I really enjoy reading the blog Kellevision.com. She says it like it is and seldom misses the point of what she's writing about. She identifies a problem in programming for homelessness and proposes a set of concepts to help clarify the situation.

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Many of the "barriers" faced by the chronically homeless are not external. They are self-inflicted. Repeatedly failing to pay one's utility bills is not a barrier. It is a behavior. Repeatedly getting into relationships with drug addicts and being evicted because you have allowed your new girlfriend to turn your affordable housing into a crack house is not a barrier. It is a behavior. Choosing to pay your boyfriend's bail instead of the rent is not a barrier, it is a behavior. Consistently refusing to hold down steady employment and being evicted for not being able to pay the rent is not a barrier, it is a behavior.

[..]Lastly, how we label the problem determines how we approach solving it. True social barriers need to be addressed by social services. Better programs need to be designed to specifically address the needs of the mentally ill population. Programs designed to assist the medically disabled need to be accessed. But behaviors require a clinical intervention - therapy. Clients who demonstrate patterns of behavior which result in repeated instances of homelessness need counseling, not social services. The problem is not a social problem. It is an individual problem which requires an individual intervention.

I think it's much more complicated than that. Our world has always had an underclass, a group of individuals who have been largely invisible in the US except during the Depression. These people largely function outside the visible society and economy. They share housing with family and friends, squat in abandoned buildings, and sometimes live under bridges. They live off their housemates or family, work for temp job agencies, borrow, steal, deal drugs, and even engage in formal criminal enterprise. Given our recent policies that have reversed the tax-based redistribution of wealth since FDR, the stagnant wages, disappearing jobs, and ever increasing cost of living, that underclass has become so large it is again visible.

They are chronically under or unemployment and are not collecting Social Security, either because they don't qualify, try though they may to apply, or they haven't the where-with-all to get themselves qualified. This chronic underclass is best described as a sub-culture. They are structurally built into the economy. "Full employment" doesn't include them. Because they have given up on finding work, they no longer register with unemployment offices and so are not counted among the unemployed. Those who are chronically homeless are a sub-group of this sub-culture, and probably represents some of its most dysfunctional members.

By describing the chronically homeless, Kellevision describes most of the common attributes of this subculture.

For the majority of the [chronically] homeless population, homelessness is a lifestyle, not an event.

[..]My purpose here is not to blame the victim, but to talk openly about the severe dysfunction I see in chronically homeless families. Unless we identify the true problem, we will not be able to form a lucid solution. Homeless families typically do not function well on any level. Children are frequently truant from school and display numerous behavior and developmental problems. Dorm rules are constantly broken and there is constant turmoil between the families on the dorm. Relationships are fleeting, intense and severely dysfunctional including domestic violence, substance abuse and exploitative. Interactions with other people are inappropriate or dysfunctional. Most homeless families have burnt all their bridges with every social service agency and with their own families because of their severe dysfunction. Shelter staff often feel like we are running a middle school rather than a homeless shelter. This behavior is what needs to be addressed rather than giving them more money or building more homes.

[..]What are the elements of the homeless mindset? I'm still trying to work this out in my mind, but here are some of them which I see frequently:

• An external locus of control
• the belief that they have no control or responsibility for their choices, actions or behaviors but they are the victim of circumstances
• the belief that the causes for good or bad events in your life are totally outside your control or responsibility
• Sense of entitlement
• the belief that the worlds owes them something and they should be able to collect immediately
• the belief that they should be taken care of by others, by the government or by social service agencies
• the belief that they should be given things they have not earned (i.e. free housing, clothing, food, etc.)
• the belief that others should "help" them (i.e. by paying their unpaid bills or appealing their housing denial)
• Impulsivity
• Poor boundaries
• Emotional immaturity
• Need for instant gratification
• Dependency issues
• Predatory/antisocial behaviors
• Pathological relationships

Certainly, not every member of what I'll call the "underclass sub-culture" share all of these attributes. Each and every person has a story behind their situation. A careful account of their histories, something they usually reluctantly give, chronicles the development of these problems. It's important to discourage a prejudice developing against a whole group of people who are already stigmatized along with the "welfare mother" of the AFDC era. But we are not going to get to a more complete solution without understanding the problem. I suspect that why there is little commentary on this topic.

Kellevision hits on what I believe to be one of the most common roots of dysfunction, repeated traumas throughout their life.

A vast majority of our clients seem to have endured some sort of trauma(s) during their childhood which has(have) halted their emotional development. The result is immaturity, impulsivity, dependency, a sense of entitlement (that someone should take care of them rather than being responsible for themselves), an external locus of control (seeing problems as existing outside of themselves and therefore being outside of their control and/or responsibility), immature relationships and emotional lability. These factors result in behavior which appears erratic and irresponsible.

"Arrested development" is what Kellevision calls it. Indeed, this problem is pervasive and most often multi-generational. There are most often one or more of the following in the family history:

• lifelong repeated exposure to trauma:
  
  
  
  • child abuse and neglect
  
  
  • incest
  
  
  • domestic assault
  
  
  • gang or drug related violence
  
  
  • repeated exposure as a crime victim including assault, rape, and drive by shootings
  
  
  • inconsistent parenting ranging from abusive to no supervision
  
  
  • one or more family member who was murdered
  
  
  
  
• poor performance/attendance at school


• high school drop-out


• parenthood started by mid-teens


• by their twenties, they have several kids with mostly different partners


• sporadic work history and chronic unemployment


• efforts to qualify for Social Security


• family members relying on other families income, so no family member is able to break the pattern of poverty


• chemical abuse


• drug dealing to support a habit


• mental illness


• parents, spouses, brothers, sisters in prison


• criminal activity as income


• crime as a family enterprise

Persons who are members of the underclass see dysfunction as normal. They've never known any different. Many think this is how everyone lives. While they may dream of a good job, they appear to not have the self-discipline to keep a good job. Many of this group might be diagnosed with an anti-social personality DO. Personally, I think this diagnosis is misleading at best. A person earns this diagnosis if their history includes sufficient "anti-social" behavior. This doesn't account for family cultures that teach a confusing mix of conventional and anti-social values. Thus we have neighborhoods that have no constructive relationships with police, believe that justice is against them and label anyone reporting a crime as an informant and not to be trusted. This of course contributes to the chaos in the neighborhood.

In my experience people who get diagnosed anti-social are the ones the clinician don't trust or believe. The whole underclass culture tries to keep their business to themselves. Lying to protect one's family's reputation is encouraged. I suspect while there may be a few classic psychopaths out there, most of those folks who populate our jails are drug abusing, impulsive, underclass members with shut down emotional systems due to repeated chaos and trauma. These folks won't tell you the truth unless they are desperate and already feel they are the lowest of the low. Their judgment is so impaired that they see fear as a weakness they must squelch out. Danger in their world is everywhere and it must be faced, not avoided.

I have worked with some persons of the underclass who have a clinical presentation of PTSD after many years of participation in gang violence. They know what conventional values are, but they also know what is the law of streets. They are scared and tired of living a nightmare, and want a stable peaceful life but are tortured about what they've seen and what they've done to others over the years. Just seeing a gun sets off flashbacks. They describe their younger years as being "shut off" emotionally, and "not caring" about anyone or anything but money. But now in my office, they are presenting a mostly full range of emotion and a guilty conscience that suggests conventional values. Has their impulsive, "immature brain", associated with anti-social acts, matured into a more conventional pattern? Or is it more accurate to describe them as a product of an anti-social sub-culture? I suspect the latter is more accurate.

Returning to the homeless and Kellevision, she notes the major problem with relationships is homeless people's "picker is broken".

For every person in a homeless shelter with dependency issues we seem to have an predator waiting for them. Half the population seems to be working or receiving some form of assistance and the other half seem to be trying to hook up with them to take advantage of that income....

It is important to realize that single parents contribute to the problem of picking the wrong partner with their own pathology. The single mothers in the family dorm are not simply victims of the men they pick out. There seems to be a predominant attitude of these women that the man should "take care of them". They believe it is just a matter of picking out the right one. The first problem is that their "picker" is broken. They do not pick out a good one. They usually pick out one of the predators roaming the alley behind the shelter. The second problem is that you cannot sit at home expecting to be taken care of in our modern economy. That might have worked in the 1950's, even in the 1970's, but June Cleaver is no more. The modern American household takes two paychecks. Two full-time paychecks. The third problem presents it self when the man expects to be supported by the woman. Even if the woman is working full-time and picks out a man who wants to live off of her, women traditionally earn much lower wages than men. So the family's financial stability is even more shaky.

This predatory - dependent dyad seems to play out in most of their relationships and I wonder if it is not the source of their alienation from their families of origin. A person who constantly expects to be taken care of can be quite tiring. By contrast, a person who is constantly preying on others also becomes quite tiring.

Having grown up in a chaotic home and living a chaotic lifestyle, repeated trauma has numbed their emotions to the point that they are unable to make proper judgments about who is worthy of trust. The predator-prey dyad began in their family of origin where parents exploited the children when they were young, and when the children grow up, they exploit their vulnerable elderly parents. Recently, in my therapy group, one male member admonished a older woman for setting limits with her adult children because they were tacitly supporting her grandchildren for default on a loan she'd co-signed. He felt family was entitled to lean on, effectively use, each other.

Mental illness is often cited as a factor in homelessness. A significant number of homeless clients suffer from debilitating mental illnesses and many researchers sight the high numbers of mental illness in the population. However, each researcher seems to define it in their own way. Some include only the big three Axis I diagnoses (Schizophrenia, Bipolar I and Major Depression). Others include substance abuse (since it is an Axis I diagnosis in the DSM IV) which dramatically inflates the numbers of the "mentally ill". Others include Axis II personality disorders, but only some of them, usually Antisocial Personality Disorder. Still others include Post Traumatic Stress Disorder. In my experience, mental illness is a factor in about 10-20% of our homelessness clients and it is a serious problem. However, it does not explain the other 80%. These 80% use an unusually high percentage of services and monies devoted to the homeless and they are repeat customers.

Here I have to disagree with Kellevision. Everyone I've counseled with substance abuse were running from their feelings about themselves and/or their past. I have found Bipolar DO in significant numbers behind petty criminal activity, gambling addiction, alcoholism, sexual addiction, exotic dancing and prostitution. I participated in a local county survey that identified their most expensive clients. The general profile was bipolar chemically abusive who revolved in and out of the hospital, placements and jail. Personality disorders are mental illness. While many may think the rest of the world is the problem and are not willing to take responsibility, many others are desperate for relief from a horribly chaotic and often traumatic life.

There is a very high incidence of traumatic histories in the homeless community, even before they became homeless, usually during childhood. I believe that a majority of the substance abuse problem in this population is an effort to treat trauma symptoms. However, this can be said of other populations as well, including the substance abuse community. Most trauma survivors manage to maintain housing despite their trauma symptoms. Though trauma symptoms may play a factor in homelessness, I do not believe they are the sole cause.

Sole cause, no, it's the multi-generational underclass sub-culture with it's accompanied fractured families, drug abuse, trauma, predator/prey cycle, and chaotic lifestyles. Trauma comes in forms that are not readily identified. Chaotic events in close proximity in time give the victim the impression they have no control of their fate and so they scramble for every edge in the moment, and anxiously await for the next disaster to strike. Those in the underclass go way out of their way to withhold their histories of trauma and chaos, insisting that they can handle their own problems, and it's none of anyone's business. Or is this simply the accepted cultural method to deal with the shame of their past?

Most homeless clients do not have family support systems. If they did, the family would take them in and they would not be homeless. Many homeless clients come from families who are themselves very nomadic and teetering on homelessness. Some come from families rife with substance abuse, sexual abuse or domestic violence. Others have been rejected by their families for various reasons. These reasons often involve their dependent and/or dysfunctional behaviors.

Underclass families exploit each other until the resources are gone, or the member with resources cut off the leech. Once the underclass has used up their family resources, they become at risk for homelessness. Many have family who died young living violent or drug infested lifestyles, or who are in prison. By this time, they've burned out most of their friends as well. All they can do and meet new vulnerable people and continue a new predictor/prey dynamic.

So what solutions are there for healing the cultural divide? The problem is mostly economic. The underclass lacks a realistic chance for escaping their plight. Oh, sure a few make it, usually through advanced education. But many will hit a ceiling in achievement when they rely too heavily on "temporary feel good" behavior that provides relief from stress, but self-destructively complicates their lives and increases the chances they will fall out of their newly found middle-class status.

The middle-class in America is shrinking, many of the hard working blue collar workers are falling into the underclass from where with a floundering economy, escape will be difficult. Jobs programs, affordable housing, and counseling are sorely needed but remains largely unfunded. What infrastructure is present is actually shrinking with government tax dollars.

Too often the only role models for success are the gang members, drug dealers or pimps who drive fancy cars and flash wads of money. Too many get lost in this dream turn nightmare. But my experiences working with recovering gang members is that many are retrievable when they get desperate enough to escape with the right kind of treatment and patience with their guarded presentations. I work in a Partial Hospital Program (PHP) at an inner city public hospital that is designed to intervene with persons with personality disorders. It's largely based on the Crisis Intervention model that relies on the desperation of the client to inspire commitment, insight and behavior change in therapy. The PHP format is ideal for persons who are suffering from acute exacerbation of substance abuse, PTSD or personality disorder. I call it "mental health boot camp". We have a satisfaction rate of over 90%.

Kellevision lists a number of problems within the system.

In my humble opinion, our current social services system and is a major factor contributing to the homeless mindset. This is a complicated element to explain. But I think it is important to make an attempt.

I see two major problems with the social services system: 1) the system itself - how benefits are applied and eligibility determined and 2) the people working within the system - the mindset of caseworkers and social workers working with the homeless population.

• The social services system seems to be designed to punish attempts by the poor to achieve independence. Assistance programs penalize people for working "too much" by cutting off benefits when assets accrue. These systems often reinforce irresponsibility and impulsivity while punishing people who try to work and plan ahead.
• Many social services programs seem to "teach" clients to wait until the last minute then create a dramatic "emergency" in order to get help. This fosters the emotionally immature and histrionic displays in emergency rooms.
• Our current welfare system does not allow exchanging work for benefits. Benefits are given away free.
• Caseworkers and social workers have a bad habit of doing things for clients, rather than expecting the client to do it or teaching them how.
• So what have clients learned so far?
  • Don't work too much.
  • Don't plan ahead.
  • Expect someone else to provide you with what you need.
  • Don't take responsibility. Someone else will fix it for you.

The welfare system is complex, cumbersome, and difficult to change into a working entity. The major problem is that it is designed not to serve the poor, but to mollify the political needs of the tax payer. That makes it inherently punitive. As we know from behavioral science, punishment doesn't change behavior. I believe it in fact feeds the cycle similar to the one Kellevision describes above. As long as we put political considerations ahead of evidence-based methods, we'll have a broken system.

Kellevision proposes ideas that I think have significant merit.

I think counseling should be provided liberally. Teach people how to fish. Teach them how their maladaptive behaviors impair their ability to function. Stop rewarding bad behavior. Stop giving away money. Stop cleaning up their messes for them. Stop giving away free stuff.

Once homeless clients are assigned jobs, they would be provided with counseling to address the behavior problems that interfered with their ability to maintain employment. If they failed to come to work due to a poor work ethic, substance abuse problems, domestic violence or other relationship issues, etc. instead of getting fired - again - and having another black mark on their work history, they would be required to participate in counseling or group work to address it.

We spend billions on imprisoning the largest proportion of our population than any other nation. Too many of those imprisoned are petty drug offenders. In prison, they some learn how to be more effective criminals and then are turned loose to re-offend. Too many are very young.

Petty drug offenders often need CD treatment, not prison. Many are simply supporting the habit that keeps them from a more productive life. However, petty criminals can become hardened career criminals just from the experience of prison.

These are facts that have been known for many years. The only thing that keeps us from acting on this knowledge is an uneducated electorate. At the recent APA convention, another expert repeats the message.

Image by Rennett Stowe via Flickr

"The current design of prison systems don't work," said criminal justice expert Joel Dvoskin, PhD, of the University of Arizona. "Overly punitive approaches used on violent, angry criminals only provide a breeding ground for more anger and more violence."

Presenting at the American Psychological Association's 117th Annual Convention, Dvoskin discussed his upcoming book, "Applying Social Science to Reduce Violent Offending," which examines why prisons are failing and what needs to change.

"Prison environments are replete with aggressive behaviors, and people learn from watching others acting aggressively to get what they want," Dvoskin said in an interview.

Applying behavior modification and social learning principles can work in corrections, he said. "For example, systematic reinforcement of pro-social behaviors is a powerful and effective way to change behavior, but it has never been used as a cornerstone of corrections," he said.

Also, punishment can be effective in changing behavior, but it only works in the short term and immediately after the unwanted behavior happens, he said. While there is a place for punishment, it should be used in psychologically informed and effective ways. However, punishment should not be one-size-fits-all, Dvoskin said.

"We need to know what may be behind the criminal behavior to know what the best treatment is," he said. "A person who commits crimes when drunk but not when sober is likely suffering from an alcohol problem. Treating the alcohol problem may diminish the criminal behavior."

Valium is widely known as an addictive drug that is still occasionally prescribed for anxiety. Long-term use of Valium takes risks with a drug with perhaps the worst withdrawal syndrome of any addictive drug. Now there is evidence that the addictive effects occur with the very first dose of the drug.

Psych Central News

... a single drug or alcohol dose is sufficient to generate an initial stage of addiction. Recent research conducted under the umbrella of the Academy of Finland Research Programme on Neuroscience (NEURO) has discovered the same phenomenon in the dosage of benzodiazepine diazepam.

"Previously, addiction to benzodiazepines has been explained by reference to negative rather than positive reinforcement. In other words, the thinking has been that the reason people continue to use the medicine is that it helps to alleviate their distressing withdrawal symptoms and general discomfort, rather than because it provides a sense of reward," says Professor Esa Korpi, who has been in charge of the research project at the University of Helsinki.

However, according to the latest research it seems that diazepam causes a similar change in the brain's reward-inducing dopamine cells as a dose of alcohol, morphine, amphetamine or cocaine.

Furthermore, neural message transmission in the dopamine cells is reinforced for up to 72 hours after ingestion of diazepam.

"Our studies have shown that diazepam also affects the dopamine system, which adds a new positive reinforcement mechanism of reward learning to the theory of benzodiazepine addiction," Korpi explains.

There has been a long standing myth about marijuana that has been around since the 1960s. The myth says marijuana is less harmful to you than alcohol and tobacco. At best the myth is misleading. At worse, it becomes part of the denial based self-justification for marijuana dependence.

Marijuana today is 100 to 1000 times the strength of marijuana of the 1960s. Studies from that era are simply no longer applicable. At that time, it was asserted that marijuana is NOT addictive, rather it produces psychological dependence on those so inclined. This is still a controversial topic today. Addiction theory hinges on a habituation response. Alcoholics "learn to handle" more alcohol before getting drunk. Actually, their body becomes tolerant to it's psychological effects. Other addictive drugs are well known for their habituation response.

Marijuana is said to not habituate. However, there is one problem with this assertion. Marijuana is a highly variable substance. It has a number of differing amounts of psychoactive alkaloids. So effectively, each plant is a different mix of a variety of "drugs", not a consistent dose like an ounce of alcohol. So it is possible, I believe probable, that while habituation builds as the original source is consumed, tolerance starts at least partly from the beginning with a new plant.

Marijuana's worst behavioral effect for frequent users (weekly), is what has been called "amotivational syndrome". Regular marijuana users lose the will to work hard to better their lives. They become content to sit still, appear "lazy", lose creative energy and the willingness to take risks in novel ways. Personal growth grinds to a halt.

Marijuana has a withdrawal syndrome similar to tobacco, as we see below. We all know how addictive and destructive tobacco is to our health. Add to that amotivational syndrome from marijuana and you have a drug that rivals alcohol in it's destructiveness to people's lives. And we are just beginning to understand how marijuana affects our bodies and minds, especially young developing minds.

DrugMonkey

Common symptoms

• Anger or aggression
  
• Decreased appetite or weight loss
  
• Irritability
  
• Nervousness/anxiety
  
• Restlessness
  
• Sleep difficulties including strange dreaming
  

Less common symptoms/equivocal

• Chills
  
• Depressed mood
  
• Stomach pain
  
• Shakiness
  
• Sweating
  

[...]Very broadly consistent with symptoms established for other drugs of abuse, including nicotine.

[...]Discontinuation of both substances seemed to cause the greatest degree of withdrawal, particularly in terms of anger, irritability and aggression. Cannabis discontinuation (alone) seemed to cause sleep disturbances for longer than did nicotine discontinuation (alone). Perhaps most strikingly, the discontinuation of cannabis (alone) or nicotine (alone) seemed to produce approximately equivalently severe withdrawal symptoms as rated by these dual-users.

[...]In total, these studies paint a picture in which the discontinuation of nicotine and cannabis produce withdrawal symptoms of relatively similar severity and in similar proportion.

While still excluded from the DSM IV TR, Internet addiction has graduated to a subject worthy of research. And not surprisingly, like all other addictive behaviors, what I like to call "temporary feel goods", are associated with a lot of other diagnoses. Avoiding negative emotions has serious consequences, beyond even addictions.

CNS Spectrums

Internet addiction were more likely to have MDD, dysthymic disorder, social phobia and adult ADHD than their unaffected counterparts. Adult ADHD is the most significant predictor for Internet addiction, followed by depressive disorders. Social phobia, however, was not correlated with Internet addiction in our sample after controlling for depressive disorders and adult ADHD. Further, depressive disorders and Internet addiction were associated in the male college students, but not the females.

It would appear that one of the most abused drug among teenagers maybe available at home in the medicine chest. Prescription drugs were reported abused by a disturbingly high proportion of high school students. If I recall my numbers correctly, the usual proportion for life time alcohol abuse at about 60%, marijuana abuse in the 25% range, cocaine and sniffing glue around 10%. Nearly 1/2 high schoolers have abused prescription drugs and about half of them had given or sold the drugs to others. Ten percent to PARENTS!

Remember the classic and coarse stand up comedy of George Carlin, and his 1970s diatribe on "DRUGS Store"? He observed that the young people's preoccupation with getting high in the 60s and 70s were driven by the culture of pill popping parents who bought their drugs off the glitzy TV ads from pharmaceutical companies. I think his point is well demonstrated in the data in this survey.

Rates of prescription use and misuse were high in this single-site survey. Several surveys have highlighted increases in the nonprescribed use of prescription drugs among adolescents. In the current study, researchers constructed a web-based survey with questions about four classes of drugs (stimulants, sedatives/anxiolytics, pain medications, and sleep aids). The participants were 1086 students from 7th through 12th grades from a single school district (age range, 11–17; 68% of eligible students). There were similar numbers of each sex and race (white and black).

Thirty-six percent of respondents had at least one prescription from at least one drug class within the past year, and 49% had at least one during their lifetime. The most common class was opioid analgesia (past year, 33%; lifetime, 45%). Of the respondents, 24% gave away or loaned their medications; 10% acknowledged diverting drugs to parents, 8% to siblings, and 19% to friends. Teens were significantly more likely to divert drugs to same-sex friends than to opposite-sex friends. Of 390 students with past-year prescriptions, between 29% and 62% were asked to divert their medications.

Comment: The burgeoning problem of prescription medication diversion has been associated with high rates of illicit-substance use. The sobering data require both further research and development of preventive and interventional strategies, e.g., school-based health education. Whether nonprescribed diversion is related to the specialty of the prescribing physician and whether physicians discuss diversion with patients would be useful to know. An immediately useful approach for psychiatrists would be to inquire about all medications that other physicians have prescribed for their patients.

— Barbara Geller, MD

Published in Journal Watch Psychiatry April 30, 2007

Citation

Boyd CJ et al. Prescription drug abuse and diversion among adolescents in a southeast Michigan school district. Arch Pediatr Adolesc Med 2007 Mar; 161:276-81. [Medline® abstract]

There is a secret that is just not talked about in a lot of circles. Drug abuse is not solely the scourge of poverty. In fact, drug abuse among poor minorities is dropping. Drug abuse among educated white middle aged women is higher than it's ever been and growing. Along with it, aging baby boomers are well represented in the latest crime wave.

New York Times

When releasing last week’s Monitoring the Future survey on drug use, John P. Walters, the director of the Office of National Drug Control Policy, boasted that “broad” declines in teenage drug use promise “enormous beneficial consequences not only for our children now, but for the rest of their lives.” Actually, anybody who has looked carefully at the report and other recent federal studies would see a dramatically different picture: skyrocketing illicit drug abuse and related deaths among teenagers and adults alike.

[...]According to the Centers for Disease Control and Prevention, the number of Americans dying from the abuse of illegal drugs has leaped by 400 percent in the last two decades, reaching a record 28,000 in 2004. The F.B.I. reported that drug arrests reached an all-time high of 1.8 million in 2005. The Drug Abuse Warning Network, a federal agency that compiles statistics on hospital emergency cases caused by illicit drug abuse, says that number rose to 940,000 in 2004 — a huge increase over the last quarter century.

Why are so few Americans aware of these troubling trends? One reason is that today’s drug abusers are simply the “wrong” group. As David Musto, a psychiatry professor at Yale and historian of drug abuse, points out, wars on drugs have traditionally depended on “linkage between a drug and a feared or rejected group within society.” Today, however, the fastest-growing population of drug abusers is white, middle-aged Americans. This is a powerful mainstream constituency, and unlike with teenagers or urban minorities, it is hard for the government or the news media to present these drug users as a grave threat to the nation.

Among Americans in their 40s and 50s, deaths from illicit-drug overdoses have risen by 800 percent since 1980, including 300 percent in the last decade. In 2004, American hospital emergency rooms treated 400,000 patients between the ages 35 and 64 for abusing heroin, cocaine, methamphetamine, marijuana, hallucinogens and “club drugs” like ecstasy.

Equally surprising, graying baby boomers have become America’s fastest-growing crime scourge. The F.B.I. reports that last year the number of Americans over the age of 40 arrested for violent and property felonies rose to 420,000, up from 170,000 in 1980. Arrests for drug offenses among those over 40 rose to 360,000 last year, up from 22,000 in 1980. The Bureau of Justice Statistics found that 440,000 Americans ages 40 and older were incarcerated in 2005, triple the number in 1990.

[...]Few experts would have suspected that the biggest contributors to California’s drug abuse, death and injury toll are educated, middle-aged women living in the Central Valley and rural areas, while the fastest-declining, lowest-risk populations are urban black and Latino teenagers. Yet the index found exactly that. These are the sorts of trends we need to understand if we are to design effective policies.

The United States’ drug abuse crisis has exploded out of control. Scientifically designed strategies are urgently needed to target the manifest drug-caused damage that current policies are failing miserably to address.

It's not clear how to explain the trends, but the perception that drug abuse has been and always was a problem for the poor is not true, and probably never was.

Have you talked to your child about drugs and alcohol? How about tobacco? How about inhalants? More and more parents are talking to their children about drugs and alcohol, but unfortunately, inhalants have not made the hit list. Sadly, they are making a come back in abuse patterns of the young. The better informed you are about drugs, the more your children will listen.

DrugFree.org

• One in five teenagers (20 percent), or 4.7 million teenagers nationally, report abusing inhalants in their lifetime.
• 64 percent of teenagers in 2005 agree strongly that inhalants can kill you, down 19 percent from 2001.
• 77 percent of teenagers in 2005 agree strongly that inhalants can cause brain damage, down nine percent from 2001.
MORE

[...]Research shows an alarming number of teenagers are intentionally abusing a variety of Rx and OTC medications to get high. Approximately one in five teenagers has already abused a prescription painkiller to get high, and one in 11 has abused OTC products, like cough medicine. These medications have become increasingly more accessible to teens, in some cases directly via the internet, and generally are more prevalent in their teen’s lives than parents realize.

Hat tip to Anxiety, Addiction and Depression Treatments.

The US has one of the highest rates of incarceration of any country in the world. At year end 2002, 1,440,655 prisoners were under the jurisdiction of State or Federal correctional authorities. Four years later, that number is estimated at 1.8 million. In 2001, about 592,000 State prison inmates were released to the community after serving time in prison. (DOJ). Of the more than half a million offenders released every year, nearly 70% of them return to prison within three years.

In reaction to the problem of the "career criminal", the states and federal legislators passed tough new mandatory sentencing laws. The prison population as a result has grown precipitously. Now virtually every prison in the US is overcrowded. There is evidence that overcrowding "creates competition for limited resources, aggression, higher rates of illness, increased likelihood of recidivism and higher suicide rates." In addition, the cost of incarcerating an ever increasing population is skyrocketing, for the most part made up of non-violent offenders.

A study by an advocacy group called Families Against Mandatory Minimums (FAMM) finds that rigid mandatory sentencing laws are largely to blame for the growth in incarceration of non-violent offenders, who make up over half of all prisoners. According to a FAMM news release, one in four prisoners are serving time for a property offense, one in five for a drug offense, and one in 12 for driving under the influence (DUI).

[...]The report also outlines comprehensive suggestions for sentencing reform and immediate steps to reduce overcrowding and save money. [...] "After 25 years, the verdict is clear: Arizona's mandatory sentencing laws do not enhance public safety and the certainly do not deliver justice," says Judge Rudy Gerber, who helped author the 1978 criminal code that established mandatory sentencing. "In my 22 years on the bench, I was forced to sentence far too many people to prison when treatment, community service and restitution to victims would have been more appropriate."

FAMM is a non-profit organization dedicated giving back to the judge the option of setting sentences. It's website makes a strong argument:

The American justice system traditionally permits judges to weigh all the facts of a case when determining an offender's sentence. But in the 1970s and 1980s, the U.S. Congress and many state legislatures passed laws that force judges to give fixed prison terms to those convicted of specific crimes, most often drug offenses. Lawmakers believed these harsh, inflexible sentencing laws would catch those at the top of the drug trade and deter others from entering it. Instead, this heavy-handed response to the nation's drug problem filled prisons with low-level offenders, resulting in over-capacity prison populations and higher costs for taxpayers. Mandatory sentencing laws disproportionately affect people of color and, because of their severity, destroy families. Two decades after the enactment of mandatory sentences, these laws have failed to deter people from using or selling drugs: drugs are cheaper, purer and more easily obtainable than ever before.

Some have argued that the increase in prison populations led to a drop in crime rate during the Clinton years. Other studies demonstrate:

"that crime rates have risen again after 2000 while the incapacitation and sentence/crime imprisonment/population both remained high."

There is other correlative evidence that suggests other factors were involved including:

(1) a strong economy and low unemployment; (2) a decline in the nature of drug markets, especially a change in the crack-cocaine market; (3) a reduction in the number of young males in the population as the 1960s birth cohort matured; (4) increased law enforcement budgets under the Clinton presidency; (5) increased adoption of community policing strategies.

Newsweek, in it's 4/24/06 issue, describes a new movement to adopt a primary role of rehabilitation for offenders incarcerated for methamphetamine offenses.

As the methamphetamine epidemic continues to ravage the country, some states are responding with a new innovation: "meth prisons" dedicated exclusively to inmates addicted to the drug. The Montana Department of Corrections just approved construction of two of them—an 80-inmate unit for men and a 40-inmate unit for women. Illinois, which already has a two-year-old drug prison that handles a variety of addictions, plans to open two meth-specific facilities by July 2007; each one will house 200 male inmates.

[...]The meth prisons are aimed not just at drug dealers and manufacturers, but also at those who commit crimes, like robberies, to feed their addictions. While the Illinois program will be voluntary for offenders, the law in Montana will authorize judges to order prisoners to serve time in a meth facility. Treatment will include group counseling, individual therapy and seminars on work, family and life skills. In Montana, family visits won't be permitted until inmates are deemed ready. Upon their release, case managers will monitor parolees to ensure that they continue to attend treatment programs.

Similar approaches appear to be working elsewhere. In Indiana, where corrections officials have set up meth units within four regular prisons in the past year, 66 members of the first graduating class were released about six months ago; so far, none have committed another offense. In Illinois, recidivism among inmates released from the drug prison is 50 percent less than among a comparable group in the regular prisons.

Bible Believers Fellowship, Inc.

The group's study involved 190 prisoners who between 1975 and 1979 had taken part in Christian discipleship training, and a similar number who had not, matched by age, race, gender and other factors. Both groups had been released from prison eight to 14 years prior to the study. It found that the religion-trained ones had an 11 percentage point lower recidivism rate than the control group. Forty percent of the religion-schooled group committed new offenses, while 51 percent of the others did so. The religiously trained group also had a longer crime-free period following release, and when they did commit new crimes, the crimes were less severe compared to past offenses. The control group had increased crime-severity. The recidivism rate for women who took religious training was even lower, only 19 percent, compared to 47 percent among the control group of women. Among men only, the differential was only seven points.

The classic book on the criminal character predicted the effectiveness of faith-based approaches to criminal rehabilitation. In the book Psychopathy by Robert D. Hare, PhD notes that religious conversion and marrying a good woman is the most effective way to teach the offender self-control. It's not a large leap of faith to see how emotional maturity is directly related to the kind of "conversion" that changes a criminal character. Clearly much of the literature reports the ineffectiveness of rehabilitation in changing career criminals. The evidence suggests that the people who are currently over-filling our prisons are not the violent anti-social career offenders who were subjects of the studies. My own clinical experience says that many of the minor offenders do respond to treatment and skills training.

We live our lives based on experiences we've had over our lifetime and the skills we learn and abilities with which we are born. People who behave in anti-social ways have learned that this behavior has advantages over socially acceptable behavior. Many of the studies reviewed in Hare's book reflect a poor relationship between parent and child, an absent or ineffective father figure, and abusive, inconsistent and/or neglectful child rearing. Children who grow up anti-social witness a disproportionate level of violence and perhaps most importantly, a level of chaos and absence of a perception of fairness and justice in their lives. They learn that their behavior in the long run doesn't change anything, delay of gratification just produces more pain. So short-term gain is chosen as the primary motivator. And the child's own self-interest is considered above all other considerations.

The American Psychological Association (APA) concludes that corporal punishment in raising children cannot be condemned or recommended based on the available literature. However, since it is statistically associated with physical abuse by parents so prone, the APA recommends that abusive parents be counseled to avoid corporal punishment.

"The act of corporal punishment itself is different across parents - parents vary in how frequently they use it, how forcefully they administer it, how emotionally aroused they are when they do it, and whether they combine it with other techniques. Each of these qualities of corporal punishment can determine which child-mediated processes are activated, and, in turn, which outcomes may be realized," Gershoff concludes.

The meta-analysis also demonstrates that the frequency and severity of the corporal punishment matters. The more often or more harshly a child was hit, the more likely they are to be aggressive or to have mental health problems.

While the nature of the analyses prohibits causally linking corporal punishment with the child behaviors, Gershoff also summarizes a large body of literature on parenting that suggests why corporal punishment may actually cause negative outcomes for children. For one, corporal punishment on its own does not teach children right from wrong. Secondly, although it makes children afraid to disobey when parents are present, when parents are not present to administer the punishment those same children will misbehave.

The quality of the relationship between parent and child has a direct impact on the effectiveness of punishment. Criminals have few relationships they value. They see society as a arbitrary punisher, rationalize that everyone is on the take, they are the unlucky one who were caught. Therefore punishment is in the context of resentment. More punishment just provokes more resentment and an escalation of anti-social behavior. Ask experienced prison guards if the violence has escalated over the years.

Hare's book noted that the method that had any hope of changing the behavior of a criminal character, was a religious conversion, falling in love with a "good" woman, or living in a situation where all the rewards of life are totally controlled by well intentioned others. Only when socially acceptable behavior is largely rewarded, and anti-social behavior is mostly punished will behavior change. Once that control is gone, the criminal character will return to anti-social behavior.

The correctional system we have is a complete failure. The only thing that works is locking people up for life. Truly, we as a society can't afford to lock up more than 2% of our total population at any one time. We need another solution. Career criminals are seldom caught. When they are, it's after more than a dozen offenses. Punishment will never be assured because we can't afford to lock them all up. We need a solution to the problem, not an over-sized band-aid.

The problem of crime and drug abuse originates in childhood. Years of research has shown that parents with chaotic lifestyles produce children with chaotic futures. Until we improve our parenting skills across the board, we will have to live with incredible crime and incarceration rates. We need to be teaching parents-to-be the skills beginning in junior high rather than assuming that parents pass on this skill to their children. Teaching parents-to-be how to nurture a quality attachment their children is critical. But it is also necessary to train parents-to-be emotion management skills and how to systematically teach those skills to their children. Competent parenting requires knowledge about emotion management and how to solve behavioral problems. My local school includes "Character Education" in it's curriculum. Creative approaches can be acceptable to both sides of the political spectrum. Improving parenting skills is critical to retrieving what has become a chronic underclass living a chaotic drug infested lifestyle.

Methamphetamine addiction has spread like a wild fire across the country. Here is some details about consequences of meth addiction.

Narconon

Methamphetamine can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain. Hyperthermia (elevated body temperature) and convulsions occur with methamphetamine overdoses, and if not treated immediately, can result in death.

Chronic methamphetamine abuse can result in inflammation of the heart lining, and among users who inject the drug, damaged blood vessels and skin abscesses. Methamphetamine abusers also can have episodes of violent behavior, paranoia, anxiety, confusion, and insomnia. Heavy users also show progressive social and occupational deterioration. Psychotic symptoms can sometimes persist for months or years after use has ceased.

Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent.

Treatment of Meth addiction has been particularly difficult. Success rates have been as low as 20%. So it is indeed good news when a breakthrough presents itself.

Dare To Dream MH Library

A common antidepressant, bupropion, can reduce the craving for methamphetamine, providing the possibility of a drug treatment for the powerfully addictive stimulant, according to a study by UCLA researchers published today. Dr. Thomas F. Newton, a UCLA psychiatrist who led the study, found that subjects who were given bupropion reported a lesser high after a meth injection as well as a less intense craving after watching a video of actors favorably portraying meth use.

The next step is more research to see if Wellbutrin can be consistently helpful. Meanwhile, the medication is readily available and one of the successful medications for treating depression.