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Tuesday, September 30, 2014
September 30 Chapter 41 v 7 v 8 TWELVE STEPPING WITH STRENGTH FROM THE PSALMS
All who hate me whisper about me ,imagining the worst ."He has some fatal disease,"they say "He will never get out of that bed!" Source : ( Gods big Book )
Step 5 - Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
My first couple of weeks of sobriety placed me in a holding cell . Isolation was my way of staying safe and holding onto my first couple of days of sobriety for dear life . The verse from the psalm was describing to perfection what I kept repeating in my head. The voices of self hounded me relentlessly . I know now my biggest enemy was me. . I fed my inner demon for sixteen years . Isolation at this point in my life was a path of self discovery and examination.I remember laying in a ball for twenty four hours or more it felt like a year .Death in my mind was coming the pain was excruciating the tears and the sweat poured from body like a river . Guilt discouragement fear and shame kept me down and I had nothing left . Life at this point was ending or at least the one I was living . Somewhere in my isolation I discovered freedom .If only I could get up and get out of this awful place .
Galatians 5 :1
For freedom Christ has set us free; stand firm therefore, and do not submit again to a yoke of slavery.
REHABILITATION NOT INCARCERATION
As my son and many of yours sit in jail without treatment, I can't help but think we need change, there has to be a better way. I hope you wear this shirt proudly....our voices must be heard. We need our help for our children, I don't believe jail is the answer especially if there are no programs to support them while they are incarcerated.
REHABILITIATION NOT INCARCERATION - To purchase yours go to http://www.teespring.com/addictsmom1
Much love to all addict's moms and their families...Barbara
Visit The Addict's Mom at: http://addictsmom.com/?xg_source=msg_mes_network
Amber Portwood: MTV's Out-There Teen Mom Star Comes Back Sober
Amber Portwood is returning to Teen Mom at two years sober and after prison — and looking to open her own rehab. She's a lesson in growing up and moving forward.
For four seasons, Amber Portwood was one of the most controversial characters on the highly polarizing MTV reality show Teen Mom. A September 2010 episode showed her hitting and kicking ex-fiancé, Gary Shirley, while their young daughter stood at her feet, prompting an investigation from Child Protective Services. She was charged with three counts of domestic violence and sentenced to probation, but it eventually became clear that part of her erratic behavior was due to a severe opioid addiction.
The year 2011 proved to be a tough one for Portwood: she suffered the trauma of a suicide attempt, a stint in rehab, and losing custody of her daughter. She was arrested that December for violating her probation, but a plea deal allowed her to dodge a five-year sentence by completing court-ordered rehab. However, she made headlines in May 2012 by admitting to a judge that she had used drugs in rehab and asked to go to prison instead.
But Portwood made the most of her rock bottom moment by completing drug rehab in prison and furthering her education, and was eventually released on parole in November 2013, after serving just sixteen months behind bars. She has largely kept a low profile ever since, but will co-star on a new season of Teen Mom that premieres next year.
Portwood spoke exclusively with The Fix about the role her daughter has played in her sobriety, her struggle to overcome sex addiction, and why she’ll never return to prison.
Where are you now in your sobriety?
I’m over two years sober now. One of the main things I learned in prison and in AA meetings is that in order to stay sober, you have to change your people, places and things. That’s exactly what I did. I don’t hang around the same people that I used to. I moved away from Anderson (Indiana). It’s hard work, but I take my sobriety seriously and doing that was absolutely necessary.
How big of a role has your daughter (five-year-old Leah) played in you staying sober?
She’s my everything. She was the main motivator to better myself and get out of prison and she’s the main motivator for me to continue staying sober. She makes my days better. I look at her and just start smiling. It just reminds me of why I’ve worked so hard these last few years.
It was hard at first because I only saw her three times when I was in prison and she had grown up so much during that time, so I had to relearn a lot of things about her. We’re at a great place in our relationship now, though.
When did your drug use first begin?
My addiction started before I was ever approached by Teen Mom. My dad was an alcoholic, so I grew up around addiction. I did a lot of partying as a teenager and did things like pills and drinking. But it was when I discovered prescription medication that things started to get out of hand.
My drug of choice was opiates. I had a love affair with opiates. I was eating Fentanyl patches while I was in rehab, on house arrest and in drug court. It took over my life.
I think a lot of people were surprised to read in the book that you also struggled with sex addiction.
I’m still trying to figure out where it came from and that’s been a work in progress, but obviously the main component is that you want to feel loved. I also just have an addictive personality, in general.
I’d like to start dating again eventually, but it’s also hard for me to get into a relationship with someone or fall in love. I get bored easily. And I’m sure part of that hesitance has to do with the eight years I spent with Gary (Shirley, the father of her child). I need to learn how to fall in love again and trust again.
You received a lot of criticism initially for choosing prison over remaining in court-ordered rehab. Did that bother you at all?
It was frustrating and annoying because people didn’t understand why I chose to go to prison and they made their own assumptions. But I knew why I did that and so did my family. They supported my decision. And ultimately, I had to do what was best for me. I can’t live my life making choices based on what other people think.
It seems like that decision served you well in the end.
You’re surrounded by hell in prison, but you can choose to live in it or work to get out of it. I chose to get out of it and worked so hard to do that. I completed drug rehab in prison, completed parenting classes, got my GED. I became the administrator of the CLIFF (Clean Lifestyle is Freedom Forever) program, which helps prisoners get sober. Once I got myself clean, I wanted to spend time helping others do the same. I found that my purpose is to help others.
I wasn’t going to just give up on myself. And if I got in there and just lived the prison life, it would have defeated the whole purpose of leaving court-ordered rehab. It was important to make the choice to get something out of that experience.
The other women in there would always tell me that I had to get out. And I promised my friends in there that I would help other people when I got out. They taught me to never give up and that it’s never too late to change. It’s hard work to do that, but it’s possible if you want it enough.
You’ve been open about your faith in other interviews, so how much has that played a role in your sobriety?
I’ve always believed in a higher power, but I wasn’t aware of it as much, until I got into the program. I’ve been through so much for only being 25 and thought there had to be a reason for that. I don’t go to church or necessarily speak about my beliefs, but I do consider myself to be spiritual.
Besides the upcoming season of Teen Mom, what are your plans for the future?
I want to open up a rehab eventually, but I’m just figuring out the first steps to doing that now and know it’s going to take a long time. But I want to have at least one rehab open by the time I’m 30 and want these facilities to be going long after I die. I also want to move more into public speaking and sharing my story. I just want to continue to be a good mom and keep being of service to others.
Did you attend the FED UP Rally this weekend?
The Addict's Mom Live Video Meeting this Thursday Oct 2nd at 7:00pm on In the Rooms www.intherooms.com, will take a look at the special moments of this a.mazing rally. To join the Addict's Mom group at http://www.intherooms.com/group/view?gid=1806
The Addict's Mom is looking for 10 TAM moms to share their special moments from attending the FED UP RALLY? Did something at the rally move you to tears; have you formed a new friendship? What did you learn?
I p.romise you it matters, your share will bring hope and inspiration to others, and they too will want to participate. We need every addict's mom to be involved fighting this horrible disease that is claiming the lives of our beautiful children.
If you will join me on Thursday please post below. Also, if you don't mind also send me an email me at Barbara@theaddictsmom.comwith your name and phone number.
***Special Note the Addict's Mom is now on Instagram @addictsmom join us for special updates, pictures and important information.
Much love to all addict's moms and their families...Barbara
Visit The Addict's Mom at: http://addictsmom.com/?xg_source=msg_mes_network
Sunday, September 28, 2014
September 28 Chp 18 v 39 TWELVE STEPPING WITH STRENGTH FROM THE PSALMS
You have armed me with strength for the battle ; you have subdued my enemies (addictions) under my feet .
Step 12 - Having had a spiritual awakening as the result o f these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs.
Everyday is a battle ! Alone to fight is what led me to use ! We were not designed or put here on this earth to suffer and struggle.The Suffering and struggles we bring on ourselves become training tools in Gods hands . I have spent more time beating myself up more than anybody else . Working the steps constantly and studying Gods big book (Bible) opened my eyes to what life is about and how through my struggles and sufferings Gods purposes and rewards can and will be obtained. If you are alone fighting life there is help only a prayer and tear away from freedom just cry out !
James 1:2 Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.
By Joseph dickerson
Drinking at an Early Age Linked With Later Problem Drinking
September 25th, 2014/
Starting to drink at an early age can increase the risk of alcohol abuse in teens, according to a new study. The shorter the time between a teen’s first drink and the first time they get drunk, the greater their risk of later alcohol abuse.
The results come from a survey of 295 high school students who drink, HealthDay reports. The teens were asked about when they first tried alcohol, when they first got drunk, how often they drank in the first month and how often they engaged in binge drinking (having more than five drinks).
“If age of any use is the primary risk factor, our efforts should be primarily focused on preventing initiation of any use,” William Corbin of Arizona State University said in a news release. “If, however, age of first intoxication — or delay from first use to first intoxication — is a unique risk factor above and beyond age of first use, prevention efforts should also target those who have already begun drinking in an effort to prevent the transition to heavy drinking.”
A teen who had their first drink at age 14 and first got drunk at age 15 would become a heavier drinker than a teen who started drinking at age 14 but didn’t first become drunk until they were 18, the study found.
The study appears in Alcoholism: Clinical & Experimental Research.
“We would recommend that parents attempt to delay their children’s use of alcohol as long as possible,” study author Meghan E. Morean said. “However, even among adolescents who have had their first drink, a significant percentage has yet to drink to intoxication. Therefore, parents’ efforts to delay drinking to intoxication may be helpful in reducing their child’s long-term risk for negative outcomes associated with early drinking.”
Heroin Easier to Buy Than Wine for Young People in Rural Pennsylvania: State Senator
September 25th, 2014/
It is easier for a young person in rural Pennsylvania to buy heroin than a bottle of wine, according to a new report on the heroin epidemic in the state.
“Heroin is cheaper and easier for young people to obtain than alcohol,” said State Senator Gene Yaw, Chairman of the Center for Rural Pennsylvania, a joint legislative state agency. He added buying heroin can be cheaper than purchasing a six-pack of beer, Reutersreports. Yaw said a small packet of heroin costs between $5 and $10, and delivers a high that can last for four to five hours.
Overdose deaths in rural areas of the state rose from one per 100,000 people in 1990, to 13 per 100,000 in 2011, according to the report.
The report recommended several legislative solutions to the opioid overdose epidemic. One bill would provide immunity to an individual who contacts authorities in the event of a drug overdose, while a second would expand the types of drugs monitored under the state Prescription Drug Monitoring Program.
“The increased use of heroin, which often has roots in the abuse of prescription painkillers like Vicodin and OxyContin, has catapulted Pennsylvania to seventh in the nation for drug-related overdose deaths in the latest federal statistics,” Yaw said in a news release. He added, “Simply locking people behind bars is not the answer. We, as a state, need to do more.”
Doctors in Kentucky See Increase in Babies Born to Drug-Dependent Mothers
September 25th, 2014/
A year after health experts gathered in Kentucky to discuss how to deal with the problem of babies born to drug-dependent mothers, the state has seen a surge in babies born with neonatal abstinence syndrome (NAS).
NAS is the condition caused by exposure to narcotics during pregnancy. Symptoms include constant high-pitched crying, vomiting, diarrhea, low-grade fever, seizures and tremors. Premature babies with the syndrome may experience respiratory distress and are put on ventilators.
At the University of Kentucky Children’s Hospital, the Neonatal Intensive Care Unit has discharged 204 babies with NAS as of this month, up from 154 in 2013, and 130 in 2012. Statewide, 955 babies were hospitalized for NAS in 2013, up from 67 in 2001.
Henrietta Bada, a neonatologist at the hospital, says doctors are frustrated because there is a lack of care for mothers who are addicted to drugs. The lack of care continues after the baby is born, she told the Lexington Herald-Leader.
In June, the state announced the Kentucky Perinatal Quality Collaborative, which will address the rising number of infants born with NAS.
“The time has come to treat neonatal abstinence syndrome like the true national public health emergency it is,” Eric Reynolds, MD, President of the Kentucky Perinatal Association, said in a news release when the collaborative was announced. “In addition to the acute withdrawal syndrome as a newborn, infants affected by NAS are at increased risk for SIDS, abusive head trauma, attention and behavioral problems at school age, and their own addictive behaviors as adults.”
Thursday, September 25, 2014
SEPTEMBER 25 CHP 31 v 10 TWELVE STEPPING WITH STRENGTH FROM THE PSALMS
I am dying from grief ; my years are shortened by sadness. Sin (addiction) has drained my strength :
I am wasting away from within .
STEP 5 - Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
We are wasting away and dying from sadness for some reason .Most just don't wake up and say I wanna get addicted to drugs and die young. Life is full of actions and reactions .Our behaviors are a reaction from the experiences we have in life. After many years of suffering and self medicating I discovered my reaction and cause to all my grief was fear guilt and insecurity . Denial of these three culprits kept me using and very sick physically , mentally , and spiritually . Step five helped me realize self medicating was my reaction to a trauma I suffered as a child and self medicating did not take away my grief , fear , guilt , and security , it strengthened them . Honesty with self and others will take the power of control out of the hands of these four culprits .
James 5 : 16 - Confess [your] faults one to another, and pray one for another, that ye may be healed. The effectual fervent prayer of a righteous man availeth much.
By JOSEPH DICKERSON
Wednesday, September 24, 2014
How Obamacare Is Killing AA’s Membership
Under Obamacare, insurance will only pay for evidence-based treatment. Consequently, rehabs are eliminating 12-step groups in favor of harm reduction and other statistically strong methods.
There is a section of the Affordable Care Act of 2008 called the Mental Health Parity and Addiction Equity Act. The Mental Health Parity Act of 2008 requires that insurance pay equally for mental and addiction treatment as general medical treatment. It ensures that if a person requires a 30-day inpatient program, insurance must pay for it.
On the surface, the Mental Health Parity and Addiction Equity Act looks extremely promising for those in the rehabilitation industry and perhaps a return to the glory days of the 1980s where 30-day inpatient drug rehabilitation was the norm. Alcoholics Anonymous very heavily depends on drug treatment centers as one of their main gateways for new membership and nearly 100% of drug rehabilitation programs treat patients with the Alcoholics Anonymous abstinence-based model. In fact, Steve Slate in his article, It’s All Twelve-Step – So Stop Talking About Science Already discusses that 98.6% of all rehabs in the United States are at least in part 12-step oriented with 78.8% directly using the 12-Step Facilitation Model.
Counting AA’s Membership: Historical Trends and Controversy
Alcoholics Anonymous uses a self-reporting system to count membership along with surveys to randomly assigned people to gather demographic information. Consistency within Alcoholics Anonymous reporting exists on the group level. Group establishment must go through a rigorous process of displaying staying power over time before being considered an official group of AA. Once a group is established, membership within a group is then reported as a group estimate of those who are regular attendees or “homegroup members.” This number is vastly overstated in most cases because many people who sign up for a homegroup fail to show up or drop out of AA without reporting. A lag of six months or more can exist before a group removes a member from its roster. This system, therefore, gives accurate reporting of groups in existence and not so accurate reporting of actual membership.
Many people have mistakenly claimed that in 1992 Alcoholics Anonymous saw its peak in membership and if we are to take these numbers at face value that is most certainly the case.Alcoholics Anonymous has a report of yearly membership and groups since its inception.However, these numbers do not add up with any mathematical consistency. From year to year, if we divide the number of members by the number of groups, on average, we see a value ranging from 18 to 22 members per group. This value significantly changes in the years 1990 to 1993. Values ranged in these years from 23 members to a whopping 28 members per group in 1992. It is simply unreasonable to believe that nearly 750,000 members showed up for those years and then suddenly dropped off the map without any new groups reporting in those years.
If we compare these values to a more consistent statistic of 19 members per group per year, however, we find those years where membership reporting was inflated. We also see some other interesting trends in the data. First, AA membership most likely did not peak in 1992, what actually occurred is the rate of membership began to diminish. According to the trend of actual group count, however, AA continued to see added membership up until 2008. It is possible based on the current trend that AA actually peaked in 2008. In fact, from 2000 to 2008, AA saw an average group count increase of 1,785 groups per year. However, from 2008 to 2011, the latest AA survey published shows an actual loss of 676 groups per year. For the past six years, AA has seen a smaller group count than they did in 2008. This is the first time in AA’s history that they have shown a consistent loss of actual group count which can then imply a significant loss in membership. As a relative value of comparing membership from year to year, it is clear that group count is much more consistent than actual membership reported.
Health Insurance and Historical Trends in AA
The rate of membership in Alcoholics Anonymous, and group count, has been shrinking over the past 20 years primarily due to health insurer’s resistance to paying for drug treatment admissions. Insurance has reverted to detox-only for inpatient, usually resulting in an average seven or more days for a form of outpatient treatment. After a few returns to detox, the health insurance industry refuses to pay for treatment altogether. The reduction of the rate at which Alcoholics Anonymous gained membership can be graphed as a direct correlation to the amount of inpatient dollars the health insurance industry was spending.
In 1992 there was a significant change in the healthcare industry where a majority of insurance companies began to place people in HMOs and began a serious crackdown on insurance payments. The first in line to go was addiction treatment, due to the high cost and low efficacy. The gradual decline in insurer’s refusal to pay for addiction treatment has been a constant trend all the way up to the Affordable Care Act of 2008. Relative to the American population, which saw an increase of 20% over the past 20 years, Alcoholics Anonymous’ numbers did not increase at the same rate. At an estimated 2.1 million members, which we know to be inflated, AA is now showing a relative decline in membership of 16% in comparison to the growing US population. That’s a serious drop in numbers over the last 20 years.
The Mental Health Parity Act of 2008 and the Final Rule
So the rehabilitation industry is in trouble. Big trouble. The recent Hazelden-Betty Ford merger should be a big clue as to how much trouble they are in. When Betty Ford had to merge with Hazelden just to survive under the new healthcare law and switch its treatment primarily to outpatient care, it shows how vulnerable the industry is. As the stats show, as the rehab industry goes so does AA.
Originally, the Mental Health Parity Act gave rehabilitation medical practitioners hope that access to their facilities would increase under the law. The problem is a part of the law called the Final Rule, which most of the industry missed when making their initial projections. The Final Rule states that all treatment must be evidence-based medicine. This means that the treatment applied must be proven to work and the level of treatment must be in accordance to what is deemed necessary by scientific studies. Unfortunately for 12-step methods of treatment, it means that insurance can and will flat out refuse to pay for inpatient 12-step facilitation simply because it is not proven to be effective.
In light of this new rule, it is no wonder that Hazelden quickly switched to adding naltrexone to its treatment model. What this means is that the 12-step model in treatment centers must now take a backseat to actual evidence-based medicine or insurance will refuse to pay for it. How bad is it?Cigna has refused 47% more inpatient treatment claims than general inpatient treatment claims citing a lack of evidence-based treatment. United Healthcare under the new law has alsosignificantly increased their denials of addiction treatment. Both insurance companies ended up in class action lawsuits over the issue (Cigna settled). The law is still being tested in court and the debate will continue simply because inpatient treatment using the Minnesota Model or Alcoholics Anonymous is simply not proven to be effective. This, while seeming bleak to many Alcoholics Anonymous proponents, is encouraging to those who promote evidence-based medicine. The American Mental Health Counselors Association hailed the Final Rule as a serious step forward for addiction medicine.
Ironically, the anonymity of Alcoholics Anonymous may be its own demise. As the law requires proof of 12-step treatment effectiveness, AA has traditionally resisted any direct involvement in studies. The same follows for 12-step rehabs. Many do not publish their efficacy most likely because it isn't encouraging. As the law requires evidence-based treatment for drug and alcohol addiction, many rehabs will be forced to switch to an evidence-based model, at least in part, in order to survive. This could be a very harsh awakening to Alcoholics Anonymous which previously saw the majority of treatment centers as private facilities that promoted their philosophy and encouraged their membership. Consider the statistics of drug and alcohol treatment admissions from the Substance Abuse and Mental Health Administration in comparison to the group count of Alcoholics Anonymous. It is undeniable seeing the two datasets together that they are correlated (see chart above) and the drop in admissions is staggering since 2008. In fact, the number of drug treatment admissions has fallen below the level of admissions in 2000. This means 2012 marked the lowest rate in drug treatment admissions for the past 12 years.
The majority of drug treatment denials have been on the basis of “medical necessity.” John T. Seybert, Esq. and Edward Stump, Esq. of the American Bar Association define medical necessity in their article, Will the Mental Health Parity and Addiction Equity Act of 2008 Successfully Encourage Employers to Provide Benefits for Inpatient Mental Health Treatment? They also clarify why health insurance is now no longer paying for non-evidence based treatment:
“Most insurance companies, however, will not provide coverage for residential treatment for mental illness or addiction unless the services are deemed ‘medically necessary.’ In general, a plan defines ‘medically necessity’ as ‘accepted medical practice or community standards of care; not for the convenience of the patient or provider; not experimental or investigational; and appropriate and effective.’”
The essential problem is that inpatient care has not been proven to be more effective than outpatient care and 12-step based models have not proven any efficacy at all. The prestigious Cochran review did a comprehensive study in 2006 and found no conclusive evidence that 12-step facilitation gave any results more favorable than no treatment. This does not bode well for inpatient treatment facilities that depend on health insurance for survival.
As a result of this law, evidence-based medicine will become the forefront of addiction treatment in America. As admissions to treatment facilities are significantly dropping, drug treatment centers will be required to change their model to a more evidence-based approach in order to receive payment from insurance. As the number of admissions to 12-step facilities continues to drop, Alcoholics Anonymous’ membership will also continue to drop. The result of this single rule in the Mental Health Parity Act has been a profound change in the way insurance now supports addiction medicine. At the rate we are currently moving, this one line in the Obamacare law may very well be the death of the 12-step movement.
Matthew Leichter is a writer based in Baltimore, Maryland. He is a published healthcare statistican and epidemiologist currently pursuing a doctorate in epidemiology from Capella University and has worked as an epidemiologist for Humana, Blue Cross Blue Shield, IMS Health, Cognilytics, and Walgreens.
People Who Overcome Substance Use Disorder Less Likely to Develop New Addiction
September 23rd, 2014/
People who overcome a substance use disorder have less than half the risk of those who do not overcome it of developing a new addiction, according to researchers at Columbia University.
“The results are surprising, they cut against conventional clinical lore, which holds that people who stop one addiction are at increased risk of picking up a new one,” Senior Author Dr. Mark Olfson told Reuters. “The results challenge the old stereotype that people switch or substitute addictions, but never truly overcome them.”
The researchers examined data from surveys taken in 2001 and 2004, which included almost 35,000 adults. They compared the occurrence of a new substance use disorder among adults who already had at least one such disorder. The survey participants were asked about a wide range of substances, including marijuana, cocaine, heroin, alcohol, tobacco, painkillers, sedatives and tranquilizers.
Of those who had a substance use disorder in 2001, about 20 percent had one by 2004. The researchers found 13 percent of those who were in recovery from their original substance use disorder developed a new one, compared with 27 percent of those who still struggled with their original addiction.
Those most likely to develop a new substance use disorder during the study were young, unmarried men who had mental health problems in addition to substance abuse.
The findings appear in JAMA Psychiatry.
“While it would be foolish to assume that people who quit one drug have no risk of becoming addicted to another drug, the new results should give encouragement to people who succeed in overcoming an addiction,” Olfson said. “I hope that these results contribute to lessening the stigma and discrimination that many adults and young people with a history of substance abuse face when they seek employment.”
Kentucky Could Become Latest State to Place Age Restriction on Cough Syrup Purchases
September 23rd, 2014/
A bill soon to be introduced in Kentucky would make it illegal to sell cough syrup containing dextromethorphan (DXM) to anyone under 18. Several states, including New York and California, already have such laws in place.
The Kentucky bill, which has been filed for the upcoming legislative session that begins in January, targets products including Robitussin DM and NyQuil, The Cincinnati Enquirerreports. The bill is designed to prevent teenagers from using these products to get high.
The effects of dextromethorphan abuse vary with the amount taken. Common DXM effects can include confusion, dizziness, double or blurred vision, slurred speech, impaired physical coordination, abdominal pain, nausea and vomiting, rapid heartbeat, drowsiness, numbness of fingers and toes and disorientation. DXM abusers describe different “plateaus” ranging from mild distortions of color and sound to visual hallucinations and “out-of-body,” dissociative, sensations and loss of motor control.
According to the Monitoring The Future study, 5 percent of high school seniors abused non-prescription cough medicine in 2013.