On June 12, the A&E Television Network ran one of its investigative reports entitled, "Inside Alcoholics Anonymous." Although promoed as including "leading national health authorities and the organization's outspoken critics. . . answer[ing] questions never before asked," it was a paean to AA with short clips from Stanton and Miriam Gilliam, with their views quickly dismissed and the program ending in a paean to the salvation AA brings. For example, not one person who rejected or was unsuccessful at AA was interviewed. However, people in that category wrote to Stanton following the program, including the following:

Dear Dr. Peele:

I have so much to say I don't know where to begin. I'll try to be concise, though. I am a 29-year-old ex-alcoholic. I grew up with an out-of-control alkie for a father, and one of my greatest fears growing up was that I would turn out to be just like him, a drunken bum. Unfortunately, all of the teaching I was exposed to at school indicated that my fears were indeed destined to come true. I even had a well-meaning, 12-stepping teacher give me copies of pamphlets about Alateen and books on ACOA's. So when I started drinking in my late teens, and drank more heavily through my mid-twenties, the prophecy began to be fulfilled. And it terrified me. I was convinced I was destined to be a hopeless drunk, just like dear old Dad, which prompted me to begin to attend AA meetings.

I spent 18 months in AA, going virtually every day, and while I was there, I was a paragon of "sobriety". But I was beginning to feel crazy in AA. When I questioned the dogma, I was told to write a 4th step. When I tried to challenge the idea of powerlessness (which I think is one of the single most damaging concepts in AA), I was told to get on my knees. I was in denial. Call my sponsor. I hated the disease theory because it always seemed to me to just be a big fat excuse for immature behavior. But still, I was so programmed that I began to feel that my failure to accept the program was my fault. Plus, I was terrified to leave because they had me convinced that I would wind up in a jail or an institution or dead.

OK, enough of the AA terminology - I'm starting to give myself the creeps. A couple of months ago I stumbled on Marianne Gilliam's book "How Alcoholics Anonymous Failed Me" and read it, cover to cover. It gave me the push I needed to leave AA for good. Since then, I have read everything I could get my hands on with regard to non-AA therapy, RR, MM, SMART, the AA deprogramming website and others and the 12-step-free email list I joined. And I have finally come to realize that I am not an alcoholic after all. I have even had a couple of drinks, and had no problems with it at all except for the echoes of 12-step hogwash in my brain, telling me it's only a matter of time, I'll wind up in the gutter, etc, etc.

But the real reason I'm writing is to make a point. In my case, anyway, the idea that alcoholism is a disease that is "passed down" through the generations was complete and utter nonsense, and very, very damaging. It was, in fact, a self-fulfilling prophecy. But I believed it, and will be dealing with the decimation of my already low self-esteem which occurred in AA for a long time. The notion that I was diseased for life and filled with character defects particularly got to me. But I intend to continue on my own path of "recovery", which is to trust myself, listen to my own intuition, research and explore alternatives until I find one that works for me, and get a good, non-12-step therapist. Maybe someday I will heal from the awful wounds of my childhood, which are the real reasons I drank to excess in the first place.

I do have to say also that my experience in AA taught me one thing - it taught me that I could stay abstinent if I so chose, without any help from the Big Guy in the Sky (How do they explain the fact that I prayed to Him as a child, daily, that I wouldn't become an alcoholic in the first place? Maybe He was on vacation.), because it was what I wanted at the time. And being abstinent for that time taught me that I could get my life together and function normally (what's normal?). I have a good job (the same job I kept throughout my period of excessive drinking), I bought a house (by myself), I am finishing my Bachelor's degree with plans to attend law school, and none of this happened as a result of AA. It happened because I made it happen.

btw, I'm so sorry for what A&E did to you and Ms. Gilliam on that horrible program last night. It's good that you went to law school. Maybe you can be your own first client.

Best wishes and thanks for your great work,

Nicole

next: Introduction to Alcohol and Pleasure: A Health Perspective
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~ all addictions articles

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are, too, those who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest. Our stories disclose in a general way what we used to be like, what happened, and what we are like now. If you have decided you want what we have and are willing to go to any length to get it then you are ready to take certain steps.

At some of these we balked. We thought we could find an easier, softer way. But we could not. With all the earnestness at our command, we beg of you to be fearless and thorough from the very start. Some of us have tried to hold on to our old ideas and the result was nil until we let go absolutely.

Remember that we deal with alcohol cunning, baffling, powerful! Without help it is too much for us. But there is One who has all power That one is God. May you find Him now!

Half measures availed us nothing. We stood at the turning point. We asked His protection and care with complete abandon.

Here are the steps we took, which are suggested as a program of recovery:

1. We admitted we were powerless over alcohol that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Many of us exclaimed "What an order! I can't go through with it." Do not be discouraged. No one among us has been able to maintain anything like perfect adherence these principles. We are not saints. The point is, that we are willing to grow along spiritual lines. The principles we have set down are guides to progress. We claim spiritual progress rather than spiritual perfection.

Our description of the alcoholic, the chapter to the agnostic, and our personal adventures before and after make clear three pertinent ideas:

(a) That we were alcoholic and could not manage our own lives.

(b) That probably no human power could have relieved our alcoholism.

(c) That God could and would if He were sought.

Being convinced, we were at Step Three, which is that we decided to turn our will and our life over to God as we understood Him. Just what do we mean by that, and just what do we do?

The first requirement is that we be convinced that any life run on a self-will can hardly be a success. On that basis we are almost always in collusion with something or somebody, even though our motives are good. Most people try to live by self propulsion. Each person is like an actor who tried to run the whole show; is forever trying to arrange the lights, the ballet, the scenery, and the rest of the players in his own way. If his arrangements would only stay put, if only people would do as he wished, the show would be great. Everybody, including himself, would be pleased. Life would be wonderful. In trying to make these arrangements our actor may sometimes be quite virtuous. He may be kind, considerate, patient, generous; even modest and self-sacrificing. On the other hand, he may be mean, egotistical, selfish, and dishonest. But as with most humans, he is likely to have varied traits.

What usually happens? The show doesn't come off very well. He begins to think life doesn't treat him right. He decides to exert himself more. He becomes, on the next occasion, still more demanding or gracious, as the case may be. Still the play does not suit him. Admitting he may be somewhat at fault, he is sure that other people are more to blame. He becomes angry, indignant, self-pitying. What is his basic trouble? Is he not really a self seeker even when trying to be kind? Is he not a victim of the delusion that he can wrest satisfaction and happiness out of this world if he only manages well? Is it not evident to all the rest of the players that these are the things he wants? And do not his actions make each of them wish to retaliate, snatching all they can get out of the show? Is he not, even in his best moments, a producer of confusion rather than harmony?

Our actor is self-centered egocentric, as people like to call it nowadays. He is like the retired business man who lolls in the Florida sunshine in the winter complaining of the sad state of the nation; the minister who sighs over the sins of the twentieth century; politicians and reformers who are sure all would be Utopia if the rest of the world would only behave; the outlaw safe cracker who thinks society has wronged him; and the alcoholic who has lost all and is locked up. Whatever our protestations, are not most of us concerned with ourselves, our resentments, or our self-pity?

Selfishness self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. Sometimes they hurt us, seemingly without provocation, but we invariably find that at some time in the past we have made decisions based on self which has placed us in a position to be hurt.

So our troubles, we think, are basically of our own making. They arise out of ourselves, and the alcoholic is an extreme example of self-will run riot, though he usually doesn't think so. Above everything, we alcoholics must be rid of this selfishness. We must, or it will kill us! God makes that possible. And there often seems no way of entirely getting rid of self without His aid. Many of us had moral and philosophical convictions galore, but we could not live up to them even through we would have liked to. Neither could we reduce our self centeredness much by wishing or trying on our own power. We had to have Gods help.

This is the how and why of it. First of all, we had to quit playing God. It didn't work. Next we decided that hereafter in this drama of life, God was going to be our Director. He is the Principal; we are His agents. He is the Father, and we are His children. Most good ideas are simple, and this concept was the keystone of the new and triumphant arch through which we marched to freedom.

When we sincerely took such a position, all sorts of remarkable things followed. We had a new Employer. Being all powerful, He provided what we needed, if we kept close to Him and performed His work well. Established on such a footing we became less and less interested in ourselves, our little plans and designs. More and more we became interested in seeing what we could contribute to life. As we felt new power flow in, as we enjoyed peace of mind, as we discovered we could face life successfully, as we became conscious of His presence, we began to lose our fear of today, tomorrow, or the hereafter. We were reborn.

We were now at Step Three. Many of us said to our Maker, as we understood Him: "God, I offer myself to Thee to build with me and to do with me as Thou wilt. Relieve me of the bondage of self, that I may better do Thy will. Take away my difficulties, that victory over them may bear witness to those I would help of Thy power, Thy love, and Thy Way of life. May I do Thy will always!" We thought well before taking this step making sure we were ready; that we could at last abandon ourselves utterly to Him.

We found it very desirable to take this spiritual step with an understanding person, such as our wife, best friend, or spiritual adviser. But it is better to meet God alone than with one who might misunderstand. The wording was, of course, quite optional so long as we expressed the idea, voicing it without reservation. This was only a beginning, though if honestly and humbly made, an effect, sometimes a very great one, was felt at once.

Next we launched out on a course of vigorous action, the first step of which is a personal housecleaning, which many of us had never attempted. Though our decision was a vital and crucial step, it could have little permanent effect unless at once followed by a strenuous effort to face, and to be rid of, the things in ourselves which had been blocking us. Our liquor was but a symptom. So we had to get down to causes and conditions.

Therefore, we started upon a personal inventory. This was Step Four. A business which takes no regular inventory usually goes broke. Taking a commercial inventory is fact finding and a fact facing process. It is an effort to discover the truth about the stock in trade. One object is to disclose damaged or unsalable goods, to get rid of them promptly and without regret. If the owner of the business is to be successful, he cannot fool himself about values.

We did exactly the same thing with our lives. We took stock honestly. First, we searched out the flaws in our makeup which caused our failure. Being convinced that self, manifested in various ways, was what had defeated us, we considered its common manifestations.

Resentment is the "number one" offender. It destroys more alcoholics than anything else. From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick. When the spiritual malady is overcome, we straighten out mentally and physically. In dealing with resentments, we set them on paper. We listed people, institutions, or principles with whom we were angry. We asked ourselves why we were angry. In many cases it was found that our self esteem, our pocketbooks, our personal relationships (including sex) were hurt or threatened. So we were sore. We were "burned up."

On our grudge list we set opposite each name our injuries. Was it our self-esteem, our security, our ambitions, our personal, or sex relations, which had been interfered with?

We were usually as definite as this example:

We went back through our lives. Nothing counted but thoroughness and honesty. When we were finished we considered it carefully. The first thing apparent was that this world and its people were often quite wrong. To conclude that others were wrong was as far as most of us ever got. The usual outcome was that people continued to wrong us and we stayed sore. Sometimes it was remorse and then we were sore at ourselves. But the more we fought and tried to have our own way, the worse matters got. As in wart, the victor only seemed to win. Our moments of triumph were short lived.

It is plain that a life which includes deep resentment leads only to futility and unhappiness. To the precise extent that we permit these, do we squander the hours that might have been worth while. But with the alcoholic, whose hope is the maintenance and growth of a spiritual experience, this business of resentment is infinitely grave. We found that it is fatal. For when harboring such feelings we shut ourselves off from the sunlight of the Spirit. The insanity of alcohol returns and we drink again. And with us, to drink is to die.

If we were to live, we had to be free of anger. The grouch and the brainstorm were not for us. They may be dubious luxury of normal men, but for the alcoholics, these things are poison.

next: Into Action
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sexual health

Here's a list of all the articles in the Sexual Health section of my site:

1. Sexual Health Home

2. Learn How To Love Yourself

3. Your Sexual Health and Attitude

4. Make Peace With Your Sexuality

5. Opening Up To Sex

back to: Psychology of Sex Sitemap

Thoughtful quotes about risk, taking risks and taking unnecessary risks.

Words of Wisdom

"Half the failures in life arise from pulling in one's horse as he is leaping." (Julius and Augustus Hare, Guesses at Truth)

"Without risk, you don't experience life." (author unknown)

"There is no security on this earth, there is only opportunity." (Douglas Macarthur)

"I tore myself away from the safe comfort of certainties through my love of truth; and the truth rewarded me." (Simone De Beauvoir)

"One doesn't discover new lands without consenting to lose sight of the shore for a very long time." (Andre Gide)

"Fortune sides with those who dare." (Virgil)

next:Spirituality/God

A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

E. Impact of Depression and Bipolar Disorder on Others

Mood disorders affect not only the lives of the victims themselves, but also the entire social setting in which he/she moves: marriage, family, friends, job, society at large. The root cause of all these impacts is the degraded ability the victim has to "perform" in these different areas of his/her life. Thus a seriously depressed person will become morose, incommunicative, withdrawn, and unable to participate actively in what is going on. He/she will often become a "wet blanket", sapping out whatever joy there might be in any occasion, and most will agree that they don't enjoy having this person around. It, therefore, can become a rather heavy burden upon family and friends to have to compensate, on the one hand, for the loss of the "social'' contribution that would customarily be expected from the victim in the normal family setting, while at the same time making an extra input of care, encouragement, supervision, and listening to him/her. A manic person is the opposite: he/she will be obtrusive, aggressive, argumentative, convinced of his/her infallibility, vain, arrogant, and quick to give orders to others. Such people can be a real pain to be around. In the family setting a manic person is often rocking the boat: causing arguments, being peremptory, making irresponsible expenditures and commitments, and unilaterally breaking agreements.

It is impossible even to estimate the amount of emotional pain, stress, and loss family members experience in trying to deal with, ultimately to help, a mentally ill person in the household. In many cases their lives are seriously disrupted, becoming a kind of living hell. Perhaps nothing is more awful than to see, day in and day out, someone you love severely degraded by an illness you don't fully understand, to do everything you can think of to help, and have none of it work. And in addition to have to deal with the stigma associated with such illness, not only by society at large, but also in your own mind, however far back you may have pushed it. And thanks to the outrageously inadequate framework provided in our society for mentally ill persons and their families, you won't get much institutional help, short of hospitalization, which ought to be only the last resort.

As the illness becomes more serious, degraded performance shades into incapacity. Thus the depressive will linger in bed, begin to be routinely late for work, be unable to make decisions or handle the workload on the job, and eventually will be perceived as an unsatisfactory employee. Likewise the manic will make quick but bad decisions based on little or no knowledge or data, will take serious risks with business assets, become insubordinate or otherwise disrupt the normal chain of command, and will be perceived as unreliable, though energetic, and therefore an unacceptable risk.

The loss of a permanent, well-paying job is one of the worst things that can happen to someone with mental illness. First, it means direct loss of income, perhaps the main source of income in the family. Second, it may mean loss of medical insurance, which may be badly needed in the weeks and months ahead. Third, it means an unsatisfactory performance rating in one's personnel file, which may come back to haunt the victim again and again as he/she tries to find further employment. Fourth, it is a serious blow to the self-esteem of a depressive, whereas a manic may not even consider the loss worth notice. Most people do not have sufficient savings to face a prolonged period without income, and available funds are usually quickly exhausted. All too quickly the rent or mortgage becomes overdue, and eviction follows. These difficulties are all magnified and accelerated if the victim is the principal wage-earner for a family. In such cases the role and value of the victim as an effective spouse or parent erodes quickly, and a separation or divorce often ensues. To make matters worse, there is almost no effective public assistance available to a seriously mentally ill person and his/her family. To obtain, for instance, Social Security disability status can take months or even a year (I don't know why so long), and the benefit, once it starts, is minimal -- adequate if the ill person is the "guest" of another family member, but totally inadequate for even bare survival of an individual. This downward spiral is the reason so many mentally ill people end up as street people in our big cities, unable to help themselves in any way that will lead to improvement or remission of the illness.

It is impossible to even guess the tremendous amount of hardship, stress, pain, and despair that our current system produces for people having the misfortune to become mentally ill. One of the most important things that can be done within the existing system is to learn how to recognize mood disorders in an early stage, before the grim scenario given above has a chance to unfold. Once recognized, the illness urgently needs prompt, effective treatment. I stress again that "mere" mood disorders can be life-threatening. If necessary, the victim should be hospitalized, and thus placed in an environment where daily needs can be met, safety can be assured, and optimal treatment given. The expense for such treatment in a private hospital can be very large, and can rapidly exhaust one's insurance. The quality of treatment in free public hospitals may be seriously substandard. These are issues of public policy; we address them briefly below.

next: Grace
~ back to Manic Depression Primer homepage
~ bipolar disorder library
~ all bipolar disorder articles

Want to know how to avoid a gift-giving blunder? To help you develop gift-giving savvy, when you give a gift during the holiday season or on any other occasion, make it a gift of the heart.

A gift of the heart is a gift we give to our friends and relatives that they want and need. A gift is defined as something freely given from one heart to another with no strings attached. A gift with strings is a gift of the ego.

The value of the gift itself is not as important as its presentation and the thoughtfulness behind the giving. Giving gifts that will benefit the recipient is a meaningful gesture. Good gifts move the recipient because they have been chosen with a thoughtful heart.

Giving gifts, while fun and enjoyable in theory, offers endless potential for frustration; thronging crowds, ransacked stores, confusion, indecision, cash depletion and, finally, the belated knowledge that you bought the wrong thing. The task of giving the right gift can be made much easier with a little bit of pre-thought.

Begin now to think and plan ahead. Listen for clues. Comments like, "Wow! That would be great in the family room!" or "It sure would be nice to not have to (fill in the blank)!" or "Oh, I love that, but it's a little more than I want to pay!" That's your cue to make a mental note and add it to your gift list.

When you give gifts people want and need, whether it is money, time, talent, advice, Love or other tangible gifts, you will begin to receive back to you what you want. Your friends and relatives will kiss the "returns counter" good-bye and reduce return trips to the mall. The last-minute, rush to the store to find a gift tells a story about you.

A gift given with the thought, "What will I get in return for this," is a gift of the ego. Why bother? It's a gift we give because we want to give it rather than a gift that fulfills a need or want. Gifts given from ego are seldom appreciated.

Giving a gift of the heart anticipates desire; what you are offering is wanted and is appropriate. Simple, well chosen gifts unite the recipient and the giver, are appreciated and are often treasured the most. Gifts of the heart light up our friends and relatives with happiness and joy beyond our wildest imaginings.

continue story below

Thoughtless, inappropriate gifts cause more attention to be given to the giver. Desire for attention is better requested, in a direct way, not with gifts. A gift given of the heart is for giving attention, not requesting it.

What to give?

We can learn everyday a little more about gift-giving by "being" with the people we love so that we know what they want and need. Proper thought, feeling and inquiry must go into the gift selection. A certain quality of attention is often absent in gift-giving. Brief consideration does not create a considerate gift. Gift must be real and given from the heart to be appreciated.

Gifts should be a symbol of being related rather than a bid for reassurance that we are loved.

The manner in which it is given is worth more than the gift - Lynn Johnsto

next: The Romantic Kiss

8. How does drug addiction treatment help reduce the spread of HIV/AIDS and other infectious diseases?

Many drug addicts, such as heroin addicts or cocaine addicts and particularly injection drug users, are at increased risk for HIV/AIDS as well as other infectious diseases like hepatitis, tuberculosis, and sexually transmitted infections. For these individuals and the community at large, drug addiction treatment is disease prevention.

Drug Addiction Treatment Is Disease Prevention.

Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment. Drug users who enter and continue in treatment reduce activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity. Participation in treatment also presents opportunities for screening, drug addiction counseling, and referral for additional services. The best drug abuse treatment programs provide HIV counseling and offer HIV testing to their patients.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

next: FAQ: 12-Step, Self-Help Programs for Drug Addiction
~ all articles on Principles of Drug Addiction Treatment
~ addictions library articles
~ all addictions articles

Kava kava is an herbal remedy for treatment of anxiety, insomnia, and related nervous disorders. Learn about the usage, dosage, side-effects of Kava kava.

Botanical Name:Piper methysticum
Common Names:Awa, Kava 

• Overview
• Plant Description
• What's It Made Of?
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• References

Overview

Kava kava (Piper methysticum) has been used as a ceremonial beverage in the Pacific Islands for thousands of years. The roots are chewed or ground into a pulp and added to cold water. The resulting thick brew, which has been compared to the social equivalent of wine in France, is typically offered to guests and dignitaries visiting the Pacific Islands.

In addition to its ceremonial purposes, kava is perhaps best known for its relaxing qualities. Kava is said to elevate mood, well-being, and contentment, and produce a feeling of relaxation. Several studies have found that kava may be useful in the treatment of anxiety, insomnia, and related nervous disorders.

However, new reports linking kava with severe liver damage has prompted regulatory agencies in Europe and Canada to warn consumers of the potential risks associated with this herb and even remove kava-containing products from the market. Based on these and other reports in the United States, the Food and Drug Administration (FDA) issued a consumer advisory in March of 2002 regarding the "rare," but potential risk of liver failure associated with kava-containing products. Be sure to visit the Precautions section for further information about the potential dangers associated with kava.

Due to these potential dangers, kava should be used only under the guidance of a qualified healthcare practitioner. Kava has been extensively studied, however, and evidence suggests that (under proper supervision) it may be helpful for the following health problems:

Kava for Anxiety
In a recent review of seven scientific studies, researchers concluded that kava extract is significantly more effective than placebo in treating anxiety. One study found that kava substantially improved symptoms after only one week of treatment. Results of clinical studies and the experiences of people using kava suggest that this herb may be as effective as certain anti-depressants and anti-anxiety medications. In fact, according to one recent study, kava and diazepam (a medication frequently used for anxiety) cause matching changes in brain wave activity, suggesting that they may work very similarly to calm the mind.

Some experts suggest that kava be considered for use when anxiety and/or stress accompany certain medical illnesses. For example, such feelings are not uncommon when being treated for cancer. In one recent survey, as many as 25% of prostate cancer patients felt depressed or anxious. The authors of this particular survey suggested that kava be considered to help relieve the feelings of such men with prostate cancer.

Kava for Insomnia
Short-term studies suggest that kava is effective for insomnia, particularly in terms of improving sleep quality and decreasing the amount of time needed to fall asleep.

Other
In addition to its anxiety-reducing (anxiolytic) and sedative properties, active compounds in kava are reputed to help prevent seizures and relieve muscle spasms. Although kava has not been studied for these purposes, some professional herbalists may recommend this herb to help relieve these and related health problems.

Plant Description

Kava root (which is used in medicinal preparations) comes from a tall shrub that grows in the islands of the Pacific Ocean. This shrub produces large, green, heart-shaped leaves that grow thickly on the branches. Long, slender flowers grow where the branches meet the stems. The roots look like bundles of woody, hairy branches.

What's It Made Of?

The main active ingredients in kava root are called kava pyrones (or kava lactones). The primary kava pyrones (including kawain and methysticum) have been extensively studied in laboratory and animal studies. These substances have been found to reduce convulsions, promote sleep, and relax muscles in animals. They also have pain-relieving properties, which explains why chewing kava root tends to cause a temporary numbness and tingling sensation on the tongue.

Available Forms

In some parts of the world, whole kava roots are chewed for their medicinal value. Kava is also available in liquid form, as tinctures or extracts, and powdered or crushed in capsules or tablets.

How to Take It

It is important to note that some people have developed severe liver damage, even liver failure, after ingesting kava. See Precautions section for more details. Under no circumstances should this herb be taken without the supervision of a qualified healthcare practitioner.

Pediatric
There are no known scientific reports on the pediatric use of kava. Therefore, it is not currently recommended for children.

Adult
If your health care provider has recommended kava, make sure you read the label to look for kava products that are standardized to contain a 70% kava lactone content.

For the relief of anxiety and insomnia, and to reduce stress, follow your provider's instructions. A commonly recommended kava dose is 2.0 to 4.0 grams as a decoction (a preparation made by boiling down the herb in water) up to three times daily. Another typical dose is 60 to 600 milligrams kava lactones daily of standardized formulas.

Length of treatment varies.

It may take four weeks before you notice improvement. Kava should not be taken for more than three months.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine. This is particularly true for kava, given its potentially serious side effects.

In recent years, several reports in the United States and abroad have linked kava ingestion with severe liver problems. Kava-containing products have been associated with at least 25 reports of liver-related injuries (including hepatitis, cirrhosis, and liver failure). In one case report, a 50-year-old man developed hepatitis after taking three to four kava extracts daily for two months. His condition quickly deteriorated and a liver transplant became necessary.

Liver-related risks associated with the use of kava have prompted regulatory agencies in other countries, including those in Germany, Switzerland, France, Canada, and the United Kingdom, to warn consumers about the potential risks associated with kava use and to remove kava-containing products from the marketplace.

Largely driven by the policies of these other countries as well as reports of adverse effects in the United States, the FDA issued an advisory in March of 2002 regarding the "rare," but potential risk of liver failure associated with kava-containing products. The advisory cautions individuals with liver disease or liver problems as well as those taking products (medications, herbs, or supplements) that affect the liver, to consult a physician before taking kava-containing products. If you have taken kava and are experiencing symptoms of liver damage (such as yellow skin [jaundice], fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain), seek immediate medical attention.

Other side effects associated with kava appear to be mild and infrequent. Some reported adverse effects include allergic skin reactions (such as contact dermatitis), dizziness, drowsiness, restlessness, stomach upset, and tremors. Long term use at high doses may cause flaky, dry, and yellowish discoloration of the skin, hair loss (alopecia), partial loss of hearing, and loss of appetite. Like alcohol, kava may also have intoxicating effects and should not be taken before driving. In addition, when taken together with kava, alcohol increases the risk of toxicity from this herb.

Pregnant or breastfeeding women should not take kava. Those undergoing surgery should also not take this herb as it may interfere with drugs used to induce anesthesia and prolong the effect of anesthesia. Kava should be stopped at least 24 hours prior to the scheduled surgery.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use kava without first talking to your healthcare provider:

Kava and Anticonvulsants
Kava may exaggerate the effects of medications used to treat seizures.

Kava and Central Nervous System (CNS) depressants
Kava may enhance the effects of CNS depressants such as benzodiazepines used for sleep disturbances or anxiety (particularly alprazolam) and barbiturates used for sleep disorders and seizures (such as pentobarbital). In fact, there has been one report of someone going into a coma from the combination of kava and alprazolam.

Kava and Antipsychotic medications
Kava may increase the risk of unpleasant side effects associated with phenothiazine medications (often used for the treatment of schizophrenia), such as chlorpromazine and promethazine.

Kava and Levodopa
There has been at least one report that kava may reduce the effectiveness of levodopa, a medication used to treat Parkinson's disease. Therefore, you should not take this herb if you are taking any medications containing levodopa.

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Supporting Research

Almeida JC, Grimsley EW. Coma from the health food store: interaction between kava and alprazolam. Ann Intern Med. 1996;125:940-941.

Ang-Lee M, Moss J, Yuan C. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-216.

Attele AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach. Altern Med Rev. 2000;5(3):249-259.

Beaubrun G, Gray GE. A review of herbal medicines for psychiatric disorders. [review]. Psychiatr Serv. 2000;51(9):1130-1134.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:221-225.

Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, Ore: Eclectic Medical; 1998:88-89.

Cauffield JS, Forbes HJ. Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. [review]. Lippincotts Prim Care Pract. 1999;3(3):290-304.

Cropley M, Cave Z, Ellis J, Middleton RW. Effect of Kava and Valerian on human physiological and psychological responses to mental stress assessed under laboratory conditions. Phytother Res. 2002;16(1):23-27.

Davies LP, Drew CA, Duffield P. Kava pyrones and resin: studies on GABA A, GABA B, and benzodiazepine binding sites in the rodent brain. Pharmacol Toxicol. 1992;71:120-126.

Ernst E. Adverse effects of herbal drugs in dermatology. [Review]. Br J Dermatol. 2000;143(5):923-929.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.

Escher M, Desmeules J, Giostra E, Mentha G. Hepatitis associated with kava, a herbal remedy for anxiety. BMJ. 2001;322:139.

Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. New York: The Haworth Herbal Press; 1999:229-231.

Fugh-Berman A, Cott JM. Dietary supplements and natural products as psychotherapeutic agents. Psychosom Med. 1999;61(5):712-728.

Gyllenhaal C, Merritt SL, Peterson SD, Block KI, Gochenour T. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev. 2000;4(2):1-24.

Heiligenstein E, Guenther RN. Over-the-counter psychotropics: a review of melatonin, St. John's wort, valerian, and kava kava. J Am Coll Health. 1998;46:271-276.

Jamieson DD, Duffield PH. Positive interactions of ethanol and kava resin in mice. Clin Exp Pharmacol Physiol. 1990;17:509-514.

Larkin M. Surgery patients at risk for herb-anaesthesia interactions. Lancet. 1999;354(9187):1362.

Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Moyad MA, Hathaway S, Ni HS. Traditional Chinese medicine, acupuncture, and other alternative medicines for prostate cancer: an introduction and the need for more research. [Review]. Semin Urol Oncol. 1999;17(2):103-110.

Pittler MH, Ernst E. Efficacy of kava extract for treating anxiety: systematic review and meta-analysis. J Clin Psychopharmacol. 2000;20(1):84-89.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:245-248.

Schelosky L, Raffauf C, Jendroska K, et al. Kava and dopamine antagonism. J Neurol Neurosurg Psychiatry. 1995;58(5):639-640.

U.S. Food and Drug Administration. Letter to healthcare professionals: FDA issues consumer advisory that kava products may be associated with severe liver injury. March 25, 2002. Accessed at: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm085482.htm.

Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiat. 1997;30:1-5.

Wheatley D. Kava and valerian in the treatment of stress-induced insomnia. PhytotherRes. 2001;15(6):549-551.

Wong AH, Smith M, Boon HS. Herbal remedies in psychiatric practice. Arch Gen Psychiatry. 1998; 55(11):1033-1044.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

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Detailed info on employee drug testing - how long drugs stay in your system, types of drug tests, false-positives on a drug test.

As a condition of employment, many people have to submit to pre-employment drug  screening or random drug testing once they're on the job.

The pre-employment check that many fear most is the pre-employment drug screening--and rightly so. A strong note of caution: if you have in the past or are presently using illegal drugs, you are strongly advised to stop using them--immediately! The day before--or even the week before—the drug test will likely be too late to achieve "clean" results. But if you make a commitment to steer clear far enough in advance, you may give your body enough time to detoxify and flush out. While many substances can clear in under a week, there are some that will stay with you much longer. For instance, some marijuana users can quit 31 days in advance and still fail the drug test.

How long do drugs stay in your system?

 There is no simple answer as to how long drugs will remain in your system, since the answer is influenced by the specific drug half-life, intensity of the usage, method of usage, length of usage, tolerance, fluid intake, body size, body fat, metabolism and (most important) the specific range which the drug testing lab uses to signify a "positive" for drug use. But the following table provides some general guidelines for the amount of time a drug can be detected by most standard drug tests:

• Alcohol 6-24 hours
• Amphetamines 2-3 days
• Barbituates 1 day to 3 weeks
• Benzodiazepines 3-7 days
• Cocaine 2-5 days
• Codeine 3-5 days
• Euphorics (MDMA, Ecstasy) 1-3 days
• LSD 1-4 days
• Marijuana (THC) 7-30 days
• Methadone 3-5 days
• Methaqualone 14 days
• Opiates 1-4 days
• Phencyclidine (PCP) 2-4 days
• Steroids (anabolic) 14-30 days

Keep in mind that detection time listed above does not mean that the drug is fully expelled from your body within that amount of time just that it has dissipated enough that it can no longer be accurately detected--or at least is not high enough to register a "positive" on a drug test. Most drugs are treated by the body as toxins which take time to eliminate. Rather than allow the toxins to potentially affect vital organs, they are often stored in fat cells, making them typically difficult to release or detoxify from the body.

Types of drug tests

The basic drug test used by most corporate drug testing programs is called a "Five-Screen" (or "NIDA-5" or "SAMHSA-5") which is testing for five types of drugs:

1. Cannabinoids (Marijuana, Hashish)
2. Cocaine (Cocaine, Crack Cocaine, Benzoylecognine)
3. Opiates (Heroin, Opium, Codeine, Morphine)
4. Amphetamines (Amphetamines, Methamphetamines, Speed)
5. Phencyclidine (PCP, Angel Dust)

Many drug testing firms now offer a "Ten-Screen" which expands to include five additional drugs:

1. Barbituates (Phenobarbital, Secobarbitol, Pentobarbital, Butalbital, Amobarbital)
2. Methaqualone (Qualuudes)
3. Benzodiazepines (Tranquilizers--, , Librium, Ativan, Xanax, Clonopin, Serax, Halcion, Rohypnol)
4. Methadone Propoxyphene (Darvon compounds)

Other drugs that can be included in drug tests include:

• Ethanol (alcohol)
• LSD Hallucinogens (Psilocybin, Mescaline, MDMA, MDA, MDE)
• Inhalents (Toluene, Xylene, Benzene)

A good general rule of thumb: if there is a drug out there, there is a drug test for it.

Second-hand exposure

How about one more thing to worry about? Second-hand smoke from marijuana and crack cocaine can be absorbed into your hair. Problem? Some companies are now using hair testing to determine drug usage. Answer? Don't even hang around others who are doing drugs. It can still be absorbed into your system and produce a positive test result. "I didn't inhale..." is not a valid response. And sufficient second-hand smoke exposure can also cause failure of standard urine drug tests. You could fail both a primary and secondary test, with no recourse other than saying that it was someone else.

If you are not a drug user and you fail the drug screening (it does happen), be as straightforward with the employer as possible, let them know that you are not a drug user and ask them if they would please do a confirmation test. Recent estimates from the Journal of Analytic Toxicology showed error rates of 5 to 14% on this initial test. Following is a list of over-the-counter medications which have been known to cause false positives in drug testing:

Ibuprofen (Advil, Motrin) Midol Nuprin Sudafed Vicks Nasal Spray Neosynephren Ephedra and Ephedrine-based products (often used in diet products) Detromethorphan Vicks 44.

False-positives on a drug test

There are more, but suffice to say that not every drug test is accurate. That's why almost all drug testing companies ask you in advance what medications you are presently taking or have taken in the last 30 days. Make sure you list them all, even over-the-counter medications. Most reputable drug testing companies will either have a doctor (or other medical professional) personally interview those who fail a drug test to determine if there was a potential false positive.

If you do receive a failing grade (actually referred to as a "positive" on your drug test--this is one test you do NOT want a positive--you want all negatives) on your drug test, ask to be retested with a confirmation or secondary test. Most employers do not automatically perform the confirmation test since it is significantly more expensive than the initial test. However, if they are unwilling to offer retesting due to the expense, offer to pay the expense on your own and then use a different testing service--ideally a secondary testing provider recommended by the employer so that you won't have a credibility problem with the second test. If you are turned down in your request or you have additional problems, you may want to seek the advice of a competent attorney.

Sources:

• Craig Medical Diagnositics
• Journal of Analytic Toxicology
• NORML (National Organization for Reform of Marijuana Laws)
• Substance Abuse & Mental Health Services Administration (Workplace Issues)

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next: Dealing with a Cyberaffair
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