Oh-Crap Sunday: Addiction, Family, and the Holidays

The treatment discussion revs up between Thanksgiving Thursday and Cyber Monday

Real talk: If you put off the substance use discussion until the New Year, you might not have a chance to have the discussion. Addiction is a disease. People die. And they only can dig themselves deeper into destruction during the Holidays without help.

That's news as ice cold as Wausau, Wisconsin or the turkey leftovers you stuffed into the back of the freezer. By the way, you're never going to eat that. It tasted dry on Thanksgiving... it won't get better by March by itself. Likewise, a drug user won't get better by March (or Christmas) by himself.

Oh-Crap Sunday means more than you blew through your entire holiday budget on Black Friday and Small Business Saturday. It's more relevant than your favorite NCAA team getting crushed on Rivalry Saturday, or your NFL team being worse than the Bears on any given Sunday at the twilight of the calendar. Oh-Crap Sunday is the pause at the start of the Holiday Gauntlet where you have an a-ha moment after the first of the season's socializing, realizing that a loved one is in over his or her head with alcohol or other drugs. Oh. Crap.

Help starts at home

What does 'in over their head' mean? Noticing someone's drug use – alcohol is a drug – means it is a problem. You don't notice someone's consumption otherwise. The nodding off is more than turkey's tryptophan. The slurred speech telling the same joke loudly for the third time isn't just because Uncle Dan is mixing the drinks. The fragrance in the bathroom isn't potpourri. Wise up. Trust your instinct. You're probably right about a drug use problem. If you're wrong, what does it cost you?

We've normalized drug use in the U.S. as pointed out in Look What Dragged the Cat In. With it being normalized, the tendency is to blow it off until it gets obvious. Then it's time to get help.

In looking for help, there is no substitute for intervention at home. You can go to every slick treatment website Google throws at you. Nobody's going for an evaluation until the personal, charged conversation takes place at home. Work with your M.D. or a treatment professional to find the right path toward 'clean and sober' after the Oh-Crap conversation. The first step is the conversation.

Drugs alter the mind, talk to the heart

Consider that all drugs of abuse licit and illicit alter the mind. An altered mind isn't going to decide for itself that it needs help. People don't take drugs to feel good, they take drugs to feel less bad. If the brain's user is going to feel more bad, he or she is going to be messaged by that brain that the drug isn't a problem. A person first needs to hear from family and friends that the drug use is concerning.

The talk is harder than you think. But not harder than talking to a corpse. Alcohologist.com has resources like videos (see the New Year, New You series opener here) that help ease into the conversation. The three-question AUDIT is also an ice-breaker/resolve-breaker.

Quick: What's the next holiday? Will you spend it without him or her in your life?

Image by Roman Stetsyk, used with permission.

Only officials drunk on alcohol money would call opioids the 'biggest health crisis'

The maker of OxyContin, Purdue Pharma, and the company’s controlling Sackler family agreed March 26 to pay $270 million to settle an Oklahoma lawsuit claiming they helped create the opioid crisis with aggressive marketing of the painkiller. “The $270 million is less than what the lawyering would have cost Purdue. The did the 'right' thing,” says author Scott Stevens.

This is the first settlement emerging from wave of nearly 2,000 lawsuits against Purdue threatening to push the company a bankruptcy safe-haven, says the author of Look What Dragged the Cat In: The Rise of an Opioid Crisis. In the book, presented in hardcover at academic conferences in Europe in 2018 and now available in e-book, Stevens demonstrates how the neither the drugmaker – nor doctors – are to blame in the 'ab irato' lawsuits. “Are their hands clean? No. But they didn't create this crisis, or the two it's spawned (benzodiazepines and methamphetamine),” according to Stevens.

Oklahoma Attorney General Mike Hunter announced the settlement, calling the crisis “this nightmarish epidemic” and “the worst public health crisis in our state and nation we’ve ever seen.” Stevens responds, “First, the death toll from opioids in Oklahoma is about 400. They're all tragic. No question. Alcohol kills at least 1,300 a year in that state. If opioids are an epidemic, alcohol is a pandemic that costs their state $4.5 billion a year, and the U.S. 90,000 lives and $250 billion a year.” His numbers are according to the Centers for Disease Control and Prevention (CDC). “We don't call out the real problem because the alcohol business is an an advertiser, a campaign contributor, and an adored and endorsed part of our culture.”

The fifth book by Wisconsin author, Scott Stevens, calls out the beverage alcohol business and a 'buzz' culture, not pharmaceutical companies and doctors, as the culprits behind the opioid crisis. Stevens says, “If you examine how many opioid-related deaths are alcohol-related, the answer is that they all are. Two thirds of illicit drug users point to alcohol as their first drug, and all of us learn to self-prescribe from alcohol.”

The book was released Aug. 23, 2018 at the International Conference on Addiction Therapy & Clinical Reports in Paris, France, capping two-years of research by the author into the escalation of opioid overdoses. “It's the same root cause of every drug 'crisis' we've observed. Cocaine in the 1980s, heroin again in the 1970s and before that the 1920s, and between the two prior heroin crises, a methamphetamine crisis in the 1950s,” says Stevens. “The thread cinching all of them together is alcohol: The drug we don't call a drug or treat as the deadly drug it is. We encourage use of this drug, then when users can't get where they want with alcohol, they up the ante with other, harder drugs. No runner runs a marathon as their first race out.”

The book examines the self-regulation of alcohol-industry ads, the pricing, and availability of alcohol. “There really is a straight-line relationship between the opioid crisis with the gateway drug, alcohol.”

The World Congress on Addiction Science in London in Sept. 2018, as well as the 2018 International Conference on Clinical Psychology in Amsterdam, also were forums for launch of Stevens' work. He's now doing radio and conferences in support of the e-book launch of the book March 26.

Stevens has no ties to the pharmaceutical industry, nor does he practice medicine, yet he finds only moderate culpability for either profession in the rise of the opioid situation. “They were accomplices to some degree, but we fail to look deeper. What causes problems is one. We just have this fear of tagging the alcohol business because of our glorification of drinking.” The book points out that society also has a notion that anything resembling reining in the alcohol business looks like Prohibition, generally considered a failure. Americans also don't 'want to believe alcohol is a drug or a problem outside of car wrecks, cirrhosis, and disease of alcoholism. “We're told we can drink responsibly when there is no responsible way to drink a toxin and known carcinogen. Buying into the glamour of the drug seduced Americans right into opioids.”

Americans defend the gateway drug, says the author. Among his solutions is a strategy like the anti-smoking campaign that began with the Master Settlement Agreement for tobacco companies in the 1990s. “We defend drinking as some sort of rite. All we're doing by guarding drinking as a personal choice is sacrificing our own children for a product with zero life-extending or life-saving properties.”


Stevens is author of five alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He Chaired the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France, where Look What Dragged the Cat In was officially launched. He's also the Chair for Addiction Science 2018, in London, UK.

Image byTom Baker, used with permission.

Blame the opioid maker? Right church, wrong pew

A new article appearing in VOX notes that one member of the Sackler family, longtime overseers of Purdue Pharma, is helping the treatment industry clean up what the opioid crisis cat dragged in. Richard Sackler, former president of Purdue Pharma, is listed on the patent application for a new form of buprenorphine. Buprenorphine (trade names Buprenex, Butrans, Probuphine, and Belbuca) is an opiod agonist used in the medication-assisted treatment (MAT) for opioid addiction.  The new product is a fast-dissolving wafer, designed to keep those administered the dose from cheeking the medication and sharing/selling it.

On one hand, 'Shouldn't we be applauding ANY help going to those who need it?' is the easy question. That question is buried under the emotion of a very traumatic crisis, however. One editorial on the article went so far as to call Sackler the 'devil incarnate,' And the spin on the article is that Purdue helped spawn the opioid crisis with its drug, OxyContin, and Stackler made bank on that drug and now seeks to profit from cleaning up the mess.

Not so fast. OxyContin and Purdue are not the drugmakers that created this crisis. The drugmakers that created this crisis, every crisis before it, and the crises emerging now, are not in the pharmaceutical industry. The drugmakers who have groomed us for drug use, drug abuse, and drug addiction make the gateway drug, alcohol.

Two thirds of drug abusers identify alcohol as the first drug they used, according to an American Addiction Centers 2018 survey. The rest of us learned to take drugs from our cultural acceptance and endorsement of drug use aka drinking. What we ignore, we permit, what we permit, we condone.

The blame-game, legislation, lawsuits, etc. target Big Pharma, sketchy doctors, China, and dope dealers. Right church, wrong pew. Look What Dragged the Cat In details how the opioid crisis (spoiler: it's a crisis, not an epidemic) really emerged (spoiler: it wasn't the Sacklers) and how we can use the tragedy of this crisis to prevent the next one.


Stevens is author of five alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He Chaired the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France, where Look What Dragged the Cat In was officially launched. He's also the Chair for Addiction Science 2018, in London, UK.

Image by Santalucia Art Inc., used with permission.

Horrible medical advice in print when doctors shill for the alcohol industry

Times-Colonist doctor uncaps a bottle of fooling-yourself alcohol-industry propaganda.

'Moderate beer drinking never killed anyone.' Not all physicians are this foolish with advice advocating drinking a toxin and known carcinogen. Sadly, many still buy in to junk science touting health benefits of drinking alcohol. There are ZERO health benefits to even 'moderate' consumption of this drug in evidence-based studies.

The full article is at The Doctor Game: Moderate beer-drinking never killed anyone,  The gist of it is "The secret for longevity remains the same — following a healthy lifestyle early in life and sticking with it. Too many attempt it unsuccessfully at the end of life.

"Add it all up, and it’s moderation throughout life that wins the day. Just consider alcohol. At least 20 studies show that moderate drinkers live longer than either teetotallers (sic) or alcoholics. [20 wish-thing observational studies which do not take into account other lifestyle factors] Alcohol lowers blood cholesterol [false, it increases triglycerides] and decreases the risk of a fatal blood clot [also false, it is a leading contributor to stroke risk].

"So beer in moderation never killed anyone on the Mayflower, or anywhere else. Beer contains no cholesterol, fat, triglycerides or sugar, and is low in sodium. It also contains vitamins, calcium for bones [untrue nutritional claims], potassium to lower blood pressure [alcohol use increases, worsens hypertension] and magnesium to regulate the heart’s rhythm. [Widely discredited heart health benefits.]

"The government doesn’t prevent the sale of cars because some idiots drive too fast. Yet ironically, and possibly criminally, it prohibits beer and liquor companies from stating that moderate drinking is a healthy habit. My advice is buy a bathroom scale and step on it every day. This will help to keep you a moderate consumer of food, alcohol, and exercise. If the scale continues to show increasing weight, need I say more?"

Yes, you need to say something honest about the drug you're proclaiming safe in moderation. There is no safe level when consuming a toxin and carcinogen, doctor, according to scientists who don't shill for the alcohol industry. And 'moderate' beer drinking increases accident risk with impairment beginning at .02 blood alcohol concentration (BAC). 

Vladislavs Gorniks image, used with permission.


Stevens is author of four alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He will Chair the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France.

Look What Dragged the Cat In: The rise of an opioid crisis

Excerpted from the 2018 USA Best Book Winner, Look What Dragged the Cat In.

The decade of the 2010’s shelled hospitals and first responders with an explosion of opioid-related illness, injury, and death. Preventable drug overdoses tallied 54,793 lives lost in 2016 – an increase of 391 percent since 1999. Accidental drug overdose deaths increased 327 percent over the same period. The majority of OD deaths (38,000) involve opioids, The drug category most frequently involved in opioid overdoses and growing at the fastest pace includes fentanyl, fentanyl analogs, and tramadol. The fentanyl category of opioids accounted for nearly half of opioid-related deaths. The dirty cat in the litter, heroin, accounted for the second highest number of deaths, claiming 14,606 lives.

America struggles with what the opioid cat dragged in: Hard-to-treat opioid addictions, fatal relapses, and needless loss of mainly young lives. Now legislators, first responders, treatment pros, and those in the medical field are forced to focus not on the death toll the cat dragged in, but instead what dragged the cat in.

Every opioid related death is alcohol related

The abuse of drugs, regardless of classification, begins with the permissiveness granted the world’s most lethal drug and third-leading cause of all preventable deaths: Alcohol. It’s a straight line.

Nearly every non-Muslim civilization on this rock has embraced alcohol. As a result, ours is largely a numbing planet, especially in the sedation-happy Americas. This is the root. This is the seed of the opium trade that has gone unstemmed since prehistory. There is legit medical use for opium derivatives: What has driven growth is demand – not by the sick but by people who cannot get the mind alteration they desire through alcohol use alone.

Alcoholics and non-alcoholics alike drink the first drink for the same reason: To relieve a stress. In the U.S., which has a laissez faire agenda toward alcohol since its prohibition failure, the culture embraces a drinking lifestyle. Americans normalize alcohol use. In other words, Americans (like many cultures) normalize drug use. The 1960’s have nothin’ on the 2010’s.

What you ignore, you permit. What you permit, you condone.

Opioid abuse happens when a person can’t get where they want to get with alcohol. The opioid crisis wasn’t created by doctors overprescribing, manufacturers wooing doctors, China shipping heroin and cheaper fentanyl via cartels and the U.S. mail. Drinking, especially binge drinking, is the pandemic that dragged in the opioid ‘epidemic.’ Americans condone the buzz, the sedation. We created this monster on our own.

What’s the way out?

Legislative attempts to curb use of potentially lethal drugs resemble shooting an arrow and then drawing a target around where it hit. Locking up dealers and traffickers, creating prescription databases and prescribing limits, and promoting Narcan availability all deal with control of the supply and its aftermath. The demand is unchanged. Within a cultural adoration of the buzz, our current crisis can only be curbed by control of the demand. If a drug user wants a drug, theywill get that drug. It’s the American freedom thing.

In 1967, 72 percent of adult men smoked. Today, 72 percent don’t. Prevention works. If there is genuine interest in healthy outcomes and preventing premature death from opioids, Americans’ permissiveness of the starter or feeder or gateway or predecessor drug has to be addressed on five levels to reduce demand for all antecessor drugs.

• Advertising agencies court alcohol manufacturers with a promise of creating demand for the drug. You can ban advertising without banning the product. When cigarette marketing/advertising was banned, demand dropped without banning the product. The National Bureau of Economic Research (NBER) studied bans in 20 countries over 26 years. The results indicate that an increase of one ban could reduce alcohol consumption by five to eight percent.

• Public drinking encourages drug use. Smoke-free regs cut down on the demand by curtailing where cigarettes can be smoked. Applying the same model for drinking – instead of popping up a brew pub on every corner – can reduce demand. The idea of having a cocaine bar on every corner is absurd, but a pub peddling a drug that kills more people (89,000 Americans per year) is somehow acceptable. The availability of alcohol can be regulated either through restricting the hours or days it can be sold or by reducing the number of alcohol retail outlets, according the a World Health Organization (WHO) study. Logicaly, reduced sales hours have been found to be effective in lowering consumption. In the former Soviet union in the mid-1980s, strict alcohol regulation, which included among other measures restricted hours and fewer outlets, led to a dramatic reduction.

• The ‘Smoking Stinks’ campaign brought an anti-smoking message down to the earliest grades. A modest effort to create similar anti-drinking messages demonstrating health risks of even moderate use (see viewbook.at/prehab) will stunt demand by discouraging the very first drink of the gateway drug.The American Journal of Public Health analysis of the anti-smoking campaign suggests that per capita consumption would have been one-fifth to one-third larger than it actually is, had the years of anti-smoking publicity never materialized.

• Increase the tax on the gateway drug. The bottom line is that many states and municipalities balance their bottom lines with so-called ‘sin taxes.’ The sin taxes on alcohol haven’t kept pace with inflation. These taxes are usually based on the amount of beverage purchased (not on the sales price), so their effects can erode over time due to inflation if they are not adjusted regularly. The Community Preventive Services Task Force (CPSTF) recommends increasing taxes on the sale of alcoholic beverages, on the basis of strong evidence of the effectiveness of this policy in reducing excessive alcohol consumption and related harms. Opioid use is a related harm. The CPSTF is an independent, non-federal panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and other interventions aimed at improving population health.

• Many will argue that legalizing recreational use of marijuana will reduce opioid abuse and erroneously point to Colorado as an example. (By the Center for Disease Control and Prevention’s (CDC) numbers, you can call BS: Colorado’s death rate from opioid overdose is barely in the top half of the state-by-state death-rate comparison … if you wanted to complete the morbid, pointless comparison. One death is too many.) What’s entirely missing from the debate is that no evidence exists that encouraging recreational use of another drug furthers public health in general. Marijuana is revenue-neutral when you subtract societal, medical, and legal costs.

When we rethink the drink we can douse the pandemic that begat the current opioid crisis. Legislators and treatment experts must lead the transition from managing aftermaths of the current crisis to prevention of the next one. And phase out the ancient alcohol crisis – the elephant in the room – America ignores.

Stevens is author of four alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He will Chair the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France.

Don't become an ugly Christmas sweater: Dodge the holiday minefields

It'll come to you...

Relapse traps sneakily pop up on any page of the calendar, but the 63 days between Halloween and New Year's Day can be the trickiest gauntlet to run. Sequestering in a bunker? Not an option. Here are nine tips for not sweating the season of celebrations:

1) Stay out of your medicine chest. Cough and cold season is here. It's especially easy to overdo the cough meds. In typical addict fashion, the think the dosage on the label is only a suggestion and if a small amount works, the whole bottle will really kick the symptoms to the curb. Not so. And the little buzz from an OD of the over-the-counter drug can lead back to the drug of choice.

2) Stay out of your medicine chest: Part II. Another relapse trap in the medicine chest is sleep aids. With the time change and extra holiday-season stress, sleep is a casualty of the calendar. Alcohol is a depressant. Sleep aids are depressants. The brain doesn't make such an exact distinction between the two and, historically, drinkers have used alcohol as a sleep aid – or excused their drinking by saying it helps them sleep. It isn't just the prescription sleep aid like Roseanne's favorite, Ambien. It's also the OTC one, and especially concoctions like Motrin PM or Tylenol PM.

3) Find sober celebrations. Not as rare as you might think. If you're timid, take someone along with you who might be even newer to sobriety. If there aren't celebrations, it could be time for a diversion like a museum or pick a dry theater and watch The Last Jedi. All the older kids are doing it.

4) Bail out. There is nothing wrong with the word 'no.' We were all pretty creative with excuses for our drinking. If you are even slightly apprehensive about an event, put the same creativity to use for why you can't go. And if you're busted telling a little white one… isn't it better than possibly challenging your sobriety? Real friends understand.

5) If you can't bail, bring candy. Seriously. Satisfying an oral fixation can make a difference. The taste on your palate will make alcohol flavorings less inviting, too. If you've ever had a beer on top of a candy cane, you know.

6) Never stay late if you do go. Our reputations as the last soldiers standing – gone. Be the first leaving. Everyone has seen a dreaded morning after, or the photos of the night before, and uttered the words, 'I shoulda left way earlier.' The more tired you get, the weaker your defenses become. My grandmother's rule was that nothing good ever happens after 10 p.m. anyway.

7) Go help another alcoholic who might be struggling. The twelve-steppers founded their fellowship on this simple act. Even if you're not a twelve-stepper or vow to never become one, give this a try. It works. There's a flawed thinking that the holidays are an inappropriate time to challenge someone who's challenged by drugs including alcohol. It may be the best gift you ever give the person with the disease of addiction – and the family around him or her. Inside every sick person sick with this disease is a trembling, sorry, sad person dying to feel well again. Invite him or her out onto the path to recovery. In the case of the disease of alcoholism, there's no worse time than waiting for tomorrow or the New Year. You wouldn't imagine postponing treatment for a chronic, fatal, progressive disease like cancer. Why postpone it for a chronic, fatal, progressive disease like alcoholism? If the worry is that it wouldn't be the holiday without that person near, what have the past few holidays told you about that… and what if there isn't a next holiday?

8) Breathe. The holidays are loaded with financial stress, family stress, traffic stress, cold-and-flu stress, and end-of-the-year work stress in addition to the normal, everyday stress of life. Alcoholics and non-alcoholics alike drink to relieve stress. There isn't a single stressor that is cured by drinking: There isn't one that got worse because you chose to just breathe rather than drinking it off the calendar.

9) Be brutally honest with yourself. The biggest charge in the holiday minefield is in the eight-inch gap between your left ear and your right. Nearly every relapse comes in the collision between reality and the five words, 'It won't happen to me.' Here's the very alcoholic reason why I still have Ibuprofen PM in my own nightstand: Because it won't happen to me, the second warning above is only for those other guys, right? Right.

By the way, these nine aren't just for the end of the year and the start of the new one. They work anytime.

– Scott Stevens is the author of five award-winning alcohol and health books, The A-Files: Alcohol A-Z DVD series, Alcohologist.com, and the Alcohology app for Android. He is a founding influencer of the world's largest medical portal HealthTap.  Image by Marina Gloria Gallud Carbonell used with permission.

Wisconsin proposes creating the next generation of damaged adults because profit trumps health

Assembly Speaker Robin Vos (R - Burlington), became the voice of reason by not throwing in with special interests' Nov. 8 attempt to lower Wisconsin's drinking age, effectively killing the proposal's future. (JournalSentinel article.) Alcohol is a toxin and known carcinogen. Instead of encouraging more people to drink by lowering the drinking age to 19, Wisconsin might want to focus on educating more kids about this drug.

The suggestions by the bill's sponsors that lowering the age to legally use this drug will save money is nearly as absurd as the concept that drinking a toxin 'in moderation' somehow has health benefits. At legal age 21, alcohol use – all alcohol use, not just drinking and driving or the disease of alcoholism – costs the economy $250 billion a year, mostly in lost productivity. That's enough to buy every man, woman, and child in the U.S. a 55-inch, HDTV for Christmas… every year. Increasing the number of legal drinkers is going to reduce the cost? A fine piece of fiction.

Of greater importance is the health impact. Increasing the drinking age was never about highway money or reducing drinking and driving, although they are lovely benefits. There are health consequences for developing brains. Cognitive damage in a developing brain lasts well past the hangover. Drinking in any amount reduces brain myelin, impairs cognitive and behavior control, and physically alter brain structure. This. Toxin. Changes. DNA. Lowering the drinking age will ultimately lead to impairments in brain function in adulthood. Since the brain's frontal lobes develop into the mid-20's, if we want to reduce social costs associated with drinking, raising the age of legal use would be more practical.

Brain damage is so significant it overshadows the cancer risk of a known carcinogen. The concern is especially acute for women drinkers of the only dietary link to an increased risk of breast cancer. The younger a woman starts, the higher the risk. Breast tissue is developing at age 21... again a case for increasing the drinking age rather than lowering it.

The public and political appetite (FYI: Beverage alcohol is among the top-spenders in elections) for raising the drinking age isn't there. And it isn't practical. What's practical is beginning alcohol education at earlier grades in the same fashion we start tobacco education. At it's simplest, it starts will calling alcohol a drug.

With that in mind, shame on the sponsors for suggesting the fictional cost savings from lowering the drinking age would be used for drug treatment. Treatment of the same drug you're peddling? Or were you only suggesting that to ride the coattails of the public interest in the opioid topic when you're fully aware that the accountability for actually spending the money for treatment doesn't exist?

Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Get the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere you buy books.  Click Alcopocalypse for the author’s 2017 Alcohol Awareness Month whitepaper. Image by  Peter Lecko, used with permission.

Image by Andrew Jalbert, used with permission.