A regeneration of addiction

April 2015

By Matt Feehery, MBA, LCDC, Senior Vice President, CEO, Memorial Hermann Prevention and Recovery Center

 Old habits die hard, but for an increasingly alarming number of the nation’s 76 million Baby Boomers, their addiction habits didn’t die at all. They lay dormant and now are coming back to haunt. A Wall Street Journal story about a 58-year-old California man who had cleaned up his act following heavy marijuana and cocaine use in the 1970s, only to begin abusing opioids and alcohol after a knee surgery nearly 30 years later, illustrated the point.

While baby boomers – those born the years 1946 to 1964 – are one of the leading age groups affected by addiction, according to the Centers for Disease Control and Prevention (CDC), the reality is  addiction touches the old, young and those in between. As defined by the National Institute on Drug Abuse, addiction “is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”

There is reason for concern about the recurrence of addiction among older Americans when one considers that in 2013 more than 12,000 deaths resulted from accidental drug overdoses, which is more deaths than car accidents, the flu, or pneumonia caused in that age group. Moreover, experts predict that more than 5.7 million people older than age 50 will be in need of substance-abuse treatment only five years from now.

Many of us in the healthcare industry are aware of the power addiction has as it relates to our specialized areas of care. But the simple fact is that addiction has a major impact on our entire healthcare system and will continue to do so indefinitely if history repeats itself and the trends of addiction among different age groups continue.

Addiction is not a phase.

The statistics, consequences, and actions surrounding addiction all suggest that it is not a phase. Addiction should not be treated as something people will grow out of or “go through.” Attitudes among teens are softening toward the negative effects of illicit drugs like marijuana.
Nearly two-thirds of all surveyed by Monitoring the Future (MTF), an annual survey conducted by the University of Michigan that measures the use of alcohol, tobacco, and illicit drugs among 8th-, 10th and 12th-graders nationwide, said that they did not think regular use of marijuana was harmful. That is in stark contrast to 20 years ago, when only 35 percent held the same belief.

In Texas, 71.4 percent of adolescents aged 12-17 perceived no great risk in smoking marijuana once a month, according to the Substance Abuse and Mental Health Services Administration. The irony in that statistic is that marijuana is more potent and harmful now than it was 20 years ago. Teens are less wary of marijuana at a time when it’s never been more harmful, which could be damning since one in six teens become addicted to marijuana compared to one in 11 who start using as adults.

Additionally, a recent study submitted to the American Chemical Society, consistently found THC levels to be above 20 percent and sometimes upward of 30 percent in legally-sold marijuana in Colorado. The “old school” marijuana consistently had THC levels of less than 10 percent. Moreover, of the 600-plus samples of marijuana provided by certified growers and sellers in the study, many contained little to no cannabidiol (CBD), the medical component of marijuana.

There is some good news. The MTF survey revealed an overall decrease in alcohol and tobacco use among teenagers over the last 20 years. However, the fact remains that adults aged 21 or older who first used alcohol at age 14 or younger, were more likely to be classified with alcohol dependence or abuse than adults who had their first drink at age 21 or older (14.8 vs. 2.3 percent), according to the 2013 NSDUH.

Use of illicit drugs has risen and fallen several times since 1994. While currently on a slight decline, more than 35 percent of high school seniors have used marijuana in the past year, according to the survey.

We need to look no further than our back yard to understand that drug and substance abuse remains a problem. A sting operation that began in August 2014 and ended in
March helped bust a drug ring allegedly run by students in the Pearland Independent School District. Six students were arrested for dealing drugs that included cocaine,marijuana, Alprazolam (Xanax), and tramadol, an opioid, analgesic.

Prescription Drug Abuse

Another component of the MNF survey broke down the prevalence of prescription drug use with teens. Adderall (dextroamphetamine) led the way with 6.8 percent of high school seniors abusing it, followed by Vicodin (hydrocodone) at 4.8 medicines at 4.1 percent, OxyContin at 3.3 percent, and Ritalin at 1.8 percent.

This last finding speaks to pharming; a term referring to the unauthorized use of prescription, over-the-counter and nonprescription drugs. Pharming has at times manifested itself among teens and young adults in the form of “pill parties” or “Skittles parties” where they share whatever pills they can get their hands on, oftentimes washing down a bad decision with alcohol.

Pharming shouldn’t be shocking to anyone,given the staggering numbers around prescription medications. The CDC says that 259 million prescriptions were written for painkillers in 2012 in the U.S. In 2013, more than half (22,767) of the drug overdose deaths in the U.S. were attributed to pharmaceuticals. According to the CDC,
55 percent of those who abuse prescription painkillers get them from a friend or relative.

Addiction is a teacher?

All of this begs the question: Will history repeat itself? Will we be able to teach and prevent the current generation from making the same mistakes of the baby boomers? It’s going to be tough as teens have more and more harmful options than before whether it is alcohol, synthetics, misused prescription medication, legalized marijuana or a possibly dangerous new product like powdered alcohol.

As professional healthcare providers, we need to be just as available. Overcoming addiction is not easy and is an endless battle. Relapse rates vary from 50 to 90 percent. Withdrawal can be potentially lifethreatening but can have reduced risk with specialty care.

The ultimate goal of treatment is to return people to a state of mind that will allow them to have productive lives in the community, at work, and especially at home. Remaining in a formal treatment program can help a person stop using drugs, decrease criminal activity, and improve their occupational, social, and psychological functioning.

Treatment options depend on several factors, including what type of substance it is and how it affects the patients. Typically, treatment includes a combination of inpatient and outpatient programs, counseling or psychotherapy, self-help groups, and medication.