Go now to the link Do you have an Alcohol or Drug problem? to see an on-line questionnaire on assessing alcohol or drug use. Another valuable survey is this one from Alcoholics Anonymous.

http://www.recovery-man.com

Do you have a drug or alcohol problem?

What is addiction?
Alcoholism and other Addictions are primary, progressive, and fatal illnesses which respond to medical treatment. If left untreated, addictions result in insanity and premature death. Addiction has also been described as a pathological relationship to a substance, person, behavior or process. The idea that addicts are weak willed or morally corrupt has long ago been debunked. That attitude keeps people from seeking treatment and fosters shame and fear around their illness. Addicts and the people who love them are often the last to accept the disease concept - this relates to shame, denial and the need to prove that they are in control.
" Shaming" addicts for their use and using behavior is counter productive, creates barriers to recovery, and greatly complicates the recovery process once begun. Addicts feel enormous shame as it is - adding to this shame is not only cruel, but may spur greater use. Addicts medicate shame, fear, anger and pain. Increasing the burden of shame can lead to overdose and / or suicide.
Signs and Symptoms of Addiction.
Alcohol is a drug! For the purpose of this page the terms "drink" and "use"or "addiction" and "alcoholism" are interchangeable.
* When you drink or use drugs, does it take more or less to get you drunk or high than it used to? (Increasing or decreasing tolerance is a sign of addiction.)
* Do you ever drink or use more than you intended to? (This indicates loss of control over your use.)
* Do you make sure you have a supply of drugs or always keep a bottle on hand? (Do you call the dealer before your stash is gone, drive across town at rush hour to refill that prescription, or lay in a case on Saturday night so you'll have it when the liquor stores are closed on Sunday? Preoccupation with supply is a characteristic of addiction.)
* Do you have blackouts or brownouts - forget what you have done or said, or "lose time" after drinking or using? (Blackouts are indicative of late stage alcoholism or addiction.)
* Do you ever drink or use drugs in the morning to reduce anxiety or cope with a hangover? (This indicates progression of addiction, hangovers are actually the onset of withdrawal.)
* Do you ever find yourself wishing for a drink or drug to calm down or steady yourself? (This indicates preoccupation and self medication, as well as progression of addiction, as what prompts this is often physical withdrawal symptoms.)
* Do you ever drink when taking prescription medications which advise against drinking alcohol? (This shows powerlessness over your drinking. It is also very dangerous. Remember Karen Anne Quinlan?)
* Have you ever gone to work or school drunk or high? (This indicates powerlessness and unmanageability in your life.)
* Do you have a history of relationships with addicts or alcoholics? (Codependent alcoholics and addicts often unconsciously find addicted partners - it allows them a smoke screen to hide behind. "I may drink or use, but I'm not like them.")
* Do you find yourself using alcohol, drugs or sex to reduce anxiety or help you sleep? (Addicts medicate emotional pain, anxiety and fear. Benzodiazapine based anti anxiety drugs (Xanex, Valium etc.) are highly addictive. Most sleeping meds are very addictive, and often have a paradoxical effect - making sleep disturbances worse with continued use.)
* When prescribed medication, do you take more than prescribed? ("If one is good - two is better", this belief is at the center of addictive thinking.)
* Have friends, family or loved ones ever commented on or expressed concern about your use? (Addicts are usually the last to recognize their disease - denial is an automatic and unconscious component of addiction. If you insist that you don't have a problem you probably do! If this makes you angry - ask yourself why?)
* Do you conceal your use from family, friends, therapists or loved ones, or "edit" stories involving your drinking or using? (Secretiveness, denial and lies about use are characteristic of active addicts and alcoholics.)
* Do you ever drink or use alone? (Indicates you are not a "social" drinker. Also, isolation and a feeling of "being different" or "not fitting in" are a common personality trait of addicts / alcoholics.)
* Do you do or say things you later regret when drinking or using? (Impaired judgement from drinking or using indicate powerlessness over use. Behavioral changes when drinking or using are a sign of progression, loss of control and late stage addiction.)
* Have you ever had a DUI, driven drunk, or had a drug or alcohol related accident or injury? Have you slept in your car, or away from home because you were too drunk to drive? Are you relieved when someone else drives so you are free to drink or use? (Drinking and driving indicates powerlessness over use, and is a part of the unmanageability of active addiction.
* Have you ever stopped or cut back on drinking or using because you felt it was causing problems in your life? (Life difficulties around use indicate a problem - many alcoholics and addicts temporarily modify their patterns of using in an effort to prove to themselves that they have control of their use. Non-alcoholics don't need to prove they are in control! Stopping drinking or use for a period is usually not difficult, staying abstinent from all mood altering substances for long periods is nearly impossible for untreated addicts.
* Is your life increasingly chaotic and turbulent? (Unmanagability is indicated by accidents, missed appointments, unpaid / late bills and rent, work and relationship difficulties, a generalized sense of desperation, and pervasive sadness or anger. A life out of control is often traceable to the progression of addiction. Addicts typically project their unmanagability outward - blaming everything but the addiction for their problems. Addicts drink or use because they are addicted. Difficult life events may trigger addictive acting out - but they are not the cause of an addict's use.
* Do you switch from one substance to another, or change drinks in an effort to regain control? (Switch from Scotch to Beer? Stop drinking but start taking pills? Give up marijuana but start drinking? Quit drinking but become sexually promiscuous? This is called cross addiction.)
* Do you believe you're not an addict because your drug of choice is legal or prescribed? (Go ask Elvis about this one! Many Medical Doctors are shockingly unaware of addiction issues, and of the addictive nature of many commonly prescribed drugs.)
If you answered yes to any of these questions you may want to look at your using and drinking patterns. If you answered yes to two moderating your drinking or use would be a good idea; three or more you would be well advised to seek professional help.
Need Help? Use the Treatment Center Search Engine.
If you have an addict or alcoholic in your life the prudent course is compassionate and loving confrontation of their addictive behavior coupled with presenting a treatment option. This is called intervention. Search Amazon.com for readings about intervention here.
If you just took this test for someone else - you may wish to learn more about codependency.
Addicts cannot be "made to recover" - effective recovery work requires personal willingness. If someone you love has a problem you can (and should) confront their use and using behaviors. You cannot control, cure or fix the problem. Sometimes you have to let go and let them continue in the addiction until things get so bad that their misery outweighs their fear of change.

http://www.alcoholics-anonymous.org/default/en_about_aa.cfm?pageid=4

IS A.A. FOR YOU? Only you can decide whether you want to give A.A.a try — whether you think it can help you. We who are in A.A. came because we finally gave up trying to control our drinking. We still hated to admit that we could never drink safely. Then we heard from other A.A. members that we were sick. (We thought so for years!) We found out that many people suffered from the same feelings of guilt and loneliness and hopelessness that we did. We found out that we had these feelings because we had the disease of alcoholism. We decided to try and face up to what alcohol had done to us. Here are some of the questions we tried to answer honestly. If we answered YES to four or more questions, we were in deep trouble with our drinking. See how you do. Remember, there is no disgrace in facing up to the fact that you have a problem. Answer YES or NO to the following questions. 1 - Have you ever decided to stop drinking for a week or so, but only lasted for a couple of days? Most of us in A.A. made all kinds of promises to ourselves and to our families. We could not keep them. Then we came to A.A. A.A. said: "Just try not to drink today." (If you do not drink today, you cannot get drunk today.) Yes No 2 - Do you wish people would mind their own business about your drinking-- stop telling you what to do? In A.A. we do not tell anyone to do anything. We just talk about our own drinking, the trouble we got into, and how we stopped. We will be glad to help you, if you want us to. Yes No 3 - Have you ever switched from one kind of drink to another in the hope that this would keep you from getting drunk? We tried all kinds of ways. We made our drinks weak. Or just drank beer. Or we did not drink cocktails. Or only drank on weekends. You name it, we tried it. But if we drank anything with alcohol in it, we usually got drunk eventually. Yes No 4 - Have you had to have an eye-opener upon awakening during the past year? Do you need a drink to get started, or to stop shaking? This is a pretty sure sign that you are not drinking "socially." Yes No 5 - Do you envy people who can drink without getting into trouble? At one time or another, most of us have wondered why we were not like most people, who really can take it or leave it. Yes No 6 - Have you had problems connected with drinking during the past year? Be honest! Doctors say that if you have a problem with alcohol and keep on drinking, it will get worse -- never better. Eventually, you will die, or end up in an institution for the rest of your life. The only hope is to stop drinking. Yes No 7 - Has your drinking caused trouble at home? Before we came into A.A., most of us said that it was the people or problems at home that made us drink. We could not see that our drinking just made everything worse. It never solved problems anywhere or anytime. Yes No 8 - Do you ever try to get "extra" drinks at a party because you do not get enough? Most of us used to have a "few" before we started out if we thought it was going to be that kind of party. And if drinks were not served fast enough, we would go some place else to get more. Yes No 9 - Do you tell yourself you can stop drinking any time you want to, even though you keep getting drunk when you don't mean to? Many of us kidded ourselves into thinking that we drank because we wanted to. After we came into A.A., we found out that once we started to drink, we couldn't stop. Yes No 10 - Have you missed days of work or school because of drinking? Many of us admit now that we "called in sick" lots of times when the truth was that we were hung-over or on a drunk. Yes No 11 - Do you have "blackouts"? A "blackout" is when we have been drinking hours or days which we cannot remember. When we came to A.A., we found out that this is a pretty sure sign of alcoholic drinking. Yes No 12 - Have you ever felt that your life would be better if you did not drink? Many of us started to drink because drinking made life seem better, at least for a while. By the time we got into A.A., we felt trapped. We were drinking to live and living to drink. We were sick and tired of being sick and tired. Yes No Did you answer YES four or more times? If so, you are probably in trouble with alcohol. Why do we say this? Because thousands of people in A.A. have said so for many years. They found out the truth about themselves — the hard way. But again, only you can decide whether you think A.A. is for you. Try to keep an open mind on the subject. If the answer is YES, we will be glad to show you how we stopped drinking ourselves. Just call. A.A. does not promise to solve your life's problems. But we can show you how we are learning to live without drinking "one day at a time." We stay away from that "first drink." If there is no first one, there cannot be a tenth one. And when we got rid of alcohol, we found that life became much more manageable. ALCOHOLICS ANONYMOUS¨ is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety. Copyright © by The A.A. Grapevine, Inc.; reprinted with permission

For more information on drug abuse including:

go to The Straight Facts about Drugs and Alcohol from the National Clearinghouse for Alcohol and Drug Information.

Straight Facts About Drugs and Alcohol
TABLE OF CONTENTS
How Can I Tell if a Friend or Loved One Has a Problem with
Alcohol, Marijuana, or Other Illicit Drugs?
How Can I Tell if I Have a Problem with Drugs or Alcohol?
How Can I Get Help?
STRAIGHT FACTS ABOUT...
Marijuana
Cigarette Smoking
Alcohol
Methamphetamine
Cocaine and Crack Cocaine
Hallucinogens
Inhalants
Messages for Teenagers
Referrals
How Can I Tell If a Friend or a Loved One Has a Problem With
Alcohol, Marijuana, or Other Illicit Drugs?
Sometimes it is tough to tell. Most people won't walk up to
someone they're close to and ask for help. In fact, they will
probably do everything possible to deny or hide the problem. But,
there are certain warning signs that may indicate that a family
member or friend is using drugs and drinking too much alcohol.
If your friend or loved one has one or more of the following
signs, he or she may have a problem with drugs or alcohol:
* getting high on drugs or getting drunk on a regular basis
* lying about things, or the amount of drugs or alcohol they are
using
* avoiding you and others in order to get high or drunk
* giving up activities they used to do such as sports, homework,
or hanging out with friends who don't use drugs or drink
* having to use more marijuana or other illicit drugs to get the
same effects
* constantly talking about using drugs or drinking
* believing that in order to have fun they need to drink or use
marijuana or other drugs
* pressuring others to use drugs or drink
* getting into trouble with the law
* taking risks, including sexual risks and driving under the
influence of alcohol and/or drugs
* feeling run-down, hopeless, depressed, or even suicidal
* suspension from school for an alcohol- or drug-related incident
* missing work or poor work performance because of drinking or
drug use
Many of the signs, such as sudden changes in mood, difficulty in
getting along with others, poor job or school performance,
irritability, and depression, might be explained by other causes.
Unless you observe drug use or excessive drinking, it can be hard
to determine the cause of these problems. Your first step is to
contact a qualified alcohol and drug professional in your area who
can give you further advice.
How Can I Tell if I Have a Problem with Drugs or Alcohol?
Drug and alcohol problems can affect every one of us regardless of
age, sex, race, marital status, place of residence, income level,
or lifestyle.
You may have a problem with drugs or alcohol, if:
* You can't predict whether or not you will use drugs or get
drunk.
* You believe that in order to have fun you need to drink and/or
use drugs.
* You turn to alcohol and/or drugs after a confrontation or
argument, or to relieve uncomfortable feelings.
* You drink more or use more drugs to get the same effect that
you got with smaller amounts.
* You drink and/or use drugs alone.
* You remember how last night began, but not how it ended, so
you're worried you may have a problem.
* You have trouble at work or in school because of your drinking
or drug use.
* You make promises to yourself or others that you'll stop
getting drunk or using drugs.
* You feel alone, scared, miserable, and depressed.
If you have experienced any of the above problems, take heart,
help is available. More than a million Americans like you have
taken charge of their lives and are living healthy and drug-free.
How Can I Get Help?
You can get help for yourself or for a friend or loved one from
numerous national, State, and local organizations, treatment
centers, referral centers, and hotlines throughout the country.
There are various kinds of treatment services and centers. For
example, some may involve outpatient counseling, while others may
be 3- to 5-week-long inpatient programs.
While you or your friend or loved one may be hesitant to seek
help, know that treatment programs offer organized and structured
services with individual, group, and family therapy for people
with alcohol and drug abuse problems. Research shows that when
appropriate treatment is given, and when clients follow their
prescribed program, treatment can work. By reducing alcohol
and/or drug abuse, treatment reduces costs to society in terms of
medical care, law enforcement, and crime. More importantly,
treatment can help keep you and your loved ones together.
Remember, some people may go through treatment a number of times
before they are in full recovery. Do not give up hope.
Each community has its own resources. Some common referral
sources that are often listed in the phone book are:
* Community Drug Hotlines
* Local Emergency Health Clinics, or Community Treatment Services
* City/Local Health Departments
* Alcoholics Anonymous, Narcotics Anonymous, or Al-Anon/Alateen
* Hospitals
For a list of additional resources and organizations, check out
the referral list at the end of this document.HERE ARE THE STRAIGHT FACTS...
About Marijuana
Marijuana is the most widely used illicit drug in the United
States and tends to be the first illegal drug teens use. The
physical effects of marijuana use, particularly on developing
adolescents, can be acute.
Short-term effects of using marijuana:
* sleepiness
* difficulty keeping track of time, impaired or reduced short-
term memory
* reduced ability to perform tasks requiring concentration and
coordination, such as driving a car
* increased heart rate
* potential cardiac dangers for those with preexisting heart
disease
* bloodshot eyes
* dry mouth and throat
* decreased social inhibitions
* paranoia, hallucinations
Long-term effects of using marijuana:
* enhanced cancer risk
* decrease in testosterone levels for men; also lower sperm
counts and difficulty having children
* increase in testosterone levels for women; also increased risk
of infertility
* diminished or extinguished sexual pleasure
* psychological dependence requiring more of the drug to get the
same effect
Marijuana blocks the messages going to your brain and alters your
perceptions and emotions, vision, hearing, and coordination.
A recent study of 1,023 trauma patients admitted to a shock trauma
unit found that one-third had marijuana in their blood.
HERE ARE THE STRAIGHT FACTS...
About Cigarette Smoking
Although many people smoke because they believe cigarettes calm
their nerves, smoking releases epinephrine, a hormone which
creates physiological stress in the smoker, rather than
relaxation. The use of tobacco is addictive. Most users develop
tolerance for nicotine and need greater amounts to produce a
desired effect. Smokers become physically and psychologically
dependent and will suffer withdrawal symptoms including: changes
in body temperature, heart rate, digestion, muscle tone, and
appetite. Psychological symptoms include: irritability, anxiety,
sleep disturbances, nervousness, headaches, fatigue, nausea, and
cravings for tobacco that can last days, weeks, months, years, or
an entire lifetime.
Risks associated with smoking cigarettes:
* diminished or extinguished sense of smell and taste
* frequent colds
* smoker's cough
* gastric ulcers
* chronic bronchitis
* increase in heart rate and blood pressure
* premature and more abundant face wrinkles
* emphysema
* heart disease
* stroke
* cancer of the mouth, larynx, pharynx, esophagus, lungs,
pancreas, cervix, uterus, and bladder
Cigarette smoking is perhaps the most devastating preventable
cause of disease and premature death.
Smoking is particularly dangerous for teens because their bodies
are still developing and changing and the 4,000 chemicals
(including 200 known poisons) in cigarette smoke can adversely
affect this process.
Cigarettes are highly addictive. One-third of young people who
are just "experimenting" end up being addicted by the time they
are 20.
HERE ARE THE STRAIGHT FACTS...
About Alcohol
Alcohol abuse is a pattern of problem drinking that results in
health consequences, social, problems, or both. However, alcohol
dependence, or alcoholism, refers to a disease that is
characterized by abnormal alcohol-seeking behavior that leads to
impaired control over drinking.
Short-term effects of alcohol use include:
* distorted vision, hearing, and coordination
* altered perceptions and emotions
* impaired judgment
* bad breath; hangovers
Long-term effects of heavy alcohol use include:
* loss of appetite
* vitamin deficiencies
* stomach ailments
* skin problems
* sexual impotence
* liver damage
* heart and central nervous system damage
* memory loss
How Do I Know If I, or Someone Close, Has a Drinking Problem?
Here are some quick clues:
* Inability to control drinking--it seems that regardless of what
you decide beforehand, you frequently wind up drunk
* Using alcohol to escape problems
* A change in personality--turning from Dr. Jekyl to Mr. Hyde
* A high tolerance level--drinking just about everybody under the
table
* Blackouts--sometimes not remembering what happened while
drinking
* Problems at work or in school as a result of drinking
* Concern shown by family and friends about drinking
If you have a drinking problem, or if you suspect you have a
drinking problem, there are many others out there like you, and
there is help available. Talk to school counselor, a friend, or a
parent.
HERE ARE THE STRAIGHT FACTS...
About Methamphetamine
Methamphetamine is a stimulant drug chemically related to
amphetamine but with stronger effects on the central nervous
system. Street names for the drug include "speed," "meth," and
" crank."
Methamphetamine is used in pill form, or in powdered form by
snorting or injecting. Crystallized methamphetamine known as
" ice," "crystal," or "glass," is a smokable and more powerful form
of the drug.
The effects of methamphetamine use include:
* increased heart rate and blood pressure
* increased wakefulness; insomnia
* increased physical activity
* decreased appetite
* respiratory problems
* extreme anorexia
* hyperthermia, convulsions, and cardiovascular problems, which
can lead to death
* euphoria
* irritability, confusion, tremors
* anxiety, paranoia, or violent behavior
* can cause irreversible damage to blood vessels in the brain,
producing strokes
Methamphetamine users who inject the drug and share needles are at
risk for acquiring HIV/AIDS.
Methamphetamine is an increasingly popular drug at raves (all
night dancing parties), and as part of a number of drugs used by
college-aged students. Marijuana and alcohol are commonly listed
as additional drugs of abuse among methamphetamine treatment
admissions. Most of the methamphetamine-related deaths (92%)
reported in 1994 involved methamphetamine in combination with at
least one other drug, most often alcohol (30%), heroin (23%), or
cocaine (21%). Researchers continue to study the long-term
effects of methamphetamine use.
HERE ARE THE STRAIGHT FACTS...
About Cocaine and Crack Cocaine
Cocaine is a white powder that comes from the leaves of the South
American coca plant. Cocaine is either "snorted" through the
nasal passages or injected intravenously. Cocaine belongs to a
class of drugs known as stimulants, which tend to give a temporary
illusion of limitless power and energy that leave the user feeling
depressed, edgy, and craving more. Crack is a smokable form of
cocaine that has been chemically altered. Cocaine and crack are
highly addictive. This addiction can erode physical and mental
health and can become so strong that these drugs dominate all
aspects of an addict's life.
Physical risks associated with using any amount of cocaine and
crack:
* increases in blood pressure, heart rate, breathing rate, and
body temperature
* heart attacks, strokes, and respiratory failure
* hepatitis or AIDS through shared needles
* brain seizures
* reduction of the body's ability to resist and combat infection
Psychological risks:
* violent, erratic, or paranoid behavior
* hallucinations and "coke bugs"--a sensation of imaginary
insects crawling over the skin
* confusion, anxiety and depression, loss of interest in food or
sex
* "cocaine psychosis"--losing touch with reality, loss of
interest in friends, family, sports, hobbies, and other activities
Some users spend hundred or thousands of dollars on cocaine and
crack each week and will do anything to support their habit. Many
turn to drug selling, prostitution, or other crimes.
Cocaine and crack use has been a contributing factor in a number
of drownings, car crashes, falls, burns, and suicides.
Cocaine and crack addicts often become unable to function
sexually.
Even first time users may experience seizures or heart attacks,
which can be fatal.
HERE ARE THE STRAIGHT FACTS...
About Hallucinogens
Hallucinogenic drugs are substances that distort the perception of
objective reality. The most well-known hallucinogens include
phencyclidine, otherwise known as PCP, angel dust, or loveboat;
lysergic acid diethylamide, commonly known as LSD or acid;
mescaline and peyote; and psilocybin, or "magic" mushrooms. Under
the influence of hallucinogens, the senses of direction, distance,
and time become disoriented. These drugs can produce
unpredictable, erratic, and violent behavior in users that
sometimes leads to serious injuries and death. The effect of
hallucinogens can last for 12 hours.
LSD produces tolerance, so that users who take the drug repeatedly
must take higher and higher doses in order to achieve the same
state of intoxication. This is extremely dangerous, given the
unpredictability of the drug, and can result in increased risk of
convulsions, coma, heart and lung failure, and even death.
Physical risks associated with using hallucinogens:
* increased heart rate and blood pressure
* sleeplessness and tremors
* lack of muscular coordination
* sparse, mangled, and incoherent speech
* decreased awareness of touch and pain that can result in self-
inflicted injuries
* convulsions
* coma; heart and lung failure
Psychological risks associated with using hallucinogens:
* a sense of distance and estrangement
* depression, anxiety, and paranoia
* violent behavior
* confusion, suspicion, and loss of control
* flashbacks
* behavior similar to schizophrenic psychosis
* catatonic syndrome whereby the user becomes mute, lethargic,
disoriented, and makes meaningless repetitive movements
Everyone reacts differently to hallucinogens--there's no way to
predict if you can avoid a "bad trip."
HERE ARE THE STRAIGHT FACTS...
Inhalants refer to substances that are sniffed or huffed to give
the user an immediate head rush or high. They include a diverse
group of chemicals that are found in consumer products such as
aerosols and cleaning solvents. Inhalant use can cause a number of
physical and emotional problems, and even one-time use can result
in death.
Using inhalants even one time can put you at risk for:
* sudden death
* suffocation
* visual hallucinations and severe mood swings
* numbness and tingling of the hands and feet
Prolonged use can result in:
* headache, muscle weakness, abdominal pain
* decrease or loss of sense of smell
* nausea and nosebleeds
* hepatitis
* violent behaviors
* irregular heartbeat
* liver, lung, and kidney impairment
* irreversible brain damage
* nervous system damage
* dangerous chemical imbalances in the body
* involuntary passing of urine and feces
Short-term effects of inhalants include:
* heart palpitations
* breathing difficulty
* dizziness
* headaches
Remember, using inhalants, even one time, can kill you. According
to medical experts, death can occur in at least five ways:
* asphyxia--solvent gases can significantly limit available
oxygen in the air, causing breathing to stop;
* suffocation--typically seen with inhalant users who use bags;
* choking on vomit;
* careless behaviors in potentially dangerous settings; and
* sudden sniffing death syndrome, presumably from cardiac arrest.
Messages for Teenagers
Know the law. Methamphetamines, marijuana, hallucinogens, crack,
cocaine, and many other substances are illegal. Depending on
where you are caught, you could face high fines and jail time.
Alcohol is illegal to buy or possess if you are under 21.
Be aware of the risks. Drinking or using drugs increases the
risk of injury. Car crashes, falls, burns, drowning, and suicide
are all linked to drug use.
Keep your edge. Drug use can ruin your looks, make you
depressed, and contribute to slipping grades.
Play it safe. One incident of drug use could make you do
something that you will regret for a lifetime.
Do the smart thing. Using drugs puts your health, education,
family ties, and social life at risk.
Get with the program. Doing drugs isn't "in" anymore.
Think twice about what you're advertising when you buy and wear T-
shirts, hats, pins, or jewelry with a pot leaf, joint, blunt, beer
can, or other drug paraphernalia on them. Do you want to promote
something that can cause cancer? make you forget things? or make
it difficult to drive a car?
Face your problems. Using drugs won't help you escape your
problems, it will only create more.
Be a real friend. If you know someone with a drug problem, be
part of the solution. Urge your friend to get help.
Remember, you DON'T NEED drugs or alcohol. If you think
" everybody's doing it," you're wrong! Over 86% of 12-17 year-olds
have never tried marijuana; over 98% have never used cocaine; only
about half a percent of them have ever used crack. Doing drugs
won't make you happy or popular or help you to learn the skills
you need as you grow up. In fact, doing drugs can cause you to
fail at all of these things.
REFERRALS
Adult Children of Alcoholics (ACA/ACoA)
P.O. Box 3216
Torrance, CA 90510
310-534-1815
Alanon/Alateen
Family Group Headquarters, Inc.
P.O. Box 862
Midtown Station
New York, NY 10018-0862
1-800-356-9996 (Literature)
1-800-344-2666 (Meeting Referral)
Alcoholics Anonymous
World Services, Inc.
475 Riverside Drive
New York, NY 10115
212-870-3400 (Literature)
212-647-1680 (Meeting Referral)
CDC National AIDS Hotline1-800-342-AIDS
1-800-344-SIDA -- Spanish
1-800-AIDS-TTY -- TDD
Center for Substance Abuse Treatment
National Drug and Alcohol Treatment Referral Service
1-800-662-HELP
Referrals To:
1-800-ALCOHOL
1-800-COCAINE
1-800-448-3000 BOYSTOWN
Children of Alcoholics Foundation, Inc.
555 Madison Avenue, 20th Floor
New York, NY 10022
212-754-0656 or 800-359-COAF
Cocaine Anonymous
World Service Office
3740 Overland Avenue, Ste. C
Los Angeles, CA 90034
1-800-347-8998
Families Anonymous
P.O. Box 35475
Culver CIty, CA 90231
1-800-736-9805
Hazelden Educational Materials
Pleasant Valley Road
P.O. Box 176
Center City, MN 55012-0176
1-800-328-9000
Marijuana Anonymous
World Services P.O. Box 2912
Van Nuys, CA 91404
1-800-766-6779
Mothers Against Drunk Driving (MADD)
511 E. John Carpenter Freeway
Suite 700
Irving, TX 75062
214-744-6233
Victim Hotline: 800-438-6233 (GET MADD)
NAFARE Alcohol, Drug, and Pregnancy Hotline
200 N. Michigan Avenue
Chicago, IL 60601
1-800-638-BABY
Nar-Anon Family Group Headquarters, Inc.
P.O. Box 2562
Palos Verdes Peninsula, CA 90274
310-547-5800
Narcotics Anonymous (NA)
World Service Office
P.O. Box 9999
Van Nuys, CA 91409
818-773-9999
National Association for
Children of Alcoholics
11426 Rockville Pike, Suite 301
Rockville, MD 20852
301-468-0985
National Clearinghouse for Alcohol
and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
301-468-2600
1-800-729-6686
National Council on Alcoholism
and Drug Dependence
12 West 21st Street, 7th Floor
New York, NY 10010
1-800-NCA-CALL (will refer you to your local treatment
information center)
National Families in Action
2296 Henderson Mill Road
Suite 204
Atlanta, GA 30345
770-934-6364
National Highway Traffic Safety Information
400 7th Street, SW
Washington, DC 20590
202-366-9550
Auto Safety Hotline: 1-800-424-9393
National Women's Health Network
514 10th Street, NW, Ste. 400
Washington, DC 20004
202-682-7814
Rational Recovery Systems
P. O. Box 800
Lotus, CA 95651 1-800-303-CURE
Secular Organizations for Sobriety (SOS)
P.O. Box 5
Buffalo, NY 14215 310-821-8430
Women for Sobriety
P.O. Box 618
Quakertown, PA 18951
1-800-333-1606

Women have historically been stigmatized when they are alcoholic. Until recently, most treatment programs were geared toward men, as was almost all the research conducted on addiction. Linda J. Beckman, PhD, author of "Treatment Needs of Women With Alcohol Problems" in Alcohol Health and Research World (Vol. 18, No. 3, 1994), says women's needs in treatment include addressing physiology, as "excessive drinking can adversely affect menstrual cycle, fetal development and childbirth; can lead to changes in sexual desire, such as sexual inhibition; and has been linked to early menopause."; violence, as many women drug and alcohol abusers have been sexually abused as children, or beaten or abused as adults; and the higher percentage of dual diagnoses, especially panic disorder and depression.

The National Institute on Drug Abuse has been researching Women's Health and Gender Differences, focusing on etiology, consequences and prevention.

Women's Health and Gender Differences

National Institute on Drug Abuse Overview of NIDA Research on Women's Health and Gender Differences [Etiology] [Consequences] [Prevention] [Treatment and Services] Introduction.  In past research on drug abuse, as well as other fields of public health, research subjects have been almost exclusively male; as a result little data have been available on women. In recent years, however, the National Institute on Drug Abuse (NIDA) has promoted drug abuse research focusing on the study of women and gender differences. Data from laboratory, field and clinical research is beginning to show gender differences in biological factors in drug abuse, the progression and initiation to drug use and abuse, the antecedents and consequences of drug use and abuse, and prevention and treatment. Research on women and gender differences is now supported in all of NIDA's programmatic branches and is grouped into four major program areas: Etiology, Consequences, Prevention, and Treatment and Services.   Etiology.  NIDA supports a broad base of animal and preclinical human research as well as field research aimed at investigating gender differences in the nature and extent of drug-using behaviors, gender differences in the pathways and determinants of initiation, progression and maintenance of drug use, and gender differences in the basic behavioral, biological, neurochemical and genetic factors underlying drug dependence and vulnerability. Included in the etiological research effort are studies on gender differences in psychosocial factors that increase risk for early onset and severity of drug abuse such as stress and coping strategies, self identity and self esteem, sexual identity, social role, and socioeconomic status, as well as family studies that examine intergenerational transmission and genetics of drug abuse from the perspective of gender. Studies also examine gender differences in the co-existence of drug abuse with psychiatric disorders, especially depression, PTSD, anxiety, eating disorders, borderline personality disorder, and antisocial personality. NIDA's research effort on women, violence, trauma and drug abuse includes study of victimization (e.g., childhood and adulthood rape, sexual assault, physical assault, serial assault by know persons, crime victimization), trauma from natural catastrophes and loss as potential factors in the differential etiology of drug abuse in males and females. A newly developed initiative (PA 97-043) aims to promote studies on gender differences in the origins and multiple pathways to drug abuse and the factors that determine individual's susceptibility and/or resistance to each potential stage of drug involvement. Another newly developed initiative (PA 97-005) seeks knowledge on gender differences within the field of adolescent drug abuse.   Consequences.  NIDA supports basic laboratory research, both animal and human, and field research aimed at identifying gender differences in the behavioral and biological effects of abused drugs. Research is also examining the impact of drug use on pregnancy and maternal functioning, as well as effects on pregnancy outcome, the newborn and the behavioral, intellectual and social development of children prenatally exposed. Research on maternal functioning includes examination of maternal psychiatric status and drug use, maternal-infant bonding and interaction, and a wide range of behaviors relating to the ability of drug abusing mothers to provide for the basic safety, physical and emotional needs of their children. A major research effort is devoted to the study of women and HIV/AIDS, including etiology, pathogenesis, the relationships between drug abuse and associated behaviors and infection with HIV and progression to AIDS, including drug modulation of HIV infectivity and progression to AIDS. Research is addressing gender roles and gender differences relating to the transaction and dynamic aspects of drug-using behaviors, sexual behaviors associated with drug use, partner notification, and needle hygiene and needle exchange. Perinatal issues are addressed through examination of the impact of drug abuse on maternal-infant transmission, the mother's health and the health of the developing fetus. A newly developed initiative (PA 96-010) seeks knowledge on gender differences relating to mechanisms by which substance abuse affects cardiovascular, renal, hepatic, pulmonary and respiratory, immunologic, endocrine, and other organ systems with reference to medical outcomes. The initiative encourages identification of the occurrence of various medical disorders in female drug-abusing populations, including those not usually associated with drug abuse.   Prevention.  Among NIDA's drug abuse prevention research objectives is the solicitation of research proposals designed to address issues unique and specific to females of all ages with a focus on the development of prevention strategies designed to identify risk and protective factors that may be associated with gender value systems and life experiences, and ethnicity and culture. NIDA's ongoing program on the prevention of drug use among children and adolescents is aimed at evaluating the effects of a variety of prevention strategies based on identified patterns of drug use and risk and resiliency factors for drug abuse among various subgroups of children and adolescents. One initiative (PA 96-013) focuses on prevention through family intervention and seeks gender specific studies in the areas of risk and protective factors, interventions related to the gender-specificity indicated by these factors, and gender specific interventions from the perspective of both the parent and child. Another NIDA prevention initiative (PA-96-018) seeks to develop, refine and test the efficacy and effectiveness of theory-based, universal, selective and indicated drug abuse prevention interventions for females and minorities. It is imperative that gender status be treated as an explanatory variable and not just a descriptive one; that is, there must be a theoretical basis offered that lends guidance to the intervention designed and that will allow for discussions of outcomes in a manner that contributes to a detailed scientific understanding of prevention theory and program priorities that best meet the unique needs of women and minorities. In 1990 NIDA established the 17-site Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program aimed at preventing the further spread of HIV infection among injection drug users, their sexual partners, and those at demonstrable risk for initiating injection behavior. Research has included a major focus on female partners of injection drug users and evaluation of the female condom. A recent initiative (PA 95-083) on women's HIV risk and protective behaviors aims to promote basic social and behavioral research on women's HIV risk and/or protective behaviors combined with community-level interventions strategies aimed at understanding and preventing HIV/AIDS in women whose drug and sex practices put them at high risk of HIV infection.   Treatment and Services.  NIDA supports a broad-based comprehensive drug abuse treatment program that includes pharmacological, psychotherapeutic, behavioral and psychosocial treatment modalities. Studies examine the development of and effectiveness of drug abuse treatment models that address the unique needs of women, including various forms of pharmacotherapy, psychotherapy, behavior therapy, cognitive therapy, skills training, counseling, and other rehabilitative therapies. In addition to treatment for drug abuse, models also address treatment for co-existing psychiatric disorder (e.g., depression, anxiety, PTSD, eating disorders). Considerable research effort is devoted to addressing treatment and services issues specific to parenting and/or pregnant women. Studies on improvement of treatment outcomes include strategies for treating family/social dysfunction; strategies to improve recruitment, retention, and compliance with treatment; strategies to improve the drug abuse treatment program environment and the delivery of treatment services; investigation of the barriers and the impact of these barriers to entry and engagement in drug abuse treatment for all women but in particular women who are pregnant and those with young children. Studies also investigate the short- and long-term effectiveness of comprehensive drug abuse treatment for women and their young children based in a variety of settings (e.g., hospitals, outpatient clinics, residential facilities, home-based care, etc.). NIDA has initiated a program of research on models and strategies linking primary care with drug abuse treatment in order to improve the medical treatment for drug users. This program has a strong HIV/AIDS component that seeks to improve outcomes and long-term effectiveness among HIV-infected women and includes studies relating to treatment access, disease detection, AZT treatment for pregnant women and the interaction of illicit drugs and AZT in pregnant women. For a complete listing of NIDA program announcements on women's health and gender differences, see Program Announcements Encouraging Research on Women's Health and Gender Differences [W&GR Home]

There is a special danger when pregnant women drink, that the child will be born with Fetal Alcohol Syndrome, a characteristic set of intractable physical and neurological birth defects from intrauterine exposure to alcohol. Please go to http://www.nofas.org/main/what_is_FAS.htm to find out about Fetal Alcohol Syndrome.

http://www.nofas.org/main/what_is_FAS.htm

What is Fetal Alcohol Syndrome?
FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy.

FAS is the leading known cause of mental retardation and birth defects.

What are Alcohol-Related Neurodevelopmental Disorder (ARND) and Alcohol-Related Birth Defects (ARBD)? Prenatal alcohol exposure does not always result in FASÑalthough there is no known safe level of alcohol consumption during pregnancy. Most individuals affected by alcohol exposure before birth do not have the characteristic facial abnormalities and growth retardation identified with FAS, yet they have brain and other impairments that are just as significant.

Alcohol-Related Neurodevelopmental Disorder (ARND) describes the functional or mental impairments linked to prenatal alcohol exposure, and Alcohol-Related Birth Defects (ARBD) describes malformations in the skeletal and major organ systems.

What are the Primary Characteristics of FAS, ARND and ARBD?
Individuals with FAS have a distinct pattern of facial abnormalities, growth deficiency and evidence of central nervous system dysfunction. In addition to mental retardation, individuals with FAS, ARND and ARBD may have other neurological deficits such as poor motor skills and hand-eye coordination. They may also have a complex pattern of behavioral and learning problems, including difficulties with memory, attention and judgment.

How often do FAS, ARND and ARBD Occur?
As many as 12,000 infants are born each year with FAS and three times as many have ARND or ARBD. FAS, ARND and ARBD affect more newborns every year than Down syndrome, cystic fibrosis, spina bifida and Sudden Infant Death Syndrome combined.

How can Alcohol-Related Effects be prevented?
FAS, ARND and ARBD are 100% preventable when a woman completely abstains from alcohol during her pregnancy. NOFAS prevents alcohol-related effects through public awareness and education, and by increasing access to prenatal health care. Another key to prevention is to screen all women of reproductive age for alcohol problems and to use appropriate strategies, such as treatment for alcohol problems, to eliminate drinking before conception.

How does a motherÕs drinking affect her unborn child?
When a pregnant woman drinks alcohol, so does her baby; through the blood vessels in the placenta, the motherÕs blood supplies the developing baby with nourishment and oxygen. If the mother drinks alcohol, the alcohol enters her blood stream and then, through the placenta, enters the blood supply of the growing baby.

Alcohol is a teratogen, a substance known to be toxic to human development. Depending on the amount, timing and pattern of use, if alcohol reaches the growing babyÕs blood supply, it can interfere with healthy development.

If a woman drinks wine, beer or liquor when she is pregnant, her baby could be born with FAS. There is no known safe amount of alcohol during pregnancy.

What if I am pregnant and have been drinking?
If you consumed alcohol before you knew you were pregnant, stop drinking now. Abstaining from alcohol for the remainder of your pregnancy can have a beneficial effect even on functions that might have been affected by earlier drinking. The sooner you stop drinking, the better the chance of having a healthy baby. You could be pregnant and not know it. So if you are trying to get pregnant or are sexually active and not using contraception, donÕt drink alcohol.


The following summary is excerpted from the 10th Special Report to the U.S. Congress on Alcohol and Health produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The passage further describes FAS and the issues associated with prenatal alcohol exposure and serves as an introduction to the reportÕs comprehensive chapter on the subject. To view the full report, visit the NIAAA Web site at www.niaaa.nih.gov.


Fetal Alcohol Syndrome (FAS) is a set of birth defects caused by maternal consumption of alcohol during pregnancy. At birth, children with FAS can be recognized by growth deficiency and a characteristic set of minor facial traits that tend to become more normal as the child matures. Less evident at birthÑbut far more devastating to FAS children and their familiesÑare the lifelong effects of alcohol-induced damage to the developing brain.

FAS is considered the most common nonhereditary cause of mental retardation. In addition to deficits in general intellectual functioning, individuals with FAS often demonstrate difficulties with learning, memory, attention, and problem solving as well as problems with mental health and social interactions. Thus these individuals and their families face persistent hardships in virtually every aspect of life.

Estimates of FAS prevalence vary from 0.5 to 3 per 1,000 live births in most populations, with much higher rates in some communities (Stratton et al. 1996). However, the diagnosis of FAS identifies only a relatively small proportion of children affected by alcohol exposure before birth. Children with significant prenatal alcohol exposure can lack the characteristic facial defects and growth deficiency of FAS but still have alcohol-induced mental impairments that are just as serious, if not more so, than in children with FAS. The term "alcohol-related neurodevelopmental disorder" (ARND) has been developed to describe this condition. In addition, prenatally exposed children without FAS facial features can have other alcohol-related physical abnormalities of the skeleton and certain organ systems; these are known as alcohol-related birth defects (ARBD).

Because the effects of prenatal alcohol exposure on the developing brain appear to be especially long lasting and debilitating, a significant proportion of research has concentrated on brain malformations as well as cognitive and behavioral abnormalities. In this chapter, the section on "Prenatal Alcohol Exposure: Effects on Brain Structure and Function" describes research using neuroimaging techniques to provide precise pictures of brain abnormalities found in persons exposed to alcohol before birth. The studies strongly support the notion that alcohol has specific, rather than global, effects on the developing brain. The section also describes current research on the many behavioral manifestations of this structural brain damage, including problems with cognitive and motor functions as well as mental health and psychosocial behavior.

It is unlikely that a single mechanism can explain all of the deleterious effects that result from alcohol exposure during pregnancy. As described in the section "Underlying Mechanisms of Alcohol-Induced Damage to the Fetus," alcohol exerts its effects on the developing fetus through multiple actions at different sites. In the developing brain, for example, alcohol has been shown to interfere with the development, function, migration, and survival of nerve cells. Also, in the embryonic cell layer that develops into the bones and cartilage of the head and face, alcohol exposure at critical stages of development induces premature cell death that is thought to be linked to the FAS facial defects. These actions of alcohol have provided scientists with numerous paths for pursuing possible biochemical mechanisms for these actions. Better understanding of the mechanisms may point to pharmacologic approaches for intervening or for preventing alcohol-related fetal injury.

Although research in animals and humans is continuing to provide details about alcohol-induced deficits, efforts to prevent these problems are not nearly so advanced. The section "Issues in Fetal Alcohol Syndrome Prevention" notes that numerous strategies to prevent FAS have been implemented in recent years, but that rigorous analysis of the effectiveness of these approaches is in its infancy. The section summarizes major reviews of FAS prevention efforts, presents issues related to research methods and evaluations, and describes research on prevention approaches targeted to women at different levels of risk. Recent research underscores an intensifying need for effective prevention strategies. One study found that although alcohol use among pregnant women decreased between 1988 and 1992 (from 22.5 to 9.5 percent), by 1995 it had increased to 15.3 percent (Ebrahim et al. 1998). Moreover, binge drinking (defined in the study as five or more drinks per occasion) among pregnant women, a particularly hazardous drinking pattern in terms of FAS risk, increased significantly between 1991 and 1995 (from 0.7 to 2.9 percent of pregnant women) (Ebrahim et al. 1999). In light of these unsettling findings, and because FAS and other adverse effects of drinking during pregnancy are completely preventable, the need for a solid research base to guide prevention program developers is critical.

References
Ebrahim, S.H.; Diekman, S.T.; Floyd, L.; and
Decoufle, P. Comparison of binge drinking
among pregnant and nonpregnant women,
United States, 1991Ð1995. Am J Obstet Gynecol
180(1 pt. 1):1Ð7, 1999.

Ebrahim, S.H.; Luman, E.T.; Floyd, R.L.;
Murphy, C.C.; Bennett, E.M.; and Boyle, C.A.
Alcohol consumption by pregnant women in the
United States during 1988Ð1995. Obstet Gynecol
92(2):187Ð192, 1998.

Stratton, K.; Howe, C.; and Battaglia, F., eds.
Fetal Alcohol Syndrome: Diagnosis, Epidemiology,
Prevention, and Treatment. Washington, DC:
National Academy Press, 1996.

The problems that adolescents have with substance abuse are often overlooked and rationalized by thinking that "everyone parties" or "as long as they don't drive and drink, it is OK." In fact, many adults started their problems with drugs and alcohol as teenagers or even earlier. When assessing the alcohol use of this population it is vitally important to:

• take a thorough family history to see if alcoholism runs in the family;
• to rule out physical and sexual abuse;
• explore sexual harassment if the teenager is gay or lesbian;
• assess if the teenager is self-medicating for depression, ADD, etc.;
• explore the social/economic climate of the adolescent's life (poverty, school, friends, job, family relations, etc.).

The 1997 National Household Survey on Drug Abuse found that "illicit drug use among the overall population remained flat from 1996 to 1997, but increases occurred among young people aged 12 to 17. "

 

Tips for Teens: The Truth About AIDS AIDS--Acquired Immunodeficiency Syndrome--is caused by HIV, the Human Immunodeficiency Virus. HIV impairs your immune system, making it less resistant to diseases and infections. HIV is transmitted through exposure to the bodily fluids of someone infected with HIV. This exposure most commonly occurs during unprotected sex, by sharing needles, through blood transfusions, or by contact with open wounds. Babies born to women with HIV can also become infected. It's not a "gay thing." HIV infections among all teenagers and young adults are increasing. Also, nearly one-fourth of AIDS cases among adolescents and adults under age 25 stem from injection drug use. Alcohol and drugs affect your self-control. Alcohol and illicit drugs lower your inhibitions and impair your judgment. Drinking and drug use can lead to risky behaviors you're less likely to do if sober, including having unprotected sex. This increases your risk for exposure to HIV/AIDS and other sexually transmitted diseases (STDs). Any drug use increases the risks for HIV/AIDS. Non-injection drugs also contribute to the spread of HIV/AIDS when users trade sex for drugs or money or when their judgment and decision-making skills are impaired. Get the facts. Not having sexual intercourse is the most effective way to avoid STDs, including HIV/AIDS. For those who choose to be sexually active, the following HIV prevention activities can be effective: Engaging in sexual activity that does not involve vaginal, anal, or oral sex Having intercourse with only one uninfected partner Using latex condoms every time you have sex Stay informed. Even though more effective drugs are now used to treat HIV/AIDS, there is no cure or vaccine. Know the risks. Even tobacco use impacts HIV/AIDS. Smokers with the HIV virus develop full-blown AIDS twice as quickly as nonsmokers. How can you tell if you or someone else may already have HIV? If you have not shared a needle or had unprotected sex, it is very unlikely that you have HIV. The only way to be certain is to be tested. Most people with HIV do not have any visible symptoms for many years. Once symptoms do begin to show, some of the more common ones include: Rapid weight loss Profuse night sweats Ongoing, unexplained fatigue Swollen lymph glands Diarrhea that lasts longer than a week White spots or blemishes in the mouth or throat Pneumonia Do not assume you are infected if you have any of these symptoms. Each of these symptoms can easily be related to other illnesses. Again, the only way to determine for sure whether you are infected with HIV is to be tested. What can you do to help someone whose substance abuse problem is putting them at risk for HIV/AIDS? Be a real friend. You might even save a life. Encourage your friend to stop using substances or seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at 800-729-6686. For more information go to ncadi.samhsa.gov Q. Can you get HIV/AIDS from deep kissing or from someone's sweat? A. No. There are no known cases of HIV transmission through sweat or saliva. HIV is primarily transmitted in blood, semen, or vaginal fluid during unprotected sex or from sharing needles. Q. If you already have the HIV virus, does it really matter whether you drink and use drugs? A. Yes. Being smoke-free, clean, and sober improves your chances of staying healthy longer. Q. Who is most likely to get HIV/AIDS? A. Anyone who has unprotected sex, shares needles, or exchanges bodily fluids or blood with an infected person is at risk. HIV is a virus. AIDS is a disease. Viruses do not care about age, race, or sexual orientation. The bottom line: If you know someone who is risking exposure to HIV/AIDS, urge him or her to stop or get more information. If your behavior places you at risk for exposure to HIV/AIDS-stop! If you have already possibly been exposed to HIV/AIDS, get tested and follow your doctor's instructions. The longer you ignore the real facts, the more chances you take with your life. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! To learn more about HIV/AIDS or obtain referrals to programs in your community, contact: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 TDD 800-487-4889 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov.

 

Tips for Teens: The Truth About Alcohol Slang--Booze, Sauce, Brews, Brewskis, Hooch, Hard Stuff, Juice Alcohol affects your brain. Drinking alcohol leads to a loss of coordination, poor judgment, slowed reflexes, distorted vision, memory lapses, and even blackouts. Alcohol affects your body. Alcohol can damage every organ in your body. It is absorbed directly into your bloodstream and can increase your risk for a variety of life-threatening diseases, including cancer. Alcohol affects your self-control. Alcohol depresses your central nervous system, lowers your inhibitions, and impairs your judgment. Drinking can lead to risky behaviors, including having unprotected sex. This may expose you to HIV/AIDS and other sexually transmitted diseases or cause unwanted pregnancy. Alcohol can kill you. Drinking large amounts of alcohol can lead to coma or even death. Also, in 1998, 35.8 percent of traffic deaths of 15- to 20-year-olds were alcohol-related. Alcohol can hurt you--even if you're not the one drinking. If you're around people who are drinking, you have an increased risk of being seriously injured, involved in car crashes, or affected by violence. At the very least, you may have to deal with people who are sick, out of control, or unable to take care of themselves. Know the law. It is illegal to buy or possess alcohol if you are under 21. Get the facts. One drink can make you fail a breath test. In some states, people under the age of 21 who are found to have any amount of alcohol in their systems can lose their driver's license, be subject to a heavy fine, or have their car permanently taken away. Stay informed. "Binge" drinking means having five or more drinks on one occasion. About 15 percent of teens are binge drinkers in any given month. Know the risks. Mixing alcohol with medications or illicit drugs is extremely dangerous and can lead to accidental death. For example, alcohol-medication interactions may be a factor in at least 25 percent of emergency room admissions. Keep your edge. Alcohol can make you gain weight and give you bad breath. Look around you. Most teens aren't drinking alcohol. Research shows that 70 percent of people 12-20 haven't had a drink in the past month. How can you tell if a friend has a drinking problem? Sometimes it's tough to tell. But there are signs you can look for. If your friend has one or more of the following warning signs, he or she may have a problem with alcohol: Getting drunk on a regular basis Lying about how much alcohol he or she is using Believing that alcohol is necessary to have fun Having frequent hangovers Feeling run-down, depressed, or even suicidal Having "blackouts"--forgetting what he or she did while drinking Having problems at school or getting in trouble with the law What can you do to help someone who has a drinking problem? Be a real friend. You might even save a life. Encourage your friend to stop or seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at 800-729-6686. Q. Aren't beer and wine "safer" than liquor? A. No. One 12-ounce beer has about as much alcohol as a 1.5-ounce shot of liquor, a 5-ounce glass of wine, or a wine cooler. Q. Why can't teens drink if their parents can? A. Teens' bodies are still developing and alcohol has a greater impact on their physical and mental well-being. For example, people who begin drinking before age 15 are four times more likely to develop alcoholism than those who begin at age 21. Q. How can I say no to alcohol? I'm afraid I won't fit in. A. Remember, you're in good company. The majority of teens don't drink alcohol. Also, it's not as hard to refuse as you might think. Try: "No thanks," "I don't drink," or "I'm not interested." To learn more about alcohol or obtain referrals to programs in your community, contact: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 TDD 800-487-4889 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov. The bottom line: If you know someone who has a problem with alcohol, urge him or her to stop or get help. If you drink--stop! The longer you ignore the real facts, the more chances you take with your life. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! Footnotes 1. Fatality Analysis Reporting System. National Highway Traffic Safety Administration, 1998. 2. 1998 National Household Survey on Drug Abuse. Substance Abuse and Mental Health Services Administration (SAMHSA), 1998. 3. Holder, H.D. Effects of Alcohol, Alone and in Combination with Medications. Walnut Creek, CA: Prevention Research Center, 1992. 4. 1998 National Household Survey. (SAMHSA), 1998. 5. National Institute on Alcohol Abuse and Alcoholism press release. January 14, 1998.

 

Tips for Teens: The Truth About Marijuana Slang--Weed, Pot, Grass, Reefer, Ganja, Mary Jane, Blunt, Joint, Roach, Nail Marijuana affects your brain. THC (the active ingredient in marijuana) affects damages the nerve cells in the part of the brain where memories are formed, making it hard to remember things. Marijuana affects your self-control. Marijuana can seriously affect your sense of time and your ability to do things that require coordination-like driving. In 1998, nearly 77,000 people were admitted to emergency rooms suffering from marijuana-related problems. This was an increase of more than 373 percent since 1991. Marijuana affects your lungs. There are more than 400 known chemicals in marijuana. A single joint contains four times as much cancer-causing tar as a filtered cigarette. Marijuana affects other aspects of your health. Marijuana can limit your body's ability to fight off infection. It can increase your heart rate and lead to frequent chest colds. Some research even shows that long-term marijuana use can increase the risk of developing certain mental illnesses. Marijuana is not always what it seems. Before it is sold, marijuana can be laced with other dangerous drugs without your knowledge. "Blunts"-hollowed-out cigars filled with marijuana-sometimes have substances such as crack cocaine, PCP, or embalming fluid added to them. Marijuana can be addictive. As with alcohol and many other drugs, not everyone who uses marijuana becomes addicted, but some users do develop signs of dependence on the drug. They may experience such withdrawal symptoms as loss of appetite, sleep problems, weight loss, and shaky hands. In 1995, 165,000 people entered drug treatment programs to kick their marijuana habit. Know the law. It is illegal to buy or sell marijuana. In most states, holding even small amounts of marijuana can lead to fines or arrest. Get the facts. There is NO proof that smoking marijuana is healthy and tons of evidence that it is not healthy. Smoking any substance--tobacco, marijuana, or crack cocaine--increases your risk of developing pneumonia and other illnesses. Stay informed. It has not yet been proven that using marijuana leads to using other drugs. But, the fact is very few people use other drugs without first using marijuana. Teens who smoke marijuana are more likely to try other drugs, in part because they have more contact with people who use and sell them. Know the risks. Using marijuana or other drugs increases your risk of injury from car crashes, falls, burns, drowning, and other accidents. Keep your edge. Marijuana affects your judgment, drains your motivation, and can make you feel anxious. Look around you. Most teens aren't smoking marijuana. According to a 1997 study, four out of five 12- to 17-year-old youth had never even tried marijuana. How can you tell if a friend is using marijuana? Sometimes it's tough to tell. But there are signs you can look for. If your friend has one or more of the following warning signs, he or she may be using marijuana: Seeming dizzy and having trouble walking Having red, bloodshot eyes Having a hard time remembering things that just happened Acting disinterested in school, family, or activities he or she used to enjoy Acting silly for no apparent reason What can you do to help someone who is using marijuana or other drugs? Be a real friend. Encourage your friend to seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at (800) 729-6686. For footnote references, see our Web site at http://ncadi.samhsa.gov. Q. Isn't smoking marijuana less dangerous than smoking cigarettes? A. No. It's even worse. One joint affects the lungs as much as four cigarettes. Q. Can people become addicted to marijuana? A. Yes. Research confirms you can become hooked on marijuana. Q. Can marijuana help cure cancer? A. No. Some people with cancer, HIV/AIDS, and other diseases claim to experience relief from pain and other symptoms that they attribute to marijuana use. However, scientific research has not yet confirmed these benefits and more research on this topic is being done. What is known is that smoking marijuana can cause lung damage. To learn more about marijuana or obtain referrals to programs in your community, contact: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 TDD 800-487-4889 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov. The bottom line: If you know someone who smokes marijuana, urge him or her to get help. If you're smoking marijuana--stop! The longer you ignore the real facts, the more chances you take with your health and well-being. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! Footnotes 1. Mid-Year 1998 Preliminary Emergency Department Data From The Drug Abuse Warning Network. Substance Abuse and Mental Health Services Administration (SAMHSA), 1998. 2. Effects of Marijuana on the Lungs and Its Immune Defenses. University of California-Los Angeles School of Medicine Study, 1997. 3. IBID. 4. Marijuana: Facts Parents Need to Know (Revised). National Institute on Drug Abuse (NIDA), 1998. 5. IBID. 6. Mueller, M.D. NIDA Notes, Vol. 12, No. 1. NIDA, Jan/Feb 1997. 7. 1997 National Household Survey on Drug Abuse. SAMHSA, 1997.

Tips for Teens: The Truth About Heroin Slang--Smack, Horse, Mud, Brown Sugar, Junk, Black Tar, Big H, Dope, Skag Heroin affects your brain. Heroin enters the brain quickly. It slows down the way you think, slows down reaction time, and slows down memory. This affects the way you act and make decisions. Heroin affects your body. Heroin poses special problems for those who inject it because of the risks of HIV, hepatitis B and C, and other diseases that can occur from sharing needles. These health problems can be passed on to sexual partners and newborns.1 Heroin is super-addictive. Heroin is highly addictive because it enters the brain so rapidly. It particularly affects those regions of the brain responsible for producing physical dependence. Heroin is not what it may seem. Despite the glamorization of "heroin chic" in films, fashion, and music, heroin use can have tragic consequences that extend far beyond its users. Fetal effects, HIV/AIDS, tuberculosis, violence, and crime are all linked to its use. Heroin can kill you Heroin is one of the top three frequently reported drugs by medical examiners in drug abuse deaths.2 Know the law. Heroin is an illegal Schedule I drug, meaning that it is in the group of the most highly addictive drugs. Get the facts. In the 1990's, hospital emergency department episodes involving heroin nearly quadrupled among youths ages 12-17.3 Stay informed. The untimely deaths of several popular musicians and other celebrities may have influenced many young people to stay away from heroin use, but to others, the dangers are still not clear. The average age of first use was 21.3 in 1998.4 Know the risks. Because the strength of heroin varies and its impact is more unpredictable when used with alcohol or other drugs, the user never knows what might happen with the next dose. Look around you. The vast majority of teens are not using heroin. According to a 1999 national study, only 2 percent report ever having tried it. How can you tell if a friend is using heroin? Signs and symptoms of heroin use are: Euphoria Drowsiness Impaired mental functioning Slowed down respiration Constricted pupils Nausea Signs of a heroin overdose include: Shallow breathing Pinpoint pupils Clammy skin Convulsions Coma What can you do to help a friend who is using heroin? Be a real friend. You might even save a life. Encourage your friend to stop or seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at 800-729-6686. Q.Isn't heroin a less dangerous drug if you snort or smoke it instead of injecting it? A. No. Heroin is heroin. There is no safe way of ingesting it. You can still die from an overdose or become addicted by snorting or smoking it. Q. Can withdrawal from heroin kill you? A. Although it is seldom fatal, withdrawal from heroin produces drug cravings, restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and other symptoms that usually last about a week, but may last for many months. Q. Will heroin use alter my brain? A.Yes. Heroin enters the neurons or cells of the brain and changes the speed of the chemicals in the brain. It not only affects your brain physically, but also affects the way you think. To learn more about heroin or obtain referrals to programs in your community, contact: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov. The bottom line: If you know someone who uses heroin, urge him or her to stop or get help. If you use heroin--stop! The longer you ignore the real facts, the more chances you take with your life. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! For footnote references, see our Web site at ncadi.samhsa.gov

Tips for Teens: The Truth About Hallucinogens Slang--Lysergic acid diethylamide: LSD, Acid, Blotter. Psilocybin: Magic Mushrooms, Shrooms. Phencyclidine: PCP, Angel Dust, Boat, Ozone, Wack. Ecstasy: E, X, XTC. Hallucinogens affect your brain. Hallucinogens alter how the brain perceives time, reality, and the environment around you. They also affect the way you move, react to situations, think, hear, and see. This may make you think that you're hearing voices, seeing images, and feeling things that don't exist. Hallucinogens affect your heart. The use of hallucinogens leads to an increase in heart rate and blood pressure. Hallucinogens can put you in a coma. They can also cause heart and lung failure. Hallucinogens affect your well-being. The use of hallucinogens may change the way you feel emotionally. They may cause you to feel confused, suspicious, and disoriented. Use of PCP may interfere with hormones related to normal growth as well as with the learning process.1 Hallucinogens affect your self-control. The impact of hallucinogens varies from time to time, so there is no way to know how much self-control you might maintain. They can cause you to mix up your speech, lose control of your muscles, make meaningless movements, and do aggressive or violent things. Know the law. Hallucinogens are illegal to buy, sell, or possess. Get the facts. Hallucinogenic drugs distort your perception of reality. Hallucinogens cause your sense of space and time to become distorted and cause you to see objects that aren't really there. Stay informed. It's easy to quickly develop a tolerance to hallucinogens so that it takes more and more of the drug each time to get the same effect. This is dangerous because taking more and more of the same drug may lead to an overdose with severe effects. Know the risks. Hallucinogens can cause flashbacks. Effects of the drugs, including hallucinations, can occur weeks, months, even years after use. Look around you. The majority of teens are not using hallucinogens. According to a 1999 study, only 1 percent of teens use hallucinogens regularly and 94 percent of teens had never even tried hallucinogens.2 How can you tell if a friend is using hallucinogens? Sometimes it's tough to tell. But there are signs you can look for. If your friend has one or more of the following warning signs, he or she may be using hallucinogens: Depression Weakness and lack of muscular coordination Anxiety or paranoia Trembling Nausea Dizziness Facial flushing Dilated pupils What can you do to help someone who is using hallucinogens? Be a real friend. Encourage your friend to stop or seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at 800-729-6686. Q. Do hallucinogens have long-term effects? A. Yes. In addition to flashbacks, long-term effects may include decreased motivation, prolonged depression, anxiety, increased delusions and panic, and psychosis. Q. Can I predict if I will have a "bad trip"? A. There is no way to predict a "bad trip." There is no consistency in hallucinogenic drugs, so each "trip" may differ depending on the drug's strength and purity. The psychological effects of the hallucinogen are also dependent on the user's frame of mind. Q. How can I help someone through a bad trip? A. Don't try to handle this situation on your own; call 911 and a trusted adult immediately. While waiting, address the person by name, remind them who and where they are, talk to them calmly, make sure they're safe, and don't leave them alone. The bottom line: If you know someone who uses hallucinogens, urge him or her to get help. If you're using them-stop! The longer you ignore the real facts, the more chances you take with your life. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! To learn more about hallucinogens or obtain referrals to programs in your community, contact: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 TDD 800-487-4889 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov. The bottom line: If you know someone who uses inhalants, urge him or her to stop or get help. If you're using inhalants-stop! The longer you ignore the real facts, the more chances you take with your life. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! Footnotes 1. National Institute on Drug Abuse (NIDA). NIDA Infofax, http://165.112.78.61/Infofax/pcp.html last accessed on December 18, 2000. 2. 1999 National Household Survey on Drug Abuse. Substance Abuse and Mental Health Services Administration (SAMHSA), 1999.

 

 

Tips for Teens: The Truth About Methamphetamine Slang--Speed, Meth, Crystal, Crank, Tweak, Go-fast, Ice, Glass, Uppers, Black beauties Methamphetamine affects your brain. In the short term, meth causes mind and mood changes such as anxiety, euphoria, and depression. Long-term effects can include chronic fatigue, paranoid or delusional thinking, and permanent psychological damage. Methamphetamine affects your body. Over "amping" on any type of speed is pretty risky. Creating a false sense of energy, these drugs push the body faster and further than it's meant to go. It increases the heart rate, blood pressure, and risk of stroke. Methamphetamine affects your self-control. Meth may be as addictive as crack and more powerful.(1) Methamphetamine is not what it seems. Even speed drugs are not always safe. Giga-jolts of the well-known stimulants caffeine or ephedrine can cause stroke or cardiac arrest when overused or used by people with a sensitivity to them. Methamphetamine can kill you. An overdose of meth can result in heart failure. Long-term physical effects such as liver, kidney, and lung damage may also kill you. Know the law. Methamphetamine is illegal in all states and highly dangerous. Get the facts. The ignitable, corrosive, and toxic nature of the chemicals used to produce meth can cause fires, produce toxic vapors, and damage the environment. Stay informed. Ninety-two percent of methamphetamine deaths reported in 1994 involved meth in combination with another drug, such as alcohol, heroin, or cocaine.(2) Know the risks. There are a lot of risks associated with using methamphetamine, including: Meth can cause a severe "crash" after the effects wear off. Meth use can cause irreversible damage to blood vessels in the brain. Meth users who inject the drug and share needles are at risk for acquiring HIV/AIDS. Look around you. Everybody doesn't think it's okay to take methamphetamine. A 1999 National High School Survey indicates that over 80 percent of teens disapprove of using meth even once or twice.(3) How can you tell if a friend is using meth? It may not be easy to tell. But there are signs you can look for. Symptoms of methamphetamine use may include: Inability to sleep Increased sensitivity to noise Nervous physical activity, like scratching Irritability, dizziness, or confusion Extreme anorexia Tremors or even convulsions Increased heart rate, blood pressure, and risk of stroke Presence of inhaling paraphernalia, such as razor blades, mirrors, and straws Presence of injecting paraphernalia, such as syringes, heated spoons, or surgical tubing What can you do to help someone who is using meth? Be a real friend. You might even save a life. Encourage your friend to stop or seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at (800) 729-6686. Q. Isn't methamphetamine less harmful than crack, cocaine, or heroin? A. Some users get hooked the first time they snort, smoke, or inject meth. Because it can be made from lethal ingredients like battery acid, drain cleaner, lantern fuel, and antifreeze, there is a greater chance of suffering a heart attack, stroke, or serious brain damage with this drug than with other drugs. Q. Isn't using methamphetamine like using diet pills? A. No. Though it is easily attainable, methamphetamine is dangerous and addictive. Between 1993 and 1995, deaths due to meth rose 125 percent. Between 1996 and 1997, meth-related emergency room visits doubled. Use by 12- to 17-year-olds has increased dramatically in the past few years. To learn more about methamphetamine or obtain referrals to programs in your community, contact one of the following toll-free numbers: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 TDD 800-487-4889 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov The bottom line: If you know someone who uses meth, urge him or her to stop or get help. If you're use meth--stop! The longer you ignore the real facts, the more chances you take with your life. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov. Footnotes 1. Alan Leshner, NIDA. 2. 1999 National Household Survey on Drug Abuse. Substance Abuse and Mental Health Services Administration (SAMHSA), 1999. 3. Monitoring the Future Study. National Institute on Drug Abuse (NIDA), 1999.

 

Tips for Teens: The Truth About Steroids Slang--Arnolds, Gym Candy, Pumpers, Stackers, Weight Trainers, Juice Steroids affect your heart. Steroid abuse has been associated with cardiovascular disease, including heart attack and stroke. These heart problems can even happen to athletes under the age of 30. Steroids affect your appearance. In both sexes, steroids can cause male-pattern baldness, cysts, acne, and oily hair and skin. Steroids affect your mood. Steroids can make you angry and hostile for no reason. There are recorded cases of murder attributed to intense anger from steroid use. Steroids increase your risk of infection. Sharing needles or using dirty needles to inject steroids puts you at risk for diseases such as HIV/AIDS and hepatitis. Other slang terms associated with steroid use include: Roid rages--uncontrolled outbursts of anger, frustration, or combativeness that may result from using anabolic steroids. Shotgunning--taking steroids on an inconsistent basis. Stacking--using a combination of two or more anabolic steroids. Know the law. Steroids are illegal to possess without a prescription from a licensed physician. It is illegal for individuals to sell steroids. Get the facts. Doctors prescribe steroids for specific medical conditions. They are only safe for use when a doctor monitors the person. Know the risks. Illegal steroids are made overseas and smuggled into the United States or made in underground labs in this country. They pose greater health risks because they are not regulated by the government and may not be pure or labeled correctly. Look around you. The majority of teens aren't using steroids. Among teenage males, where most steroid use is concentrated, past year use was reported by 2.2 percent of 8th graders, 3.6 percent of 10th graders, and 2.5 percent of 12th graders.1 How can you tell if a friend is abusing steroids? Sometimes it's hard to tell. But there are signs you can look for. If your friend has one or more of the following warning signs, he or she may be abusing steroids: For Guys: Baldness Development of breasts Impotence For Girls: Growth of facial hair Deepened voice Breast reduction For Both: Jaundice (yellowing of the skin) Swelling of feet or ankles Aching joints Bad breath Mood swings Nervousness Trembling What can you do to help someone who is abusing steroids? Be a real friend. You might even save a life. Encourage your friend to stop or seek professional help. For information and referrals, call the National Clearinghouse for Alcohol and Drug Information at 800-729-6686. Q. Are steroids addictive? A. Yes, they can be. Withdrawal symptoms include mood swings, suicidal thoughts and/or attempts, fatigue, restlessness, loss of appetite, and sleeplessness.2 Q. How long do steroids stay in your system? A. The length of time that steroids stay in the body varies from a couple of weeks to more than 18 months.3 Q. What can I do to excel in sports if I don't use steroids? A. Focus on getting proper diet, rest, and good overall mental and physical health. These things are all factors in how your body is shaped and conditioned. Excelling in sports is achievable and done by millions of athletes without relying on steroids. To learn more about steroids or obtain referrals to programs in your community, contact: SAMHSA's National Clearinghouse for Alcohol and Drug Information 800-729-6686 linea gratis en espa–ol 877-767-8432 Web site: ncadi.samhsa.gov Curious about the TV ads of the National Youth Anti-Drug Media Campaign? Check out the Web site at http://www.freevibe.com or visit the Office of National Drug Control Policy Web site at http://www.whitehousedrugpolicy.gov. The bottom line: If you know someone who abuses steroids, urge him or her to get help. If you're abusing them--stop! The longer you ignore the real facts, the more chances you take with your life. It's never too late. Talk to your parents, a doctor, a counselor, a teacher, or another adult you trust. Do it today! Footnotes 1. Monitoring the Future Survey. U.S. Department of Health and Human Services (HHS). Press Release, 2000 Monitoring the Future Survey Released: Moderating Trend Among Teen Drug Use Continues. December 14, 2000. 2. NIDA Research Reports. www.nida.nih.gov/ResearchReports/Steroids/anabolicsteroids4.aspx#addictive last accessed on December 18, 2000. 3. Anabolics.com. http://anabolics.com /_private/steroidtest.asp last accessed on December 18, 2000..

 

Here is a 12-Question Quiz directed toward adolescents. While many teenagers we know would not sit down and answer these questions in a therapy session, they are important issues to the therapist to hold in mind when working with families. Questions asked include:

1 Do you drink because you have problems? To relax?
2 Do you drink when you get mad at other people, your friends or parents?
3 Do you prefer to drink alone, rather than with others?
4 Are your grades starting to slip? Are you goofing off on your job?
5 Did you ever try to stop drinking or drink less — and fail?
6 Have you begun to drink in the morning, before school or work?
7 Do you gulp your drinks?
8 Do you ever have loss of memory due to your drinking?
9 Do you lie about your drinking?
10 Do you ever get into trouble when you're drinking?
11 Do you get drunk when you drink, even when you don't mean to?
12 Do you think it's cool to be able to hold your liquor?

 

AIDS and HIV transmission is greatly increased by drug and alcohol abuse. Not only is intravenous drug use and needle sharing a known source of contracting the virus, alcohol use impairs judgement. This contributes to high risk behavior, including unsafe sex. NIDA, the National Institute on Drug Abuse targeted AIDS prevention efforts to young adults with the slogan ""Get High, Get Stupid, Get AIDS". The Institute considers drug abuse and HIV/AIDS as "Intertwined Epidemics". http://www.nida.nih.gov/about/organization/camcoda/InterEpidem.html

Adult/Adolescent AIDS Cases by Exposure Category   n=657,077 (98.8% of all cases) Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1998:10(1) Pediatric (<13 years old) AIDS cases 52.7 Percent of Pediatric AIDS Cases are Drug Related Pediatric AIDS = 1.2 Percent of Total Cases   n=8,280 (1.2% of total cases) Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1998:10(1) Female Adult/Adolescent AIDS Cases 60.2 Percent of AIDS Cases Among Females Are Drug-Related Female AIDS = 15.6 Percent of Total Cases   n=104,028 (15.6% of total cases) Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1998:10(1) NIDA Research Responds to the Drug-Related AIDS Epidemic   HIV infection is not limited to drug injectors and their sex partners. In poor inner city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection, exhibiting HIV prevalence rates as high as 30%. While the proportion of new HIV cases attributed to injection drug use has steadily increased up to 50% in 1996, a significant proportion (up to 25%) of new HIV cases may also be drug abuse-related through exposure associated with other drug abuse or through heterosexual contact with an injection or intravenous drug user (IDU). NIDA has responded by building a multiple disciplinary program of research which comprehensively addresses the AIDs and drug abuse problem. The focus of the program has been to develop improved strategies to reduce drug-abuse related behaviors that are linked to the transmission of HIV. These strategies include drug abuse treatment and outreach strategies to drug abusers not in treatment. In support of this effort, NIDA's program also includes epidemiologic studies of seroincidence, seroprevalence, and progression to disease among drug users (in and out of treatment), their sexual partners, and their children; and studies of the effects of drugs of abuse on the immune system. NIDA has expanded its research on ways to improve drug abuse treatment, as a means of reducing levels of HIV infection by reducing overall levels of drug use, particularly drug injecting. NIDA research has demonstrated that drug abusers in drug treatment are at lower risk for seroconversion than those not in treatment. One recent study found a six fold difference in the rate of seroconversion between injecting drug users in methadone maintenance treatment (3.5%) and those who stayed out of treatment (22%). NIDA will continue to support research to improve existing treatment approaches and to develop new pharmacologic and behavioral therapies to improve drug abuse treatment as an AIDS prevention strategy. NIDA has established large scale studies to reach drug abusers not currently in treatment. Through such community outreach studies, NIDA has assessed strategies to inform and counsel drug abusers about AIDS, to encourage them to seek treatment for their drug abusing behaviors, and to educate them on methods to reduce their risk of transmitting and contracting HIV. NIDA also conducts research on other community based strategies to reduce HIV infection, such as needle exchange programs. About 85% of the chronic drug abusers (primarily hardcore cocaine and heroin users) are not in drug treatment. Out-of-treatment drug abusers have higher rates of high risk behaviors, greater seroprevalence, and higher rates of seroincidence than in-treatment populations. Significantly, these studies have shown that even relatively small amounts of education and counseling can help many drug users modify their HIV risk behaviors, even without achieving total abstinence from drugs. NIDA will continue to conduct research to improve educational and behavioral strategies to reduce HIV transmission among drug abusers, and have begun new initiatives focussing on gender and cultural issues, drug-using networks, and pediatric AIDS. To support these efforts and to enhance the knowledge base about HIV infection and AIDS in drug abusers, NIDA has also supported natural history studies of drug abusers, studies of drugs of abuse as cofactors in HIV disease, studies of behavior change and abuse as cofactors in HIV disease, studies of behavior change and relapse prevention, and basic and clinical research on the effects of drugs of abuse on the immune system. These studies have provided critically important information on the epidemiology of the AIDS epidemic among drug users, on the role of drug abuse in risky behaviors, on the role of drugs of abuse in infection and progression to AIDS, and on the effects on the immune system. Drug abuse treatment and prevention programs that change high risk behaviors can most effectively reduce the drug abuse-related transmission of HIV. Consequently, NIDA has and plans to continue to develop and enhance effective methods for treating and preventing drug abuse-related risky behaviors. The continuation and strengthening of this research is central to the Nation's hopes for developing effective HIV/AIDS prevention strategies.

 

Older adults can have difficulty with substance abuse, particularily a decreased capacity to metabolize alcohol combined with prescription medication. We are seeing an increase of "late-onset" alcohol problems, sometimes a response to depression and loss in the geriatric patient.

http://www.niaaa.nih.gov/publications/aa40.htm

National Institute on Alcohol Abuse and Alcoholism                No. 40           April 1998

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Alcohol and Aging

Persons age 65 and older constitute the fastest growing segment of the American population. Although the extent of alcoholism among the elderly is debated, the diagnosis and treatment of alcohol problems are likely to become increasingly important as the elderly population grows. This Alcohol Alert reviews recent research on the extent of alcohol consumption and associated problems among the elderly, updating an earlier Alcohol Alert on this subject (1).

Drinking Prevalence and Patterns Among the Elderly

Surveys of different age groups in the community suggest that the elderly, generally defined as persons older than 65, consume less alcohol and have fewer alcohol-related problems than younger persons. However, some surveys that track individuals over time suggest that a person's drinking pattern remains relatively stable with age, perhaps reflecting societal norms that prevailed when the person began drinking (1). For example, persons born after World War II may show a higher prevalence of alcohol problems than persons born in the 1920's, when alcohol use was stigmatized (2). In addition, some people increase their alcohol consumption later in life, often leading to late-onset alcoholism (1).

In contrast to most studies of the general population, surveys conducted in health care settings have found increasing prevalence of alcoholism among the older population (3). Surveys indicate that 6 to 11 percent of elderly patients admitted to hospitals exhibit symptoms of alcoholism, as do 20 percent of elderly patients in psychiatric wards and 14 percent of elderly patients in emergency rooms (4). In acute-care hospitals, rates of alcohol-related admissions for the elderly are similar to those for heart attacks (i.e., myocardial infarction) (5). Yet hospital staff are significantly less likely to recognize alcoholism in an older patient than in a younger patient (6).

The prevalence of problem drinking in nursing homes is as high as 49 percent in some studies, depending in part on survey methods (7). The high prevalence of problem drinking in this setting may reflect a trend toward using nursing homes for short-term alcoholism rehabilitation stays (8). Late-onset alcohol problems also occur in some retirement communities, where drinking at social gatherings is often the norm (9).

Comparison among studies is complicated by the diversity of the subject population: The "elderly" span more than four decades in age and range from the actively employed to the disabled and institutionalized. Consequently, different studies employ different definitions of the term (8). In addition, surveys of alcohol consumption among the elderly are subject to potential sources of error for some of the following reasons:

• Questionnaires customarily used to screen for alcoholism may be inappropriate for the elderly, who may not exhibit the social, legal, and occupational consequences of alcohol misuse generally used to diagnose problem drinkers (10,11).
• Alcohol-related consequences of heavy drinking can be mistaken for medical or psychiatric conditions common among the elderly. Such consequences may include depression, insomnia, poor nutrition, congestive heart failure, and frequent falls (1).
• Because alcohol-related illnesses are a major cause of premature death, excess mortality among heavy drinkers may leave a surviving older population who consume less alcohol (1).

Combined Effects of Alcohol and Aging

Although many medical and other problems are associated with both aging and alcohol misuse, the extent to which these two factors may interact to contribute to disease is unclear. Some examples of potential alcohol-aging interactions include the following:

• The incidence of hip fractures in the elderly increases with alcohol consumption (12,13). This increase can be explained by falls while intoxicated combined with a more pronounced decrease in bone density in elderly persons with alcoholism compared with elderly nonalcoholics (4).
• Studies of the general population suggest that moderate alcohol consumption (up to two drinks per day for men and one drink per day for women) may confer some protection from heart disease (14,15).¹ Although research on this issue is limited, evidence shows that moderate drinking also has a protective effect among those older than 65 (16). Because of age-related body changes in both men and women, NIAAA recommends that persons older than 65 consume no more than one drink per day (17).
• Alcohol-involved traffic crashes are an important cause of trauma and death in all age groups. The elderly are the fastest growing segment of the driving population. A person's crash risk per mile increases starting at age 55, exceeding that of a young, beginning driver by age 80. In addition, older drivers tend to be more seriously injured than younger drivers in crashes of equivalent magnitude (18). Age may interact with alcoholism to increase driving risk. For example, an elderly driver with alcoholism is more impaired than an elderly driver without alcoholism after consuming an equivalent dose of alcohol, and has a greater risk of a crash (18).
• Long-term alcohol consumption activates enzymes that break down toxic substances, including alcohol. Upon activation, these enzymes may also break down some common prescription medications. The average person older than 65 takes two to seven prescription medications daily. Alcohol-medication interactions are especially common among the elderly, increasing the risk of negative health effects and potentially influencing the effectiveness of the medications (19,20).
• Depressive disorders are more common among the elderly than among younger people and tend to co-occur with alcohol misuse (11,21). Data from the National Longitudinal Alcohol Epidemiologic Survey demonstrate that, among persons older than 65, those with alcoholism are approximately three times more likely to exhibit a major depressive disorder than are those without alcoholism (22). In one survey, 30 percent of 5,600 elderly patients with alcoholism were found to have concurrent psychiatric disorders (23). Among persons older than 65, moderate and heavy drinkers are 16 times more likely than nondrinkers to die of suicide, which is commonly associated with depressive disorders (24).

Does Aging Increase Sensitivity to Alcohol?

Limited research suggests that sensitivity to alcohol's health effects may increase with age. One reason is that the elderly achieve a higher blood alcohol concentration (BAC) than younger people after consuming an equal amount of alcohol. The higher BAC results from an age-related decrease in the amount of body water in which to dilute the alcohol. Therefore, although they can metabolize and eliminate alcohol as efficiently as younger persons, the elderly are at increased risk for intoxication and adverse effects (25).

Aging also interferes with the body's ability to adapt to the presence of alcohol (i.e., tolerance). Through a decreased ability to develop tolerance, elderly subjects persist in exhibiting certain effects of alcohol (e.g., incoordination) at lower doses than younger subjects whose tolerance increases with increased consumption (26). Thus, an elderly person can experience the onset of alcohol problems even though his or her drinking pattern remains unchanged. These conclusions are supported by laboratory experiments with rats that indicate age-related changes in tolerance to alcohol (27).

Aging, Alcohol, and the Brain

Aging and alcoholism produce similar deficits in intellectual (i.e., cognitive) and behavioral functioning. Alcoholism may accelerate normal aging or cause premature aging of the brain. Using magnetic resonance imaging techniques, Pfefferbaum and colleagues (28) found more brain tissue loss in subjects with alcoholism than in those without alcoholism, even after their ages had been taken into account. In addition, older subjects with alcoholism exhibited more brain tissue loss than younger subjects with alcoholism, often despite similar total lifetime alcohol consumption. These results suggest that aging may render a person more susceptible to alcohol's effects (29).

The frontal lobes of the brain are especially vulnerable to long-term heavy drinking (28). Research shows that shrinkage of the frontal lobes increases with alcohol consumption and is associated with intellectual impairment in both older and younger subjects with alcoholism (30). In addition, older persons with alcoholism are less likely to recover from cognitive deficits during abstinence than are younger persons with alcoholism (28).

Age-related changes in volume also occur in the cerebellum, a part of the brain involved in regulating posture and balance (31). Thus, long-term alcohol misuse could accelerate the development of age-related postural instability, increasing the likelihood of falls (32).

Treatment of Alcoholism in the Elderly

Studies indicate that elderly persons with alcohol problems are at least as likely as younger persons to benefit from alcoholism treatment. The outcomes are more favorable among persons with shorter histories of problem drinking (i.e., late onset). Additionally, although evidence is not entirely consistent, some studies suggest that treatment outcomes may be improved by treating older patients in age-segregated settings (33,23).

The use of medications to promote abstinence has not been studied extensively in elderly subjects. However, one study has suggested that naltrexone (ReVia¨) may help prevent relapse to alcoholism in subjects ages 50 to 70 (34). Results of research in animals suggest that age-related alterations in specific chemical messenger systems in the brain may alter the effectiveness of medications used to treat alcoholism and mental disorders (35).

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Alcohol and Aging--A Commentary by
NIAAA Director Enoch Gordis, M.D.

Because alcohol problems among older persons often are mistaken for other conditions associated with the aging process, alcohol abuse and alcoholism in this population may go undiagnosed and untreated or be treated inappropriately. Health care providers should discuss alcohol use with their older patients as a part of routine care. Advice to older patients should include the medical conditions common to older people, such as high blood pressure and ulcers, that can be worsened by drinking and over-the-counter and prescription drugs that can be dangerous, or fatal, when mixed with alcohol. Where there is no medical condition that would preclude the use of alcohol, older patients should be advised to limit their alcohol intake to one drink per day. Finally, health care providers, including emergency room personnel and admitting physicians who suspect an alcohol problem in their elderly patients, should refer such patients to treatment. It is a mistaken belief that older persons have little to gain from alcoholism treatment; each stage of life has its own rewards for sobriety, and they are all valuable.

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Acknowledgments

The National Institute on Alcohol Abuse and Alcoholism wishes to acknowledge the following individuals who have contributed their time and expertise to the development of the Alcohol Alert series over the past several years: John Allen, Ph.D.; Loran D. Archer; Gregory Bloss; Gayle Boyd, Ph.D.; John Doria; Mary Dufour, M.D., M.P.H.; Michael Eckardt, Ph.D.; Joanne Fertig, Ph.D.; Richard Fuller, M.D.; David Goldman, M.D.; Bridget Grant, Ph.D., Ph.D; Brenda Hewitt; Susanne Hiller-Sturmhoefel, Ph.D.; Jan Howard, Ph.D.; Walter Hunt, Ph.D.; Leslie Isaki, Ph.D.; Robert Karp, Ph.D.; William Lands, Ph.D.; the late Markku Linnoila, M.D., Ph.D.; Stephen Long; Susan Martin, Ph.D.; Margaret Mattson, Ph.D.; Diane Miller; Theodore Pinkert, M.D.; Norman Salem, Jr., Ph.D.; Eve Shapiro; Ernestine Vanderveen, Ph.D.; Kenneth Warren, Ph.D.; Forrest Weight, Ph.D.; Dianne Welsh; Ellen Witt, Ph.D.; Lori Wolfgang; and Sam Zakhari, Ph.D.

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References

(1) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert No. 2: Alcohol and Aging. Bethesda, MD: the Institute, 1988. (2) Beresford, T.P. Alcoholic elderly: Prevalence, screening, diagnosis, and prognosis. In: Beresford, T., and Gomberg, E. Alcohol and Aging. New York: Oxford University Press, 1995. pp. 3-18. (3) Adams, W.L. Interactions between alcohol and other drugs. In: Gurnack, A.M., ed. Older Adults' Misuse of Alcohol, Medicines, and Other Drugs: Research and Practice Issues. New York: Springer, 1997. pp. 185-205. (4) Council on Scientific Affairs, American Medical Association. Alcoholism in the elderly. JAMA 275(10):797-801, 1996. (5) Adams, W.L.; Yuan, Z.; Barboriak, J.J.; et al. Alcohol-related hospitalizations of elderly people. JAMA 270(10):1222-1225, 1993. (6) Curtis, J.R.; Geller, G.; Stokes, E.J.; et al. Characteristics, diagnosis, and treatment of alcoholism in elderly patients. J Am Geriatr Soc 37:310-316, 1989. (7) Joseph, C.L. Misuse of alcohol and drugs in the nursing home. In: Gurnack, A.M., ed. Older Adults' Misuse of Alcohol, Medicines, and Other Drugs: Research and Practice Issues. New York: Springer, 1997. pp. 228-254. (8) Adams, W.L., and Cox, N.S. Epidemiology of problem drinking among elderly people. In: Gurnack, A.M., ed. Older Adults' Misuse of Alcohol, Medicines, and Other Drugs: Research and Practice Issues. New York: Springer, 1997. pp. 1-23. (9) Atkinson, R.M.; Tolson, R.L.; and Turner, J.A. Late versus early onset problem drinking in older men. Alcohol Clin Exp Res 14(4):574-579, 1990. (10) Lakhani, N. Alcohol use amongst community-dwelling elderly people: A review of the literature. J Adv Nurs 25(6):1227-1232, 1997. (11) Adams, W.L. Late life outcomes: Health services use and the clinical encounter. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (12) Bikle, D.D.; Stesin, A.; Halloran, B.; et al. Alcohol-induced bone disease: Relationship to age and parathyroid hormone levels. Alcohol Clin Exp Res 17(3):690-695, 1993. (13) Schnitzler, C.M.; Menashe, L.; Sutton, C.G.; et al. Serum biochemical and haematological markers of alcohol abuse in patients with femoral neck and intertrochanteric fractures. Alcohol Alcohol 23(2):127-132, 1988. (14) Klatsky, A.L.; Armstrong, M.A.; and Friedman, G.D. Alcohol and mortality. Ann Intern Med 117(8):646-654, 1992. (15) Thun, M.J.; Peto, R.; Lopez, A.D.; et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. New Engl J Med 337(24):1705-1714, 1997. (16) Fried, L.P.; Kronmal, R.A.; Newman, A.B.; et al. Risk factors for 5-year mortality in older adults: The cardiovascular health study. JAMA 279(8):585-592, 1998. (17) Dufour, M.C.; Archer, L.; and Gordis, E. Alcohol and the elderly. Clin Geriatr Med 8(1):127-141, 1992. (18) Waller, P.F. Alcohol, aging, and driving. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (19) Korrapati, M.R., and Vestal, R.E. Alcohol and medications in the elderly: Complex interactions. In: Beresford, T., and Gomberg, E., eds. Alcohol and Aging. New York: Oxford University Press, 1995. pp. 42-55. (20) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. No. 27: Alcohol-Medication Interactions. Bethesda, MD: the Institute, 1995. (21) Welte, J.W. Stress and elderly drinking. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (22) Grant, B.F., and Harford, T.C. Comorbidity between DSM-IV alcohol use disorders and major depression: Results of a national survey. Drug Alcohol Depend (39):197-206, 1995. (23) Moos, R.; Brennan, P.; and Schutte, K. Life context factors, treatment, and late-life drinking behavior. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (24) Grabbe, L.; Demi, A.; Camann, M.A.; et al. The health status of elderly persons in the last year of life: A comparison of deaths by suicide, injury, and natural causes. Am J Public Health 87(3):434-437, 1997. (25) Dufour, M., and Fuller, R.K. Alcohol in the elderly. Annu Rev Med 46:123-132, 1995. (26) Kalant, H. Pharmacological interactions of aging and alcohol. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (27) Spencer, R.L., and McEwen, B.S. Impaired adaptation of the hypothalamic-pituitary-adrenal axis to chronic ethanol stress in aged rats. Neuroendocrinology 65(5):353-359, 1997. (28) Pfefferbaum, A.; Sullivan, E.V.; Mathalon, D.H.; et al. Frontal lobe volume loss observed with magnetic resonance imaging in older chronic alcoholics. Alcohol Clin Exp Res 21(3):521-529, 1997. (29) Oscar-Berman, M.; Shagrin, B.; Evert, D.L.; et al. Impairments of brain and behavior: The neurological effects of alcohol. Alcohol Health Res World 21(1):65-75, 1997. (30) Harper, C.; Kril, J.; Sheedy, D.; et al. Neuropathological studies: The relationship between alcohol and aging. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (31) Sullivan, E.V.; Rosenbloom, M.J.; Deshmukh, A.; et al. Alcohol and the cerebellum. Alcohol Health Res World 19(2):138-141, 1995. (32) Malmivaara, A.; Heliovaara, M.; Knekt, P.; et al. Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol 138(6):384-394, 1993. (33) Atkinson, R. Treatment programs for aging alcoholics. In: Beresford, T., and Gomberg, E., eds. Alcohol and Aging. New York: Oxford University Press, 1995. pp. 186-210. (34) Oslin, D.W., and Mellow, A.M. Neurotransmitter-based therapeutic strategies in late-life alcoholism and other addictions. In: Gomberg, E.S.L.; Hegedus, A.M.; and Zucker, R.A. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA, 1998. (35) Druse, M.J.; Tajuddin, N.F.; and Ricken, J.D. Effects of chronic ethanol consumption and aging on 5-HT2A receptors and 5-HT reuptake sites. Alcohol Clin Exp Res 21(7):1157-1164, 1997.

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¹A standard drink is generally considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits, each drink containing approximately 0.5 ounces of alcohol.

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All material contained in the Alcohol Alert is in the public domain and may be used or reproduced without permission from NIAAA. Citation of the source is appreciated.

Copies of the Alcohol Alert are available free of charge from the National Institute on Alcohol Abuse and Alcoholism Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849-0686.

Full text of this publication is available on NIAAA's World Wide Web site at http://www.niaaa.nih.gov

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service * National Institutes of Health

 

There is much debate in the field regarding ethnicity and drug abuse. We like the concept of cultural competence which emphasizes knowing as much about the client's culture as possible, much as you would explore the family of origin. We are concerned however that there remains racial stereotyping in some of the assumptions that practitioners make about any ethnic group's response to alcohol. Socioeconomic factors such as poverty, discrimination, joblessness, etc. seem much more relevant than ethnicity in creating a culture of despair that promote addiction and substance abuse.

http://ncadi.samhsa.gov/govpubs/MS500/

Technical Assistance Bulletin Following Specific Guidelines Will Help You Assess Cultural Competence in Program Design, Application, and Management September 1994 In order for prevention programs to be effective, they must acknowledge and incorporate the culture of the service recipients that they are trying to reach. Programs that are applying for funding, or existing projects that are being evaluated, must be measured by how appropriately they address culture in their design and implementation. However, it is difficult to evaluate the cultural elements of a program because, unlike other areas of evaluation, there have been few guidelines offered to assess these elements. The knowledge base on managing and evaluating programs and preparing grant applications continues to expand. Evaluators generally consider factors such as cost effectiveness, replicability, possibility of linkages with other programs, potential impact, and content quality when assessing a program's efficacy. While these considerations have become standard, the important aspects of culture are often omitted from the assessment process. To address this need, this bulletin presents seven indicators or guidelines to assist you in developing or assessing the cultural competence of prevention programs. These guidelines will be useful for evaluators who are assessing existing programs or grant application as well as for individuals who are developing prevention programs. Although these guidelines were developed specifically to assess alcohol, tobacco, and other drug (ATOD) problem prevention programs, they can also be used to help assess the cultural competence of other kinds of programs. Why Consider Culture? Culture provides people with a design for living and for interpreting their environment. Culture has been defined as "the shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people." Culture shapes how people see their world and structure their community and family life. A person's cultural affiliation often determines the person's values and attitudes about health issues, responses to messages, and even the use of alcohol, tobacco, and other drugs. A cultural group consciously or unconsciously shares identifiable values, norms, symbols, and ways of living that are repeated and transmitted from one generation to another. Race and ethnicity are often thought to be dominant elements of culture. But the definition of culture is actually broader than this. People often belong to one or more subgroups that affect the way they think and how they behave. Factors such as geographic location, lifestyle, and age are also important in shaping what people value and hold dear. Organizations that provide information services to diverse groups must understand the culture of the group that they are serving, and must design and manage culturally competent programs to address those groups. Culturally Competent Programs Cultural competence refers to a set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing targeted interventions, communications, and other supports. A culturally competent program is one that demonstrates sensitivity to and understanding of cultural differences in program design, implementation, and evaluation. Culturally competent programs: Acknowledge culture as a predominant force in shaping behaviors, values, and institutions Acknowledge and accept that cultural differences exist and have an impact on service delivery Believe that diversity within cultures is as important as diversity between cultures Respect the unique, culturally defined needs of various client populations Recognize that concepts such as "family" and "community" are different for various cultures and even for subgroups within cultures Understand that people from different racial and ethnic groups and other cultural subgroups are usually best served by persons who are a part of or in tune with their culture Recognize that taking the best of both worlds enhances the capacity of all. Guidelines for Assessing a Program's Cultural Competence A careful consideration of the following guidelines or indicators can help you in developing, implementing, and evaluating the cultural aspects of a prevention program. These guidelines or indicators have been designed to raise awareness and to stimulate thinking about the important role that culture plays in successful prevention programs and activities. They should be expanded and tailored to your prevention program or organization. Organizations that are engaged in prevention activities must often balance money, staff, and time. Following guidelines such as these may seem too expensive and time consuming. These problems may not be easy to solve and may require dedicated and creative solutions. But it is well worth the effort because a culturally competent program and organization will help to create strong and sound prevention efforts. Experience or Track Record of Involvement With the Target Audience The sponsoring organization should have a documented history of positive programmatic involvement with the population or community to be served. The organization's staff, its board, and volunteers should have a history of involvement with the target population or community to be addressed that is verifiable by the general cultural group and by the specific community to be served. Training and Staffing The staff of the organization should have training in cultural sensitivity and in specific cultural patterns of the community proposed for services. Staff should be identified who are prepared to train and translate the community cultural patterns to other staff members. There should be clear cultural objectives for staff and for staff development. These objectives can be demonstrated by a staff training plan that: Increases and/or maintains the cultural competency of staff members Clearly articulates standards for cultural competency, including credibility in hiring practices, and calls for periodic evaluations and demonstration of the cultural and community-specific experience of staff members. Emphasis should be placed on staffing the initiative with people who are familiar with, or who are themselves members of, the community to be served. Community Representation The community targeted to receive services should be a planned participant in all phases of program design. There should be an established mechanism to provide members of the target group with opportunities to influence and help shape the program's proposed activities and interventions. A community advisory council or board of directors of the organization (with legitimate and working agreements) with decision-making authority should be established to affect the course and direction of the proposed program. Members of the targeted cultural group should be represented on the advisory council and organizational board of directors. The procedures for making contributions or changes to the policies and procedures of the project should be described and made known to all parties. Language If an organization is providing services to a multilinguistic population, there should be multilinguistic resources, including use of skilled bilingual and bicultural translators whenever a significant percentage of the target community is more comfortable with a language other than English. There should be printed and audiovisual materials sufficient for the proposed program. If translations from standard English to another language are to be used, the translation should be done by individuals who know the nuances of the language as well as the formal structure. All translations should be carefully pretested with the target audience. Materials It should be demonstrated that audiovisual materials, PSA's, training guides, print materials, and other materials to be used in the program are culturally appropriate or will be made culturally consistent with the community to be served. Pretesting with the target audience and gatekeepers should provide feedback from community representatives about the cultural appropriateness of the materials under development. Evaluation Program evaluation methods and instruments should be consistent with the cultural norms of the group or groups being served. There should be a rationale for the use of the evaluation instruments that are chosen, including a discussion of the validity of the instruments in terms of the culture of the specific group or groups targeted for interventions. If the instruments have been imported from another project using a different cultural group, there should be adequate evaluation and/or revision of the instruments so that they are now demonstrably culturally specific to the target group(s). The evaluators should be sensitized to the culture and familiar with the culture whenever possible and practical. Implementation There should be objective evidence/indicators that the organization understands the cultural aspects of the community that will contribute to the program's success and knows how to recognize and avoid pitfalls. Glossary of Key Terms Culture: The shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people that are unified by race, ethnicity, language, nationality, or religion. Cultural Competence: A set of academic and interpersonal skills that allows individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing targeted interventions, communications, and other supports. Cultural Group: A group of people who consciously or unconsciously share identifiable values, norms, symbols, and some ways of living that are repeated and transmitted from one generation to another. Cultural Diversity: Differences in race, ethnicity, language, nationality, or religion among various groups within a community, organization, or nation. A Community is said to be culturally diverse if its residents include members of different groups. Cultural Sensitivity: An awareness of the nuances of one's own and other cultures. Culturally Appropriate: Demonstrating both sensitivity to cultural differences and similarities and effectiveness in using cultural symbols to communicate a message. Ethnic: Belonging to a common group -- often linked by race, nationality, and language -- with a common cultural heritage and/or derivation. Language: the form or pattern of speech -- spoken or written -- used by residents or descendants of a particular nation or geographic area or by any large body of people. Language can be formal or informal and includes dialect, idiomatic speech, and slang. Multicultural: Designed for or pertaining to two or more distinctive cultures. Race: A socially defined population that is derived from distinguishable physical characteristics that are genetically transmitted. Please feel free to be a "copy cat" and make all the copies you want. You have our permission! Developed and Produced by the CSAP Communications Team. Patricia A. Wright, Ed.D., Managing Editor. Distributed by the National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20852. This bulletin is one in a series developed to assist programs that are working to prevent alcohol, tobacco, and other drug problems. We welcome your suggestions regarding information that may be included in future bulletins. For help in learning about your audience, developing messages and materials, and evaluating communications programs, contact the CSAP Communications Team, 7200 Wisconsin Avenue, Suite 500, Bethesda, MD 20814-4820, (301) 941-8500.   The National Clearinghouse for Alcohol and Drug Information A service of SAMHSA Return to More Technical Assistance Bulletins

Confrontation Unless the client comes in with the presenting problem of substance abuse, it would be wise on the part of the therapist to establish rapport and trust before approaching the denial system around substance abuse. As denial is a primary unconscious psychological defense it is inherently not something the client can consciously acknowledge. It has been a successful coping strategy for any number of months or years, or even generations. Consequently it is unlikely to retreat without a fight. We have often talked to people involved with substance abusers about different gentle forms of confronting the problem directly. Inevitably their response is along the lines of "Oh, I couldn't say that! They would have a fit!"

The defense of denial is like a gate guarded by fierce dragons and when you get too close to their truths they roar ferociously due to the impending loss of their power. Phoenix speaks of her own recovery: "I was already a newly licensed psychotherapist and admittedly shocked to discover my own struggle with addiction and how deeply the wall of denial was imbedded. How interwoven was the web of denial in my honesty to myself, my family and my friends?! As my recovery progressed I heard voices from my past pointing out the problem years before, only to be discounted by my knowing that the individuals saying these things 'just didn't understand me!'" The same ferocious defense is likely to emerge in your therapy with the substance abuser: so, be prepared. Your best preparation is knowledge.

We strongly encourage therapists to check out local programs and resources for drug abuse and alcohol treatment as well as attending a few twelve step programs. If the following symptoms are present do not immediately attribute them to a DSM classification that does not have to do with substance abuse. Once again note that dealing with underlying psychological issues when the addict's response to stress is to "use" is self-defeating for the therapist and client. Although you may want to wait until a second session, from our extensive clinical and personal experience we often gently probe the issue in the first session to avoid wasting valuable time and expense. It is also true when people exhibit obsessive compulsive addictive behaviors around other issues including sex, computers, television, food , gambling etc. It is beyond the scope of this course to deal specifically with additional complexities of these issues. There are excellent resources to advise you on the specifics . Suffice it to say that these same indications and interventions may be helpful.

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