ADDICTIONS CAN SPAN THE GENERATIONS: ONE FAMILY STRUGGLES WITH ALCOHOL, HEROIN

I am, at the least, a fourth-generation alcoholic. So is my wife,
Deirdre. Our 22-year-old-daughter, Carrick, is a recovering heroin addict.

Most members of our family have been successful professionally --
Deirdre's father was an attorney and judge; my side brims with
journalists who kept the proverbial pint flask in their desk drawers.

My great-grandfather was run over by a trolley car while covering a
story in 1904 -- still reporting, probably inebriated, but certainly
a broken man who was estranged from his family. Many of his progeny
shared his taste not only for booze but also for the illusory
camaraderie that goes with it in bars and binges.

Most of us got sober, but we've taken different routes to get there.
I've learned along the way that there is a difference between not
using a drug and being in recovery, which encompasses the way you
lead your life, interact with other people and face your mortality.

To greater and lesser degrees, we functioned despite our illnesses,
as many of you, or your loved ones, do today. More than 22 million of
us older than 12 abuse or are dependent on alcohol or illegal drugs,
according to 2004 government figures, and that's not counting
prescription drug misuse, a rising crisis. Sixty-three percent of
Americans say that addiction -- their own or another's -- has had an
impact on their lives.

I first swore off booze as a 16-year-old who'd stop off in a saloon
on the way home from high school for a few boilermakers -- shots of
bourbon chased by a beer. That period of sobriety lasted a few weeks;
relapse is part of this disease.

I had my last drink two decades ago, when I was 32. My bottom came
when I discovered the liquor cabinet was dry one evening. With my
toddler tugging on my leg for attention, I felt physically compelled
to buy a bottle of vodka, spiritually driven to stop letting alcohol
control my life, and intellectually determined to end the cycle of
waking up with a hangover, nipping at lunch to feel "normal,"
imbibing in the evening to get blotto and arising again with a hangover.

Few of my friends thought I had a problem; most drank as much as I
did. My best buddy from those days, prone to depression and Seagram's
7, blew his brains out 10 years ago, still drinking.

I did not seek treatment or help from a 12-Step program like
Alcoholic Anonymous because I was not comfortable turning over my
life to a "higher power."

Whenever someone asks me how to get sober, however, my first
recommendation is to head to the nearest 12-Step meeting. Deirdre
did, and the fellowship she found "in the rooms" was the cornerstone
of her recovery 19 years ago -- and counting.

You're always counting, because sobriety is, as the AA slogan goes,
"one day at a time." The reality is that I picked up a lot of the
12-Step philosophy by osmosis, and its precepts have helped not only
the millions who join but countless others who are "sick and tired of
being sick and tired."

Every treatment philosophy has its zealots, from 12-Steppers to
members of therapeutic communities such as Phoenix House that break
you down in order to build you up. Any of them may work for you. Some
will tell you that their way is the only way. That's true only to the
extent that it's true for them. The bottom line is that many people
overcome their addiction and flourish, but less than 10 percent of
people who need intensive treatment at a substance abuse facility
actually receive it in a given year, according to the federal
Substance Abuse & Mental Health Services Administration.

At the Bottom

Deirdre and I had our own ideas about what would work for our
daughter, Carrick, who first drank at 12, smoked marijuana at 13,
dabbled in other recreational drugs by 15, became a heroin addict at
17 and met her bottom while speedballing -- mixing heroin and cocaine
- -- at 19. By that time, she had been through three emergency rooms,
seven detoxes, three short-term residential programs, a four-month
wilderness therapy program, several 12-Step programs, four special
schools and had prematurely quit a long-term treatment community
twice. She had talked to dozens of psychiatrists, psychologists,
social workers, medical doctors and addiction counselors. The deeper
her addiction took hold, the better she got at telling them all what
they wanted to hear.

After she turned 16, Carrick was often away from home. When she'd
visit our suburban New York state home, she recently recalled, "I
would come home with a warm greeting, pillage the house and leave
with a warm farewell. It was not just stealing money, but time, sleep
and sanity."

We eventually told Carrick that we would no longer enable her in her
addiction -- including providing shelter and food -- while she was
using drugs, but we would do anything we humanly could to help her in
her recovery. Some people feel that barring our daughter from our
home was heartless. We knew her life was at risk every day she was on
the streets of New York City, but she proved time and again that she
would not face her recovery as long as we protected her from her
bottom. Nor was it fair to our son, Duncan, five years younger. Or ourselves.

In the end, Carrick decided, on her own, to try methadone
maintenance, a controversial treatment that critics contend
"substitutes one drug for another." It saved our daughter's life. She
is gradually reducing her dosage with the intention of quitting;
others may need to stay on methadone all of their lives. Many become
productive members of society, no longer scheming for the next fix.

"You've got to meet addicted individuals on their own terms rather
than confront them on yours," says Dr. Harris B. Stratyner, clinical
division director of Addiction/Recovery Services for the Mount Sinai
Medical Center in New York. "The goal is to get people to completely
stop using, but not to say to them, 'You're using, therefore I'm not
going to engage you in treatment.' That's not the way you motivate someone."

Taking Responsibility

Stratyner is a leading proponent of a "carefrontation" model of
treatment, which holds that addicted individuals should not be held
responsible for having their disease any more than diabetics are, but
must take responsibility for their recoveries. So must the family and
friends who get caught in the vortex of lies and manipulations that
swirl around an addicted person.

It's human nature to want to believe a child or spouse who tells you
"this is the last time," no matter how often you've been burned
already. At times, Deirdre and I enabled Carrick to continue using
without facing repercussions -- for example, by making excuses for
her behavior to friends and teachers.

One day, I found a hypodermic needle and a card that allowed Carrick
to exchange it for a clean one. My instinct was to break the needle
and rip up the card. But what would that have accomplished? Dirty
needles spread hepatitis C, which Carrick has contracted, and HIV.
Shuddering, I chose the lesser of two evils, a misunderstood concept
known as "harm reduction," and put the paraphernalia back.

Some say that it's fruitless to force a person into treatment,
particularly a teenager who is still enjoying the dopamine-induced
good feelings that drugs undeniably provide. More than 80 percent of
teens relapse within a year of treatment, according to one study.
Carrick will tell you, however, that she took away one very powerful
idea from the programs she attended and prematurely left: When she
was ready, she could get better. And once she tried, we again did
everything we could to help.

"Without trying to sound melodramatic, giving me another chance
probably saved my life," Carrick says. "The line between enabling and
supporting sometimes requires you to take a risk and hold onto realistic hope."

Call it paternalistic -- in my case it literally was -- but addicts
frequently don't know what's best for them and interventions may be
necessary. When Carrick was living on the streets, we prayed that she
would be arrested and mandated to treatment by a judge. When she was
finally nabbed for theft, however, she was sentenced to 30 days in
jail. She celebrated her release by getting high.

Drug courts around the nation are beginning to substitute treatment
for incarceration for nonviolent offenders. About 80 percent of the
more than 2 million teens in the juvenile justice system have drug
and alcohol problems, according to figures compiled by the Robert
Wood Johnson Foundation, and a similar percentage have diagnosable
mental illnesses.

Look at Underlying Issues

Indeed, addicted individuals of all ages who suffer from illnesses
such as bipolar disorder may use mind-altering drugs to
self-medicate. We once begged the admitting doctor at a psychiatric
hospital to treat Carrick's underlying depression. We were devastated
when he not only gave us the party line that Carrick would first have
to abstain from drugs, but also expressed his doubt, based on her
record, that she'd be able to do so.

She has, though, and is attending college with the intention of
becoming a fifth-generation journalist. An antidepressant stabilizes
her mentally; she says she no longer "gets in a crummy mood for no
apparent reason."

In 1998, more than 10 years after she got sober, my wife, Deirdre,
became so deeply depressed and so suicidal that I marked her survival
from hour to hour. She eventually signed herself into New York
Hospital-Cornell Medical Center, a psychiatric hospital in White
Plains, N.Y. Her life was saved by electro-convulsive therapy,
antidepressants and talk therapy. She has gone on to become an
accomplished substance abuse advocate and professional, working as an
intake coordinator for Madison East, a unit within New York's Mt.
Sinai Medical Center. She's a happy and productive wife, mother and citizen.

Fortunately, we've been able to afford treatment for her and Carrick
over the years, but because New York state lacks a parity law for
mental health and substance abuse, insurance coverage has been
erratic and spotty. We've broken into retirement IRAs and refinanced
our mortgage to pay medical bills.

What's most unfortunate to many of us on the front line -- addicts
and family members -- is that the war on drugs has become a polarized
battle between two camps: hardliners whose "zero tolerance" approach
relies on interdiction and prisons for illegal drugs and
laissez-faire libertarians and reformers who believe that supply,
demand and individual choice should allow the market to reach its
natural level.

A Lucrative Market

The market for mind-altering drugs is a lucrative one, indeed. They
are responsible for the livelihoods, legal and illegal, of millions
of people worldwide -- from drug lords to rapid detox clinicians,
from bartenders to prison guards, from bureaucrats to copywriters. A
recent study by researchers at the University of Connecticut
confirmed that the more alcohol ads teens see, the more they drink.
But the alcohol industry has the economic muscle to protect its
interests: The beer industry in the United States alone spends $1.36
billion in measured advertising and promotion dollars annually,
employs 1.78 million people, pays $54 billion in wages and benefits,
and generates $30 billion in taxes.

The money for treatment is harder to come by. The Bush
administration's $12.7 billon drug control budget request for 2007
earmarks 65 percent for interdiction and law enforcement and barely
36 percent for treatment and prevention. A National Center for
Addiction and Substance Abuse report found that of the $277 each
American paid in state taxes to deal with substance abuse and
addiction in 1998, only $10 went toward treatment and prevention.

There is an obvious common ground: people. If we were to focus our
efforts on the family members, friends and neighbors whose brain
chemistry has been altered by drugs and alcohol, and treat abuse and
dependency as the public health scourge that it is, we'll have
declared a war on addiction.

It's a campaign that can be won, one life at a time. I've seen it happen.

Editor's note: This is the first of a series examining addiction in
America, produced by Public Access Journalism.

- -- Thom Forbes is an author, blogger on addiction and recovery, new
media consultant and former reporter for the New York Daily News.

On the Net:

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The Top 10 Addiction Myths - and Myth Busters

Think you know about addiction? Then these common myths may sound familiar:

Myth 1: Drug Addiction Is Voluntary Behavior.

You start out occasionally using alcohol or other drugs, and that is
a voluntary decision. But as time passes, something happens, and you
become a compulsive drug user. Why? Because over time, continued use
of addictive drugs changes your brain -- in dramatic, toxic ways at
times, more subtly at others, but virtually always in ways that
result in compulsive and even uncontrollable drug use.

Myth 2: Drug Addiction Is a Character Flaw.

Drug addiction is a brain disease. Every type of drug -- from alcohol
to heroin -- has its own mechanism for changing how the brain
functions. But regardless of the addiction, the effects on the brain
are similar, ranging from changes in the molecules and cells that
make up the brain to mood and memory processes -- even on motor
skills such as walking and talking. The drug becomes the single most
powerful motivator in your life.

Myth 3: You Can't Force Someone into Treatment.

Treatment does not have to be voluntary. Those coerced into treatment
by the legal system can be just as successful as those who enter
treatment voluntarily. Sometimes they do better, as they are more
likely to remain in treatment longer and to complete the program. In
1999, more than half of adolescents admitted into treatment were
directed to do so by the criminal justice system.

Myth 4: Treatment for Drug Addiction Should Be a One-Shot Deal.

Like many other illnesses, drug addiction typically is a chronic
disorder. Some people can quit drug use "cold turkey," or they can
stop after receiving treatment just one time at a rehabilitation
facility. But most people who abuse drugs require longer-term
treatment and, in many instances, repeated treatments.

Myth 5: We Should Strive to Find a "Magic Bullet" to Treat All Forms
of Drug Abuse.

There is no "one size fits all" form of drug treatment, much less a
magic bullet that suddenly will cure addiction. Different people have
different drug abuse-related problems. And they respond very
differently to similar forms of treatment, even when they're abusing
the same drug. As a result, drug addicts need an array of treatments
and services tailored to address their unique needs. Finding an
approach that is personally effective can mean trying out several
different doctors or treatment centers before a "match" is found
between patient and program.

Myth 6: People Don't Need Treatment. They Can Stop Using Drugs If
They Really Want To.

It is extremely hard for people addicted to drugs to achieve and
maintain long-term abstinence. Research shows that when long-term
drug use actually changes a person's brain function, it causes them
to crave the drug even more, making it increasingly difficult to quit
without effective treatment. Intervening and stopping substance abuse
early is important, as children become addicted to drugs much faster
than adults and risk greater physical, mental and psychological harm.

Myth 7: Treatment Just Doesn't Work.

Studies show drug treatment reduces drug use by 40 percent to 60
percent and can significantly decrease criminal activity during and
after treatment. There is also evidence that drug addiction treatment
reduces the risk of infectious disease, hepatitis C and HIV infection
- -- intravenous-drug users who enter and stay in treatment are up to
six times less likely to become infected with HIV -- and improves the
prospects for getting and keeping a job up to 40 percent.

Myth 8: No One Voluntarily Seeks Treatment Until They Hit Rock Bottom.

There are many things that can motivate a person to enter and
complete treatment before that happens. Pressure from family members
and employers, as well as personal recognition that they have a
problem, can be powerful motivators. For teens, parents and school
administrators are often driving forces in getting them into
treatment before situations become dire.

Myth 9: People Can Successfully Finish Drug Abuse Treatment in a
Couple of Weeks If They're Truly Motivated.

For treatment to have an effect, research indicates a minimum of 90
days of treatment for outpatient drug-free programs, and 21 days for
short-term inpatient programs. Follow-up supervision and support are
essential. In all recovery programs, the best predictor of success is
the length of treatment. Patients who are treated for at least a year
are more than twice as likely to remain drug-free, and a recent study
showed adolescents who met or exceeded the minimum treatment time
were over one and a half times more likely to stay away from drugs and alcohol.

Myth 10: People Who Continue to Abuse Drugs After Treatment Are Hopeless.

Completing a treatment program is merely the first step in the
struggle for recovery that can last a lifetime. Drug addiction is a
chronic disorder; occasional relapses do not mean failure.
Psychological stress from work or family problems, social cues (like
meeting someone from the drug-using past) or the environment
(encountering streets, objects or even smells associated with drug
use) can easily trigger a relapse. Addicts are most vulnerable to
drug use during the few months immediately following their release
from treatment. Recovery is a long process and frequently requires
multiple treatment attempts before complete and consistent sobriety
can be achieved.

- -- Sources: National Institute on Drug Abuse, National Institute of
Health; Dr. Alan I. Leshner, former director of the National
Institute on Drug Abuse; "The Principles of Drug Addiction Treatment:
A Research-Based Guide" (October 1999); The Partnership for a Drug-Free America