After alcohol and marijuana, what mood altering substance is the next most popular among U.S. high school students?  You might reasonably suspect prescription pain relievers or prescription stimulants.  But in a 2012 survey of drug use in the past year by 9th to 12th graders, synthetic marijuana took third place. “Synthetic marijuana” refers to a group of products that consist of dried herbs or other plant material that has been sprayed or soaked with chemicals.  The structures of the chemicals mimic those of the psychoactive substances in marijuana (cannabinoids).  They come from a laboratory rather than a natural source, so they are classified as designer drugs.  Synthetic cannabinoids are frequently more powerful than natural ones, with a wider range of physical and mental effects—some of which can be deadly. Spice and K2 are the best-known brands.  Other street and shelf names for these products include Black Mamba, Bliss, Fire n’ Ice,...

Approximately 100 million Americans suffer from chronic pain. Nationwide, chronic pain causes more disability than cancer and heart disease combined, and costs $550 million annually in lost workdays. Clinicians classify pain as acute or chronic. Acute pain is "useful" in that it immediately signals the nervous system that something is wrong and requires attention. Its cause is usually easy to identify and straightforward to treat. Acute pain is time-limited, usually lasts a month or less, and is responsive to opioid medication and other therapies. On the other hand, chronic pain is a complex disorder of the whole person that persists for three to six or more months and serves no useful purpose. It is often associated with a long-term, incurable or intractable medical condition or disease. Though its cause can be difficult to identify, chronic pain frequently results from damage to nerve-related tissue or altered processing of pain in the central...

Ask people engaged in addiction treatment for a single word to describe where they just came from—a word that sums up the experience of active addiction—and they quickly agree on “hell.” Many years ago someone asked the then famous and now controversial evangelist Billy Sunday, “What must I do to go to hell?”  Sunday replied, “Nothing.”  In other words, make no effort; you will get there.  Beliefs about religion and an afterlife aside, Sunday’s answer speaks to people who want to get free from active addiction:  make no effort; do what comes naturally; and you will keep returning to hell. Statistics bear witness to the enormous human and dollar costs of addiction—and some measures keep going up.  As a society, if we hope to reduce the toll of addiction, we must not only recognize that addiction is a brain disease, but also that addiction persists in individual lives and gets started...

In the United States, an estimated 20 million people have problems with alcohol or other drugs.  Many of these individuals attempt to get sober, but remain stuck using addictive substances because they try to fix things their own way—and berate themselves when nothing changes—unaware they are working against the laws of nature.  Much like drivers who hit the gas but go nowhere when their car is stuck in snow, they keep using alcohol and other drugs because they don’t understand why they are stuck or how to work with the laws of nature—laws that govern human behavior, addiction, and recovery from addiction—to cope with their problems. Behavior is everything we can observe an organism do.  Examples of human behavior include talking, eating, driving, dancing, breathing, and body language.  Human behavior originates in the central nervous system, which consists of the brain and spinal cord. The brain, in turn, is made up...

People in the United States don’t shrink from passionate expressions of opposing views.  Whigs vs. Tories, Republicans vs. Democrats, and Red Sox fans vs. Yankees fans are just a few cases in point.  People’s views on marijuana are no less passionate and no less polarized.  During treatment for addiction to opioids a man in his early twenties said, “Marijuana is an herb; it’s natural.  It relaxes me; I’m not addicted to it; and I’m going to smoke it when I get out of here.”  In the same room, a man in his early thirties also in treatment for addiction to opioids said, “People disagree whether marijuana is a gateway drug.  It is for me.  If I never smoked marijuana I never would have gotten hooked on harder drugs.  And if I hadn’t tried to smoke it again after my first treatment, I wouldn’t be here right now.” Opposing views swirl around...

Too often society is unfair to people with addiction—a fact that disturbs most people with active addiction, most people who are recovering from addiction, and most people who advocate for those groups.  Fortunately we can do something about it.  Don’t be daunted—small steps can have a powerful impact. Social stigma exists within culture.  Culture may be understood as the collective knowledge, beliefs, and behaviors of a group of people that is often stable across generations.  Stigma occurs when a characteristic of a person or subgroup is perceived as different from others, is labeled, and the label becomes associated with a negative stereotype. Not only is the culture that surrounds a person important, but also the culture he or she has internalized.  For example, the labels “alcoholic” and “addict” may evoke prejudice and distancing in the general population, but acceptance and warmth in the population committed to Twelve-Step recovery.  Individuals who find...

Part Three:  Evidence-Based Practices: This series has advocated that society make disease prevention a priority—especially the prevention of substance use disorders—while recognizing that the prevention of substance use disorders (SUDs) is already a priority for some providers and agencies.  Before organizers of SUD prevention services present an intervention to a target population, they like to be confident that their efforts will result in healthy change.  Also, before funding sources contribute to SUD prevention services, they like to be confident that their investment will produce worthwhile results.  For both these reasons, organizers of SUD prevention services prefer to deliver prevention approaches that are evidence-based.  That is, organizers like to replicate programs that were shown to be effective when they were presented before. It is increasingly difficult for organizers to attract funding for anything other than evidence-based practices (EBPs).  Simply believing or hoping a program will work is no longer sufficient.  Plus, once...

 Part Two:  Preventing Alcohol Problems:  The harmful use of alcohol is the third leading risk factor for poor health worldwide and the estimated costs of alcohol abuse in the United States, which encompass lost productivity as well as medical problems, top $220 billion per year.  There’s a lot to be done.  Fortunately, a lot is being done.  April is Alcohol Awareness Month, a fitting time to acknowledge creative and effective prevention approaches that are reducing risk now—we’ve come a long way from the ineffective and sometimes harmful information-only scare tactics of the 1950s and 1960s.  Preventive interventions target the population at large (universal), persons at increased risk (selective), or persons with prodromal symptoms (indicated).  Depending upon the characteristics of a particular person, existing programs might influence that individual at one or many points across his or her lifespan. Universal interventions generally address an entire community, such as a state, county, or...

Part One - Overview and Terminology. Our society pays far more attention to disease treatment than disease prevention.  And some of the reasons for this are understandable.  When medical-scientific technology saves lives, for example, the outcomes often generate hype because they are dramatic.  When prevention works, however, nothing happens.  The resulting non-events attract little if any attention—even though the number of people saved may be larger than the number who benefit from seemingly miraculous disease treatment.  In addition, preventive interventions reduce the occurrence of other dangerous and unpleasant situations—assaults, for example, are reduced by training young people in coping skills even if the stated objective of the training is to prevent substance abuse— that might not be counted at all in tallies of disease.  The bias for treatment over prevention encompasses most or all health concerns including addiction.  One indicator is the 2013 budget of the Substance Abuse and Mental Health...

Sedative-hypnotic medications are not good choices for individuals with addiction.  Even those with vulnerability to addiction due to, for example, a family history of alcohol dependence, run a higher risk of developing problems.  Nevertheless, some medical practitioners are quick to prescribe these drugs when patients complain of anxiety or insomnia.  The prescribers aim to be helpful, but too often these prescriptions end up harming the patient and possibly others. Though some authors classify sedating antidepressants and antihistamines as sedative-hypnotics, this discussion restricts the category to medications that act in the brain by augmenting the effects of gamma-aminobutyric acid (GABA).  GABA is a chemical messenger that inhibits the activity of brain cells. Boosting GABA both calms the brain and increases dopamine in the nucleus accumbens.  That increase of dopamine is the neurobiological event most identified with the experience of pleasure and reward.  The intensity of the pleasure might be subtle or dramatic,...