Drug Abuse and Rehab in the State of Wisconsin
While Wisconsin typically reports numbers that are lower than the national average in drug abuse, those numbers have seen huge spikes over the past 10 years, reflecting a growing trend across the country. Heroin and opioids remain Wisconsin’s largest problem and account for the vast majority of illicit drug-related deaths.
Meanwhile, the use of drugs like methamphetamine and cocaine continue to be a problem. This is especially true of methamphetamine, which is now easier to make and manufacture for personal use than ever before.
In addition, alcoholism continues to represent a major health threat to the area.
The statistics themselves are alarming. In 2015, over 52,000 Americans died from drug overdoses. In 2016, that number rose to over 60,000. Opioids now kill more Americans than breast cancer, traffic accidents, and gun violence. In 2016, we lost more lives to drug overdose than the entire Vietnam war.
Alcohol continues to take lives as well. 88,000 people died in 2016 due to alcoholism. That makes alcoholism the 3rd leading cause of preventable death, just behind tobacco and poor diet. A study done in 2015 showed that Wisconsin was the heaviest drinking state in the country. This includes incidences of binge drinking, and rampant alcohol abuse disorders – not just folks relaxing with a couple of beer after a long day of work.
More troubling still is the rate of underage drinking and drug abuse, with statistics in this department also showing growing numbers. Nearly 75% of high school students reporting drinking at least once in their lives. 20% of those were before the age of 13.
To say that Wisconsin’s drug of choice is alcohol then is to put it mildly. But Wisconsin also seems to have problems with heroin, crack, and methamphetamine as well.
This article is aimed at those that are themselves looking into treatment to kick their habit or have family members or close friends that are currently in need of receiving treatment. Here, you can learn all about the various drugs, the dangers, and the addiction. You will also learn about how drug abuse is treated and what recovery means.
Drug abuse remains a serious problem all across the United States. While Wisconsin’s numbers are slightly below the national average for most illegal drugs, annual deaths caused by drug abuse continue to increase. The rates of alcoholism in the state are exceedingly high. It’s not uncommon for individuals to find themselves in the thrall of addiction, but help is out there for those who seek it.
Recovering from addiction and restoring balance to your life is within our power. The process may not be easy, but it is worth it. If you or someone you love needs help there are a number of excellent facilities in Wisconsin that can help them.
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Wisconsin and the Opioid Epidemic
Wisconsin’s drug abuse epidemic reflects a growing trend throughout the United States. More and more people dying due to overdose than ever before. The National Survey on Drug Use and Health estimates that there are nearly half a million untreated active heroin users in the United States. The rate of heroin addicts entering rehab and being admitted to emergency rooms has grown steadily in that period which has led many to proclaim that there is an opioid epidemic.
Indeed, the aggressive prescription of opioid-based painkillers and drugs like fentanyl which can now be made on the street has led to a growing scare that those in government and hospitals are ill-equipped to deal with.
All of this leads to a growing picture of a culture of addiction. From 2001 to 2007, the number of deaths attributed to heroin overdoses in Wisconsin remained roughly consistent at around 27 per year. But by 2014, that number had skyrocketed to 267 per year just in Wisconsin alone. This is despite the fact that drugs like naloxone are now routinely distributed to emergency medical personnel and can successfully prevent overdoses.
75% of that number were males. 80% were white. Only 33% had a high school diploma. Nearly half of those who died heroin overdoses lived in either Milwaukee and Dane County.
Why Heroin Abuse is on the Rise
There’s no shortage of blame to go around for who is at fault for the opioid epidemic. Many have rightfully criticized doctors and drug companies for the over-prescribing and deceptive marketing of opioid-based pain management medications. Others have noted the heroin that has found its way into the Wisconsin market is purer and does not need to be injected. Law enforcement has remarked that the distribution of heroin has grown more advanced and easier to accomplish and this has resulted in lower prices and easier access to the drug.
The key component, however, seems to the rise in abuse of prescription opioids that are marketed for pain management. Of the 834 drug overdose deaths in 2014, 382 (45%) were due to prescription opioids such as oxycontin, methadone, hydrocodone, and others, while heroin only accounted for 27%. Of that 27%, it’s impossible to say how many got their start from abusing pain medication that they were prescribed by a doctor.
Statistically speaking, the so-called opioid epidemic began around about the same time doctors and drug companies began using opioids more frequently to treat pain. While some of this has to do with the fact there aren’t enough doctors in the US that specialize in pain management, a lot boils down to the mismanaging of the medication by both doctors and their patients. Opioids have high rates of abuse and even for those whom drug abuse was not alluring or romanticized can easily find themselves in the grips of opioid addiction through no fault of their own.
It was also around this same period when a black market for prescription pain medications blossomed. Mules would go shopping for doctors who they believed would be easy marks for prescriptions. They would fake symptoms, purchase the medication, and then sell it on the street for major profits.
The pharmaceutical companies were happy because they were seeing record profits, which was exactly what they had hoped for. They were actively promoting the drugs to doctors who then prescribed them to patients that were more than willing to take them. When complications arose, the doctors might cut off the prescription, but the patient was left going through a horrible withdrawal syndrome. In other cases, the addiction would go unchecked. A number of these people were older Americans who suffered from common ailments such as arthritis. Others were middle-aged folks that were coming out of recent surgeries.
This has resulted in New York City filing a half a billion dollar lawsuit against drug companies over the opioid deaths. While heroin and other opioids were a problem in the early 2000’s and the 1990’s, the statistics were nowhere near as grim as they are in 2018. According to one report, more than 1 in 3 Americans was prescribed opioids in 2015.
Part of the issue is that insurance companies are very quick to cover opioid prescriptions for pain in the US, whereas in other countries, they’re much more reluctant. This has led to a situation in which the US is responsible for nearly 27% of the world’s drug overdoses, despite having only 4% of the population. In 2015, roughly 6,800 Europeans died of opioid-related overdoses. The number in the US was over 30,000. This is despite the fact that Europe’s population exceeds that of the US’s.
While prescription opioids, reckless doctors, and aggressive pharmaceutical companies are a huge part of the problem, another one is the availability of street-grade heroin and fentanyl. Another part of the issue is Milwaukee. Milwaukee, as the 7th largest city in the US, is well known as a key center of distribution for legitimate goods. But its location also serves to benefit drug traffickers the same way. Milwaukee sits on Lake Michigan and has one of the largest ports there. Among the cargo passed through that port is illegal drugs. Cartels have also become smarter about how they move and traffic these drugs. They can be made cheaply, moved efficiently, and this has lowered prices across the board.
Regardless of the cause, the heroin and opioid problem in the United States continues to get worse by the month. Law enforcement is overwhelmed and ill-equipped to deal with the growing crisis. Medical facilities are overwhelmed by the growing need for effective measures. Americans are more at risk each year.
What is an Opioid?
While there used to be a distinction between the terms “opiate” and “opioid”, the term “opioid” variously refers to a class of synthetically derived opiate derivatives, or any drug that activates opioid receptors in the brain. Opiates, on the other hand, only refer to naturally derived drugs like opium. This distinction isn’t overly important. The word “opioid” is generically used to describe the entire family of drugs that act on and bind to opioid receptors in the brain.
There are four classes of opioids:
1. Opioids that naturally occur in the body, also called endogenous opioids. Example: endorphins.
2. Opium alkaloids that are derived from opium, once known as opiates. Example: morphine and codeine.
3. Semi-synthetic opioids have similar structures to opium alkaloids. Example: heroin and oxycodone.
4. Fully synthetic opioids have structures unrelated to opium alkaloids. Example: methadone.
Clinically speaking, when these drugs bond to opioid receptors in the brain, they send a signal to slow breathing, reduce pain, and give a calming and tranquil effect. They also produce a temporary euphoria. For those that suffer from acute or chronic pain, these drugs can be effective at reducing that pain. In certain instances, the body can’t produce enough natural opioids itself to reduce pain.
In addition, opioid receptors are involved in the reward system of the brain. When an individual accomplishes something major, a new relationship, winning a competitive event, achievement of a lifelong goal, or a major professional success, the brain naturally produces chemicals that are involved in the sensation of joy and pleasure. Opioids can artificially stimulate this sensation.
Opioids’ effect as a respiratory depressant is what causes an overdose. Eventually, breathing is slowed to the point of stopping altogether.
What is Heroin?
Heroin is a synthetic opioid derived from morphine. Its clinical name is diamorphine. It comes in two general different kinds. Those are black tar, which is mostly produced in Mexico, and a white or brown powder that generally comes from Asia. Of the two, the powdered form is the purest. Black tar heroin is so named because it’s a claylike block that is riddled with numerous impurities. It generally needs to be injected in order to have the full effect. Powdered heroin, being far more pure, can be smoked, snorted, injected, or mixed with tea.
It was first synthesized in the late 1800’s by an English chemist, and then later produced by the Bayer corporation as an all-purpose medication. As doctors became aware of the addictive effects of drugs like morphine, an alternative was sought to produce the same effects without the addictive properties. Ironically, heroin was a product of that effort.
At the time, it was considered a miracle drug and used to treat all manner of maladies ranging from common colds to mental illness. It was given to women to treat premenstrual syndrome. Today, there is no known clinical benefit of using the drug.
One of the reasons why heroin is among the most addictive substances known to man is that the drug naturally hones the euphoric properties of the opioid class. This results in the high that users feel directly after abusing the drug.
What is Fentanyl?
Fentanyl is also a synthetic opioid. Unlike heroin, it is used to treat severe chronic pain in those that have serious pain disorders, like cancer. Until recently, fentanyl was only available in hospitals or through the prescribing of a doctor. Today, fentanyl can be produced on the street making it much more dangerous. Over the past 5 years, fentanyl has left a growing number of bodies.
Fentanyl is said to be 30-50 times more potent than heroin and 50-100 times more potent than morphine. A couple milligrams of fentanyl is lethal for the majority of people. The effects of fentanyl are often indistinguishable from those of heroin. It would be impossible for emergency medical technician to deduce simply by observing an individual that they are overdosing from fentanyl and not heroin. In some instances, they won’t know that they need to administer more naloxone, the anti-opioid drug to stop the overdose.
One of the major reasons that the drug is spreading so quickly is that it has a very high profit margin. Fentanyl can be mass produced and produces many more times the amount of weight for trafficking than a similar amount of heroin. A kilo of fentanyl can produce roughly 500,000 doses. The same amount of heroin might only produce 10,000.
Are Prescription Opiates a Gateway Drug?
Many believe that they are. Careless prescribing of prescription opioids has had a serious impact on what is now being termed “the opioid epidemic.” Doctors who have practiced in multiple countries believe that Americans are averse to pain and that American doctors believe that they can fix everything with a pill. The prescription of opioids for acute but temporary pain far exceeds the approach of pain management overseas. In some instances, opioids are being prescribed for things as simple as a toothache, where over-the-counter anti-inflammatory medications may be sufficient.
When patients are released from hospitals, they find themselves craving the drug. Many choose to indulge that craving. Hence why many of those who find themselves in the thrall of a major opioid addiction were once individuals that were prescribed the substance legally.
In addition, the black market distribution of these pills has incentivized individuals to make up symptoms in order to procure and then sell them. Pair this with pharmaceutical companies that are enthusiastic to market their product, doctors who are complying with patient requests, and easy access to these drugs on the street, and you have the making of a full-blown opioid epidemic.
The Long Term Effects of Opioid Abuse
Aside from running the risk of death caused by overdose, heroin causes severe physical and psychiatric problems for those that use it over an extended period of time. In addition, the drug takes over their entire lives, becoming their sole motivating factor. While other drugs, like nicotine and methamphetamine, are routinely cited as being more difficult to stop using, the comparison largely exists because the addiction profile of opioids, and heroin, in particular, are so high.
It doesn’t take long for a user to become addicted, and once they are, breaking the habit is exceedingly difficult. Long after the drug has left the body, the yoke of the addiction can remain.
In this section, we’ll discuss how heroin and opioids affect the brain and body. Generally speaking, all opioids have the same impact, but heroin has them to a greater degree. The high caused by the drug is thus more potent, and the withdrawal is that much worse. That’s why it’s routinely used as the standard when discussing opioids in general.
Heroin and Other Opioids Effects on the Body
One of the major issues with prescribing opioids to treat pain is that users develop a tolerance to the drug. The more they take, the more they need to take to produce the same effect. In short course, the drug begins producing as much pain as it prevents.
An opioid that is as potent as heroin can produce withdrawal effects within one day of not taking the drug. While the worst symptoms of withdrawal generally end after the first week, there are those that report experiencing symptoms after many months of not having taken the drug.
Those who take opioids habitually generally suffer from side effects like constipation, nausea, and insomnia. The drug also works as a respiratory depressant which slows breathing. When overdoses do happen, it’s usually because the opioid has stopped the victim from breathing entirely. Diseases and infections that impact the lungs are not at all uncommon for heroin addicts.
There are no safe methods of ingesting heroin. Still, those that choose to inject the drug will find that it takes a much larger toll on their body. Collapsed veins and blood infections are not uncommon. These infections can find safe passage to anywhere in the user’s body. Since heroin addicts generally don’t take their personal safety into consideration when they’re using, the rate of infection and disease among active heroin users is much higher than others. Venereal diseases like Hepatitis C and HIV are much more common among heroin addicts than the general population.
Heroin use is designed to produce a euphoric effect that is followed by several hours of blissful tranquility. Users who are high on heroin don’t generally have a very good idea of what’s going on around them. Many will die simply from choking on their own vomit and not being jarred awake by the fact that they can’t breathe.
The Effects of Heroin and Other Opioids on the Brain
As heroin binds to opioid receptors in the brain, it produces a flood of dopamine in the process. This naturally happens in the form of endorphins when something wonderful or exciting happens. Vigorous exercise can also produce the same effect.
The problem is that the individual’s brain can no longer produce dopamine without the aid of the opioids. For up to a year after ceasing the drug, users can feel a profound sense of emptiness, hopelessness, and depression. The reward center of their brain is no longer functioning properly. This can be reversed in time, but the brain must be retrained how to produce dopamine properly, and in the meantime, longtime users end up in a battle with severe depression.
In addition, studies have also shown that long-term opioid abuse deteriorates the brains white matter. This, in turn, impacts executive functions, decision making, problem solving, and the ability to regulate behavior. White matter is involved in the transmission of impulses from one part of the brain to another.
Heroin also appears to decrease the gray matter density in the frontal cortex, the area of the brain that manages our sensory input, speech, and executive functions.
In other words, long-term users end up severe brain damage from extended use of the drug.
The Effects of Heroin and Other Opioids on the Psyche
You’ve likely heard of the term “chasing the dragon.” The dragon, in this metaphor, is the pure blissful experience that the drug provides the user. But as the brain grows used to the drug, the effect is diminished with each dose.
Heroin’s addiction profile is unlike any other drug. While users have a higher rate of relapse for a drug like methamphetamine, heroin conditions a commitment to the drug that is unmatched by any other. Not only does heroin make you feel great for a short period of time, but it also makes you feel awful after the drug has worn off. Heroin punishes the user for not using and rewards the user for using. On a long enough time scale, heroin addiction becomes just as much about avoiding an awful feeling as it does about seeking out a pleasurable one.
Meanwhile, users who use heroin for a long time begin to develop a tolerance to the drug. They need more and more of the substance in order to achieve the same effect. As that happens, the torture of withdrawal becomes more and more painful. Heroin addiction is thus propelled by an irresistible urge to procure more of the substance at any and all costs. They develop antisocial tendencies, manipulating and exploiting anyone they can to get what they need.
As stated earlier, the opioid system is responsible for both the regulating of pain and the reward system as well. The brain becomes dependant on the drug in order to produce dopamine. As one of the most potent opioids ever synthesized, heroin produces an incredible euphoria within 10 seconds of taking the drug.
Another way to produce a similar effect is through rigorous exercise. Endorphins are the brain’s way of naturally producing the same effect that opioids like heroin do. Those that have gone through detox are thus encouraged to spend a lot of time exercising to help the brain produce endorphins. It helps former users through some one of the most difficult aspects of recovery. It can also help fight post-detox depression and retrain the reward center of the brain.
For those that are still heavy users of heroin and other opioids, the drugs become the center of their lives and eventually become their sole motivation. The drugs override all other desires as there is no other experience that can compare to the high of heroin. Like an abusive lover, heroin’s hold on the user is absolute.
The Persistence of Long Term Effects
Heroin addicts will spend the rest of their lives managing cravings for the drug. While recovery and abstinence are possible, they require a great deal of internal strength and willpower. Our brains have a tendency to romanticize pleasurable experiences while forgetting about unpleasant ones. In many former addict’s minds, the memory of the highs will override the trauma of detox. This is especially true with therapies that are aimed at reducing the symptoms as much as possible. The risk of relapse thus remains throughout the individual’s life.
While many users are left living with the consequences of their addiction for the rest of their lives, the human brain is remarkably resilient. It takes time to heal, and symptoms can last up to 3 years after the last use, but it does, in fact, heal.
Heroin and Other Opioid Addiction Treatment and Recovery
The idea of full recovery is a controversial one. For the purposes of this article, understanding that the battle against addiction is a lifelong process is important. It’s also important to note that heroin recovery is a process that can take anywhere from a year to three years to achieve what would be considered by medical professionals as a final stage. That includes giving the brain enough time to heal itself over a couple years of abstinence.
To say that heroin recovery is a process with no end is a bit cynical. Nonetheless, the temptation to use will last for the rest of a person’s life. That doesn’t imply that the damage heroin does to the body and brain isn’t reversible. Many individuals that were former heroin addicts do go on to live productive and rewarding lives. It just takes time.
Here, we’ll outline how heroin and opioid addiction is treated and what an individual who is just undergoing that process can expect.
Assessment and Pre-Intake
The assessment is designed to allow the doctor to perform a full work up on the patient before they undergo the process of detox. Though helper drugs like methadone and suboxone have proven very helpful at mitigating some of the worst symptoms, the process still takes a physical toll on the body. In addition, the doctor will need to know if there are any other health problems that the patient has suffered because of their drug abuse. As is often the case with those that have had a heroin problem for an extended period of time, the damage done to the body can be extensive. Treating infections and the like is often a priority.
It also helps when the doctors and medical care providers have a complete understanding of the patient’s drug abuse history. They will also need to know about prior surgeries or other health problems, and a family history of health problems can also be very illuminating. It will help the doctors anticipate complications should they occur.
Intake and Detox
Detox is the first step in the process of recovery. The drugs must be flushed from the system. The process of withdrawal, while not exactly fun, is not as bad as it once was. Doctors can mitigate some of the worst effects of heroin withdrawal by using helper drugs like suboxone and methadone to take the edge off. The user will not get the full brunt of the withdrawal symptoms, and the process of withdrawal can be spread over a longer time period.
Symptoms of opioid withdrawal include:
- Runny nose
- Dehydration
- Excessive sweating
- Tearing of the eyes
- Uncontrollable yawning
- Agitation and restlessness
- Insomnia
- Muscular pain
- Muscle spasms
- Inability to concentrate
- Aches and chills
- Tremors
- Rapid heart beat
- Nausea
- Diarrhea
- Hallucinations
Patients generally have the option of inpatient or outpatient detox programs. For obvious reasons, inpatient programs usually prove the most successful. Many patients will need to be under constant medical observation to avoid the risk of complications that might arise from the physical toll that detox takes. This depends heavily on the extent of their addiction. For those that are chronic heroin users, inpatient programs are usually required. For those that might have a problem with prescription pain medications that they’re trying to get off, outpatient rehab can sometimes allow them to continue going to work as they detox.
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Post-Acute Opioid Addiction Treatment
The post-acute phase of drug rehabilitation is when the majority of users will relapse. Even after the drug has been purged from the user’s body, and the physical addiction and withdrawal has passed, users report a strong desire to use the drug.
Heroin basically takes the place of any other potential motive toward gratification. As the brain becomes used to the drug and the euphoric effect that it has, it ceases to produce dopamine on its own. Dopamine plays a large role in the process of reward and pleasure. The medical term for this is anhedonia which literally means the inability to experience joy or pleasure.
Dopamine itself is produced by the brain when something truly good happens in our lives. A promotion at work. Getting into a major college. The birth of a child. A brand new relationship. These are all things that produce dopamine, and rightfully so. Heroin addicts can artificially produce this kind of reward using heroin. But that’s the only way that dopamine gets produced. And as time goes on, the feeling becomes less and less fulfilling. A well-lived life is just the opposite.
The post-acute phase of heroin or opioid recovery is thus the most difficult. Addicts describe this period as a feeling of:
- Hopelessness
- Depression
- Emptiness
- Despair
In addition they may suffer from:
- Restlessness and insomnia
- Feelings of dread, panic, and anxiety
Heroin addicts are not merely physically addicted to the drug. They are also psychologically addicted. Heroin conditions those who abuse it to feel as though they can not experience pleasure or happiness without the drug. While psychiatrists can treat these various symptoms of post-acute withdrawal with anti-depressants and anti-anxiety medications, the process is very difficult.
One way that heroin addicts in recovery can rehabilitate their psyche and their bodies is by getting a great deal of physical exercise. This will help restore their ability to naturally produce endorphins which are the brain’s natural way of producing an opioid-like high.
Nonetheless, this part of opioid addiction recovery is difficult. For those who are a part of the support structure of someone who is recovering from heroin and opioid addiction, it’s important to realize just how difficult this phase of recovery is. Your loved one may appear distant, withdrawn, agitated, and not a lot of fun to be around. It’s because the simple joys that we take for granted in life can’t be appreciated by a person in the post-acute phase. In time, the damage done to their brain chemistry can be corrected. In the meantime, it’s a difficult road ahead.
Treatment Options for Post-Acute Patients
Those recovering from opioid addiction have a few different options at their disposal. Those include:
- Intensive inpatient programs
- Partial hospitalization programs
- Intensive outpatient programs
Depending on the severity and length of their addiction, any of these options can be successful. Statistically, intensive inpatient programs have shown the most success.
Intensive Inpatient Programs
Intensive inpatient programs generally last for 28 days. There are also programs that last for 3 months. They offer the most restrictive environment for those in recovery and the most medical oversight as well. Inpatient programs that last 3 months have shown themselves to be more successful than 28-day programs. This is because they help those in recovery through part of the post-acute phase.
Patients are also offered a number of other services. There are group meetings in which those in recovery can talk with those who are in a similar position. They can discuss their addiction, their reasons for using, and what they plan to do once they get out of rehab. These discussions are led by counselors and designed to give those in recovery a space to talk about their addiction while gaining valuable information about how to remain sober.
Patients likewise have access to individual counselors that they can meet with on a one-on-one basis. This is an opportunity to discuss coping strategies and talk about their concerns once they leave rehab. In addition, counselors can act as a go-between which will link the patient to outpatient services. This can include linking them with housing options, a primary care doctor, and psychiatric care if that’s what they need.
Most of those that do come out of rehab will require some level of psychiatric care. Though they may not be diagnosed with a mental illness, addiction disorders themselves are mental illnesses that need follow up treatment. Counselors will ensure that they are maintaining their sobriety and address any needs or concerns that they may have moving forward.
Partial Hospitalization Programs
Partial hospitalization programs are like a hybrid of inpatient and outpatient care. They are designed for those who are experiencing acute psychiatric symptoms but can also be useful to those in recovery who are in the post-acute phase of addiction treatment.
For those who have been released from an inpatient program, partial hospitalization is a step toward a higher degree of freedom. Sometimes partial hospitalization will be court ordered, but patients can also opt into this program as well.
Partial hospitalization programs are usually 3 to 5 days a week. Structured programming is offered throughout the day. This can include group sessions and one-on-one meetings with counselors. In addition, patients can discuss concerns and problems that they are having. If they’re finding it particularly difficult to use, or the post-acute symptoms are especially difficult, they’ll have access to doctors and psychiatrists that can determine if certain medication would help. They can also be linked to services that might provide financial relief. If they need to apply for food stamps, temporary assistance, or disability, they can be linked to social workers that would help them through that process.
While many fear that partial hospitalization programs can be isolating, the opposite is true. Those in these programs can interact with others and spend time with those that are going through similar problems. All of this is designed to help those in recovery manage their cravings and develop the necessary coping strategies.
At the end of the day, patients can go back to their homes. Partial hospitalization is most effective when the individual has a secure and drug-free living environment to return to.
Intensive Outpatient Programs
Intensive outpatient programs are the least restrictive of the three options. Logistically, they are ideal for those that are highly motivated to kick the habit, have employment or school that they would rather be attending, haven’t had a drug habit for an extended period of time, and simply need some help in order to break the cycle of addiction. Unfortunately, and for a wide variety of reasons, many choose outpatient detox when they really should be considering inpatient. If they don’t have a drug-free environment to go back to, or will be enticed to return to their old way of life, an outpatient program is likely to fail.
On the other hand, most individuals after they get out of detox, do some kind of intensive outpatient program, and this also presents many difficulties. The post-acute phase of heroin addiction is the phase during which the majority of those in recovery will relapse. Those who choose this program must be reasonably certain that they will be in an environment where they won’t face the temptation to use.
Outpatient programs are successful for those that have a home-life to go back to, a job, and are otherwise engaged during the day with a support structure that’s willing to ensure that they won’t use.
Patients are still expected to check in the with the hospital, take tox screens, and meet with counselors for one-on-one sessions, and group sessions. They will be guided toward managing their cravings and taught how to deal with the stressors that cause them. This can be done around their schedule, so if they work during the day, they can still go to work and receive services.
Psychotherapy for Opioid Addiction
While there’s no one-size-fits-all solution for treating opioid dependence, drug counselors have noticed the greatest amount of success using CBT (Cognitive Behavioral Therapy). Since stress is often a key trigger for just about any addict, counselors can help patients learn better ways to manage stress using mindfulness training. This is also geared toward teaching those in recovery how to become aware of how their unconscious thoughts can influence their behaviors. Since cravings are always going to be present, and stress is unavoidable, learning these skills is a key part of maintaining sobriety. Psychotherapists can also help patients become aware of their underlying reasons for abusing drugs.
Addicts also generally suffer from other kinds of mental health disorders as well. These can either be brought about through sustained drug use or be themselves an underlying cause of drug abuse. Since each patient is different, different approaches will prove successful with different patients. It will depend on what other diagnoses they have.
Wisconsin and Crack / Cocaine
Crack and cocaine are considered the biggest drug threat by law enforcement agencies in central and eastern Wisconsin, which is right where two of its largest cities reside: Milwaukee and Madison. Crack itself has always been considered a city drug, and associated with the inner city. This is largely because it’s controlled and distributed by street gangs that are affiliated with Mexican drug cartels. The cartels handle the transportation and distribution of powdered cocaine to the cities where it is converted into crack and sold cheaply on the streets. For that reason, it is also the drug that is most associated with violent crime.
While heroin has stolen all the headlines because of the opioid epidemic, there are still those for whom stimulants are preferable. Crack and cocaine continue to be a major problem for the state of Wisconsin.
What is Cocaine?
Cocaine is a powerful stimulant that is sold as a white powder. It is derived from the coca plant that is indigenous to South America. It is there that cocaine is purified into its powdered form for transportation into America and across the world.
In the late 19th and early 20th centuries, cocaine was believed to be a miracle drug. Sigmund Freud wrote several papers on the therapeutic benefits of the drug in treating patients with various neuroses. It was also sold in several elixirs to treat a variety of different problems and used as an anesthetic for its numbing effects when injected. It even found its way into America’s favorite carbonated beverage, Coca-Cola.
In the 1920’s, it was made illegal, as doctors and their patients became aware that it was incredibly addictive. It is still used as a local anesthetic for certain kinds of surgeries. Cocaine can be injected, but normally, it’s snorted into the nostril. Its effects are instantaneous. It gives the user an instant high, followed by a period of energy, after which the only thing the user really wants is more cocaine.
In 2014, just under one million Americans found themselves addicted to cocaine in either its powdered form or as a crack. Each year, roughly one million people find themselves in the emergency room because of cocaine. Because it is associated with club and party culture, many of these people are on multiple substances at the same time. In 2014, over 5000 people died from cocaine overdoses. In Wisconsin, roughly 10% of those who were killed fatally in a car accident tested positive for cocaine.
What is Crack?
Crack is freebased cocaine. It is more potent, but the high lasts for a shorter period of time. It is considered more addictive than cocaine, and the majority of those that have serious, chronic cocaine habits are addicted to crack. Instead of being primarily snorted, crack is usually smoked.
Crack is a much younger drug. It found its way into major metropolitan centers like New York and Philadelphia in the mid-80’s. It’s still considered the drug of choice for inner-city addicts.
The Effects of Using Crack or Cocaine
Cocaine in its rock form is one of the most instantly addicting substances known to man. The majority of those who smoke are poor, urban, and live in the inner city. The African-American population has been particularly hurt by the crack trade. Urban and inner-city hospitals routinely report that around a third of pregnant mothers test positive for crack cocaine, or some other illicit drug. While the drug is mostly available in the inner cities, its use has spread to suburban and rural areas as well. Though statistics show that heroin and opioid abuse presents the greatest growing risk to America’s communities, crack and cocaine are still dangerous drugs infesting the most vulnerable part of America’s cities.
The biggest issue with a drug like crack or cocaine is that as soon as the drug has worn off, which can be anywhere from 10 minutes to an hour (in powdered form), the user immediately wants more. Because of this, crack users typically find themselves engaged in petty crime. Sometimes they engage in violent crime.
Cocaine users, on the other hand, are typically “weekend warriors” or students that enjoy the party scene on the weekend. Many of them will develop chronic habits as they begin integrating the drug more completely throughout their weekly schedule. Cocaine is considered a drug of the upper and middle class, while crack is predominantly a drug of the impoverished. How this happened is a matter of some debate and outside the scope of an article like this.
This section will cover the short-term and long-term effects of cocaine and crack abuse, and its impact on the body and brain.
Short-Term Effects of Crack and Cocaine Abuse
When a user smokes crack or snorts a line of cocaine, the effects are very similar and differ only in degree. Crack produces a more potent effect over a shorter period of time. Cocaine is designed to activate the mesolimbic dopamine channel, which is involved in the reward system of the brain. When you have sex, eat food, or something really good happens, a natural functioning brain will activate this pathway. As a result, all the feelings that are associated with happiness and excitement are released when a user does a line or smokes some crack. Unfortunately, those feelings aren’t designed to last very long. What follows is a sense of agitation, anxiety, restlessness, depression, and a strong desire to smoke more crack or do another line. Further, each time that center of the brain is activated, the effect becomes less potent. This means that the inevitable result of abusing a drug like this is restlessness and depression.
For that reason, cocaine and crack are often taken alongside depressants like alcohol. This ensures that those that are abusing the drug will not have the restless feelings and experience less agitation than those who aren’t drinking at the same time. It will also help them fall asleep, which crack and cocaine tend to make very difficult. If you think that being restless, anxious, agitated, and depressed without the ability to fall asleep sounds pretty awful, then you’re absolutely right. The feeling can be chased off briefly by doing more cocaine or crack, or by drinking heavily enough to put yourself to sleep.
Why would users ever use such a drug? There are a few reasons. In the interim and for that short period of time, cocaine makes the user feel euphoric, energetic, confident, and stimulated. They feel mentally alert and hyper-aware. Since the brain weights the pleasurable experience more heavily over the unpleasurable experience, users are often left chasing the high or chasing the low away. Cocaine causes both.
Since crack and cocaine act as a stimulant to the central nervous system, they also greatly increase a user’s heart rate. Those that overdose on the drug generally die from heart attacks. It also greatly increases the risk of experiencing a stroke, seizure, or respiratory failure.
In addition, crack users generally smoke from very small pipes since the smoke doesn’t remain potent for very long. They often end up with burnt fingers and lips from inhaling the smoke through a very short pipe.
Because of the way crack and cocaine condition the user to keep on using, it’s not at all difficult to overdose from the drug. Signs of an overdose include:
- High blood pressure
- Rapid heart rate
- Chest pain
- Extreme anxiety
- Excessive sweating
- Nausea
- (Enlarged) dilated pupils
- Seizure
- Stroke
Long Term Effects on the Brain
Like many drugs that are used for “recreational” purposes, crack and cocaine activate the pleasure and reward center of the brain artificially, stimulating it to a degree that is neither healthy nor natural. Because of this, it induces long term changes to the chemical structure of the brain. The brain becomes reliant on the drug in order to produce dopamine which leads to feelings of agitation and depression when not on the drug. Users may also begin to feel paranoid and anxious. The brain circuits that are involved in stress become increasingly sensitive the longer the user is on the drug. Users will be more prone to mood disturbances and appear more and more “bipolar” to those who are close to them.
Their decision-making processes will likewise be compromised. This is caused by cocaine diminishing the functioning of the orbitofrontal cortex (OFC). Users will feel invincible. They will not process threats or danger in the same way that an average person would. They will likely take unnecessary and bad risks while on the drug. This can include the belief that they can operate a motor vehicle properly.
In addition, cocaine produces a tolerance. Users become both more desensitized to the euphoric sensations the drug produces while becoming less desensitized to the anxiety, paranoia, depression, and negative mood disturbances. This, of course, increases the risk of overdose for regular users.
Cocaine is often used in binges alongside alcohol and designer or “club” drugs. Ecstasy is sometimes cut with cocaine. This can increase the risk of dehydration, heart attack, stroke, or psychological effects like paranoia, hallucinations, panic attacks, and psychosis.
Long-Term Physiological Effects of Cocaine and Crack Abuse
Cocaine and crack are both often cut with a variety of other substances. These to a greater or lesser degree cause their own host of issues depending on how the drug is ingested. Those who smoke crack or cocaine are at increased risk of damaging their lungs. Those who snort the substance can destroy their nasal cavity. Those who inject the substance can collapse veins.
All stimulants, including nicotine, constrict blood vessels. Cocaine and other illicit stimulants do so to a much greater degree. Because this constricts blood flow to certain areas of the body, including vital organs, those organs can be damaged by the fact that they’re not getting enough nutrients. In addition, cocaine damages the gastrointestinal tract. This can lead to ulcers and physical damage to the stomach and intestines.
One of the well known toxic side effects of cocaine is that it damages the heart and related systems. Crack and cocaine users are at a much higher risk of stroke and heart attack than the general population. In addition, inflammation of the heart muscle itself is common, and the ability of the heart to contract can be severely compromised.
Since cocaine takes the place of natural reward systems of the brain, users will not feel the urge to eat very often. This can result in rapid weight loss and poor nutrition, which itself poses a serious risk to a user’s health.
Seizures are common among long-term cocaine users alongside other serious neurological problems. Users suffer an increased risk of bleeding in their brain and Parkinson’s disease.
Lastly, cocaine has a very high rate of relapse. Since the reward system of the brain has been conditioned to be responsive only to the drug, former users in the early stages of recovery will report a feeling of intense depression. The brain will take about a year before its fully capable of repairing the chemical processes involved with the dopamine channel. The rate of relapse within the first year is thus very high.
Crack & Cocaine Addiction Treatment and Recovery
The recovery process can be divided in 4 parts. Those are:
- Pre-Intake and Assessment
- Intake and Detox
- Post-Acute Treatment
- Continued Abstinence
During a drug assessment, doctors and nursing staff will want to know about the extent of a patient’s drug abuse. Though crack and cocaine are not associated with the severe physical withdrawal effects of heroin, there will be a period of withdrawal for long-term users. Medical staff will also need to know the amount of damage the drug has done to the person’s body. This will include a full physical. For those that have suffered certain permanent physical damage to their lungs or heart, the doctor will need to know that to avoid complications and make medical recommendations. If the damage can be repaired, it will be.
Users are generally advised to go through an inpatient program that will supervise the process of detoxing. Detox symptoms can include:
- Anxiety
- Exhaustion
- Difficulty concentrating
- Mood disturbances
- Irritability
After the initial detox phase, users will also experience:
- Severe depression
- Anhedonia (inability to experience pleasure)
- Agitation and shaking
- Difficulty sleeping
- Lack of motivation
- Fits of anger
Symptoms will occur within 72 hours of the last dose taken. Withdrawal symptoms can last up to 3 months. It will take about a year for the user’s brain chemistry to restore itself.
Approaches to Treatment for Crack or Cocaine Addiction
About 6% of those who sought treatment for drug about in Wisconsin were crack or cocaine abusers. About 68% of that number were crack users. Crack and cocaine users are very likely to be multi-drug abusers and alcoholics.
Pharmacological Approaches
In terms of pharmacology, there are currently no medications available to doctors to treat cocaine or crack addiction. While there is research being done in the area, nothing has been approved by the FDA. Doctors can treat certain symptoms of cocaine withdrawal, including depression and anxiety using medications that are already readily available to them. These would include anti-anxiety medications and antidepressants. In addition, research has shown that drugs used to treat alcoholism can be effective in also treating cocaine addiction.
Researchers are also developing a cocaine vaccine that would train the body’s immune system to bind to cocaine. This would help reduce the risk of relapse, as it would dampen the effect of the drug on the user’s body and brain. The vaccine is still in development as only 38% of users were able to produce enough antibodies to affect a serious change in usage.
Behavioral and Psychotherapeutic Approaches
For most clinics, behavioral treatments are the only available intervention for cocaine addiction. This is true of most stimulant addictions. Stimulants present a difficult problem for drug counselors. The rate of relapse is very high, even more so than heroin.
Nonetheless, drug counselors have shown positive results with one form of behavioral treatment known as CM (contingency management). This is also called motivational incentives. This program uses an award system that rewards patients for not using cocaine and other drugs. It has proven especially helpful for those that are addicted to stimulants because it aids in rewiring the pleasure/reward/motivation circuit of the brain away from the drug.
CBT (cognitive behavioral therapy) has also proven effective at preventing relapse. CBT focuses on helping those in recovery become aware of their stressors and triggers that make them want to use. It also teaches mindfulness training that can help patients become more aware of the unconscious and subconscious motivations that cause cravings. Patients are taught stress management coping skills that recovering addicts can use instead of abusing drugs. Since cocaine use is heavily tied to stress, this has proven quite effective at preventing relapse.
Lastly, therapeutic communities and drug-free residences provide a culture of abstinence that will help users avoid the people, places, and things that provide the temptation to relapse. 12 step programs are also effective for avoiding relapse.
The success of these programs, however, heavily depend on an addict’s willingness to commit to their recovery. The damage that cocaine does to the reward center of the brain is reversible, but it also takes time for the brain to adjust. One setback can have the user starting from point A all over again.
Wisconsin and Alcoholism
Wisconsin is the national heavyweight champion of drinking. A state whose baseball team is named the Brewers probably would enjoy a bit harmless booze every now and again. Unfortunately, Wisconsin also leads the US in binge drinking, drunk driving, and rates of alcoholism per capita.
There are a number of reasons why Wisconsin out-drinks the rest of the US. Those include easy availability, social acceptability, and very affordable prices. Wisconsin is also one of the few states in the country in which minors are allowed to drink alcohol, so long as they are accompanied by a parent who gives their consent.
While some might think this is all good fun, the problem comes into play in other areas. Wisconsin has the nation’s highest rate of drunk driving fatalities. Alcohol remains the most common substance of abuse in the US and results in more deaths than any other drug as well. These include drunk driving deaths, medical consequences of heavy drinking, and violent deaths caused by those acting under the influence of alcohol.
In 2015, roughly 50,000 Wisconsin residents died. Over 2000 of those were directly attributable to alcohol. 58% of those were caused by “acute” conditions such a motor vehicle accident or alcohol poisoning. Only 42% were caused by “chronic” alcoholism, including cirrhosis of the liver. 37% of those who died from “acute” alcoholism died of falls. In other words, they were so drunk, they fell off a balcony (or anywhere) and literally died. In actual figures, that’s 429 people. Compare that to the number of people who died from cirrhosis: 354. The majority of these individuals were older (over the age of 65).
The number of deaths in Wisconsin caused yearly by alcohol poisoning has gone up in recent years. In 2012, the number never got higher than 182. In 2013, and each year afterward, the number was over 200 per year.
Alcoholism predominantly affects the white population of Wisconsin, but it can affect those of any race, gender, or age group. While it’s considered a “safer” drug by some because it’s legal, alcohol is a drug, and by no means safe. It must be enjoyed responsibly. It’s addiction profile is lower than drugs like crack or heroin, but the impact of long-term abuse takes an incredible toll on the body, and once addicted, it’s incredibly difficult to break that addiction.
This section will be dedicated to the treatment and effects of long-term alcohol abuse on the brain and body.
Alcohol Poisoning
In 2015, roughly 10% of those who died alcohol-related deaths died of alcohol poisoning, roughly 208 people. Alcohol poisoning happens when an individual consumes so much alcohol over a short period of time that the alcohol content of their blood literally becomes poisonous to them. The individual will have shallow breathing, appear thoroughly confused, unresponsive, and can even go into a coma. Without urgent medical treatment, it’s nearly always fatal.
Signs include:
- Confusion and stupor
- Abnormal or shallow breathing
- Nausea and vomiting
- Hypothermia
- Pale or bluish skin
In the worst cases, alcohol poisoning can cause:
- Breathing to completely stop (suffocation)
- Heart attack
- Choking on one’s own vomit
- Severe dehydration resulting in brain damage
- Hypoglycemia resulting in seizure
Users that are at the highest risk of alcohol poisoning are those that engage in binge drinking. Binge drinking means the excessive intake of a lot of alcohol all at once. Most of those who find themselves in the emergency room for binge drinking are younger, many not yet old enough to drink.
Alcohol poisoning is caused when an individual’s liver cannot keep up with the amount of alcohol that’s being consumed by the drinker. The liver cannot filter enough of the alcohol out rapidly enough and thus the bloodstream is poisoned.
Long Term Effects of Alcohol Abuse
Alcohol abuse over an extended period of time can take a heavy toll on the drinker’s body. Obviously, cirrhosis of the liver is an inevitable cause of death for the majority of long-time drinkers. But chronic alcoholism can also cause:
- Brain damage
- Nerve damage
- Sexual problems
- Beriberi
- Ulcers
- Gastritis
- Malnutrition
- Mouth cancer
- Wernicke-Korsakoff Syndrome
In addition, alcoholics are at an increased risk of committing suicide. They can suffer blackouts or memory lapses, essentially losing time. They may have difficulty forming new memories or remembering things that have recently happened.
In other words, while alcohol is legal, it is no less dangerous than other illegal drugs. It just takes longer to develop the worst symptoms.
Treatment for Alcoholism
Just because alcohol is legal, doesn’t mean that the detox process is simple or quick. Alcohol detox can be fatal. It is therefore suggested that those who have been drinking heavily over a long period of time undergo inpatient treatment so that doctors can oversee the process.
Alcohol Withdrawal and Delirium Tremens
By the time an individual has reached physical dependence on alcohol, they can experience what is called delirium tremens, also known as DTs. All alcoholics who have a physical dependence on the drug will experience some kind of withdrawal symptoms. These symptoms can be broken down into various groups.
The first group is linked to the neurotransmitter gamma-aminobutyric acid (GABA). GABA is primarily responsible for feelings of relaxation. As you might imagine, those that are going through alcohol withdrawal have a difficult time feeling relaxed. Symptoms include:
● Headaches
● Heart palpitations
● Seizures
● Anxiety
● Restlessness
● Confusion
The second group is related to the neurotransmitter dopamine which is linked to the body’s reward system, the pleasure center of the brain. Dopamine also assists with cognition, motor coordination, and attention. Alcohol aids in the production of dopamine, so when an alcoholic suddenly stops drinking, the production of dopamine stops as well. The dopamine group of symptoms include:
● Tremors
● Vomiting
● Nausea
● Loss of appetite
● Fever
● Sweating
● Mood disturbances
● Irritability
● Confusion
For those who have drunk heavily over a long period of time, a final group of symptoms called delirium tremens are possible. These are the most severe symptoms of alcohol withdrawal. They include:
● Tremors
● Fatigue
● Restlessness
● Hallucinations
● Sudden mood changes
● Deep sleep
● Delirium
● Tonic-clonic seizures
There will be some instances in which alcoholics will shake so violently that they need to be administered a paralytic in order to stop the shaking. In most instances, DTs can be treated with a benzodiazepine like Valium or Xanax. In 5% of patients, DTs will be fatal.
The Stages of Alcohol Addiction Treatment
Alcoholism treatment can be divided into 3 categories:
- Detoxification
- Rehabilitation
- Maintenance
It’s important to note here that roughly 95% of those who are struggling with alcoholism do not believe they have a problem. It won’t be until something terrible happens, they’ve lost control of their lives, or they end up being forced into treatment by the courts that they will end up getting any treatment. And even then, sobriety will only stick when they recognize the toll that alcoholism has taken on their lives. But learning to let go of alcoholism can be very similar to the various stages of grief. The first stage is denial.
Detox will generally begin 24 hours after the last drink. Symptoms will vary depending on the length of time the alcoholic has been drinking for. It will not be a pleasant experience, but medical remedies are available. Severe anxiety and restlessness are generally the most reported symptoms. In extreme cases, the patient will need to be watched for seizures.
After the patient has detoxed, rehabilitation will begin. Cognitive Behavioral Therapy is generally employed for alcoholics, as well as other therapies, both individual and group. Alcoholics will need to learn healthy ways to manage stress to prevent indulging their cravings. This stage can either be done as inpatient or outpatient.
Once rehabilitation is concluded, alcoholics can begin reacquainting themselves with a normal life. But it’s important to remember that those that suffer from alcoholism are still in process. Getting back into the swing of things presents itself with a number of major stressors. The patient is thus advised to take it slowly. Support groups can be a major source of help for those in both the early and in later stages of the maintenance process.
It will take a lifelong commitment to sobriety in order to see this process through.
Wisconsin and the Approach to Drug Crime
Since 1990, Wisconsin’s prison population has nearly tripled prompting lawmakers to relax probation violations and brainstorm other ways of managing the situation. One way that they found to handle this is to incarcerate those who are guilty of crimes prompted by drug abuse differently than others.
This includes both violent and non-violent offenders. It is widely believed that most individuals that are under the influence of certain drugs do things that they would not otherwise do in attempting to procure more of the drug. In addition, these drugs impact the decision making process in such a manner that it’s difficult to determine the quality of the individual’s character.
While some will argue that drug abuse itself is a sign of poor character, there are many good people that find themselves addicted to drugs and deserve a second chance to lead healthy, fulfilling, and productive lives.
There are two programs available to those that have been convicted of drug crimes. Those are the drug court system and the Drug Abuse Correctional Center.
The drug court program is designed to allow defendants to wipe their criminal record clean. This is usually reserved for misdemeanor offenders.
The Drug Abuse Correctional Center is geared toward reentry into society and offers daily programming which includes drug rehabilitation and work-related activities going from 8 am to 8 pm. The program usually lasts for 24 weeks, but can be extended or shortened based on the inmate’s need.
Both of these are rehabilitative in nature. They’re designed to help those that have committed minor or serious offenses reclaim their lives and move in a healthier direction.
Punishing drug users in standard prisons has proven itself to be ineffective. Access to drugs in prisons remains very high, and those that are released are no better off for having been there. On the other hand, the state has a vested interest in keeping some kinds of offenders off the streets, and these individuals would not be likely to qualify for corrections program that is geared toward reentry into the general populace.
Help for Addicts
Getting rid of a drug addiction is a difficult process. Meanwhile, all the same problems that led an individual to abuse drugs in the first place may be present once they’ve kicked the habit. The temptation to use again will be very high. Despite that, lives get better once drugs are no longer a part of them. Relationships are established again, work can be found, and a sense of meaning and purpose can be re-established.
Every day, those that have overcome drug addiction start families, get jobs, qualify for loans, buy houses, buy cars, go back to school, learn trades, and find a real sense of purpose within their communities.
Life offers more than a temporary good feeling. It also offers the foundation upon which we can look over all the things that matter to us, and feel good about them.
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