Many people who complete treatment for alcohol dependency blame relapses on unbearable cravings for alcohol.  The dependent person has usually been drinking for a reasonably long time and has a conditioned response to the alcohol cravings.  When actively drinking, the cravings were easy to deal with but what do you do now that you have been detoxed and treated for alcohol abuse?  One drink will virtually always culminate in a full blown relapse.  Some are short in duration and are caught prior to redeveloping physical alcohol dependence, others land the person back in the hospital for yet another detox. There are many tools available to help with cravings.  This article will discuss some of the methods and products available.   

Therapy – Traditional treatment rarely includes any therapy to modify behavior other than the twelve steps of Alcoholics Anonymous.  More contemporary and progressive treatment centers use psychotherapy and incorporate cognitive behavioral therapy.  Much of the alcohol dependence mechanism is controlled by repetitious or habitual behavior.  Most alcoholics have specific drinking conditions where the reward of alcohol has been used daily.  Modifying these conditions and helping the brain to learn a new behavior is extremely effective in remaining sober.  Cognitive Behavioral Therapy is used to help the dependent person learn new ways to react and behave that do not include alcohol. 

Medications – There are pharmaceuticals available which are effective in helping deal with alcohol cravings.  Among them are Naltrexone, Vivatrol, Campral and there are some early indications that Chantix may also be an effective anti-craving medication.  All of these drugs are used to occupy specific neuro-receptors that are responsible for the cravings.   

Naltrexone is an oral medication that occupies the opiate receptors in the brain and is also available in an injectible form known as Vivitrol.  This drug has proven very effective in helping reduce cravings in the majority of problem drinkers.  Many report that substantially all cravings have been abated but a small percentage of the people who have tried these medications report that they notice no reduction. 

Campral (acamprosate calcium) is another oral medication available to help reduce cravings.  The manufacturer states that the mechanism of Campral is not totally understood.  Alcohol inhibits activity of receptors called NMDARs (N-methyl-D-aspartate receptors) in a way which overproduction of these receptors is caused by excessive and prolonged alcohol consumption.  When alcohol is suddenly not present, these NMDARs become more active than normal.  Withdrawal from alcohol creates a surge in the release of neurotransmitters such as glutamate.  Campral is believed to help reduce this glutamate surge.  Again, it is effective in reducing cravings in some and in others it seems to have no effect. 

Some recent studies have indicated that promise is shown for a tobacco cessation medication called Chantix in treating alcohol cravings.  Chantix (varenicline) is a nicotinic receptor partial agonist that reduces the cravings and pleasurable effects of nicotine.  This drug is not currently indicated for alcohol cravings.  

Education – Most alcoholics have no idea what is going on with their body and brains as a result of their continued alcohol consumption.  Every attempt should be made to educate these individuals on the neurochemistry of alcohol addiction.  The more one knows about the effects that the abuse creates the more likely they are to make the difficult decision not to resume drinking. 

Nutrition – Nutrition plays a critical part in recovery from alcoholism.  Alcoholics tend to neglect nutritional needs in favor of alcohol.  The caloric content of alcohol often satisfies hunger and the dependent individual drinks rather than eating.  Alcohol contains no nutritional value and the body immediately converts any alcohol consumed into sugar.  The rapid introduction of sugar into the system raises blood sugar levels and gives the alcoholic a feeling of well being.  Rather than consuming protein and carbohydrates that are more gradually metabolized, the alcoholic drinks.  The alcohol burns rapidly and blood sugar drops dramatically causing the dependent person to feel weak, anxious and shaky, similar to the feeling a normal person gets when they are extremely hungry.  The metabolism of alcohol also depletes many vitamins and minerals.  Most alcoholics that enter treatment are severely deficient in many areas that are necessary in normal bodily functions.  Many are also pre-diabetic or hypoglycemic.  During early sobriety it is critical to address these deficiencies and resume a diet high in quality nutrients.  Supplements are also recommended to aid in the healing process.  Blood sugar irregularities are often confused for alcohol cravings. 

After accessing the individual’s specific needs, we use a combination of any or all of these components in early sobriety.  Psychotherapy, cognitive behavioral therapy, medications, education and nutrition can all play critical parts in recovery.  Often Campral and Naltrexone are used in combination to deal with cravings.  Pharmaceutical intervention and being nutritionally sound can virtually eliminate physiological cravings.  Psychological factors such as changing destructive behavior, dealing with issues that drive the addiction and understanding what is happening with your brain and body are the other often to frequently overlooked components.  Long term sobriety is rarely achieved by pharmaceutical intervention alone and must be accompanied by physiological and cognitive behavioral therapy.

Many people research how to detox themselves from alcohol.  Keep in mind that there is a huge difference between occasional or sporadic alcohol abuse and true alcohol dependence.  If you abuse alcohol occasionally you can sometime just quit drinking, survive the hangover and recover without any medical intervention.  If you have become alcohol dependent, it is a totally different story.  Alcohol Dependence is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the American handbook for medical professionals, as meeting at least three of seven criteria within a twelve month period. The criteria are:

1.      Narrowing of the drinking repertoire.

2.      Increased salience of the need for alcohol over competing needs and responsibilities.

3.      An acquired tolerance to alcohol.

4.      Withdrawal symptoms.

5.      Relief or avoidance of withdrawal symptoms by further drinking.

6.      Subjective awareness of compulsion to drink.

7.      Reinstatement after abstinence. 

If three of these criteria are met, you have become alcohol dependent and it is unsafe and potentially life threatening to detox yourself.  Many things happen when alcohol is withheld from a dependent person.  The degree of withdrawal problems will vary for each individual but the common problems incurred will include; dramatic increases in blood pressure, nausea, tremors, headache, dementia and hallucinations, seizures, heart failure and strokes.

Most good intentioned alcohol dependent people swear off alcohol many times and are determined to quit drinking on a daily basis.  Within hours of abstinence, symptoms begin to occur.  The person will have a splitting headache, be sick to their stomach and begin to tremble.  The great majority of these people are unsuccessful in there attempts to quit.  They decide to have one drink to feel better and they are off to the races again.  When the alcohol dependent person has this “one drink” their symptoms abate very rapidly.  The shaking stops, the headache goes away and they feel better.

There was an article in yesterday’s paper about a woman who died while in custody of the Phoenix Airport Police Department.  She was on a flight from New York to Arizona where she planned to enter an alcohol treatment program in Tucson.  She was arrested for disorderly conduct and unfortunately died in a holding cell.  The article was not specific about the cause of death but it was undoubtedly alcohol related.  I suspect that her disorderly conduct arrest was probably due in fact to alcohol induced dementia or delirious tremens (DT’s) which are usually interpreted as extreme intoxication.  When symptoms such as these accompany withdrawal, a stroke or seizure is almost inevitable without medical intervention.  This is a very common story and it often ends in death.

Alcohol detox must be done under medical supervision.  There are two basic types of detox methods ambulatory detox and outpatient detox.  Ambulatory detox can be safely accomplished when done under medical supervision and administration of appropriate detox drugs.  Vital signs must be taken and dosing must be done frequently to safely detox in an outpatient setting.  The alcohol dependent person must be monitored at all times during the detox and cannot be left alone.  The other detox method is done in a hospital setting.  Hospitalized detox is necessary when there is a history of DT’s or in cases where other medical problems are present.Medical protocols for detox patients will vary depending on the person’s specific medical history and severity of dependence.  In all cases, anti-seizure drugs are induced to mitigate the risk.  A variety of other medications will be used to treat symptomatic problems such as nausea, insomnia and anxiety.

In short, there is no way to safely detox yourself from alcohol if you are alcohol dependent.  Do not be fooled by advertising claims or holistic remedies.  It is a life and death situation and cannot be done safely without medical intervention.

The Gateway Drug Theory is best defined as the belief that a lower class drug can lead to subsequent use of harder drugs.  It is also defined as a drug sometimes used in a first or introductory experience.  The two drugs most frequently labeled under this definition are marijuana and alcohol. 

More people enter substance abuse treatment centers each year for treatment of alcoholism than all other substances combined.  It is available, plentiful, easily obtained, legal and socially condoned and in some cases, socially encouraged.  Thousands of people enter treatment each year for cannabis addictions but the numbers pale in comparison.   

Alcohol addiction is progressive in nature.  It takes more and more to achieve the same effect.  As the consumption levels increase, the dependence transcends one of a psychological nature and it also becomes a physical dependence. 

While many who experiment with marijuana never progress to harder drug use, just as many will progress to more addictive drugs.  Some remain with marijuana as their drug of choice and become dependent on marijuana alone.  The most common progression is marijuana to cocaine.  After using cocaine for a period of time, most coke users also become dependent on alcohol and/or benzodiazepines.  The cross addictions normally occur as a result of the users efforts to self-medicate for the sever depression or “crash” that is experienced when coming down from cocaine.  Methamphetamine users have progressive drug use and in most instances it goes form marijuana to cocaine to crack to meth.   

Once someone has become dependent on any substance to a point that treatment is necessary, they must realize that they are much more vulnerable to the potential addiction to other addictive substances.  Many treatment centers report that clients return with relapse problems that are not their original drug of choice.  They might have completed treatment for alcoholism and relapse on opiates or cocaine. 

Addicts must realize that once they have crossed the line and become physically and mentally dependent to a mind altering substance that they can just as easily become addicted to a new drug.   

Virtually all relapses begin with alcohol.  It is very difficult to get people who have never had a problem specifically with alcohol to understand that it is very dangerous to drink if you have ever had problems with other substances.  They often say that they rarely drink and they really don’t enjoy the taste.  The problem surfaces when the person consumes alcohol and reduces their inhibitions and ability to make rational decisions.  Most jokes start with “This guy in a bar…” or “This drunk…”  There is a reason for this.  When people drink they do things that they would not normally do when sober.  Drug relapses usually happen after a couple of drinks.  People who were successfully treated for drug dependence often become alcoholics.  Alcohol is also a mind altering substance and is the most common drug available. 

There is another common misconception with recovering alcoholics.  Many think that they can enjoy N/A beer.  These products are marketed under many brand names such as O’Doul’s, Sharps, and a host of others from virtually every brewery.  While these brands contain a reduce alcohol content, they still contain alcohol.  The small amounts of alcohol combined with the real beer taste often lead to relapse.  A normal beer sold in

America will have an alcohol content of approximately 5% with some such as Sam Adams Double Bock ranging as high as 8%.  N/A Beer usually has an alcohol content of about .5%.  While they are sold as non-alcoholic beverages, they contain alcohol and can easily trigger a relapse. 

Addict or alcoholic, it is a much safer plan to avoid all alcoholic beverages.  “Non-alcoholic” beverages will lead to a relapse for virtually any alcoholic and alcoholic beverages will be a major contributor in most drug relapses.

Many of the people who enter and complete treatment each day are still dealing with unresolved grief that creates a great sense of emptiness and a void that is extremely difficult to fill.   

Someone very close to us has died and left a big hole.  We keep fondly remembering the wonderful times that we had with our friend.  No one has ever been closer, more dependable or understood our thoughts and feelings more. 

We are constantly reminded of the great times and the fun we had.  We can’t go to the ball park without remembering all the smiles and laugher we enjoyed together.  We miss them on our fishing trips and somehow it just isn’t the same without them being there.  The Super Bowl and NASCAR will never again be enjoyable without that special someone by our side.  The great times we had at the clubs dancing like a couple of fools. 

If you haven’t figured it out yet, I am talking about our old friend alcohol.  For people recovering from alcohol dependence this is a huge problem and is the precursor to most relapses.  Everything we have done in our adult life has centered around alcohol and we don’t have any idea how to enjoy life without it. 

It seems that the older you are and the longer your love affair with alcohol, the more difficult the problem.  Most alcoholics started drinking at a reasonably young age and most of their adult memories are centered around events where alcohol was present and usually abused.  For some the problems came soon in our drinking careers, for others it took longer.  When we finally got sober, we didn’t quite know what to do or how to have fun. 

Young alcoholics face an even greater challenge, especially if they are single.  It seems that in our society most functions for young, single adults revolve around alcohol.  You take a case of beer water skiing.  You go to the sports bar with your buddies to watch the game.  You go to the club to meet members of the opposite sex.  How do you participate in these activities without drinking?  Won’t you stand out like a sore thumb?  Our non-alcoholic friends can do all these activities without getting smashed or drinking to excess. 

We feel somehow cheated that we cannot drink and have fun like everyone else.  What we often fail to realize is that we are not like everyone else.  With a little introspection we realize that we are different.  If you are an alcoholic, can you ever remember leaving an unfinished drink at a bar?  A half full glass of wine at the table of the restaurant?  Pouring out a beer that got warm?  Of course you can’t because it never happened.  That is why we can’t drink and have fun like everyone else.  Everyone else doesn’t even think about alcohol or if they have drained the last drop from the container.  They can take it or leave it. 

Most that have entered treatment have a great deal of anxiety and fear.  They don’t really understand how or why they ended up spiraling out of control.  The realization of fact that you will never be able to drink again is huge and it is a life changing event.   

This is true not only for alcoholics but all substance abusers.  Alcohol is always the gateway drug to relapse on the drug of choice for non-alcoholic addicts.  People that have a different drug of choice have a couple of drinks and their inhibitions are lowered.  In their altered mental state it is easy to rationalize using their drug of choice.  Most relapses start this way.  “One little joint never hurt anyone.”  “I can do one line or smoke one little rock without having a problem.”  “My back really hurts today; I think I can take a couple of Vicodins without getting addicted again.”  “I never had a problem with Xanax before.”  As Emeril would say “Bam” and we are off the wagon and under the wheels.  We hear these stories every day.   

We never seem to remember the bad things that we experienced during active addiction.   Most that have entered treatment have just as many bad memories of drinking or drugging as we do good memories.  We just choose not to remember the bad things, which is normal for all thought processes.  If it were not this way we would never try anything a second time.  When you learned to ride a bike and fell and hurt yourself you didn’t quit because you recalled the rush of going fast and the wind in your face.  Alcohol and drug addiction are no different.  We remember only the fun times we shared with our dear friend. 

When you become drug or alcohol dependent you normally have more bad memories than good.  In time, these memories fade, which again is a normal thought process.  You don’t remember the damaged relationships, the DUI’s, the throwing up, the shaking, and the total inability to perform normal functions.  When we remember going to the game and enjoying a dozen beers we rarely remember being bent over the bumper of the car in the parking lot throwing up later the same evening.  We don’t remember having to get up and have a drink to stop shaking so we could shave or put on makeup.  We don’t remember counting pills before a weekend trip to make sure we would not go into withdrawal.  We don’t remember getting a secret credit card and a P.O. Box so we could make online pharmacy dope purchases.  We don’t remember going to a questionable area of town looking for illegal drugs and putting ourselves at risk of being seriously injured or killed.  We don’t remember driving home with one eye shut so that we didn’t see two of everything or driving around drunk with our kids in the car.  We don’t remember having phone conversations, not remembering them and then having to fake our way through a conversation while trying desperately to remember.  These are but a few of the glamorous memories we alcoholics and addicts all share.  The list could go on for pages and the examples would get a lot worse. 

What we have to understand is that we are not like other people.  They are not alcoholics or addicts and do not experience the same things that we do.  They are not dependent and alcohol or drugs do not even occupy their thoughts. 

While we do not have to put ourselves in a position where drugs are being used, the case is different with alcohol.  Alcohol is socially accepted and encouraged in almost all areas of life.  We as alcoholics and addicts have to understand that if we choose to have a drink, we will end up in the same situation again and again.  The brain will heal and the resentment and cravings will abate but it takes time.  Sooner than you think the thoughts of using will leave and you will learn how to enjoy life sober.  Everything in your life will improve.  You will feel good physically, be mentally alert and sharp and friendships and relationships will once again blossom.  Stay strong, smart and remember that you and only you are in control of your own destiny.  It is possible to have fun without being high. 

An alarming number of people who have elected to have gastric bi-pass are finding that they are experiencing problems with other addictions, alcoholism being one of the primary manifestations. Some studies have indicated that as many as thirty percent of these people are experiencing what is termed “addiction transfer”. The term addiction transfer simply means that they have traded their compulsive addiction to food for another unhealthy addiction such as alcohol, drugs or gambling.

This concept is not new in studies of addicts. This type of behavior is explained as the individual seeking a new substance to fill an inner void. The fact is that a large number of these people haven’t had any therapeutic help in addressing the issues that were perpetuating their eating disorder. Many sought comfort in food and when the stomach is dramatically reduced in size that is no longer an option. In order to fill this void many turn to alcohol, which brings with it a whole new set of problems.

There are many physiological explanations for this phenomenon. It is thought that the brain’s pleasure center for these people was stimulated by food. When they consumed something that they enjoyed they stimulated their dopamine system. Dopamine is a neurotransmitter that produces pleasurable feelings when rewards are presented. It is believed to provide a teaching signal to the sections of the brain that are responsible for acquiring new behavior. Thus, the person would seek a pleasurable sensation by eating. This behavior is now being transferred to another behavior that produces the same dopamine release and emotional sensation.

One of the primary problems with alcoholism for the bariatric patient is one of a physical nature. After the surgery, the stomach is very small and the way that alcohol is metabolized is severely impacted. Alcohol is normally contained in the stomach when it is consumed where it is partially metabolized with the aid of the enzyme alcohol dehydrogenase. It is release slowly into the intestines. The length of time that the alcohol stays in the stomach is impacted by the much smaller stomach and more of the alcohol enters the intestines where it is absorbed rapidly due to the large surface area of the intestines. This causes intoxication at an accelerated pace, some studies have indicated almost twice as fast. Alcohol triggers the same dopamine release that the patient formerly received by eating. The alcohol induced dopamine release becomes the new addiction and alcohol dependence rapidly develops.

When the decision is made to have bariatric surgery the patient should consult with a psychotherapist and get the help necessary to modify compulsive behavior and treat any underlying issues that may be present. If therapy is not part of the treatment, the resulting and desired weight loss will occur but the danger of addiction transfer is substantial.

Twelve step treatment is based on the principals of Alcoholics Anonymous. While I respect and admire the fine work of AA, I find that many people cannot grasp this style of treatment. Many have tried these principals only to relapse time and time again. Some studies suggest that as many as 95% of the people that try a 12-step treatment program relapse within the first ninety days.

Traditional treatment is based on spirituality and seeking help from a higher power to resolve addiction.

The first step is admitting that you are powerless over your drug of choice and that your life has become unmanageable. Without this step it is impossible to recover with 12-step therapy. Many have a problem grasping this step. They might be very high functioning and they feel that their life is not unmanageable, just their problem with a particular substance. The great majority of the clients we treat are very successful in their chosen field.

The second step looks to a higher power to restore sanity. Again, many don’t feel that their sanity is in question, just their chemical dependency.

Step three has the person make a decision to turn their will and their life over to the care of god as they understand him.

The remainder of the steps involve taking a moral inventory and working with the god of their understanding to deal with their past and make right all of their misdoings.

This program works for many people if they embrace the philosophy and follow the program. Alcoholics Anonymous teaches you to work these twelve steps over and over and to attend meetings the remainder of your life to reinforce these teachings and carry them to others who are still active in their addiction. They also encourage members to avoid any circumstances that might put them in an atmosphere where alcohol and drugs are used. While this is typically not a problem for drug use, it is often very impractical for alcohol since it is legal and permeates every aspect of normal life.

It is very rare that someone has substance abuse without having accompanying psychological disorders. These problems range greatly but all lead to moderate to severe depression. When the addict or alcoholic uses their substance of choice it becomes a vehicle that takes them away from their problem. Traditional treatment does nothing to address the co-occurring disorders and has a tendency to actually heighten anxiety and depression due to admitting past transgressions to one or more peers.

It is very common for people with substance abuse problems to feel a great deal of guilt associated with their addiction. While protecting and perpetuating their dependency many have lived a life of deception that creates this guilt. Drugs and alcohol share the common bond of depressing the central nervous system and lowering inhibitions. When the addicted person becomes dependent on the substance they will go to great extremes to protect themselves and insure that they are not discovered or interrupted. Many have lied or taken other deceptive measures to obtain or protect their drug of choice. Some have stolen or concealed the amount of money spent on the substances to the detriment of their family and loved ones. Most have hidden drugs or alcohol or gone to great lengths to cover their tracks and not reveal their dependency.

Traditional treatment encourages that all of these feelings of guilt and shame be exposed and shared with others in an attempt to cleanse the soul and it also encourages the addict to make amends wherever possible. This divulgence process is repeated over and over for the life of the person.

AA utilizes many sayings to help their members remain sober. “One day at a time”, Keep coming back, it works if you work it”, “Easy does it” are among them. Many have suggested that with this style of treatment you trade your addiction to drugs or alcohol for an addiction to 12-step. Many feel that this idea may have merit because most addicts that get sober and remain sober with 12-step teachings tend to stay that way only when they remain active in the AA lifestyle. If the lifestyle is discontinued many relapse and resume their addictions.

Addicts and alcoholics should be encouraged to face their past and deal with the issues that might be impeding their recovery, but they must understand that the past is just that, the past. While unpleasant memories can in some instances help keep the person sober, they cannot be changed. Reliving them and dwelling on them is counter productive and harmful. Issues that cause anxiety and depression must be resolved or the addict will seek their old friend alcohol or drugs to help them escape the mental anguish. Many have been dealing with psychological issues for the majority of their life and their drug and alcohol addictions have manifested in an attempt to escape the issues by self medicating.

Drug and alcohol abuse have numerous negative impacts on the human body. Many physical effects become glaringly apparent. Alcoholics will generally exhibit one or many symptoms of the disease. Hypertension, gastro-intestinal problems, lower back pain, bronchial infections, trembling and shaky hands are but a few. What few people realize is the tremendous impact these substances have on the addict’s mental state. Alcohol and virtually all drugs dramatically impair the body’s neurotransmitters that are responsible for one’s psychological state. Primarily affected are the serotonin and dopamine systems which are utilized in normal feelings of well being and joy. Both are dramatically impacted and there presence and normal function slow and become minimized. Neurotransmitter function will continue to decrease as the addiction continues and intensifies. The continued and accelerated use of the drugs and alcohol only increase the spiral of depression.

As the drug and alcohol use progresses and the depression continues the addict begins to experience feelings of hopelessness. Their self-esteem plummets and they begin to accept the role of being an addict or alcoholic. They wonder how this all happened but feel that there is no way out because they have become dependent on their drug.

Every tool possible should be employed to help addicts get control of their substance abuse issues and addictive issues cannot be addressed without simultaneously addressing the causes. Attempts should be made to expose any and all underlying problems. Treatment should include psychiatric, psychological, physical and social assessments. When the issues are disclosed, the appropriate treatment and therapy should be utilized to help the person resolve all of the issues. One of the most important aspects of treatment and cognitive behavior therapy is to restore a sense of pride and raise the dependents self-esteem and self-image. The alcoholic or addict cannot achieve their desired goal of sobriety without caring enough about themselves not to go back to the dependency they have escaped with treatment.

Many times treatment fails because the dependent person is trying to get sober for their spouse or family. Until the person truly wants sobriety for themselves their addictive issues will continue and sobriety will be short term at best. This simple fact is true not only of 12-step treatment but of all treatment. Addicts and Alcoholics must understand this. When physical discomfort and cravings are addressed and psychological issues are dealt with, the dependent person starts achieving clarity and the feelings of despair and hopelessness are replaced with optimism. As sobriety is sustained, cravings diminish, the brain and body heal and the person once again becomes whole.

AP) Law enforcement authorities have discovered that people are willing to go to great lengths to get high, including a troubling new method that features a frightened toad.

“Toad smoking,” which is a substitute for “toad licking,” is done by extracting venom from the Sonoran Desert toad of the Colorado River. The toad’s venom _ which is secreted when the toad gets angry or scared _ contains a hallucinogen called bufotenine that can be dried and smoked to produce a buzz.

In October, a Kansas City man was charged with possessing a controlled substance after Clay County authorities determined he possessed a toad with the intent to use its venom to get high.

Clay County Prosecutor Daniel White said possessing the toad is not illegal, but using it to get high off its venom is.

“It is easier to get it, and law enforcement might not immediately know you use it to get high,” White said. “It’s sort of a New Age way to get high. You convince yourself it is OK because it is something you get naturally from our environment.

“There are a lot of things that are created naturally but they are still not legal,” he said.

White said that for years people experimented with “toad licking,” and now toad smoking is considered a substitute. To do so, a person heats up the frog’s venom to break down its toxins and preserve the hallucinogen, which is dried.

He said some Internet sites feature an instructional video on how to extract the toad’s venom.

Police found the toad when they went to a northern Kansas City home to investigate a suspected meth lab. They later arrested David S. Theiss, 21, and charged him with three counts of possession of a controlled substance and one count of possessing drug paraphernalia _ the toad.

Theiss also is accused of possessing mescaline, a controlled substance extracted from a cactus.

While smoking toad venom might sound extreme, an even more disturbing method to get high possibly includes sniffing fermented human waste. Vicky Ward, manager of prevention services at Tri-County Mental Health Services in Kansas City, said she has read e-mail warnings about a drug called jenkem.

The drug is made from fermented feces and urine.

“We work with a lot of youths and we ask them whether anyone has tried it and they said no,” Ward said. “They (the youths) have heard about it because of the Internet.”

But whether people actually use of jenkem has not been determined, Ward said, noting that a Web site that investigates urban legends isn’t clear on the matter.

“Kids get ideas that later turn out to be unfounded, but you will get some idiots who will try anything,” she said.

* Adolescents who drink alcohol, smoke and/or use drugs tend to have peers who do the same.
* New research findings suggest that girls may be more influenced by their friends’ drinking.
* Having opposite-sex friends who drink is also associated with increased drinking for both genders.

Adolescents who drink alcohol, smoke and/or use drugs tend to have peers who do the same. A new study that looked at other factors which may moderate the influence of peers has found that gender, and gender of friends, can also affect this association.

Results are published in the December issue of Alcoholism: Clinical & Experimental Research.

“Several studies have found that peer drinking has more of an influence on an adolescent’s drinking than his or her own parent’s drinking,” said Danielle Dick, corresponding author for the study. Now at

Virginia Commonwealth University, Dick was an assistant professor at

Washington University,

St. Louis when this study was conducted.

“We wanted to more closely examine the role that gender may also play, because even though there are profound differences that occur in development between girls and boys during adolescence, little is known about how influences on alcohol use may differ between the sexes during this developmental period,” said Dick.

Researchers used data from a population-based, longitudinal twin study of behavioral development and health-risk factors from

Finland (n= ~ 4,700 individuals). They analyzed the association between friendship characteristics and alcohol use, testing for interaction with gender and gender of friends. They also used the twin structure of the data to examine the extent to which similarity in drinking behaviors between adolescents and their friends was due to shared genetic and/or environmental pathways.

“Our findings suggest that girls may be more susceptible to their friends’ drinking,” said Dick, “and that having opposite-sex friends who drink is also associated with increased drinking, for both sexes. Furthermore, genetically based analyses suggest that the correlation between adolescent/friend drinking was largely attributable to shared environmental effects across genders. This suggests that the association between an adolescent’s alcohol use and that of his or her peers is not merely a reflection of genetic influences on the adolescent’s own alcohol use that cause them to select drinking peers.”

In other words, said Kenneth J. Sher, Curators’ Professor in the department of psychological sciences at the

University of

Missouri, the influence of risk factors associated with the peer network appeared to be stronger in girls.

“Those who design and implement prevention approaches should take gender into account as a potentially critical moderator of prevention outcomes,” said Sher. “We need to better understand the ‘why’ of sex differences in risk in order to shed important light on the nature of risk processes. For example, are girls potentially more ‘vulnerable’ to peer-related effects at this stage of life because they are likely to be more intimately involved with their closest friends than are boys” That is, does gender simply serve as a ‘proxy’ of a variable such as intimacy or closeness during this time of their lives?’”

Both Dick and Sher cautioned parents to be very aware of their child’s friends, as well as how they spend their time together. “This awareness,” said Dick, “is particularly important for girls, and when the friendship group consists of members of the opposite sex.”

Sher suggested that future studies look more closely at how friendship networks change over time, and how that may affect alcohol use among peers.

“These investigations need to carefully consider the ages being studied because the extent that alcohol use is deviant changes rapidly over the course of adolescence, the relative importance of genetic and environmental factors appears to change, and the degree of gender differences in risk factors might also vary as a function of age,” he said.

This study was reported in the Science Daily on November 7, 2007. The study shows that cognitive behavioral therapy significantly improved depression in adolescent patients that participated in the study.

ScienceDaily (Nov. 7, 2007) — The antidepressant fluoxetine combined with cognitive behavioral therapy appears as effective for treating depression among teens who also have substance use disorders as among those without substance abuse problems, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine. “Adolescents with substance use disorders (SUDs) have higher rates of depression (15 percent to 24 percent) than adolescents in the general population,” the authors write as background information in the article. “Comorbid [co-occuring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates.”Paula D. Riggs, M.D., and colleagues at the University of Colorado Denver conducted a randomized controlled trial of the antidepressant fluoxetine in 126 teens (average age 17) who met diagnostic criteria for major depressive disorder, lifetime conduct disorder and at least one substance abuse disorder other than tobacco. The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or placebo, along with cognitive behavioral therapy, a type of psychotherapy addressing the way individuals currently think and act rather than past events. The cognitive behavior therapy was focused on substance abuse rather than depression.At the end of the 16-week treatment period, fluoxetine combined with cognitive behavioral therapy improved the teens’ scores on one of the two depression scales used. There were no significant differences on the other depression scale or in substance use or conduct disorder symptoms between the fluoxetine and placebo groups.The results, the authors write, “indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response.”

The Collier County Florida Sheriff’s Office of Criminal Intelligence recently circulated a bulletin describing a “new drug” called Jenkem.

Jenkem is far from a new drug and was originated in Africa and other third world countries. It is made by fermenting raw sewage in order to create an inhalant. According to the Sheriff’s bulletin, it is gaining popularity in American schools.

Jenkem is a homemade substance which consists of fecal matter and urine. The substances are place in a bottle or jar and covered most commonly with a balloon. The container is then placed in a sunny ar