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Ex-DEA agent: Opioid crisis fueled by drug industry and Congress

Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities — knowing that people were dying — and says industry lobbyists and Congress derailed the DEA’s efforts to stop it.

In the midst of the worst drug epidemic in American history, the U.S. Drug Enforcement Administration’s ability to keep addictive opioids off U.S. streets was derailed — that according to Joe Rannazzisi, one of the most important whistleblowers ever interviewed by 60 Minutes. Rannazzisi ran the DEA’s Office of Diversion Control, the division that regulates and investigates the pharmaceutical industry. Now in a joint investigation by 60 Minutes and The Washington Post, Rannazzisi tells the inside story of how, he says, the opioid crisis was allowed to spread — aided by Congress, lobbyists, and a drug distribution industry that shipped, almost unchecked, hundreds of millions of pills to rogue pharmacies and pain clinics providing the rocket fuel for a crisis that, over the last two decades, has claimed 200,000 lives.

Ex DEA agent and 60 mins correspondent

JOE RANNAZZISI: This is an industry that’s out of control. What they wanna do, is do what they wanna do, and not worry about what the law is. And if they don’t follow the law in drug supply, people die. That’s just it. People die.

“This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices, that distributed them out to people who had no legitimate need for those drugs.”

Joe Rannazzisi is a tough, blunt former DEA deputy assistant administrator with a law degree, a pharmacy degree and a smoldering rage at the unrelenting death toll from opioids.  His greatest ire is reserved for the distributors — some of them multibillion dollar, Fortune 500 companies. They are the middlemen that ship the pain pills from manufacturers, like Purdue Pharma and Johnson & Johnson to drug stores all over the country. Rannazzisi accuses the distributors of fueling the opioid epidemic by turning a blind eye to pain pills being diverted to illicit use.

JOE RANNAZZISI: This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices, that distributed them out to people who had no legitimate need for those drugs.

BILL WHITAKER: Who are these distributors?

JOE RANNAZZISI: The three largest distributors are Cardinal Health, McKesson, and AmerisourceBergen. They control probably 85 or 90 percent of the drugs going downstream.

BILL WHITAKER: You know the implication of what you’re saying, that these big companies knew that they were pumping drugs into American communities that were killing people.

JOE RANNAZZISI: That’s not an implication, that’s a fact. That’s exactly what they did.

In the late 1990s, opioids like oxycodone and hydrocodone became a routine medical treatment for chronic pain. Drug companies assured doctors and congressional investigators — as in this 2001 hearing — that the pain medications were effective and safe.

Purdue Executive to Congress in 2001: Addiction is not common, addiction is rare in the pain patient who is properly managed.

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Rannazzisi accuses distributors of fueling the opioid epidemic by turning a blind eye to pain pills being diverted to illicit use.

With many doctors convinced the drugs posed few risks, prescriptions skyrocketed and so did addiction.

Many people who’d become addicted to painkillers turned to shady pill mills — pain clinics with rogue doctors to write fraudulent prescriptions and complicit pharmacists to fill them — one-stop shopping for controlled narcotics.

JOE RANNAZZISI: Pain clinics overnight popping-up – off an entrance ramp, or an exit ramp on an interstate. And all of a sudden there’s a pain clinic there.

BILL WHITAKER: Had you ever seen anything like that before?

JOE RANNAZZISI: Never. In fact– it was my opinion that this made the whole crack epidemic look like nothing.

JOE RANNAZZISI These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.

BILL WHITAKER: You know what a chilling picture that paints?

JOE RANNAZZISI: I do, ’cause I watched them get arrested, and I was the one who approved the cases.

Despite arrests of unscrupulous purveyors, opioids kept flooding the black market.  The death toll kept rising. This map shows the U.S. death rate from drug overdose in 1999. By 2015, the map looked like this. Most of these deaths were opioid related. Joe Rannazzisi told us prosecuting crooked doctors and pharmacists wasn’t stemming the epidemic, so he decided to move up the food chain.

JOE RANNAZZISI: There had to be a choke point. And the choke point was the distributors.

Ex DEA Agent and 60 mins correspondent walking in front of Capitol Building in DC

BILL WHITAKER: What took you so long to go to that choke point of the distributors?

JOE RANNAZZISI: This was all new to us. We weren’t seeing just some security violations, and a few bad orders. We were seeing hundreds of bad orders that involved millions and millions of tablets. That’s when we started going after the distributors.

A distributor’s representative told us the problem is not distributors but doctors who overprescribe pain medication, but the distributors know exactly how many pills go to every drug store they supply.  And they are required under the Controlled Substances Act to report and stop what the DEA calls “suspicious orders” — such as unusually large or frequent shipments of opioids. But DEA investigators say many distributors ignored that requirement.

JIM GELDHOF: They had a business plan. Their plan was to sell a lotta pills and make a lot of money. And they did both of those very well.

“All we were looking for is a good-faith effort by these companies to do the right thing. And there was no good-faith effort. Greed always trumped compliance. It did every time.”

Jim Geldhof, a 40-year DEA veteran, ran pharmaceutical investigations from dea’s detroit field office. Frank Younker supervised the agency’s operations in Cincinnati.  Joe Rannazzisi was their supervisor. They saw distributors shipping thousands of suspicious orders. One example: a pharmacy in Kermit, West Virginia, a town of just 392 people, ordered nine million hydrocodone pills over two years.

JIM GELDHOF: All we were looking for is a good-faith effort by these companies to do the right thing. And there was no good-faith effort. Greed always trumped compliance. It did every time. But don’t sit here and tell me that, “Well, we’re not sure what a suspicious order is.” Really? I mean this– this co– this pharmacy just bought 50 times an amount that a normal pharmacy purchases and they are in a town of 5,000 people.  You don’t know that that’s suspicious? I mean at some point you’re just turning a blind eye to it.

BILL WHITAKER: These companies are a big reason for this epidemic?

JIM GELDHOF: Yeah, absolutely they are.

JIM GELDHOF: And I can tell you with 100 percent accuracy that we were in there on multiple occasions trying to get them to change their behavior. And they just flat out ignored us.

In 2008, the DEA slapped McKesson, the country’s largest drug distributor, with a $13.2 million dollar fine. That same year, Cardinal Health paid a $34 million fine. Both companies were penalized by the DEA for filling hundreds of suspicious orders — millions of pills.

Over the last seven years, distributors’ fines have totaled more than $341 million. The companies cried foul and complained to Congress that DEA regulations were vague and the agency was treating them like a foreign drug cartel.  In a letter, the healthcare distribution alliance, which represents distributors, told us they wanted to work with the DEA. Effective enforcement, they wrote, “must be a two-way street.”

BILL WHITAKER: Frank, you said you were tough but fair. The industry says you guys were unfair. That you were taking unfair hits at them.

FRANK YOUNKER: Tell that to the people who lost their sons and daughters. See how fair they think it is.

In 2011, more than 17,000 Americans died from opioid prescription overdoses.  That same year Cardinal Health, the second largest distributor, started pushing back at Joe Rannazzisi.  The companies’ attorneys went over his head and called his bosses at the Justice Department, who called in Rannazzisi to have him explain his tactics.  

JOE RANNAZZISI: And it in– infuriated me that I was over there, trying to explain what my motives were or why I was going after these corporations? And when I went back to the office, and I sat down with my staff, I basically said, “You know, I just got questioned on why we’re doing– why we’re doing what we’re doing. This is– this– this is– now this is war. We’re going after these people and we’re not going to stop.

BILL WHITAKER: Do you really think you were getting this pushback because you were going after big companies, Fortune 500 companies?

JOE RANNAZZISI: I have no doubt in my mind.  So the question is, why would it be any different for these companies as compared to the small mom-and-pops that we had done hundreds of times before.

BILL WHITAKER: What’s the difference?

JOE RANNAZZISI: The difference is, is they have a lot of money, and a lot of influence. And that’s the difference.

Rannazzisi says the drug industry used that money and influence to pressure top lawyers at the DEA to take a softer approach.  Former DEA attorney Jonathan Novak said it divided the litigation office. He said in 2013, he noticed a sea change in the way prosecutions of big distributors were handled. Cases his supervisors once would have easily approved, now weren’t good enough.

JONATHAN NOVAK: We had been achieving incredible success in an almost unstoppable wave, and then suddenly it stopped.

Novak prosecuted cases brought to him by Joe Rannazzisi’s investigators. He said his caseload started to slow down dramatically.

JONATHAN NOVAK: These were not cases where it was black — where it was grey… These were cases where the evidence was crystal clear that there was wrongdoing going on.

He said his bosses started to bog down the system, demanding ever more evidence.

JONATHAN NOVAK: But now, three undercovers by four officers over three months, that wouldn’t be enough. Maybe we need an expert to explain how recording equipment works. Maybe we need an expert to explain– the system for prescribing. What’s a prescription? It felt honestly confusing and almost insane. Where was this coming from?

Jim Geldhof says his investigations were getting bogged down too. He was looking into one mid-sized distributor that had shipped more than 28 million pain pills to pharmacies in West Virginia over five years.  About 11 million of those pills wound up in Mingo County, population 25,000. Suddenly, he said, he ran into roadblocks from one of attorney Jonathan Novak’s bosses.

JIM GELDHOF: “I spent  a year working on this case. I sent it down there and it’s never good enough. Every time I talked to this guy he wants something else. And I get it for ’em and that’s still not good enough.” You know? And this goes on and on and on.  When this– these roadblocks keep– get thrown up in your face, at that point you know they just don’t want the case.

BILL WHITAKER: But this is the DEA. That’s what you’re supposed to do.

FRANK YOUNKER: Yeah.

JIM GELDHOF: You would think.

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The DEA’s toughest sanction is to freeze distributors shipments of narcotics — a step they haven’t taken in almost two years.

JONATHAN NOVAK: I mean there’s no denying the numbers. At the height of the opioid epidemic, inexplicably, they slowed down.

He said one big reason for the slowdown: DC’s notorious revolving door. Novak said he saw a parade of DEA lawyers switch sides and jump to high-paying jobs defending the drug industry. Once they’d made the leap, they lobbied their former colleagues, novak’s bosses, and argued the dea’s cases were weak and ultimately would lose in court. It had a chilling effect on dea litigators.

JONATHAN NOVAK: Some of the best and the brightest former DEA attorneys are now on the other side and know all of the — the — the weak points. Their fingerprints are on, memos and policy and — and — and emails going out where you see this concoction of what they might argue in the future.

BILL WHITAKER: You and the other attorneys had been winning these cases.

JONATHAN NOVAK: All of the time.

The Justice Department is the agency that oversees the DEA. A senior attorney at the department at the time, told us in a statement, ”Department of Justice leadership was not advised that DEA had changed enforcement strategies…Any significant policy shift should have been brought to [our] attention.”

FRANK YOUNKER: There was a lotta pills, a lotta people dyin’, and– and we had tools in our toolbox to try to use and stem that flow. But it seemed down in headquarters that that toolbox was shut off.

BILL WHITAKER: You’re watching an out of control epidemic and yet you both feel that at the height of this epidemic your– your– your hands were being tied?

FRANK YOUNKER: Yeah, if it’s a war on drugs then treat it like a war.

JOE RANNAZZISI: Addiction rate was still increasing. The amount of people seeking treatment was still increasing. It was all increasing. Still, the amount of prescriptions were increasing. And we started slowing down.

As cases nearly ground to a halt at DEA, the drug industry began lobbying Congress for legislation that would destroy DEA’s enforcement powers. That part of the story when we return.

In 2013, Joe Rannazzisi and his DEA investigators were trying to crack down on big drug distributors that ship drugs to pharmacies across the country.  He accused them of turning a blind eye as millions of prescription pain pills ended up on the black market.  Then, a new threat surfaced on Capitol Hill. With the help of members of Congress, the drug industry began to quietly pave the way for legislation that essentially would strip the DEA of its most potent tool in fighting the spread of dangerous narcotics.

JOE RANNAZZISI: If I was gonna write a book about how to harm the United States with pharmaceuticals, the only thing I could think of that would immediately harm is to take the authority away from the investigative agency that is trying to enforce the Controlled Substances Act and the regulations implemented under the act. And that’s what this bill did.

The bill, introduced in the House by Pennsylvania Congressman Tom Marino and Congresswoman Marsha Blackburn of Tennessee, was promoted as a way to ensure that patients had access to the pain medication they needed.

Jonathan Novak, who worked in the DEA’s legal office, says what the bill really did was strip the agency of its ability to immediately freeze suspicious shipments of prescription narcotics to keep drugs off U.S. streets — what the DEA calls diversion.

JONATHAN NOVAK: You’re not gonna be able to hold anyone higher up the food chain accountable.

BILL WHITAKER: Because of this law?

JONATHAN NOVAK: Because of this law

BILL WHITAKER: How hard does it make your job in going after the wholesale distributors?

JONATHAN NOVAK: I would say it makes it nearly impossible.

This 2015, Justice Department memo we obtained supports that. It states the bill “could actually result in increased diversion, abuse, and public health and safety consequences.”

JONATHAN NOVAK: They are toothless. I don’t know how they stop this now. It’s a very sad state of affairs.

Who drafted the legislation that would have such a dire effect? The answer came in another internal Justice Department email released to 60 Minutes and The Washington Post under the Freedom of Information Act: “Linden Barber used to work for the DEA. He wrote the Marino bill.”

Ad: Hi, My name is Linden Barber. I’m the director of the DEA litigation and compliance practice at Quarles and Brady’s Health Law Group. 

Barber went through the revolving door. He left his job as associate chief counsel of the DEA and within a month joined a law firm where he lobbied Congress on behalf of drug companies and wrote legislation. He advertised what he could offer a client facing DEA scrutiny.

Ad continued: If you have a DEA compliance issue, or you’re facing a government investigation, or you’re having administrative or civil litigation involving the Controlled Substances Act, I’d be happy to hear from you. 

JONATHAN NOVAK: It’s not surprising that this bill, that has intimate knowledge of the way that DEA, you know, regulations are enforced, the way that those laws work, was written by someone who spent a lot of time there, charged a lot of cases there.

BILL WHITAKER: Knew the workings?

JONATHAN NOVAK: Very much so.

Eric Holder was the attorney general at the time, he warned the new law would undermine law enforcement efforts to ”prevent communities and families from falling prey to dangerous drugs.”  The major drug companies — distributors, chain drug stores and pharmaceutical manufacturers — mobilized too. According to federal filings, during the two years the legislation was considered and amended, they spent $106 million lobbying Congress on the bill and other legislation, claiming the DEA was out of control, making it harder for patients to get needed medication.

Ex-DEA agent Joe Rannazzisi

A particular thorn for the drug industry and the bill’s sponsors was Joe Rannazzisi. He had been a witness before Congress more than 30 times and was called on again to testify about this bill.

JOE RANNAZZISI: 16,651 people in 2010 died of opiate overdose. OK. Opiate-associated overdose. This is not a game. We are not playing a game.

MARSHA BLACKBURN: Nobody is saying it is a game, sir. We’re just trying to craft some legislation. Let me ask you… 

Rannazzisi, who admits to having a temper, felt so strongly about the damage the bill could do, he lashed out at Marino’s committee staffers.

TOM MARINO: It is my understanding that Joe Rannazzisi, a senior DEA official, has publicly accused we sponsors of the bill of –quote supporting criminals –unquote. This offends me immensely.

BILL WHITAKER: Congressman Marino from Pennsylvania said that you accused him of helping criminals.

JOE RANNAZZISI: I’ve never accused Congressman Marino of helping criminals. I said that this bill is going to protect defendants that we have under investigation. And if Congressman Marino thinks I accused him of something, I don’t know what to tell you.

But a week after the hearing on legislation that would hobble the DEA’s enforcement authority, Marino and Blackburn wrote the inspector general for the Justice Department, demanding that Rannazzisi be investigated for trying to quote “intimidate the United States Congress.”

MATT MURPHY: There were people in industry that didn’t care much for Joe Ranazzisi, wanted him silenced, or wanted him outta the way. Basically unceremoniously kick him to the curb.

After almost 30 years with the DEA, Matt Murphy, Rannazzisi’s lieutenant, became a consultant for the drug industry — an industry with which he’s now disillusioned. He said he was shocked at the animosity he witnessed toward his friend and former boss.

MATT MURPHY: My theory is that the industry through lobbying groups donated — a certain amount of money to politicians to get a law passed that favored the industry. And also maybe using those political ties to have Joe removed.

BILL WHITAKER: Congress launched an investigation of him?

MATT MURPHY: Right.

BILL WHITAKER: And he was out?

MATT MURPHY: Yeah, pressure was put on for him to be moved out. I’m pretty confident of that. There was no reason to take the guy who was the most qualified person in DEA to run the Office of Diversion Control out of the Office of Diversion Control.

The investigation requested by Congressman Marino against Rannazzisi went nowhere, but soon after, Rannazzisi was stripped of his responsibilities. He says he went from supervising 600 people to supervising none — so he resigned.

JOE RANNAZZISI: We were totally focused on all these people dying and all these drugs being diverted. And we were not really looking at our flanks, waiting for somebody to come after us. So maybe that was my fault. And I just never realized that that was something that would have occurred.

In the end, the DEA signed off on the final version of the “Marino bill.” A senior DEA representative told us the agency fought hard to stop it, but in the face of growing pressure from Congress and industry lobbyists, was forced to accept a deal it did not want.  The bill was presented to the Senate in March of 2016.

Majority Leader Mitch McConnell introduced the legislation and it passed the Senate through unanimous consent with no objections and no recorded votes.

It passed the House the same way, with members of Congress chatting away on the floor.

A week later, with no objections from Congress or the DEA, President Barack Obama signed it into law without ceremony or the usual bill signing photo-op. Marino issued a press release the next day claiming credit for the legislation.

The drug distributors declared victory and told us the new law would in no way limit DEA’s enforcement abilities. But DEA chief administrative law judge, John J. Mulrooney, who must adjudicate the law, wrote in a soon-to-be-published Marquette Law Review article we obtained, that the new legislation “would make it all but…impossible” to prosecute unscrupulous distributors.

JOE RANNAZZISI: I just don’t understand why Congress would pass a bill that strips us of our authority in the height of an opioid epidemic in places like Congressman Marino’s district and Congressman Blackburn’s district. Why are these people sponsoring bills, when people in their backyards are dying from drugs that are coming from the same people that these bills are protecting?

BILL WHITAKER: Why do you think that is?

JOE RANNAZZISI: Because I think that the drug industry — the manufacturers, wholesalers, distributors and chain drugstores — have an influence over Congress that has never been seen before. And these people came in with their influence and their money and got a whole statute changed because they didn’t like it.

Seven months after the bill became law, Congressman Marino’s point man on the legislation, his Chief of Staff Bill Tighe, became a lobbyist for the National Association of Chain Drug Stores.

Since the crackdown on the distributors began, the pharmaceutical industry and law firms that represent them have hired at least 46 investigators, attorneys and supervisors from the DEA, including 32 directly from the division that regulates the drug industry.

Mike Gill, chief of staff for the DEA administrator, was hired by HDJN, one of the country’s largest healthcare law firms.

And most recently, Jason Hadges, a senior DEA attorney overseeing enforcement cases during the slowdown, joined the pharmaceutical and regulatory division of DC-based law firm Hogan Lovells. He declined to speak with us.

AmerisourceBergen and McKesson declined our requests to appear on camera.

So did Cardinal Health, which three months ago hired the author of the bill, Linden Barber, as senior vice president. With Scott Higham and Lenny Bernstein of the Washington Post, we called the head of public relations of Cardinal and asked to speak with Barber.

BILL WHITAKER: This is Bill Whitaker I’m a correspondent with 60 Minutes, I was calling to see if, um, we could speak with Linden Barber.

We were told the company would not make him available.

We also tried for several months to speak to Congressman Marino. Finally, we went to his DC office.

BILL WHITAKER: Hello. I’m Bill Whitaker with, uh, 60 Minutes.

MARINO STAFFER: Yes.

BILL WHITAKER: And we’d like to speak with Congressman Marino if we could.

MARINO STAFFER: I’m going to have to refer you to our Chief of Staff.

We were told he was not available…

MARINO CHIEF OF STAFF: Can you please turn the camera off and we have to ask the camera to leave the office.

His staff then called the Capitol Hill Police on us.

CAPITOL POLICE: Just accept the uninvite and leave the area.

When Joe Rannazzisi looks back he has one regret.

Joe Rannazzisi:  You know all these people that died happened under my watch. The one thing I wanted to do, the one thing that I just thought would have the most impact, is to lock up, arrest one of these corporate officers. You arrest a corporate officer. You arrest somebody that’s involved in the decision process, knowing what the law is. If you make that arrest, then everybody sits up and takes notice because three-piece-suit guys just don’t do well in prison. They don’t.

Joe Rannazzissi now consults with state attorneys general who have filed suit against distributors for their role in the opioid crisis. Tennessee Congresswoman Marsha Blackburn is running for the Senate. As for Congressman Marino, he was just nominated to be President Donald Trump’s new drug czar.

Link to original article here: Ex-DEA agent: Opioid crisis fueled by drug industry and Congress

Completely Unexpected Benefits of Being Sober

Better skin, more energy, good night’s sleep, money-saving – these are all popular benefits of being sober. As wonderful as they all are, there’s actually several more advantages to sobriety that are often overlooked…and they’re some of the best ones!

Lucy Rocca, the founder of the incredible alcohol addiction and abuse support network Soberistas, joins me in this article to discuss her experiences of the amazing advantages of choosing a sober lifestyle.

You’ll discover new personality traits

Drinking alcohol can blind, and even repress, our true personality traits. One of the most incredible things about being sober is you’ll really discover who you are and where your true potential lies.

For Lucy, it was discovering she is more of an introvert than she initially imagined. “I’m a bit shier than I ever thought I was – particularly in big groups. It took me a few years to recalibrate I think, after quitting drinking. At first I became a bit of a hermit but gradually I’ve merged the best bits of the old Lucy with the best bits of the new version. And finally, aged 41, I think I’m ok – that’s a novelty still, actually thinking I’m ok. I think having a positive mental outlook on life has been the biggest change in me.”

This is one of life’s greatest gifts – to see yourself for who you really are. Many people discover they’re more reserved when they stop drinking. This in itself can be a wonderful attribute. It’s easy to understand why a lot of people realise they’re introvert as an adult, because the chances are we probably started drinking in our teenage years and never really got to know ourselves as adults.

Eliminating alcohol from the equation brings a fresh new perspective on ourselves as adult individuals. Some even discover they’re a natural extrovert and didn’t even need alcohol in the first place. It doesn’t matter if you learn that you’re a peaceful introvert, a charming extrovert or even a split balance – knowing yourself is one of the keys to happier, healthier life.

Man Jumping a Rock

No more ‘alcohol anxiety’

Long gone are the days when you wake up worrying about what you said and did the night before. Instead, you get to wake up hangover-free and ready to enjoy your day. You might also find you’re far less likely to cancel on friends, skip the gym or shun work responsibilities.

Not only is sobriety great for your physical health, it can boost other aspects of your life such as your career, relationships, mental well being and so much more.

Strong relationships with the people who matter the most

When you first cut down on alcohol or quit altogether, you’re likely to distance yourself from those who seem to be the ‘bad influences’ in your life. I’m talking about friends you only hang out with in the pub – the type of people you only seem to spend time with if alcohol is involved.

Without the negative influences in your life – who are you left with? The people that truly love and care about you and like you for you! This is one of my favourite benefits of being sober – I know who I can trust and I know who’s going to be in my life all through the ups and downs!

And don’t forget all the new friends you’re going to make along the way – especially those also building a new sober lifestyle!

Time is a powerful thing

I won’t say being sober and staying sober gets easier over time, but time does seem to play a factor in successfully adjusting to a sober lifestyle. So one of the major perks of being sober is your mindset is more likely to change over time and your willpower could improve.

Lucy explained, “I do think it’s possible to rewrite your mental make-up, so things that once constituted a trigger for alcohol alter, your associations begin to change. For instance, if I’m stressed these days I go for a run, I never think “Oh, I’d kill for a drink right now!”. A sunny day makes me think about taking the kids somewhere for a lovely picnic, or going surfing, not getting trashed in a pub beer garden. Time does heal, I firmly believe that.”

There is such a thing, a ‘healthy hedonism’

You can have so much fun without drink – it seems crazy, right? Healthy hedonism is an especially rewarding benefit of sobriety if you’re noticing a shift in your mindset.
Healthy hedonism is different for everyone – you might be more active and take up some very interesting sports such as rock climbing to get that adrenaline pumping. Or you might find your creativity has rocketed through the roof and you spend days at a time painting, writing, playing guitar – anything that feeds your soul or gives you a natural high.

And that’s what healthy hedonism is all about. Pursuing activities that give you natural pleasure.

“For me, it’s running, surfing, skiing, trying new things, never stagnating, seeing life as a really exciting journey that I can now travel, totally unencumbered by alcohol or any other addiction,” said Lucy, “The world opened up to me when I stopped drinking, I haven’t looked back and wished I could still drink for many years. When I drank, I lived a dull life, it was Groundhog Day. Life sober is a really good life, I am a million times happier now than I ever was when I drank.”

Father playing with his kids in a field with sunlight

You’re in good company

This is one of the most overlooked benefits of sobriety – there are so many amazing role models out there. I know becoming sober has its obstacles, but realising there are so many inspirational people out there is one of the best benefits of sobriety.
Lucy, although one of the best role models I know, also looks up to several people, “It’s got to be Anthony Kiedis of the Red Hot Chili Peppers and the late Johnny Cash. And all of the many inspiring, strong and amazing people who make up the Soberistas community – they inspire me every day!”

Dr Bunmi Aboaba
bunmi@thesoberadvantage.com

Link to original article:  Completely Unexpected Benefits of Being Sober

Study highlights unmet treatment needs among adults with mental health and substance use disorders

Despite current treatment guidelines, fewer than 10 percent of adults with co-occurring mental health and substance use disorders receive treatment for both disorders, and more than 50 percent do not receive treatment for either disorder. The findings highlight a large gap between the prevalence of co-occurring disorders and treatment rates among U.S. adults and the need to identify effective approaches to increasing treatment for those with these conditions. An analysis of data from U.S. adults with both a mental health disorder and a substance use disorder indicates that only 9.1 percent of those adults received both types of care over the past year, and 52.5 percent received neither mental health care nor substance use treatment.

Crumpled Paper Taped Brain

The study, based on data collected from the 2008-2014 National Survey on Drug Use and Health, reports that 3.3 percent of the adult U.S. population, or some 7.7 million individuals, suffers from both a mental health and substance use disorder. Those adults with co-occurring disorders who did receive both types of treatment tend to have more serious psychiatric problems and accompanying physical ailments and were more likely to be involved with the criminal justice system compared to individuals who did not receive both types of care. The primary reasons for not seeking care were inability to afford treatment, lack of knowledge about where to get care, and a low perceived need among those with both disorders.

For more information about mental health and substance use disorders, go to: https://www.drugabuse.gov/related-topics/mental-health.

Link to article here: Study highlights unmet treatment needs among adults with mental health and substance use disorders

Here’s The Real Reason Why Some People Become Addicted to Drugs

Why do they do it? This is a question that friends and families often ask of those who are addicted.

It’s difficult to explain how drug addiction develops over time. To many, it looks like the constant search for pleasure. But the pleasure derived from opioids like heroin or stimulants like cocaine declines with repeated use. What’s more, some addictive drugs, like nicotine, fail to produce any noticeable euphoria in regular users.

So what does explain the persistence of addiction? As an addiction researcher for the past 15 years, I look to the brain to understand how recreational use becomes compulsive, prompting people like you and me to make bad choices.

Myths about addiction

There are two popular explanations for addiction, neither of which holds up to scrutiny.

The first is that compulsive drug taking is a bad habit – one that addicts just need to “kick.”

However, to the brain, a habit is nothing more than our ability to carry out repetitive tasks – like tying our shoelaces or brushing our teeth – more and more efficiently. People don’t typically get caught up in an endless and compulsive cycle of shoelace tying.

Another theory claims that overcoming withdrawal is too tough for many addicts. Withdrawal, the highly unpleasant feeling that occurs when the drug leaves your body, can include sweats, chills, anxiety and heart palpitations.

For certain drugs, such as alcohol, withdrawal comes with a risk of death if not properly managed.

The painful symptoms of withdrawal are frequently cited as the reason addiction seems inescapable. However, even for heroin, withdrawal symptoms mostly subside after about two weeks. Plus, many addictive drugs produce varying and sometimes only mild withdrawal symptoms.

This is not to say that pleasure, habits or withdrawal are not involved in addiction. But we must ask whether they are necessary components of addiction – or whether addiction would persist even in their absence.

Pleasure versus desire

In the 1980s, researchers made a surprising discovery. Food, sex and drugs all appeared to cause dopamine to be released in certain areas of the brain, such as the nucleus accumbens.

Rat Receiving Brain Transmissions

This suggested to many in the scientific community that these areas were the brain’s pleasure centres and that dopamine was our own internal pleasure neurotransmitter. However, this idea has since been debunked. The brain does have pleasure centres, but they are not modulated by dopamine.

So what’s going on? It turns out that, in the brain, “liking” something and “wanting” something are two separate psychological experiences.

“Liking” refers to the spontaneous delight one might experience eating a chocolate chip cookie. “Wanting” is our grumbling desire when we eye the plate of cookies in the centre of the table during a meeting.

Dopamine is responsible for “wanting” – not for “liking.” For example, in one study, researchers observed rats that could not produce dopamine in their brains. These rats lost the urge to eat but still had pleasurable facial reactions when food was placed in their mouths.

All drugs of abuse trigger a surge of dopamine – a rush of “wanting” – in the brain. This makes us crave more drugs. With repeated drug use, the “wanting” grows, while our “liking” of the drug appears to stagnate or even decrease, a phenomenon known as tolerance.

In my own research, we looked at a small subregion of the amygdala, an almond-shaped brain structure best known for its role in fear and emotion.

We found that activating this area makes rats more likely to show addictive-like behaviors: narrowing their focus, rapidly escalating their cocaine intake and even compulsively nibbling at a cocaine port. This subregion may be involved in excessive “wanting,” in humans, too, influencing us to make risky choices.

Involuntary addicts

The recent opioid epidemic has produced what we might call “involuntary” addicts. Opioids – such as oxycodone, percocet, vicodin or fentanyl – are very effective at managing otherwise intractable pain. Yet they also produce surges in dopamine release.

Most individuals begin taking prescription opioids not for pleasure but rather from a need to manage their pain, often on the recommendation of a doctor. Any pleasure they may experience is rooted in the relief from pain.

However, over time, users tend to develop a tolerance. The drug becomes less and less effective, and they need larger doses of the drug to control pain. This exposes people to large surges of dopamine in the brain. As the pain subsides, they find themselves inexplicably hooked on a drug and compelled to take more.

The result of this regular intake of large amounts of drug is a hyperreactive “wanting” system. A sensitised “wanting” system triggers intense bouts of craving whenever in the presence of the drug or exposed to drug cues.

These cues can include drug paraphernalia, negative emotions such as stress or even specific people and places. Drug cues are one of an addict’s biggest challenges.

These changes in the brain can be long-lasting, if not permanent. Some individuals seem to be more likely to undergo these changes.

Research suggests that genetic factors may predispose certain individuals, which explains why a family history of addiction leads to increased risk. Early life stressors, such as childhood adversity or physical abuse, also seem to put people at more risk.

Addiction and choice

Many of us regularly indulge in drugs of abuse, such as alcohol or nicotine. We may even occasionally overindulge. But, in most cases, this doesn’t qualify as addiction. This is, in part, because we manage to regain balance and choose alternative rewards like spending time with family or enjoyable drug-free hobbies.

Girl Overlooking Skyline

However, for those susceptible to excessive “wanting,” it may be difficult to maintain that balance. Once researchers figure out what makes an individual susceptible to developing a hyperreactive “wanting” system, we can help doctors better manage the risk of exposing a patient to drugs with such potent addictive potential.

In the meantime, many of us should reframe how we think about addiction. Our lack of understanding of what predicts the risk of addiction means that it could just as easily have affected you or me.

In many cases, the individual suffering from addiction doesn’t lack the willpower to quit drugs. They know and see the pain and suffering that it creates around them. Addiction simply creates a craving that’s often stronger than any one person could overcome alone.

The ConversationThat’s why people battling addiction deserve our support and compassion, rather than the distrust and exclusion that our society too often provides.

Article written by: Mike Robinson, Assistant Professor of Psychology, Wesleyan University.

Link to article: Here’s The Real Reason Why Some People Become Addicted to Drugs

What It Feels Like To Have An Opioid Addiction

We are in the midst of an epidemic of opioid addiction and death. Almost everyone knows someone living an opioid addiction or who has died from one. And they all have the same question: why can’t we, didn’t we, stop?

Why, they wonder, do we hock, trade, sell everything we own; why do we steal and hurt the ones we love just to get our roxies, dilaudid, our heroin? But the answer to that question is really very simple.

I started using heroin in 1976 when I was 20 years old. For the next 13 years I used occasionally, never enough to become addicted. I earned a B.A. in psychology, a masters in experimental psychology, and a doctorate in bio-psychology. After I completed the doctorate in 1987 I was awarded a national institute on drug abuse post-doctoral fellowship in the pharmacology and toxicology department at the University of Arkansas for medical sciences.

My area of research was behavioral pharmacology which is the study of how drugs affect the brain and behavior. During all of this time I was still, on occasion, using. In April of 1989 I got into a bottle of methadone hydrochloride from the behavioral pharmacology lab and the whole time I was shooting that methadone I told myself that I would stop. And I believed that. Until I couldn’t.

For the next 22 years I lived the life of opioid addiction. The last year and a half of my addiction I was homeless, living on the streets and sleeping on the ground, homeless shelters, and people’s floors. The last time I used an opioid was December 11, 2011.

I am sharing this because I want you to know that I understand what your child, what your loved one, experiences in their addiction. I have lived it. And that because of my education and research, I also understand the neurocircuitry, neuropharmacology, and behavioral aspects of opioid addiction.

I believe in science. I believe in its truth. And science has shown that opioid addiction is a disease of brain structure and, thus, function. The continual intake of these opioids, day after day, year after year, alters the brain on a cellular, molecular basis. These alterations are opioid addiction. And they are manifested as behavior directed toward the survival of the individual.

The neurobiological explanation of this illness is beyond the scope of this article. But maybe this will help.

Let’s say that you haven’t had anything to eat for three or four days. You are starving. Can you feel it? What it’s like to be really starving? What would you be thinking about? You would be thinking about food. You would be needing, craving food. This craving that you feel is the brain’s mechanism that drives you to survive. Its purpose is to make everything else fall away and to force you to focus solely on acquiring what you have to have to live.

Young man in the dark with hands clasped together

Now, let’s go further. Let’s say that food is restricted. There’s a famine or some kind of government control that limits the amount of food. There are no soup kitchens; there are no food banks. And no one will give you any food because they don’t have enough for themselves. There is, however, a black market in food. But the food in this black market is scarce and expensive. And it is illegal. It is against the law to buy food in this black market. What would you do if you were starving? Would you break the law? Would you steal to eat and to live? How much of yourself would you sacrifice? How much of who you are and what you are would you let go of to survive?

This craving for food is measured in days. Our craving for opioids is measured in hours. Four to five hours after our last use we begin to starve. And we crave. Everything but our need for these opioids falls away. And we focus solely on what we have to do to survive. We don’t have a choice. We really don’t.

Please understand I’m not trying to excuse our behavior. I am, though, trying to help you to see why we do these things. I know it may be difficult to believe that even when we stole from you, were verbally and maybe even physically abusive, we loved you. We are not narcissistic hedonists. When we hurt you we hurt too. We do these things not because we want to do them, but because we have to survive. We become desperate, and in our desperation we do things that we know are wrong; we do things that we know are not us. But this doesn’t mean we don’t care. If you are starving, you still love. What it does mean is that we are so desperate in our starvation that we will hurt the ones we love to end that hunger.

What is sad is that we don’t understand why we are hurting the ones we love. And because we don’t understand, we can’t explain it to you. We can’t explain why we are hurting you. And this lack of understanding can rip a family apart. It can replace love with resentments and anger. On both sides. And in this pain, in this lack of understanding, we lose each other.

The knowledge that I hope you take away from this article is that your child or your loved one did not hurt you so that they could go out and buy roxies, dilaudid, or heroin. What they bought was their survival.

For those of you that have lost a child or loved one to overdose and addiction, I hope this article will help you to understand that there is no blame here. Whatever you did, however you tried to help the one you loved, you did your best. Because that’s what love does. And I hope you also understand that your child or your loved one also did their best. They fought, they struggled, they did all they could to stop. But, ultimately, their disease took their life.

Understanding and knowledge is power. The lack of it is confusion and helplessness.

 

Sam Snodgrass, Contributor

PhD. Board of Directors, Broken No More/GRASP

Link to article here: What It Feels Like To Have An Opioid Addiction

Ohio medical professionals team up in battle against opioid addictions

COLUMBUS (WCMH) — More than 600 doctors, nurses, coroners and others spent the day together studying what is and isn’t working in the battle against opioid addictions.

The Ohio Department of Health said 4,050 Ohioans died from drug overdoses last year. 50,000 more are in recovery.

The numbers are straining every service involved.

The statewide meeting held at OSU’s 4H Center included 18 satellite locations. It was meant to bring together medical professionals for education on substance abuse, opioid addiction treatment and the need for continued care.

Amy Parker is now one of them, a peer counselor.

BrightView's peer support specialist, Amy Parker

“Most people look at me and they would never imagine that I have a criminal record, that I use to be heroin addict, that I walked away from my daughter. I was a thief and a liar,” said Parker.

Her point being she said is drug addiction is a disease without a quick fix.

“It takes a lot of time and compassion and a lot of therapy to build up a person’s life coming through substance abuse disorder,” said Parker, who has custody of her 14-year-old and is the mother of an infant.

Dr. Shawn Ryan said treatment for addiction is key for those wanting to recover and is beneficial for all of us as well.

BrightView's Chief Medical Officer, Dr. Shawn Ryan

“We definitely need to spend more money on treatment, but the good news is that has a huge return on investment, so every dollar we spend is high as eighteen in return, so we should look at it as an investment in our community,” said Dr. Ryan, who is the President of the Ohio Society of Addiction Medicine.

 

The Ohio Attorney General said 12 people die every day from this drug epidemic. He asked what we would do if this was a terrorist attack?

“You know we would be up in arms. We would have the National Guard out. We would be going crazy. Yet that is what is happening every single day, we are losing that many people,” said Attorney General Mike DeWine.

Dr. Shawn Ryan, speaking at the event

Ohio babies are born addicted to drugs every day, and the Ohio Attorney General said half of all children in foster care have parents who are drug addicts.

Link to original article and video with BrightView’s Chief Medical Officer, Dr. Shawn Ryan and our peer support specialist, Amy Parker here: Ohio medical professionals team up in battle against opioid addictions

 

Google Sets Limits on Addiction Treatment Ads, Citing Safety

As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.

But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.

This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.

Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.

In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.

 “This is a bold move by one of the world’s biggest companies, saying people’s lives are more important than profit,” said Greg Williams, co-founder of Facing Addiction, a nonprofit group that is an advocate for people struggling with addiction.

Syringes

Many rehab centers, a large number of which are clustered in warm climates like Florida, Arizona and California, rely on Google searches to attract patients from across the country. Their strategy often included buying an ad that would come up when someone searched for phrases like “drug rehab” or “alcohol treatment centers.”

As of this week, Google has stopped selling ads related to those searches, although it may lift the restriction if it can find a way to weed out misleading advertisements.

Search ads for addiction treatment are lucrative. Treatment providers, in some cases, have been willing to pay $70 per ad click, according to an analysis that Mr. Williams’ group conducted and presented to Google executives.

But the payoff for those clicks can be significant. Addicts who sign up for 30 days of residential treatment can bring in tens of thousands of dollars from private insurance.

The crucial, if unwitting, role that Google has played in the treatment industry exposes the deep flaws in how drug addicts are cared for in America. Despite the rapid growth in the number of addiction cases — and the Trump Administration’s declaration that the opioid crisis is a national emergency — the treatment industry remains a hodgepodge of upstart businesses, with only a few well-known providers.

 What constitutes treatment is also all over the map, from yoga and equine therapy to daily doses of medication. And unlike other serious illnesses, like cancer or heart disease, where a physician typically refers the patient for treatment, many addicts and their families look for help on the internet.

That has made Google one of the largest referral sources for treating a disease that affects millions of Americans. And the companies willing to the pay the most for ads are the one that addicts are most likely to see on their search.

But ad-driven searches, according to advocates and law enforcement officials, have not always led patients to the best care. In some cases, they have found that patients are being duped, a phenomenon Google on Thursday acknowledged.

Last December, a Florida grand jury released a report detailing abuses in the state’s addiction treatment industry, which is centered around Palm Beach County. Among the findings, the grand jury zeroed on the problems with how some of the shoddy programs were being marketed online.

One witness, according to the grand jury report, described how “online marketers use Google search terms to essentially hijack the good name and reputation of notable treatment providers only to route the caller to the highest bidder.”

Google Headquarters

Another common trap: Addicts search Google for a rehab program close to their home, but they will click on an ad for a referral service pitching treatment in another state. The referral service then collects a fee, if they signed up.

Google’s restrictions were cheered by health officials, who have called for more medically based treatment. “People don’t always know what good treatment is,” said Dr. Vivek Murthy, who was surgeon general in the Obama Administration and published a oft-cited report last year that warned of the nation’s addiction crisis. “I am glad Google took steps to prevent the spread of these false ads.”

In targeting the ads for addiction treatment, Google consulted with experts including Mr. Williams, who himself has been in recovery for many years. He said he began discussions with Google executives around the time that Dr. Murthy released his report.

Mr. Williams said that he had explained to Google that his own experience trying to buy ads from the company had illustrated how the process of finding information about addiction treatment online was providing people with unreliable information. Mr. Williams said he discovered this when his group received a grant from Google that would help him buy ads promoting a website providing information about community based treatment — and found he couldn’t compete.

Buying ads on Google involves bidding to place your ad at the top of the search results when a user types in words relevant to your product or service. But Mr. Williams found that the bid prices for words related to treatment had gotten so expensive that his group couldn’t pay as much as the for-profit treatment providers. Some of those treatment providers, Mr. Williams told Google, were not only misleading, they had been charged with crimes.

In a series of phone calls and a meeting in Washington, D.C., Mr. Williams presented the company his research. He highlighted that some of the biggest buyers of ad words related to treatment had been accused of misdeeds related to insurance fraud and sexual assault.

Link to article: Google Sets Limits on Addiction Treatment Ads, Citing Safety

Author: MICHAEL CORKERY

How Science Is Unlocking the Secrets of Addiction

We’re learning more about the craving that fuels self-defeating habits—and how new discoveries can help us kick the habit.

Addiction hijacks the brain’s neural pathways. Scientists are challenging the view that it’s a moral failing and researching treatments that could offer an exit from the cycle of desire, bingeing, and withdrawal that traps tens of millions of people.

Patrick Perotti scoffed when his mother told him about a doctor who uses electromagnetic waves to treat drug addiction. “I thought he was a swindler,” Perotti says.

Perotti, who is 38 and lives in Genoa, Italy, began snorting cocaine at 17, a rich kid who loved to party. His indulgence gradually turned into a daily habit and then an all-consuming compulsion. He fell in love, had a son, and opened a restaurant. Under the weight of his addiction, his family and business eventually collapsed.

He did a three-month stint in rehab and relapsed 36 hours after he left. He spent eight months in another program, but the day he returned home, he saw his dealer and got high. “I began to use cocaine with rage,” he says. “I became paranoid, obsessed, crazy. I could not see any way to stop.”

When his mother pressed him to call the doctor, Perotti gave in. He learned he would just have to sit in a chair like a dentist’s and let the doctor, Luigi Gallimberti, hold a device near the left side of his head, on the theory it would suppress his hunger for cocaine. “It was either the cliff or Dr. Gallimberti,” he recalls.

Patient receives electromagnetic pulses

Gallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says.

 More than 200,000 people worldwide die every year from drug overdoses and drug-related illnesses, such as HIV, according to the United Nations Office on Drugs and Crime, and far more die from smoking and drinking. More than a billion people smoke, and tobacco is implicated in the top five causes of death: heart disease, stroke, respiratory infections, chronic obstructive pulmonary disease, and lung cancer. Nearly one of every 20 adults worldwide is addicted to alcohol. No one has yet counted people hooked on gambling and other compulsive activities gaining recognition as addictions.

In the United States an epidemic of opioid addiction continues to get worse. The Centers for Disease Control and Prevention reported a record 33,091 overdose deaths in 2015 from opioids, including prescription painkillers and heroin—16 percent more than the previous record, set just the year before. In response to the crisis, the first ever U.S. surgeon general’s report on addiction was released in November 2016. It concluded that 21 million Americans have a drug or alcohol addiction, making the disorder more common than cancer.

After spending decades probing the brains of drug-loving lab animals and scanning the brains of human volunteers, scientists have developed a detailed picture of how addiction disrupts pathways and processes that underlie desire, habit formation, pleasure, learning, emotional regulation, and cognition. Addiction causes hundreds of changes in brain anatomy, chemistry, and cell-to-cell signaling, including in the gaps between neurons called synapses, which are the molecular machinery for learning. By taking advantage of the brain’s marvelous plasticity, addiction remolds neural circuits to assign supreme value to cocaine or heroin or gin, at the expense of other interests such as health, work, family, or life itself.

“In a sense, addiction is a pathological form of learning,” says Antonello Bonci, a neurologist at the National Institute on Drug Abuse.

Rat Simulated Slot Machine

Gallimberti was fascinated when he read a newspaper article about experiments by Bonci and his colleagues at NIDA and the University of California, San Francisco. They had measured electrical activity in neurons in cocaine-seeking rats and discovered that a region of the brain involved in inhibiting behavior was abnormally quiet. Using optogenetics, which combines fiber optics and genetic engineering to manipulate animal brains with once unimaginable speed and precision, the researchers activated these listless cells in the rats. “Their interest in cocaine basically vanished,” Bonci says. The researchers suggested that stimulating the region of the human brain responsible for inhibiting behavior, in the prefrontal cortex, might quell an addict’s insatiable urge to get high.

Gallimberti thought TMS might offer a practical way to do that. Our brains run on electrical impulses that zip among neurons with every thought and movement. Brain stimulation, which has been used for years to treat depression and migraines, taps that circuitry. The device is nothing but a coiled wire inside a wand. When electric current runs through it, the wand creates a magnetic pulse that alters electrical activity in the brain. Gallimberti thought repeated pulses might activate drug-damaged neural pathways, like a reboot on a frozen computer.

He and his partner, neurocognitive psychologist Alberto Terraneo, teamed up with Bonci to test the technique. They recruited a group of cocaine addicts: Sixteen underwent one month of brain stimulation while 13 received standard care, including medication for anxiety and depression. By the end of the trial, 11 people in the stimulation group, but only three in the other group, were drug free.

The investigators published their findings in the January 2016 issue of the journal European Neuropsychopharmacology. That prompted a flurry of publicity, which drew hundreds of cocaine users to the clinic. Perotti came in edgy and agitated. After his first session, he says, he felt calm. Soon he lost the desire for cocaine. It was still gone six months later. “It has been a complete change,” he says. “I feel a vitality and desire to live that I had not felt for a long time.”

It will take large, placebo-controlled trials to prove that the treatment works and the benefits last. The team plans to conduct further studies, and researchers around the world are testing brain stimulation to help people stop smoking, drinking, gambling, binge eating, and misusing opioids. “It’s so promising,” Bonci says. “Patients tell me, ‘Cocaine used to be part of who I am. Now it’s a distant thing that no longer controls me.’”

Not long ago the idea of repairing the brain’s wiring to fight addiction would have seemed far-fetched. But advances in neuroscience have upended conventional notions about addiction—what it is, what can trigger it, and why quitting is so tough. If you’d opened a medical textbook 30 years ago, you would have read that addiction means dependence on a substance with increasing tolerance, requiring more and more to feel the effects and producing a nasty withdrawal when use stops. That explained alcohol, nicotine, and heroin reasonably well. But it did not account for marijuana and cocaine, which typically don’t cause the shakes, nausea, and vomiting of heroin withdrawal.

The old model also didn’t explain perhaps the most insidious aspect of addiction: relapse. Why do people long for the burn of whiskey in the throat or the warm bliss of heroin after the body is no longer physically dependent?

The surgeon general’s report reaffirms what the scientific establishment has been saying for years: Addiction is a disease, not a moral failing. It’s characterized not necessarily by physical dependence or withdrawal but by compulsive repetition of an activity despite life-damaging consequences. This view has led many scientists to accept the once heretical idea that addiction is possible without drugs.

The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders, the handbook of American psychiatry, for the first time recognizes a behavioral addiction: gambling. Some scientists believe that many allures of modern life—junk food, shopping, smartphones—are potentially addictive because of their powerful effects on the brain’s reward system, the circuitry underlying craving.

“We are all exquisite reward detectors,” says Anna Rose Childress, a clinical neuroscientist at the University of Pennsylvania’s Center for Studies of Addiction. “It’s our evolutionary legacy.”

For years Childress and other scientists have tried to unravel the mysteries of addiction by studying the reward system. Much of Childress’s research involves sliding people addicted to drugs into the tube of a magnetic resonance imaging (MRI) machine, which tracks blood flow in the brain as a way to analyze neural activity. Through complex algorithms and color-coding, brain scans are converted into images that pinpoint the circuits that kick into high gear when the brain lusts.

Childress, who has flaming red hair and a big laugh, sits at her computer, scrolling through a picture gallery of brains—gray ovals with bursts of color as vivid as a Disney movie. “It sounds nerdy, but I could look at these images for hours, and I do,” she says. “They are little gifts. To think you can actually visualize a brain state that’s so powerful and at the same time so dangerous. It’s like reading tea leaves. All we see is spots that the computer turns into fuchsia and purple and green. But what are they trying to tell us?”

The reward system, a primitive part of the brain that isn’t much different in rats, exists to ensure we seek what we need, and it alerts us to the sights, sounds, and scents that point us there. It operates in the realm of instinct and reflex, built for when survival depended on the ability to obtain food and sex before the competition got to them. But the system can trip us up in a world with 24/7 opportunities to fulfill our desires.

Desire depends on a complex cascade of brain actions, but scientists believe that the trigger for this is likely to be a spike in the neurotransmitter dopamine. A chemical messenger that carries signals across synapses, dopamine plays wide-ranging roles in the brain. Most relevant to addiction, the flow of dopamine heightens what scientists call salience, or the motivational pull of a stimulus—cocaine, for instance, or reminders of it, such as a glimpse of white powder. Each drug that’s abused affects brain chemistry in a distinct way, but they all send dopamine levels soaring far beyond the natural range. Wolfram Schultz, a University of Cambridge neuroscientist, calls the cells that make dopamine “the little devils in our brain,” so powerfully does the chemical drive desire.

How powerfully? Consider the strange side effect of medications that mimic natural dopamine and are used to treat Parkinson’s. The disease destroys dopamine-producing cells, primarily affecting movement. Dopamine-replacement drugs relieve the symptoms, but about 14 percent of Parkinson’s patients who take these medications develop addictions to gambling, shopping, pornography, eating, or the medication itself. A report in the journal Movement Disorders describes three patients who became consumed by “reckless generosity,” hooked on giving cash to strangers and friends they thought needed it.

Through learning, the signals or reminder cues for rewards come to provoke surges of dopamine. That’s why the aroma of snickerdoodles baking in the oven, the ping of a text alert, or chatter spilling out the open door of a bar can yank a person’s attention and trigger craving. Childress has shown that people who are addicted don’t have to consciously register a cue for it to arouse their reward system. In a study published in PLoS One she scanned the brains of 22 recovering cocaine addicts while photos of crack pipes and other drug paraphernalia flashed before their eyes for 33 milliseconds, one-tenth the time it takes to blink. The men didn’t consciously “see” anything, but the images activated the same parts of the reward circuitry that visible drug cues excite.

In Childress’s view the findings support stories she has heard from cocaine patients who relapsed yet couldn’t explain what prompted it. “They were walking around in environments where most of the time one thing or another had been signals for cocaine,” she says. “They were basically getting primed, having that ancient reward system tingled. By the time they became conscious of it, it was like a snowball rolling downhill.”

The brain, of course, is more than an organ of reward. It houses evolution’s most sophisticated machinery for thinking, considering risks, and controlling runaway desire. Why do craving and habits overpower reason, good intentions, and awareness of the toll of addiction?

“There’s a strong-ass demon that messes you up,” says a burly man with a booming voice who smokes crack regularly.

He sits in a black swivel chair in a small windowless room at the Icahn School of Medicine at Mount Sinai in Manhattan, waiting for his MRI. He’s taking part in a study in the lab of Rita Z. Goldstein, a professor of psychiatry and neuroscience, about the role of the brain’s executive control center, the prefrontal cortex. While the scanner records his brain activity, he’ll view pictures of cocaine with instructions to imagine either the pleasures or the perils that each image evokes. Goldstein and her team are testing whether neurofeedback, which allows people to observe their brains in action, can help addicts take more control over compulsive habits.

“I keep thinking, I can’t believe I’ve wasted all that damn money on the drug,” the man says as he’s led to the MRI machine. “It never balances out, what you gain versus what you lose.”

Goldstein’s neuroimaging studies helped expand understanding of the brain’s reward system by exploring how addiction is associated with the prefrontal cortex and other cortical regions. Changes in this part of the brain affect judgment, self-control, and other cognitive functions tied to addiction. “Reward is important in the beginning of the addiction cycle, but the response to reward is reduced as the disorder continues,” she says. People with addiction often persist in using drugs to relieve the misery they feel when they stop.

In 2002, working with Nora Volkow, now the director of NIDA, Goldstein published what has become an influential model of addiction, called iRISA, or impaired response inhibition and salience attribution. That’s a mouthful of a name for a fairly simple idea. As drug cues gain prominence, the field of attention narrows, like a camera zooming in on one object and pushing everything else out of view. Meanwhile the brain’s ability to control behavior in the face of those cues diminishes.

Goldstein has shown that as a group, cocaine addicts have reduced gray matter volume in the prefrontal cortex, a structural deficiency associated with poorer executive function, and they perform differently from people who aren’t addicted on psychological tests of memory, attention, decision-making, and the processing of nondrug rewards such as money. They generally perform worse, but not always. It depends on the context.

For example, on a standard task that measures fluency—how many farm animals can you name in a minute?—people with addiction may lag. But when Goldstein asks them to list words related to drugs, they tend to outperform everyone else. Chronic drug users are often great at planning and executing tasks that involve using drugs, but this bias may compromise other cognitive processes, including knowing how and when to stop. The behavioral and brain impairments are sometimes more subtle than in other brain disorders, and they’re more heavily influenced by the situation.

“We think that is one of the reasons why addiction has been and still is one of the last disorders to be recognized as a disorder of the brain,” she says.

Goldstein’s studies don’t answer the chicken-and-egg question: Does addiction cause these impairments, or do brain vulnerabilities due to genetics, trauma, stress, or other factors increase the risk of becoming addicted? But Goldstein’s lab has discovered tantalizing evidence that frontal brain regions begin to heal when people stop using drugs. A 2016 study tracked 19 cocaine addicts who had abstained or severely cut back for six months. They showed significant increases in gray matter volume in two regions involved in inhibiting behavior and evaluating rewards.

Marc Potenza strides through the cavernous Venetian casino in Las Vegas. Electronic games—slot machines, roulette, blackjack, poker—beep and clang and trill. Potenza, an affable and energetic psychiatrist at Yale University and director of the school’s Program for Research on Impulsivity and Impulse Control Disorders, hardly seems to notice. “I’m not a gambler,” he says with a slight shrug and a grin. Out of the pleasure palazzo, he heads down an escalator and through a long concourse to a sedate meeting room in the Sands Expo Convention Center, where he will present his research on gambling addiction to about a hundred scientists and clinicians.

The meeting is organized by the National Center for Responsible Gaming, an industry-supported group that has funded gambling research by Potenza and others. It takes place on the eve of the industry’s mega convention, the Global Gaming Expo. Potenza stands at the podium, talking about white matter integrity and cortical blood flow in gamblers. Just beyond the room, expo exhibitors are setting up displays touting innovations engineered to get dopamine flowing in millennials. E-sports betting. Casino games modeled on Xbox. More than 27,000 game manufacturers, designers, and casino operators will attend.

Potenza and other scientists pushed the psychiatric establishment to accept the idea of behavioral addiction. In 2013 the American Psychiatric Association moved problem gambling out of a chapter called “Impulse Control Disorder Not Elsewhere Classified” in the Diagnostic and Statistical Manual and into the chapter called “Substance-Related and Addictive Disorders.” This was no mere technicality. “It breaks the dam for considering other behaviors as addiction,” says Judson Brewer, director of research at the Center for Mindfulness at the University of Massachusetts Medical School.

The association considered the matter for more than a decade while research accumulated on how gambling resembles drug addiction. Insatiable desire, preoccupation, and uncontrollable urges. The fast thrill and the need to keep upping the ante to feel the fireworks. An inability to stop, despite promises and resolve. Potenza did some of the first brain-imaging studies of gamblers and discovered that they looked similar to scans of drug addicts, with sluggish activity in the parts of the brain responsible for impulse control.

Older Couple Drinking Beer In A Royal Room with Chandelier

Now that the psychiatric establishment accepts the idea that addiction is possible without drugs, researchers are trying to determine what types of behaviors qualify as addictions. Are all pleasurable activities potentially addictive? Or are we medicalizing every habit, from the minute-to-minute glance at email to the late-afternoon candy break?

In the United States the Diagnostic and Statistical Manual now lists Internet gaming disorder as a condition worthy of more study, along with chronic, debilitating grief and caffeine-use disorder. Internet addiction didn’t make it.

But it makes psychiatrist Jon Grant’s list of addictions. So do compulsive shopping and sex, food addiction, and kleptomania. “Anything that’s overly rewarding, anything that induces euphoria or is calming, can be addictive,” says Grant, who runs the Addictive, Compulsive and Impulsive Disorders Clinic at the University of Chicago. Whether it will be addictive depends on a person’s vulnerability, which is affected by genetics, trauma, and depression, among other factors. “We don’t all get addicted,” he says.

Perhaps the most controversial of the “new” addictions are food and sex. Can a primal desire be addictive? The World Health Organization has recommended including compulsive sex as an impulse control disorder in its next edition of the International Classification of Diseases, due out by 2018. But the American Psychiatric Association rejected compulsive sex for its latest diagnostic manual, after serious debate about whether the problem is real. The association didn’t consider food addiction.

Nicole Avena, a neuroscientist at Mount Sinai St. Luke’s Hospital in New York, has shown that rats will keep gobbling sugar if you let them, and they develop tolerance, craving, and withdrawal, just as they do when they get hooked on cocaine. She says high-fat foods and highly processed foods such as refined flour may be as problematic as sugar. Avena and researchers at the University of Michigan recently surveyed 384 adults: Ninety-two percent reported a persistent desire to eat certain foods and repeated unsuccessful attempts to stop, two hallmarks of addiction. The respondents ranked pizza—typically made with a white-flour crust and topped with sugar-laden tomato sauce—as the most addictive food, with chips and chocolate tied for second place. Avena has no doubt food addiction is real. “That’s a major reason why people struggle with obesity.”

Two sheriffs patting down a citizen next to a bicycle

Science has been more successful in charting what goes awry in the addicted brain than in devising ways to fix it. A few medications can help people overcome certain addictions. For example, naltrexone was developed to treat opioid misuse, but it’s also prescribed to help cut down or stop drinking, binge eating, and gambling.

Buprenorphine activates opioid receptors in the brain but to a much lesser degree than heroin does. The medication suppresses the awful symptoms of craving and withdrawal so people can break addictive patterns. “It’s a miracle,” says Justin Nathanson, a filmmaker and gallery owner in Charleston, South Carolina. He used heroin for years and tried rehab twice but relapsed. Then a doctor prescribed buprenorphine. “In five minutes I felt completely normal,” he says. He hasn’t used heroin for 13 years.

Most medications used to treat addiction have been around for years. The latest advances in neuroscience have yet to produce a breakthrough cure. Researchers have tested dozens of compounds, but while many show promise in the lab, results in clinical trials have been mixed at best. Brain stimulation for addiction treatment, an outgrowth of recent neuroscience discoveries, is still experimental.

Although 12-step programs, cognitive therapy, and other psychotherapeutic approaches are transformative for many people, they don’t work for everyone, and relapse rates are high.

In the world of addiction treatment, there are two camps. One believes that a cure lies in fixing the faulty chemistry or wiring of the addicted brain through medication or techniques like TMS, with psychosocial support as an adjunct. The other sees medication as the adjunct, a way to reduce craving and the agony of withdrawal while allowing people to do the psychological work essential to addiction recovery. Both camps agree on one thing: Current treatment falls short. “Meanwhile my patients are suffering,” says Brewer, the mindfulness researcher in Massachusetts.

Brewer is a student of Buddhist psychology. He’s also a psychiatrist who specializes in addiction. He believes the best hope for treating addiction lies in melding modern science and ancient contemplative practice. He’s an evangelist for mindfulness, which uses meditation and other techniques to bring awareness to what we’re doing and feeling, especially to habits that drive self-defeating behavior.

In Buddhist philosophy, craving is viewed as the root of all suffering. The Buddha wasn’t talking about heroin or ice cream or some of the other compulsions that bring people to Brewer’s groups. But there’s growing evidence that mindfulness can counter the dopamine flood of contemporary life. Researchers at the University of Washington showed that a program based on mindfulness was more effective in preventing drug-addiction relapse than 12-step programs. In a head-to-head comparison, Brewer showed that mindfulness training was twice as effective as the gold-standard behavioral antismoking program.

Mindfulness trains people to pay attention to cravings without reacting to them. The idea is to ride out the wave of intense desire. Mindfulness also encourages people to notice why they feel pulled to indulge. Brewer and others have shown that meditation quiets the posterior cingulate cortex, the neural space involved in the kind of rumination that can lead to a loop of obsession.

Brewer speaks in the soothing tones you’d want in your therapist. His sentences toggle between scientific terms—hippocampus, insula—and Pali, a language of Buddhist texts. On a recent evening he stands in front of 23 stress eaters, who sit in a semicircle in beige molded plastic chairs, red round cushions nestling their stockinged feet.

Donnamarie Larievy, a marketing consultant and executive coach, joined the weekly mindfulness group to break her ice cream and chocolate habit. Four months in, she eats healthier food and enjoys an occasional scoop of double fudge but rarely yearns for it. “It has been a life changer,” she says. “Bottom line, my cravings have decreased.”

Nathan Abels has decided to stop drinking—several times. In July 2016 he ended up in the emergency room at the Medical University of South Carolina in Charleston, hallucinating after a three-day, gin-fueled bender. While undergoing treatment, he volunteered for a TMS study by neuroscientist Colleen A. Hanlon.

For Abels, 28, a craftsman and lighting design technician who understands how circuitry works, the insights of neuroscience provide a sense of relief. He doesn’t feel trapped by biology or stripped of responsibility for his drinking. Instead he feels less shame. “I forever thought of drinking as a weakness,” he says. “There’s so much power in understanding it’s a disease.”

He’s throwing everything that the medical center offers at his recovery—medication, psychotherapy, support groups, and electromagnetic zaps to the head. “The brain can rebuild itself,” he says. “That’s the most amazing thing.”

About the author: Fran Smith is a writer and editor. This is her first article for National Geographic. Max Aguilera-­Hellweg is a photographer who also trained as a medical doctor. His last assignment for the magazine was “Beyond Reasonable Doubt,” in the July 2016 issue.

Link to article here: How Science is Unlocking the Secrets of Addiction

 

Hamilton County to boost Narcan by 400 percent to fight overdose deaths

Dr. Shawn Ryan President CMO BrightView Health

Hamilton County is preparing a first-in-the-nation Narcan project with a goal of saving lives by infusing the community with the overdose antidote.

The project will bring 400 percent more doses of Narcan to a broader section of the community. New groups that will get the doses include jails, syringe exchange programs, emergency departments and faith-based groups.

The distribution of Narcan is underway, but new agencies will begin to receive it in about two months. It will take a year or two to get out all the supply, officials said.

“Opioid use disorder has become an enormous problem,” said Hamilton County Public Health Commissioner Tim Ingram. “Drug overdoses are robbing us of our future.

“We want to save lives.”

Ingram announced the initiative Thursday with others at the health department. Hamilton County and Cincinnati public health agencies, private addiction providers, hospitals and county governments are among those that have joined for the effort.

The project will cost about $550,000, Ingram said. Collaborative members, including hospitals in Hamilton County, BrightView Health, private foundations and Interact for Health, and Hamilton County commissioners contributed to that amount. . The commissioners contributed $25,000 toward an individual who will lead distribution of the medication.

Dr. Shawn Ryan, a certified addiction expert, initiated the idea. Ryan has expanded access to on-demand medication assisted treatment with his practice at BrightView Health clinics and is president of the Ohio American Society of Addiction Medicine.

Ryan said he’s alarmed by the rise in opioid overdoses, particularly by fentanyl, a synthetic that is far more potent than heroin and is rampant in the region.

Hamilton County sees an average of one opioid overdose death per day, but it can go higher, Ingram said. Ohio has about 11 overdoses deaths each day. Nationwide, the deaths number about 91 per day.

Fentanyl and related potent opioids were involved in more than half of 4,050 drug overdose deaths in Ohio last year, according to a recently released report by the Ohio Department of Health.

“It scares me,” Ryan said. “We can’t wait any longer.”

Adapt Pharma is providing the bulk of the Narcan, 25,000 doses, adding to the current supply in the county, said company spokesman Thom Duddy.

The company makes Narcan in a concentrated, four-milligram dose that has proven effective to those overdosing on fentanyl and other synthetic opioids. Narcan Nasal Spray is easy to use, which is a key reason why Adapt Pharma was asked to join the Hamilton County effort.

The county’s Narcan supply will go from about 7,000 doses to more than 30,000. It will be distributed to more locations within reach of people who are at high risk, or have a loved one at high risk, of overdosing.

Currently, Hamilton County naloxone is distributed to first responders, treatment agencies, law enforcement and community groups that provide it to the public.

Dr. Michael Lyons, of the University of Cincinnati College of Medicine, will head research for the project, tracking the distribution of Narcan and overdoses and deaths in the county.

If the influx of Narcan prevents more deaths, Ingram said, the project could become a model for communities nationwide in the fight against opioid addiction.

Public health officials stressed that addiction treatment, especially with medication, must follow overdoses and be available to those with opioid addiction.

“As has been scientifically proved, medically assisted treatment is the gold standard treatment,” said Hamilton County Commissioner Denise Driehaus, representing the county and its heroin task force.

Ingram noted that access to treatment in Hamilton County has increased, but added “we need more.”

What is naloxone?

Known also by its brand name, Narcan, naloxone is an antidote to opiate-related overdose. The non-narcotic can restore breathing in people who are overdosing from heroin or other opioids, saving lives.

Hamilton County first responders saved lives with naloxone provided by the health department almost 6,000 times from June 2016 to July 2017, Health Commissioner Tim Ingram said. They administered nearly 9,000 doses of the overdose reversal medication.

Want naloxone?

Go to a local pharmacy

Ask your doctor

Call your health department

Overdose deaths in Greater Cincinnati:

Warren County saw the largest percent increase in overdose deaths from 2015 to 2016. Last year, 58 people died of drug overdoses, up from 42 in 2015. The county’s annual overdose death rate since 2011 trails the state average.

Overdose deaths in Butler County increased from 195 in 2015 to 211 in 2016. In the last five years, the county has seen 37.9 overdose deaths annually per 100,000 residents, the second-highest in the state.

In Clermont County, the overdose death rate was 37.5 per 100,000 residents, fourth-highest in the state. Ninety-six people died of an overdose last year, down from 105 in 2015.

In Hamilton County, 318 residents died of an unintentional drug overdose in 2016, down from 335 in 2015. Since 2011, the rate of local deaths was 29.4 per 100,000 residents, 13th highest in the state.

 

 

 

 

 

How My Overdose Saved My Life

I’m a mom and a wife. I’m a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio, supporting those struggling with substance use disorder.

And I’ve been in recovery from heroin addiction for five years.

That’s today.

Five years ago, I was sprawled on the pavement getting a dose of naloxone. I had overdosed on heroin. It was a near-death end to a reckless existence that had started without warning.

Naloxone didn’t just bring me back to life, it gave me a second chance at life. But more than that – naloxone was the bridge that got me from the brink of death to treatment and recovery.

When I was young, I had several knee surgeries. I was prescribed pain medication on a regular basis, whether or not I needed it. And at no point was naloxone part of any medical conversation.

If it were, maybe I would have been more aware of the high risks and addictive properties of prescription opioids.

Suddenly, I was hooked. By 15, I was diagnosed as an addict and the cycle of addiction consumed the next decade of my life. I doctor shopped for pills, took opioids, used cocaine, methamphetamine and ecstasy to get my fix. I dropped out of high school, gave up the rights to my first child, and married an abusive man whose drug use was like my own.

What started as a prescription from my doctor spiraled into a deadly mission of finding the next, stronger high – eventually leading me to heroin.

I committed felonies for drug money and couldn’t hold a steady job. My young life was decaying. I became associated with members of a Mexican drug cartel and eventually became a drug mule, buying and selling black tar heroin.

I was so far gone, until thankfully, I overdosed. I say thankfully because had it not happened then, I may not be here to share my story.

Addiction is no joke. It’s not a choice. Yes, I chose heroin, but I didn’t choose to be an addict. Naloxone gave me the chance to correct my wrong choice. It didn’t enable me to keep using, like some may think.

The only thing naloxone enables is breathing.

When I overdosed, my body was pushed out of a car and onto the pavement of a parking lot. I was revived by naloxone, I woke up to strangers around me. I refused treatment and within minutes, I stood up and walked away from where my body laid, moments from death. Six weeks later, I entered into treatment, March 9, 2012.

For ten days, I slowly purged my body of the deadly drugs that brought me to that place. I left clean and with a conviction to stay that way.

Quitting heroin was the easy part, rebuilding my life was hard. But it is possible.

I cleared my criminal record, I mended relationships with my family – my daughter that I had walked away from so long ago. I remarried and gave birth to another beautiful baby girl.

As I rebuilt my life, I decided to focus my energy on helping those that were in the same nightmare I had just escaped. I went through a certification course to become a Chemical Dependency Counselor Assistant. I have worked incredibly hard to build my credibility as someone working in the field to show other addicts that recovery is possible.

So today, on International Overdose Awareness Day, what I want everyone to know is that if it weren’t for naloxone, I’d be one of the mourned, not one of the recovered.

The second chance I got is only possible with the ability to enter treatment. If an addict is still alive, there is still hope.

When a person is revived with naloxone, that is the crucial time when we as a society must offer love and compassion to them. That is the moment to look at the patient and say, “You’ve been through a lot, I want to help you find treatment and change your life.” Because no matter how far a person has gone in their life to support their addiction, as long as they are alive, hope is never gone.

I carry naloxone with me everywhere I go. It is the world we are living in today, that I need to be prepared to reverse an overdose at any time. The only way we are going to change this epidemic is if we as members of society and fellow human beings call upon each other to show compassion and love. Not one person is immune to addiction. Addiction has no prejudice and does not care who you are or how much money you have or what you look like. I am living and breathing proof why naloxone needs to be in everyone’s possession. My life is beautiful today, because of naloxone.

Amy Parker is a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio. She is a member of the WCPO 9 News Heroin Advisory Board and a Motivational Speaker. Amy has been in recovery from heroin addiction for more than five years.