This week, New Hampshire Public Radio looks at a multi-million dollar problem -- substance abuse. The chemicals that limit a person's ability to act, think and feel help fill the prisons, add to the cost of health care, strain our social services, and reduce business profits.
We begin with a look at the landscape of substance abuse. As New Hampshire Public Radio's Jon Greenberg reports, one drug in particular causes most of the damage.
At age 40, Darlene's life has taken her through virtually all the things one can drink, inhale, swallow or inject to affect the brain. She grew up in Nashua and began drinking in her early teens. She used cocaine for a couple of years before she turned 20, then stopped. Her drinking continued, mainly on weekends.
Until an infant son died in his crib.
20:00 The day he died, I drank. I could not get through the day without drinking. That was the start of the prescription medication "
Darlene continued with this cocktail of prescription drugs and alcohol for many years. She paused only when she became pregnant with another child, a daughter.
But while this new child was still an infant, a friend invited her to try heroin.
4:50 I found my ultimate relief. A sense of belonging. I wanted to feel that I was OK. It felt like the sun shine in my soul.
Within three months, Darlene was using heroin every morning and every night. She was arrested and eventually saw her daughter and an older son taken away to be raised by a cousin.
She now lives at Southeastern New Hampshire Services, one of the state's few comprehensive treatment centers.
Darlene is part of a small but growing number of heroin addicts in New Hampshire. The impact of this drug reaches from small towns like Newport, Plymouth and Seabrook, to larger cities like Manchester and Nashua.
The illegal drugs, heroin, cocaine, methamphetamines, marijuana and others can all be found here. The latest study by the federal Substance Abuse and Mental Health Services Administration estimates that the state has as many as 24 thousand people who abuse them.
Of that, marijuana accounts for the largest share. All of the hard drugs together add up to a small fraction. And according to federal researchers, about a third of illicit substance abuse involves an otherwise legal substance, prescription drugs.
Nurses log: 1:08 She's in with a patient right now, can I get your last name again?
If the hard drugs like heroin exist at the margins of society, prescription drug abuse is right in the mainstream, including at the clinic my family uses.
Ambiance kids in background
This is the Capitol Region Family Health Center in Concord.
Dr. David Bisbee is the Medical Director.
Bisbee 5:18 In my practice, it is very common to have 25-30% of the patients coming for a medication that we would consider addicting.
That amounts to about 3000 patients. Over the past four years as prescription drug abuse rose, the center has developed a careful process to monitor patients. Every staff member is trained to be alert.
Claudia Wright, a medical assistant, says she and others who deal directly with patients face this issue almost every day.
Wright 2:00 Patients will call and ask for their pain meds. One of the red flags, Ask for name brands // why // those are the ones that sell on the street.
Ambiance in full then fade
No journey through the landscape of substance abuse in New Hampshire would be complete without a stop for a look at the feature that looms largest in the state. Alcohol.
Jazz and party hum
The ballroom at the Nashua Country Club on this Saturday night is not a place where alcohol is being abused. Most of these well dressed people hold martinis. But this is a fundraiser for New Hampshire Child and Family Services and while the crowd might be drinking for a purpose, it isn't intoxication. Still, in this completely safe place, a setting that's familiar to most of us, where drinking does no harm at all, it's interesting to ask a couple of questions.
Tape Lozeau :40 Have you had a martini tonight. Yes. Enjoy it? Yes. My next question is, do you know anyone for whom alcohol is significant problem? Yes, of course.
Almost everyone knew someone, someone relatively close if not an actual relative, who could not control their drinking
3:45 I know several, someone I work with. The second is in my husband's family. We've been trying to help him beat his problem
Macnamy 1:30 Yes, I do. I've had many good friends and family members who have been alcoholic.
Mason 1:20 Absolutely. We have had a problem on one side of our family .. they get out of control.
The results from federal surveys over the years are very consistent. The number of people who abuse or are dependent on alcohol is two to three times bigger than the number of illicit drug users. Which is why some state officials are more concerned about alcohol than any other drug.
Dr. William Kassler is the state's medical director. He says the greater damage done by alcohol is not intuitively obvious.
CUT 23:43 We see the movies that focus on the injection drug users. But alcohol is far more subtle.
Kassler finds alcohol's toll in social costs, in the workplace and in health care.
CUT: when you add up the medical costs. Add the workplace accidents, the motor vehicle, the cost begins to far exceed that of illegal substance abuse.
The alcohol industry understands this issue very well. They know that criticism of their products can run high. Jeff Becker, president of the Beer Institute, the national lobbying arm of the beer industry, does not dispute that more people abuse his legal product than illegal ones.
CUT 1:37 I think the abuse of alcohol is of concern to the industry and ought to be of concern to society in general. And I think that regardless of what the numbers are for underaged drinking or abuse, certainly any of those numbers are far too high for our society and therefore, we need to come together and develop a strategy where we can reasonably attack this problem.
Becker says new strategies are needed. But District Judge Ed Kelly, chair of the state's commission on alcohol and drug abuse, sees little movement in that direction. He's frustrated by what he sees as a lack of interest in the damage done by this very ordinary substance. Each Monday, Kelly hears about 75 arraignments at the district court in Plymouth.
CUT 6:53 Of those arraignments, at least 80% are alcohol related. That happens week after week. Why, How. The community doesn't consider this a major problem. If it did, we'd have treatment programs in every community.
In the landscape of substance abuse in New Hampshire, alcohol is our Mount Washington. It disrupts more lives and costs taxpayers more dollars than any other drug. But it is an odd mountain because even though it is the tallest, it often seems to blend into the rest of the scenery.
For NHPR News, I'm Jon Greenberg
The main point of this report is that alcohol causes more damage than any other drug. This is not to say that alcohol is basically "the same as" any other drug. In the first place, it is possible to talk about a dose of alcohol that does not incapacitate. It is harder to imagine a dose of heroin, methamphetamine or cocaine that does not seriously impair the user. (My thanks to a substance abuse counselor named Candace for helping me to see this distinction more clearly.)
Nor is there any suggestion that heroin in particular is not a growing problem in the state. It is. Increasingly, people showing up at state-funded treatment clinics report heroin as their primary drug.
But alcohol remains far and away the most common reason that people seek treatment and every government survey shows that 2-3 times as many people abuse or are dependent on alcohol as all the other substances combined.
By the way, this measure of "abuse or dependent on" is a fairly stringent standard. The National Household Drug Survey collects information on what people do and based on questions such as "Has the use of X substance made you late for work in the past X months" it is possible to separate casual users from occasional abusers from full blown alcoholics/addicts.
If you look at the number of risky drinkers, commonly thought of as "binge" drinkers, the number of people to be concerned about rises four fold -- 222,000 of them in 2001 according to the federal Substance Abuse and Mental Health Services Administration.
on a wide scale yes alcohol is worse but it does it's "magic" after a long period and it doesn't cause addiction that easily.
The most addictive drugs are tobacco and coffee with billions of addicts.
The addictive properties of alcohol are not the problem; it is the cultural context of its use, one that makes the natural desires of children criminal. The "gateway drugs" to the adult criminal behavior are the criminal use of tobacco and criminal use alcohol, both illegal to all under age 18.
"It is harder to imagine a dose of heroin, methamphetamine or cocaine that does not seriously impair the user."
What???
Millions of people are given opiates daily over long periods of time, and it is a common practice for people in the military to take "go pills" aka speed to enhance their performance. Truckers were in the 50s, 60s, and 70s heavy users of speed because they had been introduced to them while serving in the military, provided by the military to enhance their performance. Today, millions of children are "treated" for ADD with speed. As kids get older and more experienced, they frequently self regulate their doses of speed to maximize their performance, pleasure.
The dominate motivation behind the drug laws was racism. When the temperance movement succeeded in targeting the minorities, they leverage that broadly supported prohibition to alcohol, but when they tried to move on to tobacco, coffee, and tea, drugs that were used daily by the majority, the temperance movement lost majority support. The crime resulted from making natural human behavior criminal, created more problems than the drugs ever caused, and the WASP drug of choice was legalized, but racism kept the opiate, hemp, and coca illegal.
But in any case, drugs were used for tens of thousands of years without significant problems by cultures incorporating their use into the rituals anc customs. The innovation of the past century has been to make this natural and long standing practice criminal, and thus create a culture were criminal behavior is a common part of our US culture, and the US has sought to make criminal the customs of other cultures, such as that of the natives of America, with the criminalization of coca, mushrooms, etc. Of course, the abuse of tobacco was promoted by the government for centuries.