What is the drug Flakka?

Perhaps you’ve heard of bath salts or the meth epidemic. Now, a new synthetic drug called Flakka has hit the market…
But, what is Flakka? If you want to learn more about Flakka abuse, addiction, and treatment considerations…read here in our Flakka Addiction Treatment Programs and Help guide. In this article, we review the drug Flakka as well as the consequences of its use. We also explore why addicts use drugs in the first place, and invite your questions or comments at the end.

Horrible New Designer Drug Hits the Streets

A new designer drug called “Flakka” has been showing up on the streets of Florida, Texas and Ohio, and its effects are truly frightening. Due to the way the drug acts upon neurotransmitters, it can trigger anxiety, paranoia and delusions, which in turn can lead to a psychotic state. Tendencies toward violent behavior coupled with increased strength and loss of awareness of reality mark this substance as a problem for authorities and communities.
In one case in Miami a man ran out of his home, screaming and ripping of his clothes in a violent rage. He was perspiring, paranoid, delusional, and hallucinating after smoking Flakka. It required five police officers to subdue him.

What is Flakka?

Flakka is a synthetic amphetamine-like substance similar to the family of drugs known as cathinones, commonly referred to as bath salts. Just as bath salts are addictive, so is Flakka highly addictive both physically and psychologically, and can be smoked, inhaled, swallowed, or injected. Since it can also be vaporized, it’s use in an e-cigarette makes it hard to detect even when used in a public setting.
The drug is synthesized from a compound derived from khat, a plant grown in the Middle East and parts of North Africa that has been used traditionally to produce, when chewed in leaf form, a moderate high. As with cocaine, which when used traditionally by chewing coca leaves, the synthetic or distilled product has a vastly more powerful and deleterious effect. In the case of Flakka, the drug inhibits the re-uptake of dopamine and norepinephrine, two crucial neurotransmitters affecting mood and normal brain function. The result is a prolonged effect of what is known as “excited delirium.”

Danger: Flakka Hits the Market

Flakka typically comes to the U.S. through three main supply points: China, Pakistan and India. By the time it hits the streets, it has likely been adulterated in a number of ways. The U.S. Drug Enforcement Administration (DEA) reports no statistics involving the drug in 2010, 85 cases in 2012, and 670 in 2014. In Fort Lauderdale, the police have formed a special unit to deal with Flakka in anticipation of an increase in use.
One reason for the emergence of this new designer drug is that it is relatively cheap: an eighth of an ounce of Flakka costs about $150, or about one third the cost of an equivalent amount of crystal meth. At five dollars a single dose-one with effects lasting three to four hours-the drug has appeal to low-income users, although teens experiment with it for its euphoric effect.

Why would anyone become a Flakka drug addict?

As with bath salts, Flakka has a reputation on the streets for having the potential to produce highly unpleasant results, but that doesn’t seem to stop the spread of its abuse. This of course brings up the question of motivation: Why would anyone purchase a drug with known consequences as dire as those of Flakka?
The problem of addiction starts with the problem of the addict’s condition between highs. There is something radically unsatisfactory with the individual’s experience of life and self, to the extent that the addicted brain puts a premium on the possibility of relief from its condition via a drug and discounts the potential cost.
Consider the drug Krokodil, a homemade drug that has horrific effects that are publicly known and yet consumers continued to use it. Denial includes a mindset of exemption from consequences, and so drug abusers are inherently compromised when it comes to making decisions regarding their self-interest.

What can you do about Flakka?

If drugs exert such a strong pull on you or a loved one that they have priority over healthy pursuits: social, recreational, educational and professional. For these people, treatment is the best option. Without help, an addict is trapped in a spiral of self-defeat and continued abuse. Recovery through treatment offers not only freedom from dependency but also an entirely new life of hope and possibility.

Written on Drug Addiction Blog at: Flakka


8 Ways to Prevent Relapse

In many 12-step programs, there is an adage, “Relapse may be part of my story, but it doesn’t need to be part of my recovery.” And it sounds great on paper. The truth is, there are many men and women who get clean and sober and stay clean and sober without ever suffering a relapse. But I was not one of them.
If we were to perform an autopsy on my relapse, you would find a set of universal precursors to my taking that first drink, which eventually led up to my sticking a needle in my arm again. And although I realize that in hindsight, vision is usually 20/20, I also realize that a primary component of my relapse was my ability to rationalize my behavior, or rather, my ability to rationalize the behaviors that led up to my relapse. Because, like many addicts and alcoholics, I have the uncanny ability to talk myself into taking that first drink, regardless of the consequences. That said, I have to tell you that I don’t live like that anymore.
Because I grew up.
Reparenting yourself and then, conversely, policing yourself in sobriety is no mean feat. Men and women who are new to recovery face challenges that for normal people seem small and easy to cope with, but for the alcoholic or the drug addict are almost overwhelming. This is why the newly-recovered person needs structure and support in the beginning, and why it is vital for them to accept that they are not like normal people — that they have a very real problem for which abstinence and vigilance are only part of the solution.
To that end, I offer you these eight simple ways to help prevent relapse. But I’m afraid I can only offer these tools to you; it is ultimately up to the addict/alcoholic to incorporate them into his or her recovery and use them.
Believe me, I know how hard it is in the beginning. But I can promise you that as time goes by, the self-esteem that is built from having these components in your life will more than make up for the absence of the substances you’ve been using to destroy yourself. Because, ultimately, it’s about feeling good about yourself.

1. Flex Your Willpower Muscles.

Research studies show that willpower can be limited, but only if we believe it is limited. The truth is that temptation is everywhere. However, when you resist one temptation, you can better resist the next one more easily. And, every time you let an urge pass without giving in to it, you strengthen your neural connections so that with time, it gets easier to resist those urges. Long story short: You are only as strong as you will let yourself be.

2. Be Proactive and Positive.

It’s not easy to maintain a positive attitude at all times, but there are things you can do to stay away from obsessing over a negative thought. Call your sponsor or therapist, Have that person on speed-dial, because knowing that support is right there at your fingertips can build your ability to stay positive. When you are restless, you need company; go find some.

3. Live in the Moment.

Vigilance is the key, and you can’t be vigilant if you’re romanticizing the past. Most of your self-esteem will come from being sober and working through your issues, but don’t take your renewed self for granted. If you are overconfident, you may want to “prove” to someone that you can handle a drink or two. Live in the truth and understand that every moment you spend glorifying your past or obsessing over your future is a moment that diminishes your power in the now; and today, we’re all about taking our power back so that our lives aren’t ruled by alcoholism or drug addiction.

4. Stay in Therapy.

Now that you are sober, you have a world of emotional issues to confront without the numbing agents of drugs and alcohol. You may find familial, platonic or romantic relationships that are causing problems for you, and all of you need to learn how to resolve conflicts in healthy ways. But you are the key. Continue weekly appointments with your therapist (for at least a year or two after getting sober) as well as group meetings. This will complete your healing and provide the coping tools that are your insurance.

5. Have Patience.

Patients and their families all need lots of patience as they wait for the healing to set in. Emotions are volatile, insomnia is rampant, and patients begin to feel as if they will be miserable for the rest of their lives. Their loved ones are also seemingly on constant vigil, thinking, “Is he late because he’s out drinking?” No one needs to assume that relapse will happen, and there’s no point in constantly worrying about it. If you get bored, however, join a health club, get out of the house, plan a trip — expose yourself to new things. Don’t waste time feeling sorry for yourself. Everything that you’ve accomplished so far has been nothing short of heroic, but things aren’t going to change overnight. In many 12-step programs, there’s a concept called “slowbriety” that I think you should explore, especially when you feel as though you are climbing out of your skin. Take your time with this; be kind to yourself. You’re right on schedule and you’re on the right track.

6. Sleep.

Sure, we need to exercise and eat healthy foods, but nothing we can do has the health-restorative benefits of simple sleep. Our overall sleep patterns keep us healthy for a lifetime. As addicts, of course, many of us have lost the ability to get enough rest. Our abuse of drugs and alcohol has totally untrained our bodies in the art of falling asleep. We’ve tampered with our brain chemistry. During deep sleep and REM (rapid eye movement) sleep, the brain regulates all of its chemicals and resets the neurotransmitter systems. The only caveat I have about sleeping is that you shouldn’t sleep during the day and isolate yourself from the rest of the waking world because, frankly put, it’s counter-productive. Reestablishing healthy sleep patterns is an important component of early recovery, but you need to approach this component in an intelligent manner; the last thing you want to do is make sleeping too much your new problem.

7. Avoid Being Around Alcohol and Drugs.

You can still be crazy, funny, daring, and cool. Your life can still be full — actually more full — of great times and memorable people and places. That’s good crazy. Recovering addicts are probably the most fun, smart, and entertaining people I know. And they enjoy huge success by staying out of harm’s way, especially in the beginning. Bars, nighclubs, neighborhoods or environments where you used to drink and use — it should be a conscious choice to avoid these places until you develop the ego strength to go there. Long story short: If you hang around the barbershop long enough, you’re going to get a haircut. Am I telling you to join a monastery? No. But, I am asking you to take your power back and decide where you want to go and why you want to be there. You got clean and sober to have a new life. And, I don’t know of anyone who gets a new lease on life and then dances on a minefield. You have options today. Use them.

8. Realize That Your Symptoms Are Normal.

Your emotions are sensitive in early recovery, because they are no longer covered up by your substance abuse. This can be overwhelming when you’re not used to dealing with your feelings. You might get depressed or develop resentful thoughts. It’s totally normal to feel this way. Your feelings will eventually start to calm down. You may even start to embrace these emotions once you can respond in a healthy way. Can you imagine the triumph in that? You’ve been a human piñata for so long, taken from pillar to post by your feelings that you had to self-medicate with drugs and alcohol, that just getting through the day knowing what to say or do when those same feelings come up is a really huge deal. I’m here to tell you that not only is it possible, it happens all the time. You don’t have to be alone in this. Even if you are in an igloo in the middle of the frozen tundra, there are resources at your disposal. All you have to do is realize that you haven’t used every resource at your disposal until you’ve asked for help.

Is relapse going to be part of your story? Maybe. But, the unfortunate truth is, you may not make it through that relapse alive. And believe me, I know a lot of people who didn’t survive their relapse. They just didn’t make it. It’s a terrible, tragic reality of the disease of addiction.

But if you open yourself up to the possibility that there might be a way to prevent relapse from becoming a part of your recovery, you may find yourself not only clean and sober, but immersed in a life worth staying clean and sober for.

Written by Howard C. Samuels, Psy.D. on Relapse Prevention

Fentanyl is fueling a new overdose crisis. Here’s what you need to know about the deadly opioid.

WASHINGTON — Fentanyl, a super potent synthetic opioid at the center of a new overdose epidemic, is presenting uniquely vexing challenges for law enforcement officials because it’s so deadly, so versatile and so profitable.
It’s flowing into the U.S. across the southern border and via the mail system. It’s being trafficked by Mexican cartels with vast dealer networks and by small-time operators ordering the drugs online. It’s being purchased by people with opioid addictions looking for the most potent dose on the street and by unsuspecting consumers looking for cheap pain pills from shady Internet retailers.
“It truly is everywhere,” said Barbara Carreno, a spokeswoman for the federal Drug Enforcement Agency.
Here are the key things to know about the drug fueling this deadly crisis:

Where is the fentanyl coming from?

The primary source is China, where thousands of illicit labs led by rogue chemists manufacture fentanyl and a raft of copycat substances.

Experts say the primary buyers are Mexican drug cartels, who mix the fentanyl with heroin and other substances and then smuggle those diluted mixtures across the U.S.-Mexico border. But the amount of fentanyl coming into the U.S. via the mail system is growing — in smaller packages and at much greater potency.
“I expect that in fiscal year 2017, the numbers of seizures in the mail and express consignment environment (such as FedEx and UPS) will be much higher than they were last year,” said Robert Perez, an acting commissioner with the U.S. Customs and Border Protection (CBP) agency.
Perez said the CBP seized more than 400 pounds of fentanyl in fiscal year 2016 — up from eight pounds in 2014. A few granules of the drug can be deadly, and many customs agents are now equipped with Narcan, the anti-overdose medication, in case they come into contact with the substance.

What role is China playing?

Chinese officials were initially slow to respond to pleas from American officials to crack down on fentanyl, which is a Schedule II narcotic in the U.S.
China has a booming pharmaceutical industry, and fentanyl was not causing a deadly overdose epidemic in China, so the government there wasn't focused on controlling it.
“It’s hard to get cooperation from another country on a substance that’s not illegal in their country,” said Richard Baum, acting director of the Office of National Drug Control Policy.
But China has become more aggressive, Baum and others say. This year, for example, China’s National Narcotics Control Commission banned four fentanyl-class substances, including carfentanil — which is normally used as a large-animal tranquilizer and is 10,000 times more potent than morphine, according to the DEA.
That should cause a drop in the amount of carfentanil flowing into the U.S. But every time the Chinese ban one synthetic opioid, drugmakers in that country tweak their recipes to get around the new restrictions.
“These rogue chemists in China can just tweak a molecule and then you have a new substance,” said Carreno. That often leaves American law enforcement officials “three or four generations behind” the chemists, she said.

Why is fentanyl supplanting heroin as a key driver of the overdose epidemic?

It’s easier and cheaper to produce than heroin, which is derived from poppy plants. With fentanyl, there are no crops, just chemicals.
“You can make it as strong as you want, and in bulk and fast,” said Tim Reagan, a Cincinnati-based DEA agent. And because it’s so potent, a little bit goes a long way, making it extremely profitable.

How difficult is it for local law enforcement officers to prosecute cases?

“With it coming through the mail, it just adds a whole different dynamic that we’ve never dealt with with any other drug,” said Tom Synan, police chief in Newtown, Ohio, which has been particularly hard hit by the influx of fentanyl.

Synan said it’s dangerous to collect evidence at an overdose scene because fentanyl is so toxic. In May, a police officer in northeast Ohio overdosed after he brushed a bit of the white powder off his uniform. He had just returned to the station from making a drug arrest, where he had used gloves and a mask to search a suspect’s car. Without the protective gear, it took four doses of Narcan to bring him back.

Synan said his officers focus on reviving overdose victims and keeping themselves safe, and they worry about making arrests and building cases later. Even when officers are able to ensnare dealers, Synan and others said, it can be hard to connect them to a broader drug ring.
“When you had crack cocaine, you had a lot of organized gangs that were really the primary pushers,” said Synan. With fentanyl, some dealers are connected to Mexican cartels, but many others are independent operators.
The dealer may lead to just “one string, instead of a tree,” Synan said. “Right now, we’re just kind of surviving and just trying to save lives.”
Reagan said the DEA has had “a ton of success identifying street dealers” whose transactions have resulted in overdose deaths. But those dealers are often unwilling to cooperate, stymieing efforts to target operators further up in the supply chain.
As for tracing sources in China, Reagan said, the DEA can turn over incriminating information to Chinese authorities to see whether they will prosecute. Or try to bring charges in the U.S. and ask for extradition.
“There’s definitely more cooperation than ever,” he said. But “this is all kind of new.”

Why do individuals with opioid addiction take fentanyl-laced drugs when they are so likely to result in an overdose?

First, medical experts note that addiction is a brain disease that can impair self-control and judgment. People suffering from addiction are not making rational decisions.
Second, some individuals with substance abuse disorders don’t realize fentanyl has been mixed into the drugs they’re buying. Take this person who posted a message in a fentanyl chat room on Reddit asking about what might be in his opioid pills.
“With real oxy, I usually have at least a day after my last dose before the withdrawls (sic) kick in, but now it’s literally like 3-4 hours after my last dose,” this person wrote. “Is this normal for fent or are my pills laced with something else?”
Finally, those with opioid addiction want the most intense high, and some seek out fentanyl-laced drugs even if they realize it could kill them. “If a user dies … (others) are going to try to find that dealer, because they’re looking for the best stuff,” Reagan said.

Another person on Reddit explained the decision to use fentanyl this way:
“So because oxycodone is so gosh darn expensive I've decided to start using fentanyl but have no idea how to use it,” this individual wrote. “How much am I supposed to use without killing myself thanks for your help.”

What role is the Internet playing in fentanyl sales and distribution?

A big one. Dealers and those with opioid addiction can buy fentanyl directly from Chinese manufacturers with just a Google search and a few clicks.
More sophisticated operators use the so-called dark web, which hides the servers and identities of a websites administrators and users. These clandestine sites often use digital currencies, such as Bitcoin, to further disguise financial transactions.
“These dark web markets are like eBay” for illegal products, said Isak Ladegaard, a researcher at Boston College who has studied digital drug markets. “If you order something through the dark web and it’s delivered to your address, there is no evidence you were the person making the order.”
The Department of Justice announced on July 20 that it had shuttered one the largest online criminal marketplaces, AlphaBay, and Dutch authorities also recently closed a similar site called Hansa Market. At the time of the AlphaBay bust, there were more than 250,000 listings for illegal drugs and toxic chemicals on the site, the Department of Justice said, along with thousands of listings for other illicit goods.
But Ladegaard said the Justice Department crackdown would not dampen the illegal fentanyl trade.
“All research thus far suggests that when a market is closed down, there is a period when there is some instability and people are not entirely sure what to do,” he said. “But fairly soon, traffic moves on to other (dark web) marketplaces.”

How do Customs officials stop fentanyl shipments from getting into the U.S.?

In June, Border Patrol agents seized 34 pounds of fentanyl during a vehicle stop at a California checkpoint — discovering 10 plastic-wrapped bundles of fentanyl in the car's trunk, with an estimated street value of more than $1 million, according to a CBP news release.
But the dangers at the border are the same as on the street. Even drug-sniffing dogs are at risk of death if they accidentally ingest fentanyl during searches, and the agency is now engaged in a pilot project to specially train dogs for these synthetic opioids.
Finding fentanyl in the mail can be even more difficult, because of the sheer volume of packages and the lack of electronic data detailing shipments sent via the U.S. Postal Service.
“How we inspect and how we select packages in the mail is still a very manual process,” said Perez, the CBP commissioner.

Written on USA Today at: Fentanyl

Study: Alcohol Fuels Drastic Increase in Liver Disease

A new study found that cirrhosis-related deaths increased the most among people aged 25 to 34 from 2009 to 2016.

Deaths from liver disease, especially among young people, have increased dramatically since 1999, according to new research.
A study published Wednesday in The BMJ examined deaths related to cirrhosis and liver cancer from 1999 to 2016. Researchers discovered that cirrhosis-related deaths increased 65 percent among men and women across all ethnicities, totaling 34,174. Deaths from liver cancer doubled to 11,073. Asians and Pacific Islanders was the only subgroup that saw a decrease in mortality from cancer.
According to the study, from 2009 to 2016, "the period of worsening death rates," people aged 25 to 34 experienced the highest annual increase in cirrhosis-related deaths (10.5 percent), which was entirely fueled by alcohol-related liver disease. The researchers stated this finding is "reinforced by parallel changes in mortality due to alcohol use disorders and all alcohol-related liver disease."

Deaths from cirrhosis rose the most among Native Americans, whites and Hispanics. They also rose the fastest in Southern and Western states, such as Kentucky, New Mexico, Arkansas, Indiana and Alabama. Additionally, men experienced twice as many deaths from cirrhosis as women.
Cirrhosis is the scarring of the liver, which prevents it from functioning properly. Common causes include heavy alcohol consumption and hepatitis.

Lead author and professor at the University of Michigan, Dr. Elliot Tapper, told CNN that an increase in binge-drinking culture among young people could be the cause of the rise in cirrhosis-related deaths. Tapper said he has been treating more young people with liver disease and that these deaths are preventable if the right measures are taken before it's too late.
"We were struck by how the current concept of who develops cirrhosis didn't quite match what we were seeing," Tapper told CNN. "It was really striking to us to have people that were younger than us in our clinic dying from cirrhosis."
Tapper suggests using blood tests to diagnose the disease and raising the price of alcohol.

Written on USN at:


A Mother’s Love – A Mother’s Heartache

The day before Thanksgiving, nine years ago, I lost all happiness, peace of mind...and my daughter.

My name is Renee. I have a beautiful daughter…a beautiful daughter that happens to be a heroin addict. I have gone through every imaginable scenario and disaster in parenting her. She started using at the tender age of 18.
The day before Thanksgiving, nine years ago, I lost all happiness, peace of mind…and my daughter.
I remember looking at her that first time in detox and thinking, “Its okay; we can fix this. She will be fine.” As I walked in to visit her, she was sleeping with a rosary in her hands across her chest. That moment sticks with me and knowing she had God with her…well, I just knew it would all be okay.
She stayed in detox for a total of five days before she convinced me she didn’t need the whole thirty days in rehab. I think back to how naive I was – and still am, at times.

Looking Back

I’ll give you the very short version: She has been admitted to a total of 13 rehabs – completing only one at 19 years old – she’s been in jail a half dozen times – three of those times I’m the one who turned her in. She’s stolen everything from my house and our family members’ homes. She broke into my home, lied, stole, destroyed every relationship in the family (and we have a huge family).

Everyone has given up on her…even her two brothers. But not not me; I’m her mother.
She used to show up everyday, run into my house, grab food, then try to lock the bathroom door and shower. We finally put locks on everything in the house just to keep her out.
About three months ago, she showed up at five in the morning, which isn’t abnormal. She was very sick I let her come in. She stayed and I eventually got her into a methadone program. Then, of course, things started going missing again, so off she went.
I was beside myself, but this time was different.

Cutting Ties Hurts

I realize I can’t – and won’t – do this anymore. I cant save her! So, I went down to the court house and got a restraining order.
I have to do this; it’s the only thing I haven’t done so I have to completely cut her off. God, I pray I’m doing the right thing. When I don’t hear from her, I worry. Then when she shows up, I’m relieved…but it’s always the same outcome.

Written on Recovery at: A Mother's Love

How Does Drug and Alcohol Detox Work?

Having an addiction to drugs and/or alcohol can have an impact on a person’s overall health. It can cause both physical and psychological damage. Trying to quit can be extremely dangerous, and in most cases requires specialized treatment. The process for drug and alcohol detox can be successful, but it should be done under medical supervision to avoid complications, including possible death. After detox, it is also important for an individual to consider attending a rehab program for better success in recovery.
According to the U.S. National Library of Medicine, a successful detoxification process can be measured, in part, by whether an individual who is substance dependent enters, remains in, and is compliant with the treatment protocol of a substance abuse treatment/rehabilitation program after detoxification.

How Does the Drug and Alcohol Detox Process Work?

Depending on the severity of the addiction, and other factors such as a person’s current health status -detoxing from drugs or alcohol can vary from one individual to another. A person that enters into a detox program will undergo certain criteria before the detox process begins. Some of the procedures to expect before, during and after may include:

Before detox:

An assessment will be necessary to help the medical professionals understand the severity of the drug or alcohol problem. Questions regarding the history of drug and/or alcohol used will be asked, and if any co-occurring disorders may be present that may of lead to substance abuse, and were never treated. A person will also need to undergo a physical examination to identify conditions such as malnutrition or dehydration. This helps the licensed professionals create a treatment plan that meets your needs.

During detox:

Depending on how much drugs and/or alcohol is in your system, and what damage they have done, the detox process can take from several days to several weeks, especially if your body has toxins from several substances. Medication, according to the treatment plan can be started to help ease the withdrawal symptoms associated with drug and alcohol detox. This medication also helps reduce the cravings often experienced from withdrawal- which usually cause an addict to start using drugs or alcohol again.
Medications may vary, but the most commonly used ones during detox include:



Other drugs-such as opiates:


Not everyone that suffers from the same disease of addiction will receive the same medication, or expect the same detox process. Some may need additional medical treatment if the severity of the addiction has caused health complications that may be irreversible. While treatment can help, it cannot be cured. Which is very important to have a follow-up plan after detox to prevent the temptation of using drugs and/or alcohol again.
Not only can alcohol, and certain drugs cause permanent damage to both physical and mental health, but the more the abuse continues -the higher the probability of it producing fatal results.

After detox:

When the toxins are out of the body, it does not mean that all is fine. Now the most important part can take place. Therapies, such as counseling, group sessions, behavior therapy, medications to help with psychological elements if necessary, and other important factors need to be addressed and followed up on. Therapy and/or a recovery program can help you to avoid relapse, and the longer you were on substances -the more help you will need after drug and alcohol detox. Those who attend and complete addiction treatment after detox have a lower risk of relapse.

Written on Detox at: Detox

Personal Story: #RecoveryIsPossible

In my experience, my active alcoholism was much more than a disease or substance use disorder. It was a full-blown way of life. EVERYTHING, from the moment I awoke in the morning to how and when I brushed my teeth, was dictated by my alcoholism. You see, I may not have drank every day or drank to oblivion each time I did drink, but what I did have was other-worldly (completely irrational, delusional, “insane”) thoughts about alcohol. Alcoholism was my moral compass, where everything and everyone that I pulverized was done so with the idea that alcohol was more important than anything else. Getting drunk and achieving that effect was more important than my employability and my relationships with friends and family.
Growing up, I experienced the loss of my father at the age of 14, very suddenly, when he had a heart attack. This loss set the ball in motion for self-centered fear. I was afraid of being hurt again in such a manner, so I would isolate and keep people away, but close enough to obtain things I needed. Fear ran my life until alcohol did. Adding alcohol to my psyche at that particular time was like pouring gasoline on the fire, where my fears and insecurities became even more acute. So why did I keep going back to alcohol? Alcohol deluded me into believing that it freed me from worry and insecurity and provided me with fellowship with others. Honestly, I did have some good times early on; however, I crossed the line from social drinker to problem drinker very quickly, if not after the first night I drank. See, when I drank the first time, it was like discovering oxygen. No longer was I a square peg being pounded into the round hole. I felt like I was a part of something and no longer terminally unique from my fellows. Alcohol was the solution to my life of fear and hurt.
Unfortunately, the good feeling that alcohol gave me did an about-face and knocked me out on more than one occasion. I became involved in the criminal justice system due to drinking and my alcoholism told me that I had a drinking and driving problem, not a drinking problem. Alcoholism progressed to the breaking point on September 28th, 2010. That evening, I was arrested for my 2nd DUI. That night, after I had made a phone call home to be picked up from the hospital where I was administered a blood test, the words “I think I need to go to AA” were uttered. Where these words came from, I do not know. But some part of me knew that the game was over.
I have been blessed to have a supportive family throughout my active alcoholism and recovery. My step-dad drove me to my first meeting on October 5th, 2010 and it was here, where I met other people who drank like I did, thought about alcohol like I did, and felt about the world like I did. However, they had something that I was missing – a solution to living life without drinking. I would love to say that I jumped in the “recovery lake” all the way from the start, but that would not be the truth. While I have not had a drink since September 28th, 2010, I did not begin participating in a program of recovery until August of 2011. In the period of time between September 2010 and August 2011, I was grazing the surface of the “recovery lake” with my big toe by attending 12-step meetings, participating in court-mandated treatment, and completing a halfway house program tailored specifically for 2nd time DUI offenders in Berks County. I was also working at a residential treatment center for behaviorally challenged youth, as well as rehabbing a blown out ACL suffered on the job.
What happened in August of 2011? I surrendered my driver’s license to the Commonwealth of PA and surrendered my job to my employer due to my inability to drive. I was at a crossroad in my life and my scorecard read zero. I remember the people at 12-step meetings who thought and drank like I did, but ALSO had time and purpose in their life, say things like “meeting makers make it,” “this is a program of action,” “it works WHEN you work it,” etc. So I went to the same meeting I went to back on October 5th, 2010 on August 2 and reached out for help. I got connected with a sponsor who marched me through the 12-steps – which are still my moral compass to this day – and attended meetings every day for the next several months.
I also made the decision to go back to grad school to earn my MSW. This program was tailored in such a way where the initial classes were ripe with introspection and challenging of self. Coupled with the 12-step work being done with my sponsor and being guided through these classes by a great faculty, I began to understand more about myself, my biases, my family history, and perhaps most importantly, the power of people as agents of change. Slowly, but surely, I began to put the pieces of the puzzle together and learn about why my life, which was guided by fear and insecurity, had transpired the way it had, especially when alcohol was poured all over it (in some cases, very literally poured all over it!) I learned about the power of connection between one recovering person and another; where sharing experiences, strength, and hope with each other provide example and inspiration to continue “one day at a time.”
I sit here today full of gratitude for the people I have met along the way, from my supportive parents, my sponsor and friends in recovery, the Social Work Department and my classmates at KU, and my employers since finding recovery. Today, I have a monthly car payment, I have monthly student loan payments, there is the possibility of becoming a home-owner at some point this year, I pay taxes, and I am involved in my community. I am also blessed to be employed with a great organization that is a local leader in changing the public perception and negative stigma of addiction to promoting recovery as a way of life.
Just like how alcoholism used to be a way of life for me, my new way of life is one based on recovery. No longer am I a taker, looking for what I can get from situations, I am now looking at ways in which I can contribute. No longer do I isolate, I surround myself with like-minded people and travel together to places where a presence of recovery can be useful. I am now a proud social worker who understands, firsthand, the value of investing in our friends, neighbors, and communities. While the gifts of sobriety are bountiful, one of the greatest gifts is the fact that I am no longer afraid and am secure in my own skin. I can now look myself in the eye and be cool with the man staring back at me in the mirror.
So if you are new to recovery, please stay with us. There are many pathways to finding the life of purpose and usefulness in recovery. Read some of the stories posted here. Attend one of the dozens upon dozens of local 12-step meetings in the area. Or if you wish, there are other secular and faith-based recovery fellowships available to try, as well. If you are a loved one of someone who has yet to find recovery, do not lose hope. There are also fellowships available for you who can assist you in your own personal recovery journey, too. Don’t quit before the miracle happens!
-Daniel Pfost

Written on Recovery&Me at:


Co-occurring Disorders

The coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorders.

Co-occurring disorders were previously referred to as dual diagnoses. According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH), approximately 7.9 million adults in the United States had co-occurring disorders in 2014.
People with mental health disorders are more likely than people without mental health disorders to experience an alcohol or substance use disorder. Co-occurring disorders can be difficult to diagnose due to the complexity of symptoms, as both may vary in severity. In many cases, people receive treatment for one disorder while the other disorder remains untreated. This may occur because both mental and substance use disorders can have biological, psychological, and social components. Other reasons may be inadequate provider training or screening, an overlap of symptoms, or that other health issues need to be addressed first. In any case, the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death.
People with co-occurring disorders are best served through integrated treatment. With integrated treatment, practitioners can address mental and substance use disorders at the same time, often lowering costs and creating better outcomes. Increasing awareness and building capacity in service systems are important in helping identify and treat co-occurring disorders. Early detection and treatment can improve treatment outcomes and the quality of life for those who need these services.

Written on SAMSHA at Co-occuring Disorders

Opioid Overdose Reversal with Naloxone (Narcan, Evzio)

What is naloxone?

Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.

How is naloxone given?

There are three FDA-approved formulations of naloxone:

Injectable (professional training required)

Generic brands of injectable naloxone vials are offered by a variety of companies that are listed in the FDA Orange Book under "naloxone" (look for "injectable").

Note: There has been widespread use of improvised emergency kits that combine an injectable formulation of naloxone with an atomizer that can deliver naloxone intranasally. Use of this product requires the user to be trained on proper assembly and administration. These improvised intranasal devices may not deliver naloxone levels equivalent to FDA-approved products. In fact, the manufacturer of an internasal atomizer device issued a voluntary reacall on 10/27/16 noting that some of the devices “may not deliver a fully atomized plume of medication, making the drug potentially less effective.”  An approved, prefilled nasal spray is now available (see below).


EVZIO® is a prefilled auto-injection device that makes it easy for families or emergency personnel to inject naloxone quickly into the outer thigh. Once activated, the device provides verbal instruction to the user describing how to deliver the medication, similar to automated defibrillators.

Prepackaged Nasal Spray

NARCAN® Nasal Spray is a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while patients lay on their back.

Note: Both NARCAN® Nasal Spray and EVZIO® are packaged in a carton containing two doses to allow for repeat dosing if needed. They are relatively easy to use and suitable for home use in emergency situations. 

Who can give naloxone to someone who has overdosed?

The liquid for injection is commonly used by paramedics, emergency room doctors, and other specially trained first responders. To facilitate ease of use, NARCAN® Nasal Spray is now available, which allows for naloxone to be sprayed into the nose. While improvised atomizers have been used in the past to convert syringes for use as nasal spray, these may not deliver the appropriate dose. Depending on the state you live in, friends, family members, and others in the community may give the auto-injector and nasal spray formulation of naloxone to someone who has overdosed. Some states require a physician to prescribe naloxone; in other states, pharmacies may distribute naloxone in an outpatient setting without bringing in a prescription from a physician. To learn about the laws regarding naloxone in your state, see the Prescription Drug Abuse Policy System website.

What dose can be provided?

The dose varies depending on the formulation, and sometimes more than one dose is needed to help the person start breathing again. Anyone who may have to use naloxone should carefully read the package insert that comes with the product. You can find copies of the package insert for EVZIO® and NARCAN® Nasal Spray on the FDA website.

What precautions are needed when giving naloxone?

People who are given naloxone should be observed constantly until emergency care arrives and for at least 2 hours by medical personnel after the last dose of naloxone to make sure breathing does not slow or stop.

What are the side effects of naloxone?

Naloxone is an extremely safe medication that only has a noticeable effect in people with opioids in their systems. Naloxone can (but does not always) cause withdrawal symptoms which may be uncomfortable, but are not life-threatening; on the other hand, opioid overdose is extremely life-threatening. Withdrawal symptoms may include headache, changes in blood pressure, rapid heart rate, sweating, nausea, vomiting, and tremors.

How much does naloxone cost?

The cost varies depending on where and how you get it. Patients with insurance should check with their insurance company to see what their co-pay is for EVZIO® or NARCAN®Nasal Spray. Patients without insurance can check on the retail costs with their local pharmacies. Kaleo, the maker of EVZIO®, has a cost assistance program for patients with financial difficulties and no insurance.

Witten on Narcan

Cocaine Information

Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "Coca" in addition to the alkaloid suffix -ine, forming cocaine.
Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine was labeled the drug of the 1980s and '90s, because of its extensive popularity and use during this period. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years. Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia, in the mid-19th century. In the early 1900s, it became the main stimulant drug used in most of the tonics/elixirs that were developed to treat a wide variety of illnesses. Today, cocaine is a Schedule II drug, meaning that it has high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as local anesthesia for some eye, ear, and throat surgeries.

Forms of Cocaine

There are basically two chemical forms of cocaine: the hydrochloride salt and "Crack Cocaine". "Crack Cocaine" is referred to as "freebase". The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable. Crack is the street name given to a freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. The term "crack" refers to the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride. Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy. Crack cocaine remains a serious problem in the United States. The National Survey on Drug Use and Health (NSDUH) estimated the number of current crack users to be about 567,000 in 2002.

Cocaine Use in the U.S.A.

In 2002, an estimated 1.5 million Americans could be classified as dependent on or abusing cocaine in the past 12 months, according to the NSDUH. The same survey estimates that there are 2.0 million current (past-month) users. Cocaine initiation steadily increased during the 1990s, reaching 1.2 million in 2001.

Adults 18 to 25 years old have a higher rate of current cocaine use than those in any other age group. Overall, men have a higher rate of current cocaine use than do women. Also, according to the 2002 NSDUH, estimated rates of current cocaine users were 2.0 percent for American Indians or Alaskan Natives, 1.6 percent for African-Americans, 0.8 percent for both Whites and Hispanics, 0.6 percent for Native Hawaiian or other Pacific Islanders, and 0.2 percent for Asians. The 2003 Monitoring the Future Survey, which annually surveys teen attitudes and recent drug use, reports that crack cocaine use decreased among 10th-graders in 30-day, annual, and lifetime use prevalence periods. This was the only statistically significant change affecting cocaine in any form. Past-year use of crack declined from 2.3 percent in 2002 to 1.6 percent in 2003. Last year, the rate increased from 1.8 percent to 2.3 percent, and this year's decline brings it to approximately its 2001 level.

Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related emergency department visits increased 33 percent between 1995 and 2002, rising from 58 to 78 mentions per 100,000 population.

The Way Cocaine is Consumed

The principal routes of cocaine administration are oral, intranasal, intravenous, and inhalation. The slang terms for these routes are, respectively, "chewing," "snorting," "mainlining" or "injecting," and "smoking" (including freebase and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves the inhalation of cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug also can be rubbed onto mucous tissues. Some users combine cocaine powder or crack with heroin in a "speedball."

Cocaine use ranges from occasional use to repeated or compulsive use, with a variety of patterns between these extremes. Other than medical uses, there is no safe way to use cocaine. Any route of administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death. Repeated cocaine use by any route of administration can produce addiction and other adverse health consequences.

How Cocaine Works

pleasurable effects, and the reasons it is so addictive. One mechanism is through its effects on structures deep in the brain. Scientists have discovered regions within the brain that are stimulated by rewards. One neural system that appears to be most affected by cocaine originates in a region located deep within the brain called the ventral tegmental area (VTA). Nerve cells originating in the VTA extend to the region of the brain known as the nucleus accumbens, one of the brain's key areas involved in reward. In studies using animals, for example, all types of rewarding stimuli, such as food, water, sex, and many drugs of abuse, cause increased activity in the nucleus accumbens.
Cocaine in the brain - In the normal communication process, dopamine is released by a neuron into the synapse, where it can bind with dopamine receptors on neighboring neurons. Normally, dopamine is then recycled back into the transmitting neuron by a specialized protein called the dopamine transporter. If cocaine is present, it attaches to the dopamine transporter and blocks the normal recycling process, resulting in a buildup of dopamine in the synapse, which contributes to the pleasurable effects of cocaine.
Researchers have discovered that, when a rewarding event is occurring, it is accompanied by a large increase in the amounts of dopamine released in the nucleus accumbens by neurons originating in the VTA. In the normal communication process, dopamine is released by a neuron into the synapse (the small gap between two neurons), where it binds with specialized proteins (called dopamine receptors) on the neighboring neuron, thereby sending a signal to that neuron. Drugs of abuse are able to interfere with this normal communication process. For example, scientists have discovered that cocaine blocks the removal of dopamine from the synapse, resulting in an accumulation of dopamine. This buildup of dopamine causes continuous stimulation of receiving neurons, which is associated with the euphoria commonly reported by cocaine abusers. As cocaine abuse continues, tolerance often develops. This means that higher doses and more frequent use of cocaine are required for the brain to register the same level of pleasure experienced during initial use. Recent studies have shown that, during periods of abstinence from cocaine use, the memory of the euphoria associated with cocaine use, or mere exposure to cues associated with drug use, can trigger tremendous craving and relapse to drug use, even after long periods of abstinence.

Effects of Cocaine Use

Cocaine's effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them perform simple physical and intellectual tasks more quickly, while others experience the opposite effect.
The duration of cocaine's immediate euphoric effects depends upon the route of administration. The faster the absorption, the more intense the high. Also, the faster the absorption, the shorter the duration of action. The high from snorting is relatively slow in onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes.
The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.
Cocaine is a powerfully addictive drug. Thus, an individual may have difficulty predicting or controlling the extent to which he or she will continue to want or use the drug. Cocaine's stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the brain's reward system, and is either directly or indirectly involved in the addictive properties of every major drug of abuse.
An appreciable tolerance to cocaine's high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitization) to cocaine's anesthetic and convulsant effects, without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.
Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

Full Article on Cocaine