Emily Haasch

Immorality or Illness?

When my teenage son was raging out of control on drugs — wasted on crystal meth and heroin, careening toward death — I finally got him into treatment, the first of a dozen rehab programs he would go to. This program included lectures for family members, like one titled “The Disease of Addiction.” By then Nic had lied to me, broken into our home, and stolen from me — and even from his little brother, too. I thought I’d raised a kind, moral, and loving child, but something had gone horribly wrong. As I listened to the speaker talk about addiction as a disease, Nic was in a lockdown ward in a wing of the hospital. Getting him there had been hell — he almost leaped out of our moving car and had tried to kick out the window. My son wasn’t ill. He was selfish, reckless, and remorseless, a narcissistic teenager obsessed with being high, with no concern for his family.

That was the first time I heard what is sometimes termed “the disease theory” of addiction, but it wasn’t the last. I tell about my struggle to understand that addiction is a disease in my book Beautiful Boy, about about my family’s struggle when Nic became addicted. The disease theory was repeated in more lectures at more rehabs, in countless therapists’ offices, and in many Twelve Step meetings I attended. I’d become enraged by it. People with leukemia have a disease. Those with Alzheimer’s or lymphoma have a disease. Nic was choosing to use and could stop if he wanted to. There was no such option for cancer patients.

Meanwhile, I struggled to make sense of what had happened to my son.

My perplexity, not to mention my fear, led me to spend the next ten years investigating this thing called addiction. I wanted to confirm my view about espousers of the disease theory, that they were looking for an excuse for addicts’ appalling behavior.

As I report in my latest book, Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, a disease, according to Stedman’s Medical Dictionary, is “an interruption, cessation, or disorder of a body, system, or organ structure or function” and “a morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.”

In researchers’ laboratories, I was shown scans of addicts’ brains compared with ones of “normal” brains that showed startling differences in the ways they functioned. Researchers showed how the brains of addicts responded to drugs differently than did nonaddicts’ brains. They explained the consistent anatomic aberrations found in the brain structure of addicts and the disruption they had of the normal flow of neurotransmitters through the nervous system. I was informed about research that demonstrated that addicts’ brains were different even before they took drugs and given incontrovertible evidence of genetic components of addiction.

I also learned about functional differences in addicts’ brains and common symptoms associated with addiction. Over time, addicts’ neurological systems build up a tolerance to a given drug. Because they become physically dependent on the drug, they experience withdrawal symptoms, some potentially lethal, when they’re deprived of the drug. Craving and associated drug-seeking behavior are other typical symptoms. All of these symptoms are caused by biology, not choice. Impairments include a range of cognitive deficits and compromised motor functions. There are measurable anomalies related to autonomic body functions.

Over time I became convinced. The evidence was undeniable. Addiction is a disease, but a unique disease because of the associated behavior. And it’s unique because it appears that people choose it.

People do choose to use drugs — at first. Nic chose to get high, but so do most other children. Before they are eighteen, 80 percent of our kids do. Most of them stop or continue to use in moderation, but some, about one out of ten, become addicted. Like Nic. He was twelve when he smoked pot for the first time. His use quickly escalated, and by the time he was eighteen, he was addicted to it. Nic didn’t choose to become addicted. No one does. Once addicted, sufferers of the disease continue to use in spite of a desire, at some point desperation, to stop. Often they repeatedly try to stop, but they can’t. Addicts’ brains are different than others’. This is a disease that impairs the parts of the brain that would normally cause people to control their impulses.

My son was ill — seriously ill. The disease of addiction is chronic and progressive. If it isn’t treated, it can be fatal. It became clear to me: Nic could die of this disease.

I’ve heard some people say that addiction shouldn’t be considered a disease because a diagnosis would discourage addicts and their families, as if it were a sentence that would doom them. But I was relieved when I understood that Nic was ill. Nic’s unconscionable behavior made sense. I heard addicts describe the need for drugs as as powerful as the need for oxygen. Deprive a person of oxygen, and he will kick, scratch, and fight for more. Deprive an addict of drugs, and he will lie, steal, and do other irrational things — whatever it takes — to get more. The diagnosis was also a relief to Nic, who’d been as mystified as I was by behavior of his that he, too, found inexplicable.

I gathered my research in Clean. The book considers the social, political, biological, health, behavioral, and other aspects, including the consequences, of the disease of addiction. One of my goals for the book was to once and for all prove to skeptics that addiction is a disease. It wasn’t merely an intellectual exercise. I came to understand that people must know that addicts are ill if our society is ever going to solve the myriad problems associated with addiction, which is now the number-three killer in America, costing the nation $425 billion for health care, criminal justice, and lost productivity.

Clean was published in April of this year. I braced myself for attacks about some of the stands I take in the book. I expected some readers and special-interest groups to vehemently disagree with my positions on marijuana legalization and the war on drugs. (I concluded that marijuana, though dangerous for adolescents, should be legalized and that the war on drugs had failed and should be ended.) I expected some drug-treatment professionals to attack conclusions I’d made about, for example, the dangerous constructs of “hitting bottom” and cold-turkey detox (they potentially lead to death and should be rejected) or the usefulness of pharmacology in the treatment of some addictions (contrary to the adamant view of some, you do treat some drug problems with drugs). But those subjects turned out to be far less contentious than my attempt to prove that addiction is a disease.

Recently, my friend Mike Moritz, chairman of Sequoia Capital, wrote an article called “Why Is Addiction Still Considered a Personal Weakness?” tackling the subject. “When we hear about someone with a heart problem, HIV, cancer or diabetes we conclude they are ill,” Mortiz wrote. “If we encounter people whose throats close when they eat peanuts or require epinephrine shots if they mistakenly eat shellfish, we understand there are aspects of their genetic wiring that make them susceptible. Yet when we hear about someone with a drug or alcohol problem, they are all too easily dismissed as weak, self-indulgent, indolent, sinful, narcissistic, debauched and feeble failures. Why don’t we assume that drug and alcohol addicts are ill and often seriously and chronically sick?”

Many people were vitriolic in their responses to both his article and my book. Their vehemence and anger caught me off guard. A man wrote, “I have no sympathy for people who make bad choices, and that’s what addicts do. They’re derelict and must be treated as such.”

“I don’t want my tax dollars or insurance premiums or whatever else wasted on other people’s bad choices,” another responded. “The label of ‘disease’ for drug addictions evokes way too much sympathy from people, and thus is misleading. And it is THAT which I cannot stand.”

Yet another: It’s simple. People make choices in their lives. They make good or bad choices. Their choices are informed by their consciences or lack thereof. Addicts have chosen their own pleasure over everything and everyone. I have no sympathy.”

And more:

“You can make the decision to use drugs or not to. That’s called will power. Some people have no will power.”

“Addiction to substances such as narcotics, alcohol, nicotine, or others is … a choice or lack of will to change.”

“It’s a personal weakness.”

“I’m sick of this ‘oh, poor addicts, they have a disease.’ Addicts just like being high more than they like being sober. They don’t care about the consequences of this choice, which is why they’re reprehensible.”

I realized that if my goal now was to convince people that addiction is a disease, I had my work cut out for me. I learned that I’m taking on deeply rooted prejudices. For some people, the bias is grounded in a belief that if addicts were seen as ill, they’d be off the hook for the choices they made, including reprehensible behavior — violence, or unconscionable actions that break up families and send some addicts to prison. I also determined that the intense reaction comes because people are threatened. They don’t want to accept that sometimes our behavior is not in our control. Our culture emphasizes self-determination and willpower. We want to be the masters of our own destiny.

But sometimes we aren’t.

No matter why people respond to the idea with such vehemence, addiction is a disease — a brain disease.

Why does it matter so much what people think? It matters because we judge and punish people who make bad choices. We demand of them confession and contrition. On the contrary, when people are ill, we treat them with compassion, and the course forward is clearer. People who are ill don’t need blame, chastisement, or punishment — they need treatment.

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Philip Seymour Hoffman’s Death Highlights Our Ignorance About Addiction

After the death of the beloved actor, addiction is still widely misunderstood. It isn’t a disorder of character, but a brain disease

If it weren’t for Woody Allen, Dylan Farrow, and, possibly, Sochi, it would have seemed as if there was no news last week other than the overdose death of the beloved actor Philip Seymour Hoffman. Predictably, there were endless news reports about the death itself: details of the actor’s last days and hours; revelations about the number of stamped packets of heroin, and the pursuit of those who sold Hoffman the drugs that killed him. Of course, there were also moving tributes to his astounding body of work. But whereas other recent drug-related deaths of celebrities — Heath Ledger’s, Cory Monteith’s — were widely covered, Hoffman’s inspired an almost overwhelming flood of commentary about addiction.

I contributed an editorial to Time.com about the addiction-treatment system (rooted in pseudoscience and tradition, not science) that failed Hoffman, and fails the more than one hundred addicts who die every day. Also on Time.com, health writer Maia Szalavitz wrote about measures that could have saved Hoffman’s life, and Reason editor Nick Gillespie argued, “There Is No Heroin Crisis.” (In the piece, his contention that hysteria around drugs can lead to calamitous policies is correct— he cites mandatory sentencing, which has been a travesty— but there is a heroin crisis.)

Time was only one source of opinion about the death. Among the New York Times’s coverage, physician Robert Hoffman wrote an op-ed that intelligently explained how heroin overdoses can be effectively prevented. On Slate, Seth Mnookin wrote about the chilling effect the actor’s death had on him personally. As a recovering addict, Mnookin was reminded of the “ever-present danger of relapsing.” Writing in the Guardian, another recovering addict, Russell Brand, charged that Hoffman “is another victim of extremely stupid drug laws.” It may sound ludicrous, but he was right, too, when he asked, “Would Hoffman have died if this disease were not so enmeshed in stigma? If we weren’t invited to believe that people who suffer from addiction deserve to suffer? Would he have OD’d if drugs were regulated, controlled and professionally administered? Most importantly, if we insisted as a society that what is required for people who suffer from this condition is an environment of support, tolerance and understanding?”

Every time I hear about an overdose death, it hits me hard. My son, a recovering addict—he’s five years sober — could easily have been one of those whose lives were cut short because of drugs. There’s no spinning a death like Hoffman’s to make it anything other than tragic. But in his death, there was, I thought, hope for other addicts.

Another contributor to Time, a colleague of Hoffman’s, the screenwriter Aaron Sorkin, wrote that the actor once told him that if he ever overdosed, it would save other addicts. Sorkin explained that Hoffman meant that the death “would make news and maybe scare someone clean.” I agree, but I anticipated that it might save others’ lives for another reason. Addiction is the number-three killer in America and costs the nation billions of dollars a year in healthcare, criminal justice, lost productivity, and other costs — yet it’s rarely sanely addressed. Former Congressman Patrick Kennedy once told me that if you mention addiction on Capitol Hill, legislators’ eyes glaze over. There’s no effective addiction lobby, possibly because many addicts aren’t in any shape to advocate for themselves and their families often stay quiet because of the shame and blame associated with this disease. I thought, because of this tragedy, maybe we’ll now have a fruitful national discussion about addiction—that we’d acknowledge the ubiquity and talk about ways to end it.

Hoffman’s death has inspired a dialogue, but after last week’s cacophony, I’m not sanguine that it will improve the way we think about addicts and treat their affliction. Fox News published a piece that was so misguided and vindictive that it’s hard to believe that it was written by a doctor. The psychiatrist Keith Ablow, a member of Fox’s “Medical A-Team,” charged, “No quirk of neurochemistry can make you rate getting high as more important than getting your kids through life. Only a disorder of character can do that.” This belies the science that has demonstrated incontrovertibly that addiction isn’t a disorder of character, but a brain disease. So much of what I read last week — by editorialists as well as readers — was informed by similar prejudice, anger, callousness, and ignorance.

Stringing up dealers won’t solve the problem. Blaming addicts’ characters won’t solve the problem. Arresting users or even dealers won’t solve the problem, nor will minimizing the travesty. What will is an understanding that addiction is a disease and that addicts’ destructive and self-destructive behavior, as terrible as it can be, is a symptom. Just as we know that prevention, early diagnosis, and immediate and appropriate intervention stop people from dying of other diseases, those same tactics will save the lives of addicts. How many other deaths — of celebrities and, closer to home, of friends and family members — will it take before we understand that addicts are ill? People who are ill don’t need judgment, they need compassion. People who are ill don’t need censure, they need treatment.

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Fashionably Stoned

A “celebrity boutique” celebrates drug use at children’s expense

The banner on the website of Kitson, the self-described celebrity boutique whose customers include Taylor Swift, Reese Witherspoon, and Paris Hilton, reads, “Pop one on and you’ll feel better. Just what the doctor ordered.” The prescription is for customers to check out the company’s line of jerseys and sweatshirts emblazoned with the words VICODIN, XANAX, and ADDERALL, three of the most misused prescription medications, the class of drugs now killing more people than any other nonnatural cause, even traffic accidents.

Pop references to drugs are nothing new. Miley Cyrus’s twerking at MTV’s Video Music Awards was talked about more than Syria, but not much was said about the song she sang that made “dancing with Molly” sound pretty great. Molly is MDMA—Ecstasy, the drug that killed two kids and left others in critical condition at the Electronic Zoo music festival in New York City on August 31. (The New York Times has reported more deaths since then.) Nicki Minaj, Madonna, Kanye West, Rihanna, and Rick Ross also sing the praises of Molly, but those endorsements are simply the latest in the tradition of countless songs, movies, TV shows, and products that make drugs seem awesome.

Earlier this year, Urban Outfitters launched its own prescription-themed product line that included syringelike shot glasses, and flasks designed to look like bottles of medications. In the script on a beer cozy, users were advised, “Take one can by mouth, repeat until intoxicated.” (Urban Outfitters has been a frequent target of criticism for products that some have viewed as offensive, including an “Obama Black” T-shirt, an EAT LESS tank that depicted an emaciated model in a miniskirt, and a game, Ghettopoly, with bonus cards that had messages like “You got yo whole neighborhood addicted to crack. Collect $50.”) This company’s drug-themed products one-up Kitson’s, because they simultaneously advertised two drugs, prescription pills and alcohol, which in combination are more dangerous than either on its own.

Angry protesters waged Facebook and Twitter attacks on the company, just as they’re currently targeting Kitson and the clothing line’s designer, Brian Lichtenberg. The constituency of people enraged by products that make light of drugs or, worse, glorify them, is not one with which any prudent company would want to tangle. Many are parents who have lost children to prescription medications. They’ve been flooding Kitson’s Facebook page for the past two weeks. A typical post reads: “As a grieving parent who lost my youngest son to an overdose of Xanax and Vicodin I find your promotion of the non-medical use of prescription drugs to be pathetic.” Another: “You obviously haven’t had a son or daughter die in your home from an overdose on prescription pills, as I have.”

Many parents have posted photographs of their children who have overdosed and died. Every photograph — each child shining with the promise of a long and productive life — has a simple caption:

“This is my son. He died from a drug overdose. You make me sick with your merchandise.”

“Salvatore Marchese, 4-11-84 to 9-23-10.”

“Here’s my son Jarrod. He WAS 19.”

“Zachary Parsons (23) 1988-2011.”

“Jacquilynne July 14, 1978 — August 21, 2012”

Lichtenberg responded on Facebook, defending his collection as “simply a commentary on what I see happening in our society.” He said, “Mission accomplished” [if the shirts] “open the door to a much-needed dialogue.” Kitson released a statement that it would donate proceeds from the shirts to Partnership at Drugfree.org’s Medicine Abuse Project, but the organization rejected the offer as long as Kitson “flagrantly, and without remorse, continue[s] to sell these products.” The organization’s president, Steve Pasierb, wrote to Kitson CEO Christopher Lee, “Tongue-in-cheek products that normalize and promote prescription drug abuse only serve to reinforce the misperception about the danger associated with abusing medicine and put more teens at risk.”

The bereaved parents and many others also contacted the pharmaceutical companies that sell the medications. Xanax producer Pfizer said that it’s considering legal action. Shire, manufacturer of Adderall, said in a statement, “The use of ‘Adderall’ by Kitson in this manner represents an unauthorized use of Shire’s ‘Adderall’ trademark. Further…it gravely concerns Shire as it glorifies the misuse and diversion of a federally controlled prescription drug for the treatment of ADHD…. Shire is currently assessing its options to address this unauthorized use of the Shire trademark ‘Adderall.’ ”

One champion of the cause has been the actress Kristen Johnston, star of the sitcoms The Exes and Third Rock From The Sun and the author of the addiction memoir Guts. Johnston has rallied her fans and followers online. Her initial missives about the drug-themed shirts were tempered, written to inform Kitson and Lichtenberg about the problem of prescription-drug abuse. In response, the company posted on its Facebook page a comment that’s testament to public relations and marketing at its most ill-advised: “We will stop selling the t-shirts in question if tv [sic] networks agree to stop accepting ad revenue from prescription drug companies. We invite Kristen Johnston to join us in this call to action since she is a working actress on a show owned by a national network, and actors’ salaries are directly affected by advertising revenue.”

Not able to leave well enough alone, Kitson also went after Today Show coanchor Tamron Hall, who, during a report on Kitson’s drug-themed shirts last week, called the company irresponsible, saying, “People should probably not shop there until they get that [the drug shirts] out.” Kitson filed a formal complaint with the Federal Communications Commission, which raises a question: By fueling the flame, are the company’s executives cynically calculating that even bad publicity is good publicity? On the show, Hall said, “Think about how many kids are dying.”

Between the lawsuit threats and public outcry, it’s probably only a matter of time before Kitson caves. Urban Outfitters did, though even as the company pulled the offensive products, its attitude about it was snarky, dismissing those who complained as too square to understand products “that represent humor, satire, and hyperbole.” The company’s press release continued, “We recognize that from time to time there may be individual items that are misinterpreted by people who are not our customers.” It’s impossible to know if many Urban Outfitters customers, including not a few receptive young teenagers, grokked the subtlety or irony in the products that would have them squirting tequila out of syringes down their throats (LOL!). Certainly there’s nothing subtle or ironic about teenagers shooting dope, swallowing OxyContin, or downing a dozen Jäger shots.

As long as there’s a drug problem in America, it’s likely that protests against whatever products and media glamorize drug misuse will continue. Already, legislators and other politicians have been enlisted to speak out against those who feed youth culture with overt and subliminal messages that idealize getting high. On September 6, the attorneys general in Florida, Kentucky, and Maine weighed in the about Kitson matter. Florida AG Pamela Bondi said, “Your tee shirts do not ‘open the door to a dialogue,’ as the designer claims, and donating some or all of the profits to a non-profit does not make this bad idea better.”

It’s typical of companies, actors, filmmakers, musicians, and other artists to defend their right to portray drugs (or guns, or sex) in whatever ways they want, as Kitson did, citing artistic freedom and railing against censorship. And like Lichtenberg, they commonly maintain — and genuinely may believe — that they have no influence on behavior and attitudes, that they’re just reflecting drug use, not promoting it.

Their arguments are, at best, disingenuous. The protestors against Kitson aren’t calling for censorship; in America, we don’t censor people for being callous, stupid, mercenary, immature, or grossly irresponsible. But it’s patently false to claim that pop culture doesn’t influence kids. They help normalize and romanticize drug use.

Obviously images and media aren’t at the root of America’s drug problem—it’s infinitely more complicated — but they contribute to it. Studies have long shown that media messages have a pronounced impact on childhood risk behaviors. For example, a study of 16,000 teenagers in six European countries found that the more that kids saw drinking in movies, the more likely they were to binge drink. When Snoop Dogg raps about smoking endo (marijuana) and sipping on gin and juice, it sounds sublime. Some of the better Seth Rogen stoner movies make me want to get high.

Advertising and product placement work. Heineken wouldn’t have paid the creators of the latest James Bond movie, Skyfall, $45 million to have Daniel Craig eschew his usual martini in favor of a beer if it had no impact on viewers. When there’s a Heineken in Craig’s hand, the brand seems fashionable and sophisticated. Emblazoned on a designer’s $98 sweatshirt, Vicodin does, too. The Kitson T-shirts, with their hidden wink-wink-we’re-so-fabulous-in-the-know-and-fuck-off-if-you-don’t-like-it messages, reinforce a culture in which drugs are hip, drug users have all the fun, and those who abstain are nerds and losers.

Whether or not Kitson pulls the drug-themed shirts, it’s naive to think that companies and artists will stop depicting drug misuse positively and, subtly or overtly, promoting it. Meanwhile, the outcry from enraged parents and others who want to protect children will become louder. Ironically, these offensive products serve the parents’ cause in one way: They unify angry people who rally together, and the movement builds.

Their desire isn’t for censorship, but responsibility.

What will it take for a head of an apparel company, studio executive, director, designer, musician, music-label chief, or actor to draw a line and refuse to participate in anything that makes it seem totally cool to get wasted? I hope it doesn’t take what drives many of the protesters: the death of someone they love.

Want to tell Kitson how often you and your friends, neighbors, and families will be visiting their stores and website as long as they sell any product that makes light of or in any way glamorizes drug misuse? Tell them on Facebook or Twitter, or write to the company’s CEO, Christopher Lee, at Kitson, 115 S. Robertson Blvd. Los Angeles, CA 90048.

Kitson’s responses to the controversy are posted on the company’s website and Facebook page.

To learn more about the epidemic of prescription-drug abuse and what you can do to protect your loved ones (safely disposing of expired or unused Rx medications, for example), visit the Partnership at Drugfree.org’s Medicine Abuse Project. Also, I have written about ways for parents to help to protect their children from misusing drugs and becoming addicted, in a previous Medium article, “The Hidden 10 Percent.”

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The Hidden Ten Percent

Our children’s drug problem and what parents can do to solve it

A mother writes:

My son ______ was addicted to prescription drugs. At twenty one he was introduced to heroin. Two years later heroin took his life…. I found him in the bathroom in respiratory arrest. I started CPR until the paramedics arrived and transported him to the hospital. He was on life support for five weeks. He passed away on 12/11/2010. Some days the pain is so unbearable that I don’t think I’ll make it.

A father told me about his daughter, “so smart and kind and loving.”

She was 20. For the last 4 years, she was using marijuana and drinking. Then she tried meth, and that’s when I lost her. She had begun college — an ivy league school. She had good friends who loved her. After her third rehab, she was clean for six months, but then she relapsed. This time someone gave her pills. She was at a park when they found her. I can hardly write these words. We lost our beautiful girl.

More letters arrive. And more. Attached to many e-mails are pictures. Or when I open envelopes that come in the mail, photographs fall out like petals falling off a flower that has died. Parents sending pictures of their children. Their beautiful boys and beautiful girls. And they are beautiful. Every one.

In my book Clean, I write about the pain parents endure. When we become parents, a primal instinct takes over to protect our children—and one of the most pervasive threats is drugs. Every parent I know worries about them. Most of them aren’t sure if there’s anything that can be done to prevent their children from using. Most don’t even know how to try. And many of us try, but fail, like me.

My eldest son, Nic, was a lovely child—smart, precocious, funny, and kind. As he grew up, I tried to protect him from using drugs. I talked to him, telling him cautionary stories, including one about a college friend of mine who died of an overdose. I educated him about drugs and resisting peer pressure.

He didn’t.

By the time Nic turned seventeen, he was addicted to methamphetamine. He went on to use every drug you can name. He almost died on multiple occasions. Nic survived, but so many children don’t. In America, we lose a child from drug overdose and addiction every four minutes.

I look back and think, What could I have done differently?

I think, If I knew then what I know now.

What do I know now? Here, in a summation of the research about effective addictive prevention that I report in Clean, is a guide that may help other parents and caregivers.

Know the risk factors for addiction

First, I’d know the risk factors that lead to addiction. When we understand that some kids are more likely to become addicted, we can pay closer attention and get help before drug use begins or escalates. Risk factors include:

  • The age of first use in childhood: Addiction almost always begins in childhood, because that’s when humans are physically and psychologically the most vulnerable. Children start using drugs precisely at the time that it’s most dangerous for them; from the time they are twelve until they reach 25, their brains are developing more than at any time other than at birth to age two. Research shows that the younger they are when they begin using, the higher the chance they’ll become addicted. Drugs cause changes to the developing neurological system that can become intractable. The evidence is irrefutable that drugs change the developing brain, sometimes irreversibly. They negatively impact kids’ ability to think and remember and can lower their IQ.
  • Learning disabilities, behavioral problems, and psychological disorders: Many studies have shown that kids whose brains are wired differently are vulnerable. At high risk are those with ADD or ADHD; psychological disorders such as depression, anxiety, or other mental-health issues; dyslexia or other learning disabilities; eating disorders, and kids who are isolated or overly aggressive or who have battered self-esteem.
  • Trauma: Early childhood trauma or trauma later in life, from physical or sexual abuse or even from parents’ divorce, have been shown to contribute to the likelihood that a child will use drugs and become addicted.
  • Stress: Some stress comes in the form of the day-to-day ennui and time-honored pressures that are especially pronounced during adolescence. Many teenagers feel defeated, confused, anxious, alienated, or just weird. They may feel inadequate and insecure—about friendships, their appearance, or sex. Kids face bullying and cyber-bullying. Some feel as if they’ll fail in life if they haven’t filled out their college résumés by the time they’re twelve. It’s much worse for many other children: those without parents or competent caretakers, the ones who are barely in school, and the many coping with abuse, poverty, and bleak and dangerous neighborhoods. It’s unsurprising that kids who struggle are more vulnerable to drug misuse.
  • Quality of parenting: Children in families with dysfunction are at high risk for addiction. The children of parents with untreated drug problems are in a particularly high-risk group. Parents’ ability to communicate with their children—to nurture and protect them—and their permissiveness play a significant role in kids’ relationships with drugs and alcohol as they mature. The kids of parents who sanction drug use and drinking — even if they’re advocating moderation or “safe” use — are in a high-risk group too.

I wish I had known more about the disease of addiction when my son Nic showed these warning signs, but I also wish I had known that while about one-tenth of our children become addicted, they don’t have to. It is not inevitable for any child, even one in a high-risk group.

Know how you can prevent addiction

Once we educate ourselves about the roots of addiction — why people use, and why some become addicted—we move forward on a new course, reversing the trajectory and prevalence of this disease. This is what else I learned: That parents can make a tremendous difference. Here’s what you can do to protect your kids:

  • Pay attention to your children. Parents are wired for denial—we can deny what’s in front of our eyes, thereby allowing problems to fester and build until they explode. Don’t ignore signs of depression, intense anxiety, anger that seems excessive, or dramatic mood swings. Pay attention if a child is isolated, struggling in school, or experiencing great stress in her life—a divorce or death of a loved one, for example. As a pediatrician told me, “If you think there’s a problem, there’s a problem.” If you’re uncertain, get help from teachers, counselors, therapists, or physicians. Parents may feel alone and isolated, but they don’t have to. Consult specialists before these problems lead a child to drugs.
  • Address family problems. Dysfunction in families can lead to drug use, but families can be fixed. If there are problems in your family, get help. Drinking or drug problems must be addressed. Seek help for anger problems or if there are arguments and persistent tension in the home. Be sure your children know they’re valued. Kids with low self-esteem are vulnerable. Parents influence the self-image of their children. Accept them for who they are, not what you want them to be. Parents can become better parents with couples counseling, family therapy, and programs such as Parent Effectiveness Training.
  • Talk to your kids. Educate yourself about drugs so you can educate your children. Don’t talk at them, talk with them. And don’t just talk—listen. It sounds easier than it is. It takes patience and practice and practicing patience. Various couples and family therapies or Parent Effectiveness Training can help with this too. You can’t do it all yourself. Insist that your child’s school educates students by using strategies that have been tested and shown to work. Just Say No, scare tactics, and the most popular program used in America’s schools, DARE, aren’t effective. In fact, DARE has been shown to increase drug use because it normalizes it.
  • Teach your children well. Use facts, not exaggeration. Teach your kids about the impact of specific drugs on the brain. Stories and pIctures are worth a thousand words: I’ve witnessed kids who had rolled their eyes when they were told about the effect of drugs start to pay attention when they heard a compelling speaker with whom they related. They also responded when they saw scans (available on the Internet) of the brains of drug users’ compared with normal brains. Teach them what happens to kids who use—the toll on memory, IQ, and learning; the lower likelihood that drug users will achieve college degrees and their reduced earning power. Acknowledge that there are exceptions to these rules—retain your credibility by being honest—but make sure that they must know these risks. Finally, teach them practical strategies to help them safely negotiate situations in which they’ll be offered drugs and practice the way the strategies might be used. The Partnership At Drugfree.org [www.drugfree.org] offers suggestions. Indeed, the Partnership website is an indispensable resource for parents.
  • Have dinner with your children. This may seem quixotic to many families. Yes, it’s hard—parents work long hours, they’re making a living, and they’re exhausted. But this applies to anyone who is raising a child. If you can’t have dinner together, find other consistent ways to spend time with your kids. Quality matters, but so does quantity. Your children need you there.
  • Take a strong stand. Parents’ values matter. You may think that your kids don’t care what you think or that you have no power to combat the other influences in their lives, but you have more influence on your children than does any other force in their lives. Some parents think a little use is okay as long as their kids use “responsibly.” Others tell their children that it’s all right to drink, but not to smoke pot. Some feel that a little pot in moderation is acceptable, but not hard drugs. Some tell kids it’s all right to use, as long as they don’t get in a car with a driver who’s high. But no matter what conditions you impose or rationalizations you make, you are sanctioning drug use and drinking. I’ve also heard quite a few parents say, “I’d rather have them get used to drinking now, so they learn moderation. Otherwise, when they go off to college, they’ll go wild.” In fact, this made sense to me, until I read the research. Postponing use is safer. There’s no evidence that kids who drink and use as teenagers will drink and use less than they otherwise would when they’re older. Again, the opposite is true: Almost every adult who has a drug problem started using as a teenager, whereas kids who haven’t used by the time they reach college age have more likely learned how to handle stress, modulate their behavior, and sustain relationships. As one doctor said, “Teenagers with drug problems will not be prepared for adult roles…. They will chronologically mature while remaining emotional adolescents.”
  • Help your kids find safe ways to be kids. Teenagers are naturally impulsive and drawn to pleasure—like toddlers. “Adolescent humans are supposed to taste and to experiment,” explains Steve Shoptaw, a psychologist and addiction specialist at UCLA. Curiosity drives both teenagers and toddlers to experiment and push boundaries in order to enter into a new phase of life. Sometimes their explorations are dangerous. A toddler may touch a hot stove. A teenager may try drugs. Rather than try to fight the teenage brain, work with it—help kids find safe and healthy ways to experiment, take risks, and feel exhilaration, through sports, engagement with the community, wilderness programs, the arts, or “healthy risk activities,” as Dr. Shoptaw describes them, things like motocross riding or rock climbing. Encourage their passions.

Know what to do if drug use begins

Research shows that parents can help protect their children, but for now, there are no guarantees. However, even if a child experiments or begins using more drugs or more-serious drugs, parents can effectively slow or stop use. In these situations, we must:

  • Intervene immediately. This a progressive problem: That means it often gets worse unless it’s treated. Remember that drug use doesn’t have to escalate to addiction for people to die or have irreparable damage. One-time use can cause accidents and fatal overdoses.
  • Rely on professionals. Consult with a psychologist or psychiatrist trained in addiction medicine, and have the child assessed. As a doctor has told me, “If you suspect that your kids are using, they’re probably using.” Rely on doctors who are trained to diagnose and treat drug problems. There are listings of such professionals atwww.aaap.org and www.asam.org.
  • Consider drug testing. There’s evidence that drug testing works as a deterrent, plus you’ll have more information that can help guide you. Some kids cheat drug tests—there are how-to guides online for how to pass them falsely. Most experts advise against parents on their own testing their kids. They say that drug tests instead should be administered by professionals.
  • Seek evidence-based treatment. If a child’s use escalates and an assessment indicates that treatment is required, find evidence-based treatment—that is, treatment that in clinical trials has been shown to work. Every child is different, and there’s no one-size-fits-all treatment. Some kids need dual-diagnosis treatment if there are co-occurring psychiatric disorders. To find appropriate treatment programs, rely on doctors trained in addiction medicine. Again, listings of doctors with this training can be found on the AAAP and ASAM websites. Don’t rely on the Internet alone. Don’t choose programs with harsh discipline—boot camps or tough-love programs. These programs have been shown to do more harm than good.

So there’s the good news. We can effectively prevent our children from becoming addicted, and treat them if they do. But there’s cautionary news, too. Even if we do everything right—and which parent does everything right?—our kids are vulnerable. We must do the best we can.

Here is something else I know, something I’ve learned from those parents who have lost their kids and who have written to me: We must never give up trying to save the life of a child.

Next Story — The Lost War
Currently Reading - The Lost War

Emily haasch

The Lost War

The war on drugs was lost because the war on addiction was never begun

The death last month of the Glee star Cory Monteith was tragic. All deaths are. But it is even more tragic when it could have been prevented — like Monteith’s.

Because of Monteith’s death from an overdose of heroin and alcohol, addiction is having its latest fifteen minutes of fame. Fifteen minutes, however, are better than none to serve as a reminder of the prevalence and perniciousness of this disease. It’s unfortunate that it takes the death of a TV star—a Canadian in this case, but beloved in America and thought of as one of our own—to talk about a disease that kills three hundred and fifty people every day.

In the ubiquitous coverage of Monteith’s overdose, I haven’t heard any commentator express the fact that this death isn’t merely sad. It is appalling­—because it might have been prevented if it weren’t for failed drug policies.

The so-called war on drugs, which President Nixon launched in 1971, has been a war on millions of addicts, including ones just like Monteith. This approach has treated the problem as though it could be stopped by interdiction, arrests, and incarcerations. Addicts, Monteith among them, have been viewed as weak willed and derelict and treated as criminals rather than what they are: People afflicted with a chronic and potentially fatal illness. (In my last Medium column, I explained the disease of addiction.) If, before his death, Monteith had been caught with drugs and paraphernalia in his possession, he would likely have been arrested. But arresting people who are ill isn’t only inhumane, it’s counterproductive: When addiction isn’t treated, it worsens. If the U.S. hadn’t spent decades and more than a trillion dollars fighting the war and instead spent the time and money to improve prevention and treatment, Monteith might have been healed, and so might every other addict.

As I report in my book Clean, in North America and the rest of the world, the chorus of voices calling for an end to the war on drugs is getting louder. The Global Commission on Drug Policy—members of which include economists, policy experts, and several former world leaders—former Secretary of State George Shultz, former chairman of the U.S. Federal Reserve Paul Volcker, and entrepreneur Richard Branson, among others—have declared that “the global war on drugs has failed, with devastating consequences for individuals and societies around the world.” Speaking at the Brookings Institution last year, New Jersey Governor Chris Christie said, “The war on drugs, while well-intentioned, has been a failure.” Soon thereafter, the NAACP took a stand: “Today the NAACP has taken a major step towards equity, justice and effective law enforcement,” said Benjamin Todd Jealous, the organization’s president and CEO. “These flawed drug policies that have been mostly enforced in African American communities must be stopped and replaced with evidenced-based practices that address the root causes of drug use and abuse in America.” In a New York Times editorial, Fernando Henrique Cardoso and Ruth Dreifuss, the former presidents of Brazil and Switzerland, respectively, argued that the war should be ended because of the appalling human-rights violations perpetrated in its name. The chorus now represents a majority of the American people. In a recent poll, only 10 percent of Americans said they considered the War on Drugs a success. Two-thirds of those polled, including the majority of both Democrats and Republicans, said it was a failure.

They’re right. The war has decimated families and communities, encouraging an out-of-control cycle of violence, addiction, and crime; targeted racial minorities; and killed tens of thousands of civilians in Mexico and other countries. It is responsible for America having more people imprisoned than any other country in the world, even China or Russia. And then there’s the money: the trillion-plus dollars that could have been used on social programs, especially ones that would have prevented addiction from flourishing.

The war has also exacerbated the nation’s current number-one drug problem, prescription-pill abuse, which leads to more non-natural deaths in America than any other cause. For these addictive medications, physicians and pharmaceutical companies, not cartels, are the suppliers. Meanwhile, prescription-medication misuse is fueling a new and mounting heroin epidemic. Many OxyContin and Vicodin users grow addicted and turn to heroin because it’s cheaper than pharmaceuticals and much easier to score. So much for the effectiveness of the drug war. It’s by now a familiar refrain: targeting the drug supply doesn’t work.

In Clean, I tell the story of a boy named Luke Gsell, who became addicted at fourteen. Gsell said that his need for drugs was such that when he couldn’t find ecstasy, pot, or cocaine, he’d “take gasoline out of the lawnmower and huff that.” People who want drugs will find them, and as long as people want them, any war that focuses on the supply of drugs is destined to fail.

The drug war has failed, but in this debate, few address a critical question. Can we afford to accept defeat? Drugs kill 120,000 people a year and cost the nation more than four hundred billion dollars, mostly in health care, criminal justice, and lost productivity. Twenty million Americans are addicted. Few of those who have called for an end to the war have offered specific solutions, instead mostly issuing a generic and obvious call to lower demand. But how?

There is a solution, and a model to follow. If we’re finally going to take on America’s drug problem effectively, we must end the war on drugs and instead fight this like we fight other diseases. We must effectively take on the disease of addiction.

Simultaneously with ending the drug war, we must work to cure addiction, just as we have worked to cure other diseases. Cancer. Heart disease. HIV AIDS. More money for addiction research is necessary. It could lead to significant advances in the creation, testing, and dissemination of effective addiction prevention and treatment. If we were to begin dismantling the drug war by budgeting, say, a third of the money currently allotted for curbing the supply, the paltry one-billion-dollar budget of the National Institute on Drug Abuse (NIDA) could be quintupled. Access to more money could allow NIDA and the researchers it funds to improve current prevention strategies and treatments and develop new ones, including addiction vaccines, prevention programs for children and young adults of all ages, medications, and behavioral treatments for the addicted. By starving NIDA and researchers around the nation of the money to improve existing treatments and find new ones, the administration is impeding progress. By failing to work with the states to create a national treatment system based on evidence-based practices, the government is allowing the perpetuation of the current system, which is based on pseudoscience and best guesses and does not work for most addicts who make it into rehab, and only one out of ten ever receive any treatment whatsoever.

It’s too late for Cory Monteith. But when we change our focus and fight the war on the disease of addiction, we’ll save the lives of countless others like him.

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