By MARÁ ROSE WILLIAMS
The Kansas City Star
More News
Heroin snaring more of suburbia’s youth
The smell of smoke at 4 a.m. abruptly woke Kristin and sent her rushing down to the kitchen.
She found mini tacos burning to a crisp in the oven — and her 20-year-old daughter sitting on the floor, head hung forward, arms limp.
“The first thing out of my mouth was, ‘What is wrong with you, is your blood sugar low?’” Kristin recalled frantically asking the former Olathe high school cheerleader and gymnast.
It wasn’t the sugar in her blood that was wrong. It was the heroin. The girl was nodding in its warm embrace.
The story is one of several catching the attention of authorities and area drug abuse counselors this year.
The problem has shown up in New York, Illinois, Alabama, New Mexico, Wisconsin, Utah and Washington state. Heroin use is on the rise among suburban youth, experts say, and although the numbers are still small, spikes in overdoses and even deaths show an alarming trend.
In Blue Springs, police dealt with five cases of heroin and youth in October after half a decade of seeing none.
In many cases, the way was paved by other opiates, the Oxycontin or Vicodin painkillers, often swiped from a medicine cabinet. But parents have become more alert to possible misuse.
While painkillers can run to $40 to $60 a pill, a bag of heroin, which produces a more intense high, is $5 to $10.
No trips on Interstate 35 to either Kansas City were necessary. The daughter said her dealer lived two blocks from Kristin’s upper-middle-class home in the 66062 zip code.
When told the truth, it was Kristin’s turn on the floor.
“I shrank on to the kitchen floor in to the fetal position,” Kristin said. “I had no strings. I lost it. I was afraid my daughter was going to die.
“I couldn’t believe it. If you could see my daughter you would never believe it, either. A blond-haired, blue-eyed California girl. Shooting up every other day? Not my girl.”
•••
The street heroin of the 1960s and ’70s was about 30 percent pure. Today, it’s often 60 percent, making it possible to smoke or snort.
Two years ago, the parents of Blue Valley Northwest High School graduate Brett Hayes found their 20-year-old son against the sink in his bathroom, the needle still in his arm, dead of an overdose.
Johnson County sheriff’s deputies listed him as one of 24 heroin overdoses and one of five deaths that year. The first five months of 2009 is the latest data they have compiled. In those months, 22 overdoses and six deaths were recorded.
The problem is steadily growing, said David Brown, a drug and alcohol abuse counselor in Olathe. “This year alone we did intervention on three young heroin addicts.”
His wife, Lucy Brown, also a drug-abuse counselor at Avenues to Recovery, added that the addicts were “children from intact homes where the parents make a comfortable living. These kids drive nice cars and have access to cash.”
Police indicated the problem had not surfaced in every suburb yet. Many said they were mostly battling other drugs, and saw keggers replaced by “pharm parties,” where teenagers pour a bottle of pilfered pills into a bowl.
•••
Maureen’s left arm is riddled with three years of scar tracks, “a daily reminder” of the injections, eventually 20 times a day.
As an Olathe high-schooler, she bought meds, such as Oxycontin, from classmates. Thus introduced to the feel of opiates, teens feel more comfortable with the idea of heroin.
Maureen said she kept a 3.7 grade-point average and was into photography.
It was as a freshman at the University of Kansas that she graduated to heroin, dropping out before her sophomore year.
“I started out snorting it and then injected it. It turned into a daily necessity,” she said. “I needed to use every day or I couldn’t get out of bed. It was a big obsession in my life.”
By 20, she was living out of her car and trying to satisfy a $200-a-day habit.
“There were a lot of us on the street,” she said of her fellow users. “We’d park our cars in Wal-Mart lots to sleep.”
Once hooked on black tar heroin, said Lucy Brown, “they are no longer involved with their school environment anymore. When they start using heroin they are exposed to a different population, and they want to be close to their source.”
Black tar heroin, predominantly from Mexico, is crudely made, with color that varies from dark brown to black.
Maureen: “I knew what I was doing was not healthy but all the people I was socializing with were using it.”
She worked periodically but could not hold a job.
“I either didn’t show up or I stole from them,” she said.
At first she was able to keep the secret from her “normal loving family” who lived in an upper-middle-class Olathe neighborhood.
When she told them about her heroin use, she got clean through rehabilitation and a prescribed substitute. But she fell back into her habit and her family had enough.
“I was using in their house. They asked me to get help or get out. All I wanted to do was get high so I left,” she said.
By the time she decided again that she had to get help, “I had stopped eating or sleeping. I ended up in the hospital and I was really sick,” Maureen said. “I was 100 pounds and my liver and my kidneys were damaged. I was either going to get better or I was going to die, and I didn’t want to die.”
Today Maureen is eight months clean and living amid recovery counselors and supporters in California. She will return to Johnson County, but “not until I get a better foundation for myself.”
She said she has heard that friends have younger brothers and sisters addicted to heroin.
“They tell me it is really bad.” said Maureen. “Sad.”
•••
The rise of heroin among suburban youth is more disturbing considering its decline among adults. Because fewer adults are involved now, the dealers tend to be other teens. Teens also are more likely to overdose, experts said.
Area high school officials said they had caught students smoking marijuana and possessing prescription drugs, but not with heroin yet.
“We have not seen a big outbreak of heroin use among students,” said Sgt. Brian Wessling, supervisor of Olathe school resource officers. Still, he said, officers “are looking for it,” and last year underwent training to spot signs of use. The canine unit that roams Olathe high school parking lots on drug searches is a big deterrent, he said.
“It’s only a matter of time before national trends hit the Midwest,” Wessling said. “We want to stay in front of that.”
Johnson County leaders launched a school initiative to alert children and parents to the danger.
•••
Kristin, who works in the medical field, was in denial even as she helped her 90-pound daughter up from the floor on taco night.
“Kids are master liars,” she said.
Yes, the kid, at 16, had been caught by police for marijuana possession. A phase, she and her husband told themselves. Later they would learn she had lifted painkillers prescribed to Kristin’s husband.
But she never fathomed her child’s slow, “air-head-like” speech was caused by heroin.
“Heroin, that’s a junkie drug,” Kristin thought. It’s an opiate that most associate with shabby apartments and dark alleys in the city core.
When Kristin mustered the courage to ask her daughter whether she was using heroin, “She told me she couldn’t go two days without it.”
The daughter has been more than half a year at a rehab center in California. Kristin said she wanted her to stay until she was clean at least a year.
“It is very devastating to the family,” she said. “I was afraid my daughter was going to die.”
It took all the strength Kristin could muster to give her daughter the ultimatum to get out of the house or let her parents help. She said she was glad she did not wait for her daughter to reach some “unidentifiable rock bottom.”
She and her husband blamed one another for not seeing the signs. Now they regularly attend group meetings for families of addicts.
“I’m in my own recovery,” Kristin said. “We had a false sense of security, thinking that just because you live in the suburbs and you send your kids to good schools. … Who would ever dream that their kid would start snorting heroin, much less, shoot up?”
Signs that a child might have a drug problem
•Drug paraphernalia — dirty spoons, syringes, pieces of burned foil, straws.
•Droopy appearance, as if extremities are heavy.
•Disorientation, poor mental functioning.
•Constricted pupils/pale, pasty skin.
• Apathy and/or lethargy. Nodding off.
•Eyes appear “lost” or have faraway look.
•Slurred speech.
•Nausea.
•Runny nose.
•Unkempt appearance/hygiene issues.
•Wearing long sleeves in warm weather.
•Missing cash or valuables, borrowing money.
•Change in performance — academic or otherwise.
•Unexplained absences at work, school or family events.
•Lying/deception
•Change in friends
•Withdrawal from usual activities or interests.
•Broken commitments
•Hostility
To contact Mará Rose Williams, call 816-234-4419 or send e-mail to mdwilliams@kcstar.com.
Posted on Fri, Nov. 12, 2010 12:06 AM
Friday 12 November 2010
Wednesday 13 October 2010
Why engage an Interventionist?
A professional alcohol interventionist is a skilled and trained professional, acting as an arbitrator between an alcoholic and their family. Prior to staging an intervention, a group of people will be chosen to confront the alcoholic and this can consist of a person’s spouse, grown children, parents, sisters and brothers. Everyone that has loved someone with an alcohol problem will have a place in the group and the interventionist will provide advice, wisdom, support and guidance throughout the process.
Before going through an intervention the group will meet and possibly hold a “mock” intervention (pre intervention), which is done to prepare before the real one takes place. During the initial mock intervention, the group will be advised on what to say and what to do, and an interventionist may have the people each write a letter to the alcoholic. The letters are written to drive home the pain the alcoholism has caused to them individually and to stress how important it is for the person to get treatment. Once the interventionist feels comfortable and prepared, a date will be selected for the actual intervention to take place.
Once a date has been selected, an alcoholic is either told beforehand or in some cases, the person is just brought to a certain predetermined location and confronted. It is never the goal of an intervention to make a person feel self-conscious or trapped, instead the process is facilitated in a loving, but controlled environment and the situation is guided by the interventionist. After each person has taken a turn and told the alcoholic how they feel, the interventionist will speak with the individual and reinforce the goal of seeking treatment. If the person refuses to enter into treatment, he or she will be made aware of the consequences of their actions and it may even involve loved ones turning their back on the individual until they get help. The letters that are written will not only include the offer of the gift of treatment but will also include the individuals bottom line for the cade that the loved one refuses to accept the gift.
The ultimate goal of an intervention is to plan out the situation from start to finish and to make sure the focus of the group remains on getting the person into treatment. An intervention is done in a constructive, caring, calm, neutral environment in which the alcoholic is shown love, support and understanding. Instead of being confronted in the same ways as before, an intervention is done with love, care and compassion. Everybody stumbles in life and everyone has problems, but when dealing with alcoholism, until treatment is received, nothing will ever change.
An alcohol interventionist is available to help a person that is ready to break away from alcoholism and make changes in life. After researching a person’s addiction history and consulting with medical professionals and rehab specialists, an interventionist will assist an alcoholic in finding type of rehabilitation programs. For some alcoholics, the first step after an intervention is going through a detoxification program in order to get the toxins of alcohol removed from the body. Once detox has been successfully completed, a person is then ready to go on to the rehabilitation program for further completion of the treatment and healing process.
Alcoholism is a destructive and dehumanizing disease which takes no prisoners and destroys everything in its path. When alcoholism has completely taken over the life of someone you love and all past efforts to help the person get into treatment have failed, it is time to consider other alternatives and options. Contacting a professional alcohol interventionist is the best way to help a person realize the misery of alcoholism and is the wakeup call many alcoholics need to finally spur them into getting treatment. When you wish to help your loved one conquer alcoholism, receiving the assistance of an interventionist can be the catalyst needed to help open their eyes to all the joy and happiness that comes from living a clean and sober life.
Before going through an intervention the group will meet and possibly hold a “mock” intervention (pre intervention), which is done to prepare before the real one takes place. During the initial mock intervention, the group will be advised on what to say and what to do, and an interventionist may have the people each write a letter to the alcoholic. The letters are written to drive home the pain the alcoholism has caused to them individually and to stress how important it is for the person to get treatment. Once the interventionist feels comfortable and prepared, a date will be selected for the actual intervention to take place.
Once a date has been selected, an alcoholic is either told beforehand or in some cases, the person is just brought to a certain predetermined location and confronted. It is never the goal of an intervention to make a person feel self-conscious or trapped, instead the process is facilitated in a loving, but controlled environment and the situation is guided by the interventionist. After each person has taken a turn and told the alcoholic how they feel, the interventionist will speak with the individual and reinforce the goal of seeking treatment. If the person refuses to enter into treatment, he or she will be made aware of the consequences of their actions and it may even involve loved ones turning their back on the individual until they get help. The letters that are written will not only include the offer of the gift of treatment but will also include the individuals bottom line for the cade that the loved one refuses to accept the gift.
The ultimate goal of an intervention is to plan out the situation from start to finish and to make sure the focus of the group remains on getting the person into treatment. An intervention is done in a constructive, caring, calm, neutral environment in which the alcoholic is shown love, support and understanding. Instead of being confronted in the same ways as before, an intervention is done with love, care and compassion. Everybody stumbles in life and everyone has problems, but when dealing with alcoholism, until treatment is received, nothing will ever change.
An alcohol interventionist is available to help a person that is ready to break away from alcoholism and make changes in life. After researching a person’s addiction history and consulting with medical professionals and rehab specialists, an interventionist will assist an alcoholic in finding type of rehabilitation programs. For some alcoholics, the first step after an intervention is going through a detoxification program in order to get the toxins of alcohol removed from the body. Once detox has been successfully completed, a person is then ready to go on to the rehabilitation program for further completion of the treatment and healing process.
Alcoholism is a destructive and dehumanizing disease which takes no prisoners and destroys everything in its path. When alcoholism has completely taken over the life of someone you love and all past efforts to help the person get into treatment have failed, it is time to consider other alternatives and options. Contacting a professional alcohol interventionist is the best way to help a person realize the misery of alcoholism and is the wakeup call many alcoholics need to finally spur them into getting treatment. When you wish to help your loved one conquer alcoholism, receiving the assistance of an interventionist can be the catalyst needed to help open their eyes to all the joy and happiness that comes from living a clean and sober life.
Monday 5 July 2010
'Mum sat on park bench drinking'
Page last updated at 12:01 GMT, Monday, 5 July 2010 13:01 UK
E-mail this to a friend Printable version Ben kept his mother's drinking a secret from his friends It is the stuff of Victorian melodrama - children terrified of their drunken parents, their lives destroyed.
And according to a survey for the BBC's Newsround programme it is still happening.
The study of more than 1,200 children aged 10 to 14 found that many of them are seriously worried about their parents' drinking.
One 10-year-old, Ben, and his mother told the BBC how her alcohol abuse had a dramatic impact on their lives.
Ben said: "When my mum first started drinking she wasn't that bad because she drank a couple on a night. But when she started getting worse it used to be during the day."
Taxi journeys
His mother explained that she was drinking up to four bottles of whisky a day following the death of her father.
"I was doing it because I thought it was helping me cope, but obviously it was making everything worse," she said.
"I was under the influence that bad that I never realised how much drink I'd got. My every thought was taxi cabs to fetch more."
Continue reading the main story I'd look at her and I'd look away like I don't know her because it used to embarrass me
Ben
Her son added: "We did a lot of taxi journeys to go to the newsagents, drink shops basically. It would be every day. I would just stand outside waiting."
The mother was aware of the damaging effect such behaviour was having on her son - but could not stop because of the drink.
She said: "I could see that it was hurting him that I was fetching alcohol. But because of being under the influence of alcohol I didn't really care, unfortunately. You don't care. You don't care about anything at all as long as you've got that drink."
And that made life a nightmare for Ben.
"Sometimes when I used to walk to school my mum would be sitting on the park bench drinking. I'd look at her and I'd look away like I don't know her because it used to embarrass me," he said.
"The house was all fell apart, really. It was dirty, messy. My mum was on the sofa and there'd be cans all over the place. That's basically all you'd see - cans, clothes, bottles. That's it. All over the place."
'Angry and upset'
He added: "I kept it a big secret. I didn't tell my friends about my mum's drinking because I felt that they might take the mick out of me and call me names.
"I love my mum and I wanted her to get back the way she was before. It was really making me angry and upset."
Nearly half of the children surveyed said they were not bothered by adults drinking - but 30% said it made them feel scared.
The survey was carried out for Newsround by Childwise, a charity that provides support for the children of problem drinkers.
The charity's founder, Emma Spiegler, said: "I would say that in moderation and drinking responsibly, adults can drink and have a good time and for kids to see that there's no problem.
"But when kids are feeling frightened and scared and it becomes a problem for the adult then it is a concern."
Bookmark with
E-mail this to a friend Printable version Ben kept his mother's drinking a secret from his friends It is the stuff of Victorian melodrama - children terrified of their drunken parents, their lives destroyed.
And according to a survey for the BBC's Newsround programme it is still happening.
The study of more than 1,200 children aged 10 to 14 found that many of them are seriously worried about their parents' drinking.
One 10-year-old, Ben, and his mother told the BBC how her alcohol abuse had a dramatic impact on their lives.
Ben said: "When my mum first started drinking she wasn't that bad because she drank a couple on a night. But when she started getting worse it used to be during the day."
Taxi journeys
His mother explained that she was drinking up to four bottles of whisky a day following the death of her father.
"I was doing it because I thought it was helping me cope, but obviously it was making everything worse," she said.
"I was under the influence that bad that I never realised how much drink I'd got. My every thought was taxi cabs to fetch more."
Continue reading the main story I'd look at her and I'd look away like I don't know her because it used to embarrass me
Ben
Her son added: "We did a lot of taxi journeys to go to the newsagents, drink shops basically. It would be every day. I would just stand outside waiting."
The mother was aware of the damaging effect such behaviour was having on her son - but could not stop because of the drink.
She said: "I could see that it was hurting him that I was fetching alcohol. But because of being under the influence of alcohol I didn't really care, unfortunately. You don't care. You don't care about anything at all as long as you've got that drink."
And that made life a nightmare for Ben.
"Sometimes when I used to walk to school my mum would be sitting on the park bench drinking. I'd look at her and I'd look away like I don't know her because it used to embarrass me," he said.
"The house was all fell apart, really. It was dirty, messy. My mum was on the sofa and there'd be cans all over the place. That's basically all you'd see - cans, clothes, bottles. That's it. All over the place."
'Angry and upset'
He added: "I kept it a big secret. I didn't tell my friends about my mum's drinking because I felt that they might take the mick out of me and call me names.
"I love my mum and I wanted her to get back the way she was before. It was really making me angry and upset."
Nearly half of the children surveyed said they were not bothered by adults drinking - but 30% said it made them feel scared.
The survey was carried out for Newsround by Childwise, a charity that provides support for the children of problem drinkers.
The charity's founder, Emma Spiegler, said: "I would say that in moderation and drinking responsibly, adults can drink and have a good time and for kids to see that there's no problem.
"But when kids are feeling frightened and scared and it becomes a problem for the adult then it is a concern."
Bookmark with
Thursday 1 July 2010
After 75 years AA works ---not sure how or why!
The church will be closed tomorrow, and the drunks are freaking out. An elderly lady in a prim white blouse has just delivered the bad news, with deep apologies: A major blizzard is scheduled to wallop Manhattan tonight, and up to a foot of snow will cover the ground by dawn. The church, located on the Upper West Side, can’t ask its staff to risk a dangerous commute. Unfortunately, that means it must cancel the Alcoholics Anonymous meeting held daily in the basement.
A worried murmur ripples through the room. “Wha… what are we supposed to do?” asks a woman in her mid-twenties with smudged black eyeliner. She’s in rough shape, having emerged from a multiday alcohol-and-cocaine bender that morning. “The snow, it’s going to close everything,” she says, her cigarette-addled voice tinged with panic. “Everything!” She’s on the verge of tears.
A mustachioed man in skintight jeans stands and reads off the number for a hotline that provides up-to-the-minute meeting schedules. He assures his fellow alcoholics that some groups will still convene tomorrow despite the weather. Anyone who needs an AA fix will be able to get one, though it may require an icy trek across the city.
That won’t be a problem for a thickset man in a baggy beige sweat suit. “Doesn’t matter how much snow we get—a foot, 10 feet piled up in front of the door,” he says. “I will leave my apartment tomorrow and go find a meeting.”
He clasps his hands together and draws them to his heart: “You understand me? I need this.” Daily meetings, the man says, are all that prevent him from winding up dead in the gutter, shoes gone because he sold them for booze or crack. And he hasn’t had a drink in more than a decade.
The resolve is striking, though not entirely surprising. AA has been inspiring this sort of ardent devotion for 75 years. It was in June 1935, amid the gloom of the Great Depression, that a failed stockbroker and reformed lush named Bill Wilson founded the organization after meeting God in a hospital room. He codified his method in the 12 steps, the rules at the heart of AA. Entirely lacking in medical training, Wilson created the steps by cribbing ideas from religion and philosophy, then massaging them into a pithy list with a structure inspired by the Bible.
The 200-word instruction set has since become the cornerstone of addiction treatment in this country, where an estimated 23 million people grapple with severe alcohol or drug abuse—more than twice the number of Americans afflicted with cancer. Some 1.2 million people belong to one of AA’s 55,000 meeting groups in the US, while countless others embark on the steps at one of the nation’s 11,000 professional treatment centers. Anyone who seeks help in curbing a drug or alcohol problem is bound to encounter Wilson’s system on the road to recovery.
It’s all quite an achievement for a onetime broken-down drunk. And Wilson’s success is even more impressive when you consider that AA and its steps have become ubiquitous despite the fact that no one is quite sure how—or, for that matter, how well—they work. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore.
What we do know, however, is that despite all we’ve learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better. “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps,” says Drew Pinsky, the addiction-medicine specialist who hosts VH1’s Celebrity Rehab. “In my world, if someone says they don’t want to do the 12 steps, I know they aren’t going to get better.”
Wilson may have operated on intuition, but somehow he managed to tap into mechanisms that counter the complex psychological and neurological processes through which addiction wreaks havoc. And while AA’s ability to accomplish this remarkable feat is not yet understood, modern research into behavior dynamics and neuroscience is beginning to provide some tantalizing clues.
One thing is certain, though: AA doesn’t work for everybody. In fact, it doesn’t work for the vast majority of people who try it. And understanding more about who it does help, and why, is likely our best shot at finally developing a system that improves on Wilson’s amateur scheme for living without the bottle.
AA doesn't work for everybody, but when it does, it can be transformative. Members receive tokens to mark periods of sobriety, from 24 hours to one month to 55 years.
Photo: Todd Tankersley
AA originated on the worst night of Bill Wilson’s life. It was December 14, 1934, and Wilson was drying out at Towns Hospital, a ritzy Manhattan detox center. He’d been there three times before, but he’d always returned to drinking soon after he was released. The 39-year-old had spent his entire adult life chasing the ecstasy he had felt upon tasting his first cocktail some 17 years earlier. That quest destroyed his career, landed him deeply in debt, and convinced doctors that he was destined for institutionalization.
Wilson had been quite a mess when he checked in the day before, so the attending physician, William Silkworth, subjected him to a detox regimen known as the Belladonna Cure—hourly infusions of a hallucinogenic drug made from a poisonous plant. The drug was coursing through Wilson’s system when he received a visit from an old drinking buddy, Ebby Thacher, who had recently found religion and given up alcohol. Thacher pleaded with Wilson to do likewise. “Realize you are licked, admit it, and get willing to turn your life over to God,” Thacher counseled his desperate friend. Wilson, a confirmed agnostic, gagged at the thought of asking a supernatural being for help.
But later, as he writhed in his hospital bed, still heavily under the influence of belladonna, Wilson decided to give God a try. “If there is a God, let Him show Himself!” he cried out. “I am ready to do anything. Anything!”
What happened next is an essential piece of AA lore: A white light filled Wilson’s hospital room, and God revealed himself to the shattered stockbroker. “It seemed to me, in the mind’s eye, that I was on a mountain and that a wind not of air but of spirit was blowing,” he later said. “And then it burst upon me that I was a free man.” Wilson would never drink again.
At that time, the conventional wisdom was that alcoholics simply lacked moral fortitude. The best science could offer was detoxification with an array of purgatives, followed by earnest pleas for the drinker to think of his loved ones. When this approach failed, alcoholics were often consigned to bleak state hospitals. But having come back from the edge himself, Wilson refused to believe his fellow inebriates were hopeless. He resolved to save them by teaching them to surrender to God, exactly as Thacher had taught him.
Following Thacher’s lead, Wilson joined the Oxford Group, a Christian movement that was in vogue among wealthy mainstream Protestants. Headed by a an ex-YMCA missionary named Frank Buchman, who stirred controversy with his lavish lifestyle and attempts to convert Adolf Hitler, the Oxford Group combined religion with pop psychology, stressing that all people can achieve happiness through moral improvement. To help reach this goal, the organization’s members were encouraged to meet in private homes so they could study devotional literature together and share their inmost thoughts.
In May 1935, while on an extended business trip to Akron, Ohio, Wilson began attending Oxford Group meetings at the home of a local industrialist. It was through the group that he met a surgeon and closet alcoholic named Robert Smith. For weeks, Wilson urged the oft-soused doctor to admit that only God could eliminate his compulsion to drink. Finally, on June 10, 1935, Smith (known to millions today as Dr. Bob) gave in. The date of Dr. Bob’s surrender became the official founding date of Alcoholics Anonymous.
In its earliest days, AA existed within the confines of the Oxford Group, offering special meetings for members who wished to end their dependence on alcohol. But Wilson and his followers quickly broke away, in large part because Wilson dreamed of creating a truly mass movement, not one confined to the elites Buchman targeted. To spread his message of salvation, Wilson started writing what would become AA’s sacred text: Alcoholics Anonymous, now better known as the Big Book.
The core of AA is found in chapter five, entitled “How It Works.” It is here that Wilson lists the 12 steps, which he first scrawled out in pencil in 1939. Wilson settled on the number 12 because there were 12 apostles.
In writing the steps, Wilson drew on the Oxford Group’s precepts and borrowed heavily from William James’ classic The Varieties of Religious Experience, which Wilson read shortly after his belladonna-fueled revelation at Towns Hospital. He was deeply affected by an observation that James made regarding alcoholism: that the only cure for the affliction is “religiomania.” The steps were thus designed to induce an intense commitment, because Wilson wanted his system to be every bit as habit-forming as booze.
The first steps famously ask members to admit their powerlessness over alcohol and to appeal to a higher power for help. Members are then required to enumerate their faults, share them with their meeting group, apologize to those they’ve wronged, and engage in regular prayer or meditation. Finally, the last step makes AA a lifelong duty: “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.” This requirement guarantees not only that current members will find new recruits but that they can never truly “graduate” from the program.
Aside from the steps, AA has one other cardinal rule: anonymity. Wilson was adamant that the anonymous component of AA be taken seriously, not because of the social stigma associated with alcoholism, but rather to protect the nascent organization from ridicule. He explained the logic in a letter to a friend:
[In the past], alcoholics who talked too much on public platforms were likely to become inflated and get drunk again. Our principle of anonymity, so far as the general public is concerned, partly corrects this difficulty by preventing any individual receiving a lot of newspaper or magazine publicity, then collapsing and discrediting AA.
AA boomed in the early 1940s, aided by a glowing Saturday Evening Post profile and the public admission by a Cleveland Indians catcher, Rollie Hemsley, that joining the organization had done wonders for his game. Wilson and the founding members were not quite prepared for the sudden success. “You had really crazy things going on,” says William L. White, author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. “Some AA groups were preparing to run AA hospitals, and there was this whole question of whether they should have paid AA missionaries. You even had some reports of AA groups drinking beers at their meetings.”
The growing pains spurred Wilson to write AA’s governing principles, known as the 12 traditions. At a time when fraternal orders and churches with strict hierarchies dominated American social life, Wilson opted for something revolutionary: deliberate organizational chaos. He permitted each group to set its own rules, as long as they didn’t conflict with the traditions or the steps. Charging a fee was forbidden, as was the use of the AA brand to endorse anything that might generate revenue. “If you look at this on paper, it seems like it could never work,” White says. “It’s basically anarchy.” But this loose structure actually helped AA flourish. Not only could anyone start an AA group at any time, but they could tailor each meeting to suit regional or local tastes. And by condemning itself to poverty, AA maintained a posture of moral legitimacy.
Despite the decision to forbid members from receiving pay for AA-related activity, it had no problem letting professional institutions integrate the 12 steps into their treatment programs. AA did not object when Hazelden, a Minnesota facility founded in 1947 as “a sanatorium for curable alcoholics of the professional class,” made the steps the foundation of its treatment model. Nor did AA try to stop the proliferation of steps-centered addiction groups from adopting the Anonymous name: Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous. No money ever changed hands—the steps essentially served as open source code that anyone was free to build upon, adding whatever features they wished. (Food Addicts Anonymous, for example, requires its members to weigh their meals.)
By the early 1950s, as AA membership reached 100,000, Wilson began to step back from his invention. Deeply depressed and an incorrigible chain smoker, he would go on to experiment with LSD before dying from emphysema in 1971. By that point, AA had become ingrained in American culture; even people who’d never touched a drop of liquor could name at least a few of the steps.
“For nearly 30 years, I have been saying Alcoholics Anonymous is the most effective self-help group in the world,” advice columnist Ann Landers wrote in 1986. “The good accomplished by this fellowship is inestimable … God bless AA.”
There’s no doubt that when AA works, it can be transformative. But what aspect of the program deserves most of the credit? Is it the act of surrendering to a higher power? The making of amends to people a drinker has wronged? The simple admission that you have a problem? Stunningly, even the most highly regarded AA experts have no idea. “These are questions we’ve been trying to answer for, golly, 30 or 40 years now,” says Lee Ann Kaskutas, senior scientist at the Alcohol Research Group in Emeryville, California. “We can’t find anything that completely holds water.”
The problem is so vexing, in fact, that addiction professionals have largely accepted that AA itself will always be an enigma. But research in other fields—primarily behavior change and neurology—offers some insight into what exactly is happening in those church basements.
To begin with, there is evidence that a big part of AA’s effectiveness may have nothing to do with the actual steps. It may derive from something more fundamental: the power of the group. Psychologists have long known that one of the best ways to change human behavior is to gather people with similar problems into groups, rather than treat them individually. The first to note this phenomenon was Joseph Pratt, a Boston physician who started organizing weekly meetings of tubercular patients in 1905. These groups were intended to teach members better health habits, but Pratt quickly realized they were also effective at lifting emotional spirits, by giving patients the chance to share their tales of hardship. (“In a common disease, they have a bond,” he would later observe.) More than 70 years later, after a review of nearly 200 articles on group therapy, a pair of Stanford University researchers pinpointed why the approach works so well: “Members find the group to be a compelling emotional experience; they develop close bonds with the other members and are deeply influenced by their acceptance and feedback.”
Researchers continue to be surprised by just how powerful this effect is. For example, a study published last year in the journal Behavior Therapy concluded that group therapy is highly effective in treating post-traumatic stress disorder: 88.3 percent of the study’s subjects who underwent group therapy no longer exhibited PTSD symptoms after completing their sessions, versus just 31.3 percent of those who received minimal one-on-one interaction.
The importance of this is reflected by the fact that the more deeply AA members commit to the group, rather than just the program, the better they fare. According to J. Scott Tonigan, a research professor at the University of New Mexico’s Center on Alcoholism, Substance Abuse, and Addictions, numerous studies show that AA members who become involved in activities like sponsorship—becoming a mentor to someone just starting out—are more likely to stay sober than those who simply attend meetings.
Addiction-medicine specialists often raise the concern that AA meetings aren’t led by professionals. But there is evidence that this may actually help foster a sense of intimacy between members, since the fundamental AA relationship is between fellow alcoholics rather than between alcoholics and the therapist. These close social bonds allow members to slowly learn how to connect to others without the lubricating effects of alcohol. In a study published last year in Alcoholism Treatment Quarterly, Tonigan found that “participation in AA is associated with an increased sense of security, comfort, and mutuality in close relationships.”
And close relationships, it turns out, have an even more profound effect on us than previously thought. A 2007 study of a Boston-area community, for example, found that a person’s odds of becoming obese increase by 71 percent if they have a same-sex friend who is also obese. (Wired covered the study in more detail in “The Buddy System,” issue 17.10.) And in April, a paper published in Annals of Internal Medicine concluded that a person is 50 percent more likely to be a heavy drinker if a friend or relative is a boozehound. Even if an alcoholic’s nonsober friends are outwardly supportive, simply being around people for whom drinking remains the norm can nudge someone into relapse. It is much safer to become immersed in AA’s culture, where activities such as studying the Big Book supplant hanging out with old acquaintances who tipple.
As for the steps themselves, there is evidence that the act of public confession—enshrined in the fifth step—plays an especially crucial role in the recovery process. When AA members stand up and share their emotionally searing tales of lost weekends, ruined relationships, and other liquor-fueled low points, they develop new levels of self-awareness. And that process may help reinvigorate the prefrontal cortex, a part of the brain that is gravely weakened by alcohol abuse.
To understand the prefrontal cortex’s role in both addiction and recovery, you first need to understand how alcohol affects the brain. Booze works its magic in an area called the mesolimbic pathway—the reward system. When we experience something pleasurable, like a fine meal or good sex, this pathway squirts out dopamine, a neurotransmitter that creates a feeling of bliss. This is how we learn to pursue behaviors that benefit us, our families, and our species.
When alcohol hits the mesolimbic pathway, it triggers the rapid release of dopamine, thereby creating a pleasurable high. For most people, that buzz simply isn’t momentous enough to become the focal point of their lives. Or if it is, they are able to control their desire to chase it with reckless abandon. But others aren’t so fortunate: Whether by virtue of genes that make them unusually sensitive to dopamine’s effects, or circumstances that lead them to seek chemical solace, they cannot resist the siren call of booze.
Once an alcoholic starts drinking heavily, the mesolimbic pathway responds by cutting down its production of dopamine. Alcohol also messes with the balance between two other neurotransmitters: GABA and glutamate. Alcohol spurs the release of more GABA, which inhibits neural activity, and clamps down on glutamate, which stimulates the brain. Combined with a shortage of dopamine, this makes the reward system increasingly lethargic, so it becomes harder and harder to rouse into action. That’s why long-term boozers must knock back seven or eight whiskeys just to feel “normal.” And why little else in life brings hardcore alcoholics pleasure of any kind.
As dependence grows, alcoholics also lose the ability to properly regulate their behavior. This regulation is the responsibility of the prefrontal cortex, which is charged with keeping the rest of the brain apprised of the consequences of harmful actions. But mind-altering substances slowly rob the cortex of so-called synaptic plasticity, which makes it harder for neurons to communicate with one another. When this happens, alcoholics become less likely to stop drinking, since their prefrontal cortex cannot effectively warn of the dangers of bad habits.
This is why even though some people may be fully cognizant of the problems that result from drinking, they don’t do anything to avoid them. “They’ll say, ‘Oh, my family is falling apart, I’ve been arrested twice,’” says Peter Kalivas, a neuroscientist at the Medical University of South Carolina in Charleston. “They can list all of these negative consequences, but they can’t take that information and manhandle their habits.”
The loss of synaptic plasticity is thought to be a major reason why more than 90 percent of recovering alcoholics relapse at some point. The newly sober are constantly bombarded with sensory cues that their brain associates with their pleasurable habit. Because the synapses in their prefrontal cortex are still damaged, they have a tough time resisting the urges created by these triggers. Any small reminder of their former life—the scent of stale beer, the clink of toasting glasses—is enough to knock them off the wagon.
AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape. Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone. This, in turn, prods the impaired prefrontal cortex into resuming its regulatory mission. “The brain is designed to respond to experiences,” says Steven Grant, chief of the clinical neuroscience branch of the National Institute on Drug Abuse. “I have no doubt that these therapeutic processes change the brain.” And the more that critical part of the brain is compelled to operate as designed, the more it springs back to its pre-addiction state. While it’s on the mend, AA functions as a temporary replacement—a prefrontal cortex made up of a cast of fellow drunks in a church basement, rather than neurons and synapses.
Finally, the 12 steps address another major risk factor for relapse: stress. Recovering alcoholics are often burdened by memories of the nasty things they did while wasted. When they bump into old acquaintances they mistreated, the guilt can become overwhelming. The resulting stress causes their brains to secrete a hormone that releases corticotropin, which has been shown to cause relapse in alcohol-dependent lab rats.
AA addresses this risk with the eighth and ninth steps, which require alcoholics to make amends to people they’ve wronged. This can alleviate feelings of guilt and in turn limit the stress that may undermine a person’s fragile sobriety.
Bill W., as Wilson is known today, didn’t know the first thing about corticotropin-releasing hormone or the prefrontal cortex, of course. His only aim was to harness spirituality in the hopes of giving fellow alcoholics the strength to overcome their disease. But in developing a system to lead drunks to God, he accidentally created something that deeply affects the brain—a system that has now lasted for three-quarters of a century and shows no signs of disappearing.
But how effective is AA? That seemingly simple question has proven maddeningly hard to answer. Ask an addiction researcher a straightforward question about AA’s success rate and you’ll invariably get a distressingly vague answer. Despite thousands of studies conducted over the decades, no one has yet satisfactorily explained why some succeed in AA while others don’t, or even what percentage of alcoholics who try the steps will eventually become sober as a result.
A big part of the problem, of course, is AA’s strict anonymity policy, which makes it difficult for researchers to track members over months and years. It is also challenging to collect data from chronic substance abusers, a population that’s prone to lying. But researchers are most stymied by the fact that AA’s efficacy cannot be tested in a randomized experiment, the scientific gold standard.
“If you try to randomly assign people to AA, you have a problem, because AA is free and is available all over the place,” says Alcohol Research Group’s Kaskutas. “Plus, some people will just hate it, and you can’t force them to keep going.” In other words, given the organization’s open-door membership policy, it would be nearly impossible for researchers to prevent people in a control group from sneaking off to an AA meeting and thereby tainting the data. On the other hand, many subjects would inevitably loathe AA and drop out of the study altogether.
Another research quandary is how to account for the selection effect. AA is known for doing a better job of retaining drinkers who’ve hit rock bottom than those who still have a ways to fall. But having totally destroyed their lives, the most desperate alcoholics may already be committed to sobriety before ever setting foot inside a church basement. If so, it might be their personal commitment, rather than AA, that is ultimately responsible for their ability to quit.
As a result of these complications, AA research tends to come to wildly divergent conclusions, often depending on an investigator’s biases. The group’s “cure rate” has been estimated at anywhere from 75 percent to 5 percent, extremes that seem far-fetched. Even the most widely cited (and carefully conducted) studies are often marred by obvious flaws. A 1999 meta-analysis of 21 existing studies, for example, concluded that AA members actually fared worse than drinkers who received no treatment at all. The authors acknowledged, however, that many of the subjects were coerced into attending AA by court order. Such forced attendees have little shot at benefiting from any sort of therapy—it’s widely agreed that a sincere desire to stop drinking is a mandatory prerequisite for getting sober.
Yet a growing body of evidence suggests that while AA is certainly no miracle cure, people who become deeply involved in the program usually do well over the long haul. In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization. The University of New Mexico’s Tonigan says the relationship between first-year attendance and long-term sobriety is small but valid: In the language of statistics, the correlation is around 0.3, which is right on the borderline between weak and modest (0 meaning no relationship, and 1.0 being a perfect one-to-one relationship).
“I’ve been involved in a couple of meta-analyses of AA, which collapse the findings across many studies,” Tonigan says. “They generally all come to the same conclusion, which is that AA is beneficial for many but not all individuals, and that the benefit is modest but significant … I think that is, scientifically speaking, a very valid statement.”
That statement is also supported by the results of a landmark study that examined how the steps perform when taught in clinical settings as opposed to church basements. Between 1989 and 1997, a multisite study called Project Match randomly assigned more than 1,700 alcoholics to one of three popular therapies used at professional treatment centers. The first was called 12-step facilitation, in which a licensed therapist guides patients through Bill Wilson’s method. The second was cognitive behavioral therapy, which trains alcoholics to identify the situations that spur them to drink, so they can avoid tempting circumstances. And the last was motivational enhancement therapy, a one-on-one interviewing process designed to sharpen a person’s reasons for getting sober.
Project Match ultimately concluded that all three of these therapies were more or less equally effective at reducing alcohol intake among subjects. But 12-step facilitation clearly beat the competition in two important respects: It was more effective for alcoholics without other psychiatric problems, and it did a better job of inspiring total abstinence as opposed to a mere reduction in drinking. The steps, in other words, actually worked slightly better than therapies of more recent vintage, which were devised by medical professionals rather than an alcoholic stockbroker.
AA is still far from ideal. The sad fact remains that the program’s failures vastly outnumber its success stories. According to Tonigan, upwards of 70 percent of people who pass through AA will never make it to their one-year anniversary, and relapse is common even among regular attendees. This raises an important question: Are there ways to improve Wilson’s aging system?
AA is obviously not about to overhaul its 75-year-old formula. But there are a few alterations that would almost certainly make the program work for more people, starting with better quality control. Since no central body regulates the day-to-day operations of local groups, some meetings are dominated by ornery old-timers who delight in belittling newcomers. Others are prowled by men looking to introduce nubile newcomers to the “13th step”—AA slang for sexual exploitation. Finding a way to impose some basic oversight of such bad behavior would likely reduce the dropout rate.
Some AA groups would also do well to shed their resistance to medication. There is nothing in the Big Book that forbids the use of prescription drugs, but there are plenty of meetings where such pharmaceutical aids are frowned upon. Perhaps this sentiment made sense back in AA’s formative years, when a variety of snake oils were touted as alcoholism cures. But today there are several medications that have been proven to decrease the odds of relapse. One such drug, acamprosate, restores a healthy balance between glutamate and GABA, two of the neurotransmitters that get out of whack in the brains of alcoholics. Naltrexone, commonly used to treat heroin addiction, appears effective at preventing relapse by alcoholics who possess a certain genetic variant related to an important mu-opioid receptor. Both can be valuable aids in the recovery process.
But the best way to bolster AA’s success rate may be to increase the personalization of addiction medicine. “We’re starting to get an inkling that something about the initial state of the brain prior to therapy may be predictive as to whether that therapy will be a success,” says Grant of the National Institute on Drug Abuse. In other words, certain brains may be primed to respond well to some therapies and less so to others.
NIDA and other government agencies are currently funding several studies that aim to use neural imaging technology to observe how various therapies affect addicted brains. One alcoholic might have a mesolimbic pathway that normalizes quickly after receiving a certain type of therapy, for example, while another will still suffer from dopamine disregulation despite receiving the same care. The hope is that these studies will reveal whether neurobiology can be used to predict a person’s odds of benefitting from one treatment over another. Perhaps there is one sort of mind that is cut out for the cognitive behavioral approach and another that can be helped only by the 12 steps.
A person’s openness to the concept of spiritual rebirth, as determined by their neural makeup, could indicate whether they’ll embrace the steps. Last September, researchers from the National Institutes of Health found that people who claimed to enjoy “an intimate relationship with God” possess bigger-than-average right middle temporal cortices. And a Swedish study from 2003 suggests that people with fewer serotonin receptors may be more open to spiritual experiences.
For the moment, though, there is no way to predict who will be transformed by AA. And often, the people who become Wilson’s most passionate disciples are those you’d least expect. “I always thought I was too smart for AA,” a bespectacled, Nordic-looking man named Gary shared at a meeting in Hell’s Kitchen this past winter. “I’m a classical musician, a math and statistics geek. I was the biggest agnostic you ever met. But I just wrecked my life with alcohol and drugs and codependent relationships.”
And now, after more than four years in the program? “I know God exists,” he says. “I’m so happy I found AA.”
Maybe one day we’ll discover that there’s a quirk in Gary’s genetic makeup that made his prefrontal cortex particularly susceptible to the 12 steps. But all that really matters now is that he’s sober.
Contributing editor Brendan I. Koerner (brendan_koerner@wired.com
A worried murmur ripples through the room. “Wha… what are we supposed to do?” asks a woman in her mid-twenties with smudged black eyeliner. She’s in rough shape, having emerged from a multiday alcohol-and-cocaine bender that morning. “The snow, it’s going to close everything,” she says, her cigarette-addled voice tinged with panic. “Everything!” She’s on the verge of tears.
A mustachioed man in skintight jeans stands and reads off the number for a hotline that provides up-to-the-minute meeting schedules. He assures his fellow alcoholics that some groups will still convene tomorrow despite the weather. Anyone who needs an AA fix will be able to get one, though it may require an icy trek across the city.
That won’t be a problem for a thickset man in a baggy beige sweat suit. “Doesn’t matter how much snow we get—a foot, 10 feet piled up in front of the door,” he says. “I will leave my apartment tomorrow and go find a meeting.”
He clasps his hands together and draws them to his heart: “You understand me? I need this.” Daily meetings, the man says, are all that prevent him from winding up dead in the gutter, shoes gone because he sold them for booze or crack. And he hasn’t had a drink in more than a decade.
The resolve is striking, though not entirely surprising. AA has been inspiring this sort of ardent devotion for 75 years. It was in June 1935, amid the gloom of the Great Depression, that a failed stockbroker and reformed lush named Bill Wilson founded the organization after meeting God in a hospital room. He codified his method in the 12 steps, the rules at the heart of AA. Entirely lacking in medical training, Wilson created the steps by cribbing ideas from religion and philosophy, then massaging them into a pithy list with a structure inspired by the Bible.
The 200-word instruction set has since become the cornerstone of addiction treatment in this country, where an estimated 23 million people grapple with severe alcohol or drug abuse—more than twice the number of Americans afflicted with cancer. Some 1.2 million people belong to one of AA’s 55,000 meeting groups in the US, while countless others embark on the steps at one of the nation’s 11,000 professional treatment centers. Anyone who seeks help in curbing a drug or alcohol problem is bound to encounter Wilson’s system on the road to recovery.
It’s all quite an achievement for a onetime broken-down drunk. And Wilson’s success is even more impressive when you consider that AA and its steps have become ubiquitous despite the fact that no one is quite sure how—or, for that matter, how well—they work. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore.
What we do know, however, is that despite all we’ve learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better. “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps,” says Drew Pinsky, the addiction-medicine specialist who hosts VH1’s Celebrity Rehab. “In my world, if someone says they don’t want to do the 12 steps, I know they aren’t going to get better.”
Wilson may have operated on intuition, but somehow he managed to tap into mechanisms that counter the complex psychological and neurological processes through which addiction wreaks havoc. And while AA’s ability to accomplish this remarkable feat is not yet understood, modern research into behavior dynamics and neuroscience is beginning to provide some tantalizing clues.
One thing is certain, though: AA doesn’t work for everybody. In fact, it doesn’t work for the vast majority of people who try it. And understanding more about who it does help, and why, is likely our best shot at finally developing a system that improves on Wilson’s amateur scheme for living without the bottle.
AA doesn't work for everybody, but when it does, it can be transformative. Members receive tokens to mark periods of sobriety, from 24 hours to one month to 55 years.
Photo: Todd Tankersley
AA originated on the worst night of Bill Wilson’s life. It was December 14, 1934, and Wilson was drying out at Towns Hospital, a ritzy Manhattan detox center. He’d been there three times before, but he’d always returned to drinking soon after he was released. The 39-year-old had spent his entire adult life chasing the ecstasy he had felt upon tasting his first cocktail some 17 years earlier. That quest destroyed his career, landed him deeply in debt, and convinced doctors that he was destined for institutionalization.
Wilson had been quite a mess when he checked in the day before, so the attending physician, William Silkworth, subjected him to a detox regimen known as the Belladonna Cure—hourly infusions of a hallucinogenic drug made from a poisonous plant. The drug was coursing through Wilson’s system when he received a visit from an old drinking buddy, Ebby Thacher, who had recently found religion and given up alcohol. Thacher pleaded with Wilson to do likewise. “Realize you are licked, admit it, and get willing to turn your life over to God,” Thacher counseled his desperate friend. Wilson, a confirmed agnostic, gagged at the thought of asking a supernatural being for help.
But later, as he writhed in his hospital bed, still heavily under the influence of belladonna, Wilson decided to give God a try. “If there is a God, let Him show Himself!” he cried out. “I am ready to do anything. Anything!”
What happened next is an essential piece of AA lore: A white light filled Wilson’s hospital room, and God revealed himself to the shattered stockbroker. “It seemed to me, in the mind’s eye, that I was on a mountain and that a wind not of air but of spirit was blowing,” he later said. “And then it burst upon me that I was a free man.” Wilson would never drink again.
At that time, the conventional wisdom was that alcoholics simply lacked moral fortitude. The best science could offer was detoxification with an array of purgatives, followed by earnest pleas for the drinker to think of his loved ones. When this approach failed, alcoholics were often consigned to bleak state hospitals. But having come back from the edge himself, Wilson refused to believe his fellow inebriates were hopeless. He resolved to save them by teaching them to surrender to God, exactly as Thacher had taught him.
Following Thacher’s lead, Wilson joined the Oxford Group, a Christian movement that was in vogue among wealthy mainstream Protestants. Headed by a an ex-YMCA missionary named Frank Buchman, who stirred controversy with his lavish lifestyle and attempts to convert Adolf Hitler, the Oxford Group combined religion with pop psychology, stressing that all people can achieve happiness through moral improvement. To help reach this goal, the organization’s members were encouraged to meet in private homes so they could study devotional literature together and share their inmost thoughts.
In May 1935, while on an extended business trip to Akron, Ohio, Wilson began attending Oxford Group meetings at the home of a local industrialist. It was through the group that he met a surgeon and closet alcoholic named Robert Smith. For weeks, Wilson urged the oft-soused doctor to admit that only God could eliminate his compulsion to drink. Finally, on June 10, 1935, Smith (known to millions today as Dr. Bob) gave in. The date of Dr. Bob’s surrender became the official founding date of Alcoholics Anonymous.
In its earliest days, AA existed within the confines of the Oxford Group, offering special meetings for members who wished to end their dependence on alcohol. But Wilson and his followers quickly broke away, in large part because Wilson dreamed of creating a truly mass movement, not one confined to the elites Buchman targeted. To spread his message of salvation, Wilson started writing what would become AA’s sacred text: Alcoholics Anonymous, now better known as the Big Book.
The core of AA is found in chapter five, entitled “How It Works.” It is here that Wilson lists the 12 steps, which he first scrawled out in pencil in 1939. Wilson settled on the number 12 because there were 12 apostles.
In writing the steps, Wilson drew on the Oxford Group’s precepts and borrowed heavily from William James’ classic The Varieties of Religious Experience, which Wilson read shortly after his belladonna-fueled revelation at Towns Hospital. He was deeply affected by an observation that James made regarding alcoholism: that the only cure for the affliction is “religiomania.” The steps were thus designed to induce an intense commitment, because Wilson wanted his system to be every bit as habit-forming as booze.
The first steps famously ask members to admit their powerlessness over alcohol and to appeal to a higher power for help. Members are then required to enumerate their faults, share them with their meeting group, apologize to those they’ve wronged, and engage in regular prayer or meditation. Finally, the last step makes AA a lifelong duty: “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.” This requirement guarantees not only that current members will find new recruits but that they can never truly “graduate” from the program.
Aside from the steps, AA has one other cardinal rule: anonymity. Wilson was adamant that the anonymous component of AA be taken seriously, not because of the social stigma associated with alcoholism, but rather to protect the nascent organization from ridicule. He explained the logic in a letter to a friend:
[In the past], alcoholics who talked too much on public platforms were likely to become inflated and get drunk again. Our principle of anonymity, so far as the general public is concerned, partly corrects this difficulty by preventing any individual receiving a lot of newspaper or magazine publicity, then collapsing and discrediting AA.
AA boomed in the early 1940s, aided by a glowing Saturday Evening Post profile and the public admission by a Cleveland Indians catcher, Rollie Hemsley, that joining the organization had done wonders for his game. Wilson and the founding members were not quite prepared for the sudden success. “You had really crazy things going on,” says William L. White, author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. “Some AA groups were preparing to run AA hospitals, and there was this whole question of whether they should have paid AA missionaries. You even had some reports of AA groups drinking beers at their meetings.”
The growing pains spurred Wilson to write AA’s governing principles, known as the 12 traditions. At a time when fraternal orders and churches with strict hierarchies dominated American social life, Wilson opted for something revolutionary: deliberate organizational chaos. He permitted each group to set its own rules, as long as they didn’t conflict with the traditions or the steps. Charging a fee was forbidden, as was the use of the AA brand to endorse anything that might generate revenue. “If you look at this on paper, it seems like it could never work,” White says. “It’s basically anarchy.” But this loose structure actually helped AA flourish. Not only could anyone start an AA group at any time, but they could tailor each meeting to suit regional or local tastes. And by condemning itself to poverty, AA maintained a posture of moral legitimacy.
Despite the decision to forbid members from receiving pay for AA-related activity, it had no problem letting professional institutions integrate the 12 steps into their treatment programs. AA did not object when Hazelden, a Minnesota facility founded in 1947 as “a sanatorium for curable alcoholics of the professional class,” made the steps the foundation of its treatment model. Nor did AA try to stop the proliferation of steps-centered addiction groups from adopting the Anonymous name: Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous. No money ever changed hands—the steps essentially served as open source code that anyone was free to build upon, adding whatever features they wished. (Food Addicts Anonymous, for example, requires its members to weigh their meals.)
By the early 1950s, as AA membership reached 100,000, Wilson began to step back from his invention. Deeply depressed and an incorrigible chain smoker, he would go on to experiment with LSD before dying from emphysema in 1971. By that point, AA had become ingrained in American culture; even people who’d never touched a drop of liquor could name at least a few of the steps.
“For nearly 30 years, I have been saying Alcoholics Anonymous is the most effective self-help group in the world,” advice columnist Ann Landers wrote in 1986. “The good accomplished by this fellowship is inestimable … God bless AA.”
There’s no doubt that when AA works, it can be transformative. But what aspect of the program deserves most of the credit? Is it the act of surrendering to a higher power? The making of amends to people a drinker has wronged? The simple admission that you have a problem? Stunningly, even the most highly regarded AA experts have no idea. “These are questions we’ve been trying to answer for, golly, 30 or 40 years now,” says Lee Ann Kaskutas, senior scientist at the Alcohol Research Group in Emeryville, California. “We can’t find anything that completely holds water.”
The problem is so vexing, in fact, that addiction professionals have largely accepted that AA itself will always be an enigma. But research in other fields—primarily behavior change and neurology—offers some insight into what exactly is happening in those church basements.
To begin with, there is evidence that a big part of AA’s effectiveness may have nothing to do with the actual steps. It may derive from something more fundamental: the power of the group. Psychologists have long known that one of the best ways to change human behavior is to gather people with similar problems into groups, rather than treat them individually. The first to note this phenomenon was Joseph Pratt, a Boston physician who started organizing weekly meetings of tubercular patients in 1905. These groups were intended to teach members better health habits, but Pratt quickly realized they were also effective at lifting emotional spirits, by giving patients the chance to share their tales of hardship. (“In a common disease, they have a bond,” he would later observe.) More than 70 years later, after a review of nearly 200 articles on group therapy, a pair of Stanford University researchers pinpointed why the approach works so well: “Members find the group to be a compelling emotional experience; they develop close bonds with the other members and are deeply influenced by their acceptance and feedback.”
Researchers continue to be surprised by just how powerful this effect is. For example, a study published last year in the journal Behavior Therapy concluded that group therapy is highly effective in treating post-traumatic stress disorder: 88.3 percent of the study’s subjects who underwent group therapy no longer exhibited PTSD symptoms after completing their sessions, versus just 31.3 percent of those who received minimal one-on-one interaction.
The importance of this is reflected by the fact that the more deeply AA members commit to the group, rather than just the program, the better they fare. According to J. Scott Tonigan, a research professor at the University of New Mexico’s Center on Alcoholism, Substance Abuse, and Addictions, numerous studies show that AA members who become involved in activities like sponsorship—becoming a mentor to someone just starting out—are more likely to stay sober than those who simply attend meetings.
Addiction-medicine specialists often raise the concern that AA meetings aren’t led by professionals. But there is evidence that this may actually help foster a sense of intimacy between members, since the fundamental AA relationship is between fellow alcoholics rather than between alcoholics and the therapist. These close social bonds allow members to slowly learn how to connect to others without the lubricating effects of alcohol. In a study published last year in Alcoholism Treatment Quarterly, Tonigan found that “participation in AA is associated with an increased sense of security, comfort, and mutuality in close relationships.”
And close relationships, it turns out, have an even more profound effect on us than previously thought. A 2007 study of a Boston-area community, for example, found that a person’s odds of becoming obese increase by 71 percent if they have a same-sex friend who is also obese. (Wired covered the study in more detail in “The Buddy System,” issue 17.10.) And in April, a paper published in Annals of Internal Medicine concluded that a person is 50 percent more likely to be a heavy drinker if a friend or relative is a boozehound. Even if an alcoholic’s nonsober friends are outwardly supportive, simply being around people for whom drinking remains the norm can nudge someone into relapse. It is much safer to become immersed in AA’s culture, where activities such as studying the Big Book supplant hanging out with old acquaintances who tipple.
As for the steps themselves, there is evidence that the act of public confession—enshrined in the fifth step—plays an especially crucial role in the recovery process. When AA members stand up and share their emotionally searing tales of lost weekends, ruined relationships, and other liquor-fueled low points, they develop new levels of self-awareness. And that process may help reinvigorate the prefrontal cortex, a part of the brain that is gravely weakened by alcohol abuse.
To understand the prefrontal cortex’s role in both addiction and recovery, you first need to understand how alcohol affects the brain. Booze works its magic in an area called the mesolimbic pathway—the reward system. When we experience something pleasurable, like a fine meal or good sex, this pathway squirts out dopamine, a neurotransmitter that creates a feeling of bliss. This is how we learn to pursue behaviors that benefit us, our families, and our species.
When alcohol hits the mesolimbic pathway, it triggers the rapid release of dopamine, thereby creating a pleasurable high. For most people, that buzz simply isn’t momentous enough to become the focal point of their lives. Or if it is, they are able to control their desire to chase it with reckless abandon. But others aren’t so fortunate: Whether by virtue of genes that make them unusually sensitive to dopamine’s effects, or circumstances that lead them to seek chemical solace, they cannot resist the siren call of booze.
Once an alcoholic starts drinking heavily, the mesolimbic pathway responds by cutting down its production of dopamine. Alcohol also messes with the balance between two other neurotransmitters: GABA and glutamate. Alcohol spurs the release of more GABA, which inhibits neural activity, and clamps down on glutamate, which stimulates the brain. Combined with a shortage of dopamine, this makes the reward system increasingly lethargic, so it becomes harder and harder to rouse into action. That’s why long-term boozers must knock back seven or eight whiskeys just to feel “normal.” And why little else in life brings hardcore alcoholics pleasure of any kind.
As dependence grows, alcoholics also lose the ability to properly regulate their behavior. This regulation is the responsibility of the prefrontal cortex, which is charged with keeping the rest of the brain apprised of the consequences of harmful actions. But mind-altering substances slowly rob the cortex of so-called synaptic plasticity, which makes it harder for neurons to communicate with one another. When this happens, alcoholics become less likely to stop drinking, since their prefrontal cortex cannot effectively warn of the dangers of bad habits.
This is why even though some people may be fully cognizant of the problems that result from drinking, they don’t do anything to avoid them. “They’ll say, ‘Oh, my family is falling apart, I’ve been arrested twice,’” says Peter Kalivas, a neuroscientist at the Medical University of South Carolina in Charleston. “They can list all of these negative consequences, but they can’t take that information and manhandle their habits.”
The loss of synaptic plasticity is thought to be a major reason why more than 90 percent of recovering alcoholics relapse at some point. The newly sober are constantly bombarded with sensory cues that their brain associates with their pleasurable habit. Because the synapses in their prefrontal cortex are still damaged, they have a tough time resisting the urges created by these triggers. Any small reminder of their former life—the scent of stale beer, the clink of toasting glasses—is enough to knock them off the wagon.
AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape. Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone. This, in turn, prods the impaired prefrontal cortex into resuming its regulatory mission. “The brain is designed to respond to experiences,” says Steven Grant, chief of the clinical neuroscience branch of the National Institute on Drug Abuse. “I have no doubt that these therapeutic processes change the brain.” And the more that critical part of the brain is compelled to operate as designed, the more it springs back to its pre-addiction state. While it’s on the mend, AA functions as a temporary replacement—a prefrontal cortex made up of a cast of fellow drunks in a church basement, rather than neurons and synapses.
Finally, the 12 steps address another major risk factor for relapse: stress. Recovering alcoholics are often burdened by memories of the nasty things they did while wasted. When they bump into old acquaintances they mistreated, the guilt can become overwhelming. The resulting stress causes their brains to secrete a hormone that releases corticotropin, which has been shown to cause relapse in alcohol-dependent lab rats.
AA addresses this risk with the eighth and ninth steps, which require alcoholics to make amends to people they’ve wronged. This can alleviate feelings of guilt and in turn limit the stress that may undermine a person’s fragile sobriety.
Bill W., as Wilson is known today, didn’t know the first thing about corticotropin-releasing hormone or the prefrontal cortex, of course. His only aim was to harness spirituality in the hopes of giving fellow alcoholics the strength to overcome their disease. But in developing a system to lead drunks to God, he accidentally created something that deeply affects the brain—a system that has now lasted for three-quarters of a century and shows no signs of disappearing.
But how effective is AA? That seemingly simple question has proven maddeningly hard to answer. Ask an addiction researcher a straightforward question about AA’s success rate and you’ll invariably get a distressingly vague answer. Despite thousands of studies conducted over the decades, no one has yet satisfactorily explained why some succeed in AA while others don’t, or even what percentage of alcoholics who try the steps will eventually become sober as a result.
A big part of the problem, of course, is AA’s strict anonymity policy, which makes it difficult for researchers to track members over months and years. It is also challenging to collect data from chronic substance abusers, a population that’s prone to lying. But researchers are most stymied by the fact that AA’s efficacy cannot be tested in a randomized experiment, the scientific gold standard.
“If you try to randomly assign people to AA, you have a problem, because AA is free and is available all over the place,” says Alcohol Research Group’s Kaskutas. “Plus, some people will just hate it, and you can’t force them to keep going.” In other words, given the organization’s open-door membership policy, it would be nearly impossible for researchers to prevent people in a control group from sneaking off to an AA meeting and thereby tainting the data. On the other hand, many subjects would inevitably loathe AA and drop out of the study altogether.
Another research quandary is how to account for the selection effect. AA is known for doing a better job of retaining drinkers who’ve hit rock bottom than those who still have a ways to fall. But having totally destroyed their lives, the most desperate alcoholics may already be committed to sobriety before ever setting foot inside a church basement. If so, it might be their personal commitment, rather than AA, that is ultimately responsible for their ability to quit.
As a result of these complications, AA research tends to come to wildly divergent conclusions, often depending on an investigator’s biases. The group’s “cure rate” has been estimated at anywhere from 75 percent to 5 percent, extremes that seem far-fetched. Even the most widely cited (and carefully conducted) studies are often marred by obvious flaws. A 1999 meta-analysis of 21 existing studies, for example, concluded that AA members actually fared worse than drinkers who received no treatment at all. The authors acknowledged, however, that many of the subjects were coerced into attending AA by court order. Such forced attendees have little shot at benefiting from any sort of therapy—it’s widely agreed that a sincere desire to stop drinking is a mandatory prerequisite for getting sober.
Yet a growing body of evidence suggests that while AA is certainly no miracle cure, people who become deeply involved in the program usually do well over the long haul. In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization. The University of New Mexico’s Tonigan says the relationship between first-year attendance and long-term sobriety is small but valid: In the language of statistics, the correlation is around 0.3, which is right on the borderline between weak and modest (0 meaning no relationship, and 1.0 being a perfect one-to-one relationship).
“I’ve been involved in a couple of meta-analyses of AA, which collapse the findings across many studies,” Tonigan says. “They generally all come to the same conclusion, which is that AA is beneficial for many but not all individuals, and that the benefit is modest but significant … I think that is, scientifically speaking, a very valid statement.”
That statement is also supported by the results of a landmark study that examined how the steps perform when taught in clinical settings as opposed to church basements. Between 1989 and 1997, a multisite study called Project Match randomly assigned more than 1,700 alcoholics to one of three popular therapies used at professional treatment centers. The first was called 12-step facilitation, in which a licensed therapist guides patients through Bill Wilson’s method. The second was cognitive behavioral therapy, which trains alcoholics to identify the situations that spur them to drink, so they can avoid tempting circumstances. And the last was motivational enhancement therapy, a one-on-one interviewing process designed to sharpen a person’s reasons for getting sober.
Project Match ultimately concluded that all three of these therapies were more or less equally effective at reducing alcohol intake among subjects. But 12-step facilitation clearly beat the competition in two important respects: It was more effective for alcoholics without other psychiatric problems, and it did a better job of inspiring total abstinence as opposed to a mere reduction in drinking. The steps, in other words, actually worked slightly better than therapies of more recent vintage, which were devised by medical professionals rather than an alcoholic stockbroker.
AA is still far from ideal. The sad fact remains that the program’s failures vastly outnumber its success stories. According to Tonigan, upwards of 70 percent of people who pass through AA will never make it to their one-year anniversary, and relapse is common even among regular attendees. This raises an important question: Are there ways to improve Wilson’s aging system?
AA is obviously not about to overhaul its 75-year-old formula. But there are a few alterations that would almost certainly make the program work for more people, starting with better quality control. Since no central body regulates the day-to-day operations of local groups, some meetings are dominated by ornery old-timers who delight in belittling newcomers. Others are prowled by men looking to introduce nubile newcomers to the “13th step”—AA slang for sexual exploitation. Finding a way to impose some basic oversight of such bad behavior would likely reduce the dropout rate.
Some AA groups would also do well to shed their resistance to medication. There is nothing in the Big Book that forbids the use of prescription drugs, but there are plenty of meetings where such pharmaceutical aids are frowned upon. Perhaps this sentiment made sense back in AA’s formative years, when a variety of snake oils were touted as alcoholism cures. But today there are several medications that have been proven to decrease the odds of relapse. One such drug, acamprosate, restores a healthy balance between glutamate and GABA, two of the neurotransmitters that get out of whack in the brains of alcoholics. Naltrexone, commonly used to treat heroin addiction, appears effective at preventing relapse by alcoholics who possess a certain genetic variant related to an important mu-opioid receptor. Both can be valuable aids in the recovery process.
But the best way to bolster AA’s success rate may be to increase the personalization of addiction medicine. “We’re starting to get an inkling that something about the initial state of the brain prior to therapy may be predictive as to whether that therapy will be a success,” says Grant of the National Institute on Drug Abuse. In other words, certain brains may be primed to respond well to some therapies and less so to others.
NIDA and other government agencies are currently funding several studies that aim to use neural imaging technology to observe how various therapies affect addicted brains. One alcoholic might have a mesolimbic pathway that normalizes quickly after receiving a certain type of therapy, for example, while another will still suffer from dopamine disregulation despite receiving the same care. The hope is that these studies will reveal whether neurobiology can be used to predict a person’s odds of benefitting from one treatment over another. Perhaps there is one sort of mind that is cut out for the cognitive behavioral approach and another that can be helped only by the 12 steps.
A person’s openness to the concept of spiritual rebirth, as determined by their neural makeup, could indicate whether they’ll embrace the steps. Last September, researchers from the National Institutes of Health found that people who claimed to enjoy “an intimate relationship with God” possess bigger-than-average right middle temporal cortices. And a Swedish study from 2003 suggests that people with fewer serotonin receptors may be more open to spiritual experiences.
For the moment, though, there is no way to predict who will be transformed by AA. And often, the people who become Wilson’s most passionate disciples are those you’d least expect. “I always thought I was too smart for AA,” a bespectacled, Nordic-looking man named Gary shared at a meeting in Hell’s Kitchen this past winter. “I’m a classical musician, a math and statistics geek. I was the biggest agnostic you ever met. But I just wrecked my life with alcohol and drugs and codependent relationships.”
And now, after more than four years in the program? “I know God exists,” he says. “I’m so happy I found AA.”
Maybe one day we’ll discover that there’s a quirk in Gary’s genetic makeup that made his prefrontal cortex particularly susceptible to the 12 steps. But all that really matters now is that he’s sober.
Contributing editor Brendan I. Koerner (brendan_koerner@wired.com
Since 2008, celebrating the Fourth of July has meant enjoying a 3-day weekend. With parades, picnics, and fireworks, the festivities can all too often
Since 2008, celebrating the Fourth of July has meant enjoying a 3-day weekend. With parades, picnics, and fireworks, the festivities can all too often lead to a trip to the hospital emergency room for underage individuals who have been consuming alcohol.
On an average July day in 2008, there were 502 emergency department (ED) visits involving underage alcohol use across the United States, according to estimates from the Drug Abuse Warning Network (DAWN). Over the 3-day Fourth of July holiday weekend, however, the number of daily ED visits jumped to 938, an increase of 87 percent. Figure 1 provides some additional details concerning underage alcohol consumption.While all underage alcohol consumption is of concern, consumption that leads to a hospital visit should be of particular concern to adults and to health care professionals. For everyone interested in preventing underage drinking, SAMHSA offers educational and other materials at: http://www.underagedrinking.samhsa.gov/.
http://oas.samhsa.gov/spotlight/Spotlight003UnderageAlcoholUse.pdf
On an average July day in 2008, there were 502 emergency department (ED) visits involving underage alcohol use across the United States, according to estimates from the Drug Abuse Warning Network (DAWN). Over the 3-day Fourth of July holiday weekend, however, the number of daily ED visits jumped to 938, an increase of 87 percent. Figure 1 provides some additional details concerning underage alcohol consumption.While all underage alcohol consumption is of concern, consumption that leads to a hospital visit should be of particular concern to adults and to health care professionals. For everyone interested in preventing underage drinking, SAMHSA offers educational and other materials at: http://www.underagedrinking.samhsa.gov/.
http://oas.samhsa.gov/spotlight/Spotlight003UnderageAlcoholUse.pdf
Monday 8 March 2010
New Survey Again Raises Alarm About Teen Drug Use, Attitudes
By Bob Curley
A new report finds that more kids say they are using alcohol and other drugs, but many parents are unable or unwilling to deal with the issue -- a bad combination when declining support for prevention and cultural apathy about the issue leave parents as the last and sometimes only line of defense against adolescent drug use.
The 2009 Partnership Attitude Tracking Study (PATS), released March 2 by the Partnership for a Drug-Free America (PDFA) and MetLife Foundation, reported rather dramatic year-over-year spikes in past-month alcohol use (up 11 percent) and past-year use of marijuana (up 19 percent) and ecstasy (up 67 percent) among U.S. students in grades 9-12.
PDFA chairman and CEO Steve Pasierb noted that all three are "social drugs," and the survey of more than 3,200 students, conducted by Roper Public Affairs, found "a growing belief in the benefits and acceptability of drug use and drinking." For example, the percentage of teens agreeing that "being high feels good" increased from 45 percent in 2008 to 51 percent in 2009, and those who said "friends usually get high at parties" increased from 69 percent to 75 percent. Thirty percent of students surveyed strongly agreed that they "don't want to hang around drug users," down from 35 percent in 2008.
"The resurgence in teen drug and alcohol use comes at a time when pro-drug cues in popular culture – in film, television and online – abound, and when funding for federal prevention programs has been declining for several years," according to a PDFA press release on the survey.
The reported spike in alcohol and other drug use and attitudinal shifts are startling enough to warrant skepticism about the validity of the findings. However, Pasierb notes that the PATS survey has been conducted using the same methodology for the past 21 years. The most recent Monitoring the Future survey, released in December, also found that use of illicit drugs has leveled off or increased after years of steady declines, and that youth attitudes about drug use appear to be softening. The 2009 PRIDE Survey of 6th- to 9th-graders reported small increases in current drug use, as well.
The PATS survey found that kids are almost as likely to get information on drugs from the Internet and websites like Youtube as from their parents, school, or media ads. "The preponderance of information that kids get online about drugs is pro-use, and to teens it's more credible," Pasierb told Join Together.
Perhaps the most surprising survey result is the reported increase in use of ecstasy -- a drug that, unlike alcohol and marijuana, has seemed to largely disappear from public consciousness since the mid-2000s. If the survey results are to be believed, more teens are now using ecstasy on a monthly (6 percent) or annual (10 percent) basis than at any point since 2004, and reported lifetime use is higher than ever reported since 1998.
Pasierb said that federal data shows that availability of ecstasy has not declined since 2001-02, and that prices for the drug have fallen. "There was just more news coverage then," he said.
"I don't buy the argument that drug use is cyclical," said Pasierb. "I think it's generational, and based on what we talk to our kids about." Drug-use trends among youth are "very malleable," he added, and what is considered cool or popular can change rapidly from the time a kid enters high school to when they graduate.
Parents Waging a Lonely Battle -- Or Not
About 20 percent of the parents surveyed by PATS believed that their children had gone beyond the experimental phase in use of alcohol or other drugs. However, almost half of these parents either did not take any action (25 percent) or waited for between a month and a year to address the perceived problem (22 percent).
Parents of children engaging in non-experimental drug use were less confident in their ability to influence their kids' drug-use decisions, according to the survey, and were more likely to believe that all teens will experiment with drugs and that occasional use of alcohol or marijuana is tolerable.
"Parents with drug-using kids have never been served by our field," said Pasierb. "They're the outliers, and they should be the focus." PDFA has developed a program called Time to Act that is designed to improve parental knowledge about teen alcohol and other drug use, set rules and boundaries, intervene when necessary, and seek outside help when needed.
"Government prevention programs have all been defunded, and society is not on our side. It's all on the parents now," said Pasierb. "Parents are convinced that their kids are getting all this (drug prevention) in school, and it's just not true. The doctor, school, or football coach is not going to step in."
COMMENTS ON THIS ARTICLE:
Posted by Dan Iser on 03 Mar 10 11:10 AM EST
It would appear that the "cultural apathy" has also filtered into the decisionmaking process that our congressional leaders utilize to determine funding for prevention. Most recently they voted to eliminate the state grants portion of the federal safe and drug-free schools program. This program provided nearly $300 million in funds to all school districts across our nation. Congress eliminated this valuable program because the amount that the average school district received was not enough to make a real difference in prevention substance abuse and violence. Many school-community anti-drug coalitions will be devasted by this action once the flow of funding stops during the 2010-2011 school year. Isn't it about time that we adopted a lesson learned by the tobacco lawyers. We need to sue someone and even perhaps the federal government itself. In realitity it was the Supreme Court that reversed prohibition that allowed the free flow of alcohol across our nation. And isn't it the responsibility of our legal and judicial system at the federal level to stop the passage of heroin and other illegal substances from coming across our borders. How often do you hear that federal agents have been monitoring the flow of illegal drugs from Mexico, South America, etc., and then from one state to another, and finally to the street corner of our communities. This process takes months and even years in order to "build a solid case". In the meantime, more of our children and young adults continue to make purchases and are well on their way to becoming full blow addicts.
Posted by Susie Vanderlip on 03 Mar 10 11:54 AM EST
This article confirms what I'm seeing especially over the last 6 months as a significant decrease in school and societal acknowledgement of the alcohol and drug use and abuse problem among teens. I am a prevention and healthy choices speakers to teens in middle and high schools and the interest in assemblies addressing these issues has severely declined in recent months. Yes, school budgets are struggling, but even Obama's state of the union address did not mention the alcohol/drug issue, and funding has been cut to Safe and Drug Free Schools. Add to that the push to legalize marijuana and apparent message to teens that pot is "safe and everybody's doing it," we are creating the perfect storm for an epidemic alcohol and drug problem in the current generation of youth and into their adult/family futures.
Posted by Lorinda Strang - Orchard Recovery Center on 03 Mar 10 11:55 AM EST
Time to Act - A must read for all parents
Posted by Diane on 03 Mar 10 12:21 PM EST
An interesting statistic to me is that "the percentage of teens agreeing that "being high feels good" increased from 45 percent in 2008 to 51 percent in 2009". Would people really get high if it didn't "feel good"? It's like saying "people eat to fill full". The other reason people use (besides after become addicted) is what?
Posted by A Parent on 03 Mar 10 12:51 PM EST
Let's stop whining about the decrease in government funding and put the pressure to educate our children about drugs, alcohol, and life in general where it should be - the parents. Our schools can't even adequately educate our children in normal educational areas (reading, writing, math, science). How will they ever be able to if they're also having to raise our children?
Posted by Ruth on 03 Mar 10 01:38 PM EST
Being a parent of a recovering addict I started a Life Skills Prevention Org.In order to prevent addiction, teaching life skills from 5th grade on is imperative..boosting self-esteem as well as giving students the tools to make healthy choices in order to live life on life's terms. For this to have a better chance of working, parents need to be involved in this process through forums and workshops, to be heard.and able to seek advice through Q & A. On another note; maybe when kids say "being high feels good" they are those in the experimental stage,and are they really feeling good? Or, are they running from themselves and that's what feels good? If those in the addiction stage were asked I know the answer would not be the same....they're not feeling good..they're not feeling! We owe it to the next generation of adults, our children, to prevent addiction and their consequences by teaching life skills, working with parents and present Staff Development in Schools. Proact not React!!!!
Posted by Dave on 03 Mar 10 01:43 PM EST
The other reason people use is to stop feeling bad. Depression, anxiety, problems in living all can be (temporarily) removed with alcohol or drugs. You may not feel good, but at least you don't feel so bad. In recovery we need to address both issues: people need to find new healthy ways to get "high" and they also need to find ways to cope with stress and other things that make them unhappy. From a prevention standpoint, these skills are precisely what parents can model to their children to protect them from the increasingly addictive character of our culture. The problem though is not only that the parents lack confidence or hope that they can help their kids; even more its that the parents themselves are engaging in addictive behaviors focussed on self-centered, pleasure oriented quick fixes. What we need is a new spirit of community and mutual responsibility rather than the post modern nihilism or the know-it-all fundamentalism that currently dominates our culture. These statistics are truly frightening: we could be seeing the beginning of the decline and fall of European/U.S. culture.
Posted by Jerry Epstein on 03 Mar 10 01:48 PM EST
The National Commission on Marihuana and Drug Abuse commissioned by President Nixon - 1973 report "Drug Use In America: Problem in Perspective" "We are convinced that public policy, as presently designed, is premised on incorrect assumptions ... " Unless present policy is redirected, we will perpetuate the same problems, tolerate the same social costs, and find ourselves as we do now, no further along the road to a more rational legal and social approach than we were in 1914." Their main target was alcohol (over 80% of all drug use and addiction) and (for all drugs) the vital distinction between use and abuse The foofaraw about SPECIFIC drugs and periodic faddish fluctuations just distracts from fundamental analysis. Prohibition = drug cartels = schools flooded with all drugs at a critical age. False assumptions still abound; policy must be " redirected." Parents ability to educate is damaged by the hypocrisy and much more.
Posted by Susie Vanderlip on 03 Mar 10 01:53 PM EST
Diane asked, "The other reason people use is what?" The answer from my experience is to cope with/avoid feelings. Thousands of conversations with using teens after school assemblies and via email has made it abundantly clear to me that many use to cope with feelings they do not have a clue about what to do with: grief, loss, self-loathing, abandonment, verbal abuse wounds, hopelessness plus PTSD and persistent anxiety from the influence of domestic violence throughout childhood and more. I recommend we focus on developing healthy emotional coping skills in youth - call it stress management if you must - but deal with some of the underlying emotional issues.
Posted by MyThoughts on 03 Mar 10 02:33 PM EST
It's true, it's all about the parents. We are the ones who brought them into the world and it's up to us to teach them about it. I would never assume someone else is doing this for my kids especially gov't or any institution for that matter. I have to say that I have surrounded myself with people who mostly think like I do and I feel that they aid me in my dialog with my kids but I do not depend on them to set a direction for my kids. It takes a village to find others who can help but it still comes down to what you do personally (as well as your level of knowledge on the subject). Stop looking for others to do what you should be doing and start doing it now(find out and take action). Sorry if you read brashness or directness it's just the best way I believe to approach a subject like this. Kids will learn about their world... if you are involved you will be less surprised by the outcome of the lessons learned. It is a shame that kids find it easier to get illicit drugs in school than some very resourceful parents but that is a direct characteristic of the current prohibition policy and that my friends is another very related topic.
Posted by John from Oceanside on 03 Mar 10 04:31 PM EST
Look at the numbers. The drug legalizers Drug Policy Alliance(DPA) and Marijuana Policy Project(MPP) keep stating President Bush's failed drug policy but in the bush years he cut drug use 25% over his 8 years in office. Since the Obama administration has taken over he has let his statement about marijuana be spinned by DPA and MPP. His statements are no different than President Bush but when DPA and MPP spin his words the next day he has the Drug Tzar respond but the media never picks up his statements. This is al
A new report finds that more kids say they are using alcohol and other drugs, but many parents are unable or unwilling to deal with the issue -- a bad combination when declining support for prevention and cultural apathy about the issue leave parents as the last and sometimes only line of defense against adolescent drug use.
The 2009 Partnership Attitude Tracking Study (PATS), released March 2 by the Partnership for a Drug-Free America (PDFA) and MetLife Foundation, reported rather dramatic year-over-year spikes in past-month alcohol use (up 11 percent) and past-year use of marijuana (up 19 percent) and ecstasy (up 67 percent) among U.S. students in grades 9-12.
PDFA chairman and CEO Steve Pasierb noted that all three are "social drugs," and the survey of more than 3,200 students, conducted by Roper Public Affairs, found "a growing belief in the benefits and acceptability of drug use and drinking." For example, the percentage of teens agreeing that "being high feels good" increased from 45 percent in 2008 to 51 percent in 2009, and those who said "friends usually get high at parties" increased from 69 percent to 75 percent. Thirty percent of students surveyed strongly agreed that they "don't want to hang around drug users," down from 35 percent in 2008.
"The resurgence in teen drug and alcohol use comes at a time when pro-drug cues in popular culture – in film, television and online – abound, and when funding for federal prevention programs has been declining for several years," according to a PDFA press release on the survey.
The reported spike in alcohol and other drug use and attitudinal shifts are startling enough to warrant skepticism about the validity of the findings. However, Pasierb notes that the PATS survey has been conducted using the same methodology for the past 21 years. The most recent Monitoring the Future survey, released in December, also found that use of illicit drugs has leveled off or increased after years of steady declines, and that youth attitudes about drug use appear to be softening. The 2009 PRIDE Survey of 6th- to 9th-graders reported small increases in current drug use, as well.
The PATS survey found that kids are almost as likely to get information on drugs from the Internet and websites like Youtube as from their parents, school, or media ads. "The preponderance of information that kids get online about drugs is pro-use, and to teens it's more credible," Pasierb told Join Together.
Perhaps the most surprising survey result is the reported increase in use of ecstasy -- a drug that, unlike alcohol and marijuana, has seemed to largely disappear from public consciousness since the mid-2000s. If the survey results are to be believed, more teens are now using ecstasy on a monthly (6 percent) or annual (10 percent) basis than at any point since 2004, and reported lifetime use is higher than ever reported since 1998.
Pasierb said that federal data shows that availability of ecstasy has not declined since 2001-02, and that prices for the drug have fallen. "There was just more news coverage then," he said.
"I don't buy the argument that drug use is cyclical," said Pasierb. "I think it's generational, and based on what we talk to our kids about." Drug-use trends among youth are "very malleable," he added, and what is considered cool or popular can change rapidly from the time a kid enters high school to when they graduate.
Parents Waging a Lonely Battle -- Or Not
About 20 percent of the parents surveyed by PATS believed that their children had gone beyond the experimental phase in use of alcohol or other drugs. However, almost half of these parents either did not take any action (25 percent) or waited for between a month and a year to address the perceived problem (22 percent).
Parents of children engaging in non-experimental drug use were less confident in their ability to influence their kids' drug-use decisions, according to the survey, and were more likely to believe that all teens will experiment with drugs and that occasional use of alcohol or marijuana is tolerable.
"Parents with drug-using kids have never been served by our field," said Pasierb. "They're the outliers, and they should be the focus." PDFA has developed a program called Time to Act that is designed to improve parental knowledge about teen alcohol and other drug use, set rules and boundaries, intervene when necessary, and seek outside help when needed.
"Government prevention programs have all been defunded, and society is not on our side. It's all on the parents now," said Pasierb. "Parents are convinced that their kids are getting all this (drug prevention) in school, and it's just not true. The doctor, school, or football coach is not going to step in."
COMMENTS ON THIS ARTICLE:
Posted by Dan Iser on 03 Mar 10 11:10 AM EST
It would appear that the "cultural apathy" has also filtered into the decisionmaking process that our congressional leaders utilize to determine funding for prevention. Most recently they voted to eliminate the state grants portion of the federal safe and drug-free schools program. This program provided nearly $300 million in funds to all school districts across our nation. Congress eliminated this valuable program because the amount that the average school district received was not enough to make a real difference in prevention substance abuse and violence. Many school-community anti-drug coalitions will be devasted by this action once the flow of funding stops during the 2010-2011 school year. Isn't it about time that we adopted a lesson learned by the tobacco lawyers. We need to sue someone and even perhaps the federal government itself. In realitity it was the Supreme Court that reversed prohibition that allowed the free flow of alcohol across our nation. And isn't it the responsibility of our legal and judicial system at the federal level to stop the passage of heroin and other illegal substances from coming across our borders. How often do you hear that federal agents have been monitoring the flow of illegal drugs from Mexico, South America, etc., and then from one state to another, and finally to the street corner of our communities. This process takes months and even years in order to "build a solid case". In the meantime, more of our children and young adults continue to make purchases and are well on their way to becoming full blow addicts.
Posted by Susie Vanderlip on 03 Mar 10 11:54 AM EST
This article confirms what I'm seeing especially over the last 6 months as a significant decrease in school and societal acknowledgement of the alcohol and drug use and abuse problem among teens. I am a prevention and healthy choices speakers to teens in middle and high schools and the interest in assemblies addressing these issues has severely declined in recent months. Yes, school budgets are struggling, but even Obama's state of the union address did not mention the alcohol/drug issue, and funding has been cut to Safe and Drug Free Schools. Add to that the push to legalize marijuana and apparent message to teens that pot is "safe and everybody's doing it," we are creating the perfect storm for an epidemic alcohol and drug problem in the current generation of youth and into their adult/family futures.
Posted by Lorinda Strang - Orchard Recovery Center on 03 Mar 10 11:55 AM EST
Time to Act - A must read for all parents
Posted by Diane on 03 Mar 10 12:21 PM EST
An interesting statistic to me is that "the percentage of teens agreeing that "being high feels good" increased from 45 percent in 2008 to 51 percent in 2009". Would people really get high if it didn't "feel good"? It's like saying "people eat to fill full". The other reason people use (besides after become addicted) is what?
Posted by A Parent on 03 Mar 10 12:51 PM EST
Let's stop whining about the decrease in government funding and put the pressure to educate our children about drugs, alcohol, and life in general where it should be - the parents. Our schools can't even adequately educate our children in normal educational areas (reading, writing, math, science). How will they ever be able to if they're also having to raise our children?
Posted by Ruth on 03 Mar 10 01:38 PM EST
Being a parent of a recovering addict I started a Life Skills Prevention Org.In order to prevent addiction, teaching life skills from 5th grade on is imperative..boosting self-esteem as well as giving students the tools to make healthy choices in order to live life on life's terms. For this to have a better chance of working, parents need to be involved in this process through forums and workshops, to be heard.and able to seek advice through Q & A. On another note; maybe when kids say "being high feels good" they are those in the experimental stage,and are they really feeling good? Or, are they running from themselves and that's what feels good? If those in the addiction stage were asked I know the answer would not be the same....they're not feeling good..they're not feeling! We owe it to the next generation of adults, our children, to prevent addiction and their consequences by teaching life skills, working with parents and present Staff Development in Schools. Proact not React!!!!
Posted by Dave on 03 Mar 10 01:43 PM EST
The other reason people use is to stop feeling bad. Depression, anxiety, problems in living all can be (temporarily) removed with alcohol or drugs. You may not feel good, but at least you don't feel so bad. In recovery we need to address both issues: people need to find new healthy ways to get "high" and they also need to find ways to cope with stress and other things that make them unhappy. From a prevention standpoint, these skills are precisely what parents can model to their children to protect them from the increasingly addictive character of our culture. The problem though is not only that the parents lack confidence or hope that they can help their kids; even more its that the parents themselves are engaging in addictive behaviors focussed on self-centered, pleasure oriented quick fixes. What we need is a new spirit of community and mutual responsibility rather than the post modern nihilism or the know-it-all fundamentalism that currently dominates our culture. These statistics are truly frightening: we could be seeing the beginning of the decline and fall of European/U.S. culture.
Posted by Jerry Epstein on 03 Mar 10 01:48 PM EST
The National Commission on Marihuana and Drug Abuse commissioned by President Nixon - 1973 report "Drug Use In America: Problem in Perspective" "We are convinced that public policy, as presently designed, is premised on incorrect assumptions ... " Unless present policy is redirected, we will perpetuate the same problems, tolerate the same social costs, and find ourselves as we do now, no further along the road to a more rational legal and social approach than we were in 1914." Their main target was alcohol (over 80% of all drug use and addiction) and (for all drugs) the vital distinction between use and abuse The foofaraw about SPECIFIC drugs and periodic faddish fluctuations just distracts from fundamental analysis. Prohibition = drug cartels = schools flooded with all drugs at a critical age. False assumptions still abound; policy must be " redirected." Parents ability to educate is damaged by the hypocrisy and much more.
Posted by Susie Vanderlip on 03 Mar 10 01:53 PM EST
Diane asked, "The other reason people use is what?" The answer from my experience is to cope with/avoid feelings. Thousands of conversations with using teens after school assemblies and via email has made it abundantly clear to me that many use to cope with feelings they do not have a clue about what to do with: grief, loss, self-loathing, abandonment, verbal abuse wounds, hopelessness plus PTSD and persistent anxiety from the influence of domestic violence throughout childhood and more. I recommend we focus on developing healthy emotional coping skills in youth - call it stress management if you must - but deal with some of the underlying emotional issues.
Posted by MyThoughts on 03 Mar 10 02:33 PM EST
It's true, it's all about the parents. We are the ones who brought them into the world and it's up to us to teach them about it. I would never assume someone else is doing this for my kids especially gov't or any institution for that matter. I have to say that I have surrounded myself with people who mostly think like I do and I feel that they aid me in my dialog with my kids but I do not depend on them to set a direction for my kids. It takes a village to find others who can help but it still comes down to what you do personally (as well as your level of knowledge on the subject). Stop looking for others to do what you should be doing and start doing it now(find out and take action). Sorry if you read brashness or directness it's just the best way I believe to approach a subject like this. Kids will learn about their world... if you are involved you will be less surprised by the outcome of the lessons learned. It is a shame that kids find it easier to get illicit drugs in school than some very resourceful parents but that is a direct characteristic of the current prohibition policy and that my friends is another very related topic.
Posted by John from Oceanside on 03 Mar 10 04:31 PM EST
Look at the numbers. The drug legalizers Drug Policy Alliance(DPA) and Marijuana Policy Project(MPP) keep stating President Bush's failed drug policy but in the bush years he cut drug use 25% over his 8 years in office. Since the Obama administration has taken over he has let his statement about marijuana be spinned by DPA and MPP. His statements are no different than President Bush but when DPA and MPP spin his words the next day he has the Drug Tzar respond but the media never picks up his statements. This is al
If you have teenagers you must read this
http://www.jointogether.org/news/features/2010/new-survey-again-raises-alarm.html
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