This year, a plan for sobriety

Would-be dieters and exercisers aren’t the only ones hoping to start and stick to programs this month. The greatest surge in admissions to alcohol and drug rehabilitation centers also comes at the start of the new year.

Requests for treatment and admissions to rehab centers increase after the holidays, say experts at the National Institute on Alcohol Abuse and Alcoholism and treatment centers around the country. But unlike people hoping to lose weight, addicts don’t necessarily seek help simply because of resolutions to do better. For them, the holidays can precipitate a turning point -- one recognized by themselves or by friends and family.

Justin Burton, 36, a long-time heroin user who lives in Los Angeles, sought treatment last January after hitting bottom during the holidays. “It was either get help or blow my brains out,” he said last week. A studio welder by trade, for years he shuttled between getting clean, living on the streets and time in prison. Now, he says, he’s been off drugs for 11 months.

Clare Kavin, an addiction specialist in Beverly Hills, says calls from parents of high school and college-age kids increase by about 30% after the holidays, prompted by crises involving illegal or prescription drugs.

And Mike Sanders, head of ExecuCare, an addiction recovery center in Norcross, Ga., says he started his own recovery from alcohol and the painkiller OxyContin in January 2005. He now knows to gear up for an increase in information requests and admissions after the holidays.

Other addiction experts say they too have taken to reminding staff members to expect increases in people asking for information as well as for admission to programs when January rolls around.

“Holiday-related stress such as financial worries and family issues, as well as parties offering easy access to alcohol and, often, drugs can trigger crises for addicts, pushing them -- or their family and friends -- to seek help when the holidays, and partying, stop,” says John J. O’Neill, director of the Professionals in Crisis drug and alcohol addiction program at the Menninger Clinic in Houston.

Family and friends often note problems during the holidays and use those to coax an addict to treatment afterward, experts say.

Other alcoholics or addicts reach a turning point by consuming more than usual and by finding themselves coping with a crisis, says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, or NIAAA. Until then, they may have been managing relatively well, but the sudden pressure -- financial, emotional, job related -- pushes them too far, he says.

Even those who are in recovery -- especially if it’s been less than five years -- can struggle. “Normal routines are broken up, and people may have been away from their support groups,” Willenbring says. They can resume use of alcohol or drugs even if they’ve been sober or clean for months or years.

The holidays also can mark a turning point for those who stop short of addiction.

“There’s no question that we see increases in people seeking help after the holidays, but that’s not limited to the most hardened drinkers,” Willenbring says. Many people ratchet up their consumption levels in December, finding themselves driving drunk or behaving badly at a party.

January is a good time for anyone to take stock of their holiday behavior, says Richard Rawson, head of the Integrated Substance Abuse Programs at UCLA’s School of Medicine. According to the NIAAA, only about 10% of people with an alcohol problem are in treatment -- and the numbers are even lower for drug addicts.

Rawson says the appropriate level of alcohol in one day is likely the level at which alcohol has potential health benefits: one drink per day for women, and two drinks per day for men. “If you are drinking more than that, and find you can’t cut back, that’s an indication that it’s time to discuss your drinking with a professional,” he says. (Standard drink measurements include one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine or 1.5 ounces of 80-proof distilled spirits.)

People who suspect they overindulged on alcohol during the holidays should keep track of how many daily drinks they have per week, Willenbring says. That’s a good beginning, he adds, because “people who keep track tend to drink less.”

New treatments

This year, addicts who seek help can find several recent additions to the drugs, legislation and behavioral therapies that trained counselors have used to help addicts start their road to recovery.

Addiction experts are recognizing that, as with stop-smoking programs, one-size treatment doesn’t fit all, and alcoholics and addicts may have to try several options before finding one that will be effective, Rawson says.

Among the newer treatments is Vivitrol, approved by the Food and Drug Administration last April. A monthly injection version of the oral alcoholism drug naltrexone, the medication previously had to be taken daily by tablet to be effective. Both can reduce the craving for alcohol and the chemical “reward” people can feel after drinking alcohol, Willenbring says.

Two other drugs, Antabuse and acamprosate, are also used to help treat alcoholism but are not considered cures in and of themselves. The former produces negative reactions to alcohol, including headache, sweating, thirst and vomiting. Acamprosate, approved about a year and a half ago, is designed to help addicts maintain abstinence by treating neurochemical changes that can occur with long-term alcohol use, helping to reduce the insomnia and anxiety after people stop drinking. Some patients may need more than one drug, Willenbring says.

Treatments for drug addiction include medical, psychological and behavioral therapies, with the option of inpatient or outpatient settings. For people addicted to opiates, including heroin and some painkillers, the drug buprenorphine can help in their recovery. A controlled substance carefully monitored by the federal government, the drug is the only FDA-approved medication that private physicians can use to treat opiate addiction.

In December, President Bush signed legislation increasing from 30 to 100 the number of patients that each trained physician can treat with buprenorphine.

UCLA’s Rawson also urges patients to consider behavioral therapies, “which often don’t get the publicity of drugs because there is no pharmaceutical company promoting them.”

New therapies include rewarding drug users in recovery with positive messages and even small payments and a behavioral strategy that doesn’t force a person to admit his or her addiction but addresses the reasons behind the drinking.

A support system

Although much of the activity that addiction specialists see this month is generated by addicts themselves, a friend or family who has seen someone spiral down shouldn’t wait for them to sign themselves up for treatment.

“It does work for a family member or friend to talk to an addict -- the carrot is better than a stick,” says Dr. Matthew Torrington, head of the Prometa Center in Santa Monica. Meaningful support can often be more useful than threats, he adds.

“I would say, ‘I love you and I see you getting harmed and I want to help you because this is not right for you and this is not the person who you are.’ ”

If that doesn’t work, intake specialists at addiction centers can suggest other options such as involving a physician or clergyman.

And, too, experts say, family members often need their own support and counseling. Even if the addict isn’t ready to face his or her problem, family members should not delay in helping themselves.

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How to get help

People worried about their own or a loved one’s drug or alcohol abuse should begin their search for help with their family physician or internist, experts say. He or she can help decide whether a residential facility is needed or if help can be offered from home.

Other resources

* The Substance Abuse and Mental Health Services Administration, an agency run by the U.S. Department of Health and Human Services, helps find treatment for addictions and mental health problems. The website offers some tests to help determine if you have a problem with alcohol or drugs and lists local treatment centers. Go to www.samhsa.gov/treatment/treatment_public_i.aspx or call (800) 662-HELP (4357).

* The National Institute on Alcohol Abuse and Alcoholism offers information and local substance-abuse referrals for all 50 states at www.niaaa.nih.gov/resources/relatedwebsites/referral or by calling (800) 662-HELP (4357).

Also, last week the NIAA published a resource guide for doctors treating patients with alcoholism that includes information for patients and can be downloaded at www.niaaa.nih.gov/guide.

* The Los Angeles Department of Health Services’ Alcohol and Drug Program Administration supports an array of treatment and recovery programs and provides referrals. Go to www.lapublichealth.org/adpa or call (800) 564-6600.

* The Matrix Institute on Addictions, a nonprofit organization, offers assessments and a variety of programs throughout Los Angeles. Go to www.matrixinstitute.org or call (800) 310-7700.

* Childrens Hospital Los Angeles offers an adolescent program for substance abuse. Call (323) 669-2153.