четверг, 19 июня 2008 г.

Are Vaccines the Answer to Addiction?

A vaccine that would teach the immune system to attack and destroy cocaine before the drug reached the brain is poised to enter its first large-scale clinical trial in humans. The shot is still years away from FDA approval, but the underlying concept--inoculating those at risk of addiction--is attracting increased interest.

Besides cocaine, researchers are developing vaccines against such highly addictive substances as nicotine, heroin and methamphetamine. NicVax, a nicotine vaccine by Nabi Biopharmaceuticals, is the furthest along in development. In November, one year into a phase-two clinical trial, the company reported that twice as many people taking the vaccine had quit smoking as those taking a placebo.

Addiction vaccines work the same way as the traditional vaccines used to treat infectious diseases such as measles and meningitis. Basically, they marshal the body's defense system. But instead of targeting bacteria and viruses, these new vaccines zero in on addictive chemicals that people snort, shoot or swallow.

If the new treatments make it to market, experts hope they will overcome one big hurdle that existing anti-addiction medications have failed to clear--widespread resistance to the idea of treating addicts with drugs. "Vaccines are nowhere near as stigmatized as giving drug therapy to the addicted," says Baylor College of Medicine psychiatrist Thomas Kosten, who is leading research on the cocaine vaccine. " 'Vaccine' sounds more wholesome than 'drug'."

Despite a growing body of evidence that addiction, like so many other diseases, is rooted in a person's genes, it is often seen as a personal weakness, not a medical condition to be treated or cured. That impression, some experts say, has stymied research into potential treatments for the estimated 20 million Americans who struggle with alcohol and drug addiction. "It's easy to interest the scientists, but not so easy to interest the marketing people," says Kosten.

Each of the proposed vaccines employs a similar biochemical strategy. Because the addictive-drug molecules are small enough to evade the body's immune system, they can slip undetected from the lungs and bloodstream into the central nervous system, where they disrupt brain chemistry and turn on addiction pathways that can be difficult to shut off. But when attached to a larger molecule, the addictive substances can't hide. To make the cocaine vaccine, Kosten attached the cocaine molecule to a protein made by cholera-causing bacteria. When injected, the vaccine triggers the immune system to develop antibodies. The next time the drug is ingested, the thinking goes, these antibodies will latch onto it and prevent it from crossing the blood-brain barrier.

Current anti-addiction medications do not prevent addictive drugs from entering the brain. Instead, these treatments block the drugs' neural targets, so that when a drug reaches the brain it has no place to go. Such medications --known as small-molecule therapies--have met with only limited success so far. For example, methadone, a medication used to treat heroin addicts, has itself been associated with addiction and overdose, because in addition to blocking heroin's entrance to brain cells, methadone also mimics the narcotic, producing its own, milder high. Drugs that treat alcohol and nicotine addiction have been effective only in small subsets of patients and have produced severe side effects in some cases. "With these types of drugs, the brain's receptors are still being manipulated, albeit by a replacement drug," explains Nora Volkow, director of the National Institute on Drug Abuse, which funds research on the addiction vaccines. In theory, she says, the vaccines would circumvent some of these problems by neutralizing the addictive substance before it reached the nervous system.

One day, anti-addiction vaccines could be used to prevent substance abuse as well as treat it. "It would be great if we could give kids a vaccine that would make them impervious to the effects of hard drugs," says Volkow. "In reality, we are still many years away from that."

For the cocaine vaccine to succeed, researchers will have to solve several technical problems. In early studies, for example, not all of the subjects developed antibodies against the cocaine-cholera molecule, and some developed much stronger responses than others. "This is not like an antibiotic, which is directed against the invading microbe and has roughly the same effect on everyone," says Volkow. "Here, we are stimulating the immune system, which can react differently depending on the individual."

Another concern is that a serious drug user could overwhelm the immune response by simply ingesting more cocaine than the immune system could handle. He could also switch to another drug, which the vaccine would be powerless to protect against. The determination and desperation of drug addicts notwithstanding, however, vaccines have an extraordinary track record. They could prove to be the solution to one of our most enduring public-health problems.

'I Can't Believe How Far I've Come'

She's now 26. She's a wife, and seven weeks ago she became a first-time mom. Jodie Sweetin, who played spunky middle child Stephanie on Full House from age 5 to 13, is clearly all grown up-and all tuckered out. Apologizing to her guest as she stifles a yawn, Sweetin smiles at her new baby girl, Zoie, who's happily snoozing on Dad's shoulder. "Sometimes I just look at her and go, 'You're so perfect,'" she says. "You look at your baby and think, 'Wow, I did that.' It's really amazing."

Lately life has been just that for Sweetin and her husband of 10 months, Cody Herpin. "Zoie first smiled a couple weeks ago," says Herpin, 31, relaxing with his wife in their Corona, Calif., home. "And her little facial expressions are the cutest thing." As for Sweetin, "I'm still like, 'Oh, wow, I'm a mom,'" she says. "It's the most overwhelming, exciting thing I've ever done."

It's also a far cry from what the actress has been through over the past few years: An addiction to crystal meth took over her life and wrecked her first marriage before she entered rehab in 2005. Sweetin was about 22, a college student married to Los Angeles police officer Shaun Holguin and taking a break from acting when she first tried the drug. It was popular among some friends she'd met in high school. "It wasn't so much the allure of it, but the people I was hanging out with," recalls the Southern California native. "They didn't look like the people in commercials with no teeth. They looked normal and had what I thought were normal lives. It didn't seem scary."

Soon it would become terrifying. Six months after first trying meth, she said it became a crippling daily habit. "Everything revolved around my addiction. On a typical day I'd wake up and feel terrible because I hadn't done any. You're either trying to get it, doing it or worrying about when you're going to get it next. You don't even realize that it's taken over so quickly." Sweetin's parents, once an integral part of her life, became strangers. "They lived pretty close, but I'd go for weeks not speaking to them. I didn't want anybody around." She kept the secret from her husband too-even as he watched her dwindle from 130 lbs. to a gaunt 100. "He had no idea," she recalls. "It was the elephant in the room. Something was wrong, but it wasn't talked about."

Then in 2005 Sweetin was hospitalized after a night of partying. But her "scariest, most upsetting moment" came next: Realizing she had hit bottom, she admitted her addiction to her family. "Going to my parents' house and telling them what I had been doing," she says, taking a deep breath, "was hard. I looked them in the eye and said this is the big secret I've been keeping from you … and I need help."

Six weeks of inpatient treatment followed, and after a few weeks of detox so did a breakthrough: "I started realizing I can laugh again," Sweetin recalls. "I can enjoy myself without this drug. I think I'm going to make it…. Each day that you put together, you get yourself distance. I'm very lucky to have made it through to the other side." Now, she says, "there are days that I don't think about it at all. It's always there, but it's not looming over my head like it was."

Sweetin and her first husband decided to divorce after she left treatment, while she was spending six months in sober living with people from rehab. "I had damaged the relationship so much that we couldn't fix it," she says. When she met Herpin, a film transportation coordinator, through friends, "I felt a lot stronger," she says. The couple began dating in May 2007, and wed just two months later. "From the time we met, we've been inseparable. I'd been through so much and he didn't judge anything in my past-that was important and really special." And when their whirlwind romance was quickly followed by a pregnancy, says Sweetin, "it was a blessing."

Speaking publicly also has helped her recover. Says the new mom: "I could dodge the subject, but I thought, 'Maybe I have an opportunity here.'" And she seized it, talking about her struggle at colleges. "I don't think she realizes how many people she's helped," says Herpin. "We get e-mails that say, 'Thank you so much. You saved my life.'" Adds the actress: "These students grew up watching Full House, and many of them have been through this or have family members who did, so they're grateful."

Sweetin is too. "I was really fortunate that I didn't have any residual effects. A lot of people don't come through this in one piece," she says, adding that she still has some of her Full House earnings in savings (she also used the money to buy a home, attend college and go to rehab). The actress's family and Full House costars were, and continue to be, a support system. While she was in the hospital about to give birth to Zoie, "Bob [Saget] and I texted back and forth about 15 times," says Herpin. "He left messages: 'I hope everything's okay!' He's really sweet," adds Sweetin, who's closest to Saget and Candace Cameron Bure. (She hasn't talked to the Olsens in a while but says, "I wish them nothing but the best.")

While she nests at home with Zoie this summer, Sweetin is also prepping to get back to work-reading pilots and hoping for a bid from her favorite show. "I'm begging to be on Dancing with the Stars. I've danced my whole life." But for now Sweetin is thrilled to just watch her daughter. "Cody and I will look at her and go, 'Her head grew!' or 'She didn't make that noise yesterday!'" And Sweetin's looking forward to the simple things-like Zoie's first words ("I can't wait to hear what her little voice sounds like!"), princess dresses and tea parties-something she couldn't imagine just three years ago. "I can't believe how far I've come," says Sweetin. "It's amazing to think about how different my life is now."

Tatum O'Neal BUSTED FOR DRUGS

In her 2004 memoir A Paper Life, actress Tatum O'Neal chronicled her battle with cocaine and heroin. "I've triumphed over addiction," she wrote. Sadly, her battle may not be over. On June 1, police arrested O'Neal, 44, for allegedly purchasing two bags of cocaine from a dealer near her Manhattan home. Charged with criminal possession of a controlled substance, O'Neal faces a maximum of one year in jail. But at her arraignment the next day, the District Attorney's office recommended she attend a drug awareness program. She's expected back in court July 28. "There's no excuse for what I did," O'Neal told the New York Post after spending a night in jail. Thanking police for keeping her "sober," she explained that three weeks earlier, "I lost my Scottish Terrier, Lena. That seemed to set me off…I have the disease of alcoholism. It's lifelong."

Friends were surprised by the news. "She said she wasn't using," says Peter Bogdanovich, who directed O'Neal in 1973's Paper Moon, for which she won an Oscar at age 10. "She seemed like she was in good shape." The eldest child of actors Ryan O'Neal and Joanna Moore (who died in 1997), O'Neal has said she suffered emotional and physical abuse during her childhood. A rocky marriage and bitter divorce from tennis star John McEnroe followed. In 1995, O'Neal lost custody of their kids, Kevin, now 22, Sean, 20, and Emily, 17, due to her drug use. After numerous trips to rehab, she won joint custody. Now those close to O'Neal-who appears on the FX drama Rescue Me-are hoping the troubled star can bounce back once again. "She's had some tough breaks," says Bogdanovich. "I'm sure she can recover. She's a good girl."

SECOND LIFE

DOREEN MOTTON SAYS SHE KNOWS HOW IT FEELS TO hit rock bottom: It hurts. Feelings of inadequacy helped fuel a 20-year alcohol and drug addiction. "To hide and suppress my feelings, I'd go to the bar or indulge in substances," admits Morton, who decided in 1996 that enough was enough. "I realized the only thing holding me back was me. I decided to rebuild my life."

Today, with nearly 11 years of sobriety under her belt, Morton is a newly christened entrepreneur. Of course, the 52-year-old stresses that her transformation did not happen overnight.

Morton says she had a lifetime struggle to quiet an inner belief stemming from childhood that she "just wasn't good enough." She turned to drugs and alcohol in college to cope, but recreational use developed into a lengthy battle, with her life slowly spiraling out of control. "I always had a job, traveled the world, and I was good at communicating with people," says Morton on hiding her indiscretions. "As a user you learn how to become very manipulative." But once close family members discovered her addiction, Morton says she felt "it was almost a relief." "Those were extremely dark times in my life. It's only by the grace of God that I'm still here." she adds.

In April of 1997, Morton checked herself into a rehabilitation center, and after a year of intense therapy, she emerged with a new perspective.

By 2001, the 30-year sales and marketing veteran, had landed what appeared to be a dream job as a vice president of marketing at a major financial services firm in New York But the demands of the position left the single mom feeling besieged and unhappy. "I felt robotic and mechanical," she says. "I didn't really feel that I had a purpose. And after all that I had been through in my life, there had to be a deeper meaning for me." Morton left her lucrative financial career in early 2007 and with $10,000 in personal savings launched Neero & Ana Inc.

(www.neero-ana.com)--named in part after her 16-year-old son, Dana. The New York-based company [started in 2004 as a part-time venture) specializes in organic satin products for men and women, including a line of signature satin pillowcases--a favorite of actresses Kerry Washington and Kimberly Elise. "Taking the risk to own a business was nothing compared to the risk that I took with my addiction," Morton admits. Last year, the company saw gross revenues of nearly $400,000, and expects partnerships with hotel chains, dermatologists, cosmetic surgeons, and charitable organizations to help revenues swell to more than $1 million this year. "This solidifies what I think of myself," Morton says, "that I am valuable and that I can be everything that I want to be."

Children's prescription drug deaths are focus of ad campaign

Tammy Pasanella sobbed as she stood in front of a wall of television cameras and reporters on Friday and recalled how her son, Chandler Valley Christian High School football player Danny Pasanella, slipped into a prescription drug addiction and, ultimately, death.

It was a dramatic turnaround from the days just after her son died in September when, she said, she shunned the media because they were obsessively focusing on Danny's overdose death.

Now Tammy Pasanella is embracing the attention.

She and four other mothers helped launch an ad campaign Friday that will use TV, radio, billboard and print ads to warn other parents about the dangers of prescription drugs.

"The pain that we go through is unbearable and indescribable," Pasanella said at an afternoon news conference at the Maricopa County Attorney's Office in downtown Phoenix. Her son overdosed on a combination of OxyContin, Vicodin, and heroin.

More frequently than ever before, teens are turning to their parents' medicine cabinets to get high on painkillers, the mothers said.

The pattern, as the women showed, can lead to tragedy.

Debbie DiVello said her son, Shaun, became addicted to Methadone after a dirt biking accident.

"Little by little, he was able to 'doctor shop' and get all these prescriptions," she said.

Then on Feb. 3, it killed him. "I lost my son," she said.

One after another, DiVello, Pasanella and the other moms: Cindy Sierzchula, Patte Bielman and Karen Black told similar stories.

"For me, I really felt that something good needed to come out of the loss of my son," said Black, whose son Jacob overdosed on OxyContin a year ago. "If this is the good, then that's the way I have to look at it.

The five were brought together by the Drug Free AZ campaign of the Maricopa County Attorney's Office, which is organizing the local media blitz.

"Prescription drug overdoses by their children have caused great tragedy in their families," said County Attorney Andrew Thomas at the event. "I want to applaud the courage and strength of these mothers."

The campaign will cost nearly $700,000, which includes $60,000 to produce three television ads featuring the mothers which will begin airing on local television soon.

Area legislator proposes medical marijuana study: Similar bills have languished in the legislature

Rep. Earl Jones, D-Guilford, has never been one to shy away from controversy, and he's showing that trait again with a bill he introduced to study the medicinal use of marijuana in North Carolina.

Jones, who represents parts of High Point in the N.C. General Assembly, introduced House Bill 2405 this week. The bill would allow the Legislative Research Commission to study the potential benefits of letting marijuana be used for medicinal purposes.

Jones said he envisions the study debunking myths and presenting medical evidence about the benefits of medicinal marijuana for patients suffering conditions such as cancer and glaucoma.

"What bothers me is we're missing an opportunity as a state and nation on advancements in science and the opportunity to relieve pain and suffering," said Jones, who's also been an advocate for stem-cell research in the state.

A leader of the N.C. Family Policy Council said his group objects to Jones' proposal and that it will facewide opposition. "Our concern is that the intent of it is to promote the potential legalization of marijuana in North Carolina. Even if that's done for medical purposes, it can create some significant problems," said John Rustin, vice president with the council in Raleigh.

Easier access to marijuana could promote drug addiction, Rustin said.

Jones, a three-term legislator and former Greensboro City Council member, said he thinks his proposal for a study has a reasonable chance of passing, if the study is perceived as gathering curate information. Rustin said similar bills introduced in the past on marijuana legalization have languished in the General Assembly, and he would be surprised if House Bill 2405 didn't face a similar fate.

Jones gained notice earlier this year when he was amonga handful of legislators to vote against expelling disgraced Democratic legislator Thomas Wright of Wilmington. Wright was expelled from the House just before being convicted of political corruption in office. Jones voted against the expulsion because he said it shouldn't have happenedbefore Wright's court case played out.

Jones won't face any immediate political fallout from his medicinal marijuana bill. He's unopposed for another two-year term in the fall generalelection.

Ex-drug addict, droput earns academic honors

Not long ago, Candace Small of Thomasville was a high school dropout and drug addict few would have considered for academic honors.

But after a stellar turnaround at Guilford Technical Community College, the 29-year-old mother of three graduated this month as Outstanding College Transfer Graduate. GTCC President Don Cameron also gave her the scholarship that bears his name to cover University of North Carolina at Greensboro tuition and fees for two years.

Small, who became a math whiz at GTCC, wants to become a math teacher.

Small's troubles started when at age 10 she became caregiver for two siblings. Three years later, she was diagnosed with chronic depression, post traumatic stress and obsessive compulsive disorders and left home and school. Hanging out with the wrong crowd and developing some bad habits led to drug addiction, Small said.

"Between the age of 18 and 24, I was on and off of drugs," she said. "I've been clean now for five years."

Small decided to enroll at GTCC in2005 while her then-soldier husband Joe was in Iraq with the National Guard.

"Once my husband returned, I decided I wanted to go back to school and do something else with my life in addition to being a mother and a wife," Small said.

Small also worked part time as a supplemental instruction teacher to earn extra money.

"She is a true leader in every sense of the word," said Susan Barbitta, a developmental education math instructor. "Being a student herself afforded her leverage with the math students."

Small said Barbitta's guidance encouraged her.

"I want to do algebra. It lays the foundation students will need later," Small said.

While scholarships will pay school fees, Small will have to work to earn money to cover child care expenses.

"It probably will take me three years to finish," Small said.

HIV and AIDS patients find exercise improves their health

NEVER AN ATHLETE -- simply from lack of interest, not lack of innate ability -- Travis Tanner at first did not realize the magnitude of the challenge that lay ahead.

Still, a challenge was exactly what Tanner, 29, sought. He had just come out of a darkness so intense that he could hardly bring himself to leave his midtown Sacramento apartment. His life had been in a downward spiral since February 2003 when he tested positive for HIV.

Drug addiction and depression, however, gave way in the past year to a renewed interest in work and college. And Tanner was ready to try something else, something healthier. So when he saw a flier in January for the NorCal AIDS Challenge, a four-day, 325-mile charity cycling event that begins Thursday, he thought, why not?

On a borrowed bike, he hit the American River trail one day four months ago, full of hope.

"I could only go 10 miles before being winded," he recalls. "But I started getting better right away."

Now, he's doing 100-mile rides with relative ease, lifting weights regularly at a gym and talking about hill-climbing like an experienced cyclist.

"This is definitely the best shape I've ever been in," says Tanner, whose lithe body shows distinct muscle definition. "And it's ironic because I got so sick when I first became (HIV) positive and now I'm the healthiest I've ever felt."

Such a refrain is not unusual among HIV and AIDS patients. In the decade since protease inhibitor medications have helped manage the virus, many patients have either begun exercise regimens or resumed endurance training with a vengeance.

Mounting evidence suggests that exercise not only provides a boost to well-being, but also can help the immune system fight off illness and AIDS-wasting disease by increasing muscle mass and improving heart and lung endurance.

In addition, a study in 2006 by Massachusetts General Hospital found that exercise manages symptoms of "metabolic syndrome," which increases the risk of heart disease and diabetes. Reports say as many as 45 percent of HIV-positive patients have metabolic syndrome.

And a 2005 Columbia University study found that moderate exercise, in combination with anti-retroviral drugs, led to improved nervous-system function and circulation in HIV patients.

Psychological benefits, too

Such preliminary reports are heartening to people living with HIV. Even so, many say that they would be exercising even if it showed no healthful indications.

"For me, the effects are more psychological than biochemical," says Bob Katz, a member of the Positive Pedalers, an HIV-positive cycling club in California with a membership of around 275, mostly in the Bay Area and Los Angeles. "Having a sense of self-worth, feeling comfortable in your body, is something exercising will do.

"We (HIV patients) need to be able to pay attention to what our bodies are telling us. There's nothing like physical exercise to make you aware of what's going on in your body."

Dr. Archana Maniar, an infectious disease specialist and assistant professor at UC Davis, agrees that HIV patients are no different from noninfected people -- they need proper exercise.

"With the advent of anti-retrovirals, patients are living long enough to get the diseases everybody else gets -- diabetes, hypertension, cardiovascular disease, strokes," Maniar says. "From that standpoint, exercise promotes their general wellness and increases their chances of avoiding those things.

"Some HIV patients are concerned about being prone to complications if they exercise a lot, and I tell them that listening to their body is the key, just like for anyone else."

A few HIV-positive endurance athletes say they have never let the disease limit their activity.

Perhaps the most noteworthy is Ric Munoz, 50, a Los Angeles marathoner featured in a widely aired 1995 Nike TV ad. It showed him running through the Malibu hills and ends with this message: "Eighty miles every week. Ten marathons a year. HIV positive. Just do it!"

And Munoz has done it, over and over. He tested positive for HIV in 1987, four years after he started running. He remembers telling the physician who gave him the news that he was a marathoner and he had no plans to give it up. This was, remember, before any enhanced drug regimens were developed.

"If he had objected to that, I would've found another doctor," Munoz says.

All these years later, Munoz is still running. He completed last month's Boston Marathon in 3 hours, 22 minutes, a time he wasn't happy with. He's training now for a 56-mile ultramarathon in South Africa.

Over the years, Munoz says, running as much as 80 miles a week hasn't affected his health and does not adversely interact with the "drug cocktail" he takes.

"I always thought it was a genetic thing, the way some folks are better able to fight HIV," he says.

Ten years ago, deep into his running career, Munoz chose to stop all medication. That experiment lasted for three years.

"My doctor said, 'I'm not going to force you to take it, but I can guarantee at some point, you'll come down with an opportunistic infection,' " Munoz recalls. "And I did. It was cryptosporidiosis (an intestinal infection). But even when I wasn't on medication and my T cells were dropping, that didn't affect my (marathon) performance."

Once he returned to his drug regimen, Munoz says, the condition went away. Since then, he boasts, he's running nearly as much as ever and "I've built T cells up to undetectable range."

One runner is unsure

Not all HIV athletes have been as fortunate.

Larry Teeter, a 48-year-old AIDS patient and a biomedical researcher at the Baylor College of Medicine in Houston, has run 108 races of marathon length or longer, including the Western States 100 endurance event in 2004.

All this, despite losing vision in his right eye as a result of AIDS-related CMV retinitis in 1994 and, in 2005, suffering from avascular necrosis -- bone deterioration due to lack of blood supply -- in his right hip.

For years, Teeter ran with an IV catheter poking out of his chest. (Now, he takes anti-retrovirals orally.) And his hip degeneration was corrected after surgery in 2005.

Teeter says he has seen the ravages of the disease take a toll on his body. And he says he's not sure whether his exercise routine has hastened a decline. He just knows he doesn't want to stop doing it.

"Certainly the muscle mass is there for the legs, but I have a loss of body fat and facial wasting that's characteristic for (HIV patients)," he says. "And there are some studies that suggest marathon or longer events might be detrimental to your (cell) count."

But that's countered by Richard Brodsky, an HIV-positive New York man who runs a marathon each month. Brodsky says his cell count has been "900, higher than they've ever been." But Brodsky also has brain cancer, which he says his doctors have determined is not related to his HIV status.

Exercising keeps him alive, he says.

"A lot of it just has to do with, pardon the pun, being positive about it," Brodsky says. "When I run, I tend not to get colds or any of the opportunistic infections. Some days, it feels like the HIV isn't even there."

For Tanner, the Sacramento cyclist, extreme endurance events probably won't become a habit. But he says he definitely will continue exercising after the four-day AIDS ride.

"It makes me feel better about myself," Tanner says. "When I go on a ride, the first few miles I'm thinking, 'Uh, why am I doing this?' Then I go through what I call the wall and I get into this zone -- just me and the bike. It's kind of meditative, you know?"

Prescription Drug Addiction Has Unlikely Victims

Lia Johnson sat shackled in a vacant, windowless room in the bowels of the Abingdon regional jail one afternoon in March.

The young mother was handcuffed and zipped into an orange jumpsuit. Between her and the cool, spring breeze outside were two armed guards, a long hallway and two sets of fortified doors.

"This is the last place I ever thought I would be," said the blue-eyed, 38-year-old former nurse.

Johnson had never been in trouble with the law. Just two years ago, she was a full-time nurse, mother of a young son and a productive member of society.

Today, she is the new face of drug addiction in America and in Southwest Virginia. Johnson is college educated, middle class and employed, which currently is a similar demographic of the American population addicted to prescription drugs, according to research by Martha J. Wunsch, associate professor at Virginia College of Osteopathic Medicine.

'Equal opportunity' addiction

Southwest Virginia was a rural epicenter of addiction when the use of the narcotic painkiller OxyContin exploded around 2000. The drug was nicknamed "hillbilly heroin" because its use was concentrated in rural communities such as Virginia's coal mining counties, where it eased the chronic pain of some of those who labored in the mines, said Lisa Williams, director of a treatment program at Highlands Community Services in Abingdon.

In the years since, prescription pills have become the drugs of choice -- in some circles earning a new nickname, "equal opportunity."

It seems no one is immune.

A new drug, suboxone, has emerged in the last couple of years, and some say it offers hope to the addicted, only 3 percent of whom beat their addiction, said Marsha Miller, spokeswoman at Highlands.

Johnson, from Saltville, Va., was a nurse at Johnston Memorial Hospital in Abingdon when she injured her back lifting a patient in 2001. Opting against expensive surgery, Johnson managed her pain with prescription painkillers -- five milligram doses of hydrocodone per day.

In 2006, her close cousin was killed in a car crash, and Johnson realized the opiates helped with her emotional grief, as well as her physical pain.

"I started taking it every day," she said. "It numbed me."

Johnson's life spiraled out of control in the months that followed. It wasn't long before she was taking 40 to 45 pills a day.

"Trying to get pills consumed almost all of my time. When I would get a new script, I would already be worrying about running out and where I was going to get my next," she said.

One day, out of pills and on the cusp of withdrawal, Johnson crossed the line. She called a pharmacy and pretended to be a nurse at her physician's office, so she could prescribe herself a bottle of painkillers. From that point, her crimes escalated.

"When you feel like you're going to die if you don't get something, you justify it in your mind," she said.

Searching for the bottom

Johnson's life spun out of control in a matter of months. Before long, she was calling in prescriptions at various pharmacies throughout Smyth and Washington counties to support her habit.

She knew she needed help. But her insurance didn't cover substance-abuse treatment, she said, and every effort to find help led to a dead end. She called about 15 facilities, and the cheapest she could find still cost $8,000, "and that was just one week of detox," she said.

About five months into her addiction, Johnson went to a Marion pharmacy to pick up a prescription she called in for one of her former patients. She was working as a home health-care provider at the time and as her addiction progressed, she began calling in prescriptions for patients who didn't need painkillers and then picked them up for her own use. The patient whose name she used on July 23, 2007, had recently died, but she didn't know it.

She waited at the pharmacy as the clock's minute hand orbited the hour. With each tick she became more sure that something was wrong.

When she finally left, pills in hand, two Marion police cruisers were parked beside her car.

"Somebody will have to help me now," she said she thought with relief.

Johnson pleaded guilty to 32 counts of prescription fraud in Smyth and Washington counties and was allowed to complete outpatient therapy before reporting to jail on Jan. 28. After being caught by police, she had two weeks before entering a detox program in Lebanon, Va.

"I probably used more than I ever had," she said of those two weeks.

Detox lasted six days.

It didn't work.

It was then -- after police confronted her, after she pleaded guilty and confessed to her family and following detox -- that she hit rock bottom.

It happened about a week after being released from the treatment center. Johnson called a fellow patient she had met there -- who had told her he could get some pills -- and she arranged her first illicit street drug deal.

She gave the dealer the last of her money, and he promised to meet her shortly with the pills. He never showed.

That night, Johnson endured withdrawal for what she hopes was the last time.

Withdrawal, she said, is one of the most agonizing, unbearable experiences a person can go through. It lasts for weeks, unrelenting.

"I would hurt all over, runny nose, sneezing, coughing, horrible anxiety, elevated blood pressure and heart rate, chest pain, anorexia, nausea, diarrhea, night sweats, horrible insomnia -- I didn't sleep at all in withdrawal -- and cravings. You can't think of anything but the pills. Nothing. Because you know that all that misery will end as soon as you get some pills," she said.

It's the threat of withdrawal that keeps people using, she said.

By morning, scared she might kill herself, Johnson went to an emergency room at one of the hospitals where she used to work. Her former manager was in the waiting room when she arrived.

"That was rock bottom, when I went to the ER where I worked and told them I was going to kill myself if I didn't get help," she said.

Recovery rewards

After more than 10 hours in the hospital ER, Johnson was taken by police to the Southwest Virginia Mental Health Institute, where a doctor immediately started her on suboxone.

"For the first time since active addiction I had hope," she said. " ... I felt like myself for the first time in years."

Johnson spent 27 days in the hospital, paid for by a state grant. She was introduced to a 12-step program, and upon her release she continued with meetings three nights a week, along with intensive outpatient therapy at Highlands Community Services.

"The way I maintained on a daily basis was to surrender to God's will every single morning," she said.

She stopped suboxone the day before she reported to jail. She said she experienced no withdrawal or cravings, "it was just like any other day."

Johnson got out of jail on April 16. Her boyfriend of eight years, who is the father of her 6-year-old son, picked her up and took her out to eat. Then he drove her to their son's school.

"He ran into my arms and tears started rolling down his little cheeks. I didn't expect that much emotion from a 6-year-old," she said. " ... We stood and cried in the elementary school parking lot for I don't know how long. It was a very special moment."

Johnson has now been clean for nine months.

"I appreciate my bed and my bathroom. I appreciate hearing the birds and watching the lightning. I appreciate all the people who love me," she said.

"I don't want to take anything for granted."

Johnson doesn't know what the future holds. She is legally restricted from working as a nurse for five years, a fact that upsets her. She said she was good at her job and loved her work.

She says she has no desire to ever take another pain pill.

"My biggest lesson would probably be: Never say never. I fooled myself into thinking I would never be an addict. I just didn't think it could happen to me. I felt that I was a good person and things like that didn't happen to good people," she said. "I also learned that addiction is a disease ... not a moral deficiency."

Calais: Addiction focus of summit workshop

"What is Addiction" is the focus of a five-hour summit workshop on Wednesday, May 14, at Washington County Community College.

The workshop starts at 4 p.m. and will be held in the assembly room at the college.

The Washington County Drug Action Team based out of Machias is the sponsor of the event. The team is composed of several groups including Neighbors Against Drug Abuse and the Weed and Seed program in Calais.

The public is invited, along with members of the area medical group.

Among the presenters will be Michael Edwards, director of research and evaluation at Healthways-Regional Medical Center at Lubec. Edwards will open the workshop with a talk on addiction and the brain.

Psychologist Marjorie Withers, who serves as chairwoman of Community Caring Collaborative, a Washington County-based system of services for at-risk infants, developmentally delayed infants, toddlers, preschoolers and their parents, will focus on the generational heritage of addiction.

Dr. Marc Kaplan, who understands the effects of medicines applicable to alleviate the need for drug addiction, will talk about medical issues of addictions.

Washington County Sheriff Donald Smith will talk not only about addiction problems related to people who are in jail, but also about the impact of addictions throughout Washington County.

Denise Altvater, who is chairwoman of the Criminal Justice Commission at Pleasant Point, will talk about her knowledge and experience with families directly involved with addiction issues. Her talk is titled "The Social Effects of Addiction."

Mary Ann Ogonowski, a certified social worker who is a case manager with the Women's Project of the Department of Health and Human Services, will talk about "Addiction Issues That Face and Matter to Case Managers."

Each presentation will be followed by a brief question-and-answer session. "The presenters are well-qualified experts within our county who serve our communities and their residents," the group said in a prepared release. "The workshop will conclude with group discussions to answer questions and begin to take steps toward a countywide community resolution."

There is no cost and dinner will be provided.

New Medication Shows Promise In Addiction Treatment

Prescription drug addiction continues to rage nationwide and across the region, despite state and federal intervention.

In 2006, nonmedical use of prescription painkillers drew the highest number of new users, or "initiates," than any other illicit drug, with 2.2 million users, according to the 2006 National Survey on Drug Use and Health.

And according to the U.S. Drug Enforcement Administration, there are nearly 7 million Americans abusing such drugs today -- more than the number of those using cocaine, heroin, hallucinogens, ecstasy and inhalants combined.

Despite the alarming statistics, many insurance companies don't cover substance-abuse treatment. In fact, Medicaid in Virginia didn't cover the cost for anyone but pregnant women until last July.

Lisa Williams, director of the suboxone treatment program at Highlands Community Services in Abingdon, said one of the most difficult obstacles in combating prescription drug abuse is the availability of the drugs and the lack of viable treatment options.

Until 2005, methadone was the only treatment for opiate addicts, but it has a number of drawbacks. First, it can only be distributed at clinics, which in rural areas such as Southwest Virginia can be far away. Second, methadone gives its user a feeling of euphoria that mirrors the effect of an opiate, and the more methadone you take, the greater the high.

And perhaps the most telling drawback is the spike in methadone overdose deaths in the western district of Virginia. According to the state medical examiner's office, there were 264 fatalities in 2006 from drug overdoses, 70 because of methadone. It's the leading cause of fatal overdoses in the state.

Suboxone was introduced in the U.S. in 2005 as an alternative to methadone. Like methadone, the drug works to placate withdrawal symptoms and cravings in opiate addicts.

But, Williams said, the drug is superior in several ways. Because it does not give its user a feeling of euphoria, it has little potential for abuse. It simply satiates the cravings. It also has a "ceiling effect," which means exceeding the prescribed dose does not increase the patient's relief.

Suboxone also can be prescribed by certified physicians across the country, which makes the treatment more convenient in rural communities.

But there are drawbacks. Strict criteria govern the treatment. In order to start on the drug, a patient must be in a specific phase of withdrawal and cannot be taking certain other drugs that interact poorly with suboxone. Also, only certified physicians can administer the drug, and they are limited in the number of patients they can treat.

Williams said those enrolled in her program have an astonishing 87 percent success rate at beating their addiction.

But some say the drug may not be all it's cracked up to be. Suboxone is the most expensive drug per milligram on the black market today, said Richard Stallard, head of the Southwest Virginia Drug Task Force. An 8-milligram pill sells for $25 to $30 on the street, which means 80 milligrams -- the average dosage of OxyContin -- would cost more than $400, he said.

"There have been several suboxone arrests. I am not saying that it doesn't work when used properly," he said. " ... But to say it has no potential for abuse is totally wrong. No one is going to spend $30 on a pill that don't make you feel good when you use it."

Stallard said he started seeing the drug on the street about two years ago.

"Not many weeks go by in this area that there is not a suboxone purchased by undercovers [police]," he said. "I was here when oxy came in the mid-'90s. It started slow and then got big. Suboxone has some similarities."

Coffee, pastries and hope on menu at new library cafe

Ronald Wimes was homeless and battling drug addiction.

"That's like a circle that goes down and down and down," he recalled yesterday. "It's everything that comes with homelessness -- the rain, the cold, eating in soup lines and just despair, loneliness and a lot of pain.

"I needed help. I had nothing. I had a desire, and that was the biggest piece to wanting change."

He found Project HOME, a Philadelphia nonprofit agency that deals with poverty and homelessness.

Yesterday Wimes, 47, started his first day of work as lead host at the HOME Page Cafe, a wireless-Internet cafe in the lobby of the Central Library on the Ben Franklin Parkway.

The cafe, a collaboration among the Free Library of Philadelphia, Project HOME and Bank of America, officially opened yesterday morning with a ribbon-cutting ceremony and speeches from project organizers and cafe employees.

The cafe will employ 10 formerly homeless Philadelphians and five teens from Project HOME's Harold A. Honickman Youth Entrepreneur Program. Employees will earn $8.75 an hour.

"Public libraries and homelessness are often in conflict," said Sister Mary Scullion, executive director and co-founder of Project HOME. "Those that have no home often take refuge here and sometimes people are afraid. Philadelphia has found a way to take a step forward in providing a solution to this very real tension."

Mayor Nutter and project participants cut the ribbon with a giant pair of scissors.

"This is an incredible example of the creativity we should be replicating all over the city," Nutter said.

The spacious cafe was financed partly by a $200,000 grant from the Bank of America Charitable Foundation.

The cafe serves Starbucks coffee, baked goods from Metropolitan Bakery, and sandwiches and salads from Project HOME's Back Home Cafe and Catering, situated at the group's main office at 15th Street and Fairmount Avenue.

Wimes began his recovery a year ago by moving into Project HOME's St. Elizabeth's Recovery and Resistance community at 1850 N. Croskey St., in North Philadelphia.

"I would never imagine I'd be standing here, an employee of the HOME Page Cafe and lead host," Wimes told the crowd. "I would never imagine that."

Wimes said that his position as lead host, which is full-time with benefits, is similar to a supervisor who oversees employees and manages the cafe's inventory -- areas of responsibility he never could have contemplated before.

"First of all, I wasn't lead nothing," Wimes said. "Nobody wanted to be around me, so it's a big jump in the experience of life. I've never been a supervisor or anything like that."

Another host, Jeanne Brophy, 33, also was once homeless, but has lived in Project HOME's Kairos House at Broad and Jefferson streets for 15 months.

Brophy said that she hopes to increase her hours at the cafe so that she can continue her education; she'd like to study computer technology.

"Working with these guys is awesome," Brophy said, while rushing to refill coffee carafes. "It's just incredible."

The cafe also will employ a full-time manager and a full-time "job coach." These employees will hold daily training sessions on topics including punctuality, appearance and job performance.

For Wimes, customer service is a priority.

"It's about reaching out to people, man," he said. "I've got a new sense of self-respect and respect for people. The way I was helped and served go into my customer service."

Once the cafe is self-supporting, Project HOME hopes to create a profit-sharing program for employees.

The partnership is one of many working programs that Project HOME has in the city.

Among others are: providing restroom attendants at the Central Library as well as the Back Home Cafe & Catering and Our Daily Threads Thrift Store, at Project HOME's main office.

"We celebrate today another step forward, actualizing our commitment to end homelessness in our city," Scullion said.

"By taking action, we can end this very human crisis."

'Just say no' doesn't work

Tony Gizzie speaks out against harm reduction as a strategy in fighting drug addiction. Harm reduction is a proven strategy that helps many people who drink or use drugs. I am a member of Parent Action on Drugs, a community group that, like the Centre for Addiction and Mental Health and Toronto Public Health, has successfully delivered programs based on harm reduction. They've all done so because it works.

In the U.S., the "Just Say No to Drugs" strategy did not stop youth from drinking and taking drugs. Should we just continue to preach abstinence as the only solution?

Teaching people they should not drink and drive is harm reduction. Educating youth that condom use will prevent not only pregnancy but also disease is harm reduction. Giving people options to the heavy use of alcohol is harm reduction - like showing a daily drinker that he or she can cut back to three days a week and be healthier.

Making people aware, giving them options and helping them change their behaviour - whether it's stopping, cutting back or adding new strategies to their lives - is harm reduction.

It is not a cop-out, as Gizzie implies. It's a proven solution that helps thousands of people who drink or take drugs, and helps society around them.

Nancy Miller, Toronto

Commentaries like the one written by Tony Gizzie, a banker from Oakville, are precisely the reason why harm-reduction programs fail. Such programs for intravenous drug use have been shown to be effective in reducing the burden of drug abuse in countries all over the world, including Canada.

However, many of these programs are threatened by knee-jerk appeals to the "common sense" of people with no experience treating or living with substance abuse. Gizzie referred to Alcoholics Anonymous and its policy of complete withdrawal, but he neglected to mention that many alcoholics return to normal drinking patterns later in life. He also failed to mention the enormous societal cost of treating drug addiction and the fact that for the vast majority of addicts, abstinence does not work.

"Harm reduction" applies to the society that no longer has to shoulder the immense economic, social and health burden of complications due to unsafe drug use.

It is this kind of "up by your bootstraps" thinking that shuts down progressive social programs, or prevents them from starting in the first place. I would implore the Toronto Star and Gizzie to leave the arguments on harm reduction to people who know more about it.

Ian Cromwell, Toronto

In Canada, the application of the harm-reduction approach in substance-abuse treatment has become accepted public-health policy. It is part of any professional program that seeks to assist any person who has become addicted to drugs. Self-help programs such as Alcoholics Anonymous and its offshoots, which focus on a spiritual force to recovery, can also be part of successful treatment programs.

Tony Gizzie obviously has not done his homework before stating his beliefs. There is no strong evidence that an AA approach is superior to harm reduction in any time frame for all addicts. There is no evidence that the AA immediate-abstinence approach will help all addicts or substance abusers. And there is no evidence that AA reduces overall social and health costs to the individual and society.

Non-judgmental harm reduction has been accepted in Canada and around the world as a smart strategy for the individual and society.

Man get six years for possession of drugs

A "TALENTED golfer" with a possible future as a professional has been given a six-year sentence after being caught storing cocaine valued at €27,300 in his rented house in Swords to repay a €2,500 drug debt.

Joseph Deegon (21) was due to undergo training that would have allowed him to teach golf and play as a professional.

Deegon, of Howth Road, Raheny, pleaded guilty at Dublin Circuit Criminal Court to possession on March 9th, 2003 of the drugs for sale or supply at Parklands, Northwoods, Swords.

Judge Katherine Delahunt said she believed "special and exceptional circumstances" were evident in this case to allow her depart from the 10-year mandatory minimum sentence applicable to this offence.

She noted Deegon's admissions to gardai, his early guilty plea and the fact he had a drug addiction at the time. Judge Delahunt imposed a six-year sentence with the final three years suspended on conditions.

Sgt Denis O'Callaghan testified that while searching the house on foot of confidential information they found cocaine valued at €27,300 in the bedroom and drug paraphernalia, such as a weighing scales, plastic bags and a mixer, lidocaine.

Sgt O'Callaghan said Deegon admitted responsibility and told gardai he was holding the cocaine to repay a drug debt to a third party whom he could not name as he feared for his own safety.

Sgt O'Callaghan said Deegon had 14 previous convictions, one of which was a drug offence and the remainder for road traffic offences.He agreed that Deegon had "legitimate fears" for the safety of himself and his family and had paid off the €2,500 drug debt with a bank loan.

Woman whose body was found burned had recently completed treatment for drug addiction

Tammy Cochran was a skilled cosmetologist and at one time had a salon in her Shawnee home.

"Hair, nails, all of that," said her father Mike Cochran. "She was very good."

That, however, was before her life was upended by drug addiction. Now Mike Cochran suspects his daughter's struggle with drugs contributed to her death at age 37. He thinks Cochran left her Olathe home the last few days of February, possibly with another person, for drugs.

On March 5 Cochran's burned body was found in rural Olathe. On Thursday, her family increased the reward for information about the slaying from $1,000 to $6,000.

"Hopefully this will create some justice and just finalize it," said Mike Cochran.

Cochran's body was discovered about 10:30 a.m. on March 5 in the area of the Cedar Creek boat ramp at 8255 S. Gardner Road, near the Kansas River.

Cochran's family said she had been strangled, dumped and set ablaze.

Police have declined to discuss the details of the murder.

Cochran, who has a 17-year-old son, was last seen Feb. 29 on surveillance video at a local convenience store wearing a dark blue or black jacket with a fuzzy collar. She also had on a light green shirt, black shoes and blue jeans with a design on the back pockets.

Investigators are not saying what store gave them the video but said detectives are reviewing several days of video.

"We're trying to keep people's minds open to all the places she might have been and not just have them focus in on one," said Olathe police spokesman Robert Ahsens.

He said the woman reportedly had been seen in Kansas City and Kansas City, Kan., and other area cities.

Cochran's criminal record included a 2004 municipal drug conviction in Shawnee and a misdemeanor trespass conviction in a 2004 domestic violence matter in Johnson County District Court

But Mike Cochran said his daughter's life appeared to be on the upturn in the days before she disappeared.

"It was looking so good," he said. "Everything was going well, going positively."

Earlier this year she completed drug treatment at Atchison Valley Hope and had been clean a few weeks. Cochran had recently gotten hired at a hair salon and worked one day before disappearing.

Mike Cochran said he last saw his daughter Wednesday, Feb. 27, when he brought her home from work. The next day, she had the day off. Cochran was then seen that Friday on the convenience store videotape.

"We'll always love her," Mike Cochran said. "I wouldn't trade her for the world."

Addiction - a father-son story

One of the unsettling themes in David Sheff's memoir, "Beautiful Boy," a wrenching tale about his son's drug addiction, is that even though Sheff was among what he calls the "first wave" of self-conscious parents who were hip enough to forge honest relationships with their kids, he was woefully unprepared for the vagaries of methamphetamine.

Sheff, 52, who lives in Inverness, and his ex-wife, Vicki, were decidedly attentive parents - "probably over attentive" as Sheff writes - and their well-adjusted children were supposed to glide into adulthood.

But David's then-teenage son Nic took a detour. Despite his cultured, well-to-do Marin County upbringing, during which he shared dinners with writers like Armistead Maupin, Nic developed a meth addiction that led to heroin use. By 22, he was emaciated and roaming the Tenderloin in search of a fix.

"I was blindsided," Sheff said at his home recently. "I thought I'd protected Nic with the openness. I thought I'd know if there was something going on with him, and I didn't. Everyone's generation probably feels like they're parenting in a better way. But this is definitely not what we expected."

The latest unexpected turn: Last week, Sheff embarked on a national book tour with Nic, now 25, who's been sober for two years and lives in Savannah, Ga. The younger Sheff has his own memoir to promote, "Tweak: Growing up on Methamphetamines." After the father wrote about his son's slide in a November 2005 New York Times Magazine article, an editor from Simon & Schuster contacted Nic, who was then freelancing for the online magazine Nerve.

"They thought it'd be interesting if I told my side of the story," Nic said, while on a visit to his father's home. "So I just kept writing chapters and submitting them and they kept liking them. Then they offered me the book deal."

The result is a sign of our confessional times: father-and-son memoirs, mutually promoted and both written to give hope to individuals and families who suffer the same lot. ("Beautiful Boy" will see an extra marketing push, as it has been selected by Starbucks as part of its book retail program.)

"The books have allowed us to continue the conversation," David Sheff said, as he looked across the kitchen table at his son. "These books make it pretty hard to pretend this never happened, that it wasn't as horrible and destructive as it was."

Nic Sheff snuck his first drink during a family snowboarding trip to Lake Tahoe when he was 11. But, unlike the other kids who squirmed at the taste of the hard liquor, Nic felt compelled to finish the glass until he passed out. It was a compulsive streak that followed him through high school, when he started smoking pot and got his first taste of meth. When he learned the rush was more powerful when he injected it, "that was that," he said. And in college when friends were calling it quits at 2 a.m., Nic was just getting started.

"It's like this hunger," Nic said. "It's this emptiness inside me that just opens up so wide. It feels very chemical. It feels like something in my brain has opened up and sort of needs to be fed."

Although there's no current data on the number of meth addicts in the United States, counselors have witnessed a dramatic increase in the number of addicts seeking help, according to the U.S. Substance Abuse and Mental Health Services Administration. From 1995-2005, the number of addicts seeking admissions for meth treatment increased three-fold, from 47,695 to 152,368. In 2004, an estimated 12 million people older than 12 had used meth at least once in their lifetime, and 1.4 million people had used meth during the past year.

The drug's popularity, the elder Sheff writes, had coincided with Nic's coming of age. Once reserved for biker gangs and truckers, meth has become ultra-potent and, according to law enforcement officers Sheff interviewed, has spread across the country and "marched up the socioeconomic ladder."

"When I told Nic about my own drug use, I thought I had some credibility," said the elder Sheff, who writes for such publications as Rolling Stone and Playboy. In 1980, he interviewed John Lennon and Yoko Ono.

Raising Nic, he openly discussed his own dabbling with pot and cocaine and even a try of crystal meth, hoping those stories of experimentation (and moderation) would be instructive. He divorced Nic's mother when the boy was 5. The two shared a love for writing, movies and art. On a visit to David's parents' home in Arizona, the teenage son felt comfortable enough to light a joint in front of his father.

"I accept the joint," David writes, "thinking - rationalizing - that it's not unlike a father in a previous generation sharing a beer with his seventeen-year-old son, a harmless bonding moment. ... We talk and laugh and the tension between us melts."

"I totally believe parents should talk to their kids about drugs," David said. "I totally believe that educating them in every way is really important. But on the other hand, I've learned it's not as simple as that. Things that enter into kids' decisions (to take drugs) are so much more complicated."

"It is complex," Nic added. "When I was little, we were so close and spent so much time together and had common interests. ... When I did start using hard drugs I was still talking to (my dad) about it, and who knows, maybe that little piece (of communication) could have saved my life. It probably helped me get into treatment a little faster."

When the book agent called Nic, he'd been clean for 10 months. Not long after the advance arrived, he was using meth, coke and heroin again. And again, he went into rehab. He says therapy and books by authors who were "willing to expose their inner worlds," such as William S. Burroughs and Dennis Cooper, have helped him get through his troubles.

Nic describes the rush that meth gave him as a feeling of supreme confidence, an hourslong state of achieved bliss. Yet when the drug evaporated from his system, and the money had run out, he felt an aching low. To rid himself of the habit, he went through weeks of detox, waiting for his body to return to a state of normalcy.

David said he began writing about Nic's dependence "just to get my head around it and wrestle with it." Yet he approached writing about his son with "a lot of trepidation and only after a lot of conversations" with his ex-wife and Nic.

When the New York Times article appeared, there were many friends and relatives who knew and adored Nic but were unaware of the depths to which he'd sunk: He stole money from his kid brother, broke into his mother's home and got arrested for failing to appear in court for a marijuana possession charge.

"I had many sleepless nights, wondering if this was the thing to do," David said. "But each time I thought it through, I came down on the side of being open and honest. There's a cliche: You're only as sick as your secrets." Reading both books is a reminder of how memory can serve its master. In David's book, it's a devastating moment when he realizes Nic stole $8 from his younger brother's piggy bank to buy drugs. The dramatic scene is artfully teased out for all that it symbolizes: The reality that his son's behavior had reached a pathetic low, and the ease with which Nic can inflict pain on his family.

In Nic's book, a raw, almost stream-of-consciousness journal that includes scenes of shooting dope in a high school friend's Sea Cliff mansion, the money incident gets a two-sentence mention. He awakes to the sound of his brother's tears, and recalls the theft as $5. "I got out of bed and started to pack," he writes. "I didn't remember taking the money, but I knew I had."

Still, the memoirs are undeniably related. Both men use Lennon's lyrics in the preface: The elder Sheff quotes the songwriter's "Beautiful Boy." "When you cross the street/ Take my hand"; and the son chooses from "How?" "How can I go forward when I don't know which way I'm facing?"

After the tour, Nic will return to Savannah to finish a semi-autobiographical novel about a kid from Los Angeles who cleans up his life after he moves to the Deep South.

"Writing 'Tweak,' I wanted to show that this is where the power lies," he said. "Drugs are only a byproduct of that struggle to accept yourself for who you are, and not try and hide all the time."

David Sheff is relieved his family is no longer seized with worry about Nic's well-being. David's currently working on a book that approaches addiction from a government-policy angle. He's already received hundreds of letters from parents who have also spent sleepless nights waiting for the car to pull up in the driveway. Or for the 5 a.m. phone call.

"We remember the traumas of that time, but not just the traumas, also the lovely moments, too," he said, looking at his son. "Nic's been sober for more than two years, so we've had all this time to evolve. It's sort of like back to normal. Maybe a new normal."

What Addicts Need (a long one)

DRUGS-WE LOVE THEM. WE'VE COME TO believe in a prescription for every condition and a pill for every ill. Industry advertising tells us what doctors should prescribe for a catalog of ailments, real or imaginary. And this pharmacological boom has proven particularly creative and bountiful in the treatment of addiction.

Advances in brain science have given us a new understanding of addiction and its neurological basis. They have made possible a spectrum of anti-drug drugs. The latest of these, now in development, are vaccines that may be able not just to treat addiction but to prevent it as well. These vaccines would train the immune system to recognize psychoactive substances that now slip unidentified into the bloodstream (cocaine, for example) but, when identified, can be destroyed before they can reach the brain. ANNIE FULLER KNEW SHE WAS in trouble a year ago, when in the space of a few hours she managed to drink a male co-worker more than twice her size under the table. Of course, she'd been practicing for a quarter of her life by then; at 47, she was pouring a pint of bourbon, a 12-pack of beer and a couple of bottles of wine into her 115-pound body each day. She had come to prefer alcohol to food, sex or the company of friends and loved ones. Her marriage had ended; she had virtually stopped leaving the house, except to work and to drink. Fuller had tried and failed enough times over the years to know that she would not be able to sober up on her own. The last time she'd stopped drinking her body went into violent seizures, a common and terrifying symptom of alcohol withdrawal. But the single mother and mortgage-company VP refused to sign into rehab. "I live in a small town," she says. "And when you go to a hospital for something like that, everybody knows about it." So when a family doctor told her about Vivitrol, a monthly injection that prevents patients from drinking alcohol by obliterating its ability to intoxicate, Fuller agreed. She took a sabbatical from work, sent her 15-year-old daughter to stay with relatives and hunkered down to weather the painful, frightening blizzard of detoxification in the comfort of her own living room.

What does it mean to be an addict? For a long time the answer was that someone like Fuller "lacked willpower," a tautology that is pretty much useless as a guide to treatment. In the current jargon of the recovery movement, addiction to alcohol, drugs or nicotine is a "bio-psycho-social-spiritual disorder," a phrase that seems to have been invented by the treatment industry to emphasize how complex the problem is and how much more funding it deserves. But the word itself comes from the Latin addictus, a debtor who was indentured to work off what he owed; someone addicted to alcohol or drugs is powerless over his or her fate in the same way-except debtors-as-addicts can never fully balance the books. It had been years since the pleasure of drinking outweighed the pain it caused Fuller. Looked at that way, the "social" and "spiritual" aspects of her problem seem insignificant compared with the contribution of biology. If you weigh advances in neuroscience over the last few decades against social and spiritual progress, it's clear which field is more likely to produce the next breakthrough in treatments.

While the roots of addiction remain a dark tangle of factors-most experts agree that addicts trying to quit will always need psychological support-the old white-knuckle wisdom that addicts simply lack resolve passed out of fashion decades ago. The American Medical Association recognized addiction as a disease back in 1956. But only now are we beginning to see treatments that target the underlying biochemistry of that disease.

The emerging paradigm views addiction as a chronic, relapsing brain disorder to be managed with all the tools at medicine's disposal. The addict's brain is malfunctioning, as surely as the pancreas in someone with diabetes. In both cases, "lifestyle choices" may be contributing factors, but no one regards that as a reason to withhold insulin from a diabetic. "We are making unprecedented advances in understanding the biology of addiction," says David Rosenblum, a public-health professor and addiction expert at Boston University. "And that is finally starting to push the thinking from 'moral failing' to 'legitimate illness'."

In laboratories run and funded by the National Institute on Drug Abuse (NIDA), fMRI and PET scans are forcing that infuriating organ, the addicted brain, to yield up its secrets. Geneticists have found the first few (of what is likely to be many) gene variants that predispose people to addiction, helping explain why only about one person in 10 who tries an addictive drug actually becomes hooked on it. Neuroscientists are mapping the intricate network of triggers and feedback loops that are set in motion by the taste-or, for that matter, the sight or thought-of a beer or a cigarette; they have learned to identify the signal that an alcoholic is about to pour a drink even before he's aware of it himself, and trace the impulse back to its origins in the primitive midbrain. And they are learning to interrupt and control these processes at numerous points along the way. Among more than 200 compounds being developed or tested by NIDA are ones that block the intoxicating effects of drugs, including vaccines that train the body's own immune system to bar them from the brain. Other compounds have the amazing ability to intervene in the cortex in the last milliseconds before the impulse to reach for a glass translates into action. To the extent that "willpower" is a meaningful concept at all, the era of willpower-in-a-pill may be just over the horizon. "The future is clear," says Nora Volkow, the director of NIDA. "In 10 years we will be treating addiction as a disease, and that means with medicine."

Volkow's vision of the future, however, is being greeted warily by big pharmaceutical companies, reluctant to develop products that would associate their brands with drug addicts. It is also facing resistance from some elements in the addiction-treatment community, who are wedded to the 12-Step model pioneered by Alcoholics Anonymous in 1935. Twelve-Step programs traditionally discourage members from using any psychoactive substances, on the ground that addicts will simply trade one dependency for another. That rationale has some unfortunate history on its side; both opium and cocaine were first introduced to the United States as cures for alcoholism in the late 1800s. More recently there is the example of methadone, the synthetic heroin that turned out to be addictive in its own right, and Antabuse, a drug that makes you throw up when you drink alcohol-which suffers from the shortcoming that an alcoholic planning a binge can just skip his dose.

Addictive drugs like cocaine and heroin flood the brain with the neurotransmitter dopamine, a chemical that induces a sensation of pleasure and trains the subconscious to remember everything that preceded that sensation. Together with alcohol, nicotine and amphetamines, these make up the five drugs generally considered the hardest to give up; right now, some 22 million Americans are hooked on at least one of these substances. While each causes a distinct form of intoxication and a different range of side effects and health problems, all five hijack the same pathway, deep within the brain. It's the pathway that conditions us to eat, have sex, form emotional attachments and carry out the other activities essential to our species' survival. But the agents of addiction are far more powerful than any of those natural highs. Just one dose of cocaine, for example, can release two to 10 times the amount of dopamine produced by your favorite meal, person, song or sight. Take a drug like that consistently enough, and your brain and body will come to depend on it-first for euphoria, then for normalcy. Eventually, the pursuit and consumption of drugs will become as instinctive as the pursuit and consumption of food-only far more urgent and destructive.

People vary in their innate sensitivity to dopamine, which may partly explain why addiction runs in families. A gene that codes for a dopamine receptor designated D2 (one of at least five dopamine receptors that have been identified so far) comes in several different versions, and each produces a different concentration of receptors. People with fewer receptors may receive less stimulation from their naturally occurring dopamine, and therefore be more inclined to seek an artificial high from drugs. Unfortunately, tinkering directly with the dopamine system to control addiction hasn't worked out very well. Dopamine is crucial to voluntary movement and interfering with it can cause symptoms resembling Parkinson's.

So far, other neurotransmitters that play a role in addiction have been easier to tackle. Gamma-aminobutyric acid, or GABA, exerts an inhibitory effect on neurons, telling the body to stop instead of go. Addicts' brains are deficient in GABA, so researchers are investigating a drug called Vigabatrin, which stimulates its production. In December, the pill cleared its first double-blind, placebo-controlled trial; 30 percent of patients who took Vigabatrin stayed off cocaine during the nine-week study, compared with just 5 percent in a control group. "It's the best efficacy signal that we've seen in any clinical trial for cocaine treatment," says Frank Vocci, director of the pharmacotherapies division at NIDA. "And it's worked on what many have written off as an intractable population-hard-core, long-term cocaine addicts." A drug called Camparal, which is already on the market as a treatment for alcoholism, works on yet another brain chemical, glutamate. While the early stages of addiction are driven by pleasure-seeking-hence the importance of dopamine-the motive eventually shifts to avoiding the pain of withdrawal; at that point, drug-seeking behavior is fueled by glutamate. By suppressing this neurotransmitter, Camparal has the potential to reduce cravings and help prevent relapses during recovery. Researchers think these drugs hold enormous promise. "The treatment of depression was revolutionized by medications that manipulate serotonin concentrations," says Alan Leshner, former head of NIDA, referring to Prozac and its cousins. "Drugs that act on GABA and glutamate could do the same thing for addiction."

If you're trying to quit drinking, you are advised not to hang out in bars, and if you're trying to kick cigarettes, you probably should avoid French movies from the 1950s. One reason addictions are so hard to break is that the pleasure of taking the drug becomes associated with all the situations and activities around it, which then become cues for a relapse. Researchers at the University of Pennsylvania found that showing cocaine addicts pictures of drugs or crack pipes for just 33 milliseconds-below the threshold of conscious awareness-was enough to trigger cravings. Beverly Dyess, 58, learned this last year when, after six months of sobriety-her longest stretch in 15 years-she went into a supermarket and discovered that her favorite brand of Scotch was on sale. She was seeing a therapist daily, but "as soon as I saw the label, everything else went out the window," she says. For the next two months she rode a roller coaster of frenzied drinking and crushing guilt. Some days she would get up early enough to get drunk and then sober up in time for her evening counseling session. Other days she would run to the store, buy a bottle of whisky and then, her resolve mysteriously stiffened, pour it down the sink when she got home. By suppressing the surge of glutamate that directed her to the Scotch aisle in the first place, Camparal helped ease the pain of withdrawal and allowed the counseling and behavioral therapy to work. "I still do the talk therapy," she says. "But Camparal really helps, because everything is still a cue for drinking."

Of course, you can't protect yourself against every encounter with a bottle, or, in some environments, heroin, cocaine or amphetamines. So researchers are working on ways to break the association that was Dyess's downfall. A drug called D-cycloserine, or DCS, has the remarkable effect of helping to erase learned fear responses. The classic example, in animals, is the association of a particular place with an electric shock. If you stop giving the shock, the animal eventually "unlearns" the response and is no longer afraid; DCS makes this happen faster. It has been successfully tested in people as a treatment for acrophobia (fear of heights). Now researchers want to see if it can be used to wipe out the association between visual or social cues and the impulse to relapse into addiction. So far, it's been tested only on cocaine, but if it works there it might work for other addictions as well.

Neuroscientists don't talk about "willpower," which is a philosophical concept, but they are starting to get a handle on the parts of the brain involved in self-control, the ability to impose a rational calculus on behavior. They distinguish three kinds of selfcontrol, and, unsurprisingly, addicts score poorly on all of them, although it isn't clear whether taking drugs is the cause or consequence of this deficiency, and which of the three types plays the biggest role in addiction has yet to be determined. These are:

* Delayed discounting, the willingness to put off present gratification in the interest of a bigger long-term reward. Addicts always take the immediate reward. * Reflection impulsivity, a measure of how much information is required to make a decision. Addicts typically act without processing all the available information.
Intentional action, the ability to consciously stop a behavior that has become automatic. To measure this, NIDA researchers had addicts watch a screen and push one of two buttons, according to whether a light has flashed on the left or right side-except when the light was accompanied by a tone. After several rounds, pushing the button becomes an automatic response that has to be overridden consciously, and addicts were much less able to do this than non-addicts. As scientists have known since the 1980s, the neurons that control movement are activated even before a person is aware of the intention. Now researchers have identified the part of the brain-the fronto-median cortex-that is activated when someone stops himself from executing such automatic behaviors. This is as close as we have got to finding the seat of willpower in the brain. Put an addict in an fMRI machine, and you can observe reduced activity in the fronto-median cortex. But a drug called Provigil, which is ordinarily used to treat narcolepsy, stimulates that part of the brain and is now being tested as a treatment for amphetamine addiction. "The idea that we can restore 'self-control' or 'free will' with medication is a very, very exciting one," says Vocci of NIDA. "It could be paradigm shifting. But we need more studies to see how consistently that impacts recovery."

That is a useful caution; these drugs are new and their mechanisms are still only partially understood. The brain has a way of resisting attempts to tinker with its chemistry. The discovery in 1960 that Parkinsonism was caused by a deficiency of dopamine quickly led to the use of synthetic dopamine precursors, such as L-dopa, which relieved the symptoms at first, but were not the long-term cure patients had hoped for.

A more straightforward approach to treating, or preventing, addiction is to block the action of the drug directly. If it doesn't feel good, the thinking goes, you won't do it. Naltrexone, a pill that has been around for a decade, works that way against alcohol, but an addict intent on getting high can just skip his dose. The solution to that problem is Vivitrol, a longer-lasting, injectable form of Naltrexone, which came on the market in 2006. Vivitrol, the drug Annie Fuller took, does not enhance self-control or stop the craving for liquor, but it does block liquor's effects. The day Fuller got her shot, her leg swelled to twice its normal size. The swelling subsided a day or two later, but the next few weeks were a torment of sweating, shaking, vomiting and tears-side effects that came from both Vivitrol and alcohol withdrawal. At times she couldn't walk and needed help to use the bathroom. The only thing that kept her from drinking was the knowledge that she could not get drunk. "The shot just took the relapse option off the table," she says. She got the same injection every month for the rest of the year, suffering a little less each time, and she is now off the medication and sober.

Vaccines that would arm the immune system against addictive drugs and prevent them from making the user high are, potentially, the ultimate weapons against addiction. A cocaine vaccine is poised to enter its first large-scale clinical trial in humans this year, and vaccines against nicotine, heroin and methamphetamine are also in development. In theory, these addiction vaccines work the same way as the traditional vaccines used to treat infectious diseases like measles and meningitis. But instead of targeting bacteria and viruses, the new vaccines zero in on addictive chemicals. Each of the proposed vaccines consists of drug molecules that have been attached to proteins from bacteria; it's the bacterial protein that sets off the immune reaction. Once a person has been vaccinated, the next time the drug is ingested, antibodies will latch onto it and prevent it from crossing from the bloodstream into the brain. Nabi Biopharmaceuticals, a small biotech company in Maryland, has engineered a nicotine vaccine that is in late-stage clinical trials. Earlier studies showed that it was twice as effective as a placebo in helping people quit smoking. The cocaine vaccine, developed by Thomas Kosten of Baylor College of Medicine, could be on the market as early as 2010. It would have to be given three or four times a year, but presumably not for life, says Kosten. While the vaccine is being studied in people who are already addicted to cocaine, it could eventually be used on others. "You could vaccinate high-risk teens until they matured to an age of better decision-making," Kosten says. He acknowledges the obvious civil-liberties issues this raises. "Lawyers certainly want to argue with us on the ethics of it," he says, "but parent groups and pediatricians have been receptive to the idea."

The revolution these new drugs promise will have a huge impact on the addiction-treatment industry (or, as it prefers to think of itself, the "recovery movement"), which runs the gamut from locked psychiatric wards in big-city hospitals to spalike mansions in the Malibu Hills of California. And the reaction there is guarded; the people who run them have seen panaceas come and go over the years, and the same addicts return with the same problems. They also, of course, have a large investment in their own programs, which typically rely on intensive therapy and counseling based on the 12-Step model. "We need four or five more years to see how [Vivitrol] does," says staff psychiatrist Garrett O'Connor at the Betty Ford Center, in Rancho Mirage, Calif. "And we need to be very cautious, because a failed treatment will set a person back." The Ford Center and the Hazelden Foundation, in Minnesota, use drugs sparingly, and mostly just in the first days or weeks of recovery, the "detox" phase. "Hazelden will never turn its back on pharmaceutical solutions, but a pill all by itself is not the cure," says William Moyers, Hazelden's vice president of external affairs. "We're afraid that people are seeking a medical route that says treatment is the end, not the beginning." As for Alcoholics Anonymous and its imitators, they mostly do not forbid members to use medication but there are strong institutional biases against it. "I'm not judging others, but for myself, using something like Vivitrol or Camparal feels like a crutch," says one longtime AA member, who, following the organization's practice, asked not to be named. "It's not true sobriety."

The competing view is that of Lisa Torres, a New York lawyer who has been in recovery from heroin addiction for nearly 20 years, and continues to take methadone, which she regards as medication for a chronic condition, analogous to blood-pressure or cholesterol-lowering drugs. "It's a paradox that some of addicts' biggest advocates have been the most resistant to new treatments," she says. "But a lot of them come to the field after recovering from their own addictions, and they can be very stubborn about what works and what doesn't." More pointedly, she adds, "some people feel recovery from addiction should not be easy or convenient."

So for this new paradigm to take hold, a lot of long-held prejudices will have to change. Doctors (and insurance companies) will have to get used to the idea of medicating their addicted patients, rather than handing them a brochure for AA, which a study published in 2005 in The New England Journal of Medicine found was the most common form of "treatment" offered. "If you have hypertension and it flares up, you go to a specialist," says psychologist Thomas McLellan of the University of Pennsylvania. "The specialist doesn't discharge you to a church basement. If he did, we would call it malpractice." Addicts, he adds, are by no means unique in their propensity to relapse. In a study comparing alcoholics and drug addicts to patients with diabetes, asthma and hypertension, McLellan found nearly identical rates of noncompliance and relapse; between 30 and 40 percent of each group failed to follow even half their doctors' guidelines.

Where doctors go, drug companies are likely to follow. Most of the research on addiction treatments has been done by NIDA (total 2007 budget: $994 million) or small pharmaceutical companies. "I have been imploring the bigger companies to work on this," says Volkow. "Their scientists get it, but the business people are tough to persuade." Companies with billion-dollar stakes in selling drugs for osteoporosis or cholesterol don't want their names on a product used by heroin addicts, says Leshner. Even the relatively unknown Nabi, according to CEO Raafat Fahim, decided to focus on a vaccine for nicotine "because it's not illicit and it's not something you can overdose on" (and afterward sue the company that made the drug that didn't stop you from taking it). But Steven Paul, the head of research for Eli Lilly, believes the landscape is changing. There used to be a stigma attached to depression, too, he says, but the development of Prozac put an end to that. "Anything that has a large unmet need," says Paul, "is ultimately going to succeed commercially."

And addicts may need to change their thinking, too. For nearly 75 years, that thinking has been dominated by the principles laid down by Bill W., the founder of Alcoholics Anonymous. The amount of good AA has done in the world is incalculable; most people reading this article probably can think of someone they know who owes his or her life to it. Some readers themselves have surely benefited. But in 1935 AA was, essentially, the only legitimate option. There were "cures" of various sorts, including gold chloride injections, but there was virtually no modern neuroscience or psychopharmacology. Many people are now living in society with mental illnesses like schizophrenia and bipolar disorder that would have required institutionalization back then. Addicts, like the rest of the public, need to recognize the fact that we are entering a new era in addiction treatment. Viewing her condition as a chronic, recurring disease that could be treated was precisely what Dyess needed to return to sobriety. "In the past, when I would relapse," she says, "the thinking from 12-Step or from family was that I had failed. Now I know that if it happens, it happens, and I can pick myself up and move on, instead of assuming it's all over so I might as well keep drinking." The 12 Steps begin with a confession of powerlessness over addiction. But there's hope that science may some day help put that power within the reach of anyone who needs it. And then who would choose not to grasp it, and begin the long war for sobriety-a war without end, but one worth the fighting.

Sadly, There Is No Magic Bullet

It sounds great. And the new medications will have their place as treatment protocols evolve. In our passion for the prescription quick fix and pharmacological solution, however, we should recognize that drugs alone are not the answer to addiction.

The law of unintended consequences warns us that there's a downside to just about every advance. So discovering that addiction involves profound changes in the brain has led to a widespread assumption that addicts are powerless over their condition-that drugs have hijacked their brains. This, in essence, rules out free will and the possibility that some addictive behavior may be voluntary. It is a seductive proposition, for it suggests that the addict is incapable of self-control, and hence cannot be responsible for his or her behavior.

It is clearly true that addicts become increasingly incapable of controlling their behavior, for the compulsive nature of their drug use is the defining characteristic of their addiction. Moreover, addiction is far from an equal opportunity affliction. Certain individuals-by heredity, mental illness or age-are far more vulnerable than others. There appears to be a genetic component to addiction, and a substantial proportion of addicts suffer from co-occurring mental illness. As parents and policymakers, the vulnerability of teens rightly concerns us most, for the adolescent brain is a work in progress. While the brain's pleasure-and sensation-seeking center is up and running strong at puberty, that portion of the brain exercising control over impulsive and irrational behavior isn't yet fully hooked into the mental communication system until the mid-20s. Lives can be destroyed before they even begin.

My work-I founded Phoenix House, the drug and alcohol treatment program, 40 years ago-and the work of my colleagues would be much easier if the brain were the sole culprit in addiction. As jarring as it can be to say this in a milieu constantly shaped by reports of new scientific insights, it must be said: biology is not necessarily destiny. To accept the proposition of an addict's powerlessness is to eliminate volition from the equation, for we know from hard evidence that addicts can and do kick the habit. And, no matter how difficult it eventually becomes to exercise choice, there is always a period at the outset when choice is not only possible but relatively easy.

More significantly, to treat addiction solely as a disease of the brain is to ignore the psychological factors that generally prompt and sustain it, the behavioral factors that derive from it and a broad range of social and practical issues that need to be resolved before most addicts are able to arrest drug use and achieve what is called recovery. Guilt, remorse and anger must be addressed. There are relationships to repair. It is through talk therapy that most drug abusers come to understand themselves well enough to take control of their lives, working with an individual therapist or some form of group therapy. Groups generally provide a more powerful intervention for addicts, and proper medication often proves a useful adjunct. This combination of drugs and psychotherapy can work as well for addiction as it does for depression.

What may make the search for a magic pharmaceutical bullet so attractive, however, is the harsh reality that addiction is a lifelong condition and can recur at any time. It can-but it need not. This makes addiction no different than any other chronic disorder-diabetes, asthma or heart disease-that can be treated, monitored and controlled. Neither chemistry nor psychotherapy is going to provide a quick fix or sure cure. Relapse is always possible, but it is never inevitable. To argue otherwise is to deny that treatment can be empowering. This eliminates hope-and it is hope, grounded in self-awareness, that is the best safeguard for recovery we now have.

A life of trauma, turned around

-Divorce, sexual abuse, suicide, a parent's stroke and domestic violence: By the time Bonnie Laabs was in fifth grade, she had seen or endured it all.

A childhood pockmarked with family crises led Laabs down a path of theft, drug use and destructive behavior that nearly wrecked her life as a teenager. Laabs, now 27, turned the corner in high school, but it's only in the last year that she has started speaking publicly about her mistakes in an effort to help other young people. On Sunday, she'll take another step: Laabs, who is publishing a memoir this month, will tell her story in church, to the 700-member Burnsville congregation she serves as a youth mentor.

In Grove City, Minn., where she grew up, "Everyone knew me as the bad kid," said Laabs, a college graduate who works as the director of youth ministries at River Hills United Methodist Church.

The art supplies, photos and comfy couch in Laabs' office reflect nothing of the overturned furniture and shredded pictures she saw as a child after fights between her mother and her mother's boyfriend. Nor do the young woman's smile or the small crucifix she wears on a necklace conjure up images of the sunken, sore-marred face she saw in the mirror at the lowest points of her drug addiction.

But the traumas that Laabs recounts in her books are shocking in their variety and number. By the time she entered third grade, she wrote, her parents had divorced, she had been molested by a baby-sitter and her mother had started dating an alcoholic who physically abused Laabs and her younger brother. Social workers pulled her out of class to take pictures of her bruises that year -- the same year that, walking to school one day, she saw police take down the body of a young neighbor who had hung himself off his back porch.

In fourth grade, her mother had a stroke and was paralyzed on one side of her body. In fifth grade, Laabs tried to hang herself three times, got expelled from school and spent time in a foster home. In seventh grade, her family sent her to a group home after she was caught stealing money from her father. In eighth grade, she started drinking and smoking pot. By tenth grade, she was using cocaine and crystal meth.

In the end, the promise of college, a future outside her hometown and God helped her pull through. Laabs, whose good grades had earned her a chance to take college classes while still a teenager, had sunk so far into drug use that her grades slipped and her academic counselor threatened to send her back to high school. Laabs shut herself in her room for a week and came out ready to start fresh. She spent the next year with her nose to the grindstone, avoiding the friends she'd gotten high with and fighting loneliness at home with television and ice cream.

These days, Laabs uses her experience to help others. After training with Toastmasters, she became a professional speaker and began telling her story to troubled teens and foster parents and even at the group home where she once lived. When kids pressed her for details about her recovery, she decided to write her book, "Becoming Beautiful."

And that meant making herself even more vulnerable to family and people who knew nothing of her childhood, lest teenagers in her congregation pick up the book and say, "Oh my goodness, this is my youth pastor."

"I'm very embarrassed about the things I did in my past," Laabs said. But her church has been supportive, she said, and she's working on a second book with her mother. And if her story helps other young people like her, she said, it's worth it.

Drug addiction has taken a toll on whole family

My younger sister's addiction to prescription drugs began, like most, with a legitimate medical need.

Dana was 25 when she was diagnosed with Stage 4 breast cancer in 2003. Doctors gave her little hope, since the disease runs in our family. Subsequent testing showed she carries the gene mutation for breast cancer, hence the diagnosis at an early age.

Following the diagnosis, Dana had both breasts removed, along with her ovaries. She also received heavy-duty chemo and radiation to rid her body of the cancer cells.

The chemo caused tremendous body pain, especially in her bones. Dana had been in several car accidents as a teen, so her back is pretty messed up. Because of the pain, doctors began giving her prescriptions for strong pain killers. She had a legitimate reason to take such pills. What doctor would deny a cancer patient access to pain relief?

Once Dana was in remission, a legitimate need for the pills was gone. But she befriended the wrong person at this time in her life.

She was down. Dana became a single mom to her two young boys when her boyfriend left her for the woman who stood by her side during cancer treatment. She also lost her home during Hurricane Frances in 2004 and had to move in with our mother when we lived in Florida.

Despite her ordeal with cancer and losing her home and boyfriend, Dana decided to enroll in the community college in hopes of one day becoming a teacher. She loves kids and thought teaching was her calling. But that plan was eventually derailed.

Living next door to our mom was a lady who was and continues to be a bad influence. She's had multiple back surgeries, and has an addiction to about everything. It was then the prescription pills became a problem.

Dana, at this time, was taking mild pain killers and was a functioning adult. Then she started hanging around this woman, who encouraged her to visit a pain management doctor to obtain stronger meds. Dana fell for it, and the two of them supported each other's addiction.

When one was out of pills, the other would lend some until the next script was filled. Dana was taking many more pills than her doctor recommended.

She would fall asleep at the dinner table during holidays. Our mom actually found her passed out one night with her head in a bowl of cereal.

Dana was once a cleaning freak. Before she moved in with our mom, her house was spotless and dinner was cooked every night.

Once the pills took over her life, Dana no longer cleaned like she did. She slept all the time and was constantly sick, vomiting up everything she ate.

She no longer took care of herself, took up cigarettes and drank Mountain Dew as if it were going out of style. Since she is a cancer survivor, we thought Dana should be taking better care of herself, fueling her body with fruits and vegetables, exercising and just living.

Her life was reduced to sleeping all the time, either in her bed or on the couch.

Our mom had a constant fear that she or one of the boys would find Dana dead from an accidental overdose.

Dana would have moments of clarity, when she would ask our mom for help or check herself into rehab. She's attempted to wean herself off the pain killers on many occasions, only to return to the pills. Every time she stopped, Dana would experience withdrawals. She would vomit, experience hot and cold flashes, sweat and suffered other unpleasant body functions.

Even today, living on her own in Florida, she continues down the addiction path. Dana can't maintain a job because she is always sick from the pills, and she has quit school. She has become a shell of the person she once was.

Prescription pain killers are a double-edged sword. On one hand, they are a blessing to those suffering terrible pain. But while it helps ease the pain, it can suck the user into a pit of addiction that is hard to escape.

Prescription drug addiction is a hard one to fight. It has taken its toll on our family, as well as Dana herself. Hopefully she will get help again and beat this addiction once and for all.