Charlie Sheen Substance Abuse: FAQ

By Stephanie Watson


March 1, 2011 — After actor Charlie Sheen trashed his suite at New York’s Plaza Hotel, called Chuck Lorre, the creator of the TV show “Two and a Half Men,” a “turd,” and rambled incoherently in a television interview about being a “high priest Vatican assassin warlock,” people started to wonder whether the TV star had come completely unhinged.

Sheen has admitted to a history of drug use, but is his erratic behavior a sign that he’s still addicted and in denial, or that he’s also dealing with a mental illness? Sheen certainly isn’t the first celebrity to deal with drug addiction. If it turns out, as some experts have speculated, that he’s also got a mental illness, he similarly wouldn’t be alone in having both conditions.

WebMD asked addiction experts about the connection between mental illness and substance abuse. What’s the link? What can happen when someone who is addicted refuses to get treatment? And what are the best ways to overcome an addiction?

What’s the Connection Between Addictions and Psychiatric Disorders?

Addiction and mental illness often go hand in hand. Up to half of people with depression, bipolar disorder, or another mental illness also have a substance abuse problem.

Experts say having one of these conditions increases your vulnerability for the other. “If you have a lifetime addiction and have taken drugs over a long period of time it can affect your psychiatric functioning,” says Bruce Goldman, LCSW, CASAC, program director of the Project Outreach Clinic in West Hempstead, N.Y.

Conversely, people with mental illness often use drugs and alcohol as a way to cope. “People will self-medicate, and that may be a risk factor for starting an addiction,” says Elizabeth Howell, MD, a board-certified addiction psychiatrist at the University of Utah Neuropsychiatric Institute.

The addictive substance itself can cause symptoms that mimic mental illness. Being high or going through withdrawal from drugs can make you feel anxious, angry, or restless, which are also common signs of psychiatric conditions, Goldman says.

Why Are Addictions So Hard to Overcome?

The reason why drugs like cocaine and heroin are so quick to lead to addiction is the effect they have on the brain. When you smoke cocaine, for example, you get increased levels of dopamine and serotonin– brain chemicals that give you feelings of pleasure.

Then suddenly, that good feeling is gone.

“You’re on this roller coaster where you feel this extreme dopamine spike and then you have a crash and you want more,” Howell says.

Having an untreated mental illness can make an addiction even harder to shake. So can having a lifestyle that makes drugs easily accessible, which is why so many celebrities, like Sheen, are always making headlines.

What Happens if You Don’t Get Treated for Addiction?

When actor Martin Sheen was interviewed about his son’s drug problem, he called it “a form of cancer.” Is addiction really like a disease? Howell thinks it is. “Addiction is a disease process, and we know that the diseased organ is the brain,” she says.

Just like cancer or any other serious disease, addiction can become life-threatening if it’s not treated. “It is a potentially fatal disease, and I’ve seen people die from overdose, from complications, from poor judgment — accidents,” Howell says.

Which Treatment Works Best for Addiction?

That depends on the addiction. Cocaine withdrawal is typically treated supportively and does not always require medication or hospitalization. Medications can help withdrawal symptoms for some addictions.

Cognitive behavioral therapy helps people recognize the situations where they’re most likely to use. Motivational incentives provide good reasons to stay off drugs.

This broad range of therapies allows for a very individualized treatment approach. “I truly believe that there’s no best treatment for everyone, and different treatments work better for different problems and different individuals,” Goldman says.

What’s most important is that you recover in a supportive setting where other people are also trying to get clean, Howell says.

Depending on the addiction, treatment may start with a medically supervised withdrawal, commonly called “detox,” to get you off the addictive drug. Then you need to completely abstain from not only your drug of choice, but other drugs too.

Whatever you do, don’t try to treat yourself for an addiction.

Though Sheen claims to have cured himself with “the power of my mind,” Howell says trying to self-treat for an addiction is a dangerous prospect. 

“It doesn’t work,” she says. “As a psychiatrist, I’ve been trained in how to do psychotherapy, but I never do psychotherapy on myself. If you’re a surgeon you don’t take out your own appendix. You have to have an outside person or support system helping you who has a perspective that you can never have for yourself.”

How Are People With Both Addiction and Mental Illness Treated?

Treating addiction without addressing the underlying mental illness isn’t enough.

“Many years ago when we were treating addiction, we had the false belief that if you treated the addiction and waited, some of the psychiatric problems would resolve themselves. We no longer believe that,” Goldman says. “You really need to treat both of them simultaneously to be effective.”

Considering that so many people who show up for addiction treatment also have a mental illness, centers today are well equipped to deal with both conditions.

What Should You Do if a Family Member or Friend is Addicted?

If you suspect that a family member or friend is addicted to drugs or alcohol, try to get them help. “I think if you’re concerned about someone’s health and safety, you’re compelled to step in and intervene to see that the person gets help,” Goldman says.

There is a chance the person will try to avoid facing the problem, especially if he or she also has a mental illness. It’s common for both drug users and people with conditions such as bipolar disorder to deny there’s anything wrong with them.

If your friend or family member refuses treatment, it’s hard for you to do much more, unless the situation is spiraling out of control.

“Some states do have laws that allow you to commit someone who is addicted and out of control and potentially harmful to themselves because of their addiction,” Howell says.

How Can People Stay Clean After An Addiction?

Once you’ve gone through treatment, you need begin the process of learning how to live without drugs or alcohol. That can be hard, especially if you’ve relied on the substance — or substances — for years.

Sheen says he just “blinked and I cured my brain.” But getting clean is never that easy.

“There’s no magic to it. It’s a long, arduous road,” Howell says. “It’s a chronic problem that’s going to be with people throughout their lives.”

Part of overcoming addiction involves changing your perspective, and starting to see your addiction not as something you’re going to be “cured” from, but as something you’ll have to work on throughout your life.

“Addictive disorders are chronic diseases. In other chronic diseases, such as diabetes, we don’t measure success in absolute terms over the course of a lifetime. It’s similar with addictions,” Goldman says.

The longer you stay in treatment, the better your odds for success.

“People have to be convinced personally,” Goldman says. “They have to be very motivated and committed to living a drug- and alcohol-free lifestyle.”

Source WebMD

More underage drinkers end up in ER on New Year’s

By Michelle Healy, USA TODAY


Alcohol-related New Year’s celebrations send an alarmingly high number of young people to hospital emergency rooms, says a report out today.

In 2009, 1,980 hospital emergency department visits involved underage drinking, according to the report from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). That’s nearly four times the daily average number of emergency department visits for drinking-related visits by people under 21, the report says. It’s two to three times the number of visits recorded on other “party” holidays, namely Fourth of July weekend (942) and Memorial Day weekend (676)

The study looked at all alcohol-related ER visits, but it did not specify whether they involved traffic accidents, alcohol poisoning or other issues.

The huge rise of drinking-related incidents on New Year’s “should startle us. It should wake us up,” says Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality, which did the analysis.

Though any underage alcohol consumption is cause for concern, drinking can also increase the likelihood of other risky behaviors, Delany says.

The findings are in line with other research showing more alcohol-related problems over the winter holidays, SAMHSA says.

Two to three times more people die in alcohol-related vehicle crashes during that time than during comparable periods the rest of the year, the National Institute on Alcohol Abuse and Alcoholism says. And 40% of traffic fatalities during winter holidays involved an alcohol-impaired driver, compared with 28% for other dates in December.

Fueling the underage drinking problem, especially at this time of the year, is “a combination of greater access to alcohol, less parental oversight and mixed messages” about celebrating with alcohol, Delany says.

Young people are told “don’t drink, don’t do that, but in every third commercial in recent weeks, we see something linked to alcohol and drinking,” he says.

And there’s also the issue of “what kind of message parents may give,” Delany adds. “Maybe they’re drinking a lot. Kids see that it’s OK.”

What is needed is a long-term message “that underage drinking is not OK,” he says. “But adolescents don’t do well with ‘Just say no.’ We have to find ways to help young people make good decisions.”

Lowering The Drinking Age Is Unlikely To Curb College Binge Drinking

On December 10, 2010, in Public Health, Substance Abuse, by Christopher Fisher, PhD


Although presidents at some United States colleges have argued that lowering the minimum legal drinking age could help curb binge drinking on campuses, a new study in the January issue of the Journal of Studies on Alcohol and Drugs suggests such a measure would be ineffective.

In 2008, a group of college presidents and chancellors formed the Amethyst Initiative, a call to rethink the current minimum legal drinking age of 21. They argue that the law encourages underage college students to drink at parties, where binge drinking is common. The main argument states that if students as young as 18 could legally drink in bars and restaurants, they might instead learn more moderate drinking habits, which could then lead to less binge drinking on college campuses.

So far, 135 college presidents have signed the Initiative’s public statement urging lawmakers to reconsider the legal drinking age.

But to simply lower the drinking age without an understanding of its effects would constitute a “radical experiment,” said Richard A. Scribner, M.D., M.P.H., of the Louisiana State University School of Public Health, one of the researchers on the new study.

So Scribner and colleagues at BioMedware Corporation in Ann Arbor, MI, and other institutions used a mathematical model to estimate the effects that a lower drinking age would have on college binge drinking.

The model, developed based on survey data from students at 32 U.S. colleges, aimed to evaluate the “misperception effect” emphasized by the Amethyst Initiative – that is, the idea that underage students widely perceive “normal” drinking levels to be higher than they actually are and that students would adjust their own habits if they were surrounded by social drinkers rather than binge-drinking party-goers.

Overall, the researchers found that the campuses that were most likely to see a decline in binge drinking from a lowered legal drinking age were those that had the poorest enforcement of underage drinking laws – being surrounded, for instance, by bars that do not check identification – and a significant level of student misperception of “normal” drinking (that is, students thinking that the average fellow student drinks much more than he or she actually does). If misperception levels were not present or were at the levels shown by the survey data, these campuses would likely see more binge-drinking if the legal age were lowered.

On “drier” campuses, the study found, student misperceptions would have to be even greater.

“The higher the level of enforcement of underage drinking laws, the higher the level of misperception would have to be for the Amethyst Initiative to have any hope of being effective,” explained lead researcher Dr. Jawaid W. Rasul, of BioMedware Corporation. “The misperception effect would have to be extremely large.”

And without data supporting the existence of such high levels of student misperception, Rasul said, lowering the legal drinking age would be unlikely to curb college binge drinking.

Scribner also pointed out that lowering the drinking age would not only affect college students but all currently underage young adults. And past research has suggested that when alcohol becomes more readily accessible to young people, alcohol-related problems, such as drunk driving, go up.

Material adapted from Journal of Studies on Alcohol and Drugs.

Reference
Rasul, J. W., Rommell, R. G., Jacquez, G. M., Fitzpatrick, B. G., Ackleh, A. S., Simonsen, N., & Scribner, R. A. (January 2011). Heavy Episodic Drinking on College Campuses: Does Changing the Legal Drinking Age Make a Difference? Journal of Studies on Alcohol and Drugs, 72 (1), 15- 23.

Energy Drink Consumption Is Strongly Linked With Risks Of Heavy Drinking And Alcohol Dependence

On November 19, 2010, in Health | Fitness, by Christopher Fisher, PhD


A hallmark of college life is staying up late to study for an exam the following morning, and many students stay awake by consuming an energy drink. Also increasing in popularity is the practice of mixing alcohol with energy drinks. But these drinks are highly caffeinated and can lead to other problems, in addition to losing sleep. Unfortunately, the contents of energy drinks are not regulated. The results will be published in the February 2011 issue of Alcoholism: Clinical & Experimental Research

New research indicates that individuals who have a high frequency of energy drink consumption (52 or more times within a year) were at a statistically significant higher risk for alcohol dependence and episodes of heavy drinking.

Amelia M. Arria, the lead author of the study, Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health, and a Senior Scientist at the Treatment Research Institute, said that prior research has highlighted the dangers of combining energy drinks with alcohol.

“We were able to examine if energy drink use was still associated with alcohol dependence, after controlling for risk-taking characteristics. The relationship persisted and the use of energy drinks was found to be associated with an increase in the risk of alcohol dependence.”

The study utilized data from more than 1,000 students enrolled at a public university who were asked about their consumption of energy drinks and their alcohol drinking behaviors within the past 12 months. The researchers found that individuals who consumed energy drinks at a high frequency were more likely to get drunk at an earlier age, drink more per drinking session, and were more likely to develop alcohol dependence compared to both non-users of energy drinks and the low-frequency users.

The results of this study confirm and extend earlier research about the risks of energy drink consumption. A major concern is that mixing energy drinks with alcohol can lead to “wide-awake drunkenness,” where caffeine masks the feeling of drunkenness but does not decrease actual alcohol-related impairment. As a result, the individual feels less drunk than they really are, which could lead them to consume even more alcohol or engage in risky activities like drunk driving.

“Caffeine does not antagonize or cancel out the impairment associated with drunkenness – it merely disguises the more obvious markers of that impairment,” says Kathleen Miller, a research scientist from the Research Institute on Addictions at the University at Buffalo. According to her, the next steps in this research include identifying links between energy drinks and other forms of substance abuse, as well assessing the overall prevalence of energy drink use by adolescents and young adults.

“Also needed is research that directly assesses students’ reported reasons for mixing alcohol and energy drinks. Anecdotal reports suggest that part of this phenomenon may be driven by the perpetuation of myths (e.g., mixing alcohol and caffeine reduces drunkenness, prevents hangovers, or fools a breathalyzer test) that could be debunked through further education.”

Arria agrees, adding that further research and regulations are needed to curb this disturbing trend.

“The fact that there is no regulation on the amount of caffeine in energy drinks or no requirements related to the labeling of contents or possible health risks is concerning.”

Alcoholism: Clinical & Experimental Research

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