A Conversation with Addiction Expert Dr. Andy Mendenhall
Why are you and your practice involved with the West Linn Community Task Force?
Yes. Awareness and education are critical factors in reducing and preventing drug and alcohol addiction. Our society has done a poor job of effectively educating our population about the disease of addiction. This disease is shrouded with mystery, denial and shame. We must remember that we are a species that is biologically programmed to seek out pleasure. Our society needs to openly talk about these issues and hopefully each person will be better educated about risk taking, and more informed regarding their own mission of “brain ownership.”
What is the scope of the drug and alcohol abuse problem?
Forty percent of American males and 27 percent of females abuse something in their lifetime: this means use of alcohol, nicotine or other drugs that have a negative impact on some manner on their life, such as school or work performance, interpersonal relationship issues. Substance abuse also creates legal issues that abusers and their families must deal with.
Remember, this isn’t an isolated problem. Some 9.4 percent of Americans become dependent or addicted to something during their lifetime. This means that people continue to ‘use a substance despite harm.’ Often people become so attached to their drug or alcohol use, that they fail to perform in their personal lives, start to break the law, or suffer negative health consequences (liver disease, hepatitis, HIV, sexually transmitted diseases) as a result of their addiction behavior.
What are the available treatment options for people who are using?
Lots of opportunity exists for people to change their behavior and stop “getting high.” The first step is for a person to figure out that they want or need to stop. This is not always easy, because many people who are abusing or addicted to drugs don’t want to stop. Getting high feels good for many people and the brain is evolutionarily programmed to remember the experience of getting high. This memory makes it difficult for people to forget the experience. One way to describe addiction is, “The brain cannot forget the experience of getting high.” For an addict, getting high is the experience that life becomes built around.
For people who have decided they are ready to get clean and sober, lots of opportunities exist.
The most important thing to remember is that it is very difficult for people to do this alone. It is important for people to talk with their friends and family, and their doctor , counselor or pastor or rabbi about what is going on. From this point, a person can start going to AA or NA and families can
start going to Al-Anon or Narc-Anon.
Many people need to have some kind of group treatment. This means meeting in group with other people struggling with drug or alcohol abuse or addiction. Groups can be at a local clinic or treatment center from once a week to every day of the week.
Some people are best suited for treatment at a place where they live for a month or more. Residential treatment is an opportunity to ‘hit the reset’ button. There is no opportunity to use drugs or alcohol, and there is full immersion into a treatment environment with meetings
and groups throughout the day.
Most people can be successfully treated while they remain in school or at work. The evidence shows that these individuals are more successful as they are usually earlier in the stage of the disease of addiction when they come for treatment.
An important concept to remember is that getting help early is best. It is easier for the brain to forget drug and alcohol use when it has been part of someone’s life for a shorter period of time. Equally important is to remember that it is NEVER too late to get treatment.
It’s just a little “pot,” so what’s the big deal?
Marijuana is a powerful psychoactive drug that changes the brain’s dopamine level in profound and potent ways. The experience of smoking marijuana is socially acceptable in many circles and leads to frequent and potent reinforcement of marijuana abuse.
Ten percent of people that go to residential treatment because they are unable to feel normal without marijuana and are therefore unable to stop using marijuana without help.
Marijuana use is associated with poor academic performance and impaired short- and longterm memory. In addition, there is good evidence that permanent changes occur that affect risk taking behavior and long-term judgment. Patients who use marijuana for 6 months and then quit between the ages of 15 and 19 are five times more likely to suffer significant psychiatric illness (depression, anxiety, or schizophrenia) by the time they are age 45 than agematched controls who did not smoke marijuana.
At least our kids aren’t using hard drugs, right?
Wrong. In the State of Oregon in 2009, 17.8 percent of people age 15-25 abused prescription drugs at least once in the prior year. Nationally, in 2007, 20 percent of high school seniors had abuse vicodin and 5 percent had abused oxycontin once in the prior 12 months.
These drugs create potent reinforcement and quickly create deep physical dependency. Evidence exists that prescription opiate medications are the gateway drugs to heroin in young adults. Marijuana use rates compare to prescription pill abuse in the State of Oregon, and nationally marijuana is slightly more prevalent over the last 3 years.
It is important to remember that the population of marijuana abusers are the population of risk takers who are more likely to take other drugs, drink alcohol, use nicotine and/or drive drunk. The belief that marijuana is “safer” is a completely false belief based on the above facts.
Dr. Andy Mendenhall is a graduate of Oregon Health and Sciences University and completed his family medicine residency at OHSU. He served as a Clinical Leadership Fellow prior to moving to Newberg, Ore., to enter family medicine practice. While in Newberg, Dr. Mendenhall became a consultant physician for Hazelden Springbrook, a substance abuse and addiction treatment center in Newberg. This work led to board certification in Addiction Medicine by ASAM/ABAM in 2008. Dr. Mendenhall pursued additional training in pain management and spinal diagnostics and is Diplomate Eligible with the American Academy of Pain Management. He then lead, along with his associates, HealthworksNW which is now part of Hazelden Bettyford.
A Conversation with Donny Wright Counseling
How do you know if you suffer from Substance Abuse Disorder (addiction)? Or could it just be “experimenting?”
If you use a substance long enough and consistently enough I believe it would be hard to argue that it is not possible to develop a problematic relationship with that substance.
Is is Substance Abuse (addiction) or Experimenting cont'd?
The term "addict" in my world is not actually a word I use very often as it can have many definitions. The framework that I tend to associate with "addict" is an extremely strong connection to the substance in the brain that has resulted in physiological changes, either temporary or permanent. Most of the research from the last 20+ years really highlights the risks and the connection between genetics and brain physiology when it come to addiction. The risk factor of our genetics seems to play a stronger role in who will become addicted and who stands a better chance at controlling their substance use. Much of the research to date leans toward the 'lay in wait'. The person with physiological/genetic risk factors starts using, they are at a higher risk of progressing into addiction. This risk factor appears to increase the earlier in the lifetime that the person's brain is introduced to mood altering substances.
What is the best advice you’d give a teenager?
The best advice I can give a teenager if they know that substance use is prevalent in their family is that there is likely a high probability that they have a per-programmed risk related to addictions within them. The challenge is this; How do we get that adolescent to believe it is actually a risk factor to them? Adolescent if filled with healthy risk taking and the thought of 'it won't happen to me.' The statement "if it is predictable, it is preventable" is actually a helpful intervention. If I can predict for a client the progression into problematic substance use by telling them what they can expect and how it will progress, it is hoped that as they start to experience my 'predictions' they will be more likely to accept that a problem is beginning to develop. Having had it predicted it will hopefully lend credibility to the risk and in result cause the individual to be willing to make changes and address an issue that previously they were not concerned about. Yes, I believe that statistic is accurate. I cannot remember which conference and presenter exposed me to that information so I can not definitively back it up by pointing you toward the research. It is based upon a large amount of research on the adolescent brain development. Essentially, the earlier you place a substance into a developing brain, the higher the probability it will adjust its growth and development with that substance in consideration. The longer we can keep substances out of the developing brain, the harder it is for the brain to take the substance into consideration as it grows and develops during the last significant brain growth period of a lifetime.
How do you "parent" this topic?
In this situation it is probably best to start with determining your own beliefs about experimentation of substances. Once you start the conversation your child will be best served if you are clear about what your expectations are regarding any substance use. With that being said, some good opener questions directed at eliciting a conversation can be "So what do you know about how (insert any substance here) impacts your body?" "What are some of the things kids at school are saying about (insert substance)?" I also believe it is appropriate to simply come out and ask directly, "So have you tried (insert substance)?" Or a more open ended question of "What have you experimented with?"
What if a parent suspects use?
Best approach almost always starts with an evaluation, either personal or professional. Efforts to determine the severity of the use, as well as the child's stage of change, is where I start with all of my clients. There are lots of resources out there that can have varying levels of utility in the process of trying to determine levels of concern and possible interventions or parenting responses. These range from simply talking to friends all of the way to setting up an evaluation with a professional. Professionals can be found in treatment clinics and in private practice and present with a wide range of addictions evaluation and treatment history and skill. I would seek out a professional/program who is gifted in moving people through the stages of change and history of substance use evaluation. A large part of the addictions treatment I provide is focused on trying to move adolescents through the stages of change in hopes that internally they will want to avoid substance use. Professionals can also help in determining boundary setting and parenting responses that can positively impact the family system.
What can parents do in the prevention of substance abuse and bullying?
Prevention is best influenced by different groups of people depending on the life stage the human is in. Early prevention is best influenced by role models and older individuals (infancy up to adolescence). Providing accurate information and good role modeling as adults an older siblings we begin to build a foundation that the person can stand on when the messages they have been taught start to become challenged. During adolescence the best prevention if peer influenced. The research seems to be suggesting the same is true for bullying. If we can identify the influential participants within out communities and assist them in broadcasting positive social behaviors this will impact more high school students than most other interventions. Much easier said than done. Identifying the influential peers would not be difficult to do. Having them buy into and broadcast positive messages and behaviors is the difficult part. The traditional approach to prevention (accurate information dissemination) continues to be helpful. We simply know that the peer influence during the adolescent years is stronger.
Drug and Alcohol Abuse Counseling and Mental Health Service Providers
24-hour crisis line and referral service. 503-655-8401
An adolescent mental health and substance abuse residential program located in Gladstone, Ore. 503-722-4470, www.northwestbhs.com
Portland-based outpatient treatment center or drug-abusing teens. 503-243-1065, Visit their website
Portland-based provider of mental health and substance abuse counseling services. 503-230-9654, www.cascadiabhc.org
A provider of mental health and substance abuse services with multiple Portland-area locations. 503-645-9010, www.lifeworksnw.org
Provides psychiatry, chemical dependency and pain management care. 503-644-7300, www.healthworksnw.com
Provides drug and alcohol treatment services in the Portland-area. 503-253-5954, www.changepointinc.com
Drug and alcohol treatment services at multiple Portland-area locations. 503-239-8400, www.codainc.org
Offers substance abuse and chemical dependency services at multiple Portland-area locations.
Refer to www.westernpsych.com for specific location contact information
West Linn-based provider of adolescent counseling services including drug and alcohol issues.
A national database for rehabilitation and treatment options. www.addictioncareoptions.com
A list of drug treatment centers and programs throughout Oregon. Visit their website.