Question: I have been having a lot of fun with percocets for about 6 weeks taking about 50 or 60mgs a day now. So stupid I realize now. I gotta stop this train before things get out of control but I am not sure how to do it best. Should I try to taper down slowly or should I just jump off and get this over with. I'm worried about it. Never went through anything worse than quitting smoking before. Is there any chance I am going to need some sort of detox program after such a short time on percs?

Iona Health Says...:

You are asking me if you need medical treatment as a result of your Percocet abuse. First, it is well know that a large single dose or prolonged use of Percocet can cause severe respiratory depression and death. I assume you are concerned about (1) the possibility that you could be dependent; and (2) how to detox off of Percocet without harming yourself. Taking Percocet several times per day, for several weeks, can cause someone to become addicted or dependent according to treatment centers that specialize in Percocet detoxification and treatment. This dependency can occur within three weeks from the time an individual begins to use regularly.

Characteristics of Percocet Dependency are:

• Constipation
• Constricted pupils
• Depression
• Dizziness
• Drowsiness
• Exaggerated feeling of well-being
• Itchy skin
• Light-headedness
• Nausea or vomiting
• Sedation
• Skin rash
• Slowed breathing

For more information, by video, on Percocet abuse go to:

www.percocetabusehelp.com/watch-video

The primary phase of withdrawal lasts about a week for most people, and sometimes as long as two weeks. Less severe withdrawal symptoms can last for many months after cessation of use.

At the website www.heroin-detox.org/percocet_addiction.htm the symptoms of the primary phase of Percocet withdrawal continue to include:

• Runny nose
• Nausea
• Vomiting
• Increased pain
• Fever
• Muscle aches
• Restless legs
• Insomnia
• Anxiety
• Stomach cramps
• Weakness
• Increased depression

Symptoms such as insomnia, depression, and low energy can occur with variable intensity (one day you feel great – the next you don't) for months after quitting.

My recommendation is that you take this medical problem very seriously. It requires assessment and possible medical intervention. You can consult a substance abuse professional for assessment or treatment recommendations for your own safety and wellbeing. It is standard treatment to offer a patient an opiate substitute replacement and gradually detox him. To avoid serious side effects, please consider this option.

I hope this information has been helpful to you. If you need anything else, please do not hesitate to contact me.

Respectfully yours,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: Does acupressure work as well as acupuncture to help people who are suffering while trying to taper off opiate pain drugs? I prefer no needles and there is a local acupressure therapist but I am in so much discomfort trying to reduce my daily dosage of Lortabs that I am willing to go the needles route if it is necessary.

Iona Health Says...:

From your question, I assume that you are suffering from chronic pain. Although I do not know what kind of pain you are in, I will do my best to answer your question. I have worked with chronic pain patients for years and saw many of them become addicted to prescription pain medications; such as Lortab. Lortab is a combination of Hydrocodone and acetaminophen and belongs to a group of opiate pain medications. I see that your interest in acupressure and acupuncture is in their potential use to help people “taper off” of opiate pain drugs, like Lortab. Although you do not indicate if you have become dependent on Lortab, it does appear that you do have a medical reason for tapering off of your pain medication.

I applaud you for considering alternative forms of treatments for pain control. Recent research has shown that acupuncture and acupressure, both, have been effective interventions for pain control or relief. For more information about this, go to these websites:

• www.empowereddoctor.com/acupuncture-and-acupressure-are-efficient-in-delivering-pain-relief
• www.livestrong.com/article/174591-acupressure-vs-acupuncture-in-pain/
• www.webmd.com/pain-management/ss/slideshow-acupuncture-overview

At the recent EFIC Congress “Pain in Europe VII”, it was reported that three alternative therapies can be efficient in reducing pain. These alternative therapies are called the three “A’s”, i.e. acupressure, acupuncture, and aromatherapy. For more information about this, go to this website.

For pain relief without needles, pressure, or touch, you may want to investigate an alternative healing method called pranic healing. Many people have been helped or healed of chronic pain by working with a pranic healer. For more information, go to this site.

There are numerous other alternative practices which can help with pain relief, such as Reiki, Qigong and others. I would recommend you look at the ones already mentioned as well as ones not discussed in this response.

The bottom line is that you have many alternative pain relief/control modalities to choose from. I wish you much success in your venture in self healing and recovery. If you need anything else from me, please contact me as soon as you are able.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: Is medical marijuana effective as way to give up gambling addiction? I have a hard time not visiting the casinos but when I occasionally smoke marijuana with my cousins I never feel the urge to go and play the slots. Can I get medical marijuana by prescription to control my compulsive gambling. I live in Nevada.

Iona Health Says...:

I must credit you with asking me a question I have never heard before. So out of respect, I want to look at this questions, not only from a practice wisdom perspective, but from the most current and available research.

Medical marijuana is commonly used to treat and recognized to treat:

• Arthritis
• Chronic Pain
• Back Pain
• Migraines
• Muscle Spasms
• Depression
• Alzheimer’s
• Multiple Sclerosis (MS)
• Fibromyalgia
• Glaucoma
• Nausea
• Anorexia
• Insomnia
• Lupus
• Cancer
• Movement Disorders
• Autism
• HIV / AIDS

To see the whole list of ailments aided by medical marijuana go to medicalmarijuana.com

You will not find marijuana, medical or otherwise, used as a “medical intervention”to treat addiction. As a substance abuse counselor, I have never heard of anyone being prescribed medical marijuana for any addiction(s). However, I do see addicts, particularly alcoholics, prescription and opiate addicts, self prescribe marijuana as a means to reduce and/or eliminate the harsh effects of withdrawal or inadequate coping.

As an advocate of medical marijuana, I would only recommend its use when it has been documented to help chronic, painful, and terminal conditions.

There are four phases of gambling addiction. It is the pathological phase, not the recreational phase, when gamblers are more likely to use/abuse cigarettes, alcohol, and other substances. Could your desire to use marijuana be a symptom of a bigger problem; i.e., progressed gambling addiction? You must answer this yourself or with the help of a trained addiction professional.

I am sorry to report that Nevada, like many states, has cut funding for gambling addiction treatment. However you have a great gambling recovery resource in Nevada. It is the Nevada Council of Problem Gambling.

I recognize that I may not have provided you with the answer you had hoped for. However, there is nothing in my practice experience or recent research which supports using medical marijuana to treat a process or non-substance-related addiction, like gambling. Again, I would recommend that you consult with your local resources to see what is considered “evidenced based treatment” for gambling addiction. For your information, an interesting article about the success of gambling addiction treatment by state funded treatment centers in Nevada.

This study may help you identify good treatment practices to avoid inadequate treatment for gambling addiction. Your best bet would be to work locally with an expert and professional in treating gambling addiction and to follow his/her treatment recommendations.

I wish you every success in your quest for gambling addiction recovery. If I may of further assistance, please do not hesitate to contact me.

Respectfully yours,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I am borderline and ADHD and I don’t do to well in group with a bunch of whiners so slowly spinning out their miserable tales of heartbreak and woe. I know that this makes me a bit of an asshole lacking empathy but that’s just the way I am wired. I am trying to stay off cocaine and I just keep getting pushed to these suck ass NA meetings which are just full of pathetic dudes crying into the junk they obviously no longer have. Its just not working for me. I need some sort of group for people like me. People who aren’t really sorry about shit and don’t want to cry about anything but who do want to stay clean and who are having a hard time. Any ideas? Preferably someplace minus the Jesus…

Iona Health Says...:

You have brought several issues which bear exploring sometime later which are your declarations that you are borderline, ADHD, disconnected, irritated, and struggling with others recovering from drug addiction. From what I have deducted, you are attending NA meeting because you are addicted to cocaine?! If I don’t understand this clearly, I will apologize for any misconceptions or misunderstanding in advance.

Not everyone benefits from 12 step programs. However, the most recent research suggests that a recovering person needs some type of ongoing group. Part of the reason, is because drug addicts replace their needs for human beings with drugs. People have failed the addict so he/she finds something more reliable, i.e., drugs. There is an excellent book on this subject called “The Addictive Personality: Understanding the Addictive Process and Compulsive Behavior” by Craig Nakken, which goes into detail about this.

To answer your question, specifically, I know there are two other major alternative recovery groups to NA or other 12 Step groups. They are Smart Recovery, and Rational Recovery. To find self-help groups in your location, you can go to this website www.selfhelpgrouplocator.com. In addition, there is an online support group for cocaine addiction at cocaine.supportgroups.com.

Attending any support group can be tenuous for most people. The recommendation for attending recovery groups is to attend at least 6 times before making a decision to join or not. Most people, in early recovery, struggle with interpersonal relationships. Learning to relate to others is often a former skill which can be mastered as part of the recovery process. Have you considered working with an addiction professional who provides cognitive behavioral group therapy? You have many choices other than 12 Step groups if they prove to be not helpful to you. These non-12 Step groups are considered to be secular groups, and not religious.

I hope this information meets part or fully your need to find a recovery group which is a good fit for you. If I can be of further help to you, please do not hesitate to contact me.

All the best,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: There’s a pretty big difference in the cost of different drug rehab programs. My wife needs to go to rehab and we are fortunately in a position where we can afford to send her. I want her to get the best care but we are both in agreement that she doesn’t need a ‘luxury’ experience or a beach view or any of that extra stuff that isn’t really much about addiction treatment. How much do we need to spend to get a very high quality of care if we don’t need all the fancy luxury stuff? It seems to me that a lot of places are trying to sell themselves almost like spas or resorts and the last thing she needs right now is a vacation. She needs real help.

Iona Health Says...:

I am glad that you recognize that there are different levels or types of substance abuse providers. I do not think there is a strong correlation between the increased cost of treatment and greater recovery rates. If your wife and you are clear that the “spa experience” is not desired or required, for your wife’s recovery, then more options open up to you. I have seen many people who have gone to some of the “high end” recovery centers, but did not recovery because the consequences of addiction were marginalized or minimized by more emphasis on comfort than the consequences from the disease of addiction. You asked about the cost of treatment. It would be helpful to me if I knew a few things, i.e., the exact nature of your wife’s addiction, the level of care she requires to recover, and the resources in the area of the country which you reside. There is great variance in price depending on the type of addiction, length of treatment, level of treatment, medical complications, level of motivation, relapse potential, and family support.

With this in introspect, I would recommend the following:

1. have a substance abuse professional provide your wife with a substance abuse evaluation which includes level of care (psychoeducation, intensive outpatient, residential/partial hospitalization, or hospitalization/detox). These are the four levels of care. You can obtain a free assessment through the Choose Help website for free, if you prefer. You need a diagnosis and treatment recommendation which does not obligate you in any way;
2. go to 12 meetings (AA or NA), depending on your wife’s drug of choice, and ask successful recovering members which treatment centers do they know have good recovery treatment; and
3. go to the Substance Abuse & Mental Health Services Administration (SAMSHA) which has a national facility locator website which can be found at: http://findtreatment.samhsa.gov/. Here you can find the best treatment center, check them out, and compare their programs and costs.

Between these three separate and unrelated resources, your wife and you should be able to find a good treatment center which is congruent with your desires.

I hope this information is helpful to your wife and you. Please know that the best programs have a strong family component which is critical to an impaired family member’s recovery. Also, it is important that your wife stay engaged in some form of treatment for at least 180 days from the date she begins treatment. This is critical for sustained recovery. If I can be of further assistance, please let me know.

All the best,

John W. O’Neal, Ed.S., MSW, MA, LPC, NCC

Question: My 26 year old brother has been a drug user for years. After one of his last big binges he wound up getting picked up by the police and spent a few days in a county mental psych ward because they said he had amphetamine induced psychosis. They said that it was unusual for a psychosis that was caused by meth to last for as long as his did and said that he must have been using an extreme amount in the days leading up to his getting picked up by the police because he had been hiding in a janitorial closet at the mall and he wouldn’t come out. I am really scared for him. My mom picked him up from the hospital and brought him home. She called me to come back to town to come for a visit and to talk to him. I had not seen him for about a year and I was really shocked by what he looked like. I am 2 years older than him but he looks grim and apparently he was looking a lot worse than this when they picked him up. I told him I’d sell my truck and pay for rehab if he’d go but he said it was too late for him. He says he has brain damage now and the only way he can ever feel happiness now is by using meth. He says he knows he won’t live long but there’s nothing he can do about it now. He seems really defeated and unwilling to do anything to fight to get better. Is this true or is this the drugs talking? I do not doubt that the drugs would have affected him in some ways, but I would think that once he could get really clean and sober for a while he’d be able to snap out of the depression? I feel like it’s our last chance to save his life because if we don’t get him to stop now it’s only going to get worse from here.

Iona Health Says...:

Dear Concerned Family Member,

Your brother sounds like he is very progressed in his meth addiction. It is not uncommon for meth addiction to show poor motivation for recovery. With amphetamine drugs, like meth, it is common for them to have depression as a rebound effect from using the drug. This has more to do with brain chemistry (reduced dopamine) than the actual circumstances: although they do sound grim. When you describe your young brother as grim, unhappy, hopeless, defeated, unwilling (unmotivated), and having impaired/compromised reality testing abilities, these symptoms often accompany the chronic or long term use of meth and the resulting depression.

First, it important to understand that addiction is a family disease and not just an individual problem. The most effective treatment treats the family, not just the addict in isolation. If the family does not make some changes, then an addict will frequently relapse; causing the family to lose hope themselves. To effective and therapeutically deal with an addict, the family needs support. A good basic article for the family can be found at http://www.addictinthefamily.org/chapone.html. It recommended that family members seek support in 12 Step groups, such as Al-Anon or Nar-Anon (and http://www.nar-anon.org/Nar-Anon/Nar-Anon_Literature.html. There are some excellent reading resources on these sites for the family trying to help the addict and themselves. Please try to educate your family and yourself about the exact problem you are facing with your brother.

Another suggestion would be to find out as much about meth addiction as possible. There are stories and people who are out there who have shared how they overcame meth addiction. Some good resources to begin are:

http://www.thegooddrugsguide.com/amphetamines/index.htm

http://www.drugabuse.gov/publications/research-reports/methamphetamine-abuse-addiction/how-methamphetamine-abused

http://www.drugabuse.gov/publications/research-reports/methamphetamine-abuse-addiction/what-are-long-term-effects-methamphetamine-abuse

For treatment recommendations for methamphetamine addiction from NIDA, go to: http://www.drugabuse.gov/publications/research-reports/methamphetamine-abuse-addiction/what-treatments-are-effective-methamphetamine-abusers. I would recommend a program which uses the Matrix Model for methamphetamine addiction.

Lastly, I would ask that your family and you to consider doing an intervention with your brother. An intervention is when the family and friends of the family come together to confront the addict on his self-destructive behavior and how it affects everyone involved; including the addict. The goal of the intervention is to willingly gain the addict’s consent to immediately enter into treatment. Sometimes treatment centers will offer this or you may want to hire an individual interventionist. For information about how families do their own intervention or how interventions should work, go to the free eBook at: http://www.floridahouseexperience.com/

Although your brother claimed that he has brain damage, research supports the idea that the brain is able to partially recover. I would encourage you to focus on his recovery rather than damage your brother may or may not have caused himself by his use of meth. Please consider having your brother engaged into a professional evaluation by a substance abuse professional experienced with meth abuse/addiction. Remember, there is hope even in the most desperate situations.

I wish your brother, family, and you very success in the near future. If I may be of further help, please let me know.

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I am addicted to Vicodin and I take about 15 every day. I am worried that I am going to die or wreck my liver and I know I have to stop. I am only 27. I have been using vicodin for about 2 years. I want to know if I should use Suboxone or if I should go to some sort of drug rehab? Which is the better way? I want to get free of all this.

Iona Health Says...:

From my research, you are correct about possible liver damage from Vicodin, which like many pain relievers, has acetaminophen in it. According to WebMD, no one should take more than 4000milligrams (4 grams) per day if they have no liver impairment. The problem is so many prescription medications and over the counter medications have acetaminophen in them. I would recommend that you look at every medication, prescribed or over-the-counter, so you can determine how much acetaminophen you are processing through your liver. Symptoms of liver damage are: dark urine, persistent vomiting/nausea, stomach/abdominal pain, extreme tiredness, and exhaustion. If you have any of these symptoms, it is highly advisable that you seek medical treatment. If you do have liver damage, you need to find out from your physician or pharmacist how much daily acetaminophen you safely are allowed. According to a recent CDC study, more people are dying from prescription drug abuse than street drugs. People have died from prescription drugs even they took them as prescribed. This is not a drug that mixes well with alcohol. Alcohol should not be used in conjunction with Vicodin.

To answer your question “I want to know if I should use Suboxone or if I should go to some sort of rehab? This question becomes “should I become a legal addict or should I go into recovery and address problems associated with my addiction?” First, what are the ten signs of Vicodin Addiction? They are:

Top 10 Signs of Vicodin Addiction

1. Using Vicodin for non medical reasons.
2. Consistently taking more than the prescribed amount of Vicodin resulting in rapid increases in the amount of Vicodin needed, refill requests before the refill date, repeated “loss” of Vicodin prescriptions, emergency calls to a doctors office for Vicodin prescription refills, visiting a Vicodin prescribing doctor at the end of office hours for Rx refills, or having more than one doctor who prescribes Vicodin.
3. Compulsive seeking and using Vicodin despite negative consequences, (loss of job, debt, physical problems, family problems).
4. Sluggish behavior, drowsiness, apathy, lack of energy, sleepiness or constant sleeping.
5. Social withdrawal.
6. Inability to concentrate.
7. Persistent physical symptoms of pain pill use including slower breathing, constricted pupils, flushing of the face and neck, constipation, nausea, and/or vomiting.
8. Objection or unwillingness to provide medical records and refusing to take medical exams, tests or get referrals for Vicodin prescription.
9. Neglecting usual responsibilities (work, school, or family).
10. Withdrawal symptoms when Vicodin use stops.

I do not have information as to “how” you began using Vicodin; whether for physical or emotional pain or both. However, I do sense that you have hit some kind of “bottom” as indicated when you stated you wanted “to get free of all this.” The best recommendation would be for you to undergo Vicodin detox which must be medically supervised. This is often referred to as “medical detox.” Typical hydrocodone withdrawal and detox symptoms, i.e., flu-like symptoms, include sweats and chills, upset stomach (including possible cramps, nausea, or diarrhea), anxiety, tremors, and dilated pupils may all be present during detox. These symptoms can best be treated in a treatment center with the use of the synthetic opiate, Suboxone. You do not have to take Suboxone, as a substitute for Vicodin , as you can be tapered off of Suboxone within a few days with relatively little discomfort. For more information, please see: http://www.spiritualriver.com/how-to-beat-hydrocodone-addiction/

I hope this feedback helps further you in your personal recovery from opiate addiction. Remember, you can always consult with an addiction recovery specialist. Best of luck to you, your new decision and life.

John W. O’Neal, Ed.S., MSW, MA, LPC, NCC

Question: My adult daughter has just entered a treatment facility this week for drug addiction. Our family is well aware we have been enablers for many years and allowed the addict to control our lives in many ways, but we are now attempting to get educated about dealing with this disease and how not to enable her further, as well as support her recovery. The facility is 3 hours away from our home and they allow visitation every Saturday. An extended family Christmas get together for my husband's side of the family has been planned for this Saturday and we made plans to attend prior to our daughter's admission so we explained to her we would not be visiting this first Saturday. The following Saturday is Christmas Eve and traditionally we have had my family members in our home for a celebration on Christmas Eve. My husband, mother, and brother have no problem changing our get together to Christmas night so we may visit our daughter in treatment on Christmas Eve, however my other daughter (sibling of the addict) thinks we are changing our tradition to revolve around the addict, which she believes is something we should not do. Rather than viewing this as letting her disease control us, I see changing our normal Christmas plans in order to visit as a way to show support for her recovery. Can you offer your opinion on this matter?

Iona Health Says...:

Dear Parent:

For me to clearly understand, I numbered and identified your family dynamics as you explained and as I understood them:

1. Daughter started treatment for drug addiction (new behavior and direction for her and her family)
2. Family has enablers her to progress in her disease (new information and guilt???)
3. Getting education about how “not” to enable others (new information and behavior)
4. Supports daughter’s recovery (means family changes its behavior as well as daughter)
5. Facility is 3 hours away and has only Saturday visitations (new rules and structure)
6. Father’s extended family’s Xmas get together is on a Saturday (constant variable without deviation)
7. Xmas Eve, the next Saturday, is usually spend with wife’s family (old rule and structure)
8. Mother’s family is flexible and will spend Xmas eve night with Mother, Father and other daughter (healthy and adaptable behavior by mother’s family)
9. Other daughter has the problem: She thinks family is changing their tradition to revolve around the addict and wants to influence their decision and/or control them)
10. Other daughter is against their visitation with her recovering sister because she thinks parents are enabling addicted sister (resentment??)
11. Parents do not agree that addicted daughter is continuing to control them via her drug addiction (old behavior) and now recovery.
12. Parents believe a visitation with their hospitalized daughter is showing or offering support for their daughter’s early recovery from substance abuse. (new belief and behavior by supporting recovery rather than supporting continued substance abuse).

I normally don’t breakdown family dynamics, structurally, in my writings but I thought this might be a useful tool for your family and you in understanding the current changes, new beliefs, attitudes and behaviors which have resulted since your addicted daughter and your family beginning making changes for early recovery. Because I don’t know how you are learning about addiction and recovery, I assume you may be involved in some family education, outside reading or other materials, or attending Al-Anon and/or Nar-Anon. If you have, you would know that addiction is a family disease because it doesn’t affect only an individual family member but everyone is affected by the destructiveness of the addiction.

The most prominent feature of your situation is your other daughter’s demand that you please her rather than please yourselves or your recovering daughter. I don’t know how much resentment your other daughter has about your enabling role with your addicted daughter, but this needs to be addressed in your decision-making.

One of the primary ways that family members enable other family member is people pleasing. Also, is your non-addicted daughter learning about addiction as a family disease and how families need to recover together? Is this daughter blaming you for your addicted daughter progressing in her addiction by your enabling behaviors? What is it YOU want? In recovery, people start separating their needs from their wants. Do you need to be with your daughter in treatment? Or you want to be with her? What matters is clarity in your actions and what you need/want to accomplish. I would strongly recommend that you not allow anyone to demand or manipulate anything from you. How is this demanding daughter supporting her own and her family’s recovery? Has she not been affected too? One of the predominant features of addicted families is anger. How is anger expressing itself in this situation, if at all?

You asked for my opinion. My opinion is for you to start making decisions based on what you want instead of what others want; including both of your daughters. People who live their lives for other people are sometimes called codependents. Untreated codependents can only enable and are unable to help other recover. If you believe differently from your other daughter that your action to visit on Christmas Eve furthers your addicted daughter and family in recovery, then I would support this decision. If your other daughter is right, and you are only continuing in your enabling behavior, I would let my recovering daughter know that the family has holiday traditions of being together, and you are sorry she won’t be there this time. Your daughter in treatment probably knows that she is experiencing the cost of her addiction on many levels, and not being with her family as usual is one of them. Have you asked your recovering daughter what her thoughts are about this?

I would encourage you to contact the family therapistor counselor at your daughter’s treatment facility and find out how they can help your family. Also, you may want to find out how other families are approaching this dilemma with their family members in treatment. In recovery, people learn to work a selfish program in contrast to the previous “self-centered” program.

My hope is that I answered your question as you needed. May your family have a love and wonder-filled holiday as you begin your new adventure: family recovery from addiction. Happy Holidays! 

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I’ve been riding a high of bath salts for like the last three months. Now theyre illegal all of a sudden and the price is way higher and they are getting way harder to get when they used to be on sale everywhere. Now that I have trouble getting them sometimes I am starting to realize how much I NEED THEM and this is a little bit scary to me. I always thought they were nonaddictive but now I think theyre ridiculously addictive. I used to smoke cigarettes but I quit and this is way harder than that was. Some of my friends are already switching on to meth and coke but I always said I wasn’t going to get going into those, especially the death meth. I have a few days supply left and then I don’t know if I am going to be able to get anymore and once I am afraid of what that will feel like. How can I get off the salts without feeling so terrible. I want to quit now but I am afraid if it gets to bad I will use another drug like meth just to feel that high again.

Iona Health Says...:

You are very wise to seek our professional advice about your substance abuse of bath salts. Despite that you have only used bath salts for three months; this does not address how long you have been using substances for some desired benefit. From my knowledge and research, you have not been using a non-addictive substance, i.e., bath salts. The use of bath salts to get “high” rivals the physiological and psychological damage of meth use according to many experts. The first concern that you expressed was the unavailability and dependency on your use of bath salts. The government and medical establishment have identified the dangers of getting high from bath salts. Therefore, they have made them unavailable and/or more expensive to obtain.

When you expressed that you “need” the bath salts causes some concern because it suggests possible heavy substance abuse or addiction. I am providing you with various resources for you to explore so you can decide for yourself if bath salts are less problematic or less addictive than meth or cocaine. First, I would ask you to consider whether you are showing signs of addiction with this website:

http://www.drugaddictiontreatment.com/10-signs-you-need-drug-addiction-treatment/

The following websites offer you information about the dangers and problems using bath salts to get high:

http://abovetheinfluence.com/facts/drugsbathsalts

http://www.drugaddictiontreatment.com/types-of-addiction/adolescent-drug-abuse/bath-salts-addiction/

These videos are by Dr Drew who covers the problems associated with bath salt abuse:

http://www.youtube.com/watch?v=KBF1NGdqcPA (Part 1)

http://www.youtube.com/watch?v=6qiKTm_Y2EI (Part 2)

Finally, it is important for to consider all of the costs and benefits of substance abuse with any substance but particularly bath salts. From the limited information I have, I still would highly recommend that you have an assessment for substance abuse and/or addiction to bath salts. If you require treatment, the sooner you seek it, the less intense treatment you may require. Using meth or cocaine will only compound this problem. I am very impressed that you recognized this as a serious concern. If I can be of further help to you, please let me know.

John O’Neal, Ed.S, LPC, NCC

Question: I USE COCAINE AND ECSTASY RECREATIONALLY ON THE WEEKENDS. LATELY I HAVE BEEN HAVING VERY STRONG CRAVINGS TO USE COCAINE DURING THE WORK WEEK ALSO AND I HAVE STARTED USING ONCE IN A WHILE. I DO NOT WANT TO STOP USING ON THE WEEKENDS BUT I DO NOT WANT TO BECOME ADDICTED EITHER. IF I AM CRAVING COCAINE DURING THE WORK WEEK AM I ADDICTED?

Iona Health Says...:

Cocaine and Ecstasy Addiction

I used to work on a cocaine/crack rehab units. You are very correct in being concerned about becoming dependent on cocaine. Ecstasy is not known to be addictive per se, but one can form psychological dependency if the drug is meeting a real or imagined need.

Craving, preoccupation, using despite adverse consequences are symptoms of addiction. However, you do not indicate or reveal that you have lost control over the use of cocaine. It’s the "loss of control" which is the line which is crossed from heavy usage to addiction. So you do not appear to be addicted but could still be classified as a moderate to heavy substance abuser if you spent money for cocaine that you can't afford to spend, your performance at work or school has declined, self care is deteriorating, continued use despite the concern of others, and/or any of your major areas of functioning or major relationships have been affected, then it would be very clear that you are seriously progressing towards addiction via your cocaine use. Your desire to use when you aren't planning to use does show signs toward dependency.

Be aware that the main defense of addiction is denial. Denial is a defense mechanism which clearly reports that there is no problem with addictive substances or behavior. I want to share with you that anyone who relies on addictive substances to "feel good" is not a person who is happy and whose life is satisfying or going well (without adjunct chemical coping or pleasure).

You are very wise to be concerned and to be asking questions. In addiction rehab, it is commonly understood that if you have a concern about substance abuse, then there is probably good reason to be concerned. I would ask you what does ecstasy and cocaine provide you with? What is missing from your life which these drugs provide you with?

Whenever a user is concerned about their use or excessive preoccupation, cravings, or use, red flags should go up for everyone. Since you have been very brave to go this far, I would recommend you do several things to help you gain more clarity and to help you make a "wise decision" about your continued cocaine use. They are:

1. Take a cocaine addiction self test for cocaine addiction at http://www.ca.org/literature/selftest.htm provided by Cocaine Anonymous

2. Go to the website: http://www.ca.org/

Look for a Cocaine Anonymous (CA) meeting near you and attend several meetings and listen to how cocaine has affected the members and how their stories could reflect your current experience.

3. You are keenly aware of the positive effects of using Ecstasy and Cocaine, but do you equally know their negative effects? Do your own research by going to the following websites:

Cocaine:

http://www.webmd.com/mental-health/cocaine-use-and-its-effects

http://www.acde.org/common/cocaine.htm

http://www.thecyn.com/cocaine-rehab/signs-cocaine-abuse.html

http://teens.drugabuse.gov/facts/facts_brain1.php

Ecstasy:

http://www.ecstasy-effects.com/

http://www.arizona.edu/features/monks-study-adverse-effects-ecstasy

http://teens.drugabuse.gov/facts/facts_xtc2.php

4. You could obtain a substance abuse assessment from a substance abuse professional or treatment center. Many centers will provide an assessment with recommendations for free. If it is determined that you need support in decreasing or stopping your use of cocaine, you might want to consider treatment in an outpatient program. The sooner you address this issue, the lower the level of treatment or intervention you would require.

Remember, one of the hallmarks of addiction is using drugs against our will or when we do not plan on using them. I hope this information has been helpful to you, and I hope you know that many people can relate to your struggle. This type of problem is best dealt with in group counseling not individual counseling. Best of luck to you, and if I could of future assistance, please let me know.

John O'Neal, Ed.S, LPC