Breakthrough Addiction Recovery Hour

2-09-2008

Welcome to the Breakthrough Addiction Recovery Hour. During this hour we’ll be discussing topics on addiction as it relates to alcoholism and other drugs. Our phone lines are now open, so call us at 770-226-0920 with your questions and comments.

Brian: Good afternoon Atlanta and welcome to the Breakthrough Addiction Recovery Hour. My name is Brain Fujii, Clinical Director there at Breakthrough Addiction Recovery, and with me is my co-host Jill Mattingly, our Physician Assistant. We had a wonderful experience last week and being able to talk about the issue related to opiates and also the key is that we had that anti-drug campaign and we have really had a wonderful time talking with Laura Ashley Overdike, and who’s with the White Office of National Drug Control Policy. I hope everybody did see the Super Bowl and maybe saw that ad.

Jill: Oh my gosh, I saw the Super Bowl. I was for the Giants, so I just got to say, “Yay!” I was real excited about watching for the commercials and it was probably right before half time, if you were watching the Super Bowl you might have seen a commercial where a guy, kind of a seedy character, was next to a pay phone waiting on a call, he was obviously a drug dealer, and he was saying, “Hey you know what, I’m out of business because where the kids are going now are right upstairs into their parent’s bathrooms, in their medicine cabinet, and that’s where they’re getting the drugs these days.”

And I thought, that was really a great ad. I hope it wasn’t lost on people what was going on. I’ve actually seen one other ad too, in US News & Report, it was on the back fly of the magazine, and it shows a regular medicine cabinet sitting on the side of a brick wall in an alley, and trying to get home to people that . . .

Brian: That makes it home, thinking you can get your drug dealer right out of the medicine cabinet, hooked on to the back wall of an alley.

Jill: I’m excited Brain, over a month ago we were talking about this on this radio show, and then found out that this huge national campaign is taking place, and I think it is so timely and the message has to get out because learning some of those things that we found out from Laura Ashley about how teens are getting into this type of drug abuse.

Brian: Let me just recap. We come to understand just basically having overheard with Laura Ashley that in the past 12 years there was 12.6 million non-medical users of pain relievers, imagine that. Non-medical. That means they were using this medication in non-prescription ways. 70% obtained them from a friend or a relative. Now whether or not they were given them or actually took them, the issue is 70% of them were able to obtain them. So when you’re talking about medicine cabinets, not just only family members can go in it, we have friends of family members who are over there, and they may be kind of looking around and perusing each other’s medicine cabinets trying to find this Oxycontin, Percocet, Lortab, and there are approximately 2500 teens who tried prescription pain killers to get high for the first time each day, each day. That is absolutely phenomenal.

Jill: And that’s their first time for doing anything that you get high, which it used to be most of us remember . . .

Brian: A cigarette.

Jill: No no, Brian, you’re really aging yourself. No, back in the day it was marijuana was that first drug that you used with the friends in the basement and things like that, but now it’s becoming . . . let’s just go to parties with a handful of mom and dad’s pills. And sometimes they even do what they call farming, or farm parties, where they actually take drugs from the medicine cabinets of parents, go to parties, put them in a bowl, and I know that was back in the 60’s that was pretty popular, but they’re doing it again because they’re so easy, easy to get from their own homes.

When we were talking about this last week with parents, we didn’t want to say, “Okay parents, all of the teenagers out there including yours are trying to do this.” Well that’s not the message we’re trying to say. We’re trying to say, anyone that comes into your home, anyone can be susceptible to that lure of easy medication, easy drugs.

Brian: I’m really glad you said that, because so many times parents think, “Not my little child. That person would not be doing it.” But you know the interesting thing, the average age prescription drugs are the drug of choice among 12-13 year olds. Now that’s got to be a shocker for individuals who have young teens or even pre-teens, to realize they’re already experimenting at that young age. The question then is, why do they feel the need to feel high at that young age?

Jill: Well I think that just goes back to being a teen. Most teens start to experiment with something and like I said, it used to be something that was kind of hard to get, the marijuana, the alcohol, sneaking the alcohol from your mom and dad’s liquor cabinet, things like that. This is much more difficult to detect first of all, and as we know about the brain disease of opiate addiction and benzodiazapine dependency, it changes the brain much more efficiently than marijuana and alcohol do at that young age. Yes, alcohol does have a bearing on the brain, however these medications create a very intensive dependency . . .

Brian: And very quickly, very quickly. And when you begin realizing how easy they are to get, in fact I still can remember about your niece saying when she was there at her locker and someone actually came up to her locker and offered her these kinds of pills crushed up in such a way that they could actually put it in a ballpoint pen and say, “Buy some of this.” This just blows my mind. Again, how easy it is to pass this on even at the lower school levels.

Jill: And it seems like it’s a safer high too.

Brian: That’s just false thinking.

Jill: Exactly, but we at Breakthrough Addiction Recovery, we treat opiate addiction, benzodiazapine dependency, alcohol, but here’s the thing. We got into this anti-drug campaign because what we see at Breakthrough is the average age of an opiate-dependent person is usually from 20 to 35, so I always do a very intensive medical history and exam and in talking to these young people, I find out they started this whole situation back in high school, 17, 16, they started taking Oxycontins because they were in the house or because a friend of them said, “Hey, this will make you feel better.” Or the girl might say, “I had really bad menstrual cramps, so I started taking them from my friend because they took care of it.”

But then they find out very early on that they have to have that or they start to get sick – the withdrawal.

Brian: It’s interesting you say that too because from your side of the house as you’re doing your medical assessment and finding that age, as I’m doing treatment on a daily basis, I said well how early did you start drinking alcohol? And usually it’s around 13 or 14 years old. So here we go, we’ve got youth testing and trying out alcohol, 13, 14, 15 years old, and then you’re saying also they’re experimenting now with these opiates, these pain medications, what deadly combination that is.

Jill: Absolutely. And I hope in our listening audience, if you hear this, we’ve been saying this every week. Go to your medicine cabinets find the medications such as the benzodiazapines, which we’re going to talk a lot about today, and all the pain killers or pain medications, put them in a safe place, maybe a locked area that your children or people that visit you, are not going to be able to get to when they use your restroom. We have also come upon people saying they even go into, what is that, open houses that real estate agents have?

Brian: Oh yeah, when like on Sunday open houses, people end up going to these various real estate open houses, they visit all the homes . . .

Jill: And the owners are gone.

Brian: Yeah right, and unknowingly they leave their mediations in the cabinet, people go there and they kind of have a heyday. They say, “Oh, here’s a bottle!”

And we know, based upon what Paul was saying, “I’m just grabbing this out of the shelf.”

Jill: Yes, if you are selling your home, please beware you need to lock up your medications because people will be coming through and looking at your home and making excuses to go to the restroom. So we’re going to talk a lot about some very devastating news that came out a couple of weeks ago, the death of Heath Ledger and we’re going to talk a little bit about that dangerous mixing of medications, so I really hope that if you’re listening today you’re going to stay tuned. We’re going to really help you know one important thing: and that is if you have these medications in your medicine cabinet, there could a time when you might take more than what you intend to take. And we’re going to talk about the mixing of medications when we come back.

And if you want to join us, 770-226-0920. You can call us and ask a question and comments, get in on the conversation. Also outside of Atlanta, 1-888-920-2665. Stay with us Atlanta – be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and my co-host is Jill Mattingly. And today we’re continuing our discussion about the issues related around opiate addiction and also opiate treatment. And Jill, we’ve been looking today at all the different issues related to the promotion of understanding how people are actually going to individual’s medicine cabinets and pulling out these drugs and using them at a very, very early age. I know there’s a deep concern, especially as a physician assistant and me as a person who does clinical treatment on a daily basis, how these are impacting our young people. I love the way you said the other day, I mean, just a few minutes ago, about how individuals, 21, 22, are now getting to the point of addiction, but now they actually began at 14, 15 years old. So we know this does take some time, as people begin to continue to use and their brains begin to change. Here they are now using it instead of just socially, they’re now becoming addicted to them.

Jill: Yeah, and that doesn’t show up right away in some of the teenagers. They may do it here or there at a party, it’s a claim to fame, like, “Oh yeah, I had that at a party.”

But then they get into college or post-high school and they start to remember, “You know what, I remember how that made me feel, and I’m a little stressed out now, so I’m going to try to use this for sleep.” Or they have something where they actually get a medical reason to get these pain relievers.

Brian: And that’s where so much of it begins. Maybe they had oral surgery, or perhaps they had lower back pain, and now they’re using this, initially using it as a way to deal with their pain, a healthy pain that we know is there. But now, they probably had that memory.

Jill: Plus, remember that opiates, when you’re talking about them, don’t treat everyone the same. There are people out there who are listening to us that know the first time they had surgery and tried to take an Oxycontin or Vicodin they felt very sick to their stomach, dizzy, and it was not a pleasant experience whatsoever, so they determined, I’m just going to go with Naproxen from here on out. Then of course you have those that say the first time I took this med, I was on, I felt good, calm, I could do anything I set my mind to. That means, biologically, they have a very high tolerance or propensity to go into dependency.

And here’s the thing, they go into high school, college, they have the stresses of life, and they start to take it on a regular basis. And then they have to get it, because then once they’re dependent they’re going to get sick if they try to stop. Well, what I see at Breakthrough when people come in and they’ve been on this medication for 3 to 5 years. They are actually looking at a very difficult life, and they are looking at it, their families are looking at this, and that’s usually why they come in, because all of a sudden they realize, I am completely a prisoner to this, and they’re only 22 years old.

Brian: And they’re wanting to stop because their lives are just getting miserable. They’re beginning to have these withdrawals, they know when they stop taking it they get these severe flu-like symptoms, they’re just really trying to find some way to get their lives back. Especially at 23, 24, 25 years old.

Jill: And that’s where Suboxone can actually be a lifesaver. Suboxone treatment, for those of you that don’t know, it’s an FDA-approved medication, and we use this medication to help people get off of opiates when they are dependent on them. And it’s basically just a day and a half to two days induction, they get medical and clinical wrap-around services to do so at our location. And, it’s becoming very easily managed. It’s not something like methadone where you have to do every day.

Brian: And that is that we need to make sure that our listening audience understands, it is not just only the detoxing. It’s so critical to get that psychosocial support, that therapy, because they really need to work on something. Looks like we got a call coming in here, Carrie from Norcross. Hello, Carrie.

Carrie: Hi.

Jill: Hi, Carrie. Did you have something, we were going to be talking about Heath Ledger. You probably heard us talking about that. Did you have a story or something about Heath Ledger’s death you wanted to talk about?

Carrie: Well, it was just in our family, a couple of years ago, my 22-year-old nephew took an accidental overdose. And the interesting part to begin with was that we didn’t even know he had a drug problem. His family, his parents didn’t let us know, and he had become addicted to Xanax. And they sent him off to rehab, he came home, he was clean for about a week. He went out with his friends on a typical Saturday night type of thing, and the next day he did not show up for work and the police found him in his apartment. He had one pant leg on, they said he was trying to get dressed, he was putting his uniform on, he was trying to get dressed for work and his heart failed.

The autopsy showed that he had taken, evidently at the party or wherever he was, he had marijuana, cocaine, Xanax, Oxycontin. There were also other drugs found, one was a sleeping drug. So it just really brought back a lot of memories, and I think that a lot of people don’t understand how important it is to know these things. I mean families try to keep everything a secret, and had we known, maybe we could have done something. Maybe something could have been said, we could have been more proactive, but needless to say we lost a wonderful young man. It was a horrible waste of life.

Brian: It is. And you know you’re so right, and that’s the reason why I think programs like this, Carrie, are so important to help the general public understand the dangers involved. I think so many times we have a feeling, well, it’s medicine, it was prescribed by a physician and filled by a pharmacist, and so we think it’s all fine. And as a result we don’t really understand how the dangers occur. And again, I think what Jill is saying here, that really when they start using opiates at a very young age these days, and then they just begin to move more and more into using those, and now the brain chemistry has changed, and in that . . .

Carrie: But what I found interesting was that the Xanax had been prescribed to him because of depression he was experiencing due to his parents’ divorce and remarriages. Both parents remarried, both parents started new families, and he was the ping pong ball going back and forth . . .

Jill: And Carrie, how old was he?

Carrie: When he died, he was 22. So, what really shocked us was the original intent was to, of course. to bring him out of his depression but unless he got any counseling, there is no magic pill. But he was mixing that with his drug use.

Jill: And probably alcohol also.

Brian: Yeah, I’m sure alcohol was part of it.

Carrie: Oh absolutely, because he was a bartender. So there were so many, and what upset me too was by the time we got to Florida, and we got to the church, and we began to see his group of friends begin to file in, my husband looked at me and said, most of these kids are high.

Brian: And you know that’s so true, Carrie, because so many times we hear this, if their friends are there, the way they’re going to cope with the death of a deep friend is to use, so they can cope with the fact of their own grief.

Carrie: Literally it looked as if it didn’t even phase them.

Brian: Yeah, I mean, if you’re under the influence, it probably looked like it didn’t phase them. But believe it or not, there’s a lot of struggle. We hear this so often when people are saying, “You know, I had a friend who passed away as a result of an overdose. I know I was taking this, I know how close I could have come to doing this, and I had to just have a pill or two, just so I could make it through the funeral.”

Carrie: I don’t know if any of you know this, but the interviews with Heath Ledger prior to his drug abuse, I think he was, I think he became dependent on drugs. Because the interviews right before his death, the pictures of him, he looked unkempt . . .

Jill: Yes, he did.

Carrie: He looked like there was something definitely wrong with his appearance. Which is what I noticed, the pictures they put on top of the casket, they showed his senior picture, this nice healthy-looking young man with meat on his bones, and then the most recent picture he had a shaved head, he had piercings all over his face, he looked like his cheeks were drawn, he wasn’t that boy anymore. And if that doesn’t tell you something that maybe there is something else going on . . .

Jill: Absolutely. And that’s one of the things were trying to get out to parents, too. And Carrie, thank you so much for this call.

Carrie: You’re welcome.

Jill: We’re going to continue talking about this Heath Ledger overdose and really try to educate people on that.

Carrie: That’s a good idea.

Jill: Yeah. Thank you so much for your call.

Brian: Appreciate your call.

Jill: And we are going to go to a break now, Atlanta. Please stay with us and we’ll be right back.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Jill Mattingly, and my co-host, Brian Fujii. And we are talking about some difficult things. We just had a caller talking about a nephew of hers that had been found, dying from an accidental overdose similar to Heath Ledger’s. We’re going to talk a little bit about what was found on the toxicology report from Heath Ledger. And I want to clearly get across to the listening audience how the medications that Heath was taking were actually prescribed to him and were legal medications. We are going to go through each medication and how it can be very dangerous to mix these. But it looks like we have a call. Brian?

Brian: Todd, Atlanta. Welcome to the show, Todd.

Todd: Yes, thank you. I just had a question regarding teenage opiate addiction. And I was curious how it affects teenagers neurologically because I know that they’re still in a developmental phase in a lot ways, and how it affects them compared to adults. And how opiates differ from, like, Ecstasy addiction in the brain.

Brian: Typically, Todd, when they’re really young, from what I understand, the brain actually develops from the back to the front, if you want to put it that way. And around age 21, 22 is when really gets to its full development. And one of the things we’re finding out for teenagers and really, pre-adolescents as they’re using, we’re finding out many times their brains don’t seem to develop as quickly or as maturingly. And as a result, they’re not really thinking very clearly, and this is why they end up start taking all kinds of high-risk behaviors. They definitely have seen that frontal part called the prefrontal cortex, where we get the majority of our logical thinking, and so if that part of the brain is not being developed because they use painkillers or alcohol or other types of drugs, they really are impairing their future thought patterns.

Jill: Right. And you’ve got to understand that having a drug that attaches to an opiate receptor, which most painkillers do, is going to send out neurotransmitters, and that’s going to strengthen a neuro-connection with the psychological part of the brain. It strengthens, ‘I feel stress’, and so the brain will send out messages to your frontal cortex, then this is what you need to do. So it starts what I call a neural connection or a neural circuit that strengthens with each use that is telling the brain, this is how we handle stress, this is how we handle sadness, this is how we handle depression.

And the other thing you asked about Ecstasy. Ecstasy is kind of related a little bit to the amphetamines, which has a different function. It doesn’t join to a receptor per se, but it causes dopamine to be released by the neurons, which gives you that excitatory kind of feeling, and actually that can have the same effect. You have a release.

Brian: A dopamine dump.

Jill: Yes, a hyper-release of neurotransmitter, and that produces a great, great feeling, and so the brain remembers it. The biggest problem for the teens and anyone that’s using a medication to alter their mood, is your memory. Because your memory will work against you when you start to have things like sadness, depression, stress.

Brian: That’s a great point, Jill. You know, Todd, that’s one of the things that we talk about in our treatment is, the brain has tremendous drug memory. Usually as it goes through what we call the pleasure pathway of the brain, in that lower brain, that’s the part of the brain that’s basically responsible for fight or flight, or pleasure/pain. And when they start feeling that kind of pleasure, it moves right back to a part of the brain that has great emotional memory. And so as a result, with that emotional memory, if they use any other type of drugs or alcohol, it triggers that brain to remember how good it felt and they’re right back into relapse or really feeling intense. And I like what Jill said too, you know so many times when you’re taking those drugs at such an early age, and so if you’re taking those drugs because you’re sad or you’re frustrated, or you’re worried, or you’re anxious . . .

Jill: Or you’re having a good time!

Brian: Or you’re having a good time too, yes, either the good or the bad. What happens there is that the only thing that is being truncated here is that, they’re saying, if I feel this way, the drug will help. Rather than learning how to cope with these particular emotions in a more mature way so they really are impacting both their emotional growth as well as their psychological growth.

Jill: Are you still with us, Todd? We’ve given you a big earful, huh?

Todd: Oh, no, that’s great. That’s a tremendous show. I just have one more question: Does the opiate receptors in the brain, do they grow with the continued use of the narcotic?

Jill: Very interesting stuff. There’s an interesting book out called Bliss, by Dr. Candice Perd if you ever want to look more into the science of opiate receptors. She actually discovered that in 1972 as a biochemistry graduate student, and she was the one that discovered, not discovered but proved that there was an opiate receptor. Interesting stuff. Todd, thank you so much for your call.

Brian: Great questions you asked today.

Jill: I could talk for hours, can’t you see that?

Brian: Thanks for your call.

Jill: Looks like we’re coming down to a break, and we are going to get to the Heath Ledger accidental overdose. Stay with us.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and my co-host is Jill Mattingly. And today we are talking about painkillers and how they impact the brain but also how they impact devastatingly, lives. And if you are listening out there today and want to be a part of this conversation, give us a call 770-226-0920. Or out of the area is 1-888-920-2665.

You know, Jill, we really need to let people know about our wonderful website. We have a tremendous amount of information on our Breakthrough Addiction Recovery website, and if you’re wondering about how all these different kinds of medications or drugs or alcohol can impact you or your loved one, please go to that website. It’s www.BreakthroughAddictionRecovery.com. And we offer a free consultation. It’s a wonderful opportunity for people who just say, you know, ‘I’ve got a loved one that needs some help, or I need help, I don’t know what to do.’ We get this call a lot, and so if you’re just wanting to know, what can I do for my loved one or for myself, we’d like for you to give us a call for a free consultation at our office at 770-734-8091. That number again is 770-734-8091.

Jill: That’s our office number.

Brian: That’s the office number, that is correct. So, you mentioned talking about Heath Ledger and his tragic death as a result of overdosing on several different kinds of medications. And they did determine that it wasn’t a suicide, that it truly was an accidental death.

Jill: Right, and it did say, the medical report did say acute intoxication, and unfortunately, when they did the toxicology report, it does show he had 6 different medications that when taken by themselves actually do someone good; can help take away pain, can help a person get to sleep, can help with anxiety. But once you mix these together and you don’t understand how pharmacologically they work, you can easily and mistakenly end your own life. You just don’t wake up.

Brian: Well, we know that he had at least Oxycontin and Vicodin, and both of those definitely are painkillers. What people need to understand is they also can depress the respiratory system.

Jill: Yes, when they reach a level that is, actually we call it a tissue dependence, when they reach a level that it actually can work on the brain stem and start to decrease respiration. Now that may not end up in death. You could actually find someone passed out from the pain medication, take them to the ER, give them a medication called Narcan, reverse the whole process and they’re breathing again and they survive. However, when you mix in other things - alcohol, benzodiazapines, barbiturates - when you mix those medications in, unfortunately they do the same thing, they depress respiration at different places in the brain and actually can cause it to be very difficult to reverse if you find someone that actually has taken too many of these medications. And it looks like we do have another call coming in. This is Phyllis in Norcross.

Brian: Welcome, Phyllis, to the Breakthrough Addiction Recovery Hour.

Phyllis: Well, good evening, good afternoon I should say. I am appreciating and I’m learning so much. And I’m just glad I happened to tune in to your show for the first time last Saturday. So I’m also listening today. But my question is, what does opiates, what does that term mean?

Brian: Well, it means an opiate is any particular medication that is generated or manufactured from the opium plant.

Phyllis: Ah, so it’s o-p-i-a…

Brian: O-p-i-u-m. Opium.

Phyllis: Oh, that’s what you were saying.

Brian: And opiates are actually medications that are derived from the plant called the poppy plant basically, and the drug that comes from that is opium. So they are both actual medications that are either straight from using the opiate, like morphine, or they can be synthetics, which is a combination of opium and some other medications. So sometimes they put it together with acetaminophen, and combine some of these medications synthetically, and those are called the opiates. So that’s the reason why, and they’re used as pain medications, and this is what Jill was talking about how they occupy the opiate receptor sites and help you to be able to usually withstand extreme pain. Our bodies normally have natural painkillers. They’re called endorphins, and we get that naturally from our bodies. But many times when you’re going through, say like you had back surgery, or maybe oral surgery, or something in which you have excruciating pain, then typically the physician will order some of these painkillers to help you manage the pain.

Phyllis: Thank you, and one more question: What’s the difference between an opium based drugs and cocaine-based drug?

Jill: A cocaine?

Phyllis: Yes.

Jill: oh, okay. Different plant.

Brian: Yeah. They’re different.

Phyllis: I know it’s from the cocoa plant. But an opium, I understand they’re different plants, but what’s the difference between, and what are some of those drugs that are cocoa based?

Brian: One of the things I was talking about was opium, of course, is dealing with painkillers, and typically things like cocaine is what we call a stimulant. And so that stimulant is one that will actually cause people to get an extreme high. In fact, that’s one of the real dangers sometimes about using things like cocaine in a form called crack cocaine where they can actually smoke it. They get such a tremendous high, more than just your normal feeling of well-being.

Jill: And also, Phyllis, we were just talking about our website, BreakthroughAddictionRecovery.com. We have sections that explain what these different drugs are and how they act right at our website. And if it’s not in the website, it will link you. It’s full of information and very interesting.

Phyllis: Thank you so much.

Jill: You’re welcome.

Brian: Let me tell you that website again, www.BreakthroughAddictionRecovery.com. Please go to that site. There’s a wealth of information there.

Phyllis: I appreciate you so much and I’m quite sure I’m not the only one that’s listening. I know that I’m asking questions that perhaps people who aren’t even calling in, but the information would be very helpful to them.

Jill: Thank you, Phyllis. You have a wonderful, beautiful day.

Phyllis: Thank you.

Jill: And it looks like we’re going to talk more about the Heath Ledger overdose when we do come back from this break. But I want you to listen to the drugs that were in his system when they were found: Oxycontin, Vicodin, Valium, Xanax, Restoril, and Unisom. If you have that in your medicine cabinet, I want you to listen when we come back from this break.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and I have with me Jill Mattingly, my co-host. And today we’re talking about painkillers. And you know we just got through talking . . .

Jill: And benzos.

Brian: And benzos. And also we just got through talking about 2 of the drugs found in Heath Ledger’s death report. And now we’re looking at Valium. Tell us, Jill, what does Valium do for the body when it begins combining with all these other drugs.

Jill: Actually, I want to talk about that. I’m going to talk about the other 3, because a lot of people don’t realize that these next 3 medications that were found are actually the same type of medicine. There’s Valium, which is usually prescribed for anxiety. There’s Xanax, which is very commonly prescribed for anxiety and panic attacks. And Restoril. Restoril is actually a metabolite of a longer-acting benzodiazapine, but it works for sleep. So what I see in that report there, other than that an antihistamine, an over-the-counter drug was also found called Unisom. And so what I see there in those last 4 drugs is that he had a lot of anxiety and sleep issues. And that is the number one reason people do take benzodiazapines. And don’t get me wrong, those medications work wonderfully for those people that really suffer with these problems. You might see anxiety being treated with Xanax, Librium, or Valium and those are a little bit different from each other too, because their onset of action is different. Xanax is short-acting. You take it, you get an effect from it, and two to four hours later, it’s gone. It’s not gone completely out of your system but its efficacy has decreased. Now you’ll have intermediate-acting medications like Librium, Klonopin, Valium, those are all benzodiazapines also doing the same thing.

Brian: But they last a little bit longer.

Jill: They last a little bit longer and their onset of action is a little longer. Now this is where I see the possibility of Heath getting into problems, because he might have taken the Xanax, the Xanax wears off, he has taken Valium but the Valium is taking too long to work so he takes another Xanax, and I can’t presume to know what happened. However, the reason that someone sometimes gets caught up in this problem is that they are looking for an effect, and they’re not getting it right away, they’re not falling asleep, they’re not getting over their anxiety, so they take more. And unfortunately some of these start to kick in 30 minutes to an hour later, and all of a sudden you have a synergistic effect or an additive effect of these medications. And like we said before, that can cause respiratory depression, they fall asleep, and they don’t wake up.

Brian: That’s what we’re seeing so many times. In fact when I get people asking me in treatment saying. “Well I have a high tolerance for this medication, and so because I have a high tolerance, I should be able to take a lot more.”

And what they don’t understand is, what you were talking about, the synergistic effect. They may not be getting that feeling, but the medication is still having its impact. And there’s a difference between those two. And that’s how people can move into overdose.

Jill: Looking at half-lives, a half-life is half the time it takes for the medicine you took to be halfway out of your body, how’s that?

Brian: Great. I love it.

Jill: But all these medications have different half-lives. This has highlighted what Carrie said earlier, in the death of Heath Ledger shows us that this is devastating to people. And if you have this in your medicine cabinet, and you’re using this to control your stress, or to control pain, or sadness, or anything, you can end up in this same scenario, where you mix too much of the same thing. And you have to be very careful if these are actually prescribed to you. Usually doctors will not do that and prescribe a medication like this, but just looking at that today, from watching the funeral for Heath Ledger and seeing his fiancée and his little girl and everything else. This is a devastating thing, and this is not the way to handle life’s situations. Hopefully this has taught some people, but I think we need to continue this information.

Brian: We do. And again, if this is a concern, give us a call at our local office, 770-734-8091, for a free consultation. And we’d be willing and happy to help you or your loved one.

Hope you’ll join us next week and I hope that you’ll be a part of this exciting and meaningful and informative program. And thank you for listening.

JUNE 14, 2008

Brian: Good afternoon Atlanta and welcome to the Breakthrough Recovery Hour, I am Brian Fujii and my co-host is Jill Mattingly, welcome back Jill

Jill: Hey

Brian: My partner is back and today we are going to ask a very interesting question. Who really needs rehab? Many of us are probably wondering do I need it? Or families out there looking around them and saying “You know does my loved one really need treatment” We are going to find some interesting individuals out there who have attempted treatment and not needed it.

Jill: You know there are a lot of programs out there where people look into treatment facilities, but this story is coming up and it is quite interesting and you will be shaking your head as driving around Atlanta today. So we are pulling out a topic in the news, during the week we find items about addiction and I am never disappointed let me tell you. Actually this story is called, “Drunkorexia” a new …

Brian: What

Jill: It is a cross between drunk and anorexia. A new eating disorder and this is actually coming out of England. Talking about young women who face the pressure to be thin so they are doing some math in their heads and figuring , “Ok, if I am going to drink beer with my friends tonight that means I am not going to eat anything but a cheese cube today so that I can drink at least a six pack tonight. And it is actually happening frequently on college campuses as people are going into these communities where partying is so much more accessible and these girls want to stay thin and they don’t want the extra college pounds and foregoing any type of nutritional food for alcohol.

Brian: What is the definition of a “healthy” body these days. Talk about stick thin individuals. I said stick, thin right? Stick, I just don’t understand

Jill: I have to read this quote, this is “Piper ” an assumed name, and a 21 yr old student says, she had food issues for years and so “Beer was like, you know, don’t drink beer unless you like, you know haven’t eaten all day.” That is a direct quote (laughter) another thing too, it they are thinking beer is not nutritional but maybe a bloody mary would give them vitamin C they may want to think again. There you are folks, some of college’s finest. So, drunkorexia, watch your students for this.

Anyway, sounds like it was a good show last week.

Brian; Yes, Dr. Johnston was here we had quite a few good calls and..

Jill: Last week I actually attended my sister’s 50^{th birthday, happy birthday Joy one more time, I am so glad she is turning 50 before me, but it sounds like you had a wonderful and interesting show last week, Brian: we did we talked about the different issues of how people move into what we call socio economic drift, basically what we are talking about is how people actually move into addiction and in such a way because as they move into addiction their lifestyle and quality of life begins to diminish you know we talked about one area, and in our treatment we talk about four different areas of how people move into this life degeneration we call it the introduction phase and that first phase, talking about college kids? They go in there see the beer, drink some beer do some drugs, but they are having fun and their lives are basically positive and is not revolving around the drugs or alcohol and so they go and enjoy and it is social and then as they continue to use they kind of move into the second phase which is the maintenance phase and what we teach there in our program is that the big difference is now they are getting into what we call a tissue change or tissue dependence and it is really interesting that research shows that when a person moves into that particular arena the brain actually begins to change. So when they just think about alcohol or get exposed to it the trigger we find is that the brain automatically a little bit of that dopamine and gives them what they want. Beer. And so there we go. Now we are in a situation where now the individual is seeking they are looking forward to it and in fact some in my treatment program when we were talking about it said, “I never thought about that, you know there was a period of time and I had fun, now when I think about parties I decide which party to go to , is it going to have booze and drugs and this party not? Well I am going to the party with booze and drugs.”}

Jill: So they are putting a lot more thought into the maintenance phase and how they will get what they want and satisfy those cravings.

Brian: The social choices they are making and so for now we are seeing that they are making these choices based on availability and whether or not it will be there at the time of their presence. So at that phase we see where there are a lot of positive things and now they are experiencing a few negative things missing work, classes and problems with family and friends. Then they move onto the third phase called disenchantment and now we begin to see some real significant changes and the scale gets tipped and now they experience more negative than positive and maybe they are being threatened in these areas and facing some legal circumstances and so now we talk about the socio economic drift, we see that the drinking is beginning to truly have a negative impact and goes back to a couple shows back and some use and have no problems and now in this disenchantment phase they come to a point where they do experience problems. This is when it begins to become more problematic and it is called the abuse phase and the last one is that disaster and everything is on the negative,

Jill: Brian it sounds like there are warning signs all along the way and at some point someone is going to say, “You know what, you may not want to go to that party, it might cause you some problems.” So really having a person go all the way into the disaster phase definitely speaks of a brain disease. There is a problem there is a circuitry

Brian: A real rewiring of the brain. I was wondering Jill if they are listening to this and wondering if they are at any of these stages, or their loved ones, please gie us a call at 770-226-0920- of 1-888-920-2665, again the local number is 770-226-0920, we are coming to a break and will be right back.

Jill: Call in!

Commercial Break

Jill: Welcome Back to the Breakthrough Addiction Recovery Hour, 770-226-0920 that is the number to call if you are riding around and you are in a safe situation grab your cell phone and call in and give us a comment or question having to do with some of the things we are talking about and you may want to do that after you hear this story. You may have seen this story in the AJC this past week , when I did I just shook my head and it is amazing to me and it does have to do with addiction. Our ex-mayor Bill Campbell as we know most of us anyway, he has been serving time in prison for tax evasion and that was a 30 month sentence however, former Atlanta mayor Bill Campbell misrepresented testimony and persuaded the bureau of prisons to stretch it’s policy to mind boggling extremes to get into a substance abuse program that would have shaved four months off his sentence. This just came to light after his complaint and they caught him doing this and they had to unseal court documents and now we all know what he did. After sitting in prison he decided he was an alcoholic or an alcohol dependent person and he stated that he was telling prison officials that he drank bottles of champagne daily and had a certificate of completion from the rehabilitation program, did you see this Brian?

Brian: It is fascinating, he called himself a champagneaholic.(laughter)

Jill: That is the first time I have ever heard that. This story goes on to say he actually finished a program after convincing the prison that he did have an alcohol problem and he went into a half way house and that is when federal prosecutors said, “What?” He is not supposed to finish until October. So by doing this program he was shaving four months off of his sentence now if it was two years that is one thing but this was four months and so he was yanked out of the half way house and returned to prison. It was revealed that before he actually went to jail for tax evasion he stated he had never had a problem with alcohol and didn’t even like the taste of it and the only time he used he said to his parole officer was that he drank for toasts, since he was a public servant. So you have to be alcohol dependent to go through this program and this sentence says it all “Mr Campbell is a well educated man with no health or substance abuse problems, as such Mr. Campbell is not in need of an already thinly spread services offered by the correctional system.”

That is probably what got me fired up about sharing this story. We know that the services to people in the prisons that have true needs and many times that is why they are there because of alcohol or drug dependence and they could have used that spot for someone in need and I am livid about that whole thing just to shave off four months, so let me give out the number for comments and questions. 770-226-8920, I am sure there are those out there, I had a vision of the steward on the Titanic that pushed the women and children out of the way so that he could get on the lifeboat first. That is the character of our ex-Mayor, let’s elbow everyone else aside so that I can get out of jail four months early!

Brian: Well his tax evasion states that he needs to pay his fair share

Jill: 770-226-0920 if you want to make a comment or ask a question about our illustrious ex-Mayor, anyway that brings me to why we termed this show, Who Really Needs Treatment? There are many people out there, not just in the prison system that need substance abuse treatment and you were talking earlier that a lot of people who need it never even seek it

Brian: That’s right Jill, many times we see this that there are many many people high percentage of people that have been identified as needing the treatment but unable to get it for this very reason that you just read. The lack of resources. We see this happening, the bias, the funding sources, insurance companies, managed care organizations , all of these are mitigating against the treatment that many of our citizens need. And here we are with an individual taking advantage of a scarce resource using it to manipulate the system to meet his own needs. So when we think about this, who does need rehab? There are a lot of people out there that aren’t getting it, because of scarce resources. So if we are thinking about this for those who are in our listening audience, the concern we have today is that you may be sitting in your home, your car and listening to the show and realize that someone in your life is struggling and I don’t want to be pushy. Am I identifying this situation as being accurate? I think that is a question people ask and wonder if these folks in their lives need rehab. One of the key criteria is if your loved one is drinking or drugging and at the very first segment we talked about that and if they are experiencing negative consequences then it is very likely they need to seek some help. Somehow this is what we find in families, they too are in denial, not just the person who is struggling with the problem and I really want our listening audience to understand that it is not condemnation it is natural and normal. In the active use stage it is interesting that statistics show they are in protection mode, so you ask, “What does that mean Brian?” That means they don’t want to feel the shame or the guilt and protect the family image and so they will not seek help and they are in protection mode. This is why I am hoping as our listening audience will begin to really look at what are some of the behaviors that their loved one is currently expressing, they need to understand that they might be in a situation that they could benefit from treatment.

Jill: We have a call and it is Judy in Atlanta?

Julie: It’s Julie, that’s ok

Jill: I can read I promise, you have a question for us uh go ahead

Julie: Ok my question was I know that he just said that um you really know that there is a problem when negative consequences as far as drinking goes and I was telling your screener that I do drink every day and I guess my trigger would be around dinner time it started just you know drinking wine while making dinner and throughout dinner and now it is at the point where it is like, I can’t go without it and it starts at 5 and goes till I go to bed. I really haven’t had any negative but I know it is at the point where I can’t

Brian: Julie we are coming to a break so hang on, can I ask you a question. If you have not experienced any negative consequence that is probably in a social level and I don’t know whether or not you are having any physical problems, gastritis, pancreatitis

Let me ask you this, you say that you drink every day, how much every day, a bottle? Two bottles?

Julie: A bottle

Brian: A bottle a day. You are progressing, you are getting there, for women 3 to 4 glasses of wine a day is considered heavy drinking. So you are already probably there, ok? You may not be in the uh what you might call the abuse phase yet but you are getting there. ,

Julie: Well that is my question, at what point, I just want to quit on my own, I don’t want treatment, you know but you know I know of course don’t buy it but it is harder than that you know.

Brian: It is you are right. One of the things you will find is that even though you want to quit on your own you need to ask yourself, have you ever tried to cut back but found that you couldn’t

Julie: Yes

Brian: You get annoyed when people tell you that you drink too much

Julie: Yes

Brian: You feel guilty on the day after

Julie: I don’t get drunk or black out or you know, I just get a buzz and that is you know so never feel guilty about anything that has happened.

Brian: Julie we are at a break will you hang on?

Julie: Sure

Brian: We will be right back after the break. Call us at 770-226-0920 and we will be right back

Commercial Break

Jill: Welcome back to the Breakthrough Addiction Recovery Hour my name is Jill Mattingly and we are in the process of talking to a caller right now, she called in before the break, this is Julie in Atlanta, Julie are you still there?

Julie: I am here, just driving

Jill: Be careful, but also I want to recap for the audience some of the things you were talking about, calling in and asking if starting you know to drink up to a bottle of wine of night, can that be considered too much? Can this be considered a problem if I am drinking every day trying to cut back but not able to.

Julie: Yes

Jill: Ok, first I want to thank you for calling and letting your story go out over the airwaves, there are so many people doing exactly what you are doing, and there are people in their cars right now nodding, ok? Because most of the females, and I am talking as one, this is exactly where they are when they come through our doors and they can’t seem to not have it every night. And they don’t remember how they got to the whole bottle, finishing off the whole bottle and all they know is that they are there and it is very hard once that bottle is opened at 5:00 not to finish it off. This is a disease that does not stand still and the things that Brian was talking about like the physical and legal problems those things come as you continue with your drinking. They will come and this is the best time, when you start to contemplate, “Is this a problem?” Brian just went through some things with you that yes, you are in a standing right now where understanding what’s happening in your brain and in your body is of you know utmost importance and that is what treatment is all about. Treatment isn’t say, “Come in here and sit down and don’t ever drink again!”

Brian: It’s about understanding it is a brain disease,

Jill: Exactly, that’s why people have misconceptions about treatment and what it really is, it is understanding a disease like a new diagnoses of diabetes but this does take it’s toll and addressing it as soon as possible is of the utmost importance.

Brian: Julie, I was wondering if you have any other questions, I know we talked about the identification of heavy drinking, basically by what you said you are moving into the heavy area. Have you found yourself drinking more than the bottle at any particular time?

Julie: Yes, I mean you know, it is just there, and I will drink until I go to bed. So.

Brian: That is what I am saying you are beginning to see it is progressing and that is why we call it a disease. The first is biological impacting your brain and your body and it certainly has certain signs and symptoms and it will get worse not better so,

Julie: I guess that is my question. What kind of things do you recommend to your patients as far as just I guess trying to get through those triggers like if I could get home from work without stopping at the liquor or grocery store, then I’m fine, you know. Not that I’m fine, I still wish that I had some but I am not using.

Jill: I am really glad you brought up triggers is well one of the things we do is that medically we treat for triggers, we have medications that actually can help with alcohol cravings and I have many patients that come back after starting them on Naltrexone and Campral, and they will say, “You know I looked at the clock and it was 7o’clock and I hadn’t opened the bottle.” At Breakthrough we combine that with education and therapy and combine this and find the underlying problems so I think Julie the best bet for you would be to go to your physician and ask them or come to us for a free consultation and take a seat on the couch we could talk and look at the whole problem and come up with an idea of how it would best serve you, our treatment facility. So, anyway, that is what I would recommend.

Brian: Go to the website it will be informative

Julie: Thank you very much

Jill: Thank you for calling hon. That highlights the problem that goes through the mind, you don’t know where you stand as far as needing rehab. We are coming to a break and the number is 770-266-0920. Please Call

Brian: Stay with us

Commercial Break

Jill: 770-226-0920 that is the number to call if you would like to get in on the conversation, comments and questions or just whatever is going on with you right now, if you are thinking about things that you are addicted to or having problems with and if you want to call in and talk to us on the air that is fine and we will preserve your anonymity

Brian: This topic is so good , who needs rehab. You know Jill it is scary for some and it is not easy to answer even for yourself

Jill: And you know as we were talking about the Bill Campbell story, not everyone is going around knocking on the doors of treatment centers trying to get in although with his ulterior motive Some people though, fly under the radar. I thought of isolation and denial and those can definitely cause someone to fly under the radar and no one will ever know they are polishing off a couple bottles a night and as I think about that, not everyone that comes through the door needs to be detoxified.

Brian: Yes, that’s good Jill, many do think they need that but that is not true. We have many people lin our program that have already been stabilized and are now saying, “I need some treatment and I need to find out what is wrong with me.” What is it you need to do to change your life.

It is not like what you said, we don’t mandate to someone and become parental, we help them understand that addiction is indeed a disease and it is a disease of the brain, and it has nothing to do with will power or character or our ability to say no, it is something that is a disease that they can’t help and the only way they can do it is to understand it is a disease process, they need some coping skills under their belt to handle this.

Jill: That is very important to know that there are multiple services under one roof and many don’t know that when you come to a place like breakthrough you can be addressed in many different ways, so we encourage you if you have the thought that something is going on and you need to talk to someone, please make that call, 770-226-0920 or if you want to call our office in Norcross, 770-734-8091.

Commercial Break

Jill: Welcome back to the Breakthrough Addiction Recovery Hour

Brian: I am Brian Fujii

Jill: We have a caller, Miranda in Atlanta, how are you, we are in our last segment and if we run out of time please hold on and we will talk to you after the show also

Miranda; I have a family member that needs help and some of us are trying to find ways to get them to see that they need help. Do you do an intervention, or do you drive them up to your place or how do you get someone you are sure has a problem to get help.

Brian: Sometimes we can set up a formal intervention where we get together with your family and our staff uh, many times it is the person is really struggling to see if they have an issue, sometimes it is helpful for just the family to begin sharing with the individual what some of the problems are that you personally are experiencing as a result of their using so if this person is having, is it alcohol?

Miranda: Yes, alcohol

Brian: Begin as a family to share what the negative family impact is and let that part be real clear and let them know that this particular drinking event is really causing a lot of stress and also too, if they are experiencing uh specific problems with their job or law, uh or with finances, you can use that to get them to hear you. You can share objective definable events that are producing the problem and see if he is willing to just come in and talk. Let’s see what we can do to find the level of care that he will need. He may not need detox so maybe some issues are causing the drinking.

Jill: You would be surprised Miranda that familymembers when you start to talk with non-confrontational talking they will look at the website and then when they look at that they may say that they are willing to drive up there to listen to what they have to say. We don’t force anyone to treatment, we don’t like the heel marks on the floor as you drag them through the door, so you need to share your concerns with that loved one and give them the options and that’s a formal intervention will do that but you can also do that around the dining room table tonight.

Brian: If you have not seen our website

Miranda; I have

Brian: Then you know what the resources are

Miranda: Should that be in a group setting or individually.

Brian: I would recommend that you do it individually not ganging up on the person right off of the bat. It is a process Miranda and

Miranda: I feel like the conversation falls on deaf ears, I know he will lose his job and so that is why I want to know about the next step.

Brian: On the other hand, then you need to get back with us and we will set up a formal intervention and certainly help you in that area

Miranda: Call your office?

Brian: That number is 770-734-8091

Miranda: Thank you so much

Jill: Call us and we will help as much as we can,

And to all the fathers out there, Happy Father’s Day, and to my dad , thanks, thanks for putting me through college!

Breakthrough Addiction Recovery in Norcross, we are there and we can help.

Brian: See you next week.

JUNE 7, 2008

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.

Commercial Break

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.

Commercial Break

Brian: That fits right in to the way that we try to help our clients at breakthrough to identify how they move further and further into addiction and dovetailing with what you were saying I know that many times when people first experiment with drugs they feel good and it is available at the next party etc., and initially it starts off pretty innocuous , then they move into the maintenance phase where they begin to realize that they are looking forward to the next party and the next drink and get that drug to make them feel better and we begin understanding that there is tissue change and the brain is beginning to actually look forward to the alcohol or drug. The next phase is the disenchantment where they are beginning to see that they have some social value but overall they see problems like what you are talking about, their jobs, their relationships, etc., and these encroach and these issues about alcohol and drinking impacts their physical and social and legal life. We are coming to another break, if you want to be a part of this discussion please call us at 770-266-0920. Hang with us and we will be right back.

Commercial Break

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.

Radio Show/ May 17, 2008

Brian: Welcome Atlanta, I am Brian Fujii and my co-host Jill Mattingly and we welcome you to the Breakthrough Addiction Recovery Hour, our show today, I tell you what, we have a show that will perk the ears of those that really need to have treatment and they know they need it but somehow find excuses,,

Jill: “Not to go to rehab” in the words of Amy Winehouse,

Brian: So what is your excuse this summer for not getting treatment. We are taking a look today at a very important subject and you know today we are talking about our audience and I know that a lot of people out there listening today and maybe family members, loved ones, but today we are focusing to the person with the problem. The individual that is out there right now maybe sitting in the park, working in the garage, riding the lawn tractor

Jill: They won’t be listening on the tractor

Brian: They might be! Asking themselves the questions and we will be looking at what it is that is preventing you from getting the help you need. We are talking today to the person that is struggling with the disease of alcoholism and I think that this is going to be something that people need to understand that it is their choice and family members can beg and plead but ultimately the decision belongs to them. Today we are going to focus on the potential client to realize that today is the day. I have to make a decision, my life is going down the tubes,

Jill: Brian the summer months are upon us, Memorial Day is upon us and the summer months provide the perfect opportunity for finding ways to delay or get around going in and getting that free consultation and finding out what they could do for the problem that is causing them pain um, and this is the time and the day that maybe you will hear some truth that will cause you to say, “You know what it is time for me to go in and talk to someone about this, or maybe make a call” so if you are working in the house or driving around or on your way to a soccer game with the kids or something like that and you can take some time to just really listen to what we have to say today, it might be that we say something that finally pushes into that place of “I’m ready”

Brian: It is interesting you say it that way because it seems like recently many of the calls that I am getting um, while I am on call is the actual person even today I had a call it came from the person who is suffering they knew they needed help and I think that is so profound because they are coming not because they are forced to but because they are really coming to the point that they have to do something. I hear this a lot where they know if they don’t get the help they will lose their family, their jobs, and so on.

Jill: Well this brings me to thinking about different people I have had consultations with and they have brought in their calendar and in the last few months, they want to schedule around the holidays and vacations and barbeques, weddings and so on. They say “I could do this sometime in August,” and we know that when you walk into a facility to talk about a life changing problem like alcohol dependency usually the time is now when you walk in and I have just seen many people come through and have all of these excuses already lined up before they can you know actually sit down and say “Show me how to get it under control” look at the list of the excuses that they pile up during summer starting with Memorial Day festivities and the introduction to summer,

Brian: How about graduations?

Jill: Oh yeah and the …

Brian: This would be a real challenge for those

Jill: Also Fourth of July, everything kind of runs into each other and it is so easy to say “Ok I just don’t have the free time” I don’t want to use vacation time to take care of myself. So by the end of the summer you find that it was more life changing in a negative way than getting the help you needed such as your first or third DUI. A family member saying, “Forget it, I don’t want to deal with you anymore.”

Brian: We see this so often and that is so

Jill: The loss of the job,

Brian: In this economy..

Jill: So it is not time to look at your excuses for not getting help it is time to say, “Do I have a problem and how bad is it and who can I talk to?”

Brian: This topic might be something you want to get in on so call us at 770-226-0920 what can I do with my life, how can I get it together again?”

Jill: Doing a screening over the air may help those out there understand that there is certain criteria, so if you want to call in and ask questions about alcohol dependency for yourself or loved ones, 770-226-0920 also outside the Atlanta, 1-888-920-2665. We are going to come down to a break and when we come back we will do an on air screening and the questions we would ask to determine if you are alcohol dependent.

Brian: Stay with us.

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Jill: Welcome back to the Breakthrough Addiction Recovery Hour, I don’t think anyone but Judy Garland could have sung that song. I think she knew what it was like to wake up hating herself in the morning. I chose that because you know what if you are hating yourself in the morning, then today is the day to try to figure out what is going on and if it has to do with alcohol then hopefully we can clarify you know that you have the alcohol dependency that we have been talking about. So, also, it looks like we have a phone call

Brian: Gerald from Atlanta,

Jill: Hey Gerald

Gerald: I heard your program for the first time and I have used alcohol and to me drugs for a while now I just want to know if I do have a problem. One of my family members suggested that I slow down or stop certain days and you know just being sober those days and I just wanted to know if I do have a problem.

Brian: Well Gerald that is a great question and I really appreciate your openness about this and I can just give you a real quick little screening if you will answer a couple of questions or two um just be honest and maybe this will help you answer your own questions

Gerald: Sounds good

Brian: Have you ever tried to cut back on your drinking but found it difficult?

Gerald: That is one thing that I have had, or my significant other has well she wants me to try to cut back and limit it.

Brian: Have you been successful?

Gerald: Well on the days that I do are everything goes according to planned it’s just the days when I do get off I do have a drink or a I do abuse substances when I get home.

Brian: Have you or do you ever get annoyed when people get on you about your drinking levels.

Gerald: Yeah, at first maybe I was annoyed but being honest with myself I know I shouldn’t do it daily

Brian: That’s right. Do you ever feel guilty after you use?

Gerald: Uh, I don’t and that’s one of the things in the crossroads that I have been at. I do have my significant other that I don’t have , I do go to work and at the end of the day , it is almost like I feel entitled.

Brian: So you feel like you have earned the drink?

Gerald: Yeah

Brian: Well that sounds logical. Finally do you ever use alcohol to wake up in the morning or the eye opener drink.

Gerald: No sir

Brian: Well you know it sounds like there are a couple of areas here if you have tried to cut back and a couple things going on here that could be an issue the best we could recommend we could offer you a free consultation um that we can certainly guide you to and if you have pen and paper write the telephone number down and give us a call and we will set you up. 770-734-8091. We can explore and give some explanations