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The following letters are reprinted with the permission of the Salem Evening News

My adult son recently admitted to me that he is an alcoholic. He has stopped drinking and seems to be doing ok, but I am wondering if he should attend AA meetings. I haven’t mentioned this to him, but was wondering if I should. Any advice would be appreciated. Thank you.

I think that AA can be an enormous resource for people who struggle with alcohol and other drug addictions. The support and practical strategies that AA offers can be extremely helpful and for many people, AA has been a life saver. I see no harm in asking your son if he has considered checking out AA meetings in his community. Let him know that it could be a great resource for him. If he isn’t sure whether he wants to, you can suggest that he simply check out some as he has nothing to lose and everything to gain. Rather than making the commitment to attend forever, suggest that he attends a meeting or two each week for a month, which will give him some time to see if it helps him. If he absolutely doesn’t want to attend, I would accept that, but let him know that at any time, he can change his mind, but that you simply wanted to suggest it. You can also ask him if he has considered seeing a therapist who may be able to support his life style change. As with AA, he can make an appointment to evaluate whether therapy is helpful, and if it isn’t, he can always stop. And if he absolutely refuses, it is his decision, and he can always decide to make an appointment if and when he is ready.

I would also say that given he has told you about his drinking problem, it may be useful down the road to ask him how things are going. Without being intrusive, this lets him know that you care. If things continue to go well for him, let him know that you think that is great. On the other hand, if things aren’t going well, it could be another opportunity to suggest some kind of treatment, if he initially declined. I hope that helps, and if you have any other questions, please feel free to let me know.

Someone was telling me that there is a new drug to treat alcoholism called Balcofen. Have you heard of this and do you recommend this? Thanks.

I believe what you are referring to is a medication called Baclofen. Baclofen is a muscle relaxer and antispastic drug. Baclofen is useful to treat the signs and symptoms of spasticity that result from multiple sclerosis, as well as possibly having value for patients who have suffered from spinal cord injuries and other spinal cord diseases.

There has been a report from a physician in France that has used this drug to treat his own alcoholism, and he reported that it helped him tremendously. Other doctors in Europe have also used this drug to treat addiction and some have reported very positive results. There has also been one randomized controlled study that showed positive benefits using Baclofen for the treatment of alcohol dependence. Some are suggesting that more research be conducted to see whether Baclofen can help others who suffer from alcohol and cocaine dependence, and the National Institute on Alcohol Abuse and Alcoholism stated that further research is warranted.

At this time, however, this drug is not approved for the treatment of alcohol or other addictions. Until more research is conducted, I cannot recommend this agent.

I want to take a vacation with my family and my mother told me that my father could not leave and I eventually pried it out of her that he's on methadone, goes to a clinic every morning and can't go on trips longer than a day because he has to be back there each morning. I didn't know any of this, ostensibly because she didn't want to stress me out about it but more likely because she thought she could deal with it and get past this without anyone knowing. So I have a few questions:

I don't know if he even asked if he could have a five-day supply of pills or whatever he's taking so that he could go on this trip, but if he did, is that possible or even advisable? I just learned about this whole situation, so I don't know the severity of his problem. But I'm presuming that if he's only being given a daily dose of methadone, then he might be in bad enough shape that a long trip might be a poor idea. On the other hand, maybe it would do him well to get far away from his current environment for a few days. I don't know. Any thoughts would be appreciated. Thanks.

I cannot give you any specifics about your father as I don’t know his particular situation, but let me offer the following as general practices:

Individuals who have been on methadone for an extended period of time and who have been doing well generally can earn take home privileges, so they do not have to go their program every day. Initially, one take home dose may be given each week, but as individuals continue to do well, this will be increased gradually over time. Regulations allow programs to give a maximum of a one month supply of take home methadone to clients who have demonstrated stability and abstinence from all illicit drug use, although programs can choose to give smaller amounts. This allows people to take trips, to go on vacations, and simply to have a more normalized life even when at home because they don't have to go the clinic daily to receive their dose of methadone.

When people wish to go away who do not have take home privileges, their own clinic can work out courtesy dosing at other methadone programs. If a person knows where they will be, the clinic can usually set up this kind of dosing at a clinic near will they will be for the period of time when they will be away.

I don't know the specific situation of your father, but it is perfectly fine for such a person to get away from the home environment. In general there are no contraindications to this. For a person who has been recently admitted to the program and is still getting their dose adjusted, this might not make sense.

I know some 15 and 16 year old kids who drink and often get drunk. My question is whether this will lead to alcohol problems when they older? Thanks.

It is very clear that the early use of alcohol, including getting drunk as a teenager, does increases the chances of developing an alcohol problem as an adult. In a large well designed study, it was found that almost half of people who began drinking before age 14 were dependent upon alcohol at some point in their lives compared to only 9% of those who began drinking after age 20. Past year alcohol dependence among those who started drinking before age 14 was 13%, compared to 2% for those who started drinking after age 20. I should also mention that these findings controlled for a family history of alcohol problems and other risk factors, which suggests that early drinking is a separate risk factor for the development of future alcohol problems.

Some very recent research using male rats showed some very interesting findings that relates to this issue. In this study, young male rats were given doses of alcohol to simulate binge drinking. Years later, after years of abstinence from drinking, the rats that were exposed to alcohol demonstrated higher tolerance for alcohol than did rats that were not exposed to alcohol. This suggests that early exposure to alcohol may affect brain and liver function, which may play a role in later tolerance for alcohol, and in turn, the possible development of alcohol problems.

So without a doubt, teenagers who drink and get drunk do have a greater chance of developing an alcohol problem as an adult than do teenagers who do not engage in drinking.

I have heard of something called “cheese heroin”. Have you heard of this and do you know what it is? Thanks.

Cheese heroin is a term that describes black tar heroin mixed with Xanax, an antianxiety drug, or Tylenol PM. Cheese heroin first hit the scene in northwest Dallas in the fall of 2005 and has rapidly spread around that area. It is inexpensive and is generally snorted. A number of overdoses and deaths have been attributed to the use of this, typically due to respiratory failure. Others have died from multiple organ failure after their blood became toxic. Just like heroin, it causes addiction and after prolonged use, a person will experience a withdrawal syndrome. Obviously, this is a dangerous compound and should be avoided.

Thanks for your comments on the family member's best approach to an addicted son. I found it ironic that your column's name refers to taking the first step, but you fail to mention the value of any 12-step programs. I know Narcotics Anonymous is helping thousands of people stay clean around the globe, but you failed to even mention its existence in your response. Do you not believe in the value of 12-step programs? From what I've heard, the first stop for someone getting out of detox should be a meeting. What's your opinion?

I absolutely believe in the value of 12-step programs such as Narcotics Anonymous. Very simply, I did not mention that as the focus of the question and my response was on how a person accesses a longer term residential program such as a halfway house after detoxification rather than on what other outpatient options exist. In looking over my response, I certainly could have mentioned attendance at 12-step meetings while he waited to get into a more structured program, and I also could have mentioned other options such as outpatient and intensive outpatient treatment programs, or even other self-help options. Thank you for writing it as it gave me a chance to mention the value of 12-step meetings. While not everyone will connect to such programs, they are an extremely valuable resource for many people.

I have heard that stopping drinking cold turkey can be dangerous. If a person just stops, what can happen? Thanks.

You are correct that abruptly stopping alcohol can be very dangerous for people who have been heavily drinking. Often, when people have been drinking heavily and consistently for a long time, their bodies can get used to having alcohol and when drinking is stopped, their bodies can go into a state of emergency. While not everyone will experience a withdrawal syndrome, many will. During this state, individuals can experience some or all of the following symptoms: high blood pressure; anxiety and tremors; seizures; rapid heartbeat; increased sweating; auditory, visual, and tactile hallucinations; delirium; mental confusion and agitation; nausea and vomiting; headache; and an inability to sleep. Not only can this state be very uncomfortable, but it can potentially be life threatening. As a result, if people experience any of these symptoms when they stop drinking, medical treatment is essential as they probably need to be medically detoxified to safely free their bodies from alcohol. During detoxification, a medication is given that replaces the alcohol. Initially, larger doses are given and over the course of about 4 days, the medication is slowly tapered and decreased to allow people to get used to no longer having alcohol in their body in gradual way, which will alleviate the symptoms of a severe withdrawal syndrome. So in answer to your question, it can be very dangerous for a person who has been heavily drinking to stop “cold turkey”.

Can you tell me what the definition is of alcoholism? Without revealing too much information, I have been accused of being an alcoholic and I don’t think I am. Thank you.

While the term alcoholism is commonly used to describe a disorder characterized by uncontrolled drinking, professionals talk about alcohol abuse and alcohol dependence. Let me give you a brief overview.

Alcohol abuse involves a pattern of drinking that is affecting the person in negative ways. Here, people cannot consistently predict how much they are going to drink or what is going to happen once drinking begins. The key feature of an alcohol abuse problem is that drinking is causing problems for the person and others he or she knows, yet drinking, and the problems caused by drinking, continue. People can be diagnosed with alcohol abuse is they experience one or more of the following four symptoms: continued use despite social or interpersonal problems caused by drinking; recurrent hazardous use, such as drinking and driving; recurrent alcohol-related legal problems; or an inability to fulfill major role obligations due to drinking.

Alcohol dependence, as compared to alcohol abuse, is a more severe form of the disorder. For people who are dependent upon alcohol, the use of alcohol has a central preoccupation in their lives, and more and more time and energy is spent drinking or recovering from too much drinking. Their lives begin to revolve around the use of alcohol, daily drinking is common, and despite experiencing many problems related to alcohol consumption, drinking continues. In addition, their bodies can get so used to having alcohol that they need more and more alcohol to feel its effects, called tolerance, and if alcohol is not available, their bodies can go into a state of emergency, which is called an alcohol withdrawal syndrome.

A person can be diagnosed with alcohol dependence if they experience three or more of the following symptoms: tolerance; withdrawal; a persistent desire or unsuccessful attempts to reduce or stop drinking; much time placed on drinking or recovering from drinking; drinking more and for longer periods of time than intended; reducing or stopping other important activities in favor of drinking; and continued drinking despite physical or psychological problems caused by drinking.

For me, if a person’s drinking is causing problems in the social, financial, work, physical, or legal realms and drinking continues, the person has a problem with alcohol. And often, when a person expresses concern about another person’s drinking, it may be a good time for that person to take a non-defensive, good look at his or her drinking. If a person is truly honest with him or herself, it really isn’t that hard to know whether a drinking problem exists.

Regarding the label “alcoholic”, I wouldn’t be too concerned with this term as some people who acknowledge their alcohol problem may still not want to view themselves as alcoholic. More important than what a person calls the problem is what a person is doing about it. So for you, without knowing any details about your drinking, I would suggest that you take an honest look at your drinking and decide whether drinking is causing you some problems. Again, I wouldn’t worry now about whether or not you view yourself as alcoholic; rather, I would simply decide whether drinking is causing you or others you know problems. And if it is, it may be time to address it. If I can be of further help, please contact me.

This letter is about my son, who is 24 years old. I just found out that he is addicted to heroin. He confessed to me and told me he had hit bottom and needed help. I had no idea and neither did the friends he was living with. He was able to get into a detox, but he’ll only be there for 5-7 days. Then what? From what I have heard, heroin is the toughest drug to get off of. I am sure he won't be fine in a week. I'm scared to death. I will never make him live on street as long as he is trying to help himself, but I don't want to enable him either. I'm not sure moving in with me is good. I'm at work all day, and he would be alone here for at least 9-10 hrs/day. Someone mentioned to me that he should go to a halfway house. Do you know how long it takes to arrange something like this? He thinks he will be living with me when he gets out. I'm so afraid if I say something that he might just give up and think that nobody cares. He's really at his bottom. I just don't know where to turn and I'm hoping you can guide me in the right direction. Any advice or leads you can give me would be greatly appreciated.

I hear loud and clear your fear and concern, and let me offer the following. After detoxification from opiates, which is generally 6 days, your son should get involved in some other aftercare services, whether these are outpatient services or further residential treatment. While in the detoxification program, he should talk with his case manager about what he wants to do after discharge, and the staff there can arrange this. You are right that he will not be fine after detoxification, and that he will need ongoing support. A detoxification program can only get a person drug-free; in order to maintain that, individuals must continue to work on staying abstinent and further treatment is essential.

If your son wants further residential treatment, a typical route is for a person to first get involved in a short-term residential treatment program, where he can begin to build a foundation to remain abstinent, and then to go on to longer term care, such as a halfway house. Short-term residential programs will help the person to secure a bed in a halfway house program, as those programs often have waiting lists. In general, the person will be able to stay at the short-term residential program until a bed opens at the halfway house.

In the event that there was not a bed available even at a short-term residential program, people can get placed on a waiting list and they can call everyday to see when a bed opens. During this time, they obviously need a safe place to stay and during this time, they can stay at a sober shelter or if a family member, like you, was available, they could stay with that person until a bed opens. And when the bed opens, they must demonstrate that they have not been using drugs by taking a drug screen test. Certainly, in the event your son was going to live with you, I would set clear guidelines and expectations, and let him know that this is only temporary. I do not think that allowing him to stay with you on a short term basis is necessarily enabling; rather, you are supporting him in his efforts to resolve his problems. I hope that helps and if I can be of further help, please feel free to contact me.

Is there a gene that is responsible for drug addiction? I have heard that researchers have found this, but I am not sure if this is true. Thanks.

Researchers have not yet identified a specific gene that is responsible for drug addiction, or even a gene that is responsible for an addiction to alcoholism. This does not mean that genes aren’t relevant and important, but with many complex disorders such as drug addiction, many different genes need to act together with factors in the environment for the disorder to come into existence. Recent research conducted at the National Institute on Drug Abuse has identified 89 genes of our 30,000 or so genes that seem linked to drug abuse and dependence. There may even be others, but at least 89 have been identified. These researchers also found that many of these genes were associated with addiction to several different drugs, which suggests that genes that predispose someone to addiction do this because they affect basic brain processes that include nerve connections and how the brain handles information.

So in answer to your question, there does not appear to be any one gene responsible for drug addiction, but rather numerous genes that increase one’s vulnerability to become addicted to drugs. And again, these genes need to encounter certain environmental factors for this vulnerability to come into existence. I must also say that genetic research is a blossoming field and over time, I am sure that there will be more information we learn about the genetic roots of addiction.

My daughter-in-law is pregnant and continues to smoke cigarettes. My question is whether she should try the nicotine patch or nicotine gum. Wouldn’t this be better than smoking? Thanks.

You ask a great question and the first thing I must say is that she should speak with her physician who is following her for her pregnancy and take the advice of this person. That being said, a recent study in Denmark suggested that women who use the patch or gum during pregnancy do not increase the risk of having a stillbirth and that nicotine replacement could be considered for such people.

In this study, researchers collected data on nicotine replacement therapy and smoking on about 87,000 pregnant women. Among the women who reported using nicotine replacement, 14% had not smoked during their pregnancy, 30% quit completely, and 56% continued to smoke. The researchers found that smokers who did not use nicotine replacement therapy, whether gum or the patch, during pregnancy had a 46% higher risk of having a stillbirth. While these findings are encouraging, each woman who is pregnant should discuss the pros and cons of using nicotine replacement therapy with their own physician before beginning this.

I have two adult sons, one of whom has struggled with drug addiction his whole adult life, and the other has never had this problem and is doing very well for himself. My wife and I raised them both the same and both had good childhoods. I just can’t understand why my one son has struggled with drug addiction and my other one never has. Any insight you can provide would be appreciated. Thank you.

Let me first say that I can only imagine the pain that your son’s addiction has caused you and your wife. One of the biggest struggles for any parent is to see his or her child struggle, and yet, there is nothing that the parent can do to fix the problem. And with drug addiction, ultimately, parents have no power to get their child to stop using. The question you ask is one I have had other parents ask as this issue can often plague parents and they wonder how this is possible when their parenting was the same for both children. Let me share some of my thoughts about this issue.

The etiology of drug addiction and why someone develops this problem, whereas others do not, is very complicated and complex, and depends on a multitude of reasons. Certainly, genetic vulnerabilities play an important role. I would say that on average, about 30-40% of the reason a person develops drug addiction is genetic. That, though, still leaves a large amount governed by other factors. In addition to heredity, a person’s psychological make-up is also important. For example, it is clear that individuals who struggle with other psychiatric disorders have greater rates of addiction than those that do not have a psychiatric disorder. And apart from psychiatric illness, a person’s values may also play a role. For one person, the idea of heavy drug use may not fit with his or her value system, whereas for another, this may not be a deterrent. The environment people encounter is also very important. For example, if people have a genetic vulnerability to develop an addiction, but they don’t grow up where drugs are too available, the likelihood of developing an addiction will be less. On the other hand, if the have the vulnerability and they grow up where drugs are available and their peers are using, the chance of developing an addiction will be increased. So the development of an addiction is due to a combination of variables, which include genetic, psychological, and environmental, to name three big reasons. Actually, researchers believe that many illnesses work this way: a genetic vulnerability to develop an illness will sometimes only arise if the person with the vulnerability encounters a certain environment. And certainly, parenting is important. However, even with solid parenting, for many other reasons, a person may develop an addiction to drugs.

So in regards to why one son has developed an addiction while your other son has not, the reason for this is multi-faceted. While they may have different genetic loadings to develop an addictive disorder, even if their genetic loading was similar, based upon other influences, with one son, this vulnerability may have come out, whereas with the other, this vulnerability may remain hidden. I hope that gives you some sense of how this could have happened, and how complicated this is.