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Understanding Addiction Key to Dealing With Prescription Drug Abuse

Fellowship Story Showcase

Understanding Addiction Key to Dealing With Prescription Drug Abuse

Picture of Bill Macfadyen

This article was written by Noozhawk Staff Writer Lara Cooper as part of Day 3 in Noozhawk's 12-day, six-week special investigative series. Related links are below.

The Noozhawk's Prescription for Abuse series is a special project exploring the misuse and abuse of prescription medications in Santa Barbara County. Our series is a result of an exciting and unique partnership with USC's Annenberg School for Communication & Journalism, which awarded Noozhawk a California Endowment Health Journalism Fellowship to undertake this important work.

Through our reporting and presentation, we will establish an independent baseline of where our community is with respect to the misuse and abuse of prescription medications; how the problem is affecting health care, education, law enforcement, criminal justice, addiction and treatment, and our culture and society; what we as a community can do to educate ourselves about prevention and controls; and how we can perhaps reverse what appears to be a very troubling trend.

Noozhawk staff writers Lara Cooper and Giana Magnoli are the lead reporters on the project, and they've been assisted by managing editor Michelle Nelson; reporters Alex Kacik and Sonia Fernandez; interns Kristin Crosier, Jessica Ferguson, Tim Fucci, Kristen Gowdy, Jessica Haro, Daniel Langhorne, Alexa Shapiro, Sam Skopp, Erin Stone and Sarah Webb; photographers Garrett Geyer and Nick St.Oegger; content producer Cliff Redding; and Web development staffers Will Macfadyen and Edgar Oliveira.

Ashley Almada, Garrett Geyer, Hailey Sestak and Billy Spencer of the Santa Barbara Teen News Network filmed more than two dozen public-service videos featuring many of our story sources.

The project is sponsored by the Santa Barbara Foundation in partnership with KEYT, sbTNN and Zona Seca. The Annenberg School is assisted by the Renaissance Journalism Center at San Francisco State University.


Day One:

» Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

» After Losing It All, Former Drug Addict Looking Forward to Renewed Life

» USC, California Endowment Unite to Support Health Journalism at the Source

» Bill Macfadyen: Prescription for Abuse Project Is a Series of Opportunities

Day Two:

» Local, National Statistics Reveal Alarming Jumps in Misuse and Abuse of Medications

» Marijuana Use Trends Higher, Especially Among Young Adults, Sparking Public Health Concerns

» Alcohol Plays a Role All Its Own in Setting the Stage for Local Abuse, Overdoses

Day Three:

» Understanding Addiction Key to Dealing With Prescription Drug Abuse

» Donna Genera Has Seen the Price and Perils of Drug Addiction from All Sides

» Rich Detty Bears Burden of Not Knowing Extent of Dead Son's Drug Use

Day Four:

» Escalation of Drug Overdose Deaths Includes Increased Presence of Prescription Medications

» Santa Barbara Teen News Network Adds Another Dimension to Prescription Drug Abuse Series

» Dr. Chris Lambert Sounds Warning on Mixing Prescription Drugs with Alcohol

Day Five:

» Local Oversight of Prescription Medications Is Far More Focused Than State, Federal Controls

» Elderly Are Particularly Vulnerable to Both Misuse and Abuse of Prescription Drugs

» Second-Generation Pharmacist Peter Caldwell Fills a Vital Role with Patient Health Care

Day Six:

» Early Education for Parents and Youth Emerges as Critical Tactic to Thwart Drug Use

» Student Highs Can Lead to Tragic Woes with Addiction's Hook Just One Fateful Step Away

» From an Early Age, Shereen Khatapoush Saw the Horrors of Substance Abuse

» As a Parent Herself, Prosecutor Von Nguyen Brings Empathy to Job in Juvenile Justice

Day Seven:

» Law Enforcement Fights Battle Against Prescription Drug Abuse from Outside and Inside

» Sheriff Bill Brown a Strong Supporter of Re-Entry, Drug Abuse Treatment Efforts

» Speaking from Experience, Zona Seca's Kevin Smith Keeps Drug Abusers on Road to Recovery

Day Eight:

» Prescription Drug System Is Rife with Loopholes, Fraud and Lack of Oversight

» For Clinical Psychologist Neil Rocklin, Addiction Education Can't Begin Soon Enough

Day Nine:

» Drug Abuse Treatment Programs, Expertise Are Plentiful on South Coast

» Dr. David Agnew Sees Pain as Pathway to Abuse But Cautions Against Overreaction

Day Ten:

» Awareness, Disposal Key Elements to Reversing Tide of Prescription Drug Abuse

» Dr. Joe Blum Keeps Focus on His Veteran Patients Despite Health-Care System's Restraints

Day Eleven:

» Operation Medicine Cabinet Gets the Drop on Prescription Drug Disposal

» Lacey Johnson Gives UCSB Students an Education in Dealing with Drug Abuse and Addiction

Day Twelve:

» Santa Barbara County Officials Look for Solutions in Battle Against Prescription Drug Abuse

» Noozhawk Journalists Recount Lessons Learned from Prescription Drug Abuse Series

» Annenberg Fellowships Take a Diverse Approach to Community Health Journalism

» Dr. Nancy Leffert Champions Antioch University's Role in Fight Against Substance Abuse

» Professionals Working in Addiction Field Often Share Roots at Antioch University Santa Barbara

Risk factors include genetic tendencies, adaptation and brain circuitry — and are all different in each of us
Sunday, September 18, 2011

In the past, the study of addiction has often been focused on substances — like heroin, marijuana and alcohol. But experts in the field now believe that addiction begins with the “reward circuitry” in the brain rather than the substances themselves. Understanding just how addiction works may offer clues to getting control of the growing problem of prescription drug abuse.

In August, the nonprofit American Society of Addiction Medicine released an official definition of addiction that categorized it as a “chronic disease of brain reward, motivation, memory and related circuitry.” An individual with addiction will pathologically pursue reward and or relief by substance use and other behaviors, the statement said.

“Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response,” the organization stated. “Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

“Addiction is not, at its core, just a social problem or a problem of morals. Addiction is about brains, not just about behaviors.”

John Gabbert, senior program director at the Santa Barbara Rescue Mission, puts it another way.

“I define addiction as any behavior that an individual will continue to do regardless of the negative consequences of that behavior,” he said.

A strong genetic component also exists with addiction, which helps explain why some people react to certain drugs and others don’t. According to the American Society of Addiction Medicine, genetic factors account for about half of the likelihood that a person will experience addiction.

Two local addiction experts weighed in on what they see every day in their practice. Drs. Joe Frawley and Sherif El-Asyouty are the co-founders of Santa Barbara’s Recovery Road Medical Center, which specializes in helping patients overcome addictions. The center is located at 3891 State St., Suite 205.

How rewarding a drug is to a person is one factor, while how much the person’s nervous system can adapt to the drug is another.

“If you take an 18 year old and he can handle five drinks very well without much effect, he’s more likely to have a problem 10 years later than someone who says ‘My head was spinning with the five drinks,’” Frawley said. “In those people who can handle it well, there is a much higher family history of addiction. They have a nervous system that has adapted to alcohol.”

Age is also a strong indicator.

Prescription drug abuse is most consistent among young adults aged 18 to 25 years old, according to data from the Substance Abuse & Mental Health Services Administration, a division of the Health and Human Services Department.

That age group is most likely to abuse prescription opioids, like oxycodone and hydrocodone, and these drugs are the most common drugs used at initiation, second only to cannabis, or marijuana, according to SAMHSA.

Compounding the issue is that people perceive prescription medications to be safe.

“People give a couple of pain pills out to someone like you would give them a pen,” Frawley said. “It’s that casual.”

Frawley and El-Asyouty also say there’s a strong connection between substance dependence and untreated mood and anxiety disorders; people will self-medicate with prescription drugs to feel “normal.”

A prime example is a 21-year-old Santa Barbara woman named Lynn, who spoke to Noozhawk on the condition of anonymity. Lynn said she started taking OxyContin while in a physically abusive relationship. A friend noticed bruises down the back of her arms and offered her a pill.

“I was in such a mental state that I really didn’t care,” she said. “I was so unhappy with myself and the relationship I was in.”

Family and friends would try to intervene when they saw the signs of physical abuse, like a black eye, but “I thought that I was above it,” she said.

Lynn said she liked how OxyContin and oxycodone, sometimes known as “roxies” on the street, made her feel, and after she ended the relationship, she was physically addicted and continued to use the medications for two years. She said she had enough friends taking the same drugs, so buying them was easy.

She said she would freebase the drugs for a faster high, but then the pharmaceutical company changed the chemical makeup of the pills, which prevented her from crushing and smoking them. The change prompted her to switch to heroin, which she used for about six months.

Abuse of opioid prescriptions may be a precursor to injection drug usage and drugs like heroin, according to a study published earlier this year in the International Journal of Drug Policy. Out of 150 young adults surveyed for the study, more than 80 percent initiated opioid misuse prior to heroin, which occurred two years earlier on average.

Lynn was eventually arrested last Halloween in Isla Vista, and she was charged with possession and sales of heroin and possession of cocaine.

Today, she is several months into a court-mandated treatment facility, Project Recovery run by the Santa Barbara Council on Alcoholism & Drug Abuse, and is taking a year off from UCSB to get clean. The program will last 12 to 18 months, depending on how well she does, but she hopes to return to school after treatment and finish her bachelor’s degree in environmental studies.

“I was resistant to the whole recovery thing, because I thought ‘If I really want to beat this, I can,’” she told Noozhawk. “Anything I’ve truly put my mind to, I haven’t failed at, so this was a really big life lesson.”

It’s important to remember that none of the medications are bad, said El-Asyouty, and they have a specific medical purpose when prescribed in a certain amount by a doctor.

“They become drugs when they are used for different reasons than what was intended, or in larger amounts or when you get them outside the prescribing source,” he said.

El-Asyouty said he thinks the majority of doctors mean no harm when they prescribe a medicine.

“The trick is once you start to notice (signs of addiction), it’s important to re-evaluate and not to be afraid of having those people treated,” he said.

Noozhawk staff writer Lara Cooper can be reached at Follow Noozhawk on Twitter: @noozhawk or @NoozhawkNews. Connect with Noozhawk on Facebook.