-related incidents occurred around the downtown area of Kansas City. The zip code with the most activity along these lines was 64130 (where E 51st Street intersects with Indiana Avenue). This area had 628 police incidents involving drugs in the first 10 months of 2014, more than 100 more than the second busiest zip code, which is on the corner of E 20th Street and Askew Avenue.

Seattle, WA

While Seattle’s data portal doesn’t allow for much insight into arrests by drug type, there are other sources of information available. A study by the University of Washington in 201312 made the following observations about Seattle and the county in which it resides:

Heroin morbidity and mortality have continued to increase alongside meth availability.

About one third of people who reported using meth also stated they had used heroin—a substantial increase since 2005.

Marijuana use is common following its legalization for people aged 21 or over. Arrests are down since 2009 (120 pieces of police evidence in 2013 versus a high of 868 in 2009).

Coming Soon

We began with the observation that American states differ so much from one another that their individual drug landscapes must surely look very different as well. Now that we have literally observed the drug landscapes of eight cities, that initial observation—as basic as it was—appears to be true. What’s clear is that as changes in marijuana legislation continue to spread across the country (as of June 2014, 23 states classed medical marijuana as legal13), so too will changes in drug arrest and citation rates for its possession. Arrests for the sale and possession of other, more serious drugs will surely fluctuate as well, albeit for different reasons.

We plan to examine more locations as they make their crime data available through portals similar to those used by the cities above. In the meantime, and in the next issue of Arrests Across America, we will take a close look at DUIs: where they happen, why they happen and if they’re on the increase. Stay tuned.

Sources

1. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

2. “Crime in the United States 2012 – Arrests,” FBI Uniform Crime Report (Washington, DC: US Dept. of Justice, September 2013 – See more at: http://www.drugwarfacts.org/cms/Crime#sthash.XBEmh7hG.dpuf

3. http://us-city.census.okfn.org/

4. http://www.chicagoreader.com/Bleader/archives/2013/02/22/drug-arrests-drop-in-chicago-but-still-snare-thousands-in-black-neighborhoods

5. http://www.nytimes.com/2011/08/07/us/07bcbayview.html?pagewanted=all

6. http://www.sfweekly.com/thesnitch/2013/04/26/buyers-market-for-illegal-marijuana-in-haight-ashbury

7. http://www.sfgate.com/news/article/SHAME-OF-THE-CITY-A-SENSE-OF-PLACE-Mapping-2547169.php

8. http://sanfrancisco.cbslocal.com/2014/01/12/sf-homeless-move-mid-market/

9. http://www.thedenverchannel.com/news/local-news/number-of-citations-issued-for-public-marijuana-use-in-denver-spikes-in-201406252014

10. http://kdvr.com/2014/04/20/police-continue-heavy-presence-at-sunday-420-rally/

11. http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXV/Chapter94C

12. http://adai.washington.edu/pubs/cewg/CEWG_Seattle_June2014.pdf

13. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881

Mental Health and Drug Abuse

Mental illness is common among people who struggle with substance abuse and addiction.1

  • In 2016, 8.2 million adults had a co-occurring mental illness and substance use disorder in the past year.
  • Of those 8.2 million, only 48.1% received treatment for either their mental health disorder or their addiction.
  • Roughly half of the adults with co-occurring disorders did not receive either type of treatment.
  • Only an estimated 6.9% of adults with mental illness and substance abuse disorder received the mental health and substance abuse care they needed that year.1

Studies have found that among individuals with non-alcohol substance use disorders:

  • 28% had co-occurring anxiety disorders.
  • 26% had mood disorders.
  • 18% had antisocial personality disorder.
  • 7% suffered from schizophrenia.

Availability of Co-Occurring Disorder Treatment

Unfortunately, while the prevalence of co-occurring disorders among those seeking substance abuse treatment is high, the number of programs equipped to treat co-occurring conditions may not match the need for this kind of treatment.

While many substance abuse treatment programs are able to additionally address some relatively mild forms of mood, anxiety, and personality disorders, there is evidence to suggest that these same programs may be reluctant or ill-equipped to manage individuals with severe mental illness.

Correspondingly, the mental health system, while adept at treating cases of severe and chronic mental illness, may not be equipped to address the treatment of concurrent substance use disorders.

This is extremely unfortunate, as an individual with co-occurring disorders is generally seen as “continuously at risk for relapse.”2 Comprehensive treatment and adequate aftercare may help to reduce some of this risk. One study found that, among patients with moderate-to-high severity dual-diagnosis disorders, treatment outcomes were improved when their drug abuse treatment was supplemented with targeted mental health care.2

If you need treatment for both a mental health disorder and a substance abuse disorder, it is very important that you find a facility that is equipped with the staff necessary to handle your treatment. Dual-diagnosis programs can provide care for both addiction and mental health issues.2 If you suffer from a mental health disorder, make sure to communicate that to the treatment center before you enter.2


Is Drug Addiction a Mental Illness?

The answer to whether drug addiction qualifies as a mental illness: Yes. The answer to whether drug addiction qualifies as a mental illness: Yes.

Here’s why: Addiction results in distinct brain changes and can disrupt a person’s “hierarchy of needs and desires,” leading them to prioritize drug use above all else. A person’s ability to control their compulsion to use substances becomes significantly diminished as these brain changes occur, which can promote continued drug or alcohol use despite knowledge of the harm it is causing. The compulsive behaviors associated with substance use disorders (addictions) bear similarities to other mental illnesses.3

One study found that, among patients with moderate-to-high severity dual-diagnosis disorders, treatment outcomes were improved when their drug abuse treatment was supplemented with targeted mental health care

Healthcare professionals in the United States refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) when making diagnoses of mental disorders. The DSM states that “an important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification.”

Like other illnesses, addiction may require long-term treatment approaches. This goes against the ideas that addiction is a simple issue of willpower or is a condition with the potential to be remediated by “just saying no;” instead, it is now seen as a “chronic and relapsing brain disease” that requires specialized treatment.3

In fact, genetics is shown to play a major role in a person’s risk of developing a substance use disorder—it is estimated that 40-60% of a person’s vulnerability to substance abuse is genetic.4

Substance Abuse and Other Mental Illnesses

  • Many people who regularly abuse drugs or alcohol are diagnosed with other mental health issues at some point.
  • Studies show that people who are diagnosed with mood or anxiety disorders are nearly twice as likely to have a substance use disorder compared to the general public.3
  • People diagnosed with mood or anxiety disorders are more likely to abuse substances.
  • Gender plays a factor in the prevalence of co-occurring disorders.3

In some cases, it is difficult to know what came first—the substance abuse or the mental health disorder. It can also be difficult or impossible to determine causality; even if the symptoms of one condition appeared first, it may not have caused the other.

What is known is that it is relatively common for people to self-medicate mental health symptoms with substances. Also, substance abuse may worsen or bring about symptoms of mental illness. For example, marijuana has been shown to increase the risk of psychosis for some users.3

Overlapping Risk Factors

In addition, substance use disorders and mental illness have overlapping risk factors such as:3,4

  • Certain types of neurological deficits, such as lower-than-normal activity in certain brain circuits.
  • Genetics.
  • Epigenetics.
  • Stress.
  • Adverse childhood experiences.
  • Trauma.

Research also suggests that adolescents who use drugs are more vulnerable to developing an addiction or mental health disorder.3 When a person is young, important parts of their brain, such as their prefrontal cortex, are still maturing. Exposing a still-developing brain to certain drugs can have harmful and long-lasting effects.3

The Link Between Substance Abuse and Schizophrenia

Those who are genetically vulnerable to some types of mental illness may increase their risk with the abuse of certain drugs. Studies find, for example, that heavy marijuana use may increase the risk for schizophrenia and other psychotic disorders in those with a particular gene variant.3 Daily users of marijuana had increased risk of psychotic symptoms compared to non-cannabis users.5

It’s worth noting that studies have also documented higher rates of schizophrenia among methamphetamine users compared to cocaine, opioid, and alcohol users—similar to the rates seen in marijuana users.6 Researchers believe that methamphetamine abuse is a risk factor for schizophrenia and that brain abnormalities associated with methamphetamine use may contribute to the development of schizophrenia.6

Across the board, there is a high prevalence of substance abuse among people who suffer from schizophrenia. Studies have investigated this connection and found that potential contributing factors may include genetic vulnerability, neurobiological factors, medication side effects. psychosocial issues.5

Substances commonly abused by people with schizophrenia include alcohol, nicotine, cocaine, marijuana, and methamphetamine. Some studies estimate that as many as 50% of patients with schizophrenia struggle with alcohol or illicit drug dependence and over 70% are dependent on nicotine.5

The same deficits in certain brain functioning that render an individual more vulnerable to schizophrenia may also increase the rewarding effects of nicotine and make cigarettes more difficult to quit. This phenomenon may help to explain why rates of smoking may range as high as 90% among those with schizophrenia.3



Credit: EHow

Facts About Co-Occurring Conditions

Being exposed to traumatic events can increase a person’s likelihood of developing co-occurring conditions. Among veterans, there is a compelling link. Nearly 1 in 5 military service members returning from Iraq or Afghanistan reported symptoms of post-traumatic stress disorder (PTSD). Recent studies find that almost half of all veterans who are diagnosed with PTSD also have a substance use disorder.3

Other notable facts about dual diagnoses include the following:3

  • In the United States, mental illness and substance abuse are usually treated separately and not in a dual diagnosis program.
  • Women are more likely than men to seek help from mental health providers for a co-occurring disorder, while men are more likely to seek help through substance abuse treatment providers.
  • Some substance abuse treatment centers have a potentially harmful bias about using any medications, including those needed to treat mental illnesses, such as depression.
  • Many treatment centers do not have staff members who are qualified to prescribe, monitor, or dispense psychiatric medications.
  • As many as 45% of individuals who are incarcerated have a mental health problem as well as a substance use disorder. Unfortunately, the care necessary to treat these conditions is often lacking within the criminal justice system.

It takes a well-equipped, professional treatment facility to properly diagnose and treat dual diagnosis disorders.



TODAY’S TMJ4

Dual-Diagnosis Treatment

When a dual diagnosis is at play, it’s vital that treatment addresses both the mental health issue and the substance abuse. Those who have both a substance use disorder and another mental health disorder may exhibit symptoms that are more severe and treatment-resistant than those with only one or the other.3

It’s widely acknowledged that treatment that addresses both issues will lead to better outcomes. Anyone who is potentially struggling with both addiction and mental health issues should be thoroughly assessed for the presence of a dual diagnosis and treated accordingly.3

Some treatment facilities today offer specialized dual-diagnosis treatment. The first step is often detox. Detoxification is the set of interventions used to manage substance withdrawal. Depending on the drug that the individual is detoxing from, withdrawal symptoms can be severe.

Once you are stable enough for treatment, you may begin your addiction treatment; often this involves moving into a rehab center. You will undergo an intake assessment with a staff member. A physical examination and psychological assessment will be conducted. Treatment for any pertinent medical and mental health issues will be incorporated into your rehabilitation plan. Appropriate management of both mental health issues and addiction will increase the chances of sustained recovery.

During rehab, you will likely participate in both group and individual therapy. Several therapeutic approaches may be utilized to treat co-occurring disorders, including:7

  • Cognitive behavioral therapy (CBT): This therapy helps individuals recognize and change negative behaviors and destructive thought patterns.
  • Dialectical behavioral therapy (DBT): This type of therapy is unique in that it was created specifically to help individuals reduce their thoughts and behaviors related to self-harm. This includes cutting, drug use, and suicidal thoughts or attempts.
  • Assertive community treatment (ACT): This type of therapy helps the individual engage with the community and utilizes an individualized approach.
  • Therapeutic community (TC): This is a long-term, group treatment approach where the individual lives in a residential community. During this time, staff help them to “re-socialize” and prepare in various ways for their reintegration into their daily lives when they return home.
  • Contingency management (CM): This type of treatment incentivizes individuals with vouchers or other small rewards for engaging in healthy behaviors or reaching certain milestones.

Other forms of treatment may include intensive one-on-one therapy with a psychiatrist or therapist who has experience dealing with the challenges associated with both mental health issues and addiction. Medication may be utilized to manage certain psychiatric disorders or to mitigate the withdrawal symptoms associated with detox. You may also attend support group meetings, such as AA or NA, during your time in treatment. Psychiatric medications may also be prescribed by staff physicians.

Behavioral modification therapies and experiential therapies can augment a treatment regimen, helping to alter thoughts and behaviors to better manage both disorders.

During your stay, you will work with your treatment providers to come up with an aftercare plan, as keeping a focus on your long-term mental and physical health is important to maintaining a positive recovery trajectory.


Finding a Program

If you are struggling with a dual diagnosis and you are looking for treatment, search through our online directory of programs in your area or in a location throughout the country. Given the high prevalence of dual diagnoses, more and more programs are utilizing an integrated treatment approach by combining mental health treatment and substance abuse treatment. Be sure to ask any potential programs you’re considering if they provide specialized dual diagnosis care.

 It’s widely acknowledged that treatment that addresses both issues will lead to better outcomes.

After you’ve found a few programs that look like potential fits, make a list of them, as well as a list of questions. You may want to ask about the way they approach treating mental health and substance abuse at the same time and see if it resonates with you. The most important thing when looking for treatment is finding a place that feels right to you.

Some question you may want to ask include the following:

  • Are there staff members who specialize in treating dual diagnoses?
  • What is your approach to managing dual diagnoses?
  • Can I schedule a visit?
  • Do you have pictures of the facility?
  • Where can I read reviews online?
  • What is your electronics policy?
  • What types of therapies do you use?
  • Do you use medication?
  • How long is the average stay at your center?
  • What insurance do you take?
  • What types of aftercare do you provide?

Living with untreated co-occurring conditions can be exceptionally difficult. Don’t wait another day to find the right treatment for you.


Sources

  1. Substance Abuse and Mental Health Services Administration. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
  2. Flynn, P. M., Brown, B. S. (2008). Co-Occurring Disorders in Substance Abuse Treatment: Issues and Prospects. J Subst Abuse Treat34(1), 36–47.
  3. National Institute on Drug Abuse. (2010). Comorbidity: Addiction and Other Mental Illnesses.
  4. National Institute on Drug Abuse. (2018). Common Comorbidities with Substance Use Disorders: Why is there comorbidity between substance use disorders and mental illnesses?
  5. Winklbaur, B., Ebner, N., Sachs, G., Thau, K., Fischer, G. (2006). Substance abuse in patients with schizophreniaDialogues Clin Neurosci8(1), 37–43.
  6. Callaghan, R. C., Cunningham, J. K., Allebeck, P., Arenovich, T., Sajeev, G., Remington, G., Boileau, I., Kish, S. J. (2012). Methamphetamine Use and Schizophrenia: A Population-Based Cohort Study in CaliforniaAm J Psychiatry169(4), 389-396.
  7. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.