Why would people use drugs and risk addiction?
When we first try drugs we may find their affects upon us to be very pleasurable. The more pleasure we feel, the more likely we are to become dependent upon them to provide the pleasure and satisfaction we all crave in our lives. This is specially true if our lives already seem to be lacking the stimulation most people naturally feel. For many of us it is as if we were standing at the top of a greased slide: when we step out onto the slide we find ourselves immediately sliding towards the bottom at a breakneck pace. As our usage continues, we feel less and less pleasure with each new consumption of the drug, but when we try to stop we experience discomfort, tension and stress. We started off running towards the pleasure but wound up running away from the pain. This is the trap of addiction. At first we think we have found gold but it quickly turns into something quite different.
Nora Volkow is the great granddaughter of Leon Trotsky, and I am filled with awe at her understanding of addiction. To get an understanding of her life and what has motivated her research, and to also get an understanding of why the executive control function of the brain seems to be turned off or impaired in addicts, check out the video above.
And for those of you who prefer non verbal explanations:
What is Addiction?
Follow the link to watch a really good video: From: Addictions and Recovery.org (Love this site!)
On February 13 Marvin Gaye was scheduled to sing the National Anthem at the National Basketball Association’s all-star game at The Forum in Inglewood, Calif. There was a problem though and NBA commissioner Larry O’Brien was freaking out because Marvin had not shown up and nobody knew where he was. The story goes that Marvin was smoking crack and could not get out of the door to go the The Garden. Those of you who have used crack cocaine can, I am sure, identify. They started looking for a backup, but finally, he made it to game. This was the result.
Marvin and his father, who was addicted to alcohol and had abused Marvin his whole life, got into an argument on April 1, 1984, and that argument escalated into a fight. His father went and got a gun and shot Marvin three times in the chest. Marvin had been fighting a cocaine addiction for decades and his last words were, “I got what I wanted….I couldn’t do it myself, so I made him do it.”
And so it goes. Will this never end?
A man was in the middle of living his unremarkable life, accompanied in this existence by his loving wife and his delightfully cute eight year old daughter and active, inquisitive six year old son. He was almost content, but not quite. He wanted just a little more of everything and everything a little better. He had a job as a technical writer which he found interesting and which paid him enough to take care of himself and his family. He loved his wife and children and they loved him. Yes, he was almost content, but he felt he deserved just a little more respect from his friends and neighbors. He wanted a little more wealth to spend on better electronics and nicer cars, on a more spacious home and perhaps a boat. And he wanted more excitement in his life and perhaps he wanted to experience just a little bit more satisfaction. In short, he was like most of us.
He picked up a paper one day and read a story about gold having been discovered in a remote Alaskan territory. The story went on to describe how people had come from all over the world to this area, staked mining claims, and panned for gold and some had found their fortunes. So he thought to himself, perhaps I shall give that a try, for it sounds like many of those who have gone to Alaska have found true happiness and now want for nothing. So, he took leave from his job and he and his family shuttered the house, packed those belongings they thought they would need which were portable, and moved to Alaska. He paid a man money for the right to mine a claim next to a river, and bought the materials he would need to pan for gold, and commenced his quest for wealth.
On his very first day he scooped mud from the river and began panning and found little gold flakes in the mud. He became very excited and thought to himself, “This is so easy. I am on my way to being wealthy! It is so exciting and fun.” Each day, after picking out the gold flakes from the pan, he would put them in a box he kept in the canvas tent he had erected and he would feel great satisfaction. His family, however, was not quite as satisfied, for as he obtained more and more flakes, he became more obsessed with the panning, and would spend more time away from them. His wife was lonely and his children had no father to help raise them. As time went on, his relationship with them was damaged. He no longer thought about his old job, or any of his old friends. What he did think about was the little gold flakes in the bottom of his pan, for they were the answer to everything. They would provide the wealth and the esteem he craved, and searching for them was giving him excitement and satisfaction. He found himself bragging to the other prospectors about how successful he was at finding gold, and some of them became envious. When he noticed the envy, the man became a little fearful, and so he went into town and bought himself a pistol so he could protect his wealth. He stopped talking about his great success to the others.
Time went on and, when the box had become almost full of gold flakes, the man realized he was no longer nearly as excited or as satisfied as he had once been with the panning. The activity had turned into just another ritual which he was performing. It had turned into just another job. Then one fateful night he returned to his tent to a sullen wife and angry, irritated children. His wife told him the children were misbehaving every day, they were receiving no real education, and they were all unhappy. The man thought about this and felt guilty, but he was reluctant to give up such a well producing claim. When they sat down to dinner he was troubled and he realized they had all paid a high price for the wealth he had acquired. Suddenly, the tent flap opened and a ruffian in a mask entered and pointed a gun at them all. He said “Get me your gold and I won’t hurt anyone!” At first he said “The gold is mine and I don’t believe you will hurt anyone. I will not give you my gold and I demand that you leave me and my family alone.” When the ruffian heard these words, he pointed his gun at the man’s daughter and fired a round which hit the little girl in the leg. The man was terrified and, reluctantly, stood up and retrieved the box from its hiding place and handed it to the ruffian, who greedily grabbed it, set it on the dinner table, and opened it. But, strangely, all he did when he saw the gold was start uncontrollably laughing. “Do you think I’m an idiot? This is fool’s gold. Get me the real gold or so help me, I will kill you and your whole family!” he said. The man could see the ruffian meant what he said, so he jumped up and walked over to where he’d hidden his pistol, while assuring the ruffian he would give him all his gold. He grabbed the pistol and shot the ruffian, killing him.
His wife and family were distraught. The man grabbed his box, his wife grabbed the little girl and the whole family drove as fast as they could to the hospital in town. His daughter was admitted to the emergency room and the doctor told the rest of the family that she would be fine as the bullet had passed through a non-critical part of her leg muscle and no major arteries or veins had been damaged. The man called the local sheriff and reported the attempted robbery. The sheriff came to the hospital and took the report from the man and his wife and asked to see the box. When he opened it, he too laughed. He told the man it was indeed fool’s gold. At first, the man was inconsolable. He had thought he had found the solution to all his problems. He had thought he was wealthy and he’d been spending his time in the perfect activity. Indeed, at first, each day had been exciting and satisfying. He had felt like he was finding real gold and in fact, if it had been real gold, he could not have felt any better. It’s true that as time had gone on, he had felt less and less satisfaction and excitement and, because of the time he had spent on his panning, his family had suffered more and more, but he had been so reluctant to give up on his belief that he was finding real gold. He felt ashamed and embarrassed that he had made such a silly mistake and he felt guilty about how he had treated his family and how he had endangered them all and most of all, he felt ashamed that his actions had caused his daughter to be shot in the leg.
He told his wife he wanted to die, to disappear from the face of the Earth. He didn’t see how he could face his family or his friends and neighbors when they returned home. His wife looked him in eye and told him, “There is nothing to be ashamed of or feel guilty about. Each of us is made the same. We crave excitement and satisfaction. We have evolved to be restless and slightly uncomfortable. It is who we are. Most of us want more than what we have. We only know what we have learned and are ignorant of what we have not been exposed to. What has happened is a great lesson for you and what is important is that you learn from it. We are all fools until we pan for gold. When we pan, sometimes we find gold, sometimes we are fooled. The reality is that all gold is fool’s gold and real wealth is the lessons we learn while panning. True excitement and satisfaction are found in our relationships to one another and in our relationship to the world and nature.” And for the first time in a long time, he felt a modicum of peace and comfort as he held his wife close.
If you find yourself heading towards the bottom of that slide, please do not waste time with self-loathing or shame. You are part of that section of the population which is prone to addiction and the slide was just sitting there waiting for you to set foot on it. The vast majority of people try some kind of psychoactive drug with relative impunity. They are able to partake and the substance or behavior does not become their everything. They are not us. What we can do, however, is learn from our experience and stay away from slides.
Agnostic’s View of a Possible God
A conversation with believers . . . .
I’m an agnostic, but if there’s a God, the only one I can believe in has infinite patience. I could believe in a New Testament God, but not that wrathful, human-like Old Testament God (I can conceive of many other possible Gods as well, but that’s a tune for another song). Our lives, however, are governed by the fascist, Time. Time is an arrow, loosed at birth and traveling with frightening speed towards the target of all our arrows, Death. The flight of this arrow differs from the flight of the standard arrow in that it’s path is determined not by the direction the bow was pointing or the force with which the arrow was shot, but by the infinite number of “nows” between the shot and the arrow’s arrival at the target. Though my God would have infinite patience, my time would not. If there is sin, then it is surely the wasting of that time with an unholy attachment to the repetitive behavior involved with addictions and with the hijacking of love which was meant to be shared with life and with God. Knowing this, your job is to find a NOW and direct your arrow. There are many factors which can affect your arrow’s flight: the sight-giving light of self-knowledge, the rain of misfortune, the occasionally sad, windy influences of your dark, stormy past and the sunny warmth of those who care for you and the God who waits, but none of these factors approach the importance of your will and your determination. Decide where you want to be and then go there. It need not be a straight line. Every “now” need not be a victorious now. If you fall, pick yourself up and head once again in the direction you have decided to go. A bloody knee is not the end of the world. Your past failures need not decide your direction today, but they can inform your determination. Your fear has been your close companion. Say goodbye to fear and say hello to your will, which will vanquish any fear. Decide. Harness your will. Determine the flight of your arrow.
We await you.
This video was originally from Kevin O’hara’s website.
© Jim Dickey
Do You Use Alcohol Or Drugs And Wonder If You’re Addicted Or Dependent?
Here’s a number of self assessment tools on the internet to find out:
http://casaa.unm.edu/inst/Aware.pdf (useful for predicting relapses)
I originally got the following article from EGLO.com but there has been a domain dispute and that domain now points to a light fixture provider: “We help you to find your personal luminaire in just a few easy steps. ” I love the metaphor. If you’re looking for a personal luminaire then by all means, proceed to the site. I’ve tried to find the original article on the interwebs but all my Google searches just point to me, If you’d like credit, then please contact me at Jim@JDickey.com. Tanks.
The Most Common Addictions in America
When you can stop you don’t want to, and when you want to stop, you can’t … ~ Luke Davies. America is largely a consumer culture, so addictions are prevalent in this country, whether those addictions are to particular substances or to activities that are less than healthy. Below are five of the most common addictions in America.
Many Americans are dependent upon alcohol, which is an incredibly addictive substance. Because the drinking age is 21, many teenagers begin drinking as a form of rebellion and become addicted. Bingeing is a particular problem on college campuses across the country.
Others turn to alcohol to deal with depression and other psychological issues. While some are able to enjoy alcohol as an occasional addition to a meal, far too many Americans drink to excess, leading to health problems, domestic violence and many fatal traffic accidents involving drunk drivers.
Another addiction often seen in conjunction with alcohol abuse is addiction to tobacco. While aggressive campaigns warning of the dangers of cigarettes have cut down on kids beginning to smoke and the trend toward non-smoking restaurants and other public establishments forces smokers to reduce their habit at times, many Americans still smoke regularly, especially in the home. In its own way, cigarettes are as dangerous to innocent bystanders as alcohol, since second-hand smoke can be deadly, leading to lung cancer and other respiratory illnesses. However, once a person is addicted, it is incredibly difficult to stop smoking.
While not as immediately dangerous as addiction to alcohol and tobacco, food addiction also causes many health problems for Americans. At least in the case of this addiction, one person’s consumption of food does not negatively affect another, except perhaps in the case of a child learning unhealthy eating habits early because of parents who eat the wrong kind of food and too much of it. Junk food abounds in America, and because this type of food tastes so good, many people continue to eat it in unhealthy quantities, particularly during times of stress.
One addiction that has little to do with physical health is gambling. However, this affects a person’s well-being, since those who are addicted to gambling cannot bring themselves to stop and end up losing far more money than they should have been playing with in the first place. Gambling addictions feed on themselves because the more money a person loses, the more desperate he or she becomes to regain that money. Some people have lost their life savings and racked up huge debts in this way.
Finally, Americans are increasingly addicted to media in all forms, whether it’s the television, the phone or the Internet. There is a constant need to feel connected, and while this helps make people more informed and allows them to keep in contact with other people, it can eat up hours of time without a person’s realizing it, leading to poor sleep, decreased intimacy among friends and family and dangerous habits like texting while driving.
These are only five of the common addictions in America, but they demonstrate the ease with which people become addicted to different substances and activities to the detriment of themselves and others.
Instant gratification, time distortion, and dissociation are typical coping mechanisms for someone undergoing some sort of depressive or anxious state. For instant gratification, many people resort to online activities such as internet pornography and online shopping. For people who feel alone, have lower self-esteem, or are socially inept, online gaming and spending time in social networking sites help kill time and give them virtual outlets. For those who prefer to be isolated or left alone, they resort to self-destructive online activities like online gambling.
—–First of all, according to almost all mental health experts, alcohol is just another drug. To help you find out if you are dependent on a drug, let’s look at some definitions of dependency (or addiction, two words which describe the same condition):
THE SCIENCE OF ADDICTION
Carlton K. Erickson
DRUG ABUSE: The intentional (conscious) overuse of drugs in cases of poor judgment, self-medication, over-celebration, and other situations where drug use can be harmful or illegal.
CHEMICAL DEPENDENCE: Is compulsive, pathological, impaired control over drug use, leading to an inability to stop using drugs in spite of adverse consequences.
There is no difference, as far as the brain is concerned, between substance addictions and behavior addictions. The definitions are identical.
Source for the following: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC: American Psychiatric Association, 2000.
DSM-IV Substance Dependence Criteria
Addiction (termed substance dependence by the American Psychiatric Association) is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:
1. Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
(b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance
(b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance (such as visiting multiple doctors or driving long distances), use the substance (for example, chain-smoking), or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
DSM-IV criteria for substance dependence include several specifiers, one of which outlines whether substance dependence is with physiologic dependence (evidence of tolerance or withdrawal) or without physiologic dependence (no evidence of tolerance or withdrawal). In addition, remission categories are classified into four subtypes: (1) full, (2) early partial, (3) sustained, and (4) sustained partial; on the basis of whether any of the criteria for abuse or dependence have been met and over what time frame. The remission category can also be used for patients receiving agonist therapy (such as methadone maintenance) or for those living in a controlled, drug-free environment.
The DSM V, which came out in May 2013, is explained below (From about.com)
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, commonly referred to as the DSM-V or DSM 5, is the latest version of the American Psychiatric Association’s gold standard text on the names, symptoms, and diagnostic features of every recognized mental illness, including addictions. This edition was published in May 2013, nearly 20 years after the original publication of the previous edition, the DSM-IV, in 1994.
The DSM-V recognizes substance related disorders resulting from the use of ten separate classes of drugs: alcohol, caffeine, cannabis, hallucinogens (phencyclidine or similarly acting arylcyclohexylamines), other hallucinogens such as LSD, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants (including amphetamine-type substances, cocaine, and other stimulants), tobacco, and other or unknown substances. Therefore, while some major grouping of psychoactive substances are specifically identified, use of other or unknown substances can also form the basis of a substance related or addictive disorder.
The DSM 5 explains that activation of the brain’s reward system is central to problems arising from drug use –- the rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug. While the pharmacological mechanisms for each class of drug is different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”
The DSM 5 also recognizes that people are not all automatically or equally vulnerable to developing substance related disorders, and that some individuals have lower levels of self-control, which may be brain-based, which predispose them to developing problems if exposed to drugs.
There are two groups of substance-related disorders: substance use disorders and substance-induced disorders. Substance use disorders are patterns of symptoms resulting from use of a substance which the individual continues to take, despite experiencing problems as a result. Substance-induced disorders include intoxication, withdrawal, substance induced mental disorders, including substance induced psychosis, substance induced bipolar and related disorders, substance induced depressive disorders, substance induced anxiety disorders, substance induced obsessive-compulsive and related disorders, substance induced sleep disorders, substance induced sexual dysfunctions, substance induced delirium and substance induced neurocognitive disorders.
Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
- Taking the substance in larger amounts or for longer than the you meant to
- Wanting to cut down or stop using the substance but not managing to
- Spending a lot of time getting, using, or recovering from use of the substance
- Cravings and urges to use the substance
- Not managing to do what you should at work, home or school, because of substance use
- Continuing to use, even when it causes problems in relationships
- Giving up important social, occupational or recreational activities because of substance use
- Using substances again and again, even when it puts the you in danger
- Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a mild substance use disorder, four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder. Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled environment.”
From the SciShow here
LEONARD COHEN LYRICS
“Bird On A Wire” sung by Joe Bonamassa
Like a bird on the wire,
like a drunk in a midnight choir
I have tried in my way to be free.
Like a worm on a hook,
like a knight from some old fashioned book
I have saved all my ribbons for thee.
If I, if I have been unkind,
I hope that you can just let it go by.
If I, if I have been untrue
I hope you know it was never to you.
Like a baby, stillborn,
like a beast with his horn
I have torn everyone who reached out for me.
But I swear by this song
and by all that I have done wrong
I will make it all up to thee.
I saw a beggar leaning on his wooden crutch,
he said to me, “You must not ask for so much.”
And a pretty woman leaning in her darkened door,
she cried to me, “Hey, why not ask for more?”
Oh like a bird on the wire,
like a drunk in a midnight choir
I have tried in my way to be free.
DAMIEN RICE LYRICS
Cold, cold water surrounds me now
And all I’ve got is your hand
Lord, can you hear me now?
Lord, can you hear me now?
Lord, can you hear me now?
Or am I lost?
Love one’s daughter
Allow me that
And I can’t let go of your hand
Lord, can you hear me now?
Lord, can you hear me now?
Lord, can you hear me now?
Or am I lost?
[chanting] Cold, cold water surrounds me now
And all I’ve got is your hand
Lord, can you hear me now?
Lord, can you hear me now?
Lord, can you hear me now?
Or am I lost?
Addictive Properties of Popular Drugs
Click chart to enlarge
From DrugWarFacts.org (which cites NIDA and the New York Times) from which I got the following information:
Withdrawal: Presence and severity of characteristic withdrawal symptoms.
Reinforcement: A measure of the substance’s ability, in human and animal tests, to get users to take it again and again, and in preference to other substances.
Tolerance: How much of the substance is needed to satisfy increasing cravings for it, and the level of stable need that is eventually reached.
Dependence: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance and the degree to which the substance will be used in the face of evidence that it causes harm.
Intoxication: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do.
Jack E. Henningfield, PhD for NIDA, Reported by Philip J. Hilts, New York Times, Aug. 2, 1994 “Is Nicotine Addictive? It Depends on Whose Criteria You Use.”
- (Criteria for Defining Substance Dependence) “The 1988 Surgeon General’s report lists the following general ‘criteria for drug dependence,’ including nicotine dependence (USDHHS 1988, p. 7):
• Highly controlled or compulsive use
• Psychoactive effects
• Drug-reinforced behavior
• Addictive behavior, often involves:
– stereotypic patterns of use
– use despite harmful effects
– relapse following abstinence
– recurrent drug cravings
• Dependence-producing drugs often produce:
– physical dependence
– pleasant (euphoriant) effects
“These criteria are consistent with those for a diagnosis of dependence provided in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) (American Psychiatric Association [APA] 2000) and the International Classification of Diseases, Tenth Revision (ICD-10) (Table 4.1) (World Health Organization [WHO] 1992). The diagnosis of dependence using these diagnostic systems depends on the person experiencing a specific number of these symptoms. The relevance of some of these symptoms to nicotine addiction may be questionable because the DSM criteria are used across different drugs of abuse. For example, one symptom of addiction is that a great deal of time is spent in activities necessary to obtain the substance or recover from its effect. This criterion may not be as relevant to the diagnosis of nicotine addiction compared with other abused substances.”
US Department of Health and Human Services. “How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, pp. 105-106.
- (Addictive Potential) “Of the people who sample a particular substance, what portion will become physiologically or psychologically dependent on the drug for some period of time? Heroin and methamphetamine are the most addictive by this measure. Cocaine, pentobarbital (a fast-acting sedative), nicotine and alcohol are next, followed by marijuana and possibly caffeine. Some hallucinogens—notably LSD, mescaline and psilocybin—have little or no potential for creating dependence.”Source:Gable, Robert S., “The Toxicity of Recreational Drugs,” American Scientist (Research Triangle Park, NC: Sigma Xi, The Scientific Research Society, May-June 2006) Vol. 94, No. 3, p. 208.
- (Probability of Transition From First Use to Dependence On a Substance) “In a large, nationally representative sample of US adults, the cumulative probability of transition to dependence was highest for nicotine users, followed by cocaine users, alcohol users and, lastly, cannabis users. The transition to cannabis or cocaine dependence occurred faster than the transition to nicotine or alcohol dependence. Furthermore, there were important variations in the probability of becoming dependent across the different racial-ethnic groups. Most predictors of transition were common across substances.“Consistent with previous estimates from the National Comorbidity Survey (Wagner and Anthony, 2002a), the cumulative probability of transition from use to dependence a decade after use onset was 14.8% among cocaine users, 11.0% among alcohol users, and 5.9% among cannabis users. This probability was 15.6% among nicotine users. Furthermore, lifetime cumulative probability estimates indicated that 67.5% of nicotine users, 22.7% of alcohol users, 20.9% of cocaine users, and 8.9% of cannabis users would become dependent at some time in their life.”Source:Catalina Lopez-Quintero, et al., “Probability and Predictors of Transition From First Use to Dependence on Nicotine, Alcohol, Cannabis, and Cocaione: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC),” Drug and Alcohol Dependence, 2011 May 1; 115(1-2): 120-130. doi:10.1016/j.drugalcdep.2010.11.004
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069146/pdf/nihms-258354.pdf Cycles of Addiction Link
- (Drug Rankings by Harm) “Participants were asked to score each substance for each of these nine parameters, using a four-point scale, with 0 being no risk, 1 some, 2 moderate, and 3 extreme risk. For some analyses, the scores for the three parameters for each category were averaged to give a mean score for that category. For the sake of discussion, an overall harm rating was obtained by taking the mean of all nine scores. The scoring procedure was piloted by members of the panel of the Independent Inquiry into the Misuse of Drugs Act.13
“Once refined through this piloting, an assessment questionnaire based on table 1, with additional guidance notes, was used. Two independent groups of experts were asked to do the ratings. The first was the national group of consultant psychiatrists who were on the Royal College of Psychiatrists’ register as specialists in addiction Replies were received and analysed from 29 of the 77 registered doctors who were asked to assess 14 compounds—heroin, cocaine, alcohol, barbiturates, amphetamine, methadone, benzodiazepines, solvents, buprenorphine, tobacco, ecstasy, cannabis, LSD, and steroids. Tobacco and alcohol were included because their extensive use has provided reliable data on their risks and harms, providing familiar benchmarks against which the absolute harms of other drugs can be judged. However, direct comparison of the scores for tobacco and alcohol with those of the other drugs is not possible since the fact that they are legal could affect their harms in various ways, especially through easier availability.
“Having established that this nine-parameter matrix worked well, we convened a second group of experts with a wider spread of expertise. These experts had experience in one of the many areas of addiction, ranging from chemistry, pharmacology, and forensic science, through psychiatry and other medical specialties, including epidemiology, as well as the legal and police services. The second set of assessments was done in a series of meetings run along delphic principles, a new approach that is being used widely to optimise knowledge in areas where issues and effects are very broad and not amenable to precise measurements or experimental testing,14 and which is becoming the standard method by which to develop consensus in medical matters.”From Business Insider. Cigarettes, which are the most harmful drug, were not considered.
Why All This Focus On Some Drugs And Not Others?
It is clear that some drugs are accepted by the powers that be and that others are not. These attitudes are not based on the harm, or potential harm, these drugs cause society. Rather, they are based on historical and cultural usage patterns of various ethnic groups, the frequently distorted perceptions of society as a whole, and the lobbying and advertising of special interest groups like the alcohol and tobacco industries, among other things. The War on Drugs is actually a war on subgroups, and we would be wise to remember that.
Alcohol Use Around The World
- Click the link below to see alcohol use around the world, courtesy of the World Health Organization: http://apps.who.int/gho/athena/data/GHO/SA_0000001413?x-profile=xtab&x-format=html&x-topaxis=GHO;SEX&x-sideaxis=COUNTRY;YEAR&x-title=table&filter=COUNTRY:*;SEX:*&format=html&profile=embed
Drug and Alcohol Use Worldwide from the Wiley online library – A new report published in Addiction here. From a study conducted by the World Health Organization Global statistics on addictive behaviours: 2014 status report—–A new study suggests alcohol is more harmful than heroin or crack. MOST people would agree that some drugs are worse than others: heroin is probably considered to be more dangerous than marijuana, for instance. Because governments formulate criminal and social policies based upon classifications of harm, a new study published by the Lancet on November 1st makes interesting reading. Researchers led by Professor David Nutt, a former chief drugs adviser to the British government, asked drug-harm experts to rank 20 drugs (legal and illegal) on 16 measures of harm to the user and to wider society, such as damage to health, drug dependency, economic costs and crime. Alcohol is the most harmful drug in Britain, scoring 72 out of a possible 100, far more damaging than heroin (55) or crack cocaine (54).It is the most harmful to others by a wide margin, and is ranked fourth behind heroin, crack, and methamphetamine (crystal meth) for harm to the individual. The authors point out that the model’s weightings, though based on judgment, were analysed and found to be stable as large changes would be needed to change the overall rankings.
“Drug harms in the UK: a multi-criteria decision analysis”, by David Nutt, Leslie King and Lawrence Phillips, on behalf of the Independent Scientific Committee on Drugs. The Lancet.
- (Ranking of Substances by Potential for Harm) “Method: Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.”“Findings: MCDA [multicriteria decision analysis] modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.”Source:Nutt, David J Nutt; King, Leslie A; Phillips, Lawrence D, “Drug harms in the UK: a multicriteria decision analysis,” The Lancet (London, United Kingdom: November 1, 2010) Vol. 376, p. 1558.
(Note: To access this PDF users need to log in and a fee/subscription may be required.)
- (Cannabis and Dependence) “People who develop problems with marijuana may indeed be different from those who do not, but this phenomenon has been observed with other substances of abuse. A comparison with alcohol use and dependence provides a case in point. The great majority of Americans have tried alcohol and continue to drink alcoholic beverages regularly. However, only an estimated 10 to 15 percent of alcohol drinkers develop problems, and only some of these problem drinkers seek treatment. This is also true of those who have tried cocaine or heroin (Anthony, Warner, and Kessler, 1994).
“That said, the experience of dependence on marijuana tends to be less severe than that observed with cocaine, opiates, and alcohol (Budney, 2006; Budney et al., 1998). On average, individuals with marijuana dependence meet fewer DSM dependence criteria; the withdrawal experience is not as dramatic; and the severity of the associated consequences is not as extreme. However, the apparently less severe nature of marijuana dependence does not necessarily mean that marijuana addiction is easier to overcome. Many factors besides a drug’s physiological effects—including availability, frequency and pattern of use, perception of harm, and cost—can contribute to cessation outcomes and the strength of addiction. The low cost of marijuana, the typical pattern of multiple daily use by those addicted, the less dramatic consequences, and ambivalence may increase the difficulty of quitting. Although determining the relative difficulty of quitting various substances of abuse is complex, the treatment literature reviewed here suggests that the experience of marijuana abusers rivals that of those addicted to other substances.”Source:Budney A, Roffman R, Stephens R, Walker D. Marijuana dependence and its treatment. Addiction Science and Clinical Practice. 2007;4(1):4–16.
- (Estimated Prevalence of Cannabis Dependence) “Some 4.3 percent of Americans have been dependent on marijuana, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000), at some time in their lives. Marijuana produces dependence less readily than most other illicit drugs. Some 9 percent of those who try marijuana develop dependence compared to, for example, 15 percent of people who try cocaine and 24 percent of those who try heroin. However, because so many people use marijuana, cannabis dependence is twice as prevalent as dependence on any other illicit psychoactive substance (cocaine, 1.8 percent; heroin, 0.7 percent; Anthony and Helzer, 1991; Anthony, Warner, and Kessler, 1994).”Source:Budney A, Roffman R, Stephens R, Walker D. Marijuana dependence and its treatment. Addiction Science and Clinical Practice. 2007;4(1):4–16.
Facts Specifically About Tobacco
It surprises many people that tobacco is the most dangerous drug which is commonly used, but it is (by far). Tobacco is also one of the most addictive drugs:
From Is Drug Addiction Part of Human Evolution?By: Sasha Wolfe Published: November 7, 2012 Note: Only sections are quoted. For the full article, follow the link above.
Regardless of your attitude to drugs you cannot argue that over thousands of years they have become increasingly diverse and prevalent in our society. Perhaps it is the growth in the variety of drugs and their use that has seen a very modern phenomenon emerge; the moralization and strict legal classification of drugs and their users. This recent trend of ascribing a moral label to drugs has meant that now there are basically two types of drugs that exist in the world. In the black and white world of our politically correct society drugs are classified as either medicinal or recreational in nature. Politicians, religious groups, social welfare groups and lawmakers have drawn a very distinct line in the sand between drugs that are good and drugs that are bad. Drugs that are medicinal in nature (eg: modern pharmaceutical drugs) are generally considered good for us and hence are classified as legal. In general recreational drugs are considered to be bad for us and are hence deemed illegal. The only recreational drugs that are legal are the ones that are so entrenched in our history and culture they are too hard to eliminate from society (eg: alcohol, coffee and tobacco). . . . .
It seems that naive social stigma and uneducated generalizations are now the primary drivers for the criminalization of many recreational drugs. The very concept of a “gateway” drug is as ill-informed a notion as any legal classification of a drug.
Site Administrator’s note on “gateway” anything: Almost all illicit drug consumers have consumed breast milk. Therefore . . . .
In fact the only proven gateway is the stigma associated with the criminalization of a drug itself. Once someone has stepped over the legal line their view on illegal drugs in general has forever changed. Use of an illegal drug that has minimal side-effects such as marijuana can often result in a less than realistic view of the side-effects relating to other more serious drugs such as cocaine, ecstasy and heroine. As with the failed alcohol prohibition of the 1930’s it could be that the criminalization of many drugs is actually making them more popular and widespread. People see that the criminalization of marijuana is hypocritical when compared to alcohol, and consequently many assume that the criminalization of any drug is hypocritical……and they may well be right.
The fact that the two most addictive drugs in use today are both legal is damning evidence against criminalization. Oxycodone is a prescription analgesic opioid that is often combined with paracetamol or aspirin for the relief of both acute and chronic pain. It is important to note that Oxycodone is rarely marketed under its own name but under the name of the other drugs it is combined with. Possessing an incredible 99% likelihood of addiction its widespread use throughout the medical community has spawned a national health epidemic. As with most drugs the more you take the less effective it becomes which in turn increases consumption which has swelled the bank accounts of the big pharmaceutical companies. Big Pharma insiders often call oxycodone the gift that keeps on giving and they spend billions of dollars in subtle marketing against drug free alternative medicines for pain relief. Oxycodone’s side effects include severe mood changes, depression, fainting, seizures, difficulty swallowing, fatigue, nausea, headache, anxiety and constipation. All in all it is a cure that can often be worse than the initial ailment it is designed to relieve. The next most addictive drug is tobacco with very short term “benefits” including a rise in blood pressure and the initial stimulation followed by the slow relaxation of brain activity. However the long term side effects of tobacco are well known and obviously quite devastating. Consequently the legalization of a drug appears to have nothing to do with its perceived benefits and side effects.
From the National Institute on Drug Abuse:
Tobacco use is the (my bold) leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 443,000 premature deaths in the United States each year—about 1 in every 5 U.S. deaths2—and an additional 8.6 million people suffer with a serious illness caused by smoking.3 Thus, for every one person who dies from smoking, 20 more suffer from at least one serious tobacco-related illness.3
The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death. Each year, an estimated 126 million Americans are regularly exposed to secondhand smoke and almost 50 thousand nonsmokers die from diseases caused by secondhand smoke exposure.4
“Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined, with thousands more dying from spit tobacco use. Of the roughly 400,000 kids who become new regular, daily smokers each year, almost a third will ultimately die from it. In addition, smokers lose an average of 13 to 14 years of life because of their smoking.”
From the Surgeon General’s report on the Health Consequences of Smoking
Premature deaths caused by smoking and
exposure to secondhand smoke, 1965–2014
Cause of death Total
Smoking-related cancers 6,587,000
Cardiovascular and metabolic diseases 7,787,000
Pulmonary diseases 3,804,000
Conditions related to pregnancy and birth 108,000
Residential fires 86,000
Lung cancers caused by exposure to secondhand smoke 263,000
Coronary heart disease from secondhand smoke 2,194,000
Source: Centers for Disease Control and Prevention, National
Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health, unpublished data.
For a free online “Quit Smoking” guide go to BecomeAnEx.org
The good news is: People in the tobacco industry make lots of money off of all this, but hey, War on Drugs and you can mess with my unfettered market when you pry it from my cold dead hands!!
I don’t agree with all of the conclusions from the Florida Institute of Technology (nor do I necessarily agree with everything that is presented from other organizations and groups which are reproduced on this site), but I include their information here because it represents a widely accepted viewpoint in the recovery community and much of the information is good. At the very least it gives us something to think about.
Click image to enlarge
Facts about Alcohol and Drug Abuse
From the Florida Institute of Technology
Some in the scientific community think of addiction as a disease. Others think of it as out of control behavior. What SMART’s position?
SMART Recovery’s Position on Addiction as a Disease
SMART Recovery tools can help you regardless of whether or not you believe addiction is a disease. We don’t care whether you think of it as a disease or as out of control behavior. What’s important is that you recognize addictions always become more important to people than anything else and if our lives are to have value we must gain control over them.
Alcohol is such a big part of American life today that we rarely stop to consider our pattern of drinking. We drink wine with dinner, or have a few drinks after work, or even a few beers while watching a ball game, but when a pattern of drinking begins to emerge, it can become a problem.
Drug use in America is also more commonplace than it once was. In today’s teenage population over 90 percent have used alcohol. Over 50 percent have used marijuana, 17 percent admit to trying cocaine and 12.5 percent have used some form of hallucinogen.
Why Do We Drink or Use Drugs?
- Many people feel that it is necessary to drink or experiment with drugs when at parties and social gatherings.
- Some people drink or abuse drugs as a way to cope with the daily stress and tension from school or work, or to cope with other problems such as marital distress or even physical illness.
- Alcohol and drugs may become a substitute for satisfying personal relationships, challenging work or self-fulfillment.
- Some may use alcohol and drugs as a way to compensate for feelings of guilt, shyness or low self-esteem.
Site Administrator says “They’ve left out the most important reason, which is that all potentially addictive drugs provide a dopamine release which engages the brain’s pleasure and reward centers. That is to say, they feel good. That is the reason the vast majority of all societies past and present engage in occasional drug use. This is frequently left out of people’s thinking because they try to understand the phenomenon from a puritanical point of view.
When drinking or drug use becomes a means for coping with life’s problems it can turn into addiction. Unfortunately alcohol and some drugs have become more socially acceptable, and this makes it even easier for people to experiment at younger ages. In addition, alcohol and drugs are readily accessible to many of today’s youth, which further increases the likelihood that they will use substances at some time.
Did You Know?
- The average age of first experimentation with drugs is 13, and for alcohol it is even younger. Drug use has been classified as a major problem for kids as early as fourth grade by the students themselves.
- Alcohol is the most widely used drug in America. It is the third largest cause of death in the United States, second only to heart disease and cancer. Alcohol and tobacco use are a significant “risk factor” in heart disease and cancer. It accounts for over 100,000 deaths per year in this country alone. It is also the leading cause of death for people between the ages of 15 and 24.
- Alcohol and other drugs contribute to over 50 percent of all suicides and over 50 percent of all violent crimes.
- Over 60 percent of admissions to emergency rooms are either directly or indirectly due to drug or alcohol usage.
- Over 50 percent of all traffic accidents involve the use of drugs or alcohol, with many of these being fatal.
- It is estimated that drugs and alcohol are a factor in at least 80 percent of domestic violence incidents.
- Alcohol and drug use contributes to 60 percent of all sub-standard job performance and at least 40 percent of all industrial accidents.
- Alcohol and drug addiction are treatable. However, it is our most untreated disease in the United States. It is estimated that 35 out of 36 alcoholics never receive treatment of any kind. This number is increased significantly when drug addiction of all kinds is included.
- More than 60 percent of college women who have contracted sexually transmitted diseases, herpes or AIDS were intoxicated at the time of infection.
- 28 percent of all college dropouts are alcohol users.
- Between 1986 and 1996, Driving While Intoxicated (DWI) arrests were highest for 21-year-olds.
- Individuals between the ages of 16 and 24 are involved in more than one-third of all alcohol related traffic accidents.
- 95 percent of all college campus violence is alcohol related.
- More than 40 percent of all college students with academic problems are alcohol users.
Acute Physical Effects
- Increased heart rate and skin temperature;
- Impaired muscle control causing poor coordination, slurred speech, impaired motor skills;
- Dizziness, vomiting, vision problems; and
- Loss of consciousness, respiratory arrest and death.
Acute Effects on Mental Abilities
- Judgment is frequently the first mental capacity affected by alcohol. Poor decision making, rapid decision making, not being realistic in decisions is common;
- Poor attention and concentration;
- Loss of inhibitions-we say things or do things that we normally would not;
- Exaggerated emotion (anger, fear, anxiety, sadness); and/or
- Blackouts with loss of memory for events.
Long Terms Effects of Alcohol Use
- Nutritional deficiencies effecting mental abilities;
- Damage to physical organs including the brain, liver, heart, stomach;
- Breakdown of bone and muscle tissue;
- Memory loss or impairment;
- Impaired attention and concentration;
- Inability to get along with others;
- Difficulty coping with school or employment demands; and/or
- Alcohol withdrawal effects-tremors, excessive perspiration, hallucinations.
Do You Have a Drug or Alcohol Problem?
Denial is the main symptom of drug users and alcoholics. They deny that they really have a problem. This makes it more difficult for them to be realistic about the extent of their substance use, and to recognize that it may be a problem.
- Have you ever felt like you should cut down on your drinking or drug use? Yes No
- Have you ever felt irritated by criticism of your drinking and drug use? Yes No
- Have you ever felt guilty about your drinking, drug use or your behavior during its use? Yes No
- Do you ever take a drink or use drugs in the morning? Yes No
If you answered yes to one of these questions, the possibility that you are alcohol or drug dependent is significantly increased. This may also mean that although you are not dependent on drugs or alcohol at this time, you could become dependent if your pattern of abuse continues.
If you answered yes to two of the these questions, it is very likely that you are dependent on drugs or alcohol.
If you answered yes to three or four of these questions, there is a greater than 95 percent chance that you are dependent on drugs or alcohol. Please seek assistance for your drug or alcohol problem immediately.
ALABAMA SHAKES LYRICS
Writer(s): Heath Allen Fogg, Zachary Riley Cockrell, Steven William Johnson, Brittany Amber Howard
Copyright: Alabama Shakes Publishing
“Hold On”Bless my heart, bless my soul.
Didn’t think I’d make it to 22 years old.
There must be someone up above sayin’,
“Come on, Brittany, you got to come on up.
You got to hold on…
Hey, you got to hold on…”
So, bless my heart and bless yours too.
I don’t know where I’m gonna go
Don’t know what I’m gonna do.
There must be somebody up above sayin’,
“Come on, Brittany, you got to come on now!
You got to hold on…
Hey, you got to hold on…”
“Yeah! You got to wait!
Yeah! You got to wait!”
But I don’t wanna wait!
No, I don’t wanna wait…
So, bless my heart and bless my mind.
I got so much to do, I ain’t got much time
So, must be someone up above saying,
“Come on, girl! Yeah, you got to get back up!
You got to hold on…
Yeah, you got to hold on…”
“Yeah! You got to wait!”
I don’t wanna wait!
But I don’t wanna wait!
No, I don’t wanna wait!
You got to hold on…
You got to hold on…
You got to hold on…
You got to hold on…
Have You Been Away Too Long Alice?
There is light on the other side of that dark looking glass
We banish darkness not by going away from it but by shining light upon it. When we shine light upon it we demystify it, for darkness is nothing but the absence of light. We see what is there. When we see what is there, we can live our lives without fear and can see where we want to go. We can live our lives with intention, rather than stumbling around in the dark. The understanding and comprehension of our higher selves is all we really need to live in contentment.
There is one terrible fact about addictions which should convince those who suffer from them to seek freedom from their slavery, because upon seeking that freedom they will find there is life on the other side. There are people waiting for them; waiting to join them and to share and participate in their lives, to commune with them and live in relationship to them. To fully understand this fact, we must first understand and appreciate what life can be like without addiction, for it is to life that we will return.
For no particular reason that anybody understands, the universe came into existence billions of years ago. No one knows whether this was a one-time occurrence or a cyclic event. In the beginning was a singularity containing all matter and energy which would be present in the early universe and was contained in a volume “one trillionth the size of the period which ends this sentence.” according to Neil deGrasse Tyson in “Astrophysics for People in a Hurry”. It sat there for who knows how long (it doesn’t really matter, since there was no such thing as time back then) and, suddenly, 13.7 billion years ago, the Big Bang occurred and everything that is winked into existence, along with unlimited potential. When this matter was created, almost equal parts of antimatter were created along with it, and in the early universe these particles interacted with one another and destroyed one another, releasing energy. If there were exactly the same number of matter/antimatter particles, there would be no universe. I would not be sitting here writing this and you would not be sitting there reading it. But fortuitously, for every billion particles of matter and antimatter, there was one particle of matter left over so each particle we are made of had a one in a billion chance of surviving, along with its unlimited potential, and out of this infinite potential arose life, and out of life arose mankind, and out of womankind arose you and I. A woman usually releases one egg per cycle, and on the month you were conceived your father shared with her, at least once, somewhere between 40 million and 1.2 billion sperm cells (of the roughly 525 billion sperm cells he would spew out into the universe over his lifetime) and oneof those sperm cells managed to find, and then enter and co-mingle with, that egg. If you had been conceived in a different month or if a different sperm cell had been the “lucky one”, then you would not be who you are, for your genes would be markedly different. “You” would not exist. You are astronomically improbable. Your highly unlikely life has evolved over a period of years, bumping from one event to another through the seeming randomness of its existence, and been shaped by all you have experienced. Your brain contains around 86 billion neurons, roughly the same number of stars in our galaxy, the Milky Way, which has somewhere between 100 billion and 300 billion stars. These neurons have 100 trillion synaptic connections, or about the same number of connections as there are stars in 1000 galaxies the size of the Milky Way. You have arrived in the now and you carry with you the gift of life and everything it has taught you, encoded in your wonderfully complicated neural connections. The truth is that this life, your life, is an astounding present and a wise person will not let it go to waste.
You have learned by now that life is not always fun and it is not always easy, but given its vagaries and uncertainties, you must, by now, understand that the chances of your sitting there behind your eyes and reading this, understanding this, are next to nothing. The problem with addiction is that, as time has gone by, the substance or activity you are addicted to has narrowed your attention and your focus more and more until that substance or activity has become, almost, your everything. It is an attachment which is or will be more important to you than your relationships, your work, your health, your children, your integrity and your values, for you are willing or will be willing to give up each and every one of them in order to continue with your addiction. You may not believe this, but as you travel down the addiction highway each of those gifts will be threatened and you will choose your addiction over every one of them until, finally, their threatened loss will be so alarming (or their actual loss is so painful) that you choose to give up your addiction. While it rules, addiction is the absolute dictator, and, while we are addicted, we are its absolute slaves. As Aristotle said, we are what we repeatedly do. Those who are addicted have become gerbils, running on a wheel in a cage, sprinting as fast as they can, but staying in the same place and seeing the same view day after day, doing the same thing day after day, endlessly. Their lives have become a living death, changeless and without meaning. Their “highly improbable” lives are being wasted and it has become difficult for them to learn, to grow, to taste the sweetness of love, the randomness of it all, the lessons to be learned, the truths to be gleaned.
Life is a garden filled with countless flowers and their sweet perfume smells. It is filled with companionship and adventure. There is no need for us to live today as we lived yesterday, no need to cling so tightly to our rituals and dependencies. We can calm our fears, let go of the past and embrace what lay before us, because the only real sin is to waste the wonderful opportunity of our being.
If you suffer from an addiction, then I hope with all my heart that you join us in a communion, a coming together of the miracle of consciousness. Walk through the looking glass, be brave Alice, let your addiction go and join us in life. You will not regret your decision.
If you would like to reprint or reproduce “Have You Been Away Too Long Alice?” please feel free to do so, but please credit me, Jim Dickey, and this website.
To see how unexpected life is, visit this site.
Hero stories shared here
ONE THOUGHT ON “ARE YOU ADDICTED?”
- babajimbobreptileJULY 3, 2013 AT 4:45 PM“Mothers, wives, sisters and daughters are dying at rates that we have never seen before,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, which compiled the data.The problem is one of the few health issues the CDC is working on that are clearly getting worse, he added.For many decades, the overwhelming majority of U.S. overdose deaths were men killed by heroin or cocaine. But by 2010, 40 percent were women – most of them middle-aged women who took prescription painkillers.Skyrocketing female overdose death rates are closely tied to a boom in the overall use of prescribed painkillers. The new report is the CDC’s first to spotlight how dramatic the death trend has been among women.The CDC found that the number and rate of prescription painkiller overdose deaths among females increased about fivefold 1999 to 2010. Among men, such deaths rose about 3 1/2 times.Overall, more men still die from overdoses of painkillers and other drugs; there were about 23,000 such deaths in 2010, compared with about 15,300 for women.http://www.sfchronicle.com/health/article/Prescription-drug-overdoses-killing-middle-aged-4644242.php
Addiction Select Category Reptile Dysfunction Proudly powered by WordPress