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Substance Abuse

8/16/12 2:03pm

Country vs. City Addictions Differ, Says SAMHSA

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"Country Cousin" likes "likker." Photo via

Just like the mid-2000s Saturday Night Live sketch, “Appalachian Emergency Room,” wherein country folk get admitted to the hospital for reasons far different from their citified counterparts—such as a nasty ferret bite or getting one’s hand stuck in a tampon machine—it turns out that urban and rural substance abusers also have significantly different drugs of choice, as well as using habits and characteristics, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). Based on data from 2009, the report reveals that rural substance-abuse treatment admissions are far more likely to be court-mandated, at a rate of 51.6% (rural) to 28.4% (urban). Rural treatment clients also report primary abuse of alcohol at a much higher rate—49.5%—than do their city cousins (36.1%), in addition to non-heroin opiates (10.6% country vs. 4% city).

As you might imagine, primary abuse of traditional street drugs like heroin and cocaine score more highly in urban areas, with 21.8% of city treatment admissions citing heroin as their main poison (vs. 3.1% in the country), and 11.9% cocaine (5.6% out in the sticks). Other differences include: rural substance abusers are less likely to hit the bottle or the pipe on a daily basis (23.5% do so, as opposed to 43.1% in the city)—perhaps because they are more likely to be employed full- or part-time than those in urban areas—and more likely to have first used their drug of choice prior to turning 18 (32.1% versus 26.7% on the mean streets).

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By Hunter R. Slaton

Drugs in prison

8/16/12 1:08pm

Where Prisoners Stash Their Drugs

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One of many prison stash spots Photo via

Prisoners are constantly coming up with new and ingenious hiding places—or "stash spots"—to conceal contraband items, such as drugs, homemade hooch and shanks. "There's so many places I can stash stuff in prison," one convict tells The Fix. "It's unbelievable." Hiding stuff effectively is part of a never-ending battle with prison guards and administrators, who are always seeking to find and confiscate contraband. In most prisons, guards spend a lot of their working hours shaking down cells, along with the common areas and work places. Sometimes they luck upon some drugs, but mostly they don't—prisoners' hiding places are often just too good.

"I can use a homemade screwdriver to unfasten the safety screws on the electronic outlet cover and stash stuff back there, it only takes a minute," the prisoner says. "Another good spot is taping stuff under the bunks, tables, phone stations, or even on the bottom of a fire extinguisher." Purchased items can also be put to this use: "They sell jugs on the commissary, half-gallon coolers. I can buy one, rip the inside sleeve out, take out the insulation that coats the shell on the inside and stash stuff there, around the inner sleeve, which I can reinsert." And so can clothing: "Your shoes and boots are always good to hide stuff in. You can put stuff under the insoles. They never check shoes for some reason—especially if you got an old, stinky pair." He continues, "They got these big dust mops with long tube handles; you can take the plastic fastener off the top and tape stuff down in the tube handle. If you work in recreation, the kitchen or facilities you have even more options: in the ceilings or vents—that's where dudes let their hooch cook up; in the ceramic molds or in instruments, especially drum sets; in the food cartons in the warehouse or the walk-in freezer. Like I said, it's unreal."

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By Seth Ferranti

video games

8/16/12 12:13pm

New Video Game Aims to Help Children of Addicts

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"Quico" and his abusive pal, "Monster."
Photo via

A new video game, Papo & Yo, may resonate for children of addicts, and even help them navigate their own real-life struggles. In the game, a boy named Quico and his inseparable pal Monster traipse through a lush fantasy world. But Monster is often confused and destructive and, after eating too many frogs, he sometimes transforms into a real monster who beats Quico. Game creator Vander Caballero has admitted he based the characters on his own experience growing up in South America with an alcoholic and drug-addicted father, and he hopes the game will help kids who share similar struggles. "The only way you can create empathy in video games is through interaction." says Caballero. "I want players to feel what I felt as a kid and the only way I could achieve that was by creating game mechanics that let you interact and develop relationships as you play." The question at the heart of the game becomes how to handle Monster, and even more difficult, how to handle the memories of the damage Monster inflicts—even long after the harm has been done. Caballero says his goal with the game is to create player empathy with the interactions between the characters, such as showing Quico how to carry coconuts around to guide Monster along. The atmosphere of the game is also intended to be comforting—depicting dilapidated, yet beautifully sunlit favela-scapes accompanied by trance-like tunes. In a far less comforting portrayal of addiction, another video game on the market, Max Payne, guides players from the perspective of an addict himself.

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By McCarton Ackerman

Addiction Treatment

8/16/12 11:05am

Can PTSD and Addiction Be Treated Together?

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Many PTSD sufferers are addicts, and vice
versa. Photo via

Simultaneous treatment for post-traumatic stress disorder (PTSD) and addiction may be more effective than previously thought, as Fix columnist Maia Szalavitz explains for Time Healthland. Many people suffer from both PTSD and addiction. But most experts have previously thought that PTSD treatment shouldn't take place until the addict is sober—largely due to the belief that trauma treatment may trigger relapse. However, a new study from the University of New South Wales in Sydney, Australia, suggests that PTSD treatment may be effective even without a period of abstinence. Researchers examined 103 people with both conditions as they underwent exposure therapy (in which a patient is exposed to traumatic memories) and found the therapy to be effective, regardless of a patient's continued drug use. “These findings challenge the widely held view that patients need to be abstinent before any trauma work, let alone prolonged exposure therapy, is commenced,” the authors write. “Findings from the present study demonstrate that abstinence is not required.” The study also found that despite exposure therapy requiring patients to face past traumas, it didn't cause them to increase their drug use or drop out of treatment. Michael Farrell, director of the National Drug and Alcohol Research Center at the University of New South Wales, says of the study: "The exciting thing in my view is that it supports people with drug and alcohol problems having access to other forms of psychological interventions, rather than being fobbed off and told to sort out their alcohol or drug problem first."

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By Valerie Tejeda

Headlines

8/16/12 5:00am

Morning Roundup: August 16, 2012

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Back in rehab? Photo via

By Chrisanne Grise

prescription monitoring

8/15/12 5:00pm

Drug Czar Pushes for Rx Monitoring in Missouri

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No monitoring, MO problems. Photo via

Forty-nine states have adopted drug monitoring programs to help address America's prescription drug abuse scourge—but not Missouri. US Drug Czar Gil Kerlikowske, who calls the programs "useful," is in the state today to speak with pharmacists, medical professionals, community members and lawmakers. "Our goal is not to tell people what they should or shouldn't do," Kerlikowske tells The Fix, "but we have provided a lot of information about the number of overdose deaths, and the costs in health care for treating Rx drug abuse. We wanted to put that information out there, and also to let people know that there are federal grants that pay for the start-up costs." Kerlikowske is joined today by Republican Senator Kevin Engler, who unsuccessfully pushed for a state monitoring program earlier this year; that bill was filibustered by Republican Senator Rob Schaaf, a family physician, who claims that databases infringe upon patients' privacy. "All they have to do is punch in your name and address and they can find out every controlled substance you've been prescribed," Schaaf said this week.

The Drug Czar has understandably called prescription pill abuse an "epidemic." It was responsible for nearly 21,000 deaths in 2009—more than the number of cocaine and heroin deaths combined. Most states have rolled out monitoring programs that use electronic databases to identify if a patient is "doctor shopping"—visiting different doctors to obtain multiple prescriptions. The programs can also help identify "pill mills," offices that overprescribe meds and allow addicted patients to feed their habits. Feedback on these programs has been positive: "Physicians that use these programs say they are very helpful in determining which patients may be doctor shopping, and then the goal is to help get those patients into treatment if they need help," says Kerlikowske. "We don't see prescription monitoring as a silver bullet, but it's one more tool to be used in [combatting drug abuse] and it can be very effective. Doctors have called it a patients' safety tool."

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