presentation on effect of drug abuse

• Patient Care & Health Information
• Diseases & Conditions
• Drug addiction (substance use disorder)

Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're addicted, you may continue using the drug despite the harm it causes.

Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins when they take prescribed medicines or receive them from others who have prescriptions.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill. These are called withdrawal symptoms.

Help from your health care provider, family, friends, support groups or an organized treatment program can help you overcome your drug addiction and stay drug-free.

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Drug addiction symptoms or behaviors include, among others:

• Feeling that you have to use the drug regularly — daily or even several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time than you intended
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can't afford it
• Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
• Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm
• Doing things to get the drug that you normally wouldn't do, such as stealing
• Driving or doing other risky activities when you're under the influence of the drug
• Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
• Failing in your attempts to stop using the drug
• Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing unhealthy drug use in family members

Sometimes it's difficult to distinguish normal teenage moodiness or anxiety from signs of drug use. Possible signs that your teenager or other family member is using drugs include:

• Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
• Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
• Neglected appearance — lack of interest in clothing, grooming or looks
• Changes in behavior — major efforts to bar family members from entering the teenager's room or being secretive about going out with friends; or drastic changes in behavior and in relationships with family and friends
• Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

Recognizing signs of drug use or intoxication

Signs and symptoms of drug use or intoxication may vary, depending on the type of drug. Below you'll find several examples.

Marijuana, hashish and other cannabis-containing substances

People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling "high"
• A heightened sense of visual, auditory and taste perception
• Increased blood pressure and heart rate
• Decreased coordination
• Difficulty concentrating or remembering
• Slowed reaction time
• Anxiety or paranoid thinking
• Cannabis odor on clothes or yellow fingertips
• Major cravings for certain foods at unusual times

Long-term use is often associated with:

• Decreased mental sharpness
• Poor performance at school or at work
• Ongoing cough and frequent lung infections

K2, Spice and bath salts

Two groups of synthetic drugs — synthetic cannabinoids and substituted or synthetic cathinones — are illegal in most states. The effects of these drugs can be dangerous and unpredictable, as there is no quality control and some ingredients may not be known.

Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea. A liquid form can be vaporized in electronic cigarettes. Despite manufacturer claims, these are chemical compounds rather than "natural" or harmless products. These drugs can produce a "high" similar to marijuana and have become a popular but dangerous alternative.

• Elevated mood
• An altered sense of visual, auditory and taste perception
• Extreme anxiety or agitation
• Hallucinations
• Increased heart rate and blood pressure or heart attack
• Violent behavior

Substituted cathinones, also called "bath salts," are mind-altering (psychoactive) substances similar to amphetamines such as ecstasy (MDMA) and cocaine. Packages are often labeled as other products to avoid detection.

Despite the name, these are not bath products such as Epsom salts. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.

• Feeling "high"
• Increased sociability
• Increased energy and agitation
• Increased sex drive
• Increased heart rate and blood pressure
• Problems thinking clearly
• Loss of muscle control
• Panic attacks
• Psychotic and violent behavior

Barbiturates, benzodiazepines and hypnotics

Barbiturates, benzodiazepines and hypnotics are prescription central nervous system depressants. They're often used and misused in search for a sense of relaxation or a desire to "switch off" or forget stress-related thoughts or feelings.

• Barbiturates. An example is phenobarbital.
• Benzodiazepines. Examples include sedatives, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
• Hypnotics. Examples include prescription sleeping medicines such as zolpidem (Ambien) and zaleplon (Sonata).
• Slurred speech
• Lack of coordination
• Irritability or changes in mood
• Problems concentrating or thinking clearly
• Memory problems
• Involuntary eye movements
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Falls or accidents

Meth, cocaine and other stimulants

Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall XR, Mydayis). They're often used and misused in search of a "high," or to boost energy, to improve performance at work or school, or to lose weight or control appetite.

• Feeling of happy excitement and too much confidence
• Increased alertness
• Increased energy and restlessness
• Behavior changes or aggression
• Rapid or rambling speech
• Larger than usual pupils, the black circles in the middle of the eyes
• Confusion, delusions and hallucinations
• Irritability, anxiety or paranoia
• Changes in heart rate, blood pressure and body temperature
• Nausea or vomiting with weight loss
• Poor judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Mouth sores, gum disease and tooth decay from smoking drugs ("meth mouth")
• Depression as the drug wears off

Club drugs are commonly used at clubs, concerts and parties. Examples include methylenedioxymethamphetamine, also called MDMA, ecstasy or molly, and gamma-hydroxybutyric acid, known as GHB. Other examples include ketamine and flunitrazepam or Rohypnol — a brand used outside the U.S. — also called roofie. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects.

Because GHB and flunitrazepam can cause sedation, muscle relaxation, confusion and memory loss, the potential for sexual misconduct or sexual assault is associated with the use of these drugs.

Signs and symptoms of use of club drugs can include:

• Larger than usual pupils
• Chills and sweating
• Involuntary shaking (tremors)
• Behavior changes
• Muscle cramping and teeth clenching
• Muscle relaxation, poor coordination or problems moving
• Reduced inhibitions
• Heightened or altered sense of sight, sound and taste
• Memory problems or loss of memory
• Reduced consciousness
• Increased or decreased heart rate and blood pressure

Hallucinogens

Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP).

LSD use may cause:

• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Impulsive behavior
• Rapid shifts in emotions
• Permanent mental changes in perception
• Rapid heart rate and high blood pressure
• Flashbacks, a reexperience of the hallucinations — even years later

PCP use may cause:

• A feeling of being separated from your body and surroundings
• Problems with coordination and movement
• Aggressive, possibly violent behavior
• Lack of pain sensation
• Increase in blood pressure and heart rate
• Problems with thinking and memory
• Problems speaking
• Intolerance to loud noise
• Sometimes seizures or coma

Signs and symptoms of inhalant use vary, depending on the substance. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products. Due to the toxic nature of these substances, users may develop brain damage or sudden death.

Signs and symptoms of use can include:

• Possessing an inhalant substance without a reasonable explanation
• Brief happy excitement
• Behaving as if drunk
• Reduced ability to keep impulses under control
• Aggressive behavior or eagerness to fight
• Nausea or vomiting
• Appearing under the influence of drugs, with slurred speech, slow movements and poor coordination
• Irregular heartbeats
• Lingering odor of inhalant material
• Rash around the nose and mouth

Opioid painkillers

Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes, among others, heroin, morphine, codeine, methadone, fentanyl and oxycodone.

Sometimes called the "opioid epidemic," addiction to opioid prescription pain medicines has reached an alarming rate across the United States. Some people who've been using opioids over a long period of time may need physician-prescribed temporary or long-term drug substitution during treatment.

Signs and symptoms of narcotic use and dependence can include:

• A sense of feeling "high"
• Reduced sense of pain
• Agitation, drowsiness or sedation
• Problems with attention and memory
• Pupils that are smaller than usual
• Lack of awareness or inattention to surrounding people and things
• Problems with coordination
• Constipation
• Runny nose or nose sores (if snorting drugs)
• Needle marks (if injecting drugs)

When to see a doctor

If your drug use is out of control or causing problems, get help. The sooner you seek help, the greater your chances for a long-term recovery. Talk with your health care provider or see a mental health provider, such as a doctor who specializes in addiction medicine or addiction psychiatry, or a licensed alcohol and drug counselor.

Make an appointment to see a provider if:

• You can't stop using a drug
• You continue using the drug despite the harm it causes
• Your drug use has led to unsafe behavior, such as sharing needles or unprotected sex
• You think you may be having withdrawal symptoms after stopping drug use

If you're not ready to approach a health care provider or mental health professional, help lines or hotlines may be a good place to learn about treatment. You can find these lines listed on the internet or in the phone book.

When to seek emergency help

Seek emergency help if you or someone you know has taken a drug and:

• May have overdosed
• Shows changes in consciousness
• Has trouble breathing
• Has seizures or convulsions
• Has signs of a possible heart attack, such as chest pain or pressure
• Has any other troublesome physical or psychological reaction to use of the drug

Staging an intervention

People struggling with addiction usually deny they have a problem and hesitate to seek treatment. An intervention presents a loved one with a structured opportunity to make changes before things get even worse and can motivate someone to seek or accept help.

It's important to plan an intervention carefully. It may be done by family and friends in consultation with a health care provider or mental health professional such as a licensed alcohol and drug counselor, or directed by an intervention professional. It involves family and friends and sometimes co-workers, clergy or others who care about the person struggling with addiction.

During the intervention, these people gather together to have a direct, heart-to-heart conversation with the person about the consequences of addiction. Then they ask the person to accept treatment.

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Like many mental health disorders, several factors may contribute to development of drug addiction. The main factors are:

• Environment. Environmental factors, including your family's beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
• Genetics. Once you've started using a drug, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.

Changes in the brain

Physical addiction appears to occur when repeated use of a drug changes the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate. These changes can remain long after you stop using the drug.

Risk factors

People of any age, sex or economic status can become addicted to a drug. Certain factors can affect the likelihood and speed of developing an addiction:

• Family history of addiction. Drug addiction is more common in some families and likely involves an increased risk based on genes. If you have a blood relative, such as a parent or sibling, with alcohol or drug addiction, you're at greater risk of developing a drug addiction.
• Mental health disorder. If you have a mental health disorder such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, you're more likely to become addicted to drugs. Using drugs can become a way of coping with painful feelings, such as anxiety, depression and loneliness, and can make these problems even worse.
• Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people.
• Lack of family involvement. Difficult family situations or lack of a bond with your parents or siblings may increase the risk of addiction, as can a lack of parental supervision.
• Early use. Using drugs at an early age can cause changes in the developing brain and increase the likelihood of progressing to drug addiction.
• Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or opioid painkillers, may result in faster development of addiction than other drugs. Smoking or injecting drugs can increase the potential for addiction. Taking drugs considered less addicting — so-called "light drugs" — can start you on a pathway of drug use and addiction.

Complications

Drug use can have significant and damaging short-term and long-term effects. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. Here are some examples.

• Methamphetamine, opiates and cocaine are highly addictive and cause multiple short-term and long-term health consequences, including psychotic behavior, seizures or death due to overdose. Opioid drugs affect the part of the brain that controls breathing, and overdose can result in death. Taking opioids with alcohol increases this risk.
• GHB and flunitrazepam may cause sedation, confusion and memory loss. These so-called "date rape drugs" are known to impair the ability to resist unwanted contact and recollection of the event. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol.
• MDMA — also known as molly or ecstasy — can interfere with the body's ability to regulate temperature. A severe spike in body temperature can result in liver, kidney or heart failure and death. Other complications can include severe dehydration, leading to seizures. Long-term, MDMA can damage the brain.
• One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.
• Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity. Sudden death can occur even after a single exposure.

Other life-changing complications

Dependence on drugs can create a number of dangerous and damaging complications, including:

• Getting an infectious disease. People who are addicted to a drug are more likely to get an infectious disease, such as HIV , either through unsafe sex or by sharing needles with others.
• Other health problems. Drug addiction can lead to a range of both short-term and long-term mental and physical health problems. These depend on what drug is taken.
• Accidents. People who are addicted to drugs are more likely to drive or do other dangerous activities while under the influence.
• Suicide. People who are addicted to drugs die by suicide more often than people who aren't addicted.
• Family problems. Behavioral changes may cause relationship or family conflict and custody issues.
• Work issues. Drug use can cause declining performance at work, absenteeism and eventual loss of employment.
• Problems at school. Drug use can negatively affect academic performance and motivation to excel in school.
• Legal issues. Legal problems are common for drug users and can stem from buying or possessing illegal drugs, stealing to support the drug addiction, driving while under the influence of drugs or alcohol, or disputes over child custody.
• Financial problems. Spending money to support drug use takes away money from other needs, could lead to debt, and can lead to illegal or unethical behaviors.

The best way to prevent an addiction to a drug is not to take the drug at all. If your health care provider prescribes a drug with the potential for addiction, use care when taking the drug and follow instructions.

Health care providers should prescribe these medicines at safe doses and amounts and monitor their use so that you're not given too great a dose or for too long a time. If you feel you need to take more than the prescribed dose of a medicine, talk to your health care provider.

Preventing drug misuse in children and teenagers

Take these steps to help prevent drug misuse in your children and teenagers:

• Communicate. Talk to your children about the risks of drug use and misuse.
• Listen. Be a good listener when your children talk about peer pressure and be supportive of their efforts to resist it.
• Set a good example. Don't misuse alcohol or addictive drugs. Children of parents who misuse drugs are at greater risk of drug addiction.
• Strengthen the bond. Work on your relationship with your children. A strong, stable bond between you and your child will reduce your child's risk of using or misusing drugs.

Preventing a relapse

Once you've been addicted to a drug, you're at high risk of falling back into a pattern of addiction. If you do start using the drug, it's likely you'll lose control over its use again — even if you've had treatment and you haven't used the drug for some time.

• Follow your treatment plan. Monitor your cravings. It may seem like you've recovered and you don't need to keep taking steps to stay drug-free. But your chances of staying drug-free will be much higher if you continue seeing your therapist or counselor, going to support group meetings and taking prescribed medicine.
• Avoid high-risk situations. Don't go back to the neighborhood where you used to get your drugs. And stay away from your old drug crowd.
• Get help immediately if you use the drug again. If you start using the drug again, talk to your health care provider, your mental health provider or someone else who can help you right away.

Drug addiction (substance use disorder) care at Mayo Clinic

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• DrugFacts: Understanding drug use and addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction. Accessed Aug. 15, 2022.
• American Psychiatric Association. What is a substance use disorder? https://psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder. Accessed Sept. 2, 2022.
• Eddie D, et al. Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology. 2019; doi:10.3389/fpsyg.2019.01052.
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• Poppy seed tea: Beneficial or dangerous?

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Drug Abuse Effect on the Doctor-Patient Relationship

By Nicole Pyles

Introduction

Starting in the 1990s (following the 1980s crack addiction), the use of opioid medications began to rise for reasons surrounding patient care. [1] The introduction of opioids as prescription drugs was well-intentioned and focused on relieving patients’ pain. Another intention of introducing opioids (natural, semi-synthetic, and methadone) was to prompt other clinicians and healthcare organizations to focus on pain control. When prescribing this highly addictive drug, many did not account for the miscommunication or the effect it would have on the doctor-patient relationship. Patients relied on their doctors not only for medical expertise but also for empathy, understanding, and judicious prescribing practices. Conversely, doctors depended on patients to provide accurate information about their pain levels, medical history, and potential substance use, fostering a relationship built on mutual respect and transparency. According to Arch Woodard from Allens Grove Wisconsin, a rural town, many doctors began turning away patients because of their lack of transparency when searching for opioids. [2] This caused many patients (especially in rural America) to resort to risky options to manage their main or newly developed drug addiction by seeking help from friends and family or turning to heroin. [3] In general, through the 1990s in both rural and urban America, the impact of both illicit drugs and prescription drugs has been perverse. Therefore, throughout my journalistic essay, I will discuss the risks of a drug overdose, its economic impact, and healthcare disparities in the rural United States.

Impact of Drug Abuse on the Doctor-Patient Relationship

The opioid crisis in the United States remains a serious public health issue, where there is a rise in overdose deaths at a concerning rate. [4] Most of these deaths are stemming from opioids. But through time, drug abuse has worn down the doctor-patient relationship in all parts of America. Because of this opioid crisis and persistent drug use, people struggling with addiction are more likely to hide their drug use or manipulate their prescriptions, leading to a breakdown in trust between them and their doctor. The tragic reality of drug addiction is that less than 13% of people received any treatment for their addiction in 2019 and just 18% of people with opioid use disorder received safe and effective life-saving medication that aided in their recovery. [5] Also, these patients who suffer from addict behavior, typically fall through on their appointments and treatment plans which puts a strain on the doctor and their healing process. Doctors begin to develop their stigmas surrounding patients who suffer from addiction. Many healthcare providers may fail to understand the complexity of addiction and lack empathy. Overall, drug abuse and drug epidemics significantly complicate the doctor-patient relationship.

The Doctor-Patient Relationship in Rural America/Urban America

The themes in Tweedy’s book, Black Man in a White Coat, highlight the struggles rural Americans face in managing their health without adequate care. However, some parts of rural America boasted a unique doctor-patient relationship compared to urban America, characterized by familiarity. Doctors in these areas were often closer to their patients, and more likely to know them and their families personally. This familiarity bred trust, allowing doctors to gain a deeper understanding of their patient’s medical history and individual needs. With limited access to specialists, general practitioners in rural communities had to handle a wider range of medical issues. Additionally, many rural families grappled with financial constraints, often due to higher poverty rates, impacting their ability to afford healthcare. Debbie Smith’s story from Down Home, NC, serves as a poignant example. [6] Despite her efforts to seek assistance for her drug addiction, she was turned away, underscoring the challenges faced by rural communities. Even as political figures like Mark Walker emphasize the importance of aiding addicts, actions like voting to reduce drug treatment programs contradict these sentiments, further exacerbating the struggles of rural families. [7]

In urban America throughout the 90s, the doctor-patient relationship was a mixed bag, shaped by the individuals who lived in these spaces. Healthcare connections can differ depending on the circumstances of each patient, especially in America’s urban areas where diversity is more prominent. Nonetheless, both in urban and rural settings, the core values of patient-centered care and medical ethics apply. Healthcare practitioners in both locations work to solve distinct obstacles, such as physician shortages in rural areas and urban overpopulation, and provide high-quality care. Healthcare gaps between urban and rural areas are lessened by advances in telemedicine. Even though the foundations of healthcare may be similar, efforts to alleviate disparities must continue, with a focus on each community’s particular requirements. There were equal challenges in urban America for there was a rise in “managed care” during the 1990s. Many doctors during this time were displeased with their professional autonomy being reduced, and patients did not like that they had fewer choices of doctors and hospitals.

Solutions and Recommendations

Opioids including prescription drugs (oxycodone) and other illegal drugs are extremely addictive. After their debut in healthcare in the 1990s, the increased availability of illegal opioids such as heroin has increased as well. [8] Solutions to fixing the doctor-patient relationship from the consequences of drug abuse start with reducing the flow of illicit opioids. Then, limiting prescription opioids, promoting treatment, and de-stigmatizing drug addiction. There are no simple solutions to reducing the flow of illicit opioids but in some communities, they are investing funding for law enforcement that targets large-scale opioid distribution. [9] Strategies that promote treatment include Medicaid expansion since many states have expanded Medicaid under the Affordable Care Act. [10] Any low-income individual can enroll in Medicaid and, therefore, have access to treatment options such as medication-assisted treatment (MAT). [11] To reduce the harm of opioids, educate individuals about Naloxone. Naloxone is one of the most important drugs because it can reverse the side effects of overdose and is widely available for use. Overall, to contribute to the building of the doctor-patient relationship, we have to start with helping the patient.

The intertwining issues of drug abuse and inadequate healthcare have left an indelible mark on the doctor-patient relationship across America, both in rural and urban settings. The well-intentioned introduction of opioids for pain relief has inadvertently led to an epidemic of addiction and mistrust, undermining the foundational principles of trust and effective communication that should characterize this crucial relationship. Rural areas, with their unique challenges of limited access to specialists and financial constraints, have borne a disproportionate burden, forcing many to resort to risky alternatives. Meanwhile, in urban settings, the rise of managed care has further complicated the landscape, reducing both doctor and patient autonomy. The opioid crisis has not only led to a surge in overdose deaths but has also eroded the trust between patients struggling with addiction and their healthcare providers. The resulting breakdown in communication and honesty further strains the doctor-patient relationship, making effective treatment more elusive. Only through collaborative efforts and compassionate approaches can we hope to restore the integrity of the doctor-patient relationship and ensure that all Americans receive the quality care they deserve.

[1] CDC. 2021. “Opioid Data Analysis and Resources | CDC’s Response to the Opioid Overdose Epidemic | CDC.” Www.cdc.gov. June 22, 2021. https://www.cdc.gov/opioids/data/analysis-resources.html#:~:text=The%20first%20wave%20began%20with .

[2] “Y-0079.” Southern Oral History Program Interview Database. Accessed April 23, 2024. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28378/rec/2 .

[3] “Y-0079.” Southern Oral History Program Interview Database. Accessed April 23, 2024. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28378/rec/2 .

[4] Division (DCD), Digital Communications. 2022. “National Opioids Crisis: Help and Resources.” HHS.gov. November 14, 2022. https://www.hhs.gov/opioids/index.html .

[5]   Volkow, Nora, By, Nora Volkow, and Nov. 2. “To End the Drug Crisis, Bring Addiction out of the Shadows.” AAMC, November 2, 2021. https://www.aamc.org/news/end-drug-crisis-bring-addiction-out-shadows .

[6] Smith, Debbie . n.d. Interview by Isabell Moore. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28705/rec/3 .

[7] Smith, Debbie . n.d. Interview by Isabell Moore. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28705/rec/3 .

[8] U.S. Department of Justice. 2016. “Opioid Facts.” Www.justice.gov. September 12, 2016. https://www.justice.gov/opioidawareness/opioid-facts .

[9] U.S. Department of Justice. 2016. “Opioid Facts.” Www.justice.gov. September 12, 2016. https://www.justice.gov/opioidawareness/opioid-facts .

[10] CMS, Data. n.d. “Centers for Medicare & Medicaid Services Data.” Data.cms.gov. https://data.cms.gov/fact-sheet/cms-fast-facts .

[11] CMS, Data. n.d. “Centers for Medicare & Medicaid Services Data.” Data.cms.gov. https://data.cms.gov/fact-sheet/cms-fast-facts .

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Causes and Effects of Drug Abuse

Jul 16, 2014

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Causes and Effects of Drug Abuse. Digital Story By. Cause. Cause. Cause. Cause. Cause. Effect. Effect. Effect. Effect. Effect. Once your slides are done. DELETE THIS SLIDE Save it in the jpeg format.

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Effects of Drug Abuse - PowerPoint PPT Presentation

Effects of Drug Abuse

Some people start doing drugs because there friends start doing it or they want ... affects of drug abusers are they may feel high, feel dizzy, headachy or nauseous. ... – powerpoint ppt presentation.

• By Christian
• Why Do Some People Use Drugs?
• What Are The Dangers Of Drug Abuse?
• How do drugs effect people other than the drug user?
• How to avoid Drugs?
• Some people start doing drugs because there friends start doing it or they want to be in a specific group.
• Some even do it because there friends tell them to.
• Some people use drugs because they think it will help them with their problems.
• People that use drugs may be hard to get good grades, do well in sports, and some people feel it hard to feel happy or calm.
• Some people feel that drugs will make them feel even better.
• Some of the people who start using drugs do not have problems.
• Fatal car accidents
• Some people have an overdose which usually results in death.
• Get in serious fights
• An overdose can cause a severe physical reaction or death.
• An overdose occurs when a drug user takes more of a drug then his or her body can deal with.
• Some immediate affects of drug abusers are they may feel high, feel dizzy, headachy or nauseous.
• Some drugs can kill instantly.
• Angel Dust-an illegal drug that causes very violent behavior, comas, and death.
• Cocaine-a highly dangerous, illegal drug that provides a strong high but which can be very deadly.
• Downers-a nickname for drugs that relax people and help them go to sleep.
• Heroin-a very dangerous, illegal drug that is often injected.
• LSD-a very dangerous, illegal drug that causes people to see, feel, smell, taste, or hear things that are not there.
• Tranquilizers- Drugs that doctors use to calm people many people abuse them.
• Drug Abusers- people who take drugs that can harm them.
• Cold Turkey-The sudden stopping of a drug abuse.
• Drugs-substances that cause changes in the body and the mind.
• Marijuana-a dangerous drug that is smoked or eaten. It is illegal in many countries.
• Dope-a nickname for drugs also people who abuse drugs are dopes.
• Drug Abuse,1988,Regensteiner publishing inc, Canada, pgs 5-45
• Your Health Textbook, 1999, Harcourt brace publishers, New York, pgs 232-235
• Internet Source, Lembersky Robert b, Why do some people use illegal drugs?, http// www.kidshealth.org/kid/grow/drugs_alchohal/know_dr ugs.html

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Mental Health and Substance Use Disorders Often Go Untreated for Parents on Medicaid

By Emily Baumgaertner

For parents struggling with mental health or substance use disorders, access to treatment can often mean the difference between keeping and losing their children. But a new analysis of health and child welfare records found that a significant portion of those who were eligible for Medicaid coverage for such treatment were not getting it.

The analysis, published Friday by researchers at the nonprofit institute RTI International and the Department of Health and Human Services, found that fewer than half of parents on Medicaid who had substance use disorders and had been referred to authorities over suspicions of child abuse or neglect had received treatment.

Some Context: Experts say bad situations can often be reversed with treatment.

Both mental health and drug addiction crises have been roiling the country, and the effects of parental drug use and mental illness can quickly trickle down to their children . Public health experts say substance use disorders can incapacitate a previously diligent parent and lead to the involvement of child protective services.

In 2021 alone, more than seven million children were referred to authorities over worries of maltreatment, according to a federal report , and more than 200,000 were removed from their homes. But research shows that when parents seek treatment for psychiatric and substance use disorders , they are far less likely to experience family separation.

The Numbers: What the researchers found.

To calculate treatment rates among parents on Medicaid, the health insurance program for low income people, Tami Mark, a health economist at RTI, who led the research, and her colleagues drew from a new publicly available data set that used de-identified social security numbers to link child welfare records in Florida and Kentucky with corresponding Medicaid claims records from 2020.

For comparison, they also analyzed a random sample of Medicaid recipients who had no records in the child welfare system. (The study didn’t capture any counseling or medication given outside the Medicaid system, nor any cases of mental health or substance use disorders that were undiagnosed.)

Among 58,551 parents who had a child referred to welfare services, more than half had a psychiatric or substance use diagnosis, compared to 33 percent of the comparison group. About 38 percent of those with referrals who had mental health disorders and 40 percent of those who had substance use disorders had received counseling; about 67 percent of people with mental health disorders and 38 percent of those with substance use disorders had received medication.

Norma Coe, an associate professor of medical ethics and health policy at the University of Pennsylvania, who was not involved in the research, said some of the rates were worse than general Medicaid treatment figures , suggesting that some barriers could be specific to parents.

“In general, the U.S. supports parents and caregivers less than many other countries,” Dr. Coe said, “which has numerous and lasting intergenerational effects on health and wealth.”

What Happens Next: Examining the barriers.

The study’s authors highlighted an array of roadblocks to receiving counseling and medication, including stigma, inconvenience and the fear of losing parental rights.

They called for better coordination between social programs, such as integrating the data systems of child welfare and Medicaid so that it would be clear when parents needed to be connected to specific services.

But Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University who studies inequity, said there was another challenge: a shortage of treatment providers that will accept patients on Medicaid, which pays lower reimbursement rates than private insurers.

“Access to behavioral health services is inadequate in the United States,” he said, “but it’s even worse for Medicaid beneficiaries.”

Emily Baumgaertner is a national health reporter for The Times, focusing on public health issues that primarily affect vulnerable communities. More about Emily Baumgaertner

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Understanding Benzodiazepines and How They Work

• How They Work
• Side Effects
• Drug Interactions

Advantages vs. Disadvantages

• Alternatives

Benzodiazepines are a class of drugs (commonly referred to as “benzos”) prescribed to treat anxiety, panic disorder , seizures, insomnia, and alcohol withdrawal . They may also be used along with anesthesia during surgery.

Benzodiazepines work by targeting and binding to the gamma-aminobutyric acid (GABA) neurotransmitter in the brain. This slows the central nervous system (CNS), resulting in a calming, sedating effect.

This article will cover how benzodiazepines work, their side effects and safe use, their possible drug interactions, and alternative medications.

Getty Images / Niall Carson - PA Images  / Contributor

What Are Benzodiazepines Used For?

Approved indications for benzodiazepine use in adults include:

• Anxiety disorders, including generalized anxiety, short-term anxiety, and preoperative anxiety
• Panic disorder
• Status epilepticus or seizures in adults
• Alcohol withdrawal

Benzodiazepines also have a fair number of off-label uses. When a healthcare provider uses a drug approved by the Food and Drug Administration (FDA) for an unapproved use, that use is considered off-label.

Providers are generally able to use their medical expertise to prescribe FDA-approved drugs for unapproved uses as long as they judge that the drug is medically appropriate for you.

Examples of these uses with benzodiazepines include:

• Sedation in the intensive care unit (ICU)
• Short-term treatment of spasticity (muscle stiffness or rigidness) in children with cerebral palsy
• Use alongside antipsychotics, mood stabilizers, and antidepressants in treating psychotic disorder, bipolar disorder, and other mood disorders
• Chemotherapy-associated anticipatory nausea and vomiting
• Restless legs syndrome (condition causing a strong urge to move the legs)
• Tardive dyskinesia (side effect of medications causing involuntary repetitive movements)
• REM (rapid eye movement) sleep behavior disorder (sleep disorder causing physical and vocal acting out during REM sleep)

How Do Benzodiazepines Work?

Benzodiazepines, as a class, work on a certain type of receptor found throughout your brain and spinal cord, which make up the central nervous system .

This receptor is a protein called gamma-aminobutyric acid type A (GABA-A) receptor. Benzodiazepine drug molecules mimic the naturally occurring neurotransmitter GABA and bind to this receptor. This allows chloride ions to enter the neuron cells, which results in CNS depression. Outward signs of this include calmness, sleepiness, or drowsiness.

How quickly benzodiazepines begin to work depends on which specific drug you’re taking and how you’re taking it. Taken orally, most benzodiazepines are well absorbed. Some of the fastest-acting drugs in this class are:

• Valium (alprazolam)
• Halcion (triazolam)
• Xanax (diazepam)

Intravenous (IV) injection results in rapid onset of effects. Midazolam, in particular, is one of the most lipophilic benzodiazepines, meaning it rapidly crosses the blood-brain barrier (to enter your CNS).

Why Benzodiazepines Work

Benzodiazepines target and bind to a receptor in the brain and spinal cord called GABA-A by mimicking naturally occurring GABA. This is what causes the effects of CNS depression, like sleepiness and calmness.

These effects help relieve the symptoms of certain conditions it's used for, such as anxiety and panic disorder, and are why it is sometimes used for sedation.

Examples of Benzodiazepines

Benzodiazepines are often classified by their onset of action—how quickly they begin to work after you take them. This also affects their most common uses.

For example, midazolam is given by injection and often used alongside anesthesia medications because it works quickly to cause sleepiness. It is also commonly used as a nasal spray for both anesthesia and seizures.

In comparison, Klonopin (clonazepam) is taken by mouth and used more often for panic disorder and seizure prevention because it lasts longer and is usually taken two times per day.

Most Commonly Prescribed Benzodiazepines

The most commonly prescribed benzodiazepines are:

What Are the Side Effects of Benzodiazepines?

Side effects of benzodiazepines are somewhat common. For example, the following side effects have occurred in greater than or equal to 1% of people taking Xanax during clinical trials:

• Akathisia (restlessness)
• Dermatitis (skin irritation or rash)
• Hypotension (low blood pressure)
• Increased salivation
• Light-headedness

Another commonly used benzodiazepine, Valium, has been associated with the following side effects:

• Blurred vision
• Constipation
• Slurred speech

Some more serious warnings exist for the benzodiazepine drug class as a whole. These include:

• Abuse, misuse, and addiction
• Dependence and withdrawal
• Respiratory depression in those with impaired breathing

How to Take Benzodiazepines Safely

While effective for various medical uses, benzodiazepines can sometimes cause side effects. For this reason, it's important to take them exactly as instructed by a healthcare provider.

However, here are a few general tips for taking benzodiazepines safely:

• Start at a low dose and frequency, and have another discussion with your healthcare provider no more than two to four weeks after you begin taking benzodiazepines to reevaluate effectiveness, side effects, and risks.
• Be careful about mixing benzodiazepines with other depressant substances like alcohol and opioids.
• If you take benzodiazepines on a regular, scheduled basis for several weeks or longer, do not stop taking them abruptly, as they need to be tapered down slowly to avoid withdrawal symptoms such as insomnia, anxiety, or tremor.

Benzodiazepine Use in Older Adults

The American Geriatrics Society (AGS) lists benzodiazepines as a class of medications that should be avoided in people 65 and older. Nevertheless, they're still occasionally prescribed to this population.

Use of these drugs in older adults comes with risks of dependence, cognitive deficits (or impaired thinking), falls, and car accidents.

These risks are even greater if benzodiazepines are used in older people who have a history of falls or who are already receiving two or more other CNS drugs (such as opioids, muscle relaxants, sleeping pills, or barbiturates, among others).

In cases in which benzodiazepines are necessary in an older individual, the most favored options are known as the “LOT drugs” (lorazepam, oxazepam, and temazepam). This is because they are shorter-acting and do not have active metabolites, making them less likely to cause residual or longer-term side effects.

Even in this case, the lowest effective dose for the shortest possible period will prove to be the safest in older adults.

Drug Interactions to Watch Out For

If you take benzodiazepines, be aware of potential drug or substance interactions. This includes:

• Alcohol: Alcohol is another depressant that also mimics the GABA neurotransmitter and can have a combined sedative or respiratory depressant effect if mixed with benzodiazepines.
• Sedatives like barbiturates (phenobarbital, pentobarbital): These medications that also bind to the GABA receptor and have a depressant effect can be dangerous when mixed with benzodiazepines.
• Opioids (such as hydrocodone, oxycodone , morphine): Opioids also suppress respiratory function and slow down your central nervous system. Combining them with benzodiazepines has been shown repeatedly in research to increase the likelihood of emergency room visits and death from drug overdose.
• Certain drugs called UGT inducers (e.g., carbamazepine, phenobarbital, phenytoin, and rifampin): These may make some benzodiazepines (e.g., lorazepam and oxazepam) clear from your system more quickly, reducing their effectiveness.
• CYP3A4 inhibitors like Prozac (fluoxetine), Luvox (fluvoxamine), oral contraceptives, ketoconazole, grapefruit juice, and clarithromycin: These may disrupt the clearance of benzodiazepines from your body, resulting in buildup, heavier sedation and potential worsening of side effects. If you also take these medications, you may get the same effects from a lower dose of benzodiazepines.

Benzodiazepines have both advantages and disadvantages to their use. While effective, they can come with potentially serious side effects and require some precautions when taking them.

Effective at reducing anxiety

Helpful for sleep problems

Work well as muscle relaxants

Can treat and prevent epileptic seizures

Variety of options within the drug class with different onsets and durations of actions

Potential for misuse, abuse, and addiction

Has cognitive side effects, such as mental slowing and anterograde amnesia (difficulty forming new memories)

Can be habit-forming and difficult to taper down the dose in people who have taken them regularly for more than a few weeks

Not recommended for use in older people (65 and above) due to the increased risk of respiratory depression, excessive sedation, and cognitive effects

Alternatives to Benzodiazepines

Benzodiazepines are often prescribed for conditions like anxiety and insomnia, even though other treatments exist that show equal or better results with fewer risks and side effects.

A few alternatives to benzodiazepine therapy are:

• Psychotherapy and behavior modification (such as cognitive behavioral therapy , stimulus control, and sleep restriction) are the types of treatments that are recommended first-line for cases of anxiety and insomnia.
• Medications may be considered alongside psychotherapy for anxiety, but only serotonergic agents like selective serotonin reuptake inhibitors (SSRIs) are considered first-line medications.
• Vistaril (hydroxyzine) may be effective for anxiety and insomnia, as well as nausea and vomiting or allergies

Older adults are somewhat limited in options for safe medications due to the likelihood of side effects of many drugs worsening with age.

However, the AGS considers antidepressants Silenor (doxepin) and Remeron (mirtazapine) as good and safe options for treating insomnia in older people.

Benzodiazepines are a powerful medication class with a wide variety of indications and off-label uses, such as anxiety disorders, epileptic seizures, and insomnia, and for initiating anesthesia.

While effective for these purposes, benzodiazepines come with several important risks to consider. They are associated with dependence, misuse and abuse, cognitive impairments, and increased likelihood of severe side effects, particularly when combined with other depressant substances like opioids or alcohol.

The safest way to take benzodiazepines is on an as-needed basis rather than scheduled, at the lowest effective dose possible, and ideally for only a short period.

Speak with your healthcare provider about first trying safer, evidence-based alternatives such as cognitive behavioral therapy and other medications like antidepressants.

Dubovsky SL, Marshall D. Benzodiazepines remain important therapeutic options in psychiatric practice . Psychother Psychosom . 2022;91(5):307-334. doi:10.1159/000524400

Edinoff AN, Nix CA, Hollier J, et al. Benzodiazepines: uses, dangers, and clinical considerations . Neurol Int . 2021;13(4):594-607. doi:10.3390/neurolint13040059

Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult . Crit Care Med . 2002;30(1):119-41. doi:10.1097/00003246-200201000-00020

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By Sara Hoffman, PharmD Hoffman is a Kansas-based clinical pharmacist with experience working in hospitals, specialty clinics, and community pharmacies.

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White House condemns college protesters occupying buildings as demonstrations continue

Us poised to ease restrictions on marijuana in historic shift, but it'll remain controlled substance, reclassifying marijuana.

WASHINGTON (AP) — The U.S. Drug Enforcement Administration will move to reclassify marijuana as a less dangerous drug, The Associated Press has learned, a historic shift to generations of American drug policy that could have wide ripple effects across the country.

The proposal, which still must be reviewed by the White House Office of Management and Budget, would recognize the medical uses of cannabis and acknowledge it has less potential for abuse than some of the nation’s most dangerous drugs. However, it would not legalize marijuana outright for recreational use.

The agency's move, confirmed to the AP on Tuesday by five people familiar with the matter who spoke on the condition of anonymity to discuss the sensitive regulatory review, clears the last significant regulatory hurdle before the agency’s biggest policy change in more than 50 years can take effect.

Once OMB signs off, the DEA will take public comment on the plan to move marijuana from its current classification as a Schedule I drug, alongside heroin and LSD. It moves pot to Schedule III, alongside ketamine and some anabolic steroids, following a recommendation from the federal Health and Human Services Department. After the public comment period and a review by an administrative judge, the agency would eventually publish the final rule.

“Today, the Attorney General circulated a proposal to reclassify marijuana from Schedule I to Schedule III," Justice Department director of public affairs Xochitl Hinojosa said in a statement. The DEA is a component of the Department of Justice. "Once published by the Federal Register, it will initiate a formal rulemaking process as prescribed by Congress in the Controlled Substances Act.”

Attorney General Merrick Garland's signature throws the full weight of the Justice Department behind the move and appears to signal its importance to the Biden administration.

It comes after President Joe Biden called for a review of federal marijuana law in October 2022 and moved to pardon thousands of Americans convicted federally of simple possession of the drug. He has also called on governors and local leaders to take similar steps to erase marijuana convictions.

“Criminal records for marijuana use and possession have imposed needless barriers to employment, housing, and educational opportunities,” Biden said in December. “Too many lives have been upended because of our failed approach to marijuana. It’s time that we right these wrongs.”

The election year announcement could help Biden, a Democrat, boost flagging support, particularly among younger voters .

Biden and a growing number of lawmakers from both major political parties have been pushing for the DEA decision as marijuana has become increasingly decriminalized and accepted, particularly by younger people. A Gallup poll last fall found 70% of adults support legalization, the highest level yet recorded by the polling firm and more than double the roughly 30% who backed it in 2000.

The DEA didn’t respond to repeated requests for comment.

Schedule III drugs are still controlled substances and subject to rules and regulations, and people who traffic in them without permission could still face federal criminal prosecution.

Some critics argue the DEA shouldn’t change course on marijuana, saying rescheduling isn’t necessary and could lead to harmful side effects.

Jack Riley, a former deputy administrator of the DEA, said he had concerns about the proposed change because he thinks marijuana remains a possible “gateway drug," one that may lead to the use of other drugs.

“But in terms of us getting clear to use our resources to combat other major drugs, that’s a positive,” Riley said, noting that fentanyl alone accounts for more than 100,000 deaths in the U.S. a year.

On the other end of the spectrum, others argue marijuana should be treated the way alcohol is.

“While this rescheduling announcement is a historic step forward, I remain strongly committed to continuing to work on legislation like the SAFER Banking Act as well as the Cannabis Administration and Opportunity Act, which federally deschedules cannabis by removing it from the Controlled Substances Act," Senate Majority Leader Sen. Chuck Schumer of New York said in a statement. “Congress must do everything we can to end the federal prohibition on cannabis and address longstanding harms caused by the War on Drugs.”

Federal drug policy has lagged behind many states in recent years, with 38 having already legalized medical marijuana and 24 legalizing its recreational use .

That’s helped fuel fast growth in the marijuana industry, with an estimated worth of nearly $30 billion. Easing federal regulations could reduce the tax burden that can be 70% or more for businesses, according to industry groups. It could also make it easier to research marijuana, since it’s very difficult to conduct authorized clinical studies on Schedule I substances.

The immediate effect of rescheduling on the nation’s criminal justice system would likely be more muted, since federal prosecutions for simple possession have been fairly rare in recent years.

But loosening restrictions could carry a host of unintended consequences in the drug war and beyond.

Critics point out that as a Schedule III drug, marijuana would remain regulated by the DEA. That means the roughly 15,000 cannabis dispensaries in the U.S. would have to register with the DEA like regular pharmacies and fulfill strict reporting requirements, something that they are loath to do and that the DEA is ill equipped to handle.

Then there’s the United States' international treaty obligations, chief among them the 1961 Single Convention on Narcotic Drugs, which requires the criminalization of cannabis. In 2016, during the Obama administration, the DEA cited the U.S.’ international obligations and the findings of a federal court of appeals in Washington in denying a similar request to reschedule marijuana.

Goodman reported from Miami, Mustian from New Orleans. AP writer Colleen Long contributed.

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What my drinking problem taught me about mental health and my Wisconsin roots | Opinion

Whether it’s pursuit of wisconsin’s best beer, too many liquor store runs, or white claws out of control, the deeper issue is mental health.

The lonely streetlight shone like a full moon just for me as I tipped the liquor bottle into the night sky. It was my first time drunk — mouth numb, head singing — and trouble was on the way.

First when my parents heard their teenage son was drinking in the middle of town. But much more to come.

It would take years to admit I had a drinking problem. Not seeing it kept me from a healthy relationship with alcohol, and myself. Finally facing it led me to a deeper truth about one of Wisconsin’s defining cultural characteristics : We must address mental health if we want to stop ricocheting between avoiding and condemning what alcohol means to our home state.

Looking back I can see how my life was primed for alcohol abuse. Growing up on a farm in Wisconsin — proudly one of America’s top alcohol states — in a family descended from German immigrants known for hard work and harder drinking. Later working in journalism then politics, two famous drinking professions.

But, as legendary country music drunk George Jones sang , I had choices.

Alcohol a challenge, cultural touchstone in hard-drinking Wisconsin

As a boy I sat on my grandpa’s work shoes watching game shows as he snuck me sips of beer. Over the years various family and friends emerged as alcoholics — sometimes facing job loss or jail, sometimes concealing the turmoil. Others were good role models; people like my dad who shielded us from excessive drinking. Some adults in my life were both.

For me alcohol would be both a challenge, and a meaningful cultural touchstone.

From early on, I struggled to live up to my dad, a third-generation farmer with talents for cattle and tractors I lacked. As I got older I learned he stood for a disappearing way of life I worried I didn’t fit, despite his love and support.

College offered new sources of self-worth, and a writing career that would wind through the worlds of journalism then public policy in Wisconsin, Tennessee, and Washington, D.C. Drinking followed: college keggers, Nashville’s rowdy music scene , D.C. happy hours.

There was good and bad. Harmless party nights drew my sister and I closer after I left home. Darkened barrooms built some of my best friendships. But then there was the first time I chugged a beer before work on the worn linoleum floor of my apartment kitchen. It wasn’t long before I was many years past college, still doing all-night happy hours several nights a week, followed by weekend benders. Drinking when nobody else was around became common.

I rationalized I was just taking the edge off my stressful, driven career. But I was also numbing a feeling I’d let my family down, as the first eldest son in four generations not to farm. Drinking let me look away.

The night I called my future wife drunk and broke down crying

I want to be careful to not equate my experience with others, and I’m not claiming to face the same challenges as someone with diagnosed alcohol use disorder . I’m lucky: In the dozen years of my hardest drinking, from age 19 to 31, I didn’t destroy what I was working toward in life, nobody got hurt, and I never had a relationship destroyed.

But I taxed them. And it took years of growing professional responsibility, finally becoming clear in D.C., to start moderating. Returning to Wisconsin offered ways to reconnect with our way of life — from helping my dad, to deepening family ties, to spending time on our land, to writing — but I still fought an urge I didn’t understand.

It was dark and lonely the night I called my future wife, and broke down crying. I was unexpectedly drunk, needing a ride, and finally wanting to talk to a therapist. Through years of working on my mental health I realized I felt I was failing people, tying all the way back to childhood.

Guns and mental health are taboos. They are focus of a Journal Sentinel event May 16 in Wausau.

There are people with problems they can curb, like I was lucky to do. Others face steeper biological alcohol dependence, and decide to quit altogether. But these days I believe whoever it is, we must take a sober look to help them identify their deeper issue, if we want a healthy pastime.

Some issues heal over time. Recently my first daughter was born, and I went to a favorite supper club to get carryout our first week home. I had a cocktail waiting at the bar, and despite the stress and fear of failure accompanying my joy, I felt no need for another.

I finished up, and went home.

Brian Reisinger is a writer who grew up on a family farm in Sauk County. He contributes in-depth columns and videos for the Ideas Lab at the Journal Sentinel. Reisinger has written about the hidden stories of rural America in a wide range of publications, and his forthcoming book “ Land Rich, Cash Poor ” will reveal the untold history of the disappearing American farmer. Reisinger works in public affairs consulting for Wisconsin-based Platform Communications. He splits his time between a small town in northern California near his wife’s family, and his family’s farm here in Wisconsin. Reisinger studied journalism and political science at the University of Wisconsin-Eau Claire, and has won awards from the National Society of Newspaper Columnists, Seven Hills Review literary magazine, Wisconsin Newspaper Association, and more.

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As the Biden administration is set to ease federal marijuana restrictions, NBC News’ Tom Llamas spoke with Kevin Sabet, the President at Smart Approaches to Marijuana, on what he believes are the potential dangers of reclassifying the drug. May 1, 2024

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