Georgia Prescription Opioid and Heroin Epidemic

i Jan 24th No Comments by

Georgia in Top 11 Worst Off States for Opioid Overdoses

Georgia ranks #11 in states with most prescription opioid OD deaths549 opioid drug ODs in 2015 29 counties where drug OD rates outpace U.S. average 11 Georgia ranks among top 11 states with most prescription opioid OD deaths

Georgia ranks #11 in states with most prescription opioid OD deaths, with 549 opioid drug ODs in 2015 and 29 counties where drug OD rates outpace the U.S. average. Nearly half of young people who inject heroin start by using Rx drugs.  According to Partnership for Drug-Free Kids, some teens might try prescription medication at a party because they are curious or think it will make them feel good. Medicines most commonly abused are shown here:

Or they might start taking it legally, when it has been prescribed for pain. Habit quickly becomes dependency with these highly addictive opioids, and once legal prescriptions run out, affected teens will turn to illicit opioids, and then heroin.

Governor Deal recently expanded access to naloxone to reverse opioid OD’s after seeing the White Paper that I recently edited and produced for my client, Georgia Prevention Project. Please take a moment to read the Executive Summary up front. Then sit down and talk with your kids.



Substance Abuse, Recovery, and Michael Phelps

i Aug 12th No Comments by

What does the word recovery really mean to someone like Michael Phelps?

michael phelps

Michael Phelps swam past his substance abuse issues at 2016 Rio Olympics. Photo credit:

The phenomenal Olympian’s legacy was called into question over the past 8 years after he was charged with substance abuse.

What Happened?

Photographed taking a hit from a bong
Handed two DUI’s
Sentenced to an 18 month probation
Suspended from Team USA Swimming and forced to miss world championships in Russia
Spent six weeks in an alcohol rehabilitation program

What Next?
Girlfriend became his fiancée
Estranged relationship with his father improved
Peers elected him captain of Team USA
Developed reputation as a mentor at 2016 Olympics
Increased his Olympic medal collection to 26 (as of today)

Recovery is rewarding. But recovery is a hard word to swallow. A lot of people seem to believe the word brands them as addict, or alcoholic. Yet experts tell us that only the individual who has suffered from substance abuse can brand himself or state he is in recovery.
Michael Phelps rebranded Michael Phelps. The word recovery, in my opinion, should only be used in the context that Phelps recovered his career, his self-respect, respect of loved ones and peers, and most important, a rewarding relationship with his authentic self. His journey should be celebrated on multiple levels and bring a message of hope to families who struggle with loved ones who suffer from substance abuse. Congratulations, Michael Phelps. And thanks for showing those of us who want to recover our own self-image, that we can.

Substance Abuse Over Age 18. What Boundaries Exist for an Adult?

i Aug 4th No Comments by

Age 18 is an adult whose rights and privacy are protected by law. Talk with other parents in a similar situation. Start treating him like an adult, setting boundaries between you and the substance abuser. Many parents don’t act until a problem is full blown, fueling the behaviors with excuses or multiple ‘second’ chances. An addiction therapist told me 75% of her clients “didn’t practice the tough love necessary to help their loved ones engage in recovery and responsible behaviors.”

use anywheretroubled teen

Establishing boundaries with a substance abuser  are more difficult once a teen turns 18.

Some boundaries for young adults:

Removing privileges, such as:

  • Payment for phone, car, and tuition
  • Removal of personal devices, video game and computer equipment
  • Removal from the house and locking them out
  • A restraining order if they have stolen property, cash or medications or abused drugs and alcohol in your home – or if they have been verbally or physically abusive

Young adults are resourceful. Parents with a drug or alcohol abusing teen or young adult should credit their children with the survival instinct and act swiftly to enforce a zero tolerance attitude with actions.

The blog, “Take Good Care of Yourself” offers good insight into boundaries – what they are, who needs them, how to implement them. Here are some of the blog’s clear boundaries for a teen:

1.   “Yes, I’ll be happy to drive you to the mall as soon as you’re finished with your chores.”
2.   “You can borrow my CDs just as soon as you replace the one that you damaged.”
3.    “If you put your dirty clothes in the hamper by 9:00 Saturday morning, I’ll be happy to wash them for you.”
4.    “Can I give Joe a message? Our calling hours are from 9:00 a.m. until 9:00 p.m. I’ll let him know you called.”
5.    “I’m sorry; that doesn’t work for me.  I won’t be loaning you money until you have paid me what I loaned you previously.”
6.    “You’re welcome to live here while you’re going to college as long as you follow our rules.”

Please visit these sites for more information on boundaries for teens

Experts Provide Clinical Overview of Drug Recovery Experience

i Jul 30th No Comments by

Reporting on CORE Conference Summer 2016

I attended this conference on Amelia Island Florida in July. The membership goal is to improve accessibility to and the quality of addiction treatment and to promote recovery solutions.

Ivanka Grahovac, Executive Director, Austin Recovery

I am with Ivanka Grahovac, Executive Director, Austin Recovery. She shared her own recovery experience from heroin to advocate for change at the CORE conference.

The conference is “structured as a forum to increase the collective understanding of the addiction recovery processes.” Participants are eager, in general, to improve addiction treatment outcomes by better integrating abstinence-based practices and Twelve-Step principles into therapeutic initiatives.

Four themes emerged during the four day event.

  1. Abstinence versus medication assisted treatment for recovery

More often, meds are being delivered in a physician’s office, administered in many cases by the physician’s assistant. Atlanta has seen this trend with Adderall. Used to be, a psychologist or psychiatrist would diagnose ADD or ADHD and submit the treatment plan with a prescription. Nowadays, people can get a prescription, without the rigorous assessment that was required formerly. In the case of opioid addiction, many physician’s assistants are writing the treatment plan. And many are not necessarily trained to develop it.  Doctors’ offices are focused on harm reduction, which is good. But do they understand the cravings? Do they understand how medication could actually threaten authentic sobriety? These were the sorts of questions and issues that were explored.

  1. Suboxone in the wake of a national opioid addiction trend. Just how helpful is it?

Suboxone is used as a detox agent, and it represents a $1.5 Billion market. Doctors wrote 9 million prescriptions last year. One expert stated, “And guess what? It’s harder to kick than heroin.”  Insurance companies encourage its use, allegedly, because users don’t need to go into detox, which costs insurance companies money. Many experts rejected claims of its benefits, because “it undermines the brain’s ability to present as one’s authentic self.”

Without “full surrender to abstinence, people cannot engage in recovery and 12-step (programs) as their own, real, authentic selves,” said the CEO of a recovery program. Otherwise, claimed many experts, people trying to recover can remain isolated and addicted.

  1. Twelve step programs and the role of a higher power in addiction. The most compelling speakers, across the board, advocated for complete abstinence to support this notion of showing up as yourself, no one else, because it is the surest way to remodel the brain and change behavior. No surprise that drug manufacturers and insurance companies were not present at CORE. Unless they were under the radar. Is “Big Pharma” too busy selling “meds” to physicians’ offices and using Public Relations to sell only part of the story to consumers, so that consumers will be the very people asking for those drugs? And is that a good thing?

“Full surrender” to medication-free recovery made a suboxone prescription sound sketchy, at best. But there is no question that some specific co-occurring disorders warrant medication.

4.   Pornography addiction is a big ugly taboo problem. It is impacting a lot of folks, particularly 12-16 year olds who watch online. It has serious implications for brain receptors, in terms of the stimulation, even compared to what certain drugs do to the brain. I don’t know anything more, but will keep you posted.

The many dedicated professionals were on hand at CORE who are committed to helping people recover and lead full and happy lives – they were nothing short of inspiring. I am so glad I was able to attend and learn more about what they do, how they help others. Want to learn more about CORE?

What to Look for in Teen Recovery Services

i Sep 17th No Comments by

The Substance Abuse and Mental Services Administration (SAMHSA) is a remarkable organization dedicated to helping Americans, particularly recovery professionals and people in crisis, to better navigate substance abuse issues with better tools and information. It also performs research on programs and tracks and reports outcomes. This checklist is beneficial to any parent who is trying to make a decision about what comes next for their teen in crisis. Whether a parent is alone in this journey or working with a therapist, law enforcement office, or school counselor, the list is a dependable guide to understand quickly what one must look for in terms of support services.


Knowing the right type of program for your teen to recover is important. Inpatient? Outpatient? Read on…

When you are looking for a recovery program for your teen, here is a list of services that you should feel are required.

Primary Focus of Provider

  • Substance abuse treatment services
  • Mental health services
  • Mix of mental health and substance abuse services
  • General health services

Services Provided

  • Substance abuse treatment
  • Detoxification
  • Methadone maintenance
  • Methadone detoxification
  • Buprenorphine used in treatment
  • Halfway house

Type of Care

  • Hospital in-patient
  • Out-patient
  • Partial hospitalization/ day treatment
  • Residential short-term treatment (30 days or less)
  • Residential long-term treatment (more than 30 days)

Special Programs/ Groups Offered

  • Adolescents
  • Persons with co-occuring mental and substance abuse disorders
  • Persons with HIV/ AIDS
  • Gays and Lesbians
  • Pregnant/ postpartum women
  • Women
  • Men
  • Residential
  • DUI/ DWI offenders
  • Other, Criminal justice clients

Forms of Payment Accepted

  • Self payment
  • Medicaid
  • Medicare
  • State financed insurance (other than medicaid)
  • Private health insurance
  • Military insurance
  • Access to recovery voucher

Payment Assistance Available

  • Sliding fee scale (Fee is based on income and other factors)
  • Payment assistance (Check with a facility for details)

Special Language Services

  • ASL or other assistance needed for hearing impaired
  • Spanish
  • Native American or Alaskan native languages
  • Other Languages

Substance Abuse Recovery Programs – Which Type is Right?

i Sep 2nd No Comments by

Figuring out what program, what approach, is right for your teen or young adult — is no easy decision and is best evaluated with a professional substance abuse counselor. NIH National Institute on Drug Abuse states, “Research studies on addiction treatment typically have classified programs into several general types or modalities. Treatment approaches and individual programs continue to evolve and diversify, and many programs today do not fit neatly into traditional drug addiction treatment classifications.”

Most, however, start with detoxification and medically managed withdrawal, often considered the first stage of treatment. Detoxification, the process by which the body clears itself of drugs, is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. As stated previously, detoxification alone does not address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification should thus be followed by a formal assessment and referral to drug addiction treatment.

Because it is often accompanied by unpleasant and potentially fatal side effects stemming from withdrawal, detoxification is often managed with medications administered by a physician in an inpatient or outpatient setting; therefore, it is referred to as “medically managed withdrawal.” Medications are available to assist in the withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives.”

NOTE: If your child does not need to detox, he still might need intensive residential treatment. So first assess the extent of the problem. People who need to detox can die if they skip that step. Here are some programs. For detail, visit this NIH link about different types of programs.

Types of Recovery Programs

Long-Term Residential Treatment

Long-term Residential Treatment programs provide care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months.

 Short-Term Residential Treatment

These programs provide intensive but relatively brief treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980s, many began to treat other types of substance use disorders. They consisted of a 3- to 6-week hospital-based inpatient treatment phase, followed by extended outpatient therapy and participation in a self-help group, such as AA.

Outpatient Treatment Programs

These programs vary in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs, school commitments, or extensive social supports. It should be noted, however, that low-intensity programs may offer little more than drug education.

Group Counseling

Group counseling capitalizes on the social reinforcement offered by peer discussion and to help promote drug-free lifestyles. Research has shown that when group therapy either is offered in conjunction with individualized drug counseling or is formatted to reflect the principles of cognitive-behavioral therapy or contingency management, positive outcomes are achieved.

Wilderness Programs


Insurance might not cover wilderness programs. Many programs have limited or no outcomes reporting, partly because relapse comes with addiction. Explore options.

These programs are exactly what they sound like. Wilderness programs use wilderness expeditions for the purpose of therapeutic intervention. A range of programing exists, and the philosophy behind it is to use “experiential” outdoor education to create positive outcomes in the areas of self-concept and self-esteem, along with improved social behaviors in areas such as trust and mutual support. Many therapists I have encountered believe this is an “efficient” approach for teen and young adult males, relative to other options.

Insurance providers in general offer limited or no coverage for these programs. Even court ordered programs usually require an out-of-pocket spend.

Substance Abuse Incident, What Next?

i Aug 21st No Comments by

There has been an incident with your loved one involving substance abuse. Quick – what are the first 5 steps you should take immediately?

  1. Make sure the person is out of physical danger
  2. Identify the facts about what exactly happened
  3. Remove any substances or items that could cause additional harm, including an automobile, if necessary
  4. Seek the counsel of an experienced substance abuse counselor
  5. Assess the degree or extent of the problem

The first five steps after a substance abuse incident can save a life and help people think and act more clearly.

If your teen is on your phone plan, then start monitoring their call, text and internet activity. Start a record to track habits and calls. Start exploring the best course of action. Now.

Law enforcement or Student Conduct might dictate the next step, giving you no choice regarding what to do next. Unfortunately, depending on the community or school, some teens will be forced to attend mandatory, often inadequate DUI schools, which in many cases feel so punitive, that they hardly inspire sobriety or improved behaviors. What’s more, law enforcement might also impose community service, which could add fuel to feelings of humiliation, particularly if it is a service that does not necessarily fit the transgression or the behavior.

Intensive out-patient programs (IOP), which combine therapy, group therapy, counseling and medicine dispensation, along with other programs are available. Look for details forthcoming. Here is a start, in the meantime.

  • Weekend outpatient
  • Inpatient recovery programs, which usually involve detox for addicts, alcoholics. Detox needs to be medically supervised, or death could result in severe cases
  • Comprehensive residential addition programs
  • Wilderness programs, 20 to 90 day recovery centers that focus on intensive outdoor forms of therapy, combined with individual/group therapy
  • 12-step programs or communities

Will Ban on College Campuses Curb Alcohol Abuse?

i Aug 17th No Comments by

In January of this year, the New York Times ran a story about Dartmouth banning hard liquor on it’s campus. Since then, I have been meaning to write about this.

So banning hard alcohol at frat parties and on campus will help “arrest bawdy behavior and reduce sexual assault”? Hmmm… who said so? Addiction therapists and experts at many respected facilities advise clients that it is alcohol, more than other substances, that wreaks the worst havoc on young adults and families. Beer, wine, or booze, they pretty much have the same impact. Heroin is an exceptional substance because it kills from overdose and has more addictive characteristics than many other substances. But alcohol, regardless of the form, is often more damaging.


Dartmouth College attempted to curb alcohol abuse by banning booze on campus.

In fact, the most dangerous substance abuse problem on many campuses is allegedly alcohol mixed with Xanax. So what does Dartmouth expect to accomplish with a ban on booze, but not beer and wine? Does the action placate wealthy alums who expect action but don’t understand the real facts surrounding substance abuse? Hard alcohol is easier to conceal than a case or a keg. That doesn’t mean that banning it will help.

How about institutionalizing programs that support prevention and teach and enable students to intervene if a friend is getting into hazy territory? How about mandatory group substance abuse counseling on Sunday night at the Frat house? How about a sober tailgate? Sponsored by the likes of Coke or Pepsi or Ford, and other big brands that want to target young and millennials and be part of a healthy, even a party culture?

Come on Dartmouth, show a little leadership. Show a little resourcefulness. Get real on young adult behaviors and alcohol abuse.

Marijuana Addiction is Real

i Aug 16th No Comments by

What about Weed? For parents who don’t think it is addictive, read this excerpt from an article published on CNN.

pot in the raw

Marijuana bud. Credit: US Library of Congress

We now know that while estimates vary, marijuana leads to dependence in around 9 to 10% of adult users. By comparison, cocaine, a schedule 2 substance “with less abuse potential than schedule 1 drugs” hooks 20% of those who use it. Around 25% of heroin users become addicted.

The worst is tobacco, where the number is closer to 30% of smokers, many of whom go on to die because of their addiction.

There is clear evidence that in some people, marijuana use can lead to withdrawal symptoms, including insomnia, anxiety and nausea. Even considering this, it is hard to make a case that it has a high potential for substance abuse. The article continues, “The physical symptoms of marijuana addiction are nothing like those of the other drugs I’ve mentioned. Withdrawal from alcohol… can be life threatening.

Pot.NIMH. umaLateralWholeBrain1

Brain receptors are vulnerable to marijuana among all users. If a user is among the 10% of adults prone to addiction, he or she is highly vulnerable to marijuana addiction.

I do want to mention a concern that I think about as a father. Young, developing brains are likely more susceptible to harm from marijuana than adult brains. Some recent studies suggest that regular use in teenage years leads to a permanent decrease in IQ. Other research hints at a possible heightened risk of developing psychosis.

Much in the same way I wouldn’t let my own children drink alcohol, I wouldn’t permit marijuana until they are adults. If they are adamant about trying marijuana, I will urge them to wait until they’re in their mid-20s when their brains are fully developed.”

Dr. Herbert Kleber, M.D., professor of Psychiatry, Columbia University, and pioneer in research and treatment of substance abuse, spoke at a National Center on Addiction and Substance Abuse (CASA) seminar on July 7, 2016. He stated that “…14 to 17 year old brains might not recover (from marijuana abuse) until they are 25 or older. “He also noted that edible marijuana can take one hour to kick in and can trigger a psychotic episode. Something to think about if you’re over 21 and consuming it in states where its sale is legal. For details that the professionals read on addiction, here is CASA’s most recent report on addiction.


Drug Abuse Statistics – A Look at the Numbers

i Aug 13th No Comments by

Substance Abuse Statistics are not going away.

The Facts* among the U.S. population for ages 15 to 29 is 64.6 million, over 21 percent of total U.S. population.


6.5% of this group uses marijuana daily. Photo Credit: US Library of Congress.


22.7%   used marijuana in the past month

15.5%   used a prescription drugs non-medically in 2012

 13%      prescription drug use for non-medical reasons is highest among young adults

250%   increase in young adult deaths from Rx overdoses between 1999-2010. That translates to 3000 deaths**

Complicating these facts are co-existing behavioral health disorders: In 2013, about 1 in 10 adolescents (10.7 percent) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 38.1 percent received treatment or counseling for depression in that past year.

Some research has shown that co-morbidity of addiction and mental illness can be 50%, and an office practice is not the setting of choice for most addicted patients (Clinical Philosophy: The Psychodynamic Approach to Addiction Treatment by Sid Goldman, M.A., for Caron Renaissance.)

An important part of family recovery from teen substance abuse is a willingness to help others in crisis with insight and information, all the while protecting the reputation and the future of the teens, with discretion and respect for privacy. Talk with as many people as you can and as many people as you can trust with regard to your teen’s problem, and protect his or her privacy.

Here is the NIH link to drug facts and trends among youth and teens. You are not alone.

Learn More Here