More people in treatment for drug abuse, other than alcohol abuse, began using at least one of their problem drugs prior to the age of 13. The data over the past decade show that in 1993, 12 percent of admissions to treatment for drugs (114,462 people) began using their substances before age 13. By 2003, 14 percent of admissions (162,708 people) began using drugs prior to age 13. These findings were released today in a report by the Substance Abuse and Mental Health Services Administration (SAMHSA) from continued analysis of the Treatment Episode Data Set (TEDS).

The report, “Age of First Use Among Admissions for Drugs: 1993 and 2003”, notes that the percentage of treatment admissions that initiated drug use before age 13 increased between 1993 and 2003 for marijuana and opiates. Opiates include prescription pain medications and heroin. Initiation of marijuana use prior to age 13 increased from 20 percent to 23 percent of marijuana admissions from 1993 to 2003. For opiate admissions, the percent initiating drug use before age 13 increased from 4 to 5 percent. There was a decline for cocaine admissions (from 5 percent to 4 percent) and for stimulant admissions (from 10 percent to 9 percent). Stimulant admissions include methamphetamine.

“Age at first use is an important predictor of the potential for serious substance abuse problems later in life,” said SAMHSA Administrator Charles Curie. “The increase in the proportion of admissions for drug use before age 13 should be a wake-up call to parents to speak with their children early and often about the dangers of drug use.”

The report notes that for some admissions, initiation into the drug lifestyle may have started even earlier, with a first drug that was abandoned for another drug or drugs introduced later on.

The percentage of admissions starting drug use before age 13 increased for both females (11 percent in 1993 rising to 12 percent in 2003) and males (13 percent in 1993 compared to 15 percent in 2003). The percentage using drugs before age 13 increased among Black admissions from 8 percent in 1993 to 11 percent in 2003. Among Hispanics, the percentage of admissions that began using drugs before age 13 increased from 10 percent in 1993 to 13 percent in 2003. The percentage also increased for Asian and Pacific Islander admissions (16 percent in 1993 compared to 19 percent in 2003) and American Indian/Alaska Native admissions (21 percent in 1993 compared to 23 percent in 2003). The percentage for White admissions remained the same at 15 percent.

TEDS collects data on the approximately 1.8 million annual admissions to substance abuse treatment facilities, primarily those that receive some public funding. The report is available on the web at www.oas.samhsa.gov.

SAMHSA, is a public health agency within the Department of Health and Human Services. The agency is responsible for improving the accountability, capacity and effectiveness of the nation’s substance abuse prevention, addictions, treatment, and mental health services delivery syste

Drug rehab residential is a program that people will reside in the facility for the course of the program. Residential facilities are tailored for harder case�s of addiction as it restrains the accessibility for drugs and alcohol.
The environment has always been a re-stimulation also known as a trigger for a person who is addicted to drugs and alcohol. Just the fact that the person recovering is not in their environment is therapeutic by itself. Unfortunately, this is not enough.
When searching for a residential alcohol and drug program, always make sure that it is adequate in length and that the staff ratio is good. The philosophy of the program is that addiction can be cured.

Drug Rehab Admissions for Alabama

In 2003, there were a reported 129 drug rehabilitation and addiction treatment centers in Alabama. These centers combined to serve 10,749 clients for alcohol and/or drug abuse issues.
On the average, approximately 90% of addicts go through outpatient treatment services instead of getting into residential rehabilitation program. Statistics speaking long-term residential treatment is a more effective drug-free rehabilitation approach and is better in the long run for the addict.

A large amount of the cocaine available in Alabama is supplied by Mexican origins in California, Arizona, and Texas. Furthermore, violence related with cocaine distribution cripples several of Alabama’s lower income neighborhoods.

The majority of the heroin discovered in Alabama is transported from Jamaica.

�The main origin of cannabis coming into Alabama is Mexico with connections to South America as well as through port cities of Florida and the Port of Mobile.

�Seizures and intelligence demonstrate that bulk methamphetamine distribution in Alabama is controlled by DTOs supplied by sources in Mexico with transportation routes based in California, Arizona, and Texas.

�During 2005, the DEA and state and local authorities in Alabama confiscated 276 methamphetamine labs.

Around 232.3 kilograms of cocaine were confiscated by Federal agencies in Alabama during 2005.

* AOD use can cause psychiatric symptoms and mimic psychiatric syndromes.
* AOD use can initiate or exacerbate a psychiatric disorder.
* AOD use can mask psychiatric symptoms and syndromes.
* AOD withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes.
* Psychiatric and AOD use disorders can independently coexist.
* Psychiatric behaviors can mimic AOD use problems.

The Terminology of Dual Disorders
The term dual diagnosis is a common, broad term that indicates the simultaneous presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and AOD problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).

The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an AOD disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness).

Common examples of dual disorders include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse. Although the focus of this volume is on dual disorders, some patients have more than two disorders, such as cocaine addiction, personality disorder, and AIDS. The principles that apply to dual disorders generally apply also to multiple disorders.

The combinations of AOD problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, the two disorders may each be severe or mild, or one may be more severe than the other. Indeed, the severity of both disorders may change over time. Levels of disability and impairment in functioning may also vary.

Thus, there is no single combination of dual disorders; in fact, there is great variability among them. However, patients with similar combinations of dual disorders are often encountered in certain treatment settings. For instance, some methadone treatment programs treat a high percentage of opiate-addicted patients with personality disorders. Patients with schizophrenia and alcohol addiction are frequently encountered in psychiatric units, mental health centers, and programs that provide treatment to homeless patients.

Patients with mental disorders have an increased risk for AOD disorders, and patients with AOD disorders have an increased risk for mental disorders. For example, about one-third of patients who have a psychiatric disorder also experience AOD abuse at some point (Regier et al., 1990), which is about twice the rate among people without psychiatric disorders. Also, more than half of the people who use or abuse AODs have experienced psychiatric symptoms significant enough to fulfill diagnostic criteria for a psychiatric disorder (Regier et al., 1990; Ross et al., 1988), although many of these symptoms may be AOD related and might not represent an independent condition.

Compared with patients who have a mental health disorder or an AOD use problem alone, patients with dual disorders often experience more severe and chronic medical, social, and emotional problems. Because they have two disorders, they are vulnerable to both AOD relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation, and worsening of psychiatric problems often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with dual disorders. Compared with patients who have a single disorder, patients with dual disorders often require longer treatment, have more crises, and progress more gradually in treatment.

Psychiatric disorders most prevalent among dually diagnosed patients include mood disorders, anxiety disorders, personality disorders, and psychotic disorders. Each of these clusters of disorders and symptoms is dealt with in more detail in separate chapters.

The characteristic feature of AOD abuse is the presence of dysfunction related to the person’s AOD use. The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), produced by the American Psychiatric Association and updated periodically, is used throughout the medical and mental health fields for diagnosing psychiatric and AOD use disorders. It provides clinicians with a common language for communicating about these disorders and for making clinical decisions based on current knowledge. For each diagnosis, the manual lists symptom criteria, a minimum number of which must be met before a definitive diagnosis can be given to a patient.

Criteria for AOD abuse hinge on the individual’s continued use of a drug despite his or her knowledge of “persistent or recurrent social, occupational, psychologic, or physical problems caused or exacerbated by the use of the [drug]” (American Psychiatric Association, 1987). Alternately, there can be “recurrent use in situations in which use is physically hazardous.” The DSM-IV draft continues this emphasis (American Psychiatric Association, 1993).

Thus, AOD abuse is defined as the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning. AOD abuse may or may not involve physiologic dependence or tolerance. Importantly, evidence of physiologic dependence and tolerance is not sufficient for diagnosis of AOD abuse. For example, use of AODs in weekend binge patterns may not involve physiologic dependence, although it has adverse effects on a person’s life.
AOD Abuse

* Significant impairment or distress resulting from use

* Failure to fulfill roles at work, home, or school

* Persistent use in physically hazardous situations

* Recurrent legal problems related to use

* Continued use despite interpersonal problems

Therefore, screening questions should relate to life problems that result from AOD use, taking into consideration that patients may not have the insight to perceive that their life problems are caused by AOD abuse.

The phrase AOD addiction (called “psychoactive substance dependence” in the DSM-III-R and “substance dependence” in the DSM-IV draft) is an often progressive process that typically includes the following aspects: 1) compulsion to acquire and use AODs and preoccupation with their acquisition and use, 2) loss of control over AOD use or AOD-induced behavior, 3) continued AOD use despite adverse consequences, 4) a tendency toward relapse following periods of abstinence, and 5) tolerance and/or withdrawal symptoms.
AOD Addiction or Dependence

* Pathologic, often progressive and chronic process
* Compulsion and preoccupation with obtaining a drug or drugs
* Loss of control over use or AOD-induced behavior
* Continued use despite adverse consequences
* Tendency for relapse after period of abstinence
* Increased tolerance and characteristic withdrawal (but not necessary or sufficient for diagnosis)

The DSM-III-R describes nine diagnostic criteria, of which three or more must be present for a month or more to establish a diagnosis of dependence. Screening questions can be based on these criteria. The DSM-IV draft committee deleted DSM-III-R criterion 4 and the requirement of symptoms being present for at least 1 month. The DSM-IV draft emphasizes the symptoms of tolerance and withdrawal, which the draft committee placed at the top of the list of criteria.

In the DSM-III-R, criteria 1 and 2 deal with loss of control; criterion 3 addresses time involvement; criteria 4 and 5 relate to social dysfunction; criterion 6 relates to continued use despite adverse consequences;and criteria 7, 8, and 9 relate to the development of tolerance and withdrawal. It is important to note that tolerance, physiologic dependence, and withdrawal are neither necessary nor sufficient for the establishment of a diagnosis of AOD addiction.

The term AOD dependence can be confusing because it has multiple meanings. The DSM-III-R uses the phrase “psychoactive substance dependence” to describe the process of addiction, while many pharmacologists use the term “dependence” exclusively for describing the biologic aspects of physical tolerance and/or withdrawal. The American Society of Addiction Medicine describes drug dependence as having two possible components: 1) psychologic dependence and 2) physical dependence.

Psychologic dependence centers on the user’s need of a drug to reach a level of functioning or feeling of well-being. Because this term is particularly subjective and almost impossible to quantify, it is of limited usefulness in making a diagnosis.

Physical dependence refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of AOD use. In this case, AOD type, volume, and chronicity are the important variables: Given a certain substance, the higher the dose and longer the period of consumption, the more likely is the development of tolerance, dependence, and subsequent withdrawal symptoms. Physical dependence and tolerance are best understood as two of many possible consequences (which may or may not include addiction and abuse) of chronic exposure to psychoactive substances.

Among patients with a psychiatric problem, any AOD use — whether abuse or not — can have adverse consequences. This is especially true for patients with severe psychiatric disorders and patients who are taking prescribed medications for psychiatric disorders. For patients with psychiatric disorders, the infrequent consumption of alcohol can lead to serious problems such as adverse medication interactions, decreased medication compliance, and AOD abuse. Screening questions can relate to evidence of any use of AODs, as well as frequency, dose, and duration.

Medication misuse describes the use of prescription medications outside of medical supervision or in a manner inconsistent with medical advice. While medication misuse is not an abuse problem per se, it is a high-risk behavior that: 1) may or may not involve AOD abuse, 2) may or may not lead to AOD abuse, 3) may represent medication noncompliance and promote the reemergence of psychiatric symptoms, and 4) may cause toxic effects and psychiatric symptoms if it involves overdose.

Thus, some patients may consume medications at higher or lower doses than recommended or in combination with AODs. Also, certain patients may respond to prescribed psychoactive medications by developing compulsive use and loss of control over their use.

Being a teenager and raising a teenager are individually, and collectively, enormous challenges. For many teens, illicit substance use and abuse become part of the landscape of their teenage years. Although most adolescents who use drugs do not progress to become drug abusers, or drug addicts in adulthood, drug use in adolescence is a very risky proposition. Even small degrees of substance abuse (for example, alcohol, marijuana, and inhalants) can have negative consequences. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug use and abuse.

One of the most telling signs of a teen’s increasing involvement with drugs is when drug use becomes part of the teen’s daily life. Preoccupation with drugs can crowd out previously important activities, and the manner in which the teen views him or her self may change in unrealistic and inaccurate directions. Friendship groups may change, sometimes dramatically, and relationships with family members can become more distant or conflictual. Further bad signs include more frequent use or use of greater amounts of a certain drug, or use of more dangerous drugs, such as cocaine, amphetamines, or heroin. Persistent patterns of drug use in adolescence are a sign that problems in that teen’s environment exist and need to be addressed immediately.

What causes adolescent substance abuse?
There is no single cause of adolescent drug problems. Drug abuse develops over time; it does not start as full-blown abuse or addiction. There are different pathways or routes to the development of a teen’s drug problems. Some of the factors that may place teens at risk for developing drug problems include:

o insufficient parental supervision and monitoring
o lack of communication and interaction between parents and kids
o poorly defined and poorly communicated rules and expectations against drug use
o inconsistent and excessively severe discipline
o family conflict
o favorable parental attitudes toward adolescent alcohol and drug use, and parental alcoholism or drug use

It is important to also pay attention to individual risk factors. These include:

o high sensation seeking
o impulsiveness
o psychological distress
o difficulty maintaining emotional stability
o perceptions of extensive use by peers
o perceived low harmfulness to use

How do you know when to seek help?
The earlier one seeks help for their teen’s behavioral or drug problems, the better. How is a parent to know if their teen is experimenting with or moving more deeply into the drug culture? Above all, a parent must be a good and careful observer, particularly of the little details that make up a teen’s life. Overall signs of dramatic change in appearance, friends, or physical health may be signs of trouble. If a parent believes his or her child may be drinking or using drugs, here are some things to watch for:

o Physical evidence of drugs and drug paraphernalia
o Behavior problems and poor grades in school
o Emotional distancing, isolation, depression, or fatigue
o Change in friendships or extreme influence by peers
o Hostility, irritability, or change in level of cooperation around the house
o Lying or increased evasiveness about after school or weekend whereabouts
o Decrease in interest in personal appearance
o Physical changes such as bloodshot eyes, runny nose, frequent sore throats, rapid weight loss
o Changes in mood, eating, or sleeping patterns
o Dizziness and memory problems

Howard Liddle, Ed.D.