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The Dangerous Side Effects Of Steroids, Arthritis Drugs, And NSAIDs

Commonly prescribed drugs and their dangerous side effects

A medical investigation in the United States has shown that three times more people die from legal prescription drugs than from illegal narcotic drugs, such as heroin and cocaine. This study does not account for the contra-indications of the drugs, which kill at least 30,000 a year in the U.S.

These are people who take medications, but have conditions (including drug allergies) that would cause these drugs to be dangerous for them. It is nearly impossible to determine how many people are being hospitalized because of contra-indications from drugs, but careful official estimates indicate that they make up about 5 percent of all lying in American and British hospitals today.

Steroids belong to another group of drugs that were formerly used only for extreme, life-threatening conditions. Today, they are used for minor problems such as sunburn, skin eruptions, acne and glandular fever. Patients are rarely aware of the dangers that may arise from taking these drugs. Side effects include high blood pressure, stomach ulcers with possible perforation of the stomach wall (this is how my father died), cramps and dizziness, inhibited growth in children within six weeks of taken the drugs, irregular menstruation, weakening of muscular strength, slowed healing of wounds, vision problems, skin atrophy, allergic shock, loss of libido, decrease in bone density, manic depression, and the emergence of latent diabetes.

Steroids are now handed out, even for babies, at the first sign of inflammation of any kind. But these drugs cannot cure a single condition; all they do is stop the body from responding to an abnormal condition. The new diseases caused by such drugs may require further treatment using even stronger drugs, thus adding more side effects to the ones that have already occurred.

The latest ‘breakthrough’ drugs for arthritis produce such strong side effects that it might be better to live with arthritis than to risk one’s life. The manufacturer of one popular brand was obliged to warn the consumer that this particular drug was very strong and had led to cases of leukemia (cancer of the blood) even after short term use. Additionally, the drug can have 92 side effects including hepatitis, high blood pressure, dizziness and unconsciousness, as well as headaches. The manufacturer advises the attending physician to enlighten his patients about the possible dangers that can arise from taking the drug, particularly if they are over 40 years old, and to use the smallest possible, but still effective, dosage. The manufacturers admit that the drug can cause serious and life-threatening reactions while having no effect on improving the condition of the disease!

NSAIDs, the common name for over a dozen or more non-steroidal anti-inflammatory drugs (including aspirin, ibuprofen and acetaminophen), are used to treat rheumatoid and osteoarthritis. However, for the past few years, these drugs have been given to people for such simple complaints as recurring headaches or inflammation. In return for the pain relief, however, the patient may die as a result of gastric bleeding caused by the extreme toxicity of the drugs. A warning placed on each NSAID prescription says: “Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation can occur at any time, with or without warning symptoms, in patients treated chronically with NSAID therapy.”

If this doesn’t sound like Russian Roulette to you, the death toll from taking these drugs may convince you otherwise. In the U.K., 4,000 people die each year from taking NSAIDS. In the U.S., the fatality figure is up to five times as high as it is in the U.K. Each year, hundreds of thousands of people are hospitalized due to gastric bleeding caused directly by taking NSAIDs. Other side effects include perforation of the colon, colitis, Crohn’s disease, blurred vision, Parkinson’s disease, liver and kidney damage, hepatitis and hypertension.

A 20-year-old acne medicine that millions of American teens are, no doubt, taking every day has been linked to a stunning array of negative psychiatric conditions including suicide, depression, psychosis, violent and aggressive behaviors, mood swings, emotional instability, paranoia and changes in personality. This makes one wonder if any drug, no matter how commonly prescribed, is even remotely safe.

The small print

With the enormous variety of drugs available today, many doctors no longer have the time to study the side effects of each drug they prescribe, and most patients never read the list of side effects that accompanies the drug. Also, few patients read the small printed contra-indications or ask their doctor about the possible dangers of the drugs. Doctors don’t seem to have the time to warn their patients about possible side effects either.

One report on a survey published in a 1996 issue of the British Medical Journal found that less than two-thirds of patients recalled receiving any advice from their doctors on potential side effects. Although the doctor has a moral as well as a legal obligation to inform the patient about the risks of treatment, in most cases this important step is omitted. The drug company is legally protected as long as the side effects and contra-indications are listed. This leaves it up to the patient to decide whether to take a drug.

Read side-effect labels to save your life

Side effects arising from the use of common pharmaceutical drugs can develop into some of the most grotesque symptoms imaginable. The Stevens-Johnson Syndrome (SJS), which can progress into a complication called TENS (toxic epidermal necrolysis), is caused by adverse drug reactions. Before you start taking common prescription drugs, you may need to inform yourself about this often-fatal reaction. The list of drugs that may be problematic includes antiepileptic and anticonvulsant drugs, sulfonamides, ampicillin, allopurinol and nonsteroidal anti-inflammatory agents (NSAIDs), as well as some vaccinations (such as anthrax).

The frightening fact about these drugs is that the body’s reaction to them is completely unpredictable. For instance, you may have taken ibuprofen, a popular NSAID, a hundred times, but you can never know for sure whether or when the body will suddenly become hypersensitive to the drug. When your body starts fighting the drug, it will go into an extreme inflammatory response that causes your skin to die and literally burn away. This side effect can occur with any age group, from infants and teens to the elderly. The mortality rate ranges from 25 to 80 percent. Those who survive the ordeal are scarred for life, often to a point of total disfigurement. As the number of people taking these drugs rises, the number of victims increases.

Do you really need to take these drugs?

There is no real need to take any of these drugs. Suppression of symptoms jeopardizes the body’s own healing efforts and only makes matters worse. If you do opt to take a prescription that puts you at risk for SJS or TENS, watch for any signs of an allergic reaction, such as a rash, blisters, a scalding sensation or fever, and discontinue the medication immediately. Don’t wait for your doctor to take you off the medication because your life may be at stake.

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[This is an extract from the book TIMELESS SECRETS OF HEALTH & REJUVENATION by Andreas Moritz]

Andreas Moritz is a writer and practitioner in the field of Integrative Medicine. He is the author of 13 books ( http://www.ener-chi.com/book.htm ) on various subjects pertaining to holistic health, including ‘The Amazing Liver and Gallbladder Flush’, ‘Diabetes, No More’ and ‘Cancer Is Not a Disease, It’s a Survival Mechanism’.

Drug Abuse Takes Too Much Away From Life

I have seen so many lives wasted from the abuse of drugs that it breaks my heart to see so many young people use drugs. I have not only tried drugs I have seen so many people that I have known destroyed their lives because of drug addiction. I did not take most dangerous drugs that were available when I was young. I took enough one time, after I left home, to leave me almost paralyzed for weeks, so that I learned just how much drugs could take away from my life. I thought that doing drugs was cool so I was taking pills, and I never really knew what I was taking besides speed. I could have died or overdosed just because I never thought about what was in these pills that I was taking.

I have seen so much death and waste of life by people that I cared about. I still do not know to this day what damage I did taking drugs. I have watched so many friends and their kids be come completely dependent on the drug known as crack. So many young people think that taking drugs are cool. I am here to tell young people that the use of any drug just takes away not only your independence but as time goes on the need for drugs increases. Addiction is the most costly part of taking any drug that should not be taken.

I have watched so many young people I know get so addicted to crack that they would do anything just to get another taste. There are way to many down sides to letting any drug take over a person’s life. I know you get where you constantly need the same drug and more every time that it is used. These drugs eat holes in your brain over years of use. Long term addiction destroys your ability to think clearly. These drugs not only leave physical scars, they stop the ability to learn long term. I have seen people that have taken drugs since they were young teenagers and their mental growth stopped the day the drug abuse started.

Drugs make people do things they would not do if they did not need a fix just to get through the day. Taking drugs makes that person a slave to their addiction. I have watched people steal to support their habit. I have watched drugs turn young girls into hookers and worse. I have watched girls I knew when they were young have babies that are addicted to crack. These young parents did not even care that they had a child all they wanted was their drugs. So many young children lose their mothers to drugs. I have watched three generations of the same family addicted to drugs.

Drugs become so important in life that no one else will matter as long as people feel that high. Drugs will make some people kill just to get them. Once addicted, their is only one way out to get that is to either end up dead in some crack house or worse. Getting clean is the only answer. To stay clean and get a person’s life back. Drugs may make a person’s problems go away for a while but drugs also make a person prisoner to that need. Then there are also the legal trouble that comes with needing drugs. I have also seen so many people spend their whole day just shop lifting to support their habit.

Any addiction will take away a person’s freedom because that need to have a drug becomes stronger the longer that drug is used. the long term use of drugs affects a person`s personality to the point that after some time nobody knows that person. Listen to me and learn no drug will take away your troubles – it will only make trouble worse in the long run. I can tell people that no drug abuse ever made life easier. I can not begin to tell people how much is lost with using any addictive drug. There is the loss of family and friends to the need to feed that addiction. Then there is the times in rehab when the pain is so bad that a person thinks they are going to come apart.

Most long term addicts end up dead somewhere – nobody even knows that person died. Think about the pain and loss that will come with the need to have some drug. Think about the pain and disgrace that happens to families that has a drug addict. I was one of the lucky ones most people that take drugs are not that lucky. The long term medical affects are costly to people that abuse drugs. The body`s organs suffer constant damage and aging by the use of drugs. Drugs never really stop the problem that started the addiction.

No drug is worth the long term damage that a drug addict suffers long term. I believe that a person should find another way to solve the problem nothing is worse to see then a person that is lost for life to their addiction. Do not let any person convince another person that drugs are the answer. Drugs will only make life pass by without the ability to think clearly. Drugs cheat people out of their right to a full life. Take back life before its to late to make a change after the damage that is done person`s mind and body are done. Life is hard enough to face and deal with as it is without clouding a person`s thoughts and mind with drugs. I have learned that no real life problem is as hard as getting clean. I can tell people about the real side of drug life there is no future for any person.

Any body that tells another person that taking drugs is partying this is nothing but a future full of hard times and loss of any normal life that a person hopes for. I have told people the basic truth about a life of drug use I hope that people will realize that no drug is the answer. Only by saying no can a person assure their future. I believe that by saying no to drugs will be the smartest decision that a person will ever make in their life.

To many people have been lost to these drugs already do not let another person make a person feel like they will not fit in. Believe me when it comes to drug abuse and the addiction this life will bring a person does not want to fit in. It is better not to be part of this crowd because there is really no happy ending when a person gives away the right to think with a drug free mind so just say no to any drugs.

I hope that this article will make people aware of the real truth about drugs and life. Because drugs abuse and life do not match.

As always I write with respect.

My name is Mike Carvell of the voice. I hope that this will be read by all publishers and that they agree with me that we need a voice for change. I believe that if we all work together we can change so many problems that face our country today.

I believe that if you put your column and respect on the line that we can all make this column a voice for all people, I mean all people. Tell me what you want changed, and I will keep this column honest, direct, and to the point with the commitment – you need to affect change.

Once again, I need your respect help and commitment to make this accomplishment possible. I not only believe in all Americans but the rights and respect of you all to make this commitment for which I will write with all honesty and respect and power that i can to prove this to you.

This is my column and only my column I will do all the writing with respect to all those of you who put your trust and commitment into this column now and in the future. I will be columns as many as i can on as many subjects that I can with respect for all my future work thank you mike carvell as always.

Save A Life! Seven Ways To Stop Drug And Alcohol Abuse

The problem, the stigma, the black mark that crushes everyone’s life – drugs, illegal drugs, over-the-counter drug use, how do we stop it? No one has the perfect answer on how to stop people from using drugs, but there is one way that you can give your children better chances than they might have when it comes to winning the war against drugs. How do I know this – from personal experience, from living life, from growing up in the generation of flower power and the era when drugs were prevalent and widespread throughout the large cities in America. What was one of the things that helped keep me away from drugs when drugs were all around me? If you knew the answer of how to stop your children from using drugs would you use the solution?

Nothing is guaranteed, of course. Everyone is an individual and of course, if one person wants to do drugs and if one person feels they need to do drugs, then that person will abuse drugs. However, there are little things, ordinary things that we can do to guide our children in the better directions in life, and these little things have been proven to work on most children. Here is how you can give your children a head start, a running start in the race against illegal drugs in your society.

Enforce an atmosphere where time is valuable and that valuable time is filled with good events, good projects, and valuable hobbies. Any time that is spent doing good, doing productive projects, being busy being creative is that much less time that any person will spend doing drugs or being hooked on drugs. introduce your children to being creative, to having a hobby, to becoming very interested in bringing good into their lives and you will have given your children an anti-drug asset. If you look at other teens and adults, it is usually the teens and adults that are occupied with LIFE that have no time and have no interest for illegal drug use. So, first priority, get your child or teen interested in a hobby that rocks their world. Let them choose the hobby and that hobby will last them a lifetime.
Teach your children the valuable lesson that God is forever with them, wherever they are, with no matter what they are doing. When children realize that God is with them, right there, at that very moment, then children -when approached by drug dealers — will just say no. Anyone who believes in God and believes that God is with them in every moment of their lives will be stronger when it comes to fighting against drug use. Faithful believers are generally much stronger, emotionally than people who believe in nothing. The reason for this is because it is common sense that two are stronger than one. So when a child has a strong faith in God, that child is never alone. That child has a Buddy that will help that child fight the urge to join the drug users. That works! That child has someone they can call on in times of temptation and weakness, and most times, that simple solution to lifes’ problems does work.
Talk to your child about drugs. Give them the information that they need to have in their lives. But most importantly talk to them about drugs even when you think that they are too young to know about drugs. No child is too young to learn about illegal drug use. Your approach in the talk will be different depending on the age of the child. But every single child should be taught about illegal drug use. Besides this talk to them about alcohol abuse.
KNOW that there are sometimes direct links between alcohol abuse and illegal drug use or abuse of prescription drugs. There are times when a child or teen will be very vulnerable to using illegal drugs when normally they would not dream of toughing the product. These times are the times when a child is weak or vulnerable – for example, if a child or teen has abused alcohol or is really drunk. That child will possibly accept drugs if that child is drunk when normally that child had the attitude of “just say no” to drugs. This is how educated children or teens get hooked on drugs when they have, all their life, been anti-drug. So, a clear, present, solid education on alcohol abuse is one of the weapons that you have in your arsenal against illegal drug use and against prescription drug use.
Keep your prescription drugs out of the medicine cabinet and keep them inside a locked box away from children and teens. Every child has a bit of temptation inside of them. It is best to get the drugs out of plain view. The bathroom and the medicine cabinet are private places. Children and teens can look through there and experiment in there and you would never know it happened. Knowledge is your second weapon against drug use. So keep all and any prescriptions locked up and out of the bathroom. Throw out all old prescriptions. You do not need them if they have been sitting for years. They are not valuable to you and if you need them again, you should go to the doctors and get new prescriptions.
Clear your home out. You can have alcohol in your home, just do not have a liquor store inside your home. Do not make your home a storage home for abundant alcohol or prescription, or illegal or legal drugs. This is so important in fighting the drug war. Why have a stock of these items when children and teens are in the house. Children and teens are natural curious people and they are experimenters. There are children and teens who never would have been hooked had the product not been in the home. So do your best. If you need a supply of anything in your home, make it a supply of good reading books, and good music and wonderful creative projects and and arts and crafts items.
Do not use illegal drugs yourself. Just say no! When your child or teen sees you abusing drugs, illegal or legal, you are teaching your child how to live. You do not want to teach that lesson. If you think that you can take illegal drugs and not set a bad example, you are mistaken. I know of one family who used pot but forbid the children to use pot because it was illegal. Of course, that child grew and when that child reached a certain age, that child became a full time drug user. That child grew up to be a drug dealer, and wound up in jail and is now currently either in jail or in a half-way house. That child has a lifetime of illegal drug use. That same child who watched his parents smoke “recreational pot”. Sometimes your children will not have the strength or resistance that you might have. So do not think that you can take drugs into your home and not promote these drugs to your own children. Do not use illegal drugs and do not abuse alcohol or prescription drugs. Care about your children even if you do not care about yourself. Please save your child’s life by not doing anything illegal.
Doing any or all of these things in your home will give your child and your teen strength and possibilities of avoiding illegal drug use and avoiding prescription drug abuse and avoiding alcohol abuse. Try your best to follow the instructions listed above and you will be giving your child and teen a head start in this world. It is worth trying. Yes, there are no guarantees in life. I am not saying that if you do all this that your child or teen will never take drugs. However, I am saying that if you do all these things or most of these things, your child will have better reasons to live, better reasons to enjoy life and your child will have a 85 percent chance of fighting illegal drug use and alcohol abuse than any other person has in their life. Do it. Try it. What do you have to lose? You have nothing to lose and everything to gain. This is your child’s life that we are talking about. Wouldn’t you do anything to save your child’s life? Most people would. Now, in that perspective , all those actions seem like very easy things to do!

So, what makes me an expert on illegal drug abuse? Here is how I come across this gem of information that definitely saves lives. I grew up in a city that was filled with drugs. I could get drugs whenever and wherever I wanted to. Yet, I used the policy of “Just Say No” -long before this project came out to television. That was my motto. I just said no. It is easy to just say no BEFORE you are hooked, before you ever touch an illegal drug. And that is why you begin early. Catch your child’s interest before they have a chance to take drugs, and then you have the head start. So, back to the story, most of my friends began taking drugs. (I hung out with a group of friends and little by little, I noticed that they were trying marijuana. The minute I saw that they were using illegal drugs, I ran from my friends and I ran to my “hobby”. It was my hobby that saved me from trying drugs and it was my hobby that saved me from being like my friends. That’s all it took, one hobby. Instead of becoming introduced to drugs I become fully attentive to my hobby. I am telling you from first hand experience that a hobby gives your child or teen an eighty-five percent chance -better than the average person’s chance to stay away from illegal drug use, and other abuses.

Where does faith and belief come in? I am not talking about religion. Religion has never saved anyone from drugs. I am talking about a sincere faith and belief in God and or in the Bible. That is where the strength comes from. And this is your backup plan (which should be your first plan, but everyone is individual). At times when a person is so vulnerable that they are too tired, too weak or too busy or preoccupied to reach for or to think of their hobby, that is where faith comes in. Everyone can pray; everyone can reach out to God. All it takes is a thought. That is why faith is so wonderful. Faith requires no physical effort. So faith fills in where the hobby left off. Even if you are totally exhausted and can not move, you still have the energy left for prayer, a silent prayer or verbal prayer. You can pray.

By using all of the above tools you can possibly safeguard your child and teens from jumping into the world of illegal drugs and alcohol and prescription drug abuse.

So, what was the outcome of my own tools? I grew up with almost everyone around me using illegal drugs. My knowledge let me “leave” the group and run to my hobby. I never even touched a marijuana cigarette. I never took one illegal drug. That is enough proof for me that this system and these tools works. I have many friends who have died from drug use and have many other friends who wound up in rehabs and had miserable lives because they had no hobby to run to and no faith to take over when there was no physical strength to do their hobby. Almost everyone around me, in my circle of friends caved in to peer pressure and caved in to taking illegal drugs. I wonder how many might have stopped short of that if they just had faith or a hobby. None of my friends had a hobby so when marijuana came around, they made marijuana their hobby. Many of them had religion. They had to go to church on Sundays; they had to follow certain man-made religious rules. But none of them had faith in God or faith in themselves. Their faith was in marijuana. Their faith failed them when they needed real faith.

This system works if you dare use it. Yes, yes, yes, I hear you. It is not foolproof, but I guarantee you this. If you use this system, your child will have a better chance than anyone else’s child. How do I know? I have proof of it. I just said no! Help your child say no! Bring a system, a plan into your home and into your life. You will be glad that you did.

And deep down inside of every one of us is the challenge, the need to be noticed, to be visible. If there is someone who is invisible in your life today, take a step to bring them into your big picture. You can do it and you will be glad that you did.

The Dark Side of Prescription Drugs

“I lost everything when the police raided my house looking for prescription drugs. My husband and two little children were home that night. I was so ashamed I couldn’t even look at them. I was arrested, put in handcuffs and locked up. My husband divorced me. My children were taken away from me. I knew I had hit bottom.”

Sylvia* is a 44 year-old radiologist, former president of the PTA, and prescription drug addict.

An Invisible Epidemic
A great deal has been written about alcoholism and drug addiction over the last two decades. However, information regarding prescription drug abuse and addiction only seems to surface when someone famous has a problem and needs treatment or dies.

Historically, prescription drug addiction has been the most underreported drug abuse problem in the nation( National Institute of Drug Abuse). It is also the least understood. Addiction to and withdrawal from prescription drugs can be more dangerous than other substances because of the insidious nature of these drugs.

Two types of the most commonly abused drugs are opioids and benzodiazepines. Opioids are generally used to control pain. Benzodiazepines, or tranquilizers, are used to manage anxiety. These drugs are prescribed for short-term use such as acute pain and anxiety that is in reaction to a specific event. They may also be prescribed for chronic pain or generalized anxiety.

Chronic Pain
Like many other people, Sylvia’s doctor put her on Vicodin because she suffered from chronic migraines. The pills worked effectively. They took away her headaches and allowed her to live her life. But, like other narcotics, Vicodin lost its effectiveness over time. Sylvia began to increase her dosage. She had built up a tolerance to the medication. She was physically dependent on Vicodin.

Fearing that her doctor would stop prescribing the medication if she told him that she had increased the dosage, she kept it a secret. She did not believe that she would be able to function without the pills. She began to change the numbers on the prescriptions so that she would get more pills, with more refills.

Over the next two years, she went from a physical dependence to a physical and psychological addiction. She had to continue to take this drug in increasing dosages in order to feel “normal.” She went from taking the medication as prescribed to a drug habit of 30 pills a day. She started to “doctor shop” in order to obtain several prescriptions at a time. She would make appointments with a number of doctors to get what she needed. She switched pharmacies often so that she could drop off each prescription at a different one. She went to a number of pharmacies in different neighborhoods so that no one would become suspicious.

She could not use her insurance since she was buying several prescriptions of Vicodin at one time. She used different names at each pharmacy. She spent hundreds of dollars a month. She kept a careful record of who she was at every one. As her habit increased, she had to find new ways of getting pills. She stole a prescription pad from one of her doctors and began to forge her own prescriptions. One day, she made the mistake of writing a date on the forged prescription that happened to be a Sunday. The pharmacist became suspicious and confronted her about it. She quickly left the store. He called the police.

By the time the police raided her house, she had hundreds of pills hidden in the bathroom, the kitchen, and bedroom. The police thought she was selling them. They had no idea that the amount she had wouldn’t even last her two weeks.

This may seem like an unbelievable story, detailing extreme measures to obtain narcotics. Unfortunately, Sylvia’s story is not unusual or unique. The National Clearinghouse for Alcohol and Drug Information reported in May of 2001 that approximately four million people aged twelve and up misuse prescription drugs. That is roughly 2-4% of the population, four times the amount it was in 1980. Prescription drug addiction accounts for roughly a third of all drug abuse problems in the United States.

Accidentally Addicted?
Donna, a 34 year old lawyer suffered from extreme anxiety, coupled with panic attacks. She sought the help of a psychiatrist who put her on Xanax. It helped with the symptoms for a little over a year. She then noticed she was beginning to feel more and more anxious in between doses. In addition, the dose she was taking barely helped anymore. She reported this to her psychiatrist and he responded by increasing her dosage. In less than three years, he had increased the dose to five times the amount she was first prescribed.

She was honest with her psychiatrist and he increased the dose to what she said she needed. She had convinced herself that prescription drugs were safe. She rationalized this by saying to herself, “if her psychiatrist prescribed them, they must be okay. And besides, a reputable drug company developed the pills in a nice clean laboratory, so how could they be dangerous?”

She began to feel increasingly depressed. She dreaded leaving the house. Her panic attacks increased in frequency whenever she did venture out. She did not want to see her friends. She did not answer the phone. Her world was becoming smaller and smaller.

Donna called her doctor and told him she wanted to get off the pills. He suggested a slow tapering off process and they decided that her partner, Beth, would give her the agreed upon dose each day.

She really wanted the tapering off to work, but she began to feel sick in between doses. She tried to follow the schedule, but she couldn’t tolerate the withdrawal symptoms. She would wait until Beth left for work in the morning and then tear the house apart looking for the pills. When she found them, she “stole” a few and put the vial back where Beth hid it. She pretended to continue the agreed upon tapering off process.

Donna panicked when she realized she was taking more than twice the amount she was supposed to take. Feeling like a failure and filled with shame, she did not tell her doctor. She went to another psychiatrist to get another prescription. Her partner begged her to get help. Donna didn’t feel that she could live without her pills. Her life had become completely controlled by Xanax. She would panic when she was beginning to run out.

Donna’s world was now focused on conning, getting, and taking the pills. She would count them over and over again when she picked up a new prescription. One night, several months later, Beth found Donna unconscious on the floor by the bed. She was rushed to the emergency room. When she regained consciousness, the resident informed her that the Xanax had become toxic in her bloodstream and that she would not have lived more than two weeks had she continued taking them. She had no choice but to stop. She was medically detoxed in the hospital and sent to a treatment facility to continue the process and begin to learn to live drug-free.

What leads a person to become addicted to prescription drugs?
Prescription drug addiction is no different from alcoholism or an addiction to any other substance. However, no one is prescribed alcohol or cocaine for medical reasons. People who suffer from chronic pain are in a very difficult position. Painkillers do relieve pain. For people who suffer from constant and chronic pain, narcotics may be necessary to allow them to have any quality of life. The downside is becoming physically dependent and risking the possibility of addiction.

While it is true that the drugs themselves are highly addictive, not everyone who takes painkillers becomes an addict. The statistics of those suffering from chronic pain who become addicted to these drugs are actually pretty low according to the Chronic Pain Advocacy League, a grass roots organization dedicated to helping those who suffer the debilitating effects of chronic pain. However, this is not to say that those who suffer with chronic pain are not at increased risk of prescription drug addiction.

A recent survey by the National Institute on Drug Abuse at Columbia University indicated that approximately 50% of primary care physicians have difficulty speaking with their patients about substance abuse ( FDA Consumer Magazine, Sept.- Oct., 2001).

Tolerance
Drug tolerance is basically the body’s ability to adapt to the presence of a drug. When narcotic substances are taken regularly for a length of time, the body does not respond to them as well. Tolerance then becomes defined as a state of progressively decreased responsiveness to a drug as a result of which a larger dose of the drug is needed to achieve the effect originally obtained by a smaller dose.

Dependence or Addiction
There is a difference between dependence and addiction. Dependence occurs when tolerance builds up and the body needs the drug in order to function. Withdrawal symptoms will begin if the drug is stopped abruptly. On the other hand, when a person turns to the regular use of a drug to satisfy emotional, and psychological needs, they are addicted to that substance. Physical dependence exists as well, but the drug has become a way to cope with (or avoid) all kinds of uncomfortable feelings.

Many prescription drug addicts do begin by needing the drug they are prescribed for medical reasons. Somewhere along the line, however, the drug begins to take over their lives and becomes more important than anything else. Nothing will stop them from getting their drug of choice.

It may be difficult to understand how someone could let this happen. How could someone who is reasonably intelligent and sophisticated in regards to drug addiction become an addict? Addiction has nothing to do with intelligence. And addiction to prescription drugs is no different than any other substance abuse problem. Many people in the medical profession abuse prescription drugs. Health care providers may have a slightly higher rate of addiction due to both the stressful nature of the work and their relatively easy access to supplies of narcotics. Clearly, the potential risks and dangers involved with taking narcotics are not unknown among health care providers. This, however, doesn’t stop someone from becoming an addict. Some 12-step members have described addiction as a disease of the emotions.

Addictive Behaviors
Along with addiction, there are addictive behaviors that are quite common among addicts. Lying, keeping secrets, hiding pills and obsessively counting them, making unnecessary emergency room visits and constantly “doctor shopping.” As the addiction escalates, engaging in such illegal activities as stealing prescription pads, committing forgery, and buying drugs off the street is also quite common behavior.

These behaviors usually stem from the desperation an addict feels regarding getting, securing, and taking their drug of choice. Under other circumstances, the individual would probably not engage in the behaviors listed above, unless they were previously part of his/her personality structure. In other words, addictive behaviors are limited to the addiction itself and are generally dissonant with the person’s beliefs and values in any other area of their life.

Paul
Paul* is a 29 year old advertising executive who was first prescribed medication for a relatively minor neck injury caused by a car accident. While hospitalized he was first treated with morphine and then was switched to Percocet. He left the hospital with a prescription for a week’s supply of pills.

The pills took away Paul’s pain. They made him feel calm and a little distant from his emotional pain, as well. Paul welcomed the relief from the emotional pain he was going through following the break-up of a serious relationship. It seemed to him the pills made him feel less lonely and needy. In addition, he found that the pills allowed him to feel more confident at work; he got more done, felt less stressed, and believed he functioned better.

Paul was upset when he finished his prescription. He called his doctor, telling her that he was still in pain. She prescribed more Percocet. She also let him know that if the pain continued any longer, she would prescribe Motrin. Paul felt elated that he could get more pills for now but also. decided he would stop taking them after this latest prescription was finished.

Two months later, Paul had to have oral surgery. All he could think about was how he’d now be able to get more Percocet. He found himself looking forward to, rather than dreading the surgery. After this newest prescription ran out, he began to devise aches and pains that would lead to more pills and was able to con several emergency room doctors into giving him further prescriptions.

Paul began to notice that the pills did not have quite the same effect. The initial euphoria he once felt was gone. He took more. He kept trying to “chase” that first high, but could not achieve it again.

A friend turned him on to Oxycontin. He loved the feeling the pills gave him and began to buy them from his friend. He no longer missed his ex so much. The pills made his emotional pain tolerable and filled the empty feeling he had inside.

Soon, he began to screw up at work. He was missing deadlines and no longer competed for the most prestigious and high-paying ads. Paul began to sink into a depression. His self-esteem plummeted because of his growing need for the drug and the extremes to which he would go to get it. He began chewing the pills so he’d feel their effect sooner.

Paul sank further into a depression and believed that the only thing that made him feel better was to take more pills. His friend expressed concern that Paul was becoming too dependent on Oxycontin. He told Paul that he felt uncomfortable supplying him with more pills. Sensing that Paul needed help, he suggested an NA or AA meeting. Paul was angry. He thought his friend was overreacting. He was just using pills, not something dangerous like heroin or cocaine.

Paul realized, however, that he didn’t feel he could function without his pills. It was the only thing in his life he felt he could depend on. He began to chew them by the handful. One morning he woke up in a stranger’s apartment not knowing how he’d gotten there. He couldn’t remember anything. He called his friend who said he must have had a blackout and that he needed to get off the pills before he self-destructed any further. Paul finally agreed and went into an inpatient detox and rehab program.

He began to get in touch with the empty void the pills filled up. He felt a great deal of shame about becoming addicted to them. He also felt a great deal of remorse about the behaviors he engaged in to feed his addiction.

Shame and Guilt
Both shame and guilt are feelings that are very common to the experience of addiction. No one wants to be a drug addict. There is tremendous shame in having your life ruled by a vial of pills. There may also be a tremendous amount of shame and guilt about the type of behaviors you can become capable of engaging in to get drugs. The way one behaves on pills–falling down, slurring one’s words, blackouts–are all shameful experiences.

A person whose become addicted to prescription drugs may feel guilty about the way they have treated others, particularly those closest to them. There’s a great deal of guilt associated with lying and betraying the people they love.

Neither shame or guilt is conducive to getting the help that is needed. In fact, these feelings can be quite destructive. Shame can prevent you from getting treatment. Guilt can lead to all kinds of self-destructive behaviors that will interfere with sobriety. Bottom line: shame and guilt lower self-esteem and foster self-hatred.

Getting Help
There are many treatment facilities located throughout the country. Many insurance plans cover inpatient detox. Some insurance companies will pay for a week, maybe two. Some may pay for rehab as well. It’s important to get help and not to try to get off pills on your own. Some people may feel that they can’t afford to take a week or two out of their lives to spend in a treatment facility, detoxing. The demands of children, a job, school, or other responsibilities may make inpatient treatment seem like a luxury. It is not. It is unquestionably better to leave the routine responsibilities of your life for a week than it is to suffer the inevitable outcome of prolonged drug addiction.

Withdrawal
When an individual becomes physically dependent on painkillers or benzodiazepines, they should not just suddenly stop taking them. Stopping suddenly can cause seizures and possibly even death. The risk of a seizure is actually quite high. Dependency might be dealt with by tapering off the medication. Some people have been successful using this approach. Addicts have often found tapering to be unsuccessful because their addiction is both physical as well as psychological. If tapering is done inpatient, it has more of a chance of success.

Withdrawal symptoms can be, and often are, difficult. Benzodiazepines, for example, are stored in the tissues and fat cells. Getting the drug out of your bloodstream can take a long time. Drugs that go through the digestive tract are more quickly excreted.

Even when someone detoxes inpatient, the symptoms often feel unbearable. While the acute withdrawal symptoms generally last a couple of weeks, the prolonged withdrawal, called Post Acute Withdrawal Syndrome (PAWS) lingers. These symptoms have been known to last a year or longer.

In addition, the person who suffers from chronic pain may initially be in more pain than they were before they began to take painkillers. Painkillers and benzodiazapines repress the body’s natural production of dopamine and endorphins (the “pleasure center of the brain”) and take over their function. After the drug is detoxed, it takes some time before the body’s natural pain receptors “wake up” and begin to function normally again.

What other options does someone who suffers from chronic pain have? After becoming drug-free, this issue still needs to be addressed. Some people believe that they can never take prescription narcotics again and need to remain abstinent for life. Other methods of pain relief like meditation, breathing exercises, yoga, or biofeedback may provide some relief. For recovering addicts who need to be on narcotic painkillers, having someone else responsible for the medication may be a good idea.

Who’s at Risk?
The elderly are particularly at risk; misuse of prescription medications may be the most common form of drug abuse among the elderly. According to the National Clearinghouse for Alcohol and Drug Information, as many as 17% of adults 60 and over abuse prescription drugs. While elderly people comprise just 13% of the population, this age group represents as much as 30% of the number of prescription drug abusers.

There is less likelihood that an elderly person will comply with the directions on the prescription bottle. There may be confusion regarding the dose or the frequency with which to take the medication, or difficulty reading the small print. Unintentional misuse can lead to addiction. Compounding this problem, many health care workers may prescribe an addictive substance to an elderly person more than they might to someone younger.

Another at-risk segment of the population is women. One reason is simply that women are more likely to go to the doctor when they are feeling anxious or in pain. Both women and men abuse prescription drugs at approximately the same rate, however, women are twice as likely to become addicted as men. Specifically, females between the ages of 12 to17 and 18 to 25 have shown the largest increase of prescription drug abuse over the past two decades (NIDA). In addition, young girls aged 12 to 14 report that painkillers and tranquilizers are one of the most popular drugs used to get high.

Recovery
Many recovering prescription drug addicts become involved in 12-step programs. Groups like Pills Anonymous can be very helpful and supportive. The meetings can help alleviate some of the guilt and shame through hearing and sharing the similarities of yours and others’ experiences. Unfortunately, there are very few PA meetings around the country in comparison to the numbers of AA or NA and so many pill addicts go to those meetings in addition to or instead of PA meetings.

Some people struggling with pill addiction enter therapy at this point in their lives. Therapy can help you find out what emotional need the pills served and what will fill that need now. Grief is a common feeling among addicts when giving up their “drug of choice.” Like learning to cope with other kinds of losses, the addict needs to grieve over what had become the most important thing in their life. Therapy groups can function as a safe and supportive place to deal with some of the emotions a recovering addict is likely to feel. Individual therapy can be a very effective way to deal with a lot of the underlying issues that may have led to becoming addicted to prescription drugs.

All of these forms of help can alleviate the isolation an addict may have created when they were using. No one has to deal with sobriety and recovery alone. The feelings that were hidden by the pills will begin to surface and can be frightening to deal with on your own. Having support during this time of a person’s life is crucial.

What happened to Sylvia, Donna and Paul?
Sylvia:

Sylvia began to go to NA but felt she couldn’t relate because no one shared her addiction to pills. She found it difficult to connect with others who used street drugs. She found a PA meeting not far from her job and began to attend on occasion. She also decided to enter therapy to deal with memories that started to come up when she was no longer numbing herself with pills. In exploring her migraine headaches and what usually triggered them, Sylvia realized that the headaches often followed an argument with her husband or difficulty with her kids. She began to make the connection between anger and migraines. With time, when a headache came on, she no longer felt overwhelmed with feelings of anger, rather she just felt the pain of the headache.

Anger was not an acceptable emotion in Sylvia’s family. As a result, she did not allow herself to feel it. She began to work on this issue in therapy and started to remember other times in her life when she had felt angry. After exploring this issue for some time, she began to open up about the sexual abuse she’d experienced from her uncle following her father’s death. She’d been eleven when her father died of complications due to alcoholism. Her uncle “consoled” her for months. Sylvia had kept the secret of the sexual abuse inside her for years and, prior to therapy, she’d never told anyone about it. The pills had helped to keep the feelings, as well as the event, hidden.

Along with therapy, Sylvia began to use meditation and deep breathing to deal with the stress that generally preceded a migraine. Her migraines began to lessen and she was able to get sufficient relief from over-the-counter pain relievers.

Donna:

After Donna left in-patient treatment, she continued with after-care. She attended group sessions three times a week. Her counselor stressed the importance of 12-step programs. Donna realized that she needed the support she could get from attending meetings regularly for those times in which her cravings began to surface. She liked the availability of AA and, by thinking of pills as dehydrated alcohol, could see the similarities between herself and the other members.

When her outpatient group ended, Donna sought out individual therapy. She focused on her anxiety and felt she needed to go back on medication. She went to see a new psychiatrist who specialized in substance abuse. Donna’s new psychiatrist prescribed an anti-depressant that helped lessen her anxiety.

In therapy, Donna explored what might be at the root of her anxiety. In time, she discovered she had always felt anxious as a child and throughout adolescence. For example, as a teenager, Donna had experienced difficulty accepting her lesbianism and would often go on dates with boys so she would appear “normal.”

After Donna came out and moved in with Beth, her anxiety returned. She did not understand the connection between the anxiety she felt as a teenager and what she felt once she made a commitment to Beth. Instead, she began to use Xanax to avoid facing any of the unsettling feelings that had begun surfacing and so, while on drugs, the anxiety-invoking feelings remained buried. Once off the drugs, they resurfaced and she began to deal with them in treatment.

Paul:

Paul left inpatient treatment and felt lost. He went to a few NA meetings before he went back to work. When he returned to work a month later, he cut down on the number of meetings he attended.

After six months, Paul entered into another relationship. Feelings of fear and dependency started to arise and he found the feelings intolerable. He was terrified of losing this relationship by appearing too needy. After a couple of months, he had a relapse on Darvocet. He thought that if he switched medications he’d be safe. He believed that this time he could control it and resolved to only take pills on the weekends.

In just a month Paul was taking Darvocet everyday. He realized he needed help and went back to AA. Paul elected to re-enter the treatment facility and detoxed in a few days.

He returned to NA, found a sponsor and began to attend meetings regularly. He opened up to the other members and felt more comfortable accepting his addiction.

Did Nixon Get the War on Drugs Right? Michael Massing’s The Fix

The Fix by Michael Massing. Berkeley, CA: University of California Press, 2000, 335 pp., $25.00.

The dust jacket of Michael Massing’s The Fix summarizes his thesis in bold red letters: “Under the Nixon Administration, America Had an Effective Drug Policy. WE SHOULD RESTORE IT. (Nixon Was Right).” That is a pretty extraordinary claim to make regarding an administration that gained office in large part through the “Southern Strategy” that had at its heart Nixon’s declaration of a “War on Drugs” and whose policies created the cocaine epidemic that caused so many new concerns a decade later. At most, I would agree that the Nixon administration’s pursuit of a fundamentally bad policy included some worthwhile efforts that have been devalued by every subsequent administration. This was not because Nixon or his closest advisers were right about drug policy but because Nixon was more interested in foreign policy issues and his benign neglect of domestic policy allowed a number of positive developments to blossom in the midst of the mire of incompetence and corruption that characterized his presidency.

Perceptively concluding that “policies being formulated in Washington today bear little relation to what is taking place on the street,” Massing attempts to depict the real effects of drug policy at the street level. Unfortunately, he doesn’t rely on the epidemiologic evidence or read the careful analyses conducted by researchers like myself who have systematically examined what is truly taking place on the street. Instead he relies on the journalist’s usual — and usually misleading — tool of dramatic anecdotes.

Massing’s anecdotal case is presented through the stories of Raphael Flores and Yvonne Hamilton. Flores runs Hot Line Cares, a drop-in center for addicts in Spanish Harlem. Hot Line Cares, which Flores founded in 1970, is essentially just a cramped office in of an otherwise abandoned tenement where Flores and his staff advise and assist addicts who want to get into treatment. Given the fragmented state of drug abuse treatment in New York City, and in most other American communities, it is no easy task to connect addicts with appropriate care and even harder to connect them with adequate aftercare. Massing writes, “If a Holiday Inn is full, it will at least call the Ramada down the street to see if it has a vacancy. Not so two treatment programs”

Yvonne Hamilton is a crack addict trying to get her life together. Massing describes her trials and tribulations as she copes with her illness and makes her way through New York City’s treatment non-system. It is an affecting story and well told. The author presents it as an argument for treatment and perversely as an argument against decriminalization or legalization. But she is one of the many examples that show that prohibition does not prevent addiction. And improvements in her drug problem seem to have less to do with the treatment she did receive than with changes in her life situation.

These two lives provide a touchstone to which his narrative will later return. The middle third of the book shifts dramatically in tone as Massing chronicles the evolution of the war on drugs in Washington. During Nixon’s tenure, the government spent more money on treatment (the “demand” side) than on stopping drug trafficking (the “supply” side), which he argues led to declines in both drug overdoses and crime rates. As successive presidents felt pressure to emphasize the “war” rather than treatment, he asserts that the number of chronic addicts skyrocketed. In the third and last section Massing returns to Spanish Harlem, where Hamilton continues a difficult struggle to remain drug-free and Flores struggles to keep his center afloat and to keep from falling into addiction himself.

It is the second part of the book that is the heart of Massing’s thesis. It is a tale that is familiar to those of us who are active in the field of drug policy and, in addition to scholars, other journalists have told it before — Dan Baum (1996) and Mike Gray (1998) doing so particularly well — but I will summarize (with some details Massing missed or left out) the history of drug policy under Nixon for the reader who is not familiar with the story.

In 1968, as Richard Nixon was making his comeback run for the presidency, he adopted the “Southern Strategy” that has been the key to Republican victories in presidential races ever since. Since the end of Reconstruction every Democratic presidential candidate had been able to rely on the votes of the “solid South” but the Northern Democrats’ support for civil rights had been the cause of increasing disaffection in the South, as epitomized by Strom Thurmond’s independent run for President against Truman in 1948. Then, in 1964, Alabama Governor George Wallace’s bid for the Democratic nomination for President showed that racism won votes in the North as well as the South. Nixon wanted to win the South, as well as racists’ votes in the North, without offending more traditional Republican voters by an openly racist campaign. The answer Nixon and his advisers found was to campaign against crime, which most Americans quite falsely equated with minorities. So what if the crime rate was actually declining, Americans seem to always believe that crime is increasing just as they seem to always blame it on cultural or racial outsiders.

Even better than campaigning against crime, the Nixon team soon realized, was campaigning against drugs. Most Americans, again falsely, equated drug users with violent criminals. Better still, for that great “silent majority” whose votes they sought a campaign against drugs symbolized a campaign against both Blacks and much hated hippies and anti-war protestors. When Nixon declared “war on drugs” he was appealing to the basest elements of the American electorate and it worked, just as it has worked for other candidates since.

The success of his anti-crime/anti-drug campaign presented Nixon with a serious dilemma when he took office – people were expecting results. At first his administration considered admitting that constitutionally crime control was a state responsibility and proposing to act through support of training programs and grant-in-aid to state and local police forces, but his approach had little political pizzazz and was largely abandoned after it failed to impress the public. Nixon had some ideas of his own, such as a nationwide mandatory death penalty for selling drugs – a strategy that has been tried in Red China and in Singapore and has clearly failed in both nations – but fortunately he was more interested in foreign policy and left the search for a solution to the drug problem in the hands of John Ehrlichman and the White House Domestic Policy Council.

Within the Domestic Policy Council Egil “Bud” Krogh Jr., a young lawyer who is better remembered as the man who headed the White House “plumbers” of Watergate fame, was charged with responsibility for finding a way to visibly impact drugs and crime before the 1972 election. Massing portrays Krogh as something approaching the tragic hero of the tale, but I’m not sure that many other than Massing and Krogh himself hold such a positive view of his public service. In any case, it is true that Krogh played a key role in shaping both the good and the bad in the Nixon administration’s drug policies.

In one of his other roles as liaison to the government of the District of Columbia, Krogh had become acquainted with psychiatrist Robert Dupont who was running one of the early methadone maintenance programs in DC. Krogh was reluctant to accept a maintenance approach to addiction but he did see that it was the one approach that actually had some evidence of effectiveness. In June of 1970, Krogh sent the Council’s youngest lawyer Jeffrey Donfeld to visit methadone programs in New York and Chicago, including the first such program, which was directed by Vincent Dole and Marie Nyswander of Rockefeller University, and a “mixed modality” model developed by University of Chicago psychiatrists Jerome Jaffe and Edward Senay.

Donfeld was dubious about the claimed effectiveness of methadone treatment and even more dubious about its political acceptability – in terms that have since become familiar, he wondered if it would send the wrong message. Donfeld found Jaffe in particular to be “politically sensitive” to the emotional issues involved in methadone maintenance. Donfeld believed that the “mixed modality approach,” which he called “different strokes for different folks”, by offering a range of treatments that included detoxification, drug-free, and maintenance approaches, effectively masked the methadone program from political criticism.

Much as Raphael Flores is the hero of the first part of the book, Jerome Jaffe is Massing’s hero for the second part. Jaffe has described his meeting with an essentially clueless Nixon. He sidestepped Nixon’s idea of the death penalty for dealers and suggested that the one value of law enforcement might be in pushing up the street price of drugs and thus encouraging more addicts to seek treatment – this idea was later taken up by Peter Reuter of the Rand Corporation but his research showed that the effect of aggressive law enforcement on supply was essentially nil and on price was tiny.

Jaffe attempted to make four points in his meeting with the President an d each was to bear fruit in shaping the future of drug policy under Nixon. The first was the need for more research and evaluation of treatment. The expansion of a small division within the National Institute of Mental Health into a National Institute on Drug Abuse and a National Institute on Alcoholism and Alcohol Abuse grew in part out of this recommendation. Second, he noted that currently there were a dozen different federal agencies funding treatment that didn’t even talk to each other. He felt that coordination of all these efforts was needed in pursuit of a coherent national strategy. This led to the creation of the Special Action Office for Drug Abuse Prevention, which he was startled to find himself appointed director of, as the nation’s first “drug czar”. Third, given the extent of heroin addiction, he urged that methadone maintenance should not be restricted to a few small research projects but should be made widely available. Fourth, he urged that funding for treatment be dramatically increased. These last two points were at the heart of what Massing refers to as “The Fix”.

Jaffe’s first big White House assignment was to develop a plan for controlling the skyrocketing prevalence of heroin use among U.S. servicemen in Vietnam, which involved 10 to 15 percent of all GIs in Vietnam if not more. Pentagon policy was that heroin use was a crime and that any serviceman who used heroin should be arrested and prosecuted. The result of this was an over-burdened military justice system but no reduction in heroin use. Jaffe urged that the Pentagon should adopt a treatment approach instead of a punitive one.

Massing suggests that Jaffe’s solution relied for its effectiveness on the GIs’ overpowering desire to return to the United States. He advised the Pentagon to subject all GIs to urinalysis before shipping them home. GIs who tested positive for heroin would have to stay in Vietnam for detox. The military’s reaction to his plan was to object that it would play havoc with the complex logistics of troop movement, to which Massing reports that Jaffe replied, “I cannot believe that the mightiest army on Earth can’t get its troops to piss in a bottle” When his plan was implemented, Massing reports that the percentage of GIs using heroin quickly dropped by more than half.

Jaffe himself tells it quite differently. It appears that as an academic and researcher he was aware of the growing evidence that most heroin users do not become addicted and the early follow-ups showing that most of the troops who were addicted to heroin in Vietnam abstained successfully, and usually without any treatment, after returning home (Jaffe and Harris, 1974). He didn’t fool himself into believing that the urine screening program actually deterred heroin use among the troops while serving in Nam. What he expected was that once word of the urinalysis got around heroin using GIs who weren’t addicted would stop using for the last weeks before rotation home and only the truly addicted would be unable to do so and thus fail the urine test. This is apparently what happened but it gave the politically useful appearance of a far greater success. The classic follow-up study by Robins, et al. (1980) confirmed that most of the GIs who became addicted to heroin while serving in Vietnam recovered fully and permanently after returning to the US and also found that recovery rates were not improved by receiving treatment – a finding the implications of which I discussed in several publications of that period (Duncan, 1974, 1975, 1976 & 1977).

I believe that the rapid recovery of Vietnam addicts demonstrates that for most of the GIs who became addicted, heroin use served as a coping mechanism for dealing with the stress of serving in a war zone. The relief they obtained by using heroin served as a negative reinforcer and negative reinforcement produces powerful habituation. Once they returned home their heroin using behavior extinguished in an environment where for most of them it was no longer being reinforced. Those who persisted in their addiction, according to Robins, et al. (1980), were the ones who returned to conditions of poverty, an alcoholic parent, etc. – exactly the ones who would continue to need a stress reliever. Treatment was far less relevant than environmental change, which is what Moos and his coleagues have found to be true for alcoholism treatment (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).

As Massing reports, Jaffe was able to convince the Nixon administration to increase funding for drug abuse treatment eightfold over what it had been when Nixon took office. For the only time so far since America began its failed experiment with drug prohibition, the treatment budget was larger (twofold) than that for drug law enforcement. Massing attributes a decline in narcotics-related deaths and in crime rates to this budget increase and a more than 300 percent increase in the number of persons in treatment. It would be nice for treatment advocates like me if that was true but no knowledgeable analyst is likely to agree that it is.

While more addicts in treatment probably played some role in reducing the numbers of narcotics-related deaths, there were two other factors that probably played a far greater role. First, was the introduction in 1971 of naloxone (NarcanĀ®), a full narcotic antagonist, which replaced nalorphone (NallineĀ®), a partial narcotic antagonist, as the drug of choice for treating narcotic overdoses. Second, was the growing popularity of amphetamines and other stimulants resulting in them replacing heroin as the primary drug of addiction in America. This may also have contributed to the decreasing death rate in a tertiary fashion by reducing demand for heroin and therefore reducing the price and increasing the purity of heroin on the street which would reduce deaths that often result from allergic reactions to the impurities in illicit heroin.

There is strong evidence that the availability of methadone maintenance in a community with large numbers of heroin addicts will bring about a reduction in rates of property crimes, especially the burglaries and petty thefts that addicts most often engage in to raise money to support their habit. It is very likely that the expansion of this modality under Nixon and Jaffe did lower crime rates. Crime rates, however, were already trending downward and the continuation of that trend was probably more important than any government policy.

The gravest defect of The Fix lies in its tacit assumption that the general direction and goal of our nation’s current drug policy is fine and just needs some tinkering with its budget priorities in order to “fix” it. Well, Nixon didn’t fix it, nor will or can any future president. The goal of eliminating recreational drug use has never been achieved anywhere nor is there any good reason why society should be better for achieving such a goal.

I directed one of the early treatment centers to utilize the “mixed modality” approach that Jaffe advocated and I continue to believe in its value. The fragmented state of most treatment services today, so well illustrated by Massing’s two examples, certainly is a serious barrier to the effectiveness of treatment. So I would certainly agree with Massing that America would benefit greatly from both a return to greater funding for treatment and the use of multimodality treatment. But no public health problem can be adequately controlled through treatment, or secondary and tertiary prevention as we in public health prefer to call it. It is only through primary prevention that a problem as big as drug addiction can be meaningfully reduced. It certainly cannot be reduced by operating a system in which between a third and two-thirds of the current patients don’t need any treatment at all because their drug use is recreational and not addictive.

Effective primary prevention of drug abuse, however, has to be something far different from telling people to “just say no” and telling prophylactic lies to kids in D.A.R.E. classes. First of all, effective prevention (primary, secondary or tertiary) must focus on the actual problem of addiction rather than on all use of certain selected drugs. Most users of any of the widely used drugs, with the exception of nicotine users, are not addicted, are not at great risk of becoming addicted, are not doing any substantial harm to themselves, and aren’t harming anyone else by their use of the drug. Even a small proportion of tobacco smokers are not addicted and are not harming themselves by smoking. Society has no valid interest in preventing drug use but a very clear interest in preventing addiction.

Second, primary prevention cannot be achieved by scaring people — least of all by scaring them with lies. Programs like D.A.R.E. make a strong impression on many preadolescents and early adolescents who swear they are never going to use drugs but by their mid-teens most of them have learned through observation that much the D.A.R.E. officer told them was lies and they are not only ready to experiment with drugs but cynical in viewing any valid warnings they might receive from adults about real risks. Effective prevention must be based on facts not scare stories. Instead of insisting that kids should stay drug-free forever, which virtually no one in our society is or should be, we should be teaching them how to responsibly assess drugs and situations of use so that they can choose wisely what and when and how regarding drug use.

Criminalizing drugs and drug use makes all levels of prevention more difficult. No drug user or abuser is going to be better off for being arrested. Treatment in the criminal justice system is a good idea for those who are arrested for real crimes such as theft or assault but treatment in the criminal justice system is always fighting an uphill battle against the harm done by the system. Numerous studies have shown that any form of punishment for drug use increases the likelihood that the drug user will become or persist in being addicted.

Massing is a very fine journalist but he doesn’t have the background necessary to conduct a meaningful analysis of drug policy and its effects. You can’t learn to be a physicist by watching Nova specials and you aren’t going to gain much of an understanding of drug policy by reading books like The Fix. As an introduction to the problems in the field it has merit but I would recommend the equally well written journalistic accounts by Baum (1996) or Gray (1998).