BATH SALTS AREN'T FOR BATHING!

Last year at this time I visited a 16-year-old boy in the hospital. He could not speak or walk or control any motor movements. He had been in a coma for three days and was then awake. Blood test results showed no known drugs or alcohol in his sytem. However, after interrogating his close friends, they admitted the boy had snorted bath salts at a party the night he collapsed. The words and the labeling are innocuous enough. Bath salts are meant to be a soothing additive to warm, soaking tub water in an attempt to relax us and lower our blood pressure. But these are not the common relaxing agents of our parents' generation. Today's product being sold in small shops and corner markets, can be purchased legally since they are labelled - 'not for human consumption'. Ingredients in bath salts include three toxic chemicals that were banned by the DEA last year. They are MDPV, methylone and mephedrone. They cause paranoia, psychosis, agitation, a stimulant-like effect and hallucinations. They also have been associated with delayed suicidality. The question becomes, why do young people abuse something with such potentially fatal consequences? The answer is complicated. Some do not have skills to deal with real life. Some blindly follow others. Some want to change the uncontrollable feelings within themselves that prevent their personal happiness. It is time for us to stand up and support an across the board removal of Ivory Wave, Vanilla Sky, Bliss and other bath salt products from all stores. It is too late for the 16-year-old I visited. But it is not too late for others like him.

PHARMACOTHERAPY HAS ITS PLACE

When working on recovery with my patients, I often recommend that they attend AA/NA/GA, go to meetings, join a home group and pick a sponsor. This is very therapeutic, but it is not therapy- it is adjunctive. Yet, I know that the more positive support a patient has, the better off he or she will be in long-term recovery. Whatever works is the prescription I adhere to. The patient's success is paramount. What puzzles me is the negative reception many of my patients receive when they go to AA/NA and members find out that they are on medicines to assist their recovery. Abstinence may work for many people but it is not the only way to enter recovery. Pharmacotherapy, or the use of medication to cut down on urges or cravings, is another method. We often find people who have relapsed numerous times when attempting abstinence. These are the folks who are better off taking medication to help manage their lives, then to chronically feel like a failure. Revia helps with Pathological Gambling. Suboxone works with Opioid Dependence. And both Vivitrol and Campral help with Alcohol Dependence. If folks are suicidal, we recommend their PCP use an anti-depressant. All of these of course should be combined with substance abuse treatment on a weekly basis and frequent contact with the prescriber. Folks in AA/NA/GA adhere to the abstinence model. They learn about acceptance, gratitude and surrender. What they need to learn as well is tolerance and a non-judgemental way of accepting others who struggle with addiction.

FEELING NO PAIN, USING COCAINE

We don't talk much about cocaine anymore. The emphasis these days is on opiates and prescription drug abuse. Yet just as many Americans use cocaine as they do heroin. The difference is that cocaine is 'marginally socially acceptable' in many wealthier circles. For that reason, discussion about it does not peak interest. Cocaine was more or less 'normalized' by high-level executives and celebrities. It is available at parties and bars and folks don't see it as an addictive substance. Even detoxes do not accept clients who only abuse cocaine. The problem however, is cocaine causes serious damage to the brain. Using it with alcohol, even socially, can produce cocaethylene which can be fatal. Smoking cocaine in crack form, causes Dopamine flooding and a slower re-uptake. That means that it is all but impossible to stop smoking until the crack runs out. It goes to the reward center of the brain and produces such a pleasurable effect that people do not want to stop smoking. So the question becomes, why do people smoke cocaine or snort it if it is damaging? Are they addicted? There is no one answer to these questions. People use illicit drugs for many reasons. But they are not addicted to the substance cocaine. They are addicted to the feeling they get when they use this substance. It takes them out of the everyday world that surrounds them and puts them in a different emotional state where no one can demand from them. They do not have to live up to anyone else's expectations. But, damage from cocaine abuse clearly outweighs the good feeling that users get when they are high. It is a negative tool to avoid reality and responsibility. In between use, folks become irritable and anxious. And combined with other drugs it can be fatal. Although not a gateway drug, rarely do we meet clients who only use cocaine. Patients come to us when their life is out of control. When the cocaine/crack use has financially devastated them. And when they have alienated their family and friends in favor of their on-going affair with the drug. Cocaine abuse is a serious problem in America. We should not turn our heads and ignore it when family members use the drug. We should encourage them to get help before they lose everything that is important to them.

NURSE, HEAL THYSELF FIRST

In the past seven years I have treated dozens of nurses. Some have come to us for alcohol dependence. But the majority have been Opioid Dependent. That's correct. These professionals that we depend upon to hold our hands and minister to us when we are sick, are often very ill themselves.

They begin by taking Percocets for stress, then a little Oxycontin for back pain and many of them progress to Dilaudid to get through their shift. The sad part of this behavior is that they more often than not, they take medicine from their places of work - hospitals, nursing homes and even hospice. Some even substitute placebos for the actually pain medications, leaving their patients in distress.

Although this is the minority of people in the nursing profession, it still begs the question, WHY? Is the job too stressful? Do we not provide enough down time for our most valuable caregivers? Are there folks in the profession with no regard for a work ethic and who leave their co-workers to run back to back shifts because they feel like calling in sick? Do some people enter the profession with a predisposition towards drug addiction?

I do not have the answer. What I do know is that this is becoming a problem that we need to address. I also think that support for recovery is a better idea than punishment. We need nurses. They deserve our help, if not for humanitarian reasons, than at the very least because it is good Karma.

CHILDREN DRINKING AT HOME

This morning's special news segment addressed the question about whether or not parents should introduce alcohol in the home, so that children will understand how to drink when they reach majority age. The issue with the question posed, is that there is an assumption made, that parents themselves understand how to drink reasonably.

The problem is that children and teens are not physically capable of handling alcohol. Developmentally, they need pure foods such as fruits, nuts and vegetables, grass-fed beef and poultry, for brain growth. They do not need alcohol at a time when the brain is learning and expanding its knowledge base.

They also do not need to emulate the drinking behaviors of adults around them. Especially when most do not understand that a woman should drink a maximum of 3-4 (one ounce) drinks in an evening at most, and a man about 5 ounces. A standard size glass of wine in America is over the three ounces to begin with. And watching parents who come home and have a beer to relax each night sends a negative message that alcohol is an acceptable tool to use to unwind.

Whether the drinking age is 21 or 18, teaching people how to drink is a great idea. Waiting until the brain and body can handle alcohol is an even better idea!

MARIJUANA PARENTING

Today, I attended a conference that focused on the damage drugs and alcohol can do to the adolescent brain. Most people in the audience were not worried about the effects of marijuana; they were focused on alcohol and 'hard' drugs. In fact, some even defended the position the MA DCF has taken - that removal of children for parental abuse of marijuana is not going to happen.

Yet, these attendees learned today that marijuana may not be a 'gateway' in the traditional sense, but it is harmful nevertheless. It takes approximately 18-24 months for a person to stop depending upon marijuana after discontinuing abuse through harm reduction. And in fact, withdrawal really happens; including mood swings, depression and irritability during protracted withdrawal.

The adolescent brain is not fully formed and smoking marijuana at a young age impedes the user's ability to hold memories and interpret cognitions properly. Smoking causes cognitive distortions.

Developmentally , using drugs and alcohol does not allow the user to progress from adolescence to adulthood emotionally. They get stuck - something we refer to as arrested development.

Most young people begin smoking cannabis around 11 or 12 years old. Research demonstrates that if a 'father figure' is smoking in the home when a child is 6 years old, the child will most likely grow up smoking marijuana as well within 5 or 6years. That makes me wonder whose idea it was at DCF to decide not to consider marijuana as a serious issue.

Smoking marijuana is a serious issue. It is not the cannabis of the 1960's; but cannabis that is ten times stronger. It is not a joke, or a casual source of entertainment. It is a substitute for skills we have not taught our young people. Skills that will help them manage their lives in a more balanced way.

IS MARIJUANA A GATEWAY DRUG?

The question on most folk's minds about addiction is what is wrong with smoking marijuana. It is natural. There is no data on overdose by smoking. And most smokers agree that it is not addictive. While these things may be true, the real question is why do people continue to smoke cannabis on a daily basis. And why is there so much negative press?

The answer is that smoking marijuana changes the way we feel. It numbs us, it clouds our depression, it shifts our focus from everyday stresses to an ethereal experience which takes us out of ourselves. Is the substance itself addictive? NO. Is cannabis a gateway drug leading to more intense addiction and highly volatile drug behaviors? No. So what is the problem?

The problem is that we become attached, dependent and/or addicted to the feeling. To the escape and the method of detachment. Using this method on a daily basis keeps us from doing other things. It does not allow us to develop other coping mechanisms which we need to manage our lives. It prevents us from becoming involved in family and friendships. The loss that we experience is a loss of time. Something we cannot recover.

Marijuana may not be a gateway to other drug use. But it definitely is an obstacle to living life to the fullest.