Tag Archives: Drug Addiction

Journal of the American Medical Association special report: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

15 Mar

HELPGUIDE.ORG defines substance abuse and also describes some of the traits of a substance abuser.

Drug abuse, also known as substance abuse, involves the repeated and excessive use of chemical substances to achieve a certain effect. These substances may be “street” or “illicit” drugs, illegal due to their high potential for addiction and abuse. They also may be drugs obtained with a prescription, used for pleasure rather than for medical reasons.
Different drugs have different effects. Some, such as cocaine or methamphetamine, may produce an intense “rush” and initial feelings of boundless energy. Others, such as heroin, benzodiazepines or the prescription oxycontin, may produce excessive feelings of relaxation and calm. What most drugs have in common, though, is overstimulation of the pleasure center of the brain. With time, the brain’s chemistry is actually altered to the point where not having the drug becomes extremely uncomfortable and even painful. This compelling urge to use, addiction, becomes more and more powerful, disrupting work, relationships, and health. http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

In a 2014 article the National Institute on Drug Abuse took a cautious approach in linking pain killers and drug abuse.

The National Institute on Drug Abuse wrote in Abuse of Prescription Pain Medications Risks Heroin Use:

Text Description of Infographic

In 2010 almost 1 in 20 adolescents and adults – 12 million people – used prescription pain medication when it was not prescribed for them or only for the feeling it caused.  While many believe these drugs are not dangerous because they can be prescribed by a doctor, abuse often leads to dependence.  And eventually, for some, pain medication abuse leads to heroin.

Top Figure: 1 in 15 people who take non medical prescription pain relievers will try heroin within 10 years.

Left  Graph: Number of people who abused or were dependent on pain medications and percentage of them that use heroin.  Pie charts show in 2004 1.4 million people abused or were dependent on pain medications and 5% used heroin. In 2010, 1.9 million people abused or were dependent on pain medications and 14% used heroin.

Right Top Graph:  Heroin users are 3 times as likely to be dependent.  14% of non medical prescription pain reliever users are dependent. Yet, 54% of heroin users are dependent.

Right Bottom Graph:  Heroin emergency room admissions are increasing.  In 2005 there were less than 200,000 emergency room visits related to heroin. By 2011 this number had increased to almost 260,000….https://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use

The CDC issued new recommendations regarding prescribing pain medication.

Kimberly Leonard of U.S. News wrote in Getting a Painkiller from a Doctor Is About to Get Harder:

Government health officials on Tuesday provided strategies for primary care doctors who treat patients suffering from chronic pain. Among the recommendations: to use urine drug testing before prescribing highly addictive painkillers like oxycontin, codeine and morphine.

The guidance, put forth by the Centers for Disease Control and Prevention, is part of the government’s response to the epidemic of people dying from opioid overdoses, which include prescription painkillers but also the drug’s cheaper alternative, heroin. Data from the CDC show that in 2014 these deaths surpassed car accidents as the No. 1 cause of injury-related death.

For the most part, the CDC recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. Primary care doctors have been in part responsible for the surge in addiction: Since 1999, the prescribing and sales of opioids has quadrupled, and primary care doctors account for nearly half of these prescriptions….                                                                                                           http://www.usnews.com/news/articles/2016-03-15/cdc-issues-guidance-on-prescription-painkillers

Citation:

Special Communication | March 15, 2016

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 FREE ONLINE FIRST

Deborah Dowell, MD, MPH1; Tamara M. Haegerich, PhD1; Roger Chou, MD1

[+] Author Affiliations

JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.1464

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ABSTRACT

ABSTRACT | INTRODUCTION | GUIDELINE DEVELOPMENT PROCESS | RECOMMENDATIONS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.

Objective  To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Process  The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.

Evidence Synthesis  Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.

Recommendations  There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.

Conclusions and Relevance  The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Here is the recommendation for patients from LeShaundra Cordier Scott, MPH, CHES; Sarah Lewis, MPH, CHES:

RECOMMENDATIONS FOR SAFER AND MORE EFFECTIVE PAIN MANAGEMENT

A JAMA article was published online on March 15, 2016, describing a new Centers for Disease Control and Prevention opioid prescribing guideline for chronic pain. The guideline provides recommendations based on available science for safer, more effective treatment of chronic pain outside of active cancer, palliative care, and end-of-life care.

The recommendations ask health care practitioners to

  • Use nonopioid medications and other therapies such as physical therapy instead of or in combination with opioids.
  • Prescribe the lowest effective dosage of opioids to reduce risks of opioid use disorder and overdose.
  • Discuss potential benefits and harms of opioids with patients.
  • Assess improvements in pain and function regularly.
  • Use tools such as urine drug tests and prescription drug monitoring programs to inform themselves about patients’ other medications that increase risk.
  • Monitor patients for signs of whether opioid use disorder might be developing and arrange treatment if needed

 

WHAT YOU CAN DO

 

If you have chronic pain, be sure to

  • Consider ways to manage your pain that do not include opioids, such as physical therapy, exercise, nonopioid medications, and cognitive behavioral therapy.
  • Make the most informed decision with your doctor.
  • Never take opioids in greater amounts or more often than prescribed.
  • Avoid taking opioids with alcohol and other substances or medications you have not discussed with your doctor.

If you or someone close to you has an addiction to pain medication, talk to your doctor or contact the Substance Abuse and Mental Health Services Administration’s treatment help line at (800) 662-HELP.

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Published Online: March 15, 2016. doi:10.1001/jama.2016.3224.

Here is the press release from the American Medical Association:

March 15, 2016

AMA Responds to CDC Guidelines on Opioids

For immediate release:
March 15, 2016

CHICAGO – In response to the Centers for Disease Control and Prevention (CDC) guidelines issued today, the American Medical Association (AMA) noted its shared goal of reducing harm from opioid abuse and seeking solutions to end this public health epidemic and applauds the agency for making the issue a high priority. As with any guideline development of this magnitude, we appreciated the opportunity to add the voice of patients and physicians.

“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care,” said Patrice A. Harris, MD, the AMA board chair-elect and chair of the AMA Task Force to Reduce Opioid Abuse.

“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”

###

Media Contact:
Jack Deutsch
AMA Media & Editorial
202-789-7442
Jack.Deutsch@ama-assn.org

If you or a member of your family is prescribed pain medication, the course of treatment should follow CDC recommendations.

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Yale research: Why some adolescents are more easily addicted to cocaine?

22 Feb

Yale researchers examined why cocaine affects some adolescents more profoundly than others. Bill Hathaway writes in the Yale News article, Cocaine and the teen brain: Yale research offers insights into addiction:

When first exposed to cocaine, the adolescent brain launches a strong defensive reaction designed to minimize the drug’s effects, Yale and other scientists have found. Now two new studies by a Yale team identify key genes that regulate this response and show that interfering with this reaction dramatically increases a mouse’s sensitivity to cocaine. 

The findings may help explain why risk of drug abuse and addiction increase so dramatically when cocaine use begins during teenage years.

The results were published in the Feb. 14 and Feb. 21 issues of the Journal of Neuroscience.

Researchers including those at Yale have shown that vulnerability to cocaine is much higher in adolescence, when the brain is shifting from an explosive and plastic growth phase to more settled and refined neural connections characteristic of adults. Past studies at Yale have shown that the neurons and their synaptic connections in adolescence change shape when first exposed to cocaine through molecular pathway regulated by the gene integrin beta1, which is crucial to the development of the nervous system of vertebrates.

This suggests that these structural changes observed are probably protective of the neurocircuitry, an effort of the neuron to protect itself when first exposed to cocaine,” said Anthony Koleske, professor of molecular biophysics and biochemistry and of neurobiology and senior author of both papers.

In the latest study, Yale researchers report when they knocked out this pathway, mice needed approximately three times less cocaine to induce behavioral changes than mice with an intact pathway.

The research suggests that the relative strength of the integrin beta1 pathway among individuals may explain why some cocaine users end up addicted to the drug while others escape its worst effects, Koleske theorized.

If you were to become totally desensitized to cocaine, there is no reason to seek the drug,” he said.

Koleske and Jane R. Taylor, professor of psychiatry and psychology and an author of the Feb. 14 paper, are teaming up with other Yale researchers to look for other genes that may play a role in protecting the brain from effects of cocaine and other drugs of abuse.

http://news.yale.edu/2012/02/21/cocaine-and-teen-brain-yale-research-offers-insights-addiction

For the true policy wonks, here is the citation:

Journal of Neuroscience

Integrin β1 Signals through Arg to Regulate Postnatal Dendritic Arborization, Synapse Density, and Behavior

  1. M. Sloan Warren
  2. William D. Bradley
  3. Shannon L. Gourley
  4. Yu-Chih Lin
  5. Mark A. Simpson
  6. Louis F. Reichardt
  7. Charles A. Greer
  8. Jane R. Taylor
  9. Anthony J. Koleske

Abstract

Often children who evidence signs of a substance abuse problem come from homes where there is a substance abuse problem. That problem may be generational. eMedicineHealth lists some of the causes of substance abuse

Substance Abuse Causes

Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years. Certain risk factors may increase someone’s likelihood to abuse substances.

·         Factors within a family that influence a child’s early development have been shown to be related to increased risk of drug abuse.

o                       Chaotic home environment

o                       Ineffective parenting

o                       Lack of nurturing and parental attachment

·         Factors related to a child’s socialization outside the family may also increase risk of drug abuse.

o                       Inappropriately aggressive or shy behavior in the classroom

o                       Poor social coping skills

o                       Poor school performance

o                       Association with a deviant peer group

o                       Perception of approval of drug use behavior

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self esteem. Dr. Alan Leshner summarizes the reasons children use drugs in why do Sally and Johnny use drugs?

How Can You Recognize the Signs of Substance Abuse?

Parents provides general signs of substance abuse and also gives specific signs of alcohol abuse, and several different drugs, narcotics, and inhalants. The general warning signs are:

·         Changes in friends

·         Negative changes in schoolwork, missing school, or declining grades

·         Increased secrecy about possessions or activities

·         Use of incense, room deodorant, or perfume to hide smoke or chemical odors

·         Subtle changes in conversations with friends, e.g. more secretive, using “coded” language

·         Change in clothing choices: new fascination with clothes that highlight drug use

·         Increase in borrowing money

·         Evidence of drug paraphernalia such as pipes, rolling papers, etc.

·         Evidence of use of inhalant products (such as hairspray, nail polish, correction fluid, common household products); Rags and paper bags are sometimes used as accessories

·         Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils

·         New use of mouthwash or breath mints to cover up the smell of alcohol

·         Missing prescription drugs—especially narcotics and mood stabilizers

Remember, these are very general signs, specific drugs, narcotics, and other substances may have different signs, it is important to read the specific signs.

What Steps Should a Parent Take?

The Drug Enforcement Agency (DEA) has a series of questions parents should ask If you suspect that your child has a substance abuse problem, you will have to seek help of some type. You will need a plan of action. The Partnership for a Drug Free America lists 7 Steps toTake and each step is explained at the site.

Parents, grandparents and other family members often feel tempted to wait things out and see if they get better. Sometimes they confront the child only to be accused of being distrustful or they hear angry denial, leaving them more confused than before.

It is important to remember that you don’t have to do it alone. Following are crucial steps that will ease getting help for you and your child.

1. Involve a professional to help determine what to do next….

2. Document as much evidence as you can.

§         Use checklists to record all the behaviors that concern you. Carefully record every behavior that concerns you during this period. Documenting your observations is important because your child will work hard to convince you that things didn’t happen the way you remember.

§         Some parents search their child’s room looking for evidence of drugs or paraphernalia. You should expect that your child will be offended at your invasion of privacy. If you do find contraband, oftentimes your child will claim that it belongs to someone else…..

3. Prepare what you want to say to your child….

4. Plan to talk with your child at a time in a setting where you can have uninterrupted discussion. Strengthen your interaction by using the following talking points:

§         Describe specific behaviors you and others have observed and when they occurred. The more specific you are, especially if you have written your observations down, the harder it will be for your child to deny, disagree, or argue.

§         Express your love and concern and your desire to help your child.

§         Emphasize your firm, non-negotiable position that you will not tolerate drug use and that you intend to determine if these behaviors are indications of drug use.

§         It is not useful simply to ask if your child if he or she is using drugs. Almost always, children will deny using. But it’s not a bad idea to voice your suspicions at some point.

§         If you haven’t observed very many warning signs and believe that your child has just begun using, emphasize that any use of alcohol or other drugs at all is unacceptable. Describe the consequences for further behaviors that concern you. Use strong leverage; consequences might include no driver’s license, no use of the family car, an earlier curfew. ….

5. Make an appointment for a drug assessment for your child.

§         A drug assessment is the surest way to determine the extent of your child’s problem with alcohol and other drugs. When you make the appointment, make sure that the agency understands that the evaluation is for an adolescent; also that the evaluation includes a drug test. Don’t alert your child that a drug test will be part of the assessment…..

6. Keep the appointment no matter what.

7. Don’t give up if things don’t go the way you want — go the distance.

§         If ignored, alcohol-other-drug use will progress. Your efforts to this point have been an effective intervention. Hopefully, it will work early on. Often, parents have to continue to discuss the situation with the child, document evidence and work with other significant adults in the child’s life to turn things around. This difficult intervention may take more time than you want. Persevere.

§         Get help for yourself. Parent support groups such as Families Anonymous, Tough Love, and Alanon can provide effective help as you strive to provide effective help to your child.

If your child has a substance abuse problem, both you and your child will need help. “One day at a time” is a famous recovery affirmation which you and your child will live the meaning. The road to recovery may be long or short, it will have twists and turns with one step forward and two steps back. In order to reach the goal of recovery, both parent and child must persevere.

Dr. Wilda says this about that ©

A cautionary tale: Riding the 71 bus and the death of Whitney Houston

11 Feb

This is a portion of the Seattle Times article, Whitney Houston, superstar of records, films, dies:

Houston’s publicist, Kristen Foster, said the cause of death was unknown.

Rosen said police received a 911 call from hotel security about Houston at 3:43 p.m. Saturday. Paramedics who were already at the hotel because of a Grammy party unsuccessfully tried to resuscitate the singer, he said.

Houston’s end came on the eve of music’s biggest night – the Grammy Awards. It’s a showcase where she once reigned, and her death was sure to cast a heavy pall on Sunday’s ceremony…

At her peak, Houston was the golden girl of the music industry. From the middle 1980s to the late 1990s, she was one of the world’s best-selling artists. She wowed audiences with effortless, powerful, and peerless vocals that were rooted in the black church but made palatable to the masses with a pop sheen….

But by the end of her career, Houston became a stunning cautionary tale of the toll of drug use. Her album sales plummeted and the hits stopped coming; her once serene image was shattered by a wild demeanor and bizarre public appearances. She confessed to abusing cocaine, marijuana and pills, and her once pristine voice became raspy and hoarse, unable to hit the high notes as she had during her prime.

“The biggest devil is me. I’m either my best friend or my worst enemy,” Houston told ABC’s Diane Sawyer in an infamous 2002 interview with then-husband Brown by her side.

It was a tragic fall for a superstar who was one of the top-selling artists in pop music history, with more than 55 million records sold in the United States alone.

She seemed to be born into greatness. She was the daughter of gospel singer Cissy Houston, the cousin of 1960s pop diva Dionne Warwick and the goddaughter of Aretha Franklin....http://seattletimes.nwsource.com/html/entertainment/2017485885_apusobitwhitneyhouston.html

The 71 bus was crowded, it usually is. The run is from downtown to the university district. I don’t know how many thousands attend the University of Washington, but they all seem to be riding the bus at the same time. It promised to be an uneventful trip from city center to the “district.”

I was at the end of a seat because my seatmate took over half the bench seat. But, I was happy to be sitting down and not be a strap hanger. I just wanted to close my eyes and think about nothing in particular. The gangly, black guy across from me, said “hey, did you know that Whitney Houston died?” I said that that was the first I had heard about her death. Then I asked, drugs? He said “yeh, probably, but nobody said nothing about it.” I said I wondered what causes people to start with drugs. He began to tell me his story.

At this point, I didn’t know his name or even why he began talking to me. He said that he had taken just about every drug imaginable and had even come back from the dead a couple of times. He once had a wife, children, and other family. He had made a lot of money in the fishing industry in Alaska in the 70’s. Proudly he told me about managing a team of over 75 and being respected for that. “That was something for a black man in the 70’s.” he said he made over $1400 per week back then. What happened, I said. “We were young, reckless, and we wanted to try everything because we thought nothing could touch us.” Eventually he was using heavily and began dealing to support his habit. Other members of his family including his wife were using as well.

He asked me if I worked for METRO, the local bus company. No, I said, I’m a writer. Why did you think I worked for METRO? “Because your jacket has the METRO colors.” I’m guessing he probably likes hitting on bus drivers. The conversation continued. How do you get out of the drug life, I asked. “You die, you relapse, you struggle.” He talked about his struggles. The fact that the AA he liked to attend because it was a small group folded and how hard it was for him to go to a bigger group of thirty or so. Why, I asked. “Because out of thirty folks, about ten of them will relapse and that is discouraging.” He is currently on methadone and his tests have been coming up clean. Now, “I just want to tell the truth, I just want a real life.”

His bus stop approached. I asked him if I could have his first name and whether it would be OK if I wrote about his story. “My name is Ron and I just might read your blog.”

I’m guessing, Ms. Houston never made it to the point where she just wanted to tell the truth.

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New study about substance abuse and kids

9 Nov

Huffington Post is reporting on a new study which looks at substance abuse among adolescents in the article, Teen Drug And Alcohol Use Lowest Among Blacks, Asians:

“There is certainly still a myth out there that black kids are more likely to have problems with drugs than white kids, and this documents as clearly as any study we’re aware of that the rate of … substance-related disorders among African American youths is significantly lower,” Dan Blazer from Duke’s Department of Psychiatry, a senior author of the study, told the Raleigh News & Observer….

Few teens used heroin, but of those who reported use, a quarter were using it abusively. Teens reported using marijuana more than any other drug, with 13 percent of those surveyed reporting marijuana use in the last year, followed by 7 percent reported having used prescription pain killers.

“A lack of cultural competence is identified as a major gap, as insensitivity to cultural differences can limit the ability to treat and retain minority adolescents,” the researchers write in their report. “Taken together, these findings call for efforts to identify and expand prevention measures that are culturally effective and address the quality and acceptability of treatment for adolescents with substance use problems.”

A separate report released in June supported previous research that early substance use affects the likelihood of abuse in adulthood. The study, by the National Center on Addiction and Substance Abuse at Columbia University showed that 90 percent of Americans who are current substance abusers started using drugs or alcohol before they turned 18.

http://www.huffingtonpost.com/2011/11/08/teen-drug-and-alcohol-use_n_1082219.html?ref=education

What is Substance Abuse?

HELPGUIDE.ORG defines substance abuse and also describes some of the traits of a substance abuser. Although, the focus of this article is children and teens who abuse various substances, there is a widespread problem with their parents and caretakers. A recent report found that many children live with parents who are substance abusers

Often children who evidence signs of a substance abuse problem come from homes where there is a substance abuse problem. That problem may be generational. eMedicineHealth lists some of the causes of substance abuse.

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self esteem. Dr. Alan Leshner summarizes the reasons children use drugs in why do Sally and Johnny use drugs?

How Can You Recognize the Signs of Substance Abuse?

Parents provides general signs of substance abuse and also gives specific signs of alcohol abuse, and several different drugs, narcotics, and inhalants. The general warning signs are:

·         Changes in friends

·         Negative changes in schoolwork, missing school, or declining grades

·         Increased secrecy about possessions or activities

·         Use of incense, room deodorant, or perfume to hide smoke or chemical odors

·         Subtle changes in conversations with friends, e.g. more secretive, using “coded” language

·         Change in clothing choices: new fascination with clothes that highlight drug use

·         Increase in borrowing money

·         Evidence of drug paraphernalia such as pipes, rolling papers, etc.

·         Evidence of use of inhalant products (such as hairspray, nail polish, correction fluid, common

household products); Rags and paper bags are sometimes used as accessories

·         Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils

·         New use of mouthwash or breath mints to cover up the smell of alcohol

·         Missing prescription drugs—especially narcotics and mood stabilizers

Remember, these are very general signs, specific drugs, narcotics, and other substances may have different signs, it is important to read the specific signs.

What Steps Should a Parent Take?

The Drug Enforcement Agency (DEA) has a series of questions parents should ask 

If you suspect that your child has a substance abuse problem, you will have to seek help of some type. You will need a plan of action. The Partnership for a Drug Free America lists 7 Steps to Take and each step is explained at the site.

If your child has a substance abuse problem, both you and your child will need help. “One day at a time” is a famous recovery affirmation which you and your child will live the meaning. The road to recovery may be long or short, it will have twists and turns with one step forward and two steps back. In order to reach the goal of recovery, both parent and child must persevere.

Questions to Ask a Treatment Facility

The U.S. Department of Health and Human Services, Center for Substance Abuse Treatment (Center), lists the following questions that should be asked of a treatment center. Assuming you are not one of those ill-advised parents who supply their child with alcohol or drugs like marijuana in an attempt to be hip or cool, suspicions that your child may have a substance abuse problem are a concern. Confirmation that your child has a substance abuse problem can be heartbreaking. Even children whose parents have seemingly done everything right can become involved with drugs. The best defense is knowledge about your child, your child’s friends, and your child’s activities

Resources

Adolescent Substance Abuse Knowledge Base

Warning Signs of Teen Drug Abuse

Is Your Teen Using?

Al-Anon and Alateen

Center for Substance Abuse Publications

National Clearinghouse for Drug and Alcohol Information

WEBMD: Parenting and Teen Substance Abuse

The U.S. Department of Health and Human Services has a very good booklet for families What is Substance Abuse Treatment?

The National Institute on Drug Abuse (NIDA) has a web site for teens and parents that teaches about drug abuse NIDA for Teens: The Science Behind Drug Abuse

Here is the citation to the study:

Racial/Ethnic Variations in Substance-Related Disorders Among Adolescents in the United States

Li-Tzy Wu, ScD; George E. Woody, MD; Chongming Yang, PhD; Jeng-Jong Pan, PhD; Dan G. Blazer, PhD, MD

Arch Gen Psychiatry. 2011;68(11):1176-1185. doi:10.1001/archgenpsychiatry.2011.120

Results  Of 72 561 adolescents aged 12 to 17 years, 37.0% used alcohol or drugs in the past year; 7.9% met criteria for a substance-related disorder, with Native Americans having the highest prevalence of use (47.5%) and disorder (15.0%). Analgesic opioids were the second most commonly used illegal drugs, following marijuana, in all racial/ethnic groups; analgesic opioid use was comparatively prevalent among adolescents of Native American (9.7%) and multiple race/ethnicity (8.8%). Among 27 705 past-year alcohol or drug users, Native Americans (31.5%), adolescents of multiple race/ethnicity (25.2%), adolescents of white race/ethnicity (22.9%), and Hispanics (21.0%) had the highest rates of substance-related disorders. Adolescents used marijuana more frequently than alcohol or other drugs, and 25.9% of marijuana users met criteria for marijuana abuse or dependence. After controlling for adolescents’ age, socioeconomic variables, population density of residence, self-rated health, and survey year, adjusted analyses of adolescent substance users indicated elevated odds of substance-related disorders among Native Americans, adolescents of multiple race/ethnicity, adolescents of white race/ethnicity, and Hispanics compared with African Americans; African Americans did not differ from Asians or Pacific Islanders.

Conclusions  Substance use is widespread among adolescents of Native American, white, Hispanic, and multiple race/ethnicity. These groups also are disproportionately affected by substance-related disorders.

http://archpsyc.ama-assn.org/cgi/content/short/68/11/1176

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