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Man: I WAS SURPRISED TO HEAR ALL THE DRUGS HE DID.

I HAD NO IDEA HE WAS DRINKING THAT MUCH,

OR THAT HE WAS HIGH EVERY DAY IN SCHOOL.

Young man: I'D GET UP SOME MORNINGS AND I'D BE LIKE,

"MAN, TODAY'S GOING TO SUCK."

AND SO I'D JUST HAVE, LIKE, YOU KNOW--

I'D PUT A LITTLE VODKA IN MY COFFEE.

SOME DAYS, IF I HAD SOME PRESCRIPTIONS PILLS

LEFTOVER FROM THE WEEKEND I'D POP A COUPLE OF THOSE.

Mark Willenbring: THIS IS A DISORDER OF YOUNG PEOPLE.

VERY LITTLE ADDICTION STARTS AFTER THE AGE OF 30.

IT ALMOST ALWAYS STARTS,

BETWEEN THE AGES OF 18 AND 25.

Woman: WE KEPT THINKING ONCE SHE GOT OUT OF HIGH SCHOOL

IT WOULD BE OKAY. ONCE SHE GOT OUT OF COLLEGE IT WOULD BE OKAY.

ONCE SHE GOT MARRIED IT WOULD BE OKAY. ONCE SHE BECAME A MOTHER...

UNTIL SHE DECIDES TO LAY DOWN THAT ADDICTION

THERE'S NOTHING I CAN SAY OR DO THAT'S GOING TO MAKE ANY DIFFERENCE.

THERE ARE MISCONCEPTIONS THAT REALLY DRIVE ME CRAZY

WHEN IT COMES TO ADDICTIONS.

ONE OF THEM IS THIS WHOLE IDEA THAT AN INDIVIDUAL

NEEDS TO REACH ROCK-BOTTOM

BEFORE THEY CAN GET ANY HELP.

THAT IS ABSOLUTELY WRONG.

IT'S A MYTH THAT THEY HAVE TO CRASH AND BURN

BEFORE THEY CAN GET BETTER.

IT'S MORE LIKE ANY OTHER CHRONIC CONDITION--

THE SOONER YOU START THE BETTER,

THE MORE YOU STAY ON TOP OF IT THE BETTER.

I GOT SOBER IN 1981 AND STAYED SOBER

FOR 17 AND A HALF YEARS THROUGH AA.

I HAD NO PROBLEM AND THEN

SOME PERSONAL THINGS HAPPENED TO ME IN MY LIFE

AND I'VE BEEN DRUNK EVER SINCE.

I'M ASHAMED BECAUSE I LOOKED INTO THE EYES OF MY CHILDREN

AND THAT WASN'T ENOUGH

TO MAKE ME STOP.

HOW CAN WE COMPREHEND

THE CONCEPT OF A PERSON,

THAT WANTS TO STOP DOING SOMETHING AND THEY CANNOT,

DESPITE CATASTROPHIC CONSEQUENCES?

WE'RE NOT SPEAKING OF LITTLE CONSEQUENCES. THESE ARE CATASTROPHIC.

AND YET, THEY CANNOT CONTROL THEIR BEHAVIOR.

I MEAN, THERE HAVE BEEN SO MANY THINGS THAT I HAVEN'T ACCOMPLISHED

BECAUSE--

BECAUSE OF THE PROBLEM.

I THINK... SO...

THAT'S ALL.

MY DRINKING IS KILLING ME

AND I DESPERATELY NEED HELP.

THERE'S MORE TREATMENTS AVAILABLE.

THERE'S BETTER UNDERSTANDING.

THERE'S MORE ACCEPTANCE THAT THIS IS A MEDICAL CONDITION

WITH REAL MEDICAL SOLUTIONS THEN THERE EVER HAS BEEN.

THE RIGHT MEDICATION WITH THE RIGHT THERAPY

REALLY CAN GIVE AN INDIVIDUAL

A LEG UP IN RECOVERY.

Woman: THIS WHOLE ADDICTION

WILL RUIN YOUR MIND AND THOUGHTS.

EVEN THOUGH I LIVED THROUGH IT,

I STILL DON'T UNDERSTAND IT.

THIS IS EXCELLENT. WHAT WE SEE IN YOUR BRAIN IS WHAT YOU SEE...

THE CORRECT DOSING TECHNIQUE IS TO PUT IT UNDER YOUR TONGUE.

YOUR CRAVINGS ARE ACTUALLY MUCH LOWER THAN WHEN YOU STARTED,

WHICH IS REALLY NICE.

THE OPIATES THAT WE'RE USING NOW, IT STIMULATES

THE PARTS OF YOUR BRAIN THAT HELP YOU WANT TO GET UP GO DO YOUR JOB...

( siren wailing )

HE'S GOT A BRUISE UNDER HIS MID-LEFT CLAVICLE.

Larry Gentilello: HERE AT THE TRAUMA CENTER IT'S SATURDAY NIGHT,

THESE ARE WHERE THE PROBLEMS REALLY ARISE FROM

TOO MUCH DRINKING, TO MUCH DRUG USE IN OUR SOCIETY.

PUT THE ULTRASOUND AWAY. OG-TUBE, LET'S GO.

WE'RE HERE IN THE ER. I'M NOT FLOODED TONIGHT

WITH PEOPLE WHO NEED THEIR APPENDIX TAKEN OUT

OR THEIR GALLBLADDER. IT'S ALL DRINKING AND INJURIES.

HAVE YOU EVER HAD SEIZURES FROM STOPPING DRINKING BEFORE?

- I'VE HAD BLACKOUTS. - YOU'VE HAD BLACKOUTS?

THIS IS PROBABLY OUR THIRD INCIDENT THIS EVENING

WHERE WE'VE HAD ALCOHOL OR DRUG USE INVOLVED.

GO, GO, GO.

- WHAT HAVE YOU GOT THERE? - TRACE AMOUNT OF CRACK HERE.

THEY USE THAT TO SMOKE IT.

HE'S POSITIVE FOR BENZODIAZEPINES AND OPIATES,

BUT ALSO POSITIVE FOR COCAINE.

WHAT HAPPENED TO YOU?

I GOT IN A FIGHT WITH TWO YOUNGSTERS,

CUT ME ACROSS THE HEAD AND CUT ME RIGHT HERE.

- ( yells ) - I'M SORRY.

I THINK IT'S PRETTY LIKELY THAT DRUGS AND ALCOHOL

WERE INVOLVED IN THIS INJURY,

BOTH ON THE PART OF THE PATIENT AND ON THE PART OF THOSE WHO STABBED HIM.

WHAT HAPPENED TO THIS PATIENT OVER THERE?

42-YEAR-OLD MALE IN THE PARKING LOT SLIPPED BETWEEN

THE CURB AND THE WALL, SNAPPED HIS ANKLE.

- HAS HE BEEN DRINKING? - HE'S BEEN DRINKING.

- I HAD ABOUT A SIX-PACK. - A SIX-PACK, OKAY.

- IT'S DEFORMED THERE. - I HONESTLY DON'T THINK

THAT THIS HAPPENED BECAUSE I WAS DRINKING.

I THINK IT'S JUST BECAUSE OF THE WAY I STEPPED.

YOU MAY BE RIGHT. I'M NOT SAYING YOU'RE NOT.

NORMALLY, A PATIENT LIKE THIS WOULD COME TO AN EMERGENCY ROOM,

EVERYONE WOULD FOCUS ON HIS ANKLE AND NOTHING WOULD BE DONE

FOR THE UNDERLYING DRINKING PROBLEM THAT CAUSED THIS INJURY IN THE FIRST PLACE.

NOW'S THE TIME TO OFFER HIM SOME COUNSELING. HE'S AN EXCELLENT CANDIDATE.

WE'RE GOING TO KEEP AN EYE ON HIM, GIVE HIM HIS MEDICAL CARE.

BY TOMORROW MORNING WE'RE GOING TO MAKE SURE

HE SEES A COUNSELOR BEFORE HE GOES HOME.

- HOW YOU DOING THERE, SIR? - I'M DOING ALL RIGHT NOW.

I'M 20 RIGHT NOW.

BARELY TURNED 20-- HAPPY BIRTHDAY TO ME, HUH?

TODAY YOU'VE BEEN DRINKING?

LITTLE BIT, YES, SIR. I HAVE BEEN DRINKING TODAY

- WHAT DID YOU DRINK? - I DRANK JIM BEAM, SIR.

TODAY IS MY BIRTHDAY. RIGHT NOW IS MY BIRTHDAY.

AS OF 12:00 TONIGHT IT'S MY BIRTHDAY.

- HOW OLD ARE YOU? - I'M 20 YEARS OF AGE.

- 20? - YES, SIR.

HOW MANY JIM BEAMS DID YOU HAVE?

I PROBABLY HAD ABOUT 15 TO 20 SHOTS.

( yells )

WE'RE GOING TO FIX THAT UP FOR YOU.

YOU'RE LUCKY YOU DIDN'T DAMAGE ANY ARTERIES

OR NERVES THAT CONTROL THE FUNCTION OF YOUR ARM.

THIS COULD HAVE BEEN A LOT WORSE.

DO YOU HAVE ANY OTHER HISTORY OF DRUG USE

AMONG PEOPLE WHO ARE CLOSE TO YOU?

YES, THEY ALL USE DRUGS.

I WISH THEY WOULD ALL QUIT.

MY BEST FRIEND IN THE WHOLE WORLD--

I LOVE HER SO SO SO MUCH.

BABY, I WISH YOU WOULD QUIT.

YOU KNOW WHAT I'M TALKIN' ABOUT? I AIN'T SAYING NOTHING ELSE.

PLEASE, BABY. PLEASE.

Gentilello: THIS IS WHAT WE CALL A LEVEL-ONE TRAUMA.

THIS IS SOMEONE WHO IS BADLY INJURED

WHO THE PARAMEDICS HAVE PRETTY MUCH DECIDED

IS AT RISK OF LOSING LIFE OR LIMB.

THE RESOURCES THAT WE COMMIT TO TRAUMA CARE ARE ENORMOUS.

IN FACT, IN SOME WAYS, IT'S ONE OF THE MOST

EXPENSIVE DISEASES THAT WE FACE IN MODERN SOCIETY.

AND ABOUT HALF OF IT'S RELATED TO ALCOHOL USE.

- DO WE HAVE A PULSE? - DO YOU HAVE A PULSE?

NO, HE'S 26 YEARS OLD.

Gentilello: WE'VE GOT TO GIVE HIM EVERY CHANCE.

THE MAIN THING IS TO STOP THE BLEEDING FROM HIS PELVIC FRACTURE.

LET'S SHOCK HIM. LET'S SHOCK HIM.

- GO TO 400. - CLEAR.

- CLEAR - WE GOT A PULSE.

- WE HAVE A PULSE? - YES.

HE'S GOT A RAPID PULSE AND A WEAK BLOOD PRESSURE.

NOT MUCH. I MEAN HIS CHANCES ARE PRETTY SLIM TO NONE.

BUT AS LONG AS HE'S GOT A PULSE AND A FAINT BLOOD PRESSURE

WE'RE GONNA KEEP DOING ALL WE CAN.

- YIKES! - WHAT'S HE GOT?

ALL RIGHT. ALL RIGHT. WE FOUND WHAT YOU FOUND.

IS HE BLEEDING FROM HIS BACK?

HE'S GOT A BALLOTABLE BACK. HIS WHOLE BACK'S FULL OF BLOOD.

Woman: THERE'S MORE BLOOD.

HOW LONG HAVE WE BEEN DOING CPR?

Woman: WE'VE BEEN DOING CPR FOR 19 MINUTES,

AND HE WAS DOWN SEVEN MINUTES WHEN HE GOT HERE.

GENTILELLO, WE DON'T HAVE ANYTHING.

ALL RIGHT, LET'S CALL IT.

PATIENT'S EXPIRED.

WE DID EVERYTHING WE COULD.

THANKS A LOT.

YOU NEVER GET OVER SEEING YOUNG PEOPLE DIE.

SO WE JUST CHECKED THIS PATIENT'S URINE TOXICOLOGY SCREEN.

HE WAS UNDER THE INFLUENCE OF MARIJUANA.

SO HE DIED BECAUSE OF INTOXICATION.

HE'S A YOUNG PERSON.

IT'S NOT LIKE TAKING CARE OF SOMEBODY WHO'S 75 YEARS OLD

AND DIED OF A HEART ATTACK,

OR 80 YEARS OLD AND HAS CANCER OR DEMENTIA.

THIS IS A YOUNG PERSON IN THE PRIME OF HIS LIFE.

LEFT HIS HOUSE TODAY AND EXPECTED TO COME HOME TO HIS PARENTS TONIGHT.

BUT HE WON'T.

Radio: Dispatch.

HEY, I GOT A WARRANT FOR AN INDIVIDUAL THAT I'M LOOKING FOR.

AND WE'RE HEADED OVER THERE NOW TO CHECK THE HOUSE.

SHE COULD BE ANYWHERE AROUND HERE.

I'VE HEARD ABOUT PEOPLE HAVING THEIR CHILDREN ARRESTED TO GET HELP.

AND I THOUGHT, "WHAT A DESPERATE MEASURE."

I USED TO THINK, "I HOPE I NEVER GET TO THAT POINT."

AND I THOUGHT, "I COULD NEVER ARREST MY OWN CHILD."

I MEAN HOW COULD YOU DO THAT?

THAT'S LIKE AN ADDICT GETTING DESPERATE.

THAT'S HOW A PARENT-- I'M DESPERATE NOW.

I WILL DO ANYTHING TO HELP MY CHILD.

( dog barking )

Donna: MY DAUGHTER HAS BEEN AN ADDICT FOR SEVEN YEARS.

SHE'S BEEN OUT ON THE STREETS RIGHT NOW FOR...

30 DAYS.

BUT SHE'S MANAGED TO AVOID THE LAW AND AVOID US.

AND THEY'RE VERY RESOURCEFUL.

- THEY'RE VERY STREET SMART. - SHE'S OBVIOUSLY BEEN HERE.

BECAUSE THAT'S HER STUFF ON THE OTHER SIDE.

ON THE FLOOR THERE.

CLIMB IN THROUGH THIS WINDOW--

THEY ACTUALLY CLIMB UP THE ROOF, SNEAK IN THE WINDOW.

I'VE SEEN HER OVERDOSE TWICE.

AND THE LAST ONE SHE ALMOST DIDN'T MAKE IT.

WE'VE ALREADY FOUND DRUG PARAPHERNALIA--

SPOONS, RAZORS, CRACK PIPES,

SUBOXONE--

SEVERAL DIFFERENT THINGS.

MY DAUGHTER HAS STOLEN ITEMS FROM ME.

AND IN THE PAST I'VE OVERLOOKED IT, BUT...

I'M HOPING DETECTIVE MITCHELL CAN GET HER IN JAIL,

GET HER THROUGH DETOX WHERE SHE CAN THINK CLEARLY,

BECAUSE RIGHT NOW SHE CAN'T THINK CLEARLY.

ALL SHE CAN THINK ABOUT IS THE NEXT FIX.

IN THE END OF HER LETTER SHE SAYS,

"THERE IS NO ESCAPE, BUT I'M TERRIFIED

OF GOING TO JAIL, AND EVEN MORE OF BEING DOPE SICK."

THIS IS WHEN SHE WAS ABOUT 15,

BEFORE THE ADDICTION HAD STARTED.

THIS IS HER GRADUATION PICTURE WHERE SHE, AT THIS POINT,

WAS SOMEWHERE AROUND SEVEN TO EIGHT MONTHS CLEAN.

AND THIS ONE WAS TAKEN

PROBABLY ABOUT TWO MONTHS AGO.

AND SHE LOOKS HIGH TO ME.

SHE WAS IN THE GIFTED PROGRAM AT SCHOOL,

CAPTAIN OF THE CHEERLEADING SQUAD.

SHE HAD A LOT OF FRIENDS.

SHE HAD A BEAUTIFUL VOICE.

SHE SANG AT WEDDINGS AND PLAYED THE PIANO BEAUTIFULLY.

SHE GOT THAT TALENT FROM HER FATHER.

BUT SHE NEVER LIKED HERSELF.

WHEN YOU TALK TO PEOPLE THAT DO NOT HAVE ADDICTS,

THEY JUST DON'T UNDERSTAND.

YOU'LL OVERHEAR, "WELL, WHERE WERE THE PARENTS?

WHERE WERE YOU WHEN THIS WAS HAPPENING?"

I WAS RIGHT HERE. I MEAN, I WAS RIGHT WITH MY DAUGHTER.

I HAD HER IN EVERYTHING.

I WAS-- YOU KNOW, I KEPT HER BUSY.

BUT, YOU KNOW--

OR "WHY DON'T YOU DO SOMETHING ABOUT IT?"

YOU KNOW, I'VE DONE EVERYTHING I COULD POSSIBLY DO ABOUT IT.

WHEN I PUT HER IN TREATMENT, I WAS LED TO BELIEVE--

AND MAYBE IT WAS JUST ME BECAUSE I DIDN'T KNOW,

AND THEY DIDN'T EXPLAIN IT TO ME--

THAT WE'RE GOING TO PUT YOUR DAUGHTER INTO TREATMENT

AND SHE'S GOING TO GO THROUGH THE TREATMENT

AND SHE'S GOING TO LEARN WHAT SHE HAS TO DO.

AND WHEN SHE CAME OUT OF TREATMENT I THOUGHT,

"THIS IS IT. YOU KNOW, THIS IS GOOD."

BUT IT WASN'T.

WE'RE ALSO GOING TO NEED TO CHECK THE HOUSE, IF YOU DON'T MIND.

( radio chatter )

I HAVEN'T SEEN HER OR SPOKE TO HER SINCE...

DID PATOSKI GO THROUGH EVERYTHING ELSE? THE ATTIC AND ALL THAT?

...SINCE ABOUT TWO WEEKS AGO.

I CRY A LOT AND SOMETIMES I THINK I'M NOT GONNA MAKE IT.

BUT THEN I TURN AROUND AND SAY, "I HAVE TO MAKE IT."

I MEAN, SHE'S ALL I HAVE.

IF ANYTHING HAPPENS TO ME, SHE WON'T MAKE IT.

I WANT HER TO MAKE IT BECAUSE I BELIEVE IN HER.

I KNOW SHE CAN MAKE IT.

STEP.

THERE YOU GO, 'CAUSE I DON'T WANT IT TO CHOKE YOU.

Donna: AUBREY WILL BE PICKED UP TODAY BY DETECTIVE MITCHELL.

SHE'LL BE TRANSPORTED FOR A HEARING.

I GOT THE CALL WHEN HE ALREADY HAD HER AT THE STATION.

HE SAID, "I HAVE SOMEBODY HERE THAT WANTS TO TALK TO YOU,"

AND I JUST CRIED.

I THINK IT WAS JUST THE EMOTIONS THAT BUILT UP INSIDE.

I HEARD HER VOICE AND I JUST ALL LET LOOSE.

BUT I'M NERVOUS. I'M NERVOUS WITH WHAT'S GONNA HAPPEN

AT THE MAGISTRATE'S OFFICE.

AND I'M PROBABLY MORE NERVOUS WITH HER COMING HOME.

'CAUSE IT'S NEVER WORKED IN THE PAST.

I WAS JUST DONE RUNNING.

I COULDN'T DO IT ANYMORE.

YOU GOTTA FIND A PLACE TO SLEEP EVERY NIGHT.

YOU GOTTA FIND WAYS OF GETTING MONEY EVERY DAY.

IT'S JUST TOO MUCH.

I DIDN'T CARE WHAT HAPPENED JUST AS LONG AS I GOT HIGH.

BUT THEN NEAR THE END IT'S JUST THE MONEY RAN OUT.

I HAD NOWHERE TO GO.

I WAS LIKE-- RIGHT NOW, I CARE.

THIS ISN'T WHAT I WANT.

Mitchell: YOU READY? OKAY.

THAN YOU VERY MUCH. HAVE A GOOD DAY.

- ONE MORE. - DID YOU SAY THANK YOU?

YES, MANY TIMES.

I TOLD HER, NO FRIENDS,

NO NOTHING, NO VISITS,

NO FAKE EATING PARK LUNCHES, NO--

- NOTHING. - NOTHING.

WE'RE GOING TO RUN THE HOUSE LIKE A REHAB.

I HOPE SO.

I'M JUST TRYING TO GET AT: WHAT'S IT GOING TO TAKE

FOR YOU TO REACH YOUR BOTTOM?

I DON'T REALLY KNOW WHAT A BOTTOM IS.

I GUESS IT'S DIFFERENT FOR EVERYBODY.

I MEAN, CAN I SAY I'M NEVER GOING TO TAKE

ANOTHER DRUG OR ANOTHER DRINK

FOR THE REST OF MY LIFE? NO, I CANNOT SAY THAT.

CAN I SAY I'M NOT GOING TO TAKE A DRUG OR DRINK TODAY?

YEAH, I CAN.

YOU KNOW? IT WORKS LIKE THAT.

I'M JUST THINKING, WHAT DID WE DO WRONG?

OR DID WE DO ANYTHING WRONG?

WHAT DIDN'T WE DO THAT WE NEED TO DO THIS TIME?

LIKE, STICK TO A PROGRAM.

I DON'T KNOW. I NEED-- I NEED TO NOT BE BORED.

I NEED TO GET A JOB.

I NEED TO MAKE NEW FRIENDS THAT DON'T USE.

YOU NEED TO GO TO MEETINGS.

I KNOW ENOUGH ABOUT ADDICTION AND RECOVERY.

I MEAN, I'VE BEEN GOING TO REHAB SINCE,

FOR WHAT, 10 YEARS OR SOMETHING.

- SO-- - 16.

16, WHATEVER.

EIGHT YEARS, SEVEN YEARS.

I COULD RUN A REHAB.

WE NEED TO SIT DOWN AND MAKE A PLAN,

A GOAL, A CONTRACT, SOMETHING,

AND LIVE BY IT.

- DOES THAT SOUND GOOD? - YEP.

YOU HELP ME AND I'LL HELP YOU,

AND MAYBE WE'LL MAKE IT.

- WHAT DO YOU THINK? - SOUNDS GOOD.

WHEN SOMEBODY BEGINS TO THINK

THAT A LOVED ONE OR FAMILY MEMBER

HAS A DRUG OR ALCOHOL PROBLEM

IT IS REALLY FRIGHTENING.

BECAUSE NONE OF US KNOW

HOW TO START, WHERE TO START AND WHERE TO GO.

ADDICTION IS UNPLEASANT TO THE PERSON WHO HAS IT,

AND TO THE FAMILY OF THE PERSON THAT HAS IT.

AND THAT'S WHY YOU WANT TO TREAT IT.

THIS IS NOT SOMETHING THAT DEVELOPS

OVERNIGHT FOR ANY INDIVIDUAL.

AND GENERALLY THERE IS A SERIES OF STEPS

THAT THE INDIVIDUALS GO THROUGH

FROM EXPERIMENTATION AND OCCASIONAL USE

THROUGH THE ACTUAL LOSS OF CONTROL OF USE.

USE BECOMES COMPULSIVE.

AND PEOPLE BECOME PREOCCUPIED WITH IT.

IT BECOMES VERY VERY IMPORTANT TO THEM.

ONE OF THE WAYS I DEFINE ADDICTION

IS WANTING THE WRONG THING VERY VERY BADLY.

DRUG ADDICTION IS A DISEASE OF THE BRAIN

THAT TRANSLATES-- THAT THAT DISEASE

TRANSLATES INTO ABNORMAL BEHAVIOR.

WHEN A PERSON WHO HAS THIS DISEASE

IS EXPOSED TO CUES OR STIMULI

THAT REMIND THEM OF,

OR HAVE PREVIOUSLY BEEN ASSOCIATED WITH THE USE OF A DRUG,

THERE IS AN UNCONTROLLABLE REFLEX.

IT HAPPENS VERY VERY QUICKLY IN THE BRAIN.

WE CAN SEE IT IN BRAIN IMAGING.

AND THE PERSON DOESN'T HAVE THE ABILITY TO STOP IT.

AS A MATTER OF FACT, IT MAY HAPPEN BEFORE THEY'RE EVEN CONSCIOUS OF IT.

Man: I'M OUT HERE ALONE NOW,

TRYING TO HANG ON AND SURVIVE.

THE HOLIDAYS WERE ROUGH.

I ACTUALLY THOUGHT THIS ONE WOULD BE DIFFERENT.

BUT RIGHT NEAR THE END

SOME OTHER THINGS HAPPENED...

WITH MY WIFE AND THE FAMILY

AND I DIDN'T RESPOND VERY WELL.

I SAID, "I'M GOING OUT FOR A LITTLE WHILE."

I WENT OUT.

I DON'T EVEN REALLY REMEMBER WHERE I WENT OR WHATEVER.

BUT I DO REMEMBER GOING OUTSIDE,

WALKING AROUND, BUYING DRUGS. I HAD MONEY.

AND...

USED-- AND JUST USED.

EVEN AFTER PEOPLE HAVE BEEN DRUG FREE FOR

NOT JUST DAYS OR WEEKS, BUT MONTHS OR YEARS,

THE TENDENCY TO RELAPSE IS VERY STRONG.

SO IT IS THE WAY TO UNDERSTAND

WHAT ADDICTIONS ARE.

THE TENDENCY TO RELAPSE IS PART OF THE DISORDER.

IT'S NOT A FAILURE OF TREATMENT.

IT'S PART OF THE DISORDER.

I'VE ALWAYS LOST THE BATTLE, AND THAT'S HOW I FEEL.

I'VE LOST THE BATTLE AGAIN AND I'M USING AGAIN.

YOU KNOW, I SIT AND WHEN I'M ACTUALLY USING

AFTER A BATTLE LIKE THAT, I FEEL SO BAD.

BECAUSE I COULDN'T WIN.

OR I DIDN'T WIN.

Childress: YOU'VE HAD A WILD THREE OR FOUR MONTHS HERE.

William: A ROLLER-COASTER RIDE.

RIGHT NOW I'M IN A PERIOD WHERE

I JUST CAN'T SEEM TO GET WHAT I WANT.

I DEFINITELY KNOW WHAT I WANT.

AND THAT'S CLEAN AND SOBER. THAT'S THE END.

- THAT'S THE END RESULT. - YOU WANT TO GET TO A GOOD SPOT.

IT'S SO IMPORTANT TO DO EXACTLY WHAT YOU'RE DOING, WHICH IS TO SAY,

"IF I HAD 11 MONTHS

GOOD FUNCTIONING, CLEAN TIME BEFORE..."

- YES. - "...I CAN DO THAT AGAIN."

IN FACT, ALL THE DATA SAYS THAT THE MORE TIMES YOU KEEP TRYING

YOU INCREASE YOUR LIKELIHOOD OF THAT SUCCESS BEING MORE SUSTAINED.

AND THAT'S REALLY REALLY IMPORTANT.

PATIENTS SAY, "WHY CAN'T I JUST STOP?

I'VE LOST SO MUCH. I'VE PAID SUCH A HIGH PRICE."

PARENTS SAY, "WHY CAN'T THEY JUST STOP?

THEY'VE COMPLETELY WRECKED THEIR LIVES.

OUR LIVES TOO. WHY CAN'T THEY JUST STOP?"

AND WHAT WE'RE BEGINNING TO UNDERSTAND NOW AT THE LEVEL OF THE BRAIN

IS THAT THERE ARE A LOT OF CARDS

THAT ARE STACKED IN THE WRONG DIRECTION HERE.

I'M SO STRONG-WILLED IN SUCH OTHER THINGS

THAT PEOPLE-- PEOPLE COULD ACTUALLY-- THERE'S PEOPLE THAT WOULD SAY TO YOU,

"YEAH, HE'S STRONG- WILLED IN THIS WAY."

- SO WHY CAN'T HE BE STRONG- WILLED IN THIS WAY? - EXACTLY.

SO IT'S VERY IMPORTANT FOR PEOPLE TO TRY TO UNDERSTAND

IT'S NOT A MATTER

OF MORAL FIBER OR CHARACTER OR JUST WANTING IT ENOUGH.

YOU'VE GOT PARTS OF THE BRAIN HERE THAT THINK

WHEN THEY SEE THESE SIGNALS FOR A DRUG,

THAT THAT'S AS IMPORTANT AS A RELATIONSHIP,

AS THE BEST FOOD YOU EVER SAW.

IT'S-- IT'S A TRICK THAT'S PLAYED ON THE BRAIN.

AND IN A WAY THAT TENDS TO LEAVE OUT

THIS DECISION-MAKING PART OF YOUR BRAIN.

SO IN THE BRAIN WE HAVE THESE TWO IMPORTANT SYSTEMS.

THE "GO" SYSTEM, THE ANCIENT "GO" CIRCUIT FOR HELPING US RESPOND

TO NATURAL REWARDS THAT ARE SO IMPORTANT FOR OUR SURVIVAL.

AND THE "STOP" SYSTEM, THE MORE RECENT FRONTAL LOBE SYSTEM

THAT'S IMPORTANT FOR HELPING US CONSIDER WHEN IT'S IMPORTANT NOT TO GO,

NOT TO ACT ON THE PULL OF THAT REWARD.

WHEN THINGS ARE WORKING RIGHT, THE GO CIRCUITRY

AND THE STOP CIRCUITRY REALLY ARE INTERCONNECTED

AND REALLY TALKING TO EACH OTHER

TO HELP YOU WEIGH THE CONSEQUENCES

OF A DECISION AND DECIDE WHEN TO GO OR NOT TO GO.

SO IT'S NOT THAT THEY'RE SEPARABLE.

THEY'RE INTERACTIVE. THEY'RE INTERLINKED AT ALL TIMES.

IT'S JUST THAT IT'S INTERESTING,

WITH OUR PATIENT SITUATION, IT IS AS THOUGH THEY

HAVE BECOME FUNCTIONALLY DISCONNECTED.

IT IS AS THOUGH THE GO SYSTEM

IS SORT OF RUNNING OFF ON ITS OWN,

IS A ROGUE SYSTEM NOW,

AND IS NOT INTERACTING

IN A REGULAR, SEAMLESS, INTEGRATED WAY WITH THE STOP SYSTEM.

THIS IS THE TRIGGER-- ALL OF THIS AROUND ME.

YOU CAN TURN AROUND AND LOOK AT ALL THAT, AND ALL THAT'S A TRIGGER

BECAUSE ALL OF THIS IS WHERE I'M FROM

AND I'VE ALWAYS USED IN THIS AREA.

SO YOU IMAGINE, THE TRIGGER IS HERE.

THE TRIGGER IS NOT ONLY UP HERE,

THE TRIGGER IS WHEN I WALK OUT, OPEN MY EYES AND WHAT I SEE.

THE PATIENT SEES, SMELLS, EXPERIENCES

THINGS THAT REMIND THEM OF THEIR DRUG OF ABUSE.

AND INSTEAD OF BEING ABLE TO SAY, "WAIT A MINUTE.

THINK ABOUT WHAT HAPPENED LAST WEEK.

YOU LOST YOUR JOB. YOU ALMOST LOST YOUR LIFE."

INSTEAD THE STOP SYSTEM DOESN'T SEEM TO GET INTO THE PICTURE AT ALL.

IT'S ALL ABOUT GO.

ONE OF THE EXCITING THINGS ABOUT NOW

IN TERMS OF OUR UNDERSTANDING ADDICTION

IS THAT FOR THE FIRST TIME

IN ALL OF HUMAN HISTORY

WE CAN PEEK INSIDE THE BRAIN

AND SEE WHAT MAY BE BROKEN.

AND IF WE CAN SEE WHAT'S BROKEN,

WE HAVE AN IDEA

ABOUT HOW TO GO ABOUT FIXING IT.

WE WANTED TO UNDERSTAND HOW LITTLE DOES IT TAKE

TO GET THIS SENSITIVE REWARD CIRCUIT

ACTIVATED AND OFF TO A HEAD START.

SO WHAT WE'VE NOTICED IN THE PAST YEAR IS THAT THE SYSTEM

CAN BE ACTIVATED WHEN WE SHOW PICTURES

THAT ARE AS SHORT AS 33 MILLISECONDS;

WITH THINGS THAT ARE SO SHORT

THAT THEY ARE OUTSIDE AWARENESS.

SO WHAT'S REALLY DIFFICULT HERE FOR THE STOP SYSTEM

IS WE KNOW THAT THE MESSAGE DOESN'T EVEN HAVE A CHANCE

TO GET UP TO THE FRONTAL LOBES FOR THEM TO WEIGH IN.

IT'S COMING IN UNDER THE RADAR

BEFORE YOU HAVE A CHANCE TO MOUNT A DEFENSE.

SO WHAT'S SO IMPRESSIVE TO ME IS THAT

THIS GO SYSTEM IS SO INCREDIBLY SENSITIVE

THAT WHILE MANY OF THE THINGS

WE EXPERIENCE ARE MULTIPLE SECONDS LONG,

THEY DON'T HAVE TO BE TO GET IT GOING.

FOR OUR PATIENTS, I THINK IT WILL BE

A HELPFUL PIECE OF NEWS

BECAUSE FOR THEM, THEY SOMETIMES COULDN'T POINT TO THE CUE

OR LABEL THE CUE THAT SET OFF THIS CRAVING STATE.

IF THIS KIND OF MOMENT ARISES SO QUICKLY,

WE NEED SOMETHING TO BE IN PLACE

TO SORT OF BRING THINGS INTO A MANAGEABLE RANGE

BEFORE THE CHALLENGE OF A GO MOMENT.

WE'VE BEGUN TO STUDY A MEDICATION

THAT WOULD HELP QUIET THINGS DOWN,

THAT WOULD SORT OF, LIKE, TUNE DOWN THE VOLUME ON THE GO SYSTEM.

THIS MEDICATION, CALLED BACLOFEN , IT'S FAMILIAR.

IT'S BEEN AROUND A LONG TIME.

BUT WE'VE FOUND THAT IT CAN REDUCE

THE ACTIVITY IN THIS SYSTEM A LITTLE BIT,

BRINGING IT SORT OF INTO A MORE MANAGEABLE RANGE.

SO WHAT THIS PICTURE SHOWS

IS THAT IN PATIENTS

WHO ARE UNTREATED,

WHO HAVE NO MEDICATION,

WHO SEE HALF-SECOND COCAINE CUES,

THE BRAIN HAS AN INTENSE DIALOGUE.

ONE WAY TO THINK ABOUT THIS PICTURE

IS THAT YOU'RE SEEING A VISUAL REPRESENTATION

OF "LET'S GO FOR IT."

AND YOU CAN TELL THAT IT'S A VERY INTENSE DIALOGUE

BECAUSE OF THESE VERY HOT SPOTS.

ON THE OTHER HAND,

WHEN WE LOOK AT PATIENTS

WHO ARE TREATED FOR SEVEN DAYS WITH BACLOFEN,

WHAT YOU CAN SEE IS THAT NOW

THIS INTENSE CONVERSATION

HAS BEEN REDUCED TO A WHISPER.

IT'S NOT THAT THE BRAIN IS DEAD.

THERE'S ACTIVITY.

BUT INSTEAD OF "GO GO GO,"

IT'S "I DON'T KNOW.

DOESN'T SEEM LIKE IT'S WORTH GOING."

SO THE HOPE IS THAT YOU WOULD HAVE A CHANCE

FOR THE FRONTAL LOBE TO DO ITS THING,

TO BE ABLE TO WEIGH IN AND HAVE A CHANCE

TO PUT INTO PLACE GOOD DECISION-MAKING.

I DO NOT WANT TO LIVE MY LIFE

UNDER THE GRIPS OF MY ADDICTION.

I WILL BE AN ADDICT PROBABLY--

I WILL BE AN ADDICT ALL MY LIFE.

BUT I WANT TO NOT BE AN ADDICT USING.

SO THE HOPE OF THE FUTURE IS

MEDICATIONS AND BEHAVIORAL TREATMENTS

THAT CAN COMBINE

TO LITERALLY RESET THE BRAIN.

THIS IS ME IN THE SIXTH GRADE.

I WAS KIND OF HIGH IN THAT PICTURE.

VISINE'S ALL YOU NEED.

OF ALL OF THE MENTAL DISEASES THAT I'VE SEEN,

THERE'S NOTHING THAT I HAVE SEEN

THAT DISRUPTS MORE A FAMILY THAN HAVING A KID WHO'S ADDICTED.

IT CAN BE DRUGS OR ACTUALLY IT COULD BE ALCOHOL.

I JUST EXPERIMENTED WITH ALL OF THEM.

LIKE EX, METH, MUSHROOMS.

THE ONE THAT I LIKED THE BEST WAS BUD BECAUSE

IT JUST-- LIKE, IT WAS--

IT WAS A CALMING FEELING.

I HAD RACING THOUGHTS ALL THE TIME AND IT JUST CHILLED ME OUT.

AND I LIKED THAT FEELING.

( heavy metal music playing )

YEAH, I REMEMBER I TOOK 10 CAPS OF SHROOMS.

AND THAT'S ENOUGH TO KILL YOU.

SO I JUST THOUGHT--

I WAS LIKE, "WOW, I'M AMAZED THAT I'M STILL ALIVE AFTER THAT."

THE ADOLESCENT BRAIN IS DIFFERENT

FROM THAT OF AN ADULT.

AND THAT LEADS TO BEHAVIORS

THAT DEFINITELY PUT THEM

AT MUCH HIGHER RISK TO WANT TO TRY DRUGS

THAN THE BRAIN OF AN ADULT.

THEY HAVE EVEN LESS OVERRIDE OF THEIR IMPULSIVITY.

AND PROBABLY FROM FACTORS

THAT EXISTED BEFORE THEY USED DRUGS

AND EXACERBATED BY USING DRUGS.

Scott: DYLAN WAS TURNING 10-- 10 AND A HALF

WHEN HIS FATHER, HIS BIRTH FATHER, LEFT HIM.

HE LEFT WITHOUT GIVING HIS KIDS ANY WORD.

AND THEN HE STARTED TO WITHDRAW AND GET--

HE WENT INTO A DEPRESSED STATE

THAT WE DIDN'T RECOGNIZE AT FIRST.

WHEN HE WAS IN FIFTH AND SIXTH GRADE

HE STARTED USING AT THE GRADE SCHOOL

VARIOUS DRUGS THAT WERE AVAILABLE,

AND THEN EVEN ALCOHOL THAT HE COULD FIND.

AND HE DID THIS FOR-- WELL, UP TO PRESENT DAY.

BUT HE USED ANY TYPE OF DRUG,

ANYTHING HE CAN GET HIS HANDS ON.

HE WAS KNOWN AS A CUTTER.

AND WE FOUND OUT A LOT OF ADOLESCENT TEENS ARE DOING THAT.

HE THOUGHT IT WOULD RELEASE STRESS,

BUT IT DID NOTHING MORE THAN LEAVE PERMANENT MARKS.

AND THEN HE STARTED BEING AGGRESSIVE AGAIN TOWARDS HIMSELF

BY CUTTING HIS FACE. HE BURNED HIS FACE WITH A NEEDLE.

HE TOOK IT OUT ON THINGS

THAT HE KNEW HE WOULDN'T HURT PEOPLE,

BUT HE WOULD EITHER HURT HIMSELF OR MATERIAL THINGS.

IF YOU LOOK AT KIDS COMING INTO TREATMENT,

THEY'RE CHARACTERIZED BY HAVING MULTIPLE PROBLEMS. IT'S NOT ONE THING.

ALCOHOL OR DRUG USE MAY NOT EVEN BE THEIR MOST SEVERE PROBLEM.

THEY MAY HAVE PROBLEMS WITH DEPRESSION, WITH SUICIDE IDEATION.

THEY MAY BE CUTTING THEMSELVES OR BURNING THEMSELVES OR MUTILATING THEMSELVES.

ABOUT A THIRD OF THEM DO.

THEY MAY HAVE PROBLEMS WITH ANGER AND CONTROLLING THEIR TEMPERS.

THEY MAY HAVE PROBLEMS RUNNING AWAY OR FOLLOWING RULES AND ORDERS.

SO IT TENDS TO NOT BE ONE THING BUT MULTIPLE THINGS.

DYLAN GOT IN TROUBLE LAST FALL.

BASICALLY HE WAS STARTING TO HAVE RAGE EPISODES

WHERE HE WOULD COULDN'T CONTROL HIS ANGER AT ALL.

THE DAY DYLAN DECIDED TO BREAK OUR WINDOWS

WITH A SLINGSHOT WRIST ROCKET,

HE HAD AN ARGUMENT OVER DOING A CHORE.

IT WAS A VERY SIMPLE TASK, BUT HE DIDN'T FEEL HE NEEDED TO DO IT.

SO HE SNUCK OUTSIDE, SHOT OUT THE WINDOWS.

AND BY DOING SO I HAD TO GO OUT AND CONFRONT HIM.

AND HE WAS HOLDING THE WEAPON, AIMING IT AT ME.

I WASN'T SURE IF HE WAS GONNA SHOOT ME OR WHAT.

BUT HE DIDN'T.

HIS MOM ACTUALLY CALLED THE SHERIFF.

AND THAT WAS VERY HARD, TO TURN IN YOUR OWN SON.

I FELT LIKE I WAS--

LIKE THE WORLD WAS ON MY SHOULDERS.

LIKE, "OH, I AM THIS RESPONSIBLE ADULT FOR THIS CHILD

AND THIS KID AND HE'S DOING THIS STUFF

AND THERE'S NOTHING I CAN DO."

LESS THAN ONE IN 10 ADOLESCENTS WHO ALREADY

MEET CLINICAL CRITERIA FOR ABUSE OR DEPENDENCE

ARE SHOWING UP TO TREATMENT.

NOW WHAT THAT MEANS IS WE'RE DOING A BAD JOB

OF IDENTIFYING AND GETTING YOUR KIDS

WHO HAVE PROBLEMS INTO TREATMENT.

THIS IS VERY DIFFICULT BECAUSE IT'S NOT ONE THING.

PART OF IT MAY BE THAT PARENTS AND TEACHERS

ARE HOPING, POSITIVELY, THAT THEY'LL GROW OUT OF IT.

UNFORTUNATELY THIS IS A VERY RISKY THING TO DO.

IT'S MUCH MORE IMPORTANT TO OVERREACT, POSSIBLY.

BOREDOM IS A REALLY BIG TRIGGER.

LIKE, YOU KNOW, YOU'RE JUST SITTING AROUND THE HOUSE BORED.

YOU GOT A BIG SACK OF WEED AND A COUPLE BEERS.

HAVE A PARTY RIGHT THERE.

MY PARENTS WOULD BE LIKE STRAIGHT UP,

LIKE YELLING IN MY FACE. LIKE, YOU KNOW,

"YOU FUCKIN' BLAH, BLAH, BLAH, BLAH."

AND I'D JUST BE SITTING THERE LIKE, "UH-HUH."

AND MY MIND WOULD JUST BE SOMEWHERE ELSE.

AND I WOULD JUST BE THINKING ABOUT,

"THANK GOD I GOT ANOTHER GRAM STASHED SOMEWHERE IN MY ROOM."

HE'S HAD ONE TOOL IN THE TOOL BAG. YOU KNOW?

"IT'S, YOU KNOW, IT'S A BAD DAY. I THINK I'LL GET HIGH.

THE SUN IS SHINING. I THINK I'LL--

MY GIRLFRIEND BROKE UP WITH ME. I THINK I'LL GET HIGH."

KIDS DIDN'T COME TO TREATMENT AND SAY,

"I WANT TO STOP USING DRUGS,"

BECAUSE THEY'RE THE BEST THING THAT EVER HAPPENED TO THEM.

WHY WOULD THEY? IT'S THEIR ONE COPING SKILL.

TED'S FLUNKED OUT OF AN OUTPATIENT PROCESS.

I MEAN, THE VERY FIRST DAY THEY TOLD HIM HOW TO FAKE THE URINE TESTS.

AND SO FROM WEEK ONE HE WAS DOING IT.

IT FINALLY GOT TO THE POINT THAT TED HAD BEEN KICKED OUT OF BOTH OF OUR HOUSES.

AND THAT WAS THE ONLY WAY WE GOT HIM IN HERE.

THE ONLY WAY WE GOT HIM INTO INPATIENT TREATMENT

WAS TO REALLY PUSH...

THAT FAR.

SO THE PARENTS BECOME VERY ANGRY AT THE KID.

AND THE KID THEN REACTS OUT.

THEN YOU START TO CREATE A DYNAMIC THAT'S VERY NEGATIVE.

THAT'S NOT GOING TO HELP THE ADOLESCENT,

NOR IS IT GOING TO HELP THE PARENT.

BECAUSE THE ADOLESCENT WILL REBEL AGAINST THESE NEGATIVE ATTITUDES.

ONE OF THE INTERVENTIONS THAT HAS BEEN SHOWN

TO BE QUITE EFFECTIVE ARE FAMILY INTERVENTIONS

WHERE YOU ENGAGE THE FAMILY AS PART OF THE TREATMENT.

THE CHOICES THAT DYLAN MAKES WILL RESULT IN EITHER

MORE FREEDOM...

OR A TIGHTER BOX.

AND IT'S ALL ON DYLAN.

Riggs: OFTENTIMES FAMILIES ARE REALLY ANGRY.

PARENTS ARE REALLY ANGRY WITH THEIR KIDS

BY THE TIME THEY GET TO DRUG TREATMENT BECAUSE THEY'VE LIED TO THEM.

YOU KNOW, THEY SNEAK OUT THE WINDOW.

THEY GO OUT AT NIGHT. THEY AREN'T HOME ON TIME. PARENTS ARE REALLY ANGRY.

THEY HAVE A HARD TIME WITH TRUST

OR EVEN POSITIVELY REINFORCING THEIR KIDS.

DYLAN, LET ME PUT IT THIS WAY:

IF YOU GIVE ME REASONS

TO PUT MY THUMB ON YOU, THAT'S YOUR FAULT.

AND IF YOU GO CRAZY BECAUSE YOU'RE SO RESTRICTED,

THAT'S YOUR FAULT. AND YOU PAY THE CONSEQUENCES FOR THAT.

YOU CAN GO BACK TO MONTVIEW, TO DETENTION.

WHAT A CONCEPT.

THERE ARE VERY ABNORMAL PATTERNS

IN THE COMMUNICATION OF THE FAMILY MEMBERS

THAT DEVELOP AS A RESULT OF THE ADDICTION.

IF NOT DEALT WITH, THOSE ABNORMAL PATTERNS

MAY CONTRIBUTE TO RELAPSE.

HOW ARE YOU GOING TO TELL THESE PEOPLE

I CAN'T GO WITH YOU?

I'M NOT REALLY SURE. I JUST...

KNOW THAT I, UM...

I'M A STRONG ENOUGH PERSON THAT I WOULDN'T DO THAT KIND OF A THING.

HE DOESN'T HAVE A LOT OF SKILLS YET

IN ASKING FOR HELP WHEN HE NEEDS IT.

Dennis: IF YOU REALLY WANT TO BREAK THE PATTERN

YOU HAVE TO IDENTIFY ALL OF THE CO-OCCURING THINGS

THAT ARE FEEDING OFF OF EACH OTHER

AND ADDRESS THEM AT THE SAME TIME IN TREATMENT.

IT'S BEEN GETTING EASIER.

- OKAY. - BUT, UM...

THIS IS NOT JUST WHAT DO YOU DO FOR YOUR SON OR DAUGHTER TODAY.

BUT THIS IS AFFECTING THE NEXT 50 TO 70 YEARS OF THEIR LIFE.

YOU MAY CONTROL WHETHER THEIR WHOLE LIFE--

MEASURED IN DECADES, NOT WEEKS OR MONTHS-- IS AFFECTED.

THIS IS A TREATABLE ILLNESS.

EVERY DAY, ALL DAY I SEE KIDS

WHO ARE THE MOST SERIOUS KIDS, THEY GET MUCH MUCH BETTER.

EVERY TREATMENT PROGRAM ALL OVER THE COUNTRY

SEES KIDS WHO GET MUCH MUCH BETTER.

I DON'T-- I'M LIKE OVER IT NOW, BUT...

( applause )

TED, I'M SO PROUD OF YOU.

AND THANK YOU FOR CHOOSING TO DO THIS HARD HARD WORK.

'CAUSE I REALLY-- I'M REALLY LOOKIN' FORWARD

TO BEING AROUND YOU

AND HAVING YOU IN OUR LIVES.

SO THANK YOU. AND I LOVE YOU.

( applause )

ALL OF THE DRUGS, WHETHER IT'S HEROIN,

ALCOHOL, CIGARETTES, MARIJUANA--

ALL OF THEM ACTIVATE THE DOPAMINE PATHWAY.

ALL OF THEM.

DOPAMINE IS THE NEUROTRANSMITTER

THAT'S RELEASED WITH PLEASURABLE EVENTS.

AND IT IS BASICALLY THE NEUROTRANSMITTER SYSTEM

THAT DEFINES THE PLEASURE PATHWAYS IN THE BRAIN.

THE DRUGS OF ABUSE ARE FIVE TIMES, AT LEAST,

MORE REINFORCING AND COMPELLING

AS THE THINGS THAT OUR BRAIN REWARD SYSTEM EVOLVED

IN THE FIRST PLACE TO BE REWARDED BY--

LIKE FOOD OR SEX OR WHATEVER.

AND DRUGS ARE SO MUCH MORE REWARDING

TO OUR BRAINS THAN THAT. WE WILL DO ANYTHING.

THEY COMMANDEER OUR BRAIN REWARD SYSTEM AND DRIVE OUR BEHAVIOR.

AND THAT TAKES POWERFUL TREATMENTS

TO THWART THOSE DRIVES.

HELLO, I'M DR. NORA VOLKOW.

I WANT TO ASK YOU SOME QUESTIONS.

AT ANY POINT IF YOU FEEL UNCOMFORTABLE JUST LET ME KNOW.

NOW, YOU ARE HOW OLD?

43.

SO YOU HAVE BEEN TAKING METHAMPHETAMINE FOR 10 YEARS?

- YEAH, OR MORE. ABOUT 11. - SO HOW DID IT START?

WELL, I WAS DOING A LOT OF COKE.

AND THE METH GOT ME OFF OF COKE FOR ONE THING.

METH GAVE ME THE SAME KIND OF BUZZ,

BUT IT WOULD LAST LONGER AND WOULD COST LESS.

HOW DID IT AFFECT YOUR LIFE, METHAMPHETAMINE?

WHEN YOU'RE NOT ON IT YOU JUST FEEL SO UNNORMAL.

AND YOU'D KIND OF REALLY LIKE TO GET SOME

JUST TO GET BACK TO A NORMAL FEELING.

PLACE YOUR HAND IN THAT BOX.

THAT'S GONNA GET A LITTLE WARM.

WE'RE GONNA LET YOU REST FOR ABOUT 10-15 MINUTES TO GET WARM.

- DO YOU FEEL COMFORTABLE? - SURE.

Volkow: WITH IMAGING TECHNIQUES NOW WE CAN DIRECTLY TAKE PICTURES

OF THE WORKING HUMAN BRAIN.

WE CAN COMPARE THE BRAINS OF PEOPLE THAT ARE ADDICTED TO DRUGS

WITH THAT OF PEOPLE THAT ARE NOT ADDICTED TO DRUGS

UNDER VERY DIFFERENT CONDITIONS.

FOR EXAMPLE, WE CAN STRESS THE DOPAMINE SYSTEM,

WHICH IS THE SYSTEM THAT IS ACTIVATED BY DRUGS.

Man: 20 SECONDS.

Volkow: SO WHAT WE WANT TO DO NOW IN THIS STUDY IS TO SEE

IN PEOPLE THAT ARE ADDICTED TO METHAMPHETAMINE

HOW THE DOPAMINE CELLS ARE FUNCTIONING.

Man: FIVE, FOUR...

Volkow: SO WE'RE MEASURING THE MAGNITUDE OF THAT SEARCH,

WHICH IS AN INDICATION OF REALLY, ONCE YOU STRESS

THE DOPAMINE CELLS, HOW DO THEY RESPOND.

IT'S EQUIVALENT TO WHEN, FOR EXAMPLE,

THEY SEND YOU TO A CARDIOLOGIST AND THEY PUT YOU ON A TREADMILL.

SO THEY STRESS YOUR HEART

TO SEE HOW IT RESPONDS.

OKAY, SO WE HAVE THE RESULT.

THIS IS YOUR IMAGE.

AND WHAT WE'VE SHOWN IS AN IMAGE OF A PERSON,

ALSO OF A MAN OF THE SAME AGE

THAT HAS NOT TAKEN ANY DRUGS.

LET'S LOOK AT THE NORMAL BRAIN.

AND YOU SEE THEM, THE AREAS IN RED SHOW VERY VERY HIGH CONCENTRATIONS.

THIS IS ONE OF THE CELLS

IN THE BRAIN THAT'S MOST SENSITIVE

TO THE DAMAGING EFFECTS OF METHAMPHETAMINE.

LOOK AT YOUR BRAIN AND SEE HOW

THAT RED BASICALLY HAS DISAPPEARED.

ALL OF THIS PART HERE IS GONE.

YOU CAN CLEARLY SEE THERE IS MUCH LESS ACTIVITY IN YOUR BRAIN

THAN IN THE BRAIN OF THIS PERSON.

SO ONE OF THE CONCERNS IS OF COURSE, THAT AS PEOPLE

THAT TAKE METHAMPHETAMINE GROW OLDER

AND CONTINUE TO TAKE IT,

ARE THEY PUTTING THEMSELVES AT RISK

FOR NEUROLOGICAL DISEASES?

- THAT WON'T GO AWAY. - THAT WON'T GO AWAY.

AND THAT WILL CREATE SYMPTOMS.

SO, I MEAN, WHEN WE WERE SPEAKING-- AND I'M BEING CANDID WITH YOU,

BECAUSE THERE'S NO POINT OF NOT BEING IT.

IF YOU CONTINUE TO TAKE METHAMPHETAMINE, THIS WILL NOT RECOVER.

I MEAN, IT'S BOTTOM LINE.

THE OTHER THING THAT CONCERN ME TOO IS THIS THING.

AND IT'S ACTUALLY-- THIS IS YOUR BRAIN MRI.

THIS BRAIN LOOKS LIKE THE BRAIN

OF A MUCH OLDER PERSON.

IT LOOKS LIKE THE BRAIN OF A 60-YEAR-OLD.

HE CLEARLY STATED TO US THAT HE HIMSELF

IS NOT CONVINCED

THAT HE WANTS TO GET DETOXIFIED.

AND THAT'S EXACTLY NOT UNCOMMON,

THIS AMBIVALENCE OF THE PERSON THAT'S ADDICTED.

BECAUSE IN A WAY-- IT'S LIKE THEY ARE IN LOVE WITH THE DRUG IN A WAY.

BUT AT THE SAME TIME THERE IS THIS HATRED

BECAUSE THEY ACTUALLY-- THIS LOSS OF CONTROL.

BUT THERE IS CLEARLY AN AMBIVALENCE, AND HE EXPRESSED IT.

Woman: DO YOU FEEL CONCERNED ABOUT THE IMAGE OF YOUR BRAIN?

NOT REALLY. AGAIN, I DON'T THINK--

I DON'T KNOW IF THEY CAN REALLY REALLY TELL,

WHETHER THEY'RE FUDGING THE PICTURE. I DON'T KNOW.

IT IS ACTUALLY INCREDIBLY TELLING,

THE NOTION OF SELF-DECEPTION, TO WHAT EXTENT YOU CAN

SELF-DECEIVE YOURSELF TO SAY,

"THIS DRUG HAS NOT DONE ANYTHING WRONG FOR ME."

WHAT I WANT TO IMPRESS UPON YOU IS THE IMPORTANCE

OF REALLY TRYING TO STAY CLEAN.

BECAUSE YOU CAN DO A LOT OF RECOVERY.

OUR BRAIN HAS A TREMENDOUS CAPACITY FOR RECOVERY.

SO HOPEFULLY IF I STOP USING,

IN A YEAR OR TWO IT MIGHT-- THE RED MIGHT COME BACK SOME?

YEAH. WE'VE SEEN IT IN THE PAST, BUT YOU HAVE TO STAY CLEAN.

AND IT'S NOT STAYING CLEAN FOR THREE MONTHS.

NO. OVER A YEAR. SO IT DOES REQUIRE THAT.

OKAY.

DENIAL IS CLEARLY A CORE FEATURE OF THIS DISORDER,

AND THAT, PARTICULARLY

IN THE EARLY STAGES OF THE ILLNESS,

PEOPLE JUST REFUSE TO FACE UP TO THE FACT

THAT THEIR USE OF DRUGS IS IMPACTING THEIR LIFE

IN IMPORTANT AND SUBSTANTIAL WAYS.

YOU KNOW IF YOU HAVE A DISEASE, WHY NOT DENY THAT YOU HAVE IT?

WE DO IT ALL THE TIME.

SO DENIAL IS NOT SORT OF UNIQUE TO THIS DISEASE.

AND PART OF THE DISEASE ITSELF, OF COURSE,

IS TO DENY THAT YOU HAVE IT.

IT REALLY IS THE JOB

OF THE TREATMENT PROFESSIONAL TO TAKE THAT PERSON,

WITH ALL THEIR AMBIVALENCE ABOUT BEING IN TREATMENT--

THEY DON'T REALLY WANT TO BE THERE,

THEY'RE HALF IN DENIAL ABOUT IT--

AND HELP THEM SEE BOTH WHAT DAMAGE

ADDICTION HAS DONE IN THEIR LIVES

AND HOW MUCH BETTER THEIR LIFE CAN BE

IF THEY GET CLEAN.

RECENT RESEARCH HAS MADE A GREAT DEAL OF PROGRESS

IN UNDERSTANDING WHAT'S GOING ON IN THE BRAIN

WITH ADDICTION. AND USING BRAIN IMAGING

WE CAN ACTUALLY SEE WHAT'S HAPPENING IN THE BRAIN.

WE CAN SEE WHICH PARTS OF THE BRAIN ARE ACTIVATED.

AND THIS HAS HELPED US TO DEVELOP NEW MEDICATIONS

FOR NICOTINE, ALCOHOL, COCAINE, METHAMPHETAMINE.

BUT WITH OPIATES SUCH AS HEROIN,

THE REAL BREAKTHROUGH BEGAN

IN THE 1960s WITH THE USE OF METHADONE.

FOR THE FIRST TIME IT WAS FOUND THAT A MEDICATION

COULD REDUCE CRAVING

AND BLOCK THE USE OF HEROIN,

OR AT LEAST THE PLEASURE FROM THAT,

AND ENABLE PEOPLE TO LEAD NORMAL LIVES.

THEY COULD BE ON METHADONE AND FUNCTION IN SCHOOL

OR IN A PROFESSION OR DRIVING A CAR AND DO PERFECTLY WELL.

THEN MORE RECENTLY, BUPRENORPHINE HAS COME ALONG.

AND BUPRENORPHINE ITSELF IS A VERY SAFE DRUG.

IT'S ALMOST IMPOSSIBLE TO OVERDOSE ON IT

BECAUSE IT ONLY PARTIALLY ACTIVATES THE OPIATE RECEPTORS.

IF SOMEONE TAKES AN OPIATE WHILE THEY'RE ON BUPRENORPHINE

IT'S GONNA BE RELATIVELY BLOCKED

BECAUSE OF THE STRONG AFFINITY THAT BUPRENORPHINE

HAS FOR THESE RECEPTORS.

IT'S SO SAFE THAT A DOCTOR

CAN GIVE A PRESCRIPTION FOR BUPRENORPHINE

FOR AS MUCH AS A MONTH'S SUPPLY AND THE PATIENT

CAN HAVE THEIR ADDICTION TREATED,

HAVE THEIR CRAVING REDUCED OR ELIMINATED,

AND STILL LEAD A RELATIVELY NORMAL LIFE.

Man: IT SEEMS LIKE THERE'S A LOT OF CONNECTION

BETWEEN DEPRESSION AND DRUG USE.

ESPECIALLY OPIATES, BECAUSE THEY ARE--

EVEN THOUGH THEY ARE DOWNERS, WHAT IT DOES MEAN--

DEPRESSION PRETTY MUCH IS WHEN YOU DON'T TAKE THEM THE RIGHT WAY.

LIKE THEY MAKE YOU FEEL VERY COMFORTABLE AND RELAXED,

ESPECIALLY WITH ANXIETY. A LOT OF PEOPLE DO THEM.

YOU'RE PRETTY MUCH VERY RELAXED AND, LIKE, CHATTY,

AND YOU FEEL GOOD FOR, LIKE, FIVE OR SIX HOURS.

THEN WHEN YOU COME OFF OF THEM YOU FEEL LIKE CRAP. SO...

SHE ALWAYS TAKES IN THE ANIMALS THAT ARE HURT...

OR SOMEWHAT BRAIN DAMAGED.

THE LAST ONE WE HAD WAS-- IT HAD A--

HAD SEIZURES AND THAT KIND OF STUFF.

Amanda: HE DIED.

Justin: YEAH, AND IT DIED

- HOW YOU FEEL, GIRL? - I COULD BARELY SLEEP ALL NIGHT.

AND LIKE, I COULDN'T GET OUT OF BED THIS MORNING, BARELY. I WAS LIKE, "OH GOD."

- Man: OKAY WELL, WE'D BETTER GET CRACKING. - Justin: YEP.

Amanda: I FEEL REALLY CRAPPY.

I HOPE IT WORKS, AS GOOD AS EVERYBODY SAYS IT DOES

SO I DON'T HAVE TO WORRY ABOUT FEELING LIKE THIS ANYMORE.

WHAT HAVE YOU BEEN USING FOR DRUGS?

I STARTED SMOKING POT AND DOING VICODIN AND DRINKING.

THEN I GOT INTRODUCED

TO ACID AND ECSTASY.

- VICODIN. PERCOCET. - YOU STARTED RIGHT OUT ON THOSE DRUGS?

- YEP. - YOUR MAIN-- WHEN YOU FIRST STARTED USING?

- YES. - IS THIS THE FIRST TREATMENT PROGRAM YOU'VE BEEN IN?

YEP. IT'S HARD FOR ME TO GET UP IN THE MORNING

AND COME, THOUGH, BECAUSE I WORK SO LATE.

BUT I'M TRYING MY HARDEST TO GET UP

AND BE HERE BY 9:30 OR 9:00 OR AT LEAST BY 10:30,

AND AT LEAST MAKE ONE GROUP OR COME FOR THE AFTERNOON GROUPS

OR WHATEVER I CAN. YOU KNOW?

EVERY PERSON WHO'S BORN IN THE WORLD

HAS A MOLECULE IN THEIR BRAIN

THAT'S EXACTLY THE SAME AS MORPHINE.

FIRST THING IT DOES FOR YOU IS IT HELPS

LIFT YOUR MOOD SO THAT YOU FEEL BETTER.

SECOND THING THAT IT DOES FOR YOU

IS THAT IT HELPS YOU FEEL MOTIVATED.

IT STIMULATES THE PARTS OF YOUR BRAIN

THAT HELP YOU WANNA GET UP, GO DO YOUR JOB,

TAKE CARE OF YOUR KIDS, WORK ON YOUR CAR--

MOW YOUR LAWN. ALL THAT KIND OF STUFF.

WHAT HAPPENS WHEN YOU USE OPIATES, LARGE AMOUNTS OF OPIATES

IN PARTICULAR, THAT YOU INTRODUCE FROM THE OUTSIDE,

IS THEY GO TO THESE SAME RECEPTOR SITES IN YOUR BRAIN

THAT THIS NATURAL OPIATE GOES TO, RIGHT,

AND STIMULATES THEM.

ONLY THE DIFFERENCE IS THAT TYPICALLY WHATEVER DRUG YOU'RE USING

IS WAY MORE POTENT THAN ANYTHING

THAT YOUR BRAIN'S PRODUCING.

OXYCONTIN, MORPHINE, HEROIN, DILAUDID--

THOSE DRUGS ARE WAY MORE STIMULATING

TO THOSE PARTS OF YOUR BRAIN.

AND WHAT HAPPENS IS YOU GO THROUGH THE GROSS WITHDRAWAL, RIGHT?

THE JONESING THAT EVERYBODY TALKS ABOUT.

BUT THEN WHAT HAPPENS AFTER THAT IS A LONG PERIOD OF TIME

WE CALL POST-ACUTE WITHDRAWAL SYNDROME. THAT'S JUST A FANCY WORD

FOR FEELING LIKE SHIT FOR DAYS,

WEEKS, MONTHS, YEARS ON END.

AND THAT'S WHY 90% OF THE PEOPLE

WHO DON'T USE REPLACEMENT THERAPY RELAPSE, 'CAUSE THEY CAN'T STAND

HOW THEY FEEL OVER THE LONG PERIOD OF TIME.

Man: IT SEEMS LIKE THE WORLD COMES DOWN ON YOU.

( phone ringing )

Woman: SOME PEOPLE SAY THEY TASTE LIKE AN ORANGE PEEL. OKAY?

IT USUALLY TAKES ABOUT FIVE MINUTES.

SUBOXONE-- WHICH IS THE BRAND NAME OF THE BUPRENORPHINE--

THE SUBOXONE IS A VERY EFFECTIVE DRUG

WITH THE RIGHT KIND OF A PATIENT.

AND IF YOU HAVE SOMEBODY WHO HAS TYPICALLY SOMEWHAT

OF A LOWER ADDICTION PROFILE, MEANING

THAT HAS NOT BEEN USING FOR AS LONG,

OR MAYBE NOT BEEN USING INTRAVENOUSLY,

THEN SUBOXONE IS A MEDICATION

THAT IS EFFECTIVE VERY QUICKLY.

TYPICALLY WHAT YOU SEE HAPPEN WITH PATIENTS WHO TAKE IT

IS THAT THEY WILL START REPORTING FEELING BETTER THAT DAY,

THE DAY THEY INITIATE.

ANOTHER FRIEND OF MINE IS ALSO ON SUBOXONE, AND HE SAID IT HELPS HIM.

YOU KNOW, HE HASN'T DONE A THING IN YEARS.

I'VE BEEN TRYIN' TO GET OFF OPIATES FOR OVER FOUR YEARS.

I'VE BEEN TRYING TO DO IT BY MYSELF.

I REALIZED THAT AFTER TWO OR THREE YEARS OF TRYING

TO DO IT BY MYSELF THAT I NEED HELP AND THAT I CAN'T DO IT BY MYSELF.

SO JUSTIN HAS A FAIRLY LONG HISTORY OF USING.

WE'RE NOT POSITIVE THAT THIS DRUG

IS GONNA BE ABLE TO MANAGE HIS ADDICTION WELL ENOUGH.

HE MAY HAVE TO LOOK AT DOING METHADONE.

YEAH.

AMANDA'S PROBABLY GOT A LESSER USING TIME, RIGHT?

- LESS TIME USING. - TWO YEARS.

SO IT'S MORE LIKELY OR IT'S-- SHE MAY ACTUALLY RESPOND

TO SUBOXONE VERY WELL AND JUSTIN WOULDN'T.

IN THAT CASE HE'D BE A METHADONE CANDIDATE.

AMANDA WOULD STAY ON SUBOXONE.

THE SUBOXONE ACTUALLY IS REALLY GOOD.

YOU GET ALL OF YOUR ENERGY BACK. I'VE ONLY BEEN ON IT FOR LIKE THREE WEEKS.

I THINK IT'S A WONDER DRUG. I DON'T HAVE NO CRAVINGS.

I DON'T EVEN CRAVE DRINKING ANYMORE REALLY. NOTHING.

I STILL HAVE A COUPLE OF THOSE.

BUT I MEAN, I HAVEN'T USED ANY DRUGS SINCE I'VE STARTED IT.

THE FIRST DAY YOU TOOK IT, DID YOU FEEL FINE

OR DID YOU STILL GET WITHDRAWALS?

IT WAS ALL RIGHT, I WAS JUST LIKE...

WERE YOU SORE, STILL?

IT DOESN'T TAKE ACHES AWAY. IT'S NOT LIKE METHADONE.

IT HAS, LIKE, NO NARCOTIC REALLY.

YOU KNOW, THESE PEOPLE ARE ASHAMED TO SOME DEGREE

OF THE THINGS THAT THEY'VE HAD TO DO IN ORDER

PEOPLE ARE-- EVERYONE'S MAD AT THEM, RIGHT?

THE WHOLE WORLD BASICALLY SAYS, "YOU'RE A LOSER."

AND YOU HAVE TO HAVE A TOLERANCE FOR MISBEHAVIOR

OR WHAT MANY PEOPLE PERCEIVE AS MISBEHAVIOR,

BUT REALLY ARE SYMPTOMS OF A DISORDER THAT PEOPLE HAVE,

AND NOT ELIMINATE PEOPLE FROM TREATMENT FOR EXHIBITING

THE SYMPTOMS OF THE DISORDER THAT THEY HAVE.

I MEAN, IF YOU WERE TREATING SOMEBODY WHO WAS DEPRESSED

AND THEY CAME IN AND SAID,

"GEE, I'M HAVING A TERRIBLE DAY AND I FEEL LIKE KILLING MYSELF,"

YOU WOULDN'T KICK THEM OUT OF YOUR TREATMENT PROGRAM

BECAUSE THEY WEREN'T GETTING UNDEPRESSED.

BUT WHEN SOMEBODY COMES IN WITH AN ADDICTION AND THEY SAY,

"I RELAPSED LAST NIGHT AND I USED COCAINE,"

VERY OFTEN THE REACTION IS TO SAY, "GO HOME

AND COME BACK WHEN YOU'RE READY."

IT'S AN EPIDEMIC. IT IS SO CONCERNING.

AND IT-- YOU DON'T-- PEOPLE AREN'T TALKING ABOUT IT, YOU KNOW?

MAINE IS THE NUMBER ONE STATE IN THE NATION

FOR TREATMENT ADMISSIONS RIGHT NOW FOR OPIATE ADDICTION.

WE ARE THE MOST OPIATE-ADDICTED STATE IN THE COUNTRY.

OUR RATE IS GROWING FASTER THAN ANYBODY ELSE IN AMERICA.

KEEP THE FRIES IN IT THIS TIME.

MY PERSONALITY AND MY STATE OF MIND SIX MONTHS AGO

WAS TOTALLY DIFFERENT THAN MY STATE OF MIND RIGHT NOW.

LIKE THE WAY I THINK, THE WAY I TALK,

THE WAY I DO EVERYTHING BASICALLY CHANGED TOTALLY

WHEN I STOPPED DOING OPIATES OR WHEN I GOT ON THE SUBOXONE.

WHICH IS WHAT I WAS LOOKING FOR. IT'S EXACTLY WHAT I WAS LOOKING FOR--

JUST TAKING MY LIFE AND TOTALLY TURNING IT UPSIDE DOWN

AND GOING THE OTHER WAY WITH IT.

HAVE YOU THOUGHT ABOUT THE FUTURE FOR YOU

WITH SUBOXONE? I MEAN, IS THIS SOMETHING THAT YOU'RE GOING TO CONTINUE

TO DO OVER A LONG PERIOD OF TIME, DO YOU THINK?

I FEEL LIKE IT'S HELPED A LOT ALREADY.

LIKE I DON'T THINK THAT I'LL HAVE TO BE ON IT

NEARLY AS LONG AS JUSTIN WILL HAVE TO BE ON IT.

LIKE I FEEL THAT I COULD BE OFF IT IN LIKE A YEAR.

NOW THAT I'M ON SUBOXONE

AND I'M HAVING TROUBLE GETTING THE INSURANCE

TO BE ABLE TO GET IT MYSELF,

I'M ACTUALLY THINKING ABOUT THE POSSIBILITY

OF SWITCHING TO METHADONE

BECAUSE IT'S CHEAPER

AND I CAN GET IT FOR-- AS LONG AS--

I CAN GET IT FOR THE REST OF MY LIFE FREE, BASICALLY, FROM ACADIA.

BUT SINCE I'M ON SUBOXONE IT'S GONNA COST ME

CLOSE TO $150 A WEEK WITHOUT INSURANCE

JUST TO GET MY MEDICATION.

THIS IS THE HARDEST PROBLEM THAT OUR PATIENTS HAVE--

IS AFFORDING THE MEDICATION. BY FAR, HARDEST PROBLEM WE HAVE.

ESPECIALLY THE SUBOXONE.

- SUBOXONE'S VERY EXPENSIVE. - IT'S VERY EXPENSIVE.

WELL, THE SCIENCE OF UNDERSTANDING ADDICTION

HAS JUST BEEN EXPLODING IN RECENT YEARS

THROUGH THE USE OF ANY NUMBER OF DIFFERENT TECHNOLOGIES

INCLUDING GENETICS, ANIMAL STUDIES,

STUDIES IN HUMANS AND BRAIN IMAGING.

WE ARE REALLY STARTING TO PIECE TOGETHER

SOME OF THE BRAIN MECHANISMS INVOLVED

IN THE DEVELOPMENT OF AND RESOLUTION OF

DRUG DEPENDENCE AND ALCOHOL DEPENDENCE.

THERE ARE CURRENTLY THREE MEDICATIONS AVAILABLE-- ON THE MARKET FOR

TREATING ALCOHOL DEPENDENCE IN THE UNITED STATES.

DISULFIRAM, BEST KNOWN AS ANTABUSE,

IS FOR PEOPLE WHO ARE IN RECOVERY

WHO ARE ABSTINENT AND ARE GOING INTO A HIGHER-RISK SITUATION.

IF YOU TAKE A DRINK, ANTABUSE CAN MAKE YOU SICK.

ACAMPROSATE WORKS ON THOSE

PROTRACTED ABSTINENCE SYNDROME,

THE KIND OF SYMPTOMS THAT PEOPLE GET

AND CAN HAVE FOR A YEAR OR TWO EVEN AFTER STOPPING DRINKING.

NALTREXONE REDUCES THAT PRIMING OF THE PUMP PHENOMENON.

IF YOU ARE WORKING TO STAY ABSTINENT

AND YOU HAVE A SLIP AND YOU TAKE A DRINK,

IT MAKES IT MUCH EASIER FOR YOU TO STOP DRINKING

BEFORE YOU GO ON TO A FULL-FLEDGED RELAPSE.

ONE OF THE MORE PROMISING MEDICATIONS THAT'S BEING TESTED RIGHT NOW

IS A MEDICATION CALLED TOPIRAMATE.

I GUESS I'VE ALWAYS KNOWN THAT I WAS AN ALCOHOLIC,

BUT I WAS--

WELL, FOR LACK OF A BETTER TERM, I WAS A FUNCTIONAL DRUNK.

MY DRINKING HAS NEVER BEEN BROUGHT ON BY...

SWINGS OF DEPRESSION

OR JOY OR DISAPPOINTMENT OR ANYTHING.

I JUST DRANK BECAUSE I WANTED TO GET HIGH.

EVER SINCE I WAS YOUNG I STARTED SNEAKING LIQUOR

AND DRINKING JUST BY MYSELF.

THEN WHEN I GOT TO COLLEGE I JUST WENT KIND OF CRAZY.

THEN I STARTED FALLING BACK INTO DRINKING ALONE,

WHICH IS WHAT WORRIES ME THE MOST.

WHEN I RETIRED I DRANK...

MORNING, NOON AND NIGHT.

I FEEL AN EMPTINESS THAT NEEDS TO BE FILLED,

AND ALCOHOL IS ONE WAY THAT I DO IT.

IT IS-- I WOULD SAY THERE'S A CRAVING FOR ALCOHOL THAT I HAVE.

MY DRINKING'S KILLING ME

AND I DESPERATELY NEED HELP.

Doctor: DID YOU BRING BACK YOUR OTHER MEDS?

Adam: THEY'RE ALL USED UP.

Woman: YOU DON'T NEED THEM. BUT THE MOST DETAIL THE BETTER.

I'LL CALL IF THEY HAVE YOU BRING BACK THE BOTTLES OR NOT.

Bankole Johnson: TOPIRAMATE IS A MEDICATION THAT REDUCES

THE WITHDRAWAL SYMPTOMS FROM ALCOHOL.

- I THINK YOU PRETTY MUCH ANSWERED ALL MY QUESTIONS. - OKAY.

IT'S A VERY GOOD DRUG AT CUTTING

THE CRAVING OR THE BUZZ FROM ALCOHOL.

SAY IF AN INDIVIDUAL WENT TO TRY AND TAKE A DRINK

OR SLIP BACK INTO DRINKING,

THEY FEEL LESS LIKELY TO TAKE THE NEXT AND THE NEXT DRINK.

I WAS DRINKING, JUST LEFT THEM. I'M ASHAMED TO SHOW YOU ALL THIS.

THIS IS A MESS HERE.

IT'S LIKE MY LIFE IS UNRESOLVED.

IT'S JUST NOT GOING ANYWHERE RIGHT NOW. I MEAN, JUST CRAZY STUFF.

IT'S LIKE I'M IN A HAZE. I DON'T EVEN NOTICE IT.

BUT IF SOMEONE ELSE IS AROUND THEN I GET SELF-CONSCIOUS ABOUT IT.

LAST NIGHT WOULD BE THIS...

AND THREE OF THESE--

FOUR OF THOSE.

Man: THOSE ARE THE BIG MALT LIQUOR BOTTLES.

YEAH, THIS STUFF WILL KNOCK YOU OUT.

IT'S CHEAPER AND IT'S A LITTLE MORE...

ALCOHOL CONTENT.

HAD ANY FAMILY HISTORY OF DRINKING?

A FEW. YOU KNOW, MAYBE.

MY FATHER, HIS SON FROM HIS PREVIOUS MARRIAGE,

MY HALF BROTHER,

BASICALLY DRANK HIMSELF TO DEATH.

THEY FOUND HIM DEAD IN HIS APARTMENT.

BEEN ROTTING FOR A COUPLE DAYS.

BUT I MEAN, THERE ARE A LOT OF OTHER WAYS OF GETTING HIGH

OTHER THAN CHUGGING EIGHT BEERS, RIGHT?

TELL ME ONE THAT'S BETTER FOR ME AND I'LL BELIEVE IT.

THE BEERS ARE THE ONES THAT DO IT FOR YOU?

YEAH. I-- WELL, ALCOHOL IN GENERAL IS JUST

AN OLD REGULAR. IT'S WHAT STUCK WITH ME.

BUT I WANNA STOP. I'M HOPING THE MEDICINE WILL HELP GIVE ME SOME INCENTIVE

TO FEEL A LITTLE BETTER DURING THE DAY,

SO I DON'T HAVE TO REACH FOR THE BEER

JUST TO DROWN MY FEELINGS.

WHEN I FIRST CAME HERE

IF SOMEBODY HAD ASKED ME

IF I WANTED TO HAVE A DRINK,

I WOULD HAVE TOLD THEM YES.

I WOULD HAVE LIKED TO HAVE HAD A DRINK.

NOW IF SOMEBODY TOLD ME

WOULD I LIKE TO HAVE A DRINK, I'D SAY, "NO."

IT TOOK A WHILE. THE FIRST THREE OR FOUR WEEKS

I NOTICED VERY LITTLE EFFECT AT ALL.

THE PATTERN STAYED PRETTY MUCH THE SAME--

DRINKING LATE INTO THE EVENINGS.

BUT THEN IT GRADUALLY--

I STARTED GOING TO SLEEP EARLIER

AND I STARTED DRINKING LESS.

YOUR CRAVING'S ACTUALLY MUCH LOWER

THAN WHEN YOU STARTED, WHICH IS REALLY NICE.

IT DOES-- IT'S GETTING EASIER.

I THINK WHEN I DECIDED TO QUIT DRINKING,

THAT MEDICINE BEING THERE WAS REALLY-- IT WAS A BOOST.

IT WAS A-- IT MADE ME

FEEL COMFORTABLE ABOUT IT.

YOU KNOW, WHEN AN INDIVIDUAL'S AT THE HEIGHT OF THEIR ALCOHOL DRINKING,

IT'S ALMOST LIKE AN UNQUENCHABLE THIRST.

YEAH, YOU COULD SAY THAT.

AND SO IT'S GOOD TO HAVE A MEDICATION

THAT TAKES THE EDGE OFF THAT UNQUENCHABLE THIRST

AND PROVIDES THE INDIVIDUAL WITH ACTUALLY A MECHANISM

WHEREBY THEY CAN SAY, "OKAY, I'VE NOW GONE OFF THE ACUTE PERIOD OF TIME.

NOW I CAN START THINKING ABOUT INCORPORATING OTHER THINGS IN MY LIFE,"

LIKE YOU HAVE DONE, TO BE ABLE TO HELP THE OVERALL PICTURE.

( dog barking )

BEHAVE YOURSELF, YOU BIG SILLY.

Tom: I THINK YOU HAVE TO REACH A POINT...

AND MAKE A-- YOU'VE GOT TO MAKE A DECISION.

YOU'VE GOT TO MAKE A PERSONAL STATEMENT.

BUT I THINK THAT MEDICATION

MADE IT SO MUCH EASIER FOR ME.

FOR EXAMPLE, TODAY I CAN PICK AND CHOOSE WHAT I WANNA DO.

IF I WANT TO DO SOMETHING IN THE HOUSE

OR IF I WANT TO GO OUT OR GO SOMEWHERE, I CAN DO THAT.

IN DAYS GONE BY I KNOW WHAT I'D DO.

I'D BE SITTING HERE DRINKING IN THE MIDDLE OF THE DAY.

THE DRINKING WAS BECOMING

A 24-HOUR-A-DAY,

SEVEN-DAYS-A-WEEK AFFAIR FOR ME.

IT'S TOO BAD I DIDN'T COME

TO THIS REALIZATION A LONG TIME AGO.

I CAN'T CHANGE THAT.

BUT I CAN DETERMINE

WHAT'S GOING TO HAPPEN TOMORROW.

AND I'M NOT GONNA DRINK.

IT WAS ABOUT THREE WEEKS AGO AND I WAS STILL DRINKING.

A SORT OF DEPRESSION LIFTED FROM ME

AND I STARTED LISTENING TO BEETHOVEN IT WAS, I THINK AT THE TIME.

AND I STARTED FEELING LIKE I COULD WRITE MUSIC.

I STARTED WRITING BEFORE I STOPPED DRINKING.

I STARTED WRITING MORE AND THE ALCOHOL

STARTED HAVING LESS OF AN EFFECT.

THEN LAST WEEK, I FIGURED

AS IT WAS HAVING VERY LITTLE EFFECT ANYWAY,

I JUST DECIDED TO STOP.

I HAVEN'T LOOKED BACK YET.

SO THAT'S WHERE I STAND.

ONE OF THE THINGS THAT'S MOST IMPORTANT FOR PEOPLE TO UNDERSTAND HERE

IS THAT THE MEDICINES WON'T DO THE WORK FOR YOU.

YOU'VE GOT TO WORK AT THIS IN ORDER TO CHANGE.

PEOPLE HAVE THE IDEA THAT, "I WON'T WANNA DRINK ANYMORE."

THAT IT'LL MAGICALLY MAKE THE WHOLE THING DISAPPEAR.

FOR THE MOST PART THAT WON'T WORK.

WHAT IT CAN DO IS IT CAN MAKE IT EASIER

TO DO THE RIGHT THING.

IT CAN MAKE IT EASIER TO ACHIEVE YOUR GOALS.

THERE'S NO MEDICATION THAT I CAN EVER CONCEIVE OF, EVEN IN THE FUTURE,

THAT WILL TAKE AWAY THE NEED FOR THE STRUGGLE,

THE HARD WORK THAT'S REQUIRED IN PSYCHOTHERAPY,

FAMILY THERAPY, GROUP THERAPY, WHATEVER.

BUT THE MEDICATIONS WILL GET BETTER AND BETTER

AT HELPING THE PERSON TO CONTROL THESE EXTREME COMPULSIONS

TO GO BACK AND USE DRUGS.

SO BECAUSE WE DON'T HAVE A SINGLE CURE

AND BECAUSE TREATMENT, WHILE IT'S PROVIDED,

CAN HELP THAT, IT'S FAR BETTER

TO KEEP AN INDIVIDUAL IN TREATMENT,

IN SUPERVISION AND WITH PROPER FAMILY SUPPORT

FOR A VERY LONG TIME.

BEST COFFEE IN ASTORIA.

- HOW ARE YOU DOING? - ALL RIGHT. DON'T WORK TOO HARD.

KNOCK 'EM DEAD KID.

I'M DON PERKS. GONNA BE 65 YEARS OLD.

I'VE BEEN A STEAMFITTER SINCE 1962.

I WANT EVERYBODY TO GO HOME SAFE AND SOUND.

WORK SAFE, FELLAS.

Don: A STEAMFITTER IS SOMEONE WHO PUTS IN

THE HEATING, VENTILATING AND AIR-CONDITIONING SYSTEMS.

WE PUT IN THE BOILERS. WE PUT IN THE STEAM PIPE.

WE DO POWERHOUSES. WHENEVER YOU SEE A POWERHOUSE,

IT'S ALMOST ALL STEAMFITTER LABOR.

( scraping )

GO AROUND TO THE OTHER SIDE. HOLD THAT IN THERE.

Don: WE WORK IN UNITS OF TWO. EVERYBODY HAS A PARTNER.

( chains rattling )

IN OUR BUSINESS WE CALL IT A MARRIAGE WITH NO DIVORCES.

EVERYBODY KNOWS THE STEAMFITTERS.

WE'RE THE HARDEST WORKING AND PROBABLY THE BIGGEST DRINKERS.

DRINKING WAS LIKE HAVING A SODA ON THE JOB.

IT WASN'T-- NOBODY FROWNED ON IT.

I THOUGHT I'D DIED AND WENT TO HEAVEN.

I WAS 22 YEARS OLD AND I WAS DRINKING EVERY DAY

ON THE JOB AND IT WAS OKAY.

NOBODY WOULD ADMIT TO ALCOHOLISM. NOBODY WOULD ADMIT TO ADDICTION.

YOU WIND UP DOING THINGS THAT YOU WOULDN'T DREAM OF DOING.

I WAS IN AN ACCIDENT ONE TIME WITH MY SON IN THE CAR AND HE GOT HURT.

AND I WAS DRUNK. YOU KNOW, IT WAS LIKE,

"OH MY GOD, HOW-- YOU KNOW, WHAT'S WRONG WITH YOU?"

WE WATCHED OUT FOR EACH OTHER.

WE TOOK CARE OF EACH OTHER BY ENABLING.

WE DIDN'T KNOW THAT BY PUTTING A GUY IN THE BATHTUB

AND PUTTING PLYWOOD OVER IT

AND KEEPING HIM IN THERE FOR SIX OR SEVEN HOURS

'CAUSE HE'S SO DRUNK AND THEN GETTING HIM BACK ON HIS FEET

AND GETTING HIM HOME SO HIS FAMILY COULD GET HIS PAY--

WE THOUGHT THAT WAS HELPING. WE REALLY REALLY DID.

WHAT, ARE YOU KIDDING ME? THAT'S A LAME EXCUSE, JIMMY.

I ONLY TOLD YOU I DIDN'T WANT YOU GOING OUT.

I DON'T GIVE A SHIT WHETHER YOU GO OUT OR NOT.

BUT DON'T ASK ME TO PUT YOU ON A JOB,

BECAUSE EVERY TIME YOU GO OUT TO LUNCH YOU GOT THAT DRINK IN YOU

AND YOU COME BACK AND NOBODY KNOWS WHAT THE HELL YOU'RE DOING.

LET ME TELL YOU--

HEY, WAIT A MINUTE, LET ME TELL YOU SOMETHING, JIMMY.

YOU'RE NOT TALKING TO SOMEBODY THAT GREW UP YESTERDAY.

GOD DAMN IT, I'M AN ALCOHOLIC.

I'M AN ALCOHOLIC MYSELF WHO QUIT DRINKING

AND I'M NOT PISSED OFF AT ANYBODY THAT DRINKS.

YOU GOTTA GET YOUR ACT STRAIGHT FIRST.

I'M TELLING YOU, JIMMY, FOR YOUR OWN GOOD.

Samuel Bacharach: STEAMFITTERS, LIKE MANY PEOPLE IN CONSTRUCTION,

HAVE HAD A LONG TRADITION OF DRINKING.

THE STEAMFITTERS STUCK THEIR NECK OUT AND SAID,

"YOU KNOW WHAT? THE BUCK STOPS HERE.

WE'RE TAKING RESPONSIBILITY FOR OUR OWN BROTHERS AND SISTERS."

IT IS IN THE VERY BEST SENSE OF THE WORD

WHAT THIS SOCIETY IS ALL ABOUT.

HOW DO WE HELP OUR NEIGHBORS?

IF I HAVE A PROBLEM, THIS PROGRAM WILL SAY TO ME,

"GUESS WHAT? COME TO SEE ONE OF OUR PEERS.

WE WILL GET YOU THE TYPE OF HELP WE NEED.

WE WILL BE YOUR GUIDE.

WE WILL BE THERE IN YOUR CORNER ALL THE WAY. TRUST US."

- ( phone rings ) - HELLO. STEAMFITTERS INDUSTRY ASSISTANCE PROGRAM.

CAN I HELP YOU?

Don: AN EAP IS AN EMPLOYEE ASSISTANCE PROFESSIONAL.

WE ARE THE FIRST PEOPLE THAT MEET WITH SOMEONE IN TROUBLE.

WE ARE THE FIRST ONE THAT THEY COME TO.

IT'S AN INCREDIBLE EXPERIENCE TO HAVE SOMEONE CALL YOU UP.

LIKE WHEN I CALLED, I WAS SO BROKEN AND SO SCARED.

I STILL AM IN AWE THAT PEOPLE

WOULD ACTUALLY TRUST ME ENOUGH TO CALL FOR HELP AT THAT--

AT THAT POINT IN THEIR LIFE.

'CAUSE UNLESS YOU EXPERIENCE SOMETHING LIKE THAT,

IT'S HARD TO DESCRIBE HOW LOW YOU ARE,

HOW LOST YOU ARE,

HOW DESPERATE YOU ARE.

Man on phone: You know I'm drinking too much.

And, you know my life's a mess.

- I'm just a little scared of this. - YEAH, YEAH.

YOU KNOW ABOUT WHAT THE DEAL IS

HERE WITH THE ASSISTANCE PROGRAM?

YOU KNOW IT'S A DETOX, IF IT'S NECESSARY.

THEY'LL DO AN EVALUATION.

AND ALSO IT'S A 30-DAY INPATIENT REHAB.

Yeah, I'm probably gonna need that.

YEAH, YOU KNOW, TRUTHFULLY IT'S THE BEST WAY.

- IT'S REALLY WHAT WORKS. - How quickly can I get in?

WELL, IT'S 10:00 NOW.

IT'S POSSIBLE TO GO IN TODAY.

WE CAN GET 'EM PICKED UP RIGHT AT THEIR HOUSE. AND THEY'LL TAKE 'EM UPSTATE,

DO A QUICK EVALUATION AND STICK THEM RIGHT INTO DETOX.

AND WHEN THAT DETOX IS DONE, THEY'LL PICK THEM UP

AND BRING THEM BACK DOWN TO THE REHAB.

IF I AS A STEAMFITTER GO TO ANOTHER STEAMFITTER

AND SAY TO HIM, "BROTHER, I'VE BEEN WHERE YOU ARE.

I KNOW WHAT YOU'RE GOING THROUGH. YOU'VE GOT A PROBLEM,"

THAT'S A HELL OF A LOT DIFFERENT

THAN SOME MANAGEMENT PERSON OR SOME SOCIAL WORKER COMING IN.

SO THE STEAMFITTERS USE THEIR BROTHERHOOD

AND THEIR SISTERHOOD AS A WAY OF INTERVENING.

Don: THIS UNION IS AN ABSOLUTELY INCREDIBLE UNION,

WHAT THEY DO FOR THEIR MEMBERS.

WE WANNA GET THE TREATMENT THAT THE DOCTORS RECOMMEND

WITHOUT HAVING SOMEONE INTERFERING AND TRYING TO TELL YOU

YOU DON'T NEED THAT OR YOU DON'T NEED THAT MUCH.

THE UNION DECIDED TO GO SELF-INSURED

BECAUSE THE PREMIUMS KEPT INCREASING.

WE HAVE BASICALLY DRIVEN THE INSURANCE COMPANY

AND MANAGED CARE OUT OF THE PICTURE.

WE DON'T ALLOW THEM TO CALL THE FACILITY.

THEY CAN'T CALL THE HOSPITAL TO FIND OUT HOW THE GUY'S DOING.

THAT'S OUR JOB. WE DO THAT.

I'M NOT GONNA ALLOW MY MEMBERS

TO BE KILLED BY AN OUTPATIENT DETOX.

I'M JUST NOT GONNA ALLOW THAT.

YOUNG GUY, 33 YEARS OLD,

HE COULDN'T DO IT AND HE DIED.

HE KILLED HIMSELF. HE TOOK HIS LIFE.

BEAUTIFUL KID.

I GOT CLOSE WITH HIM BECAUSE HE REMINDED ME OF MY KID.

AND HE TRUSTED ME AND I'VE SEEN HIM LAUGH--

NOT MUCH, BUT--

AND HIS OWN OLD MAN, I KNOW HIM.

HE COULDN'T-- HIS OLD MAN COULDN'T LOVE HIM.

COULDN'T LOVE HIM. AND THAT'S ALL HE NEEDED.

BUT WE COULDN'T GIVE HIM WHAT HE NEEDED

AND THAT'S THE STUFF THAT HURTS.

THAT'S WHAT MAKES YOU FIGHT HARDER.

HE DIED IN HIS FATHER'S YARD.

ALONE. FUCK.

IT'S TERRIBLE.

YOU DON'T HAVE TO GET THERE.

YOU DON'T HAVE TO GET THERE. YOU KNOW THAT.

AND THAT'S WHAT WE TRY TO TELL 'EM. YOU DON'T HAVE TO GO THERE, MAN.

DON'T FOLLOW THAT. DON'T FOLLOW THAT.

MY NAME'S WAYNE. I'M AN ALCOHOLIC AND A DRUG ADDICT.

HI, I'M GENE. I'M AN ALCOHOLIC.

HOW YOU DOING? MY NAME IS MIKE. I'M AN ALCOHOLIC AND AN ADDICT.

Don: THE THURSDAY GROUP IS THE AFTERCARE GROUP

THAT WE PUT TOGETHER BACK IN 1990.

I'VE BEEN IN REHAB SIX TIMES AND I'VE NEVER LET IT WORK.

AFTERCARE IS JUST THAT--

IT'S A CONTINUING CARE THAT YOU REALLY NEED TO BE INVOLVED IN

IF YOU'RE GONNA WANT TO SURVIVE THIS.

IF YOU JUST LEAVE 30 DAYS TREATMENT AND YOU DON'T GO TO MEETINGS

AND YOU DON'T GET INVOLVED WITH A SPONSOR AND A GROUP AND A COMMITMENT,

YOU'RE GOING BACK. IT AIN'T GONNA BE NO TIME AT ALL THAT YOU'RE BACK.

YOU CAN'T RESIST THE TEMPTATION.

WHEN I HEARD THE WORD AA, I WOULD RUN AWAY FROM 'EM.

Don: I TELL 'EM YOU GOTTA COME A MINIMUM OF SIX WEEKS.

'CAUSE IF WE CAN GET 'EM SIX WEEKS, WE GOT 'EM. WE OWN 'EM.

I GOT A LITTLE OVER 11 MONTHS NOW WHICH IS LIKE--

( applause )

I NEVER-- I WOULD HAVE BEEN WITH THE PEOPLE I USED TO HANG OUT WITH,

LEAST LIKELY EVER TO WANNA GET SOBER.

THEY ARE NOT BUILT TO SIT AROUND IN GROUPS

AND WHINE ABOUT THEIR LIVES,

AND TALK ABOUT THEIR PAIN

AND ASK OTHER PEOPLE TO HELP THEM

OR EVEN UNDERSTAND THEM.

THEY'RE TOUGH GUYS. THEY'RE VERY TOUGH GUYS.

I FEEL GOOD. I'M TAKING ALL THE SUGGESTIONS THIS TIME.

I'M DOING IT THE WAY THAT THEY SUGGESTED TO ME

RATHER THAN DOING IT MY WAY.

Don: IT'S A TEAM EFFORT. SO WE WATCH PEOPLE.

YOU SEE SOMEONE THAT LOOKS A LITTLE BIT--

HE COMES IN AND YOU CAN JUST SEE THERE'S SOMETHING ELSE.

HE'S ISOLATING, HE'S DRIFTING AWAY OR HE'S OVER TALKATIVE.

WE SAY, "PIN HIM DOWN TONIGHT."

AND THEY DO ONE-ON-ONE.

JUST TO GIVE THE GROUP A LITTLE BIT OF A BACKGROUND--

THIS IS MY FIFTH TIME TO THE VILLA.

AND I FELT DIFFERENT THIS TIME.

YOU KNOW, I FELT LIKE A BIG WEIGHT COME OFF MY SHOULDERS.

THE FIRST YEAR IN RECOVERY IS SO FREAKING IMPORTANT.

IT'S SO IMPORTANT. AND WE KEEP THEM FOR A YEAR.

MORE, YOU KNOW, IF WE SEE THAT

THEY'RE STILL A LITTLE ANTSY OR A LITTLE--

WE'LL KEEP 'EM LONGER. WE'LL KEEP 'EM FOR 10 YEARS IF THEY HAVE TO.

YOU KNOW, WAKING UP EVERY DAY AND HAVING TO GET

A COUPLE HUNDRED DOLLARS JUST TO FEEL NORMAL,

IT'S NOT A GOOD PLACE TO BE.

AND I DON'T WANT TO BE THERE EVER AGAIN.

Don: WE'RE NOT HERE TO STOP PEOPLE FROM DRINKING.

THAT'S NOT OUR PURPOSE.

WE'RE HERE TO HELP PEOPLE THAT WANT TO STOP.

THAT'S OUR PURPOSE. IF YOU WANT TO KEEP DRINKING,

THEN THAT'S WHAT YOU DO.

IF YOU WANNA STOP, COME SEE US. WE CAN HELP.

GOOD JOB. NOBODY GOT HURT.

EVERYTHING'S WHERE IT'S SUPPOSED TO BE.

THIS PROGRAM WITH DON HELPS YOU THINK AGAIN.

GETS YOU CLARITY. IT JUST, IT BRINGS YOU BACK TO LIFE.

IT HELPS YOU LIVE LIFE AGAIN.

TOUGH GUYS AIN'T ON THE STREET REALLY ANYMORE.

YOU WANT TO BE A MAN? STEP UP TO THE PLATE.

DO WHAT YOU'RE SUPPOSED TO DO.

- GOOD NIGHT. - SUPPORT YOUR FAMILY. TAKE CARE OF YOURSELF.

PAY YOUR RENT, PAY YOUR BILLS. YOU KNOW?

AND THAT'S WHAT I'M DOING.

THAT'S WHAT WE'RE ALL DOING.

ADDICTS ARE DISCRIMINATED AGAINST IN WAYS

THAT PEOPLE SUFFERING FROM NO OTHER DISEASE ARE AFFECTED.

SO THERE'S HUGE DISCRIMINATION AGAINST ADDICTS,

WHICH MAKES IT MUCH MUCH HARDER FOR THEM TO RECOVER.

ONE OF THE THINGS THAT IS VERY VERY TRAGIC

IS THAT MANY OF THE INSURANCES

DON'T PAY FOR THE TREATMENT OF DRUG ADDICTION.

THEY DON'T COVER TREATMENT AT ALL OR THEY COVER IT

WITH SIGNIFICANTLY HIGHER DEDUCTIBLES AND COPAYS,

WHICH IS A VERY EFFECTIVE BARRIER BECAUSE PEOPLE DON'T

HAVE THE MONEY TO PAY OUT OF THEIR POCKETS.

MANAGED CARE HAS REDUCED THE AMOUNT,

DURATION, QUALITY AND INTENSITY

OF ADDICTION TREATMENT FAR MORE

THAN IT HAS REDUCED DURATION OR ANY OF THOSE PARAMETERS

IN ANY OTHER AREA OF CARE.

Beverly Mackereth: ADDICTION TREATMENT CANNOT WAIT.

WE NEED TO HELP INDIVIDUALS AND SAVE LIVES NOW.

( applause )

IT IS BECAUSE WE NEED TO ACT NOW

TO SAVE THE LIVES OF THOSE SUFFERING FROM ADDICTION

THAT WE ARE HAVING ANOTHER HEARING TODAY.

THIS HEARING WILL FOCUS ON THE IMPACT

OF DENIED TREATMENT ON CRIME IN OUR STATE,

ON EMPLOYERS, ON MEDICAL PRACTICE,

AND MOST IMPORTANTLY, ON OUR FAMILIES.

THIS INDUSTRY HAS TURNED THEIR BACK

ON THE STATUTE OF PENNSYLVANIA

THAT IS THE LAW.

AND I DON'T WANT TO LINE THE POCKETS

OF THE INSURANCE PEOPLE AND PROVIDERS WHEN YOU HAVE PEOPLE

LIKE THESE PEOPLE BEHIND YOU THAT HAVE TO STAND THERE

AND HOLD THEIR SONS AND DAUGHTERS

BEFORE THE PEOPLE OF PENNSYLVANIA.

IT'S NOT FAIR.

IT'S NOT RIGHT.

- AND IT'S AGAINST THE LAW. - ( applause )

THE MANAGED CARE SYSTEM HAS TAUGHT DESPAIR TO FAMILIES

THAT MY LOVED ONE WILL NEVER GET WELL.

IT HAS ALSO GOT FAMILIES BEATEN UP ON TREATMENT PROGRAMS SAYING,

"YOU DIDN'T WORK,"

WHEN IN FACT THE TREATMENT PROGRAM WAS NOT PERMITTED

TO PROVIDE THE CARE THAT IT KNOWS IT NEEDS TO PROVIDE.

THERE'S NOTHING THAT SAYS SOME BUREAUCRAT

IN AN INSURANCE COMPANY, A HEALTH INSURANCE COMPANY,

HAS THE RIGHT TO OVERRULE OVER THE TELEPHONE

WITHOUT LOOKING AT THE ADDICTED PERSON;

HAS THE RIGHT TO OVERRULE A DOCTOR,

A LICENSED PSYCHOLOGIST WHO'S JUST SPENT TWO HOURS

DOING A PROFESSIONAL, CAREFUL DETERMINATION

OF WHAT THE TREATMENT NEEDS ARE OF THE PATIENT.

BUT THE SUFFERING THAT'S CAUSED, GOOD GOD.

( applause )

MY NAME'S ROBERTA LOJAK.

THIS IS MY DAUGHTER ASHLEY.

ASHLEY WAS MY FIRST CHILD.

SHE WAS A BLESSING FROM THE DAY SHE WAS BORN.

I KNEW MY DAUGHTER HAD A PROBLEM

PROBABLY IN MARCH OF 2001.

WE WENT TO A REHAB CENTER ON OUR OWN.

THEY WOULD NOT ADMIT HER TO AN INPATIENT TREATMENT,

BUT THEY DID ADMIT HER FOR AN OUTPATIENT.

I'D LIKE TO READ A LETTER THAT ASHLEY WROTE TO ME.

"I'M STILL YOUNG AND I STILL HAVE SOMETHING TO LIVE FOR.

I DON'T WANT TO END UP LIKE MY OLD FRIENDS

AND BE A DOPE HEAD MY WHOLE LIFE.

'CAUSE I KNOW I'M HERE TO DO SOMETHING GOOD.

AND I HAVEN'T SEEN ANYTHING IN THIS WORLD SO FAR AND I WANT TO.

AND I DECIDED THAT ALL THAT

WAS MORE THAN ENOUGH REASONS TO QUIT.

I AM ENOUGH REASONS TO QUIT.

MOM, I LOVE YOU."

BUT I CALLED ANOTHER REHAB FACILITY.

IT WAS A COUPLE HOURS AWAY FROM MY HOME.

WHEN WE WERE THERE

THEY TOLD ME THEY WERE GONNA ADMIT HER.

THEY SAID SHE WOULD PROBABLY BE THERE

AT LEAST 28 DAYS TO START.

- NOW WAS THAT A SURPRISE? - OH, YEAH.

WHY?

'CAUSE THEY TOLD ME SHE'D BE THERE AT LEAST 28 DAYS.

SHE WASN'T READY TO COME HOME. I KNOW SHE WASN'T.

I KNEW SHE WASN'T. SO WENT BACK HOME

AND ASHLEY MADE US DINNER AND SHE WENT TO BED.

THE NEXT MORNING I LOOKED IN AT ABOUT 8:00

AND I SAW HER LAYING THERE SLEEPING.

TV WAS ON. SHE STILL WAS HOLDING A REMOTE.

AND I LOOKED AT-- HER FINGERNAILS WERE BLUE.

SO I STARTED SCREAMING.

I RAN OUT OF THE ROOM.

I CALLED 911, WENT BACK IN THERE.

I PICKED HER UP AND PUT HER ON THE FLOOR

AND TRIED TO DO CPR TO MY OWN DAUGHTER.

BUT SHE WAS ALREADY DEAD.

I'VE BEEN A PROSECUTOR FOR 25 YEARS. I DEAL WITH CRIMINAL CONDUCT.

I'M GONNA READ YOU A STATUTE THAT I HOPE THE LAWYERS

FOR THESE PEOPLE WILL TAKE A LOOK AT.

TITLE 18, SECTION 2504: INVOLUNTARY MANSLAUGHTER.

GENERAL RULE: A PERSON IS GUILTY

OF INVOLUNTARY MANSLAUGHTER WHEN AS A DIRECT RESULT

OF DOING OF AN UNLAWFUL ACT IN A RECKLESS

OR GROSSLY NEGLIGENT MANNER HE CAUSES THE DEATH OF ANOTHER PERSON.

IS IT INVOLUNTARY MANSLAUGHTER? THERE DISCUSSIONS ABOUT THAT.

NO ONE'S EVER BEEN PROSECUTED FOR THAT.

BUT THERE'S A FIRST TIME FOR EVERYTHING.

THOSE OF YOU IN THE MANAGED CARE INDUSTRY

THAT ARE LOOKING AT THIS ISSUE, ASK YOURSELF:

DO YOU WANT TO TAKE THIS CHANCE?

I MEAN YOU'RE DANCING RIGHT UP TO THIS--

TO THE EDGE OF THIS STATUTE.

THE THING THAT I WOULD TELL A FAMILY TO DO

IS-- NO MATTER WHAT THEY'RE BEING TOLD, IS KEEP FIGHTING,

IS TO SAY, "NO, THIS IS WHAT IT SAYS IN MY BENEFIT.

AND I NEED THIS BENEFIT."

IF THE FAMILIES DON'T MAKE AN ISSUE OF THIS

AND DUST IT UP, IT'S GONNA CONTINUE.

GOOD EVENING. MY NAME IS JOAN WARD.

I LIVE IN CRANBERRY TOWNSHIP.

THIS IS OUR SON ROB.

WHEN ROB WAS A SENIOR IN HIGH SCHOOL

WE DISCOVERED THAT HE WAS ABUSING DRUGS.

YOU'VE HEARD A NUMBER OF VERY TRAGIC STORIES HERE TODAY,

OF YOUNG LIVES LOST.

PLEASE DON'T BE COMFORTED INTO BELIEVING

THAT THESE ARE ABERRATIONS.

WE ARE NOT THE EXCEPTION. WE ARE THE RULE.

THE WORLD LOOKS AT OUR CHILDREN

AND THEY SEE DRUGGIES,

JUNKIES, FELONS.

WE LOOK AT OUR CHILDREN

AND WE SEE COWBOY BOOTS AND BALLET SLIPPERS.

WE SEE CHRISTMAS MORNINGS AND BIRTHDAY PARTIES.

WE HOLD FOREVER IN OUR HEART THAT FIRST INSTANT

THAT WE FIRST LOOKED INTO THEIR INFANT EYES

AND WE KNEW IN A HEARTBEAT

THAT WE WOULD GIVE OUR VERY LIVES FOR THEM.

UNFORTUNATELY THAT'S THE LAST ABSOLUTE OF PARENTING.

IT'S ALL GUESSWORK AFTER THAT.

WHEN YOU GET RIGHT DOWN TO IT,

OUR OPTIONS REALLY ARE QUITE LIMITED.

WE CAN BUILD A BETTER SYSTEM

OR WE CAN CONTINUE TO BURY OUR CHILDREN.

I GREATLY APPRECIATE YOUR EFFORTS IN THIS AREA.

THANK YOU FOR YOUR TIME TODAY.

( applause )

All: KEEP COMING BACK. IT WORKS IF YOU WORK IT.

Woman: OKAY, FELLAS, THANK YOU.