Info Facts: Crack And Cocaine

Cocaine is a powerfully addictive stimulant drug. The powdered, hydrochloride salt form of cocaine can be snorted or dissolved in water and injected. Crack is cocaine that has not been neutralized by an acid to make the hydrochloride salt. This form of cocaine comes in a rock crystal that can be heated and its vapors smoked. The term "crack" refers to the crackling sound heard when it is heated.*

Regardless of how cocaine is used or how frequently, a user can experience acute cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke, which could result in sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest.

Health Hazards

Cocaine is a strong central nervous system stimulant that interferes with the reabsorption process of dopamine, a chemical messenger associated with pleasure and movement. The buildup of dopamine causes continuous stimulation of receiving neurons, which is associated with the euphoria commonly reported by cocaine abusers.

Physical effects of cocaine use include constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine's immediate euphoric effects, which include hyperstimulation, reduced fatigue, and mental alertness, depends on the route of administration. The faster the absorption, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of time a user feels high and increases the risk of addiction.

Some users of cocaine report feelings of restlessness, irritability, and anxiety. A tolerance to the "high" may develop—many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive to cocaine's anesthetic and convulsant effects without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, may lead to a state of increasing irritability, restlessness, and paranoia. This can result in a period of full-blown paranoid psychosis, in which the user loses touch with reality and experiences auditory hallucinations.

Other complications associated with cocaine use include disturbances in heart rhythm and heart attacks, chest pain and respiratory failure, strokes, seizures and headaches, and gastrointestinal complications such as abdominal pain and nausea. Because cocaine has a tendency to decrease appetite, many chronic users can become malnourished.

Different means of taking cocaine can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose. Ingesting cocaine can cause severe bowel gangrene due to reduced blood flow. People who inject cocaine can experience severe allergic reactions and, as with all injecting drug users, are at increased risk for contracting HIV and other blood-borne diseases.

Added Danger: Cocaethylene
When people mix cocaine and alcohol consumption, they are compounding the danger each drug poses and unknowingly forming a complex chemical experiment within their bodies. NIDA-funded researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine's euphoric effects, while potentially increasing the risk of sudden death.

Treatment

The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.

One of NIDA's top research priorities is to find a medication to block or greatly reduce the effects of cocaine, to be used as one part of a comprehensive treatment program. NIDA-funded researchers are also looking at medications that help alleviate the severe craving that people in treatment for cocaine addiction often experience. Several medications are currently being investigated for their safety and efficacy in treating cocaine addiction.

In addition to treatment medications, behavioral interventions—particularly cognitive behavioral therapy—can be effective in decreasing drug use by patients in treatment for cocaine abuse. Providing the optimal combination of treatment and services for each individual is critical to successful outcomes.

Extent of Use

Monitoring the Future (MTF) Survey **
Lifetime,*** annual, and 30-day cocaine use remained stable among all three grades in 2005. Perceived harmfulness of occasional use also remained stable in 2005, measuring at 65.3 percent among 8th-graders, 72.4 percent among 10th-graders, and 60.8 percent among 12th-graders.

Use of Cocaine in Any Form by Students, 2005:
Monitoring the Future Survey

8th-Graders 10th-Graders 12th-Graders Lifetime 3.7% 5.2% 8.0% Annual 2.2 3.5 5.1 30-Day 1.0 1.5 2.3

Crack Cocaine Use by Students, 2005:
Monitoring the Future Survey

8th-Graders 10th-Graders 12th-Graders Lifetime 2.4% 2.5% 3.5% Annual 1.4 1.7 1.9 30-Day 0.6 0.7 1.0

Community Epidemiology Work Group (CEWG)****
Cocaine-related death mentions in 2003 were particularly high in New York City/Newark, Detroit, Boston, and Baltimore, as measured by one Federal data source. Reports from local medical examiner data named Texas and Philadelphia as sites with the highest rates of cocaine-related deaths from 2003 through 2004.

Primary cocaine treatment admissions in 2004 accounted for 52.5 percent of treatment admissions, excluding alcohol, in Atlanta, 38.9 percent in New Orleans, and approximately 36 percent in Texas and Detroit.

National Survey on Drug Use and Health (NSDUH)*****
In 2004, 34.2 million Americans aged 12 and over reported lifetime use of cocaine, and 7.8 million reported using crack. About 5.6 million reported annual use of cocaine, and 1.3 million reported using crack. An estimated 2 million Americans reported current use of cocaine, 467,000 of whom reported using crack. There were an estimated 1 million new users of cocaine in 2004 (approximately 2,700 per day), and most were aged 18 or older although the average age of first use was 20.0 years.

The percentage of youth ages 12 to 17 reporting lifetime use of cocaine was 2.4 percent in 2004. Among young adults aged 18 to 25, the rate was 15.2 percent, showing no significant difference from the previous year. However, there was a statistically significant decrease in perceived risk of using cocaine once a month among Americans in the 12 to 17 age bracket in 2004.

Past month crack use was down for 16- or 17-year-olds but up for 21- to 25-year-olds; 21-year-olds also showed increases in past year use of both crack and cocaine.

Past month use of cocaine was down among females aged 12–17 and Asians 12 or older, but up among Blacks aged 18 to 25. There was a decrease in past year cocaine use measured among Asians aged 18 to 25.

Following a decline between 2002 and 2003, NSDUH data show an increase in the number of people receiving treatment for a cocaine use problem during their most recent treatment at a specialty facility, from 276,000 in 2003 to 466,000 in 2004.

Stop! Go! A Rogue System in the Brain

Summary

• Drug abuse damages a person's ability to make decisions.
• Healthy people have interacting systems in their brain that signal when to take action (go) and when to refrain (stop).
• A leading addiction researcher says that when someone is addicted, it's as if the "go" system is "running off on its own" instead of interacting with the "stop" system.

Our brain controls our decisionmaking, letting us know when to go forward with an action and when to stop. Scientists have learned which parts of the brain send these messages. And they know that for addicted people, these "stop" and "go" systems are impaired.

The brain's reward, or "go" system, is basic to all humans. Called the mesolimbic dopamine system, it evolved to help us pursue things necessary for survival such as food or sex. Conversely, the brain's frontal lobes or "stop" system evolved to help us weigh the consequences of our impulses. For example, this system will help keep us from driving through a red light when we're in a hurry, because the brain will tell us that doing so would be both dangerous and illegal. In this case, the "stop" system sends a message that the consequences of doing what the "go" system wants are too negative.

"When things are working right, the 'go' circuitry and the 'stop' circuitry really are interconnected and are really talking to each other to help you weigh the consequences of a decision and decide when to go or not to go," says Dr. Anna Rose Childress, a psychology researcher at the University of Pennsylvania. "It's not that they're separable. They're interactive. They're interlinked at all times." That means that even when you are in a great hurry and risk missing an appointment, you still do not run the red light. "Go" and "stop" have communicated with each other, and "stop" has prevailed.

With Childress's addicted patients, however, "it is as though [the systems] have become functionally disconnected. It is as though the 'go' system is sort of running off on its own, is a rogue system now, and is not interacting in a regular, seamless, integrated way with the 'stop' system."

When an addicted person, even one who is working to recover, gets certain signs, or triggers, such as conflict with a companion, the "go" system overwhelms the part of the brain that's telling them, "Stop! This is a very bad idea!" The trigger can be something essential to the addicted person's life: one recovered writer realized that his addiction was partly triggered by the deadline pressure of his chosen profession as a journalist, and was prompted to start a new career; other recovering people often move from their old neighborhoods to be away from triggers. But a trigger can also be something as subtle as a scent that reminds a person of the place where they used to buy drugs.

When that trigger surfaces, Childress says, "instead of being able to say, 'What? Wait a minute. Think about what happened last week. You lost your job. You almost lost your life,' the 'stop' system doesn't seem to get into the picture at all. It's all about 'go.'"

Recovery and Relapse inventory worksheet

Recovery and Relapse inventory worksheet

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

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

Recovery and Relapse inventory worksheet

1) what fear did your relaps create?

2) what guilt did it bring?

3) what regret did it create?

4) what harm did you do to yourself?

5) what harm did you do to others?

6) what financial harm was done?

7) what relationship damage was done?

what did it do to your self esteem?

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

10) what other problems did your using create?

Read recovery and relapse every day for a month.

The chapter says a relapse means we are holding on to

Reservations.

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

you identify any reservations?

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

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

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

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

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

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

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

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

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

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

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

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

How did my behavior change? In what ways?

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

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

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

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

List them:

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

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

What active actions can I take to promote my recovery?

How does my behavior need to change?

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

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

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

What does a complete surrender mean to me?

Nebraska Drug News

Nebraska Drug News

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

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

“We felt it was important to notify the public that the trash you might as a Good Samaritan be out picking up on the side of the road could possibly be dangerous to you,” says Lt. John Eichkorn of the Kansas Highway Patrol. The agency issued a news release in March that warned volunteers and highway cleanup crews.
advertisement

Bystanders who come across materials used to make the drug can be burned or their lungs damaged from inhaling fumes. Clues indicating a dumpsite include empty bottles attached to a rubber hose, the smell of ammonia and coffee filters stained red or containing a white powder residue.

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

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

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

Among actions:

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

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

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

Managing alcoholism as a disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Heroin Addiction

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

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

What is Heroin?

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

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

How is Heroin Used?

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

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

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

Consequences of Heroin Use

Short-Term Effects

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

Long-Term Effects

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

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

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

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

What are the Treatments for Heroin Addiction?

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

Detoxification

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

Methadone programs

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

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

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

LAAM and other medications

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

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

Behavioral therapies

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

What are the Opioid Analogs and their Dangers?

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

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

Character Defects

Step 4 Made a searching and fearless moral inventory of ourselves. Step Four as used my Alcoholics anonymous Narcotics anonymous Cocaine anonymous Overeaters anonymous Emotions anoymous Al-anon Sex and love addicts anonymous Gamblers anonymous recovery program. Step four, Took a fearless moral inventory, 12 step recovery program.

Doing this step four I can write honestly, it made me realise why I had suffered, and what the cause of that suffering was!

Moral means; " A standard". So I had to look at my standards for myself, and the standards I had set other people (THE CAUSE OF SO MUCH RESENTMENT).

My sponsor suggested that I list all of my guilt’s, resentments, fears and sexual conduct because between these I would find the cause of my emotional pain or spiritual dis-ease, call it what you will.

Why do this step?. Well, if you are a product of your past and you are unhappy now, then something has gone wrong in the past!. If you have spent, drank, used drugs, eaten to get away from bad feelings, then it is suggested you look at the cause of these bad feelings.

There is a cliché that says, “The straw that broke the camels back”. Well, taking a fearless moral inventory takes straws off our backs; it makes life less of a burden. It lightens the load!.

When you are full of resentment it is like farting, everyone close to you gets a whiff!.

But when you are on a spiritual path it is like wearing a lovely perfume, everyone close to you gets a whiff!.

The idea of a fearless moral inventory is to start to see what is in our character that causes triggers for resentment, guilt, and fear from other people to us or us to other people.

It is about learning not to over react!. A word that flies off the tongue is like an arrow leaving a bow for a target!.

If you are an angry or resentful person then the following list of defects of character are the cause of your pain!. Without these defects you will have peace of mind!.

Simple!. Learn the cause and effect, and then learn to practice opposites, result peace of mind; and that is what it is all about. Practice opposites.

The following defects are the cause of resentment, anger and hatred. Anger is not a defect of character. If someone attacks you, you have to be angry to save your life!. But if your anger is caused by one of the following defects of character, then that is self-righteous anger which means that we will always suffer, until we see the true cause of our Dis-ease. For Books About Step 4 Click here

THE CAUSE OF SUFFERING OR DEFECTS OF CHARACTER.

PRIDE – HIGH OPINION OF ONES OWN QUALITIES, MERITS OR CONDUCT.

Does pride stop you saying sorry, or asking for help?

Does your pride say “The best way not to fail, is not to try?”

A prisoner of peoples opinions that can lead us to overreact, or not to do anything because of “what will people will think”.

Healthy price, makes us act in a way that is caring to ourselves and other people. It is a good sense of well being knowing that you have tried your best (you may of even failed, but you tried!).

IMPATIENCE – Not enduring!. Wanting everything now.

HEALTHY IMPATIENCE – When your sick of being the way you are! And want to change now!

INTOLERANCE – Not able to endure opinions, beliefs, or actions.

HEALTHY INTOLERANCE – When your endurance of your habit, drinking, taking drugs or letting people walk all over you stops!

ENVY – Resentful of more fortunate people. Their health, looks, intelligence or ways.

HEALTHY ENVY – When it turns to admiration!

JEALOUSY – The fear of being out done, suspicious, dislike of someone who you see as better than you, wealthy, women, looks. The fear of being replaced by another! Seeing people as rivals.

HEALTHY JEALOUSY - Makes you treat people well!, or they will go elsewhere.

SELFISHNESS - Doing your own desires or interests without caring how it effects other peoples emotions or life.

HEALTHY SELFISHNESS - Doing what’s best for you! Not being a prisoner of peoples opinions.

SELF-PITY - A feeling of being hard done by!. Poor me.

HEALTHY SELF PITY - “People have hurt me, people have used me, people have stolen from me, people have abused me, but I am not going to resent, I am going to enjoy life and learn from the experience of the past".

SELF-CENTEREDNESS - Pre-occupied with your own ways and actions, not caring about other people.

HEALTHY SELF

CENTEREDNESS - When you stop being a door mat, and stand up for what is right for you!

ARROGANCE - I am right and you are wrong! Tending never to listen, but to argue, and to believe that you are always right. What is an argument? A billion ways to say “I am right and you are wrong”.

HEALTHY ARROGANCE - What you think of me does not matter, humility when you think, “Does it matter?”.

SLOTH - Slow or absence of activity. When actions should be done.

HEALTHY SLOTH - Taking time out of the rat race and relaxing, meditating, contemplating!

DISHONESTY - DECEITFULNESS, FRAUDULENT, LACK OF HONOUR (before you resent, ask, “Have I ever done anything similar in my life for what I am going to resent that person for?”)

HEALTHY DISHONESTY - Is when a friend says “Do you think that I am fat and ugly?” and you say “No!”, even though you know different.

LUST - Animal desire for sexual indulgence!. To want passionately.

HEALTHY LUST - I want peace of mind, I want to live a blameless life!. Or a romantic weekend.

GREED - To want more than is needed.

HEALTHY GREED - To have peace of mind, and to then want more.

INTO ACTION

It is best to start with listing your resentments, my sponsor suggested to do it this way. List each resentment separately, never write the word "and" (between each resentment) because it is another resentment.

List Each Resentment For Books About Resentment Click here

WHO

WHY

DEFECTS

This after listing MY defects here I started to see how much power I had given people!. I started to see that it is not the action of other people, but MY reaction is the cause of your resentment/emotional pain.

Remember that "moral" means standards you have from yourself or other people.

A FEW EXAMPLES OT TAKING A MORAL INVENTORY

RESENTMENT

WHO

John WHY

He chatted my wife up

DEFECTS

Self Pity (How could he do that to me?).

Jealousy (The fear of being replaced by another).

Dishonesty (Have I ever chatted anyone up? Have I ever been unfaithful?).

This resentment can be undone by thinking “Is my wife with me now?”.

Or

“Well, to be honest, I have chatted up other men’s wives and girlfriends”.

RESENTMENT

WHO

Fred

WHY

He came into work late, he is always doing it, I have to do more work and the boss gets angry

DEFECTS

Impatience, Self Pity, Dishonesty.

Impatience – I want him to be on time

Self Pity – Poor me

Dishonesty – Have I ever been late?

RESENTMENT

WHO

Mary

WHY

She dumped me for someone else

DEFECTS

Self Pity, Pride, Self-centredness, Dishonesty.

Self Pity – Poor me, how could she doe that to me?.

Pride – What will people think?.

Dishonesty – Have I ever finished with anyone?.

Self-Centeredness – You are only thinking of your happiness, in fact you want to take her prisoner!.

If you look at this resentment you will see the cause of the reaction, I resented Mary because she finished with me, but had I ever finished a relationship?, Yes, would I have liked her to resent you? Would you have wanted her to put emotional handcuffs on you?, No. Then don’t do it to her!.

Dishonesty is resenting someone for something that you have done yourself.

When you look at the right hand column you start to see the real problem and that peace of mind will not come if you hang on to your resentments. Practice the opposite of the defect box and peace and freedom will flow in!.

In short, I may of had the worst childhood, or the worst parents/wife/girlfriend. They may have abused me psychologically or sexually by resenting, by hating them, they are still abusing me!. We have to learn to accept our past. That does not mean I agree, but I stop hurting myself by making the mind spin around by wanting my life to be different!. That is the cause of my emotion, wishing it had been different.

Again I had to learn that if I wanted peace of mind, acceptance is the key to the doorway that will lead me out of misery!. I owe it to myself to let the past go.

If someone walked into the room now and hit you on the head with a hammer and then dropped the hammer on the floor and ran out, would you pick the hammer up and carry on hitting yourself, no, it would be madness, but with resentment we do carry on doing it to ourselves. Remember, resentment means to re-feel!! So we re-feel every time we hate them, resent them, despise them or want to get back at them. They have won!. You are still suffering. Ask yourself how many weeks, months, years that you have had this resentment! Let it go.

If you hair went on fire now you would rush to water and put the fire out. But because of your instincts to survive or self preserve would kick in and take over. But with resentment we watch the fire and blame someone for lighting it!. They are at fault, look what they did to me all those years ago.

see http://www.the12steps.com

FEAR It was suggested to me that I should list all of my fears. Just like I did my resentments.

FEARS

People

Death

WHY

I think they will see me blush

I don’t want to die

DEFECTS

Pride, Self Pity!, Arrogance

Pride – What people think of me?.

Self Pity – They will laugh at me and I will run away.

Arrogance - Who am I to be laughed at?.

Self Pity

Self Pity – Poor me, I am going to die.

This is one of the biggest fears I have come access in my time whilst going through and doing the steps with people.

Self-Pity is the trigger!.

Acceptance sets you free. Think that every time you become obsessed with death, you are killing your joy for life. Say to yourself, “Am I alive now?”.- If you are, enjoy your life, help people, try and get out of self-obsession.

A Buddhist way of getting over the fear of death is by meditation on your own death. We will cover this in step 11.

I once said to a Buddhist monk, “I am scared of dying, what can I do?”. He said “You are going to be very disappointed one day!” That was my answer, ACCEPTANCE.

SEXUAL CONDUCT

It was suggested to me that I list all of my sexual exploits and see if my pursuit of sex had lead me to be selfish, dishonest, had it caused resentment – had I taken chances where I could of caught some dis-ease, had I effected my dignity or someone else's?.

The idea behind this is to look, and to see that a bit of hugging, puffing and a few squelching noises, I put a lot of effort into the pursuit of it.

In short list, your sexual exploits and weigh it up.

If you are frigid, talk about!.

GUILT

It was suggested to me that I list all of my guilt's. When I wrote them down it seemed that I resented myself!. I could write forever about guilt, but I will keep it very short.

I wrote my guilt’s down. I soon learnt that "Guilty" was not a punishment from God, but a feeling that was telling me that what I did in the past was not my true character, if it had of been, I would not be feeling guilty!. So I became willing to make amends (See Steps 8 and 9) and that I did.

Guilt is alright before the event when the head thinks “If I do that I will not feel right because I will hurt someone”. So that is what guilt is about, stopping you doing something that will cause harm. So look at your guilt's. Make amends, where needed and forget it!. (I bet your thinking, "It's alright for you, but if you had my Catholic, Jewish, Muslim etc, guilt", you would be tormented). Well I was tortured by guilt but I am not now!. Why, because I did what my sponsor said, and truly realised that guilt was not a punishment but a feeling telling me that what I did at that time was a combination of what was going on in my life at that time!. It was telling me it was not my true character!

In short, drop your guilt as you would a ton weight on your shoulders, because the longer you carry it the more damage it does, and in the end you will buckle under the weight.

http://www.the12steps.com

I am known by in the 12 step fellowships I belong to as soldier Billy. I am a recovering alcoholic and addict. I owe my life to the 12 step recovery program. I have been through some very tough times of late and I have not relapsed back into addiction thanks to the help of the 12 steps and some great members of the fellowships I belong to! I have lived a tough life amd know heartache. The 12 steps has helped me to rebuild my life and find some peace of mind.