[8/10/2006 11:43:16 AM] [Bill S] "me either"

[8/10/2006 11:45:30 AM] [SHARON LEVY] "To Jrosenbluth's question - kids who have been treated for substance abuse need long term follow-up. Recovery High Schools, which were discussed in one part of the series, are an attempt to provide a safe place for kids who have drug problems to return to normal functioning."

[8/10/2006 11:46:24 AM] [MODERATOR] "Sharon, would there also be treatment different issues for a child who was, say 12, than a teen? What would they be?"

[8/10/2006 11:47:17 AM] [Ross] "Thanks Sharon. At 16 years of age I was brought with all sorts of symptoms from alcohol abuse mostly impaired abstract thinking concentration problems and short term memory problems and anxiety. I was told that this was ADHD and given ritalin and seroxat aka paxil. I strongly believe I became physiologically dependent on ritalin without abusing it as when i tried to stop it I suffered unreality severe depression and agitation worse so than when trying to quit drinking. While on ritalin I found it stimulated my alcohol desire and my thirst for alcohol was double. Most doctors I have seen admit I was dependent on ritalin but describe it as discontinuation reaction I call it an out and out drug withdrawal. In my 20's I went on a massive binge of cocaine and amphetamine for the first time and found the come down was identical to ritalin. Do you believe ritalin and amphetmine helps addiction in adolescents or worsens it?"

[8/10/2006 11:47:54 AM] [SHARON LEVY] "Bill S - just to clarify, are you asking if the state of MA is limiting residential treatment for adolescents to 90 days?"

[8/10/2006 11:49:16 AM] [Bessie Oster] "Dr. Levy, are there any specific prevention curricula that you would recommend for older teens who may have some prior experience with alcohol and/or other drugs. "

[8/10/2006 11:50:09 AM] [jrosenbluth] "Dr. Levy, How common is prescription or over the counter drug abuse in teens in your opinion or from what you are seeing in your SA program?"

[8/10/2006 11:51:05 AM] [SHARON LEVY] "Ross - It sounds like your concentration problems were related to drinking alcohol, and not a "primary problem" (as in ADHD). If that was the case, the best treatment would have been to stop drinking, rather than to take a stimulant. You bring up a good point that the diagnosis of ADHD should only be given after careful evaluation. Research has shown though, that when ADHD is properly diagnosed, the use of stimulant medication can reduce the chance of developing a drug problem."

[8/10/2006 11:53:07 AM] [Robert C. Wright] "In our residential adolescent program we have been having some challenges with acceptance of Gay and Lesbian teens. One incident involved violence, any tools you could suggest for the staff to address this would be most appreciated."

[8/10/2006 11:53:17 AM] [SHARON LEVY] "Hi Bessie. Prevention curricula are not my area of expertise. Partnership for a Drug Free America, Join Together, SADD, NIDA and SAMHSA websites might be worth checking into."

[8/10/2006 11:53:20 AM] [Bill S] "NO. THEY ALLOW PROGRAMS TO HAVE CHILDREN STAY LONGER IF CLINICALLY INDICATED, BUT THE (SORRY about the caps) question really is an attempt to validate their claims that length of tsay is better shorter, which seems to go against most of the research i have reviewed."

[8/10/2006 11:55:39 AM] [SHARON LEVY] "Jrosenbluth - There is lots of evidence that abuse of prescription and over the counter medication is on the rise, in fact other than alcohol and marijuana, prescription meds are abused more than any illicit substance. Pain killers, opiates and cold medications in particular are commonly abused by teens. There is regional variation in drug use. In Massachusetts use of opiates (pain killers) is particularly common."

[8/10/2006 11:56:47 AM] [Ken C] "Do you think a "scientifically based" approach also might apply to what I would call the "messaging" or the communications programs around anti-addiction or drug campaigns. Should we communicate more to adolescents about the science and medicine behind addiction as opposed to the emotional aspects? Perhaps we're selling young people short in thinking that they won't understand or appreciate the science of addiction. "

[8/10/2006 11:58:34 AM] [SHARON LEVY] "Ken - I think you have a very good point. "Scare messages" do not seem to be effective with adolescents. Some programs are looking into incorporating teaching about drugs and alcohol into the biology curriculum; I believe that will be a good approach."

[8/10/2006 11:59:12 AM] [MODERATOR] "Robert, just to help answer for Sharon, are you familiar with the Lesbian, Gay, Bisexual and Transgender Community Center Speak OUT!: Voices for Recovery in NY? phew! I can give you url, phone number etc."

[8/10/2006 12:00:23 PM] [MODERATOR] "Sharon, I have a 12-year-old son and what they DON'T teach him about alcohol, heredity (in school health class) is pretty astonishing. "

[8/10/2006 12:01:17 PM]  [Robert C. Wright] "I am familiar with the Center but not the program you mentioned here. I would appreciate the phone number thank you"

[8/10/2006 12:01:39 PM] [SHARON LEVY] "That is amazing - we have a long way to go. One of the articles in the series points out that the field of substance abuse treatment for adolescents is in its infancy."

[8/10/2006 12:02:27 PM] [MODERATOR] "Robert: Here you go ... 212 620-7310. www.gaycenter.org -- my understanding is that they have help for children, altho they do focus on recovery."

[8/10/2006 12:03:40 PM] [Robert C. Wright] "Thanks"

[8/10/2006 12:04:18 PM] [Ross] "Thanks for your views and I agree that I should have been treated for alcoholism rather than adhd. I am very skeptical of the research of ritalin and amphetamine. I have read studies that show ritalin in animals activates from memory the cfos gene in therapeutic doses equiv to those given to kids. This gene gets activated in cocaine and amphetamine abuse. I have done a lot of research on alcohol, SSRI's and stimulants and I believe it is dangerous to give drugs or abuse drugs in adolesence whether prescribed or not. In effect I believe giving stimulants or other psychotropic drugs to a developing brain can permanently or at least cause a long term (years after cessation) changes which indeed will leave the person requiring psychotropic drugs for the rest of their life. I believe there needs to be more education on the dangers of alcohol or street drug use in adolesence and I believe this research and studies should NOT be done by people with any affiliation to the alcohol industry or pharmaceutical industry. I would be interested in your thoughts?"

[8/10/2006 12:05:39 PM]  [SHARON LEVY] "To Bill - I have seen some information suggesting that brief interventions can be as effective as longer ones, but I have not seen the work that you are referring to"

[8/10/2006 12:06:17 PM] [jrosenbluth] "As far as scare tactics go, I think you're right. They don't work but knowledge alone does not prevent use. Facts including the biological basis of addiction and the physical and psych consequences of use are important to teach kids but my own experience in prevention has demonstrated the importance of teaching life skills such as decision making, coping with stress, social norms, etc. in order to really prevent use - getting at the "root" of why kids use. "

[8/10/2006 12:08:12 PM] [SHARON LEVY] "Ross - there is a fair body of literature on the use of low dose stimulants to treat patients with ADHD. There is no question, though, that kids can abuse their prescription medications and become dependent on stimulants."

[8/10/2006 12:09:38 PM] [SHARON LEVY] " jrosenbluth - Well said. All of these skills and information should be taught together. That is why we need more than one approach."

[8/10/2006 12:09:52 PM] [MODERATOR] "One of our stories focused on Tony Landecker, who had his first beer at age 9, and thereafter followed life-threatening drug use. In your experience, how young can addiction take hold? "

[8/10/2006 12:11:51 PM] [SHARON LEVY] "The youngest patient we have seen in our clinic was 12 years old - though most are 15 and over. The younger kids start drinking and using drugs the more likely they are to have life long problems. This is a really important point for the field of prevention - it seems that if we can get kids to delay using drugs and alcohol through a certain "developmental window" we are giving them lifelong protection against drug and alcohol problems."

[8/10/2006 12:12:15 PM] [MODERATOR] "Thom Forbes, who wrote the first article in series chronicling his family's drug use, feels there's too little importance placed (by parents) on keeping kids from "experimenting" in their teens. Do you think that's true?"

[8/10/2006 12:14:47 PM] [Ross] "Most of the studies on Ritalin and amphetamine are funded by the pharmaceutical industry though. I did not abuse ritalin but I did become dependent on it. I don't abuse or get high on tobacco but I am physically dependent on nicotine. You don't have to get high to get addicted. Infact abusing drugs does not guarantee addiction for example if the drug is abused occasionally. I don't agree that abuse is necessary for addiction. I could pull up lots of references which counter what you state. Please don't take this the wrong way I think your aims for reducing addiction as a paediatrician is excellent and I am glad to see you doing such good work. The reason I have this knowledge is because of personal experience and I am heavily involved in prescription drug addiction support groups and also to a degree in alcohol recovery groups."

[8/10/2006 12:15:27 PM] [SHARON LEVY] "Absolutely. Parents can protect their kids by setting clear expectations and limits of no drug use. An exception is the use of alcohol in a ceremonial way, such as part of a religious ceremony, with parents present - research suggests that this does not increase the risk of developing long term problems. But parents should NOT allow kids to drink unsupervised, even if they are somewhere else in the house."

[8/10/2006 12:16:10 PM] [MODERATOR] "Robert, I was just curious, up to now, have you been using any special programs to address lesbian and gay teens in your program?"

[8/10/2006 12:17:18 PM] [jrosenbluth] "In your state can adolescents be mandated to treatment (other than those from probation or juvenile justice)? "

[8/10/2006 12:20:40 PM] [SHARON LEVY] "Ross - some people use the term "physical dependence" to describe tolerance and withdrawal from a substance. People can become physically dependent on lots of different substances, for example people on medication for chronic pain may become physically dependent even though they are not abusing the medication. Addiction is something different - it really refers to a loss of control over drug use. Tolerance and withdrawal may be part of an addiction, though not necessarily. Abusing a drug, that is using it in a way that negatively impacts functioning, comes before developing an addiction."

[8/10/2006 12:21:40 PM] [SHARON LEVY] "jrosenbluth - juveniles can be mandated to treatment outside of the court system, but it is very difficult and not commonly done."

[8/10/2006 12:21:47 PM] [Ken C] "I'd like to see a survey in which young people are asked if they would likely experiment in high school with alcohol, drugs or...steroids. I think many (admittedly, non athletes) have come to conclusion, largely through media coverage, that steroids are dangerous and they would avoid them for fear of a long-term health risk. They are not making the same connection with drugs/alcohol. "

[8/10/2006 12:23:01 PM]  [Ross] "dependence in my opinion is the medical term for addiction you can have psychological addiction which includes abuse and physical addiction which includes what you have described. Phyiscal addiction is the same as physical dependence etc. Or am I wrong?"

[8/10/2006 12:23:47 PM]  [Ross] "I guess addiction has different definitions."

[8/10/2006 12:24:01 PM] [SHARON LEVY] "Ken C - I'm not sure your premise is true. Unfortunately steroid abuse is quite common among high school students. There are a couple of treatment and prevention curricula specifically designed for this topic"

[8/10/2006 12:25:25 PM] [Ross] "I am from the UK. I may be wrong about medical definitions in the USA. My father is a doctor so I have obviously spoke to him about my addiction problems to ritalin, alcohol and diazepam."

[8/10/2006 12:25:51 PM] [SHARON LEVY "Ross - addiction doesn't have a formal set of diagnostic criteria, and I think you are right - it means different things to different people."

[8/10/2006 12:26:12 PM] [Ross] "ok Sharon yea"

[8/10/2006 12:26:52 PM] [MODERATOR] "Is there a move to formally define addiction, diagnostically speaking?"

[8/10/2006 12:28:28 PM] [Ross] "I think though Sharon that you can loose control of drug use due to physical dependence. I am counselling a young girl from Ireland who keeps escalating her benzodiazepine use to overcome withdrawal symptoms. She has never even got drunk or high before."

[8/10/2006 12:28:49 PM] [SHARON LEVY] "There is a manual called the "Diagnostic and Statistical Manual" that lists diagnostic criteria for all mental health disorders. Substance abuse and dependence are both included, but addiction is not. Most people in the field use "abuse" and "dependence" for diagnostic purposes, though they may use "addiction" when speaking informally."

[8/10/2006 12:28:55 PM] [Ross] "she never abused her benzodiazepine. In her case she is on lormetazepam and xanax."

[8/10/2006 12:29:14 PM] [jewelie] "I just want to dovetail what Ken C is talking about in talking to teenagers about the science of addiction. In my work, as a CDP, I go out into the middle and high schools and give presentations about the brain and drugs. My partner and I have only recently started doing these over the past 6 months and have had a great response. Most of the teenagers we see do not have much if any education around the brain and the science of addiction. The teens feed off of this information and are very stimulated by the presentation to the point of being engaged enough to ask very thought provoking questions. I have found that teenagers appreciate our being honest about what is happening to the brain (and body for that matter) and they are learning something that is new. They are tired of hearing the scare tactic messages and want to have information that will help them to make well-informed decisions about their health."

[8/10/2006 12:30:04 PM] [SHARON LEVY] "Jewelie - that sounds like a fabulous program."

[8/10/2006 12:30:06 PM] [Ross] "100% of the people who wrote that diagnostic criteria had finanical ties to the drug industry. It is the same as asking the alcohol industry representatives to write the diagnostic criteria for alcoholism lol. I am sorry but I can't help my views."

[8/10/2006 12:30:23 PM] [MODERATOR] "Jewelie -- that sounds great. If you'd like, please send me info on your program to add to our website, www.silenttreatment.info."

[8/10/2006 12:31:15 PM] [MODERATOR] "We’re just about out of time. Thanks so much for joining us. This chat, as well as the five others on addiction topics, will be archived if you would like to check it out later. Thanks again for being here for our last chat, and thank you, Sharon, for your time and expertise."

[8/10/2006 12:31:35 PM] SHARON LEVY] "Thanks again."