Drug Treatment

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Drug treatment very stressful

Parents must realize that many teenagers try drugs. Good kids, from good families can become curious or succumb to peer pressure. Then, they may like the high it gives, or use it as an escape from their problems, and do it again and again. None of them think they're ``hooked'' but they also don't want to give it up.

If treatment is going to work, the teenager must buy in. For him to buy in, we might first find out how the drugs are disrupting his life -- is he getting in trouble at school, in trouble with the police, in a car accident while he was high? A drug program might offer to help him, with the police, with money (e.g. through the cooperation of the parents), car insurance, school, if he sticks with the program.
We also get parents off their backs. Parents must realize that drug treatment is a very stressful time for their teenager. This is not the time to be angry with him -- be tolerant, overlook other minor infractions, as long as he's in the drug program. Let's deal with the drugs first.

Parents are encouraged to join support groups, so they can release their anger, express their fears and disappointments, by sharing with other parents who have had similar experiences (and survived). They will realize that others have had their child lie and steal from them, too.
Downplay use

By the time a parent or a court has forced a child into a drug program, that child has probably experimented with several drugs. All kids minimize how much they use drugs, how dependent they are on them, and see no problem with ``minor'' drugs, like alcohol and marijuana. While they may understand (though not agree with) the treatment of a ``hard'' drug, like cocaine, they may resist mightily when the program insists that all drugs have to stop.

These kids are totally unprepared for the irritability, the fatigue, the difficulty sleeping, which occurs when the drugs stop. If they equated drugs with friends and a good time, they will also be very anxious and upset, thinking that life will be the pits (forever).

These kids can't ignore their old friends or all of a sudden have a new group of friends, especially because ``straight'' kids will have nothing to do with them. They have to be encouraged to be honest, to tell their old friends that they have to stay clean because they're undergoing urine testing and if they test positive there will be severe consequences, like going to jail or losing the use of the car.

Still, these kids will feel lonely so, it's very important to get them involved with other people and other activities, like a part-time job and/or joining a support group (e.g. Alcoholics Anonymous), so they can talk to other people who are going through the same ordeal. Regular counselling also helps, as it not only encourages and supports the teenager, but it also monitors him.

Kids will think that their family should trust them as soon as they join a drug program, but it isn't that simple. It took months, if not years, for that trust to break down, and it will take time to built it up. The child will need to know how he can realistically earn trust and independence, and parents must allow him to earn it (gradually).
Be patient

Most adolescents slip, have a few relapses, even after they start a drug program, so don't be devastated if it happens. If he slips very often, however, it means he's not ready for the treatment. For kids who are unco-operative, who frequently slip back into drugs, some hope that they will quickly sink so low that they will be motivated to kick the habit. One teen had to wake up in the gutter covered with her own vomit, before she decided that she wanted treatment.

No one recommends that parents become detectives but it is nonetheless true that they should keep their eyes and ears open. Don't ignore the signs. Too many parents think it can't happen to their child, that it only happens to ``bad'' kids or kids from dysfunctional families. It does happen to good, loving, decent kids, too, and it's so much easier to treat if it's caught in it's early stages.

Drug treatment may help sleep disorder

Dear Dr. Donohue: I was tested last year in a sleep clinic and was told I have central sleep apnea. I understood at the time that there is no cure for this. My main problem is sleepiness in the day that hinders my driving home from work in the dark. I explained to my boss and asked for a change of shift. As a result, I am now out of a job. I was let go. Is there something that can be done? - Y.C.
Answer: Besides a more understanding boss, your immediate need is for a return visit to that sleep clinic. There is help for people with your problem. More on this later.

You have the less common form of sleep apnea, which I should explain for other readers is periodic breathing disturbance that awakens the patient during sleep. The common form is obstructive apnea, brought about by physical obstruction to breathing. In central apnea, the problem lies in the brain's breathing control mechanism.

The symptoms of the two apneas vary also. In the obstructive kind, heavy snoring is interrupted by sudden silence, then awakening. In central apnea, snoring is not so much the symptom as is a sudden gasp and choking sound. This may happen countless times in a night.

It's easy to understand why you would have difficulty driving home after work. Such fitful sleep produces daytime drowsiness for even sedentary people, much more so for those engaged in constant activity.
There is help for central sleep apnea. Medicines like medroxyprogesterone, theophylline and protriptyline can help by stimulating the brain breathing centers at night and lessening the nocturnal episodes. There is even a device called an implantable diaphragmatic pacemaker to stimulate breathing muscles the way heart pacers stimulate cardiac muscles. It's your move, Y.C.

New drug treatment court offers addicts the chance to break free

In the grip of a three-year-long heroin jag, Mark sags into a chair outside courtroom 309 after appearing before a court judge and promising to clean up.

Mark and a few other addicts -- cocaine, heroin, or both -- are making their case before provincial court Judge Jane Godfrey, who presides over the newly opened drug treatment court.
It's only the second in Canada after one began in Toronto a few years ago.

"Look at me. I look like a mess," says Mark, stating the obvious. "I've got scabs all over me. It's time to clean up."

His eyelids signal a struggle to process a reporter's questions, never rising above half-mast as he recounts a life gone awry: wife and two kids split, trucking job gone.

He had recently been released from jail "and got right back into it" when he was arrested last week for low-level trafficking -- defined as dealing to support your own habit.
This time, however, he might get the break and the opportunity he says he wants. He's being offered an alternative: the drug treatment court or back to jail.

A pilot project of the federal and B.C. governments and the City of Vancouver, the drug treatment court opened in early December at the provincial courthouse, a fortress-like building located in the heart of the notorious, drug-infested Downtown Eastside.

"It was a recognition that the regular court system wasn't addressing the needs of those people who were coming to court because of their addiction," said Martha Devlin, a federal Justice Department prosecutor in charge of the drug court.

"It's a much more onerous program than going to jail."

Those selected for the program must go to treatment every day, attend the court to report on their progress and submit to random urine tests.

The program is also picky about who it accepts and criteria they must meet.

In an interview during a recent court break, the judge explained the admission requirements.

When people are arrested overnight, the drug court prosecutor goes over the lists the next day.

"She flags those files and gets the duty counsel to talk to these people to see if they're guilty and are they interested in drug court," said Godfrey.

The court's treatment manager also talks to them to make sure they don't have psychiatric problems since they'll have to work in a group setting five days a week.

The person charged must agree to plead guilty to the charge. When they appear in court they are released on stringent bail conditions, including staying out of the Downtown Eastside, keeping a curfew, abstaining from alcohol, going to the treatment centre every day and submitting to random urine tests.
A person would usually spend a year attending the treatment centre before "graduation" and returns to court for sentencing -- usually a term of probation that might include continued random urine testing.
The first drug treatment court was established in 1998 in Toronto under the guidance of Kofi Barnes, senior Crown counsel and a special adviser to the court.

The Toronto program has had 47 graduates to date and three have relapsed, said Barnes.

That court is still compiling statistics to gauge its cost- effectiveness, but Barnes is confident the eventual evaluation will be positive.

"In terms of crime, when we compared people in drug treatment court to counterparts who have similar characteristics but are not in drug treatment court, we found persons in drug court were one- fifth as likely to re-offend," said Barnes.

He had some advice for those who set up the Vancouver program.

"Design a court that fits Vancouver, taking into account culture and resources of Vancouver and also the characteristics of target population," said Barnes, who has travelled extensively to give advice in the United States, where there are now about 400 drug courts in operation.

David MacIntyre, the director of the Vancouver drug court's treatment program, took the advice.
All the people -- nine as of last week -- who have entered the Vancouver program came from the Downtown Eastside. Many have no fixed address, are in poor health, inject intravenously and sometimes are addicted to heroin and cocaine.

"So you have a more damaged population and a less healthy one," says MacIntyre.

The judge points out that Toronto had a centre for addiction and mental health up and running before it opened its drug court.

"We had to create ours from the start, find a location, get it modified, find treatment providers and a doctor," says Godfrey.

Preliminary studies, says Barnes, indicate the program is worthwhile.

Drug addicts cost the system in a number of ways: the cost of police, correctional institutions, the court process and the more difficult-to-measure lost productivity.

"In Ontario it costs about $4,500 to treat somebody a year," said Barnes. "It costs about $45,000 to incarcerate them."

B.C. Attorney General Geoff Plant lauds the drug court, but also expresses a keen interest in the bottom line.

"All these programs deserve to be assessed against the test of whether they are worth the dollars that are being spent," said Plant.

"In this particular case, saving the system money is as much an objective as trying to provide an opportunity to give some people a chance to turn their lives around."

More addiction treatment focused on cocaine abusers

Cocaine addicts are harder to treat, less likely to admit they have a problem and more likely to leave a treatment program before completing it.

Alberta's cocaine addicts have grown from only a handful to several thousand over the past decade.

The Alberta Alcohol and Drug Abuse Commission has seen cocaine use rise from two per cent (476) of all its adult clients in 1986 to 11 per cent by 1990.

Of 20,000 Albertans treated for addictions in 1990 by AADAC, 2,558 had some form of cocaine problem.

Of 8,215 admitted to treatment programs in the Edmonton area in 1990, 1,204 had a form of cocaine addiction. By comparison in 1986 when 8,227 people were admitted to programs, only 178 had cocaine problems.

In the whole province among adolescent addicts, only one per cent (13) were treated for addiction in 1986 compared to more than seven per cent (97) in 1990.
During that four-year AADAC study, adult male cocaine users outnumbered female addicts by up to three to one in nearly all age groups.

According to AADAC statistics of adolescent cocaine users, most are 16 or 17-years-old, likely to be at least one grade behind in school and likely to use other types of drugs.
Cocaine users commonly use alcohol and/or marijuana to mitigate the highs and lows of cocaine, AADAC says.

David Hewitt, AADAC's director of policy and program analysis, says the users tend to be mostly unemployed younger males.
"They tend to be somewhat harder to treat, they are less likely to think they have a problem," Hewitt said of cocaine addicts.
"They tend to think they have a medical problem, not a cocaine problem."

The average age of an Albertan undergoing cocaine addiction treatment is 29, compared to the average age of 37 for all other addicts in treatment.

AADAC breaks down cocaine use into three categories:

* those who only use cocaine;
* those who primarily use cocaine along with other substances;
* those who primarily use other substances plus cocaine.
Across the city and province more than 65 per cent of cocaine users are unemployed.

"They tend not to stay in the treatment program as long as needed," Hewitt said.
Cocaine addiction, like many other addictions is both psychological and physical. People who use cocaine regularly have more of a physical addiction, while casual users tend to suffer more from psychological addiction.

Cocaine addicts often switch back and forth with other drugs when they cannot buy cocaine and often mix cocaine and alcohol at the same time.

Drug treatment has side effects

Public health officials have been dispensing the drug Rifampin as a precaution against further spread of meningococcal disease.
The drug destroys the bacteria that causes blood poisoning and meningitis, said Dr. Ian Gemmill, the region's associate medical officer of health.

The dosage is eight pills, taken over two days. The medicine may produce side effects, including dizziness, nausea and ringing in the ear. People who experience side effects should contact their family doctor.
The drug temporarily changes the color of bodily fluids -- to bright orange. The color change poses no harm, but will permanently stain soft contact lenses. People who wear soft contact lenses were told not to wear their lenses for four days after their last dose.

Meningococcal meningitis is a rare bacteria infection. The bacteria enters the body through the nose and throat, infecting the blood stream and inflaming the membranes surrounding the brain and spinal cord.
Symptoms, which can come on rapidly, include a fever, headaches, vomiting, stiff neck and a body rash. It is spread by direct contact with secretions from the nose and the throat of an infected person.

Addicts turn in coupons for free drug treatment

Arnold Rincover is a registered psychologist, author of The Parent-Child Connection (Random House), and associate professor at the University of Toronto. This column is not intended to provide treatment and anyone concerned about a psychological problem should seek professional assistance
Everyone likes a bargain, even drug addicts. The New Jersey State Department of Health started an experimental drug treatment coupon program and it has been a flaming success. Little green coupons are distributed by ex-addicts who comb the streets for users, and the coupons are redeemable for a free three-week drug treatment program. While undergoing treatment, the addicts are also given a one-hour AIDS education course.

The AIDS instruction may be an important kicker _ those who take intravenous drugs (that is, with a needle) have a much higher risk of catching AIDS. Studies in two New Jersey counties found that 52 per cent of those suffering from AIDS had a history of using intravenous (IV) drugs.

Many drug users know they are walking targets for AIDS, and they are afraid for their lives. This may explain why, among 970 coupons initially handed out, an incredible 837 (more than 85 per cent) were used to get treatment and 95 per cent of the participants received the AIDS briefing.

Not only did drug addicts attend in unheard-of numbers, but there were long-lasting gains from the education program. For example, 23 per cent of the addicts continued in methadone maintenance programs after the initial three-week program ended. There were also other benefits _ safer sex practices (the number using condoms almost doubled), sterilization of needles, etc.

Because of this success, the State Dept of Health soon expanded the program to include 15 cities and printed another 2,700 coupons.

There is a major downside to such programs: A high proportion of IV users drop out of the methadone program and return to drugs if they test positive for AIDS. Researchers say the patient thinks he is ''done for,'' and that it doesn't matter what he does. Perhaps the drugs help him to escape those thoughts for awhile.

Knowing this, researchers think that individual and group education and prevention sessions are essential companions to any AIDS testing, and should begin before the test results are in. And the New Jersey study found that the counselling sessions seemed to help. While initially 72 per cent of addicts who tested positive for AIDS returned to drugs within three months (as compared to only 40 per cent of those who tested negative), more than half of the test-positive drop-outs returned for methadone treatment and AIDS counselling during the next 12 months.

It is unclear what accounted for the success of this coupon program. Perhaps the ex-addicts only handed them out to periodic users, rather than hard-core daily users. Perhaps the fear of AIDS was crucial, and the AIDS session was the primary motivation for many. Perhaps it was the ''freebie,'' or simply the information telling them it was available, where to go and when.

Though we don't know why this program was successful, its success can't be questioned. The program should be copied, studied and improved everywhere.

The benefits in psychological, physical and economic terms are inestimable: How do you put a price tag on the reduction in crime, the devastation to a family, physical addiction and the fear of AIDS?

Drug treatment programs save us tax dollars

A WEEK ago last Thursday, something unprecedented happened here in Toronto.

Risking the scorn of onlookers, about 100 heroin addicts held a noisy rally outside Queen's Park. By doing so, they publicly identified themselves as people for whom many in our society have little sympathy.

Although we've now recognized that it isn't sufficient simply to blame alcoholics for their problem and then dismiss them from our minds, we still tend to approach drug addicts in this manner.

But, as these demonstrators tried to make us understand, there are compelling reasons for us to re-examine our attitudes. Quite simply, it's in our economic interest to do so.

By providing more help to those addicts who are trying to turn their lives around, we could be saving ourselves significant health- care dollars (by discouraging the spread of AIDS and hepatitis B), and trimming hundreds of millions more from other areas of our budget.

It costs about $250,000 a year to support a heroin addiction. The price tag for society at large, however, is thought to be closer to $1 million each year per addict (there are an estimated 15,000 to 20,000 in Metro alone).

Many of these people turn to crime - particularly theft - in order to support their habit. Not surprising, many are arrested. This, in turn, strains Legal Aid's resources and ties up court time. The need for probation and parole officers increases. And, as our overcrowded jails become more so, taxpayers fork over between $40,000 and $60,000 a year to keep each inmate.

However, as one of the picket signs at the rally pointed out, "Treatment Turns Addicts into Productive Members of Society." This is not a fanciful, left-wing notion, but a proven reality.

Here in Toronto, the Queen-Dufferin Treatment Centre has developed a comprehensive methadone maintenance program geared to helping heroin addicts for whom other forms of treatment have failed.
Under strict medical supervision, addicts are administered methadone, a chemical substitute for heroin. They undergo regular urine screenings and take part in mandatory counselling. Since it began two years ago, the clinic has helped 160 people become drug free.

It's important to point out that this program costs taxpayers little. The only government funding the centre receives is from OHIP, when the physicians who staff it bill the plan for their medical services.
Out of these funds, the doctors pay the salaries of one part- time and two full-time counsellors, as well as a full-time administrative assistant. The clinic has developed treatment protocols and designed counselling manuals - at no cost to the public. But its future, and that of its patients, is now in jeopardy.
The provincial government's new health-care proposals, which are aimed at reducing costs, will limit the number of hours of psychotherapy OHIP will cover to two hours per week, or 100 per year per patient. Unfortunately, this proposal makes no distinction between the more costly one-on-one forms of therapy and the significantly less expensive group therapy sessions that are the backbone of the heroin treatment program.

Methadone maintenance, by itself, is insufficient to beat heroin addiction. Especially in the early stages, it must be combined with intensive therapy. People whose sensibilities are no longer numbed by heroin have to begin dealing with the pain and anxiety of life again.

They need support and guidance in order to avoid a relapse. In the first few months of the program, therefore, they require between eight and 10 hours of counselling per week.

If the doctors who provide much of this counselling can no longer bill OHIP for large chunks of their time, the clinic will be forced to close. According to its director, Dr. Stanley Shapiro, that's the bottom line.
Suddenly, the $27 million a year the government says we'll save by implementing this particular cost-saving measure, doesn't sound so impressive.