BRIAN: Good Afternoon Atlanta and welcome to the Breakthrough Addiction Recovery Hour, I am Brian Fujii and I am the Clinical Director at Breakthrough Addiction Recovery and my co-host Jill Mattingly is away today but our Director of Psychiatric Services, Dr. Neil Johnston is with us, he has some things going on in his neighborhood today and so is with us via telephone. We are continuing our discussion of last week and socio economic dread as people move further and further and further into addiction. Some topics we most recently saw in the Atlanta Journal Constitution and how alcohol seems to be so accessible to many of our teens. How are you Dr. Johnston?

NEIL: Fine Brian and it is good to be with you today.

BRIAN: We will also be talking about alcohol and domestic abuse and it is very critical how people are being hurt in their own homes and that is at tremendous increase and if you are interested in our discussion call us at 770-266-0920. So if you want to be a part of this discussion call us at 770-266-0920. Dr. Johnston you mentioned the article in the Atlanta Journal this past Sunday.

Neil: Yes and please don’t hesitate to call in if you have a question about mental health and substance abuse today. Yes, the article about teenage drinking and alcohol abuse. The statistics of what students say about their access to alcohol and they refer to substance abuse trap and the percentage was statewide 25% of high school seniors admit to having binge drinking which means 5 or more drinks at one sitting. That means one quarter of all seniors in the last month.

Brian: These are individuals that may be on the road intoxicated.

Neil: And then Cobb County um, which is considered a bit more affluent 51% of 8^{th graders think it is easy to get alcohol and by 12th grade 80% think it is easy to getBrian: that is phenomenal, it keeps moving up and Dr. Johnston as we do our evaluations and day treatment programs at Breakthrough I ask my clients what is the age that you typically started drinking and it is between 13 and 14 years old. So here we are certainly fitting within that category 51% of 8th graders and you know this tells us something because we were talking before the show that we are living in a society today where truly both parents are working outside the home and our kids have a lot of unsupervised hours and that presents some challenges and many of the kids try to do their very best and temptation is strong when you have access to the bar or pull open the case and get the gin or bourbon or vodka and pour some for themselves and so one of the key things to constantly remind our listening audience is the issue of accessibility and we have to check it out that our medicine and liquor cabinets are secure.Neil: The street drugs of cocaine and heroin are not as nearly as common as are the prescription drugs that have been diverted and taken from a grandparent or parent and the teen abusing. The last one was Walton High School in Cobb County which is considered an exceptionally good school uh 56% of the senior said that had had alcohol in the last 30 days and 37% had been binge drinking and even your highest performing students this is not a class issue this is pervasive throughout and so we are a great family and have a beautiful house doesn’t mean your kids aren’t getting drunk.}

Brian: Getting drunk and you don’t know about it, but that is the typical thing we find characteristically with those that do have problems with alcohol is that know how to conceal very well. If this is striking a chord with you please call us at 770-226-0920. You know as we look at the statistics too, what are some of the issues perhaps like even in your practice as we look at individuals do you find them to be younger and younger when they begin and by the time they have problems they are in their 30s and 40s.

Neil: 12 or 13 years with the first drink, I had a patient this last week whose first week was at 6 years old. This is clearly a family unit that encouraged it or felt it was find or no problem for a child to have a beer and this is the old kind of the mother who has a child who is teething and rubs rum on their gums or maybe a problem with that per se and maybe better things to do but giving a 6 year old a couple sips of the beer , well I don’t want to come across as blaming parents because that is of no use but parents need to understand that their behavior is going to translate into what their kids do and the level of permissiveness and access that they allow their kids to have is going to contribute to it,

Brian: Then again they are developing behaviors and we will see how these particular concepts of how we use alcohol and I think you know ways that we can help family members to teach their children how to teach their children to use alcohol responsibly and learn how to see the dangers and I know that there are and I know we talk about this in our treatment that there are those that know how to use it responsibly and there are those that get in trouble because of abuse and we do know that people can move into dependency on alcohol and drugs. Dr. Johnston looks like we have a caller…Welcome David

David: Thank you. Yes, I was running across a number of studies and it almost seem like there is a profile of an addiction oriented person and it dovetails with the profile of a contemporary cigarette user and you can extrapolate from cigarette user in 2008 has high propensity for addictive behavior. Is this a genetic predisposition or a psychological h orientation toward I thin they say, I can’t recall the exact phrase but they are people that don’t weigh consequence and are in high risk behavior.

Neil: David that is a good point number one adolescence are what you describe they don’t anticipate consequence and so feel invincible and take more risks and then there are certain psychiatric illnesses like ADD that can create that same problem of lack of impulse control and h so there certainly illness states and genetic states that can create less aversion to risk and but there is a specific personality type and if we use to study personality type of a cocaine abuser or alcohol abuser

Brian: We are at a break will you hang on for a minute and we will come back from our break and we will continue this point because it is excellent, so call us at 770-226-0920 again 770-226-0920 David hang on and we will be right back.

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Brian: Welcome back I am Brian Fujii and my guest today is Dr. Neil Johnston, Director of Psychiatric Services at Breakthrough Addiction Recovery and we are talking with our caller David and he hung on with us, that’s great, I know that your question was about the studies being done about the propensity of cigarettes and nicotine with alcohol

Neil: I am not sure if I am answering to your question

David: Basically I want to see if there is a group already predisposed to the addictive behaviors maybe from OCD to various substance abuses. I know from knowing a few people that there are a group of very rare substance abusers that seem impervious to addiction. These are the guys that take whatever it is and somehow never develop addictive behavior and they use everything in the book and 9 out of 10 people look at them and think well if it doesn’t bother them maybe it won’t bother me.

Neil: I actually know someone like that who can have one cigarette every other week, occasionally have cocaine or a drink and never over indulge with anything um, they tend to be more rare to be honest and those poly substance recreational users of course I am bias, if you don’t have a problem you won’t come see me. So as far as a group of people that are pre-disposed? Absolutely. To give you an example folks with bi-polar disorder probably 60% to 80% will have substance abuse problems and often time to self medicate to help their symptoms to they just know they feel bad and they need the substance to make them feel better. Also genetically alcoholism is divided into two types and early onset and late onset, early is teen to 20s and late is 30s to 40s and early onset tends to genetically come down from father to sons and a family history of that is certainly at higher risk, but figuring out type A personalities of that nature, no we have nothing like that on the personality test that could determine a group of people more likely but it would be great if we did because then we could test adolescents and see who is at risk and save time and money.

David: But I wind up working with people with traumatic brain injuries but we actually have a couple of cases percentage 2% or less of people who addicted behavior ceased due to the injury.

Neil: That is interesting and depending on where it occurred and I have see those with love injuries that loose their inhibitions and due all sorts of things that they would have not done before the injury and I am sure that some of the others have seen “Regarding Henry” where the Harrison Ford character becomes more likeable after his brain injury.

David: Or, the story of a railroad spike damaging a man’s frontal lobe due to an explosion and it ends up that it completely changes his behavior.

Neil: That’s where lobotomy started and we don’t do those anymore. There are still occasional rare surgeries for OCD that can be beneficial but that is about it and for depression they are doing some deep brain stimulation with therapies and even inserting electrodes deep into the brain but still in the research phase for that so as far as anything close to brain surgery or alteration..

Brian: Ok, we are coming down to our next break and we are appreciative David for the discussion and very insightful and what a wonderful job you are doing with traumatic brain injury patients. Again, listen and call again

David: Thank you sir.

Brian: Again, we are dealing with alcohol and accessibility so if interested please call 770-226-0920 and if outside Atlanta 1-888-920-2665 and the local call is 770-226-0920.

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Brian: Welcome Back, Breakthrough Addiction Recovery Hour, my name is Brian Fujii and my guest is Dr. Neil Johnston, Director of Psychiatric Services at Breakthrough Recovery and we are talking about securing alcohol from children and drugs and how they are being impacted in the socio economic world. Their life is being impacted and as a result we have a call from David,

David: How are you? I have a question do you support the legalization of drugs as I do. My premise is that eventhough they can be a problem in some cases the criminality aspect is much worse than even really serious addiction, I mean being arrested for drugs is a worse problem than having ..so if you took away the government laws I think things would change for the better.

Neil: Let me comment on that, I have worked at many of the county jails in Atlanta, with many of the drugs they are dangerous used and so I think that prescriptive control should be there. I had lots of patients that were heroin users that when the heroin potency hanged on the street they ended up However as far as marijuana concerned it makes no sense if tobacco and alcohol legal. Marijuana at least has some medicinal value. That drug I will agree but as far as heroin absolutely not and not for the prescription drugs. Point blank there are too many dying from mixing their drugs and they did not know better, so we need to take control of too many accidental deaths,

David: I agree to a point but I would add that alcohol if you criminalized it like in the 1920s basically it is a horrible drug and if someone invented it in the lab tomorrow, the government would never ever let people anywhere near it and it is such a part of our culture and so many drink it and have no problem , I would rather hang around a hard core drug user and I think if some of those hard drugs like before 1913 were over the counter and you didn’t have problems with purity levels ….and it is kind of like during prohibition bathtub gin…

Neil: You had opium and didn’t have heroin and IV use and uh you were having very small quantities and that is the difference today we have you know people getting drugs for their arthritis or their pain very powerful drugs that if a teen has a few tablets and crushes and snorts them they will die. Those things have to be controlled and that is absolutely right alcohol is much worse than marijuana

Brian: Alcohol is legal and this is interesting because both alcohol and nicotine do more damage than most of the others out there in fact we do now that alcohol produces more damage to organs than any other legal or illegal drug. We have to figure out how to use what we have and not abuse it and that is a fight we face. David thanks for the insightful call and again we are going to be looking at the area of addiction but it looks like we are going to stop this one here.

Let’s take a look at domestic violence we are briefly going to talk about this even though we may not have time to finish, many feel that domestic violence is directly related to alcohol and many say that between 25 to 80% have a direct relationship between abuse and violence. So what I am hearing from the studies is that it is learned behavior and observing parents and their behavior, so stay with us we are coming until another break so if you are interested in or have experience, perhaps you are a victim or right now are facing danger, please give us a call at 770-226-0920 we do know that this is a big issue in this area not only in Atlanta but in the United States , call us 770-226-0920 and we will be right back.

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Brian: Welcome Back Atlanta, I am Brian Fujii here with my special guest Dr. Neil Johnston, Psychiatric Director at Breakthrough Addiction Recovery. We are going to be talking at this point of domestic violence and we do know that it is a tragic situation and many times we believe there is a very close link with using alcohol and yet some of the studies indicate that that is not always the case. Some information about that, efforts to link them makes society view battery as deviant behavior so, battering is a socially learned behavior and men who batter frequently use alcohol abuse as an excuse for domestic violence. Dr. Johnston what do you think about that? It is true some of this emotional acting out…here we are talking not so much about use of substance that lowers inhibition but it is truly learned behavior and we know that those that are abusers have been abused in their past,.

Neil: Well I do see evidence to support that in my practice from both sides of the picture. Meaning that um, an abuser could have grown up in an abusive family seeing a parent being abused and took on the role of the abuser and on the other hand a child will grow up and identify and become a victim. But at the same time there very well could be a genetic aspect to it. I have never seen a twin study of identical twins raised separately to see if there were separate instances of domestic violence which is the only way you could say it is in play there. As far as substance abuse, I don’t think alcohol or even cocaine or whatnot is going to turn a non-abusive wonderful person into an evil abusive individual. However, someone who already has the propensity to be one is going to be worse due to the drinking.

Brian: What you are saying they are already exhibiting behavior …

Neil: We are all inhibited toward violence even abusers express guilt after abuse, whether sincere or not I can’t tell you but the ones I work with always appear to feel guilty and again I am skewed because they come to me to stop the behavior. I do think that alcohol and substance abuse play a role but not necessarily a cognitive role in the big picture of the abuser but a smaller picture when it occurs, I think if you asked a police officer how many times do you get called to a dispute domestically that there is alcohol, I would bet at least a large percentage of the time it is substance abuse.

Brian: This topic is going to generate discussion in the future and I would like all of us to be thinking about this issue, we have one minute left. Alcohol and drugs may relate and we do know that in some areas the abuse varies widely 25% of the cases relate only to alcohol. Stay with us for next week and we look forward to visiting with you again and call us at 770-734-8091 if we can help you. Join us next week.