Category: Treatment

By Martin Peters, BA (Hons), Dip HE, RN Martin is a UK national who has worked in a variety of settings within the Healthcare sector over the past 16 years. After receiving his BA (Hons) in Social Policy and Administration from the University of Plymouth (UK), his studies and passion for working with people led on to a Diploma of Higher Education in Nursing Studies with Registered Nurse status from the University of the West of England (UK).

Can Maintenance Medications Be Used In Abstinence Based Programs?

As practitioners, how often do clients ask the question: “is there a tablet that can stop me drinking?” Over the past 20 years pharmacology has become important in the field of addiction, but the evidence about the efficacy of medications that allegedly reduce cravings, or stop people drinking, are fairly erratic.

Big pharmaceutical companies continue to look for a magic drug that will ‘treat’ addiction, but realistically, even if such medications exist, compliance is also an important factor. While Disulfiram might have effective reactive properties that cause unpleasant sensations when alcohol is consumed, this does not necessarily reduce cravings. As a result, the drug has a poor rate of compliance and in essence, Disulfiram should not be seen as a long-term solution to enabling abstinence.

Saying this, there is absolutely no reason why Disulfiram shouldn’t be used as a support for clients who may initially be struggling with any form of abstinence, but have a degree of motivation and are receiving psychological interventions. It is imperative that any client who is prescribed Disulfiram is fully informed about its reaction to alcohol due to its slow absorption and elimination; in some cases, the effects may last up to two weeks after initial intake. Notably a case study by Fuler et al (1986) found that abstinence rates of patients on Disulfiram receiving a 250mg daily dose versus those that were receiving counseling only were insignificant. Interestingly, the reason for this finding was that only 20 percent were compliant with the medication regime. Nevertheless, in more controlled environments, along with ongoing therapy and compliance, abstinence is likely to be greatly increased. A study by Krampe H., Stawicki S., and Wagner T. et al. (January 2006) that followed 180 clients over a 7 year period found abstinence rates over 50 percent. Whilst Disulfiram was almost exclusively the medication of choice for alcohol dependency during the 20th century, new alternatives have come to the forefront in the last decade that potentially suggests a more pro-active way of promoting abstinence.

One such medication is Baclofen. Available since the mid-1950s, Baclofen is a derivative of gamma-amino-butyric acid (GABA). Historically used to treat spasticity, Baclofen is in the early stages of research for use in the treatment of alcoholism. A notable Italian study by Addolorato G., Leggio L., Ferrulli A., Cardone S., Vonghia L., Mirijello A., Abenavoli L. and D’Angelo C. et al. (Dec 2007) found Baclofen both reduces craving and alcohol withdrawal. The most well-known publication on Baclofen has been the writings of Dr. Oliver Amesien, a French Cardiologist who has battled with alcoholism for many years. In his memoir, “The End of My Addiction” (Farrar, Straus and Giroux, 2009), Dr. Amesien had sought help from various rehabilitation centers at least eight times and attended nearly 5,000 Alcoholics Anonymous (AA) meetings without being able to maintain sobriety. Dr. Amesien then began experimenting with Baclofen, and noticed that as he increased his daily dose his cravings were greatly reduced. Most interestingly, Dr. Amesien claims he has consistently been able to abstain from drinking altogether or drink moderately in social situations without having cravings or other addiction-related problems.

Despite this well-documented memoir, Baclofen as a frontline treatment is still in its infancy. A further study conducted in conjunction with the University of Glasgow found that, “Tailored Baclofen treatment in alcohol dependent patients with medical disease reduces self-reported alcohol consumption and results in significant improvement in craving and negative consequences of drinking. There may also be improvements in depression and anxiety, but quality of life appears unaffected. The overall satisfaction with tailored Baclofen treatment is high. Baclofen is a promising treatment option for alcohol dependency, which needs further study.” (Masson et al, 2011). Despite these promising findings, all studies to date have been relatively small in scale. To counter these concerns, a further study at the University of Amsterdam was commenced in 2011.

Whatever the findings of this new study, addiction therapists often discount the benefits of maintenance medications such as Baclofen as they are not compatible with a ‘total abstinence’ policy. Working steps and attending meetings is not always the solution for every client. Sometimes, we have to look at alternative ways of supporting people through their addiction by moving away from the ‘one size fits all’ treatment ideology. The big question is whether we sometimes do ourselves a disservice by maintaining that pharmacological interventions are not compatible with the principles of abstinence treatment? The short answer is perhaps. Efficacious treatment programs combined with maintenance medication may be extremely effective.

While the side effects of Baclofen appear to be relatively minimal, will a medication that is non-patented be championed by the medical profession and most importantly, large pharmaceutical companies? In an article in Time, Maia Szalaviz made a salient point, “At issue is the definition of treatment. In the U.S., successful treatment of addiction has traditionally been an all-or-nothing undertaking, involving complete abstinence – as promulgated by supporters of 12-step programs like AA – rather than a regimen of moderation. For many, that definition includes abstinence even from drugs that would help fight cravings. Indeed, for decades, experts have debated whether drug addicts who cannot or will not quit should even be offered ongoing treatments that would reduce harm related to their drug abuse. Although many providers have recently become more open to new options, the majority of American addiction treatment continues to use the 12-step abstinence model.” (Time, July 2009). While I am not advocating a harm reduction model of treatment within a primary rehabilitation setting, I feel we should be more open to supplementing our treatment modalities. Understandably, any pharmacological intervention should be followed up with addiction counseling and support meetings. Counselors should be open to innovative and hybrid approaches as opposed to the traditional ‘all or nothing’ philosophies. Why can’t some of the current medications be part of an abstinence based program?

Here in Thailand, there remains little knowledge of the use of such medications, other than in a harm reduction modality. In fact, Baclofen is not presently prescribed off-license. In the past 12 months, I have only worked with one client who was prescribed Baclofen with mixed results. As with previous maintenance medications, there are concerns about compliance. Maybe in the future Baclofen will come in the form of an implantable drug depot, but until further larger scale clinical studies are carried out this seems unlikely.

The emergence of Vivitrol in 2006 as a monthly injection offers some hope with regards to compliance issues. Saying this, how Vivitrol works in people with alcohol dependency is still relatively unknown and requires further long term research. Initial studies suggest that Vivitrol can manage alcohol cravings, but a significant part of treatment efficacy will again be in conjunction with counseling, although some researchers continue to doubt the compatibility of maintenance medications with an abstinence base. In a subset of patients who abstained from drinking in the week prior to receiving their first dose of medication, those treated with Vivitrol (380 mg) were more likely to maintain complete abstinence (without relapse) and showed a greater reduction in drinking days, as well as a greater reduction in heavy drinking days, compared to the placebo-treated group over a 6 month treatment period (James C. Garbutt, MD, Henry R. Kranzler, MD, Stephanie S. O’Malley, PhD, David R. Gastfriend, MD, Helen M. Pettinati, PhD, Bernard L. Silverman, MD, John W. Loewy, PhD and Elliot W. Ehrich, MD 2005).

Not surprisingly, a major factor that needs to be considered with any pharmacological intervention is the side effects associated with their use. Issues such as weight gain, dizziness, dry mouth, nausea and headaches will certainly affect compliance. If we can continue to keep an open mind as to what medications may be effective, and promote and support clients working towards abstinence, then in my mind, we should not automatically turn a blind eye to the benefits of maintenance medications.

By Roland F. Williams, MA, Licensed Advanced Addiction Counselor (LAADC), Internationally Certified Addictions Counselor (ICADC), Nationally Certified Addiction Counselor Level II (NCAC II), Certified Drug and Alcohol Counselor Level II (CDAC II), Advanced Certified Relapse Prevention Specialist (ACRPS), Nationally Certified Substance Abuse Professional (SAP)

Cultural Considerations In Addiction Treatment

This article will help you be more effective, confident, and competent in working with clients from culturally different backgrounds. The following guidelines are useful to consider whenever you are working with a minority or culturally diverse group or individual; they are generic enough to be applied to any cross-cultural counseling situation. Take these recommendations to heart – many mistakes occur because of inadequate considerations of cultural concerns in addiction treatment.

Self-Assessment: Identifying Your Prejudices & Limitations

Before you can assess any client it is important to examine and identify your own preconceived ideas about this particular group or individual. What has been your experience with this population? Have your experiences and/or views tainted your interaction style? Identifying your own prejudices makes it clearer when you are attempting to work with your client’s problems. After all, counselors’ issues often get confused as the client’s issues. The old adage, “If you can’t name it, you can’t tame it”, comes to mind. Most of us prefer to think of ourselves as ‘prejudice free’ or believe we’ve ‘worked through’ these issues; it somehow means something negative to admit that you are, in fact, the not-so-proud possessor of racist attitudes or beliefs.

In reality, we all have racism to certain degrees. Become aware of what feelings and attitudes really exist for you regarding Africans, Indians, Muslims, Jews, or any other culture different from your own – be careful and don’t allow yourself to be blind-sided by a surprise appearance of your own prejudice or racism during a therapy session. Certainly, it’s a form of countertransference that can be owned and managed.

Some issues to consider might be: How do you feel when a big black man walks into your office? What do you think of the slang that many blacks tend to use? How do you feel about the arrogance and sexism you sense from men of certain cultures? Do you find yourself stereo-typing certain groups or cultures? Do you tend to sit in judgment of different kinds of drugs users? For example, do you think less of heroin or crack addicts than you do of alcoholics or prescription drug abusers? Maybe some groups have been aggressive and rude to you, and you feel uncomfortable with them. Maybe you are somehow embarrassed or ashamed because of the oppression and poverty that some groups have endured. Are you willing to confront people from different cultures the same way you would of your own race? Do you find yourself talking differently to some cultures? For example, do you ‘talk down’ or patronize certain groups? Do you use racial slurs? Would you want someone of a different race to marry your sister, brother, or child? If not, why not?

These questions are designed to help identify your own issues that may be unresolved or even unrealized. Deciding what prejudices you actually own is the beginning of more effective cross-cultural counseling, putting you in a much better position to understand the differences between your agenda and the clients. You may also decide that your issues prevent you from being fair and effective and therefore choose to have someone else work with these clients. It is important to recognize that at times, this is appropriate; the primary concern is to always ensure clients’ get the best possible care, which is exactly what they deserve.

Racism does not always manifest itself in negative and abusive words and actions. Some cultures receive extra-favorable treatment from therapists who want to somehow express their solidarity and support for a specific culture’s cause. However, ‘special treatment’ is never in the best interest of the individual and can even be counterproductive in terms of their personal growth. Treating someone differently because you’ve determined this is necessary to address their individual clinical needs is certainly not the same as treating them differently because it somehow makes you feel better. Always examine your motivations whenever you feel a client is getting preferential treatment from you.

Stereotyping & Overgeneralization

Just as all addicts aren’t the same, not all people of the same race or culture are the same. For example, it’s difficult to be sensitive to ‘black’ issues when they often appear totally different depending on the individual. I remember being in organizations where a black client would walk in, and automatically be referred to me. The idea was that we would be able to work better together because we were both black – in reality, there have been cases where the only thing we had in common was our race. All Indians, Africans, Asians and Europeans are not the same – even though individuals in each group share a racial heritage, they may have totally different cultural experiences and challenges. We must recognize that cultural experiences are so diverse that one can easily do more harm than good by trying to address the cultural needs of a whole race. Most cultural groups have completely different views and identity issues depending on what part of the world they’re from, their level of education, socio-economic background, complexion, and how they were raised.

Beware of generalizations and stereotyping. The best advice is to use good therapeutic skills. Develop a treatment plan that takes into account your client’s unique and specific clinical needs. In some cases, the client’s race will be more of an issue than in others. Not every person will have barriers that are created and nurtured by their ethnicity. With other clients, it will dominate the focus of your treatment.

Adaptation & Coping Styles

A variation of the following model was made popular by Peter Bell and Jimmy Evans in their book “Counseling the Black Client: Alcohol Use and Abuse in Black America” (Hazelden, 1981). A helpful tool to determine treatment approaches for culturally diverse clients; it addresses how individuals adapt to dominant cultures and where they feel most comfortable. In viewing this model, it’s apparent that the same approach will not work for every client. We will look at three client types and show that the clinical needs for each client may be totally different. The client types listed below are not meant to be absolutes, merely brief examples of different coping styles. In these examples, I will use the term ‘dominant culture’ to represent the main culture that exists within your agency, community and/or majority client population.

Client A: Centered In One’s Own Culture

• Has made no attempt to fit into the majority culture.
• May be described by some as a separatist and maybe even a racist.
• Might wear culturally identifiable garb and associate primarily with others from their own race and culture.
• Has little interest or desire to be accepted and approved of by the dominant culture.
• May often see cultures different from their own as the enemy or someone who doesn’t understand their issues.
• Feels much more comfortable with people of their own race and culture and avoids others.
• Distrusts and has difficulty relating with people outside of their race and culture.

This client type can be the most difficult for counselors to work with, and they might even be more difficult for a counselor from the same culture who is centered in the dominant culture (see the next client type). In dealing with this client, you might often see anger, resistance, and denial. They might excuse or explain their behavior by describing it as retaliation for racial oppression that their culture may have endured. They might demonstrate a sense of entitlement that causes power struggles, and be very distrustful of the counselor and their techniques. They might be resistant to taking responsibility for their addiction, instead blaming it on racism, prejudice and/or a lack of understanding. They can be controlling and antagonistic, and will most likely trigger any unresolved racial or cultural issues for the counselor.

Client B: Centered In Dominant Culture

• Does everything possible to fit in and be accepted by the dominant culture.
• May be described by some as not being true to their own culture and mimicking the dominant culture.
• Tries hard to gain the approval of friends from the dominant culture.
• Avoids contact with other members of his culture and has little connection to his own cultural community.
• Often sees other members of his race and culture as ‘the enemy’ and/or a source of shame and embarrassment.
• Has difficulty trusting other members of his own culture and usually feels ‘better than’ or ‘less than’.
• Often will adapt speech and mannerisms that mimic the dominant culture.
• May not like being reminded of being a member of his own race or culture.

This client type will prefer to work with a counselor from the dominant culture, and will get uncomfortable around others from their own race or culture. They will resist having their race be a topic of conversation and may feel superior to other members of their race/culture or even demonstrate strong racist views against their own race. They are usually articulate and well-educated with a sophisticated denial and rationalization system.

Client C: Bicultural

• Is able to function well in both cultures.
• Might sometimes feel bilingual or socially schizophrenic.
• Can speak the language of the dominant culture then go into their own community and switch to another language and mannerism.
• Feels a connection and loyalty to both worlds.
• Does not feel that being a member of their own race or culture requires exclusivity.
• Periodically feels pressure from both worlds to conform.
• Because of the ability to be in both cultures, will demonstrate the best and worst of each.
• Is often privy to conversations the separatist doesn’t hear.
• Is most likely to use a larger support system in recovery due to the exposure and comfort experienced in both cultures.

For this client, race will not be a primary focus of treatment. However, there is a possibility of feeling disconnected in both cultures. They might describe feeling like they’re in limbo between the two. Their ability to move from one culture to the next can be used as escapism in certain situations. For example, when hurt or pressured by his non-Asian friends, he can retreat to the Asian community or Asian ‘mannerisms’ for comfort and vice versa. This can be confusing and painful to the client and his friends. This client will expect to be treated as an individual and will resist stereotyping.

Counseling Versus Education

As tempting as it might be, don’t use your counseling session as an opportunity to learn more about another culture. Therapists often find themselves fascinated as their clients give them first-hand knowledge of the inner workings of their specific culture. Finding out what makes a person from a different culture ‘tick’ may be much more interesting than the treatment process. However, we must remember that the time spent with the client is their time; if you’re benefiting more than they are, something is very wrong. This isn’t to say that wanting to learn more about different cultures isn’t a good idea; just don’t use your clients as teachers or your counseling sessions as classrooms. Take workshops, read books, and spend time with your friends that are members of that culture or race. If you don’t have any friends from different races or cultures, reread the beginning of this article!

Sometimes the client may feel it’s their duty to teach you how their people think and feel. That is not the purpose of the session, and the client should be made aware of this. Again, the primary focus is the client and whether they are receiving what they need to achieve and maintain recovery.

How It Relates To The Addiction

This is a tricky one. Addicts often like to talk about anything other than what they need to do to recover. Many will find a million ways to divert the focus from the primary issue of addiction. Often they are looking for ways to avoid confrontation and feedback. Race is the perfect distraction. You may find that some clients want to talk about racial topics rather than the assignment they are working on, and when you touch on a hot issue they change the subject to a racial topic. Now here is the tricky part… when you refuse to talk about the cultural/racial complaints and instead insist on talking about the recovery assignments you might be labeled as insensitive and discounting. While honoring the cultural diversity of your client is important, you must remember that your primary purpose in addiction treatment is to help the client get clean and stay sober.

Any issue the client raises may be important. However, the questions you must ask are: How does this relate to the addiction? How has this contributed to their using? How is it going to prevent them from staying clean and sober? In the days of task-oriented, brief therapy and managed care, we don’t have the luxury of wasting sessions on issues that don’t relate directly to recovery. Gently remind the client that although you are interested in their views and opinions regarding race, you would be short-changing them if you didn’t bring the discussion back to the task at hand: how to get clean and stay sober.

Don’t Minimize Your Own Qualifications

Take a moment to rate your own clinical skills as a therapist. A ten means you believe you provide top-quality counseling in a compassionate and professional manner. A one indicates you need another job. I’ll bet you feel pretty good overall about the work you do and why shouldn’t you?

Can you work effectively with clients who feel depressed, have denial, or don’t trust you? Can you do conflict resolution and active listening? Are you familiar with chemical dependency and relapse prevention? Do you know how and when to confront a client? Can you read nonverbal communication? Can you facilitate a group? Can you do a lecture? Well, it sounds like you know your stuff.

Don’t minimize your own capabilities when working with a different culture. Don’t back down when you get accused of not knowing what you’re talking about. Don’t allow your own fears, insecurities, and self-doubt to cause you to abandon all your training. You don’t have to have walked in someone’s shoes to be able to help them. You don’t have to know all the inner workings of each culture in order to be effective. The most important description of a good therapist is: know what you’re taking about and care about your client. If you can communicate that to your clients, you’re in great shape. Remember, use your skills.

Individualize Treatment Based On Specific Clinical Needs

By reading this article you are already interested in cross-cultural counseling. You want to be more effective working with clients from different races and cultural backgrounds. You want to know as much as you can about the different cultures so you can provide better treatment. Well, by now you must have figured out that many cultures have a range of issues that are not only complicated, but also diverse. How can you possible study and learn enough to be prepared for the ‘type’ of client that might show up in your office? Trying to learn and understand the different cultural nuances amongst a racially diverse group of clients can be complicated. What about the Latino client? Is he Cuban, Puerto Rican or Mexican? First or second generation? What about the Middle Eastern client? Which country are they from? What part of the country? How about Asians or Pacific Islanders? And culture isn’t just race related. How much do you know about gay and lesbian issues? How about the different drugs people use? Do you know about the culture of people who smoke PCP versus people who smoke crack? Do you know about who uses ecstasy and goes to raves? Do you understand the difference between people who shoot heroin and those who smoke it? A bit overwhelming, isn’t it? Well, it certainly is. There is no way for any therapist to be knowledgeable about every culture that they might wind up working with, so what’s the answer?

Individualized treatment is the key. If you treat each of your clients as an individual with specific clinical needs, your treatment will be a success. You don’t need to be pregnant to work with a pregnant woman, and you don’t need to be black to work with a black client. However, you do need to avoid generalizing and stereotyping. You will see common issues that all addicts and alcoholics deal with, but they might be communicated or influenced differently based on cultural experience. If you create a truly individualized treatment plan, you will always be in a better position to provide professional, and competent care. At the end of the day, if the client leaves the session and feels you care about them and you know your job, you will be effective.

By Roland F. Williams, MA, Licensed Advanced Addiction Counselor (LAADC), Internationally Certified Addictions Counselor (ICADC), Nationally Certified Addiction Counselor Level II (NCAC II), Certified Drug and Alcohol Counselor Level II (CDAC II), Advanced Certified Relapse Prevention Specialist (ACRPS), Nationally Certified Substance Abuse Professional (SAP)

The Danger of Prescription Drugs

In rehabilitation centers all over the world more and more people are being admitted for abusing prescription drugs. At support networks, such as Alcoholics Anonymous and Narcotics Anonymous, relapses from long term recovery as a result of prescription drug abuse are also on the rise. Most concerning, increasing numbers of teenagers are also having problems with prescription drugs. Increases in prescription drug use, abuse and dependence has caused hospitals, doctors and treatment centers to take a long hard look at what it is, what causes it and what addiction professionals need to do to address this problem.

Prescription drug abuse is the intentional use of a medication without a prescription; in a way other than as prescribed; or for the experience or feeling it causes. It is not a new problem, but one that deserves renewed attention due to the addictive potential of many new drugs combined with their increased availability. While prescription drugs can be powerful allies, their abuse poses serious health risks.

In 2010, approximately 7.0 million people (2.7 percent of the U.S. population) were current users of psychotherapeutic drugs taken non-medically (Source: NIDA – National Institute of Drug Abuse). This class of drugs is broadly described as those targeting the central nervous system, including drugs used to treat psychiatric disorders. The medications most commonly abused are:

• Pain Relievers – 5.1 million
• Tranquilizers – 2.2 million
• Stimulants – 1.1 million
• Sedatives – 0.4 million

Every day in the U.S., 2,500 youths (12 to 17 years) abuse a prescription pain reliever for the first time. In 2005, 4.4 million teenagers (12 to 17 years) in the U.S. admitted to taking prescription painkillers, 2.3 million took a prescription stimulant such as Ritalin, and 2.2 million abused over-the-counter drugs such as cough syrup. Alarmingly, the average age for first-time users is now only 13 to 14 years old (Source: Foundation for a Drug Free World). A 2007 survey in the U.S. found that 3.3 percent of 12 to 17 year olds and 6 percent of 17 to 25 year olds had abused prescription drugs in the past month. Among adolescents, prescription and over-the-counter medications account for most of the commonly abused drugs by high school seniors. Amazingly, nearly one in twelve high school seniors reported nonmedical use of Vicodin and one in twenty reported abuse of OxyContin (Source: NIDA). When asked how prescription narcotics were obtained for nonmedical use, 70 percent of 12th graders said they were given to them by a friend or relative. Interestingly, the number obtaining them over the internet was negligible. Among those who abuse prescription drugs, high rates of other risky behaviors, including abuse of other drugs and alcohol, have also been reported (Source: NSDUH – National Survey on Drug Use and Health). Almost 50 percent of teens believe that prescription drugs are much safer than illegal street drugs with 60-70 percent stating that home medicine cabinets are their primary source. According to the National Center on Addiction and Substance Abuse at Columbia University, teens who abuse prescription drugs are twice as likely to use alcohol, five times more likely to use marijuana, and twelve to twenty times more likely to use illegal street drugs such as heroin, ecstasy and cocaine than teens who do not abuse prescription drugs.

In 2006 in the U.S., 2.6 million people abused prescription drugs for the first time. In the U.S. alone, more than 15 million people abuse prescription drugs, more than the number of people who reported abusing cocaine, hallucinogens, inhalants and heroin combined (Source: NIDA). While most prevalent in the U.S., prescription drug abuse is also a problem in Europe, Southern Africa and South Asia.

Prescription drug abuse causes the largest percentage of deaths from drug overdosing; CNS depressants (e.g. Ambien, Ativan, Librium, Lunesta, Sonata, Valium and Xanax), opioids and stimulants are responsible for more overdose deaths (45 percent) than cocaine, heroin, methamphetamine and amphetamines (39 percent) combined. Of the 22,400 drug overdose deaths in the U.S. in 2005, opioid painkillers were the most commonly found drug, accounting for 38.2 percent of these deaths. In the U.S., most deaths used to take place in inner city African-American neighborhoods, but they have now been overtaken by white rural communities. The same trend can be seen in the rates of hospitalization for substance abuse and emergency hospitalization for overdoses. Of the 1.4 million drug-related emergency room admissions in 2000, 598,542 were associated with abuse of pharmaceuticals alone or with other drugs (Source: NIDA).

In 2010, the Drug Enforcement Administration found that the abuse of the painkiller Fentanyl (thirty to fifty times more powerful than heroin) killed more than 1,000 people in the U.S. that year. Tellingly, most people who die from prescription drug overdose are taking someone else’s medications (Source: Drug Enforcement Administration).

Prescription narcotics are being handed out almost like candy by doctors, some of whom are genuinely interested in patient care, others who run so-called ‘pill mills’, where narcotic prescriptions are traded for cash to feed addictions. A recent CDC (Centers for Disease Control and Prevention) study found that enough narcotics are prescribed every year to medicate each and every adult in America every day for a month. It is unclear if Americans are suffering from more pain than ever, but they are definitely getting more prescriptions for its control. The use of Vicodin, the most popular pain relief drug in the country, has grown dramatically from 112 million doses prescribed in 2006 to 131 million in the U.S. today, according to a national survey conducted by the consulting firm IMS Health. Experts say most of those prescriptions are unnecessary. The U.S. makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids and 99 percent of the world’s hydrocodone, the opiate constituent in Vicodin.

Although there are likely multiple factors at work, there are three main aspects driving the increasing prevalence of prescription drug abuse:

1. Misperceptions about their safety. Because these medications are prescribed by doctors, many people assume that they are safe to take under any circumstances. This is simply not the case. Prescription drugs act directly or indirectly on the same brain systems affected by illicit drugs. Using a medication other than as prescribed can potentially lead to a variety of adverse health effects, including overdose and addiction.
2. Increasing environmental availability. Between 1991 and 2010, prescriptions for stimulants increased from 5 million to nearly 45 million and for opioid analgesics from about 75.5 million to 209.5 million (Source: CDC – Centers for Disease Control and Prevention).
3. Varied motivations for their abuse. Underlying reasons include: to get high; to counter anxiety, pain, or sleep problems; or to enhance cognition. Whatever the motivation, prescription drug abuse comes with serious risks.

While prescription drug abuse is definitely on the rise, thankfully there are some practical suggestions to help people avoid dependence:

• Realize that just because a doctor prescribes a medication this does not mean it’s safe.
• Investigate a non-narcotic alternative to the prescribed medication.
• Ask if there is a drug with less abuse potential then the one being prescribed.
• If a person has a history of substance abuse, inform their doctor immediately.
• Instead of a 30-day supply, ask for a one week supply.
• Try acupuncture, massage, physical therapy, yoga and/or other holistic treatments.
• Create and/or utilize a support network.
• Ensure any suspicious behavior and/or abuse signs are reported.
• When the medical condition is resolved, destroy the remaining medication – do not save them for any future problems.

At DARA, we specialize in treating people who have developed a pattern of abuse or dependence on prescription drugs. We can assist them in managing any withdrawal symptoms and by using a holistic approach, develop a plan to address any residual pain or discomfort that might have led to the original problem. We also appreciate that the road to abuse or dependence is different in many cases from the person with a traditional substance abuse problem. After all, the doctor usually prescribed the drugs for a legitimate reason. While prescription drug abuse has the makings of a future epidemic, particularly amongst the young, taking a long hard look at what it is, what causes it and what addiction professionals need to do to address this problem is definitely a step in the right direction.