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

Dear Dr. Levy

I read your response to the reader who asked if the recent rise in methadone deaths was due to take home doses from clinics. I want to thank you profusely for telling the truth - that it is primarily due to the increase in it being prescribed for chronic pain. There are several groups who are doing their best to point the finger of blame at the clinics and to rescind all take home privileges from all clinic patients forever, because it is so much easier to blame and stigmatize a population that is already downtrodden, stigmatized and struggling to recover, as opposed to pain patients (and those who steal from them). Methadone has gotten an incredible amount of bad press in the past several years, much of it undeserved, and I always try to take time to write and thank anyone who speaks out with the truth about Methadone Maintenance Treatment. Thanks again.

Thank you for writing your letter. You are correct in that often, due to the stigma in our society of drug addiction, many look at methadone treatment programs in disparaging ways and quickly target such programs when problems with methadone are seen. As you may not know, the Drug Enforcement Agency (DEA) recently announced that pharmaceutical companies have agreed to restrict access to larger 40 mg. doses of methadone beginning next year. Going forward, 40 mg. tablets of methadone will only be distributed to hospitals and methadone treatment programs and will be used primarily for the treatment of opiate addiction and not for chronic pain. In fact, the 40 mg. tablet of methadone is not approved for the treatment of chronic pain. This announcement demonstrates that authorities have realized that methadone treatment programs are not responsible for the increase in overdoses from methadone, but rather, that methadone overdoses are due to the proliferation of larger tablets of methadone from other sources. Thanks again for writing in.

Dear Dr. Levy:

I have been hearing about something called Salvia. Do you know what this is?

You are referring to Salvia divinorum, a powerful hallucinogenic plant related to sage. There are reports of youth using this to get ‘high”. This drug has been used for thousands of years by Mexican shamans, and it is starting to be distributed in the United States. It is illegal in Australia, some European countries, as well as some states in the United States. Many are calling for it to be illegal everywhere.

Regardless of its legality, many believe that this is a dangerous drug and when taken, it can cause a temporary inability to speak, visual and auditory hallucinations, uncoordinated movement, and unsettling feelings. There is also concern that this drug interacts with receptors in the brain that may be linked to schizophrenia, a severe and serious.

Obviously, it is a drug to stay away from using.

Dear Dr. Levy:

I know that drinking is terrible to do during pregnancy as it can harm a fetus. I am wondering, though, if you know whether drinking during pregnancy can cause the baby to develop an alcohol problem when the baby grows up. Thank you.

You ask a very interesting and complicated question. I say it is complicated because it is difficult to separate genetic factors associated with developing an alcohol problem from in utero alcohol exposure. That is, if a mother drinks during pregnancy and then has a child who develops an alcohol problem, the reason the baby eventually develops an alcohol problem may be the alcohol the baby was exposed when it was developing.

However, it is also possible that the baby developed an alcohol problem due to the genes that the mother passed along as an alcohol problem also has genetic roots. And one can argue that a mother who drinks during pregnancy may have an alcohol problem and a genetic vulnerability to have such a problem.

With that being said, I did see a study that did investigate this question. Despite all of these complicated issues, in this study, it was found that fetuses exposed in utero to alcohol had an increased chance of developing an alcohol problem by the time they reached 21 years old. In particular, the children of mothers who drank 3 or more drinks per occasion at least a few times per month during pregnancy had an increased chance of developing an alcohol problem in early adulthood. The researchers believe that alcohol can affect the central nervous system and the development of the brain in such a way that can increase the probability of developing an alcohol problem. So, in summary, while environmental and genetic factors are still very important in the development of an alcohol problem, in utero exposure to alcohol also seems to play a role.

Dear Dr. Levy:

I know that many kids now mix alcohol with energy drinks. My question is whether this is dangerous? Thank you.

Researchers have begun to look at this issue and it appears that college students who mixed alcohol with energy drinks double their risk of being injured or hurt that requires medical attention. In addition, mixing alcohol and energy drinks together increases the chances of driving with someone who is intoxicated, as well as being taken advantage of sexually, or taking advantage of another sexually. The researchers believe that this occurs because due to feeling alert due to the energy drink, students may not think that their motor skills, reaction times, and judgment are particularly impaired. In truth they are, but due to the stimulant effect of the energy drink, they do not perceive themselves as being impaired.

Dear Dr. Levy:

My son who is 17 years old has developed an addiction to Oxycontin. He has tried to stop numerous times without success and is involved in counseling. He has even gone into residential treatment, but relapsed shortly after getting out. I am wondering if you would recommend Suboxone for him. Some people think he is too young for that medication, but nothing else has worked. I would greatly appreciate your advice. Thank you.

First, I am sorry to hear the situation with your son. I can only imagine how painful his addiction for you and him. Without knowing too many specifics about your son’s situation, in general, I do not think that your son is too young for Suboxone treatment. Suboxone has been studied among adolescents and very young adults and the results are similar to when adults are treated. Suboxone can help individuals achieve abstinence from opiate-type drugs and younger people tolerated this drug as well as adults.

If your son has been unable to achieve abstinence from Oxycontin and wants to try Suboxone, I believe that Suboxone should be tried.

Dear Dr. Levy:

I know that second hand smoke is bad for you physically. But I am wondering if being around second hand smoke can affect your mind and thinking. Thanks.

There is research that supports the idea that second hand smoke can affect performance on standardized school tests. In a study that looked at thousands of 16-18 year olds in the United States, youth that were exposed to second hand smoke at home performed 30% worse than did youth that were not exposed to in-home second hand smoke. The researchers also took into account socioeconomic status, and the youth’s own smoking. So it appears that second hand smoke exposure can affect cognitive abilities.

I also saw a recent study that showed that youth exposed to second hand smoke between the ages of 5-12 were twice as likely to become smokers during adolescence as compared to those who were not exposed to second hand smoke. And in this study, the researchers took into account socioeconomic status and the presence of adult smokers in the home. The researchers believe that being exposed to tobacco smoke as a child may cause a cigarette rush which appears to predict whether the child will smoke in adolescence. So this is yet another reason for ensure that children are not exposed to second hand smoke.

I would like to comment on your answer to the woman whose husband has decided to stop drinking without seeking outside help:

Three years ago, my fiancé decided to stop drinking and chose to ‘fly solo’ as well. He has done a remarkable job and I am so grateful for the wonderful life he has reclaimed for himself, his son and me. It hasn’t been easy, nor would it be for anyone battling addiction, regardless of what type of treatment they received. However, it hasn’t been easy for us, either! Maintaining a healthy relationship with someone who’s kicking the bottle is nothing less than daunting, and I think you should have encouraged this woman to consider getting help for herself and her family if she felt the going was rough.

Like her, I believed that AA or counseling was the only way. I found myself struggling with how to be supportive without becoming the Drink Police or his shrink! Daily life became overshadowed by my own anxiety about his drinking and my desire to help his son brave the emotional turmoil. The day I learned about letting go of my fiancé’s addiction and minding my own business was the first day that this family got on the right track. Although I chose Al-Anon, I would imagine a qualified recovery program, counselor, minister, or support group could offer other families the same support. Please let your readers know they don’t have to go it alone!

You also you mentioned a study on other people who resolved their drinking issues without treatment. Would it be possible to get more information on that study? I would love to share others’ success with the family.

Thanks for your letter and your point is well-taken. I did not mention that this person could obtain some help for herself and I certainly could have.

In regards to studies that have demonstrated that people can resolve their drinking problem without outside help, a good book that documents this is called “The Natural History of Alcoholism” by George Vaillant. In this book, individuals who struggled with alcohol were followed for over four decades and it was found that many helped themselves without formal treatment. Two other studies, one conducted in the United States and the other in Canada, demonstrated this same phenomenon. The study in the United States is reviewed by Dawson (1996). Correlates of past-year status among treated and untreated persons with former alcohol dependence.

Alcoholism: Clinical and Experimental Research 20: 771-779. The study conducted in Canada was by Sobell, Cunnngham, and Sobell (1995). Recovery from alcohol problems with and without treatment: Prevalence in two population surveys. American Journal of Public Health 86: 966-972.

I must also say that while some can recover without outside help, others need additional support. There is no right or wrong way to enter a program of recovery. Rather, different people require different things, which is true for most kinds of behavior change. For example, some people who want to begin an exercise program can essentially do this on their own, whereas others require more structure and support. Another example is people who make the decision to lose weight. Some can do this solo, whereas others need more help. Essentially, people need to find a path of recovery that meets their needs, and there are many different paths into recovery.

Dear Dr. Levy:

My 19 year old son is partying a lot with his friends. He is drinking, staying out all night with his friends, getting put in protective custody and he has been arrested, too. Due to the fact that he is 19, we are not contacted by the police when he is arrested and probably do not know everything that has gone on. We told him that this is unacceptable behavior and gave him a midnight curfew. Could he already be an alcoholic and we don't know it? If this was your son, what would you do?? Any advice would be greatly appreciated.
Thanks!

First, I am sorry to hear about this sad and horrible situation with your son. As I often state, this is one of the most painful situations for a parent to experience. In answer to your question whether your son could be alcoholic, it is certainly possible that your son could experience an alcohol abuse or dependence problem. Based upon what you stated, given that he has been arrested and placed in protective custody, it is quite likely that his problem with alcohol fairly severe and that he meets criteria for alcohol abuse or dependence. Certainly, alcohol problems tend to develop in the late adolescent and early adulthood years.

In regards to what you can do, the first thing you need to know is that you have no control over what your son does. While you can and should talk with him and express your concern, he may not listen to you. However, at least you are bringing this to his attention and he may begin to think about what you say.

What you do have control over is your own life and to what extent you will allow his behavior to affect you. If his staying out all night affects you adversely and you decide that you can no longer live this way, you may reach the conclusion that he can no longer live with you if he continues to do this, and this is something to tell him. And if his behavior continues, he might need to leave the home. On the other hand, you may not be ready to do that as this is an extremely difficult decision for any parent to make, and only you can decide what you need to do for yourself and what you are able to do. As this is such a difficult situation, one suggestion is to get some support for yourself so that you can decide how to manage this situation. Your own therapist can be very valuable, as together, you can sort out the best way to proceed. Your therapist can also explore and review the benefits of possibly doing a family intervention, or even considering taking out something called a Section 35 through the legal system, which could force your son into treatment for a limited period of time. In addition, getting involved in Al-Anon, an organization designed to help those affected by another person’s alcohol problem, can also be considered. Information about Al-Anon can be obtained by calling 1 (888) 4AL-ANON, or by checking out their website at www.al-anon.org. If I can be of further help or you have additional questions, please contact me again.

Dear Dr. Levy:

My husband has finally agreed to stop drinking after years of us fighting about this. While I am thrilled that he has agreed to stop drinking, he is refusing to go for any help. He says he doesn’t want to go to AA meetings or see a counselor, and he says that he can do it by himself. I am not sure how much I should push him to get some help, or just let it go and pray for the best. I really think he would benefit from help. Thank you.

First, it is great that your husband has finally made the decision to stop drinking. And you are probably right that your husband probably could benefit from getting some kind of treatment. However, that being said, many people, although not all, are able to successfully stop drinking without receiving help of any kind. In a very large well-designed study that I am aware of, many people who had resolved a drinking problem reported that they did so without receiving outside help of any kind.

At this time, no one knows whether your husband will be able to successfully resolve his drinking problem without help, and only time will tell. However, it is clear that he prefers to do this on his own and I would respect and accept his decision. He may find, however, that over time, it is harder than he thought and if this turns out to be the case, he might then accept some outside help. In fact, I would talk with him and let him know that you respect and accept his decision. At the same time, I would see if he would agree to go for some kind of outside and treatment if he finds that he is not successful. He may agree to this, but only after he first tries to do this on his own. In summary, I wouldn’t make his refusing to go for help a big issue, but I would see if he would agree to get some help if he finds that he is not able to do this on his own.

Dear Dr. Levy:

My son who is 17 years old has developed an addiction to Oxycontin. He has tried to stop numerous times without success and is involved in counseling. He has even gone into residential treatment, but relapsed shortly after getting out. I am wondering if you would recommend Suboxone for him. Some people think he is too young for that medication, but nothing else has worked. I would greatly appreciate your advice. Thank you.

First, I am sorry to hear the situation with your son. I can only imagine how painful his addiction is for you and him. Without knowing too many specifics about your son’s situation, in general, I do not think that your son is too young for Suboxone treatment. Suboxone has been studied among adolescents and very young adults and the results are similar to when adults are treated. Suboxone can help individuals achieve abstinence from illicit opiate-type drugs and younger people tolerated this drug as well as adults. If your son has been unable to achieve abstinence from Oxycontin and wants to try Suboxone, I believe that Suboxone could be considered.

Dear Dr. Levy:

I have a friend who has been struggling with heroin for years. He’s been detoxified many times and is finally interested in getting on methadone or maybe Suboxone. Which would you recommend? Thanks.

Without knowing too much about your friend, let me offer the following. In general, Suboxone is more appropriate for a person who is fairly stable, who’s only drug of abuse is heroin or other opiates, and who does not have a lengthy history of heavy opiate use. In addition, Suboxone is more suited for a person who does not have a very heavy current heroin habit. I say this because Suboxone will not adequately cover the withdrawal symptoms of a person who is heavily opiate-dependent.

Methadone, on the other hand, is better able to cover the withdrawal symptoms that can occur with greater opiate dependence, so it more appropriate for the person with a heavy opiate addiction. In addition, if your friend is using other drugs as well as heroin, I would suggest methadone over Suboxone. Methadone programs offer significant structure and more support than Suboxone programs, which may be required for a person who is using a variety of drugs. Another factor to consider is that methadone programs, at least initially, require daily attendance whereas Suboxone does not because individuals obtain their, even initially, are able to keep their medication at home. While this should not be the determining factor, a person needs to think about getting to the methadone program daily until they can demonstrate abstinence from other drugs.

I hope this helps to clarify things. If you have other questions, please feel free to contact me.

Dear Dr. Levy:

I have friend who has struggled with methamphetamine, and had been doing real well. Recently, however, I suspect that he may again be using as he isn’t returning my phone calls and seems more distant. I want to say something to him, but I am concerned that if he isn’t using, he will get offended and angry with me. I am not sure if I should say something or not, or even what to say. Do you have any advice? Thanks.

Overall, I think that it is fine to express your concerns to him. It does, though, need to be said in a way which will increase the chances that he will hear you and will decrease the chances of him getting upset or angry with you. As a suggestion, you can say to him that while you may be totally wrong, you have been concerned that he has gotten back into using methamphetamine. You can briefly let him know why you are concerned: that he has seemed more distant and hasn’t been returning your phone calls. Let him know that you are bringing this up because you are concerned and that you care for him. You can also let him know that you may be wrong, but that you thought it was better to talk about this and be wrong than to not to say anything and ignore your feelings and concerns.

If said in the right way, which has to do with your caring for him, I do not think that your friend will get angry and offended with you. There may be another explanation for his distance from you, which he can explain.

And if he does get angry, I tend to think that this is because you are hitting a chord and he may have begun using again. But in general, speaking with a friend about a possible return to drug use should not result in a big disagreement if done with care and compassion, and I think it should be done.

Dear Dr. Levy:

My husband recently started seeing a therapist for his alcohol problem, and I insisted that he go. I want to go with him to a session to make sure his therapist knows exactly what has been going on, but he doesn’t want me to. Is there anything that you can suggest? Thanks so much.

Let me first say that as you probably know, it is your husband’s decision whether or not to allow you to come to his session. With that being said, you said that you want to go to a session with him to ensure that his therapist knows exactly what has being going on. Based upon that, I suspect that you think that he isn’t being completely truthful with his therapist or concerned that he will not be completely honest. I am not sure why you suspect this, but as a simple suggestion, you can ask him whether he has fully informed his therapist of his problem with alcohol.

Let him know that you think that this is important to do as his therapist needs to know all that is going on, the extent of his drinking, and how concerned you are about this. Another suggestion is to see if your husband would allow you to come with him for part of a session, as he may be more agreeable to that. You can also ask him if he would allow you to meet with his therapist without him for one session. If he agrees to this and lets his therapist know, his therapist could meet with you and might then suggest that your husband attend as well. If his therapist suggests a conjoint meeting, rather than you, your husband might agree. I am also not sure why he doesn’t want you to be involved and that is something that you can ask him as well. Perhaps he has some misinformed idea and if you clarified things, he might allow it.

Finally, it appears as though you strongly suggested he see a therapist as I suspect his alcohol use was impacting your relationship with him and his drinking was bothering you very much. If he refuses to allow you to be involved in any way, regardless of what he is or is not saying to his therapist, you need to decide what you want to do regarding your relationship with him based upon whether his use of alcohol is continuing to affect you and your relationship with him. That is, even if he is being completely honest with his therapist, he may continue to drink and this may continue to affect the marriage. If this continues, you may need to decide what you want to do so that his drinking no longer affects you and perhaps seeking some help for yourself might have some benefit for you. Having your own therapist might provide you with some helpful support. Another suggest are Al-Anon meetings, which are designed to help family members of alcoholics. If I can be of further help, please contact me again.

Dear Dr. Levy:

Are there any drugs that can help a person who is addicted to cocaine? Thanks so much.

Developing medications that can augment psychosocial treatment to help cocaine-addicted individuals is one focus of the National Institute on Drug Abuse. There has been some research that has shown that Antabuse, or disulfiram, a medication used for the treatment of alcohol dependence, may have some benefit for cocaine dependence as well. In this research, cocaine-dependent individuals who were given Antabuse along with psychosocial therapy used less cocaine than those given a placebo. It was also found that individuals who were not alcohol dependent and those that did not drink throughout the study had the best outcome, which suggests that Antabuse has a specific impact on cocaine dependence.

Another medication that is being researched to treat cocaine dependence is Modafinil. In this study, it was found that individuals treated with Modafinil as compared to those given a placebo gave fewer cocaine-positive urine screens. In addition, a greater percentage of individuals given Modafanil were able to maintain abstinence for three weeks or more. According to the researchers, some participants reported that even if they used cocaine, they did not experience intense cravings to use more and more, which is extremely common among people who are dependent upon cocaine. While Modafinil is not presently approved for the treatment of cocaine dependence, more research is being planned to study this drug’s benefit for the treatment of cocaine dependence.

Dear Dr. Levy:

I am finally planning to stop smoking cigarettes, but I am worried about cravings to smoke as in the past, they caused me to go back. Do you have any ideas about what I can do? I don’t really want to take medication. Thanks.

First, congratulations to you for making the decision to quit. Now, in terms of how to deal with cravings, if you don’t want to take medication, there is the nicotine patch or nicotine gum, which can help with cravings, although these can be viewed as a type of medication, so you may not want to use them. However, there are also many other things you can do, such as:

Dear Dr. Levy:

Can you tell me if marijuana is addicting? I know some people who can take it or leave it, but others seem to want to smoke it constantly.
Thanks.

Before I answer this question, I need to first say that addiction to a drug means that people use the drug compulsively despite it causing problems for them. With that definition, marijuana has the potential to be very addicting. Many people start to smoke marijuana and their use of it eventually becomes a central preoccupation in their lives. In fact, marijuana use can become so compulsive that it is smoked daily and individuals begin to neglect or lose interest in other important things, whether this is school, work, or other relationships. Individuals addicted to marijuana often report that they cannot cut down their use or stop smoking it, and that they have committed crimes to obtain money to buy it.

You are correct, though, in stating that others can take it or leave it and it never becomes a central preoccupation in their lives. This is true for many drugs in that not everyone who uses the drug becomes addicted. For example, let’s take alcohol. Some people drink socially and the use of alcohol never becomes problematic for them. Others, however, start using it heavily and compulsively, and become addicted to it.

Many people also wonder if marijuana causes physical dependence. That is, when a person stops using it, will that person experience a withdrawal syndrome? Research has shown that while many individuals can abruptly stop using marijuana without experiencing significant withdrawal, other report some withdrawal symptoms that include anxiety, irritability, and some mental confusion. And it should be remembered that whether or not a drug causes a withdrawal syndrome is not the criteria that should be used to determine whether a drug is or is not addicting. For example, individuals addicted to cocaine do not experience severe withdrawal when they stop using, yet cocaine is highly addicting.

So, in answer to your question, some individuals who smoke marijuana do become addicted to it, although it is also true that there are people who use marijuana who never become addicted.

Dear Dr. Levy:

Someone was telling me that nicotine is being studied to cure some diseases? Can that be true? Thanks.

Actually, as amazing as this sounds, there are researchers that are investigating whether nicotine, or at least drugs similar to nicotine, can be used to treat some medical conditions. Nicotine has a number of effects on the brain that some believe may be able to help treat conditions such as depression, attention deficit hyperactivity disorder, anxiety, schizophrenia, Alzheimer's disease and Tourette Syndrome, to name some. It is my understanding that the researchers are trying to take the best therapeutic qualities of nicotine, which obviously exclude its addictive and toxic qualities, to see whether this drug can have health benefits.

And this in no way should be interpreted that smoking is or can be good for you. Rather, it is possible that the active ingredient in nicotine, when used through different delivery systems and with its harmful effects removed, may have some health benefits.

Dear Dr. Levy:

I don’t know if you know the answer to this question, but I am wondering why some people who are addicted to drugs are able to quit, whereas others can’t and seem to always relapse. Thanks.

That is a great question and one that is difficult to answer. I believe that the reasons why a person gets addicted to drugs in the first place are caused by numerous things, whether this is due to genetic, psychological, social, and family factors, to name just some, and the reasons why a person is able to successfully quit is due to many of these same things. That is to say that getting addicted to drugs, as well as being able to stop, is very complicated and due to a variety of factors.
And there is still much that we need to learn to completely understand why some people are successful at quitting and others are not.

With that being said, as a general overview, I would say that if a people are going to successfully quit, they must first make an intense commitment to change their use of drugs and make this a number one priority in their lives for some time. No longer using drugs must be one of the most important things to them. Second, there must be important and compelling reasons to stop and they need to remain mindful of these reasons, and to remember what will again take place if they return to using drugs. If there are not compelling reasons to change, it will be hard to sustain the effort. In addition, people must work hard to develop meaningful and quality lives after they quit and always to remember how much better their lives are without using drugs. This can help to counter any urges to use again as they will not want to lose what they have obtained and the joy they now have in their lives. They must also imprint in their minds that no matter what occurs, they can never use drugs even once and they need to develop the coping skills to resist any urges to again use drugs.

And on top of this, having confidence in oneself to change is key. If a person does not believe they can change, this will become a self-fulfilling prophesy and the person will not change. On the other hand, believing in oneself and knowing that change is possible will help immensely and again, is essential. Finally, getting involved in treatment is tremendously important.

I also must say that although a person may struggle to achieve abstinence and it looks like they "can't", I never give up hope. There are many people who struggle for years to stop using drugs, but at some point, they are able to achieve success. So for me, I never say that a person "can't" achieve abstinence; rather, they haven't yet.

I hope that helps to answer your question. Again, why some people are able to quit drugs, whereas others continue to struggle with this throughout their lives, is a very complicated question and we still have much to learn and understand. However, no matter what other issues a person is struggling with, the mental state of mind I reviewed is essential.

Dear Dr. Levy:

I stopped drinking and using cocaine about three weeks ago. While things are going better for me, I can’t say that I feel great. I don’t think that I am depressed, but it is hard to get excited about things, like I am just going through the motions. I am hoping these feelings will pass. I guess my question is whether these feelings are normal. Thanks.

Let me first say that it is great you stopped your alcohol and use of cocaine. I promise you that if you stay on track, things will improve with time.

Without knowing your specific situation, the feelings you report aren’t real surprising. Assuming that you are not clinically depressed, when a person first stops using drugs and alcohol, it can take some time to start feeling better, which can be due to many reasons. For example, you may need to develop other leisure activities that do not include alcohol and drugs, and this can take some time. You may also need to develop another social support system with people who do not use drugs and alcohol.

Also, despite the problems alcohol and cocaine caused, there were parts of it that you enjoyed, and again, it takes time to find other sources of pleasure or to learn to enjoy the things you used to do under the influence without being under the influence. You may also be dealing with some problems that your use of drugs and alcohol caused, which can make you feel a little down. Depending upon how long you have been using, it takes time to develop a new drug-free life style and to feel comfortable with that.

And speaking of learning to find other sources of pleasure, drug addiction can cause changes in the brain that make it somewhat harder to find such pleasure, at least in the early stages of abstinence. Very simply, the main pleasure chemical in the brain is dopamine and when people use drugs, over time, the brain produces less dopamine or the places in the brain that dopamine attaches get reduced. As a result, initially, it can be harder for newly abstinent people to feel normal amounts of pleasure.

You need to force yourself to do those things anyway, and over time, the brain can heal.

So there are many reasons why you may be feeling down, and some of these feelings are to be expected. However, it is possible that you are depressed and if these feelings don’t go away with time, or they are severe, I would strongly encourage you to speak with a professional who can carefully assess you and help you to start feeling better. While achieving abstinence isn’t always easy, it should not be an extremely painful experience. And please remember that no matter what, returning to alcohol or drug use will not make things better, but will only make things worse. Even if in the very short term it helps you to feel better, in the long run, it will only create more problems for you. I wish you the best and feel free to contact me again.

Dear Dr. Levy:

I know that many heroin addicts die prematurely. My question is why? Is this due to drug overdose, using dirty needles and getting infected with HIV, because of the effects of heroin on their body, or because of their life style? I ask because over the last few years, several of my friends have died, who were all in their early 40s, and I am just curious. When I asked why they have died, it was like people didn’t want to discuss it.

Maybe this will help me to put some closure on my feelings, and to try to make sense of this. Thanks.

First, I am very sorry to hear about the loss of your friends. Drug addiction unfortunately does cause premature death and is responsible for many, many lost lives. And as there is such a stigma related to drug addiction, it is not surprising that people did not want to talk about why the individuals had died, and in particular, if this was due to drug overdose, which carries a huge stigma.

Clearly, premature death related heroin addiction occurs for numerous reasons, and the ones you mention are relevant. Research has looked at this issue and has given more specific insight into what is responsible. One study in particular studied almost 600 individuals who were addicted to heroin and who received mandatory drug treatment for their drug use. People were studied every 10 years for a little over 30 years, and the average age of the people at the beginning of the study was 25. During this follow-up, almost half of the individuals had died, and the average age of death was 47, which in and of itself, is very disturbing. In looking at the leading causes of death, 17% were from heroin overdose, 15% was due to chronic liver disease, 12% was due to cardiovascular disease, 11% from cancer, 8% was from accidents, and another 7% was due to homicide.

As you can see, while the majority was due to drug overdose, causes of death were from many sources, which involve life style issues, as well as accidents that take place that are often due to being under the influence of drugs. As I began this letter, drug addiction causes premature death and many lost lives, which is why drug treatment is so important as treatment can help people save their lives.

Dear Dr. Levy:

Someone was telling me that there is some medication that can help compulsive gamblers to stop gambling. Have you heard of this? Thanks.

I believe that you are referring to a drug called Nalmefene, or trade name Revex. This drug, which is an opiate blocker, is currently used to reverse the effects of opiate-type drugs after drug overdose or general anesthesia. Research has shown that this medication has been beneficial for the treatment of compulsive gambling. Interestingly enough, there are also some reports that this medication may be also helpful for the treatment of alcohol problems. This research is not conclusive, however, and this medication is currently not recommended for the treatment of alcohol dependence.

Dear Dr. Levy:

My husband admits he has a drinking problem, but he says he drinks because he gets so anxious. He has always been uptight, but he says that his anxiety gets overwhelming and that he almost gets panic attacks. His drinking has been increasing and again, while he knows his drinking isn’t good, he says that it’s the only thing that helps with his anxiety. I am not sure if you have any suggestions for what he can do. Thanks.

Without knowing the specifics of his situation, let me offer the following. First, it is good that your husband admits he has a drinking problem, which is a great first step. In regards to his anxiety, it is almost impossible to know what is going on with him while he is continuing to drink. For example, it is possible that the anxiety he feels may be a symptom of withdrawal from alcohol. If he is physically dependent upon alcohol, his body can get used to having alcohol, and when it is not there, a withdrawal syndrome can occur and one symptom of withdrawal is anxiety.

If this is what is going on, when he drinks, it will help his anxiety as he is medicating his withdrawal symptoms. So he may not even have a true problem with anxiety; rather, his anxiety may be due to alcohol withdrawal.

However, it is also possible that his anxiety is a separate issue and even if did not drink, he would experience some kind of anxiety disorder. Certainly, some people who experience a drinking problem do also have an anxiety disorder that may play a role in the use of alcohol.

As it is not possible to know what is truly going on as long as he continues to drink, my suggestion would be for him first to address his drinking problem. And by saying this, I mean that he needs to stop drinking to see how he feels when he no longer has alcohol in his system. And he should absolutely speak with his physician or health insurance company to get properly evaluated and treated. He should not just stop drinking on his own as withdrawal from alcohol can potentially be life threatening without proper treatment. To ensure that he safely stops drinking, getting a proper medical evaluation and treatment is absolutely essential. This may entail getting medically detoxified on an inpatient basis, although it is possible that the detoxification can also take place on an outpatient basis. Whoever evaluates him can determine what is safe for him.

Once he stops drinking, if he continues to experience anxiety, he can then receive treatment for this in addition to continuing to obtain treatment for his drinking problem. There are psychological treatments to help people better manage their anxiety, in addition to a variety of medications that can be used if psychological treatment does not provide enough benefit.

I hope this is useful to you. If you have any other questions, please contact me.

Dear Dr. Levy:

My question is if a person at a young age, like 19 or 20, is already having a problem with alcohol, what are the chances that this person will continue to have an alcohol problem as an adult? Thank you.

You ask a great question. Let me first say that a diagnosis of alcohol abuse or alcohol dependence at an early age, like 18 years old, is a predictor of later alcohol problems as an adult. Such people have a significantly greater chance of having an alcohol problem as an adult than people who did not have an alcohol problem at that age. That being said, it is also true that many people mature out of this problem, and as adults, no longer have an alcohol problem. In a study that followed over 1000 people from age 18 to 25, it was found that remission of an alcohol problem was quite common. In particular, approximately 57% to 75% of people with an alcohol abuse diagnosis at age 18 no longer had such a problem at age 21 or 25, and about half of people with an alcohol dependence diagnosis at age 18 had no alcohol diagnosis at ages 21 or 25. What is also interesting is that almost all of these people were still drinking, but in ways that was no reflective of either alcohol abuse or alcohol dependence.

So in answer to your question, for a person who has an alcohol problem at an early age, that individual has roughly a 50% chance, or in some cases, a somewhat lower chance of continuing to have a drinking problem.

While that is good news, the down side is that such an individual has an increased risk, compared to people who never had a drinking problem, to continue to have a problem with alcohol. Those are general trends, which is to say that on a case-by-case basis, it is hard to predict who will and who will not continue to have a problem. However, it is safe to say that the more severe the person’s problem is, the greater the chance that problematic drinking will continue.

Dear Dr. Levy:

Is there true evidence that smoking marijuana can really damage your lungs?

The use of marijuana over a lengthy period of time can increase the risk of respiratory symptoms and other complications. In a review of over 30 studies that have looked at this issue, it was found that longer-term marijuana use increased the risk of cough, sputum production, wheezing, sore throat, shortness of breath, and a worsening of asthma symptoms.

While the authors of this review noted that some of the studies were not well designed and sometimes the amount of marijuana smoked was not specifically defined, it still was clear that the long term use of marijuana did have a negative impact of respiration.