Pubdate: Tue, 28 Nov 2000 Source: Atlanta Journal-Constitution (GA) Copyright: 2000 Cox Interactive Media. Contact: Journal: Constitution: http://www.accessatlanta.com/ajc/ Forum: http://www.accessatlanta.com/community/forums/ Author: Patricia Guthrie THE MANY FACES OF ADDICTION With New Initiatives And Insights, A Problem That Exacts A Heavy Toll On Lives And Society Comes Into Clearer Focus Actor Robert Downey Jr.'s fall down the hole of drug relapse comes as no surprise to those in the recovery field. And that, they say, is what should be the news --- that effective treatment continues to elude many of the nation's 14.8 million illicit-drug users, whether they be famous, infamous or Joe Average Addict. Today, the federal government plans to launch a National Treatment Plan Initiative aimed at bolstering health insurance coverage for substance abuse treatment and establishing standardized care for it. "Treatment programs have a wide range of effectiveness," said Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, a division of the U.S. Department of Health and Human Services. The center developed the initiative after six months of public hearings around the country. "We're hoping to create an effective, seamless system based on high-quality programs proven to work," Clark said. "Research leads to good practice. If we're spending a billion dollars in research on drugs, we want to make sure that research reaches the streets." Clark's plan will call upon private insurance companies to provide or broaden what's known as "parity," or allowing for equal coverage of drug addiction and mental illness on par with what is allowed for other ailments. Another goal of the initiative is to change attitudes that stigmatize those in recovery. Drug or alcohol dependency is not a bad habit or a moral failing, Clark said, but a physiological disease. Currently, about $11.9 billion a year is spent to treat drug addiction, Clark said. But even having the luxury of time and money to spend at the nation's premier private rehabilitation centers does not guarantee an end to the addiction, as Downey, Darryl Strawberry, Joan Kennedy and a host of other high-profile people can attest. When it comes to recovering from an addiction, whether it be alcohol or cocaine, each individual is different. Some may stay sober while others relapse three or four times, and still others may end up battling addiction like a chronic disease. Relapses are common because an addict's brain gets essentially tricked into wanting, needing and craving the pleasurable feelings that alcohol and drugs provide. With PET scan technology, doctors have been able to track the physiological changes in the brain through the cycles of abuse, recovery and relapse. Drugs that fall into the category of pyschostimulants, such as cocaine and methamphetamine (Downey's choices), give the same sense of emotional well-being as a grand meal, sex or other activities that provide us with doses of euphoria. "Cocaine taps into this naturally occurring pleasure center so you feel compelled to do it again and again," explains Dr. Michael Kuhar of the Yerkes Regional Primate Research Center of Emory University. Cocaine addicts describe the rush as being like a whole-body orgasm, a tremendous thrill to the body and brain. Crack cocaine, the smokable version of that drug, has become one of the most abused illegal drugs because it gets to the brain within seconds. In describing his overwhelming urge for drugs, Downey told a judge last year that it's "like I've got a shotgun in my mouth, with my finger on the trigger, and I like the taste of gunmetal." Downey relapsed less than four months after being released from prison and relaunching his acting career. Cocaine addicts also don't yet have a substitute drug to help wean them through their cravings, as heroin addicts do with methadone. But several such compounds are proving promising, including one developed at Yerkes under Kuhar's research. Keeping triggers at bay while sober is one of the biggest challenges for addicts, experts say. They can be encouraged to relapse by seeing old friends, depression or even driving through a particular neighborhood. "People with money have one of the biggest triggers at their disposal," said Dr. Andrew Spickard Jr., founding director of the Vanderbilt Institute for Treatment of Addiction at Nashville's Vanderbilt Medical Center. "I have a client who told me his major trigger is getting his paycheck." Another trap in recovery can actually be the location of the treatment facility, said James Cole of the Metropolitan Atlanta Council on Alcoholism & Drugs. "Metro Atlanta has several of its treatment programs located in high-use neighborhoods," Cole said. "People that may have resource or transportation problems who may not be able to afford a private center in the suburbs are then exposed to the drugs and people they need to avoid." To get help for drug or alcohol abuse, call the Metropolitan Atlanta Council on Alcohol & Drugs, 404-351-1800 or 770-239-7442, or visit www.livedrugfree.org. Drug abuse by the numbers An estimated 14.8 million Americans used an illicit drug in 1999, or 6.7 percent of the population 12 years old and older. Marijuana is the most commonly used illegal drug, the choice of 75 percent of current drug users. Fifty-seven percent of illicit drug users consumed only marijuana, 18 percent used marijuana and another illicit drug, and the remaining 25 percent used an illegal drug but not marijuana in the past month. An estimated 1.5 million Americans used cocaine in 1999. That represents 0.7 percent of the population age 12 and older. The estimated number of current crack users was 413,000 in 1999. An estimated 900,000 Americans used hallucinogenic drugs, and 200,000 used heroin. Some 3.6 million Americans were dependent on illicit drugs in 1999, and 8.2 million were dependent on alcohol. Of these, 1.5 million were dependent on both alcohol and illicit drugs. An estimated 2.8 million people (1.3 percent of the population age 12 and older) receive some kind of drug or alcohol treatment each year in the United States. Untreated alcohol and drug problems cost an estimated $166 billion annually in the United States, for health care, criminal justice, social services and lost productivity. Sources: Substance Abuse and Mental Health Services Administration, an agency of the Department of Health and Human Services; Hazelden Foundation of Center City, Minn. - --- MAP posted-by: Keith Brilhart