All posts by fgreenagel

16Jun/14

What to do when your friend or family member has a drug problem

Last month, a story about me and my friend Fraser appeared on the Rutgers Today website. It is currently featured on the front page of the Rutgers New Brunswick website.

Fraser and I met at Voorhees High School in the the winter of the 1991-92 school  year. We were in honors sophomore English. There were a number of difficult kids in that class, and I still feel a bit badly for our teacher, Peggy Quadrini. Fraser and I spent the next couple of years partying, joking, eating, slacking off, watching sports, arguing and generally getting involved in chaos and mayhem. Eventually, I changed my behavior, joined the Army and went to college. Fraser spiraled downward. He cycled in and out of jails and recovery, bouncing from job to job and house to house. It was a nomadic life. A couple of times a year, he would put 60 to 120 days of continuous sobriety together. Each time he relapsed, I felt despair and anger. My first thought would be, “How could he do this to me?” and my second thought would be, “Why can’t he get it?”

frank better photo with friendfeature

In 2001, Tuffer and I picked him up from the Green Street Jail in Newark. They made us wait 4 hours until he had been there for 12 hours, so that they could bill someone for a full day in jail. After 9/11, Fraser talked his way onto the site at Ground Zero and helped in the rescue and rubble clearing efforts. In 2002, I visited him at the Somerset County Jail. His father had just passed away, and he told me, “The last time I saw my Dad was through the thick, plate-glass window of the visiting room here in jail.”  The last time I saw him was on July 8, 2002 in Clinton, NJ. He was boarding a van to go back to Freedom House (a halfway house that I really like in Glen Gardner, NJ). Eventually, he left it against medical advice. On September 23, I received a phone call from our friend Nat that Fraser had died the night before. We pieced together that he had been drinking and doing drugs. He threw up and choked on his own vomit and died. We suspect that the person he was dating was there at the time and didn’t call emergency services for several hours (because she was high at the time and there wasn’t a Good Samaritan Act then). I cried for days and felt empty. I kept thinking “I could have done more” or “I should have been there.”

Several people pointed out that I couldn’t have prevented his death and that I was powerless over his addiction. I grieved for a long time. Eventually, I realized that I was also angry at him for dying. It was hard being angry at my dead friend. I talked about it with a lot of people. A few months after his funeral, I left for Toyko, Japan. I taught English there for a year and then traveled around Japan and Southeast Asia. I mourned for Fraser and thought about what I was going to do with my life. When I returned to America, I took at job at Integrity House in Secaucus, NJ. A month after I started that job, I also applied to the MSW program at Rutgers.

I have been working in the field of substance abuse for 11 years now. The following is the best advice that I can give people that are concerned about a friend, family member or loved one that you think has an alcohol and/or drug problem:

(1) Don’t drink or do drugs with them

(2) Don’t drink or do drugs around them

(3) Set firm boundaries – don’t let them drink or do drugs around you.

(4) Don’t give them money. For anything. Money you give them for food, rent, clothes, legal fees or something else is very likely to be used for alcohol or drugs

(5) Get into therapy. You need someone to talk to about this. If you are a student in middle school, high school or college, there should be a counselor available at there for you to talk to

(6) Attend Al-Anon or Alateen. At least 6 times. If you go to a meeting and the focus is on the alcoholic or addict, go find a different meeting where the people there talk about themselves, their feelings and their actions (or inaction)

(7) Work with a professional and consider imposing consequences: taking away the car, their phone, kicking them out or even calling law enforcement on them. Encourage (or force) them to go see a licensed professional

(8) Confront them. Express your concerns. Do not yell, curse or name-call. Explain how you see they have changed, how you feel and what you want to be different (a professional can really help you with this). This is extremely important, as one of the criteria that professionals look for is, “Has someone every confronted you about your drinking or drug use?” If multiple people have confronted someone, that can help them get clean years before they might otherwise.

There are other things you can do, but this is a great start. Stop and think about how much time and energy you have spent worrying about your loved one. Do you get distracted during the middle of your day or lie in bed thinking about her late at night? Have you neglected other areas (or people) in your life? Have you made excuses or blamed others (their friends, the school, co-workers, ex’s or cops) for his behavior? If you’ve answered yes to any of those three questions, then you should go see a professional and follow my aforementioned steps. You may or may not be able to help your loved one, but you’ll certainly be able to help yourself.

 

13Jun/14

Heroin: White People and Black People

I read an article on Fox recently with the headline “Face of Heroin Addiction Now Young, White and Suburban” (you can read the article here). The article was written after the release of a small study of people seeking treatment for opiate addiction. The major point of it is this:

Today, the average heroin user is 23 years old and tends to live in a suburban or rural area. More than 90 percent of the study subjects who reported that they began abusing heroin in the past decade were white. However, the study authors acknowledged that their research was limited, since they only analyzed participants seeking treatment for their addiction.

There are two points here, and neither of them should be considered new nor news. The first point is that a lot of young white people are using opiates. When “Glee” star Cory Monteith died last summer, the articles about “the new face of heroin” abounded. We’ve known this for about a dozen years. The proliferation of prescription drugs introduced a new class (and generation) of people to opiates. When those prescription opiates became too costly, they switched to heroin. The second point is that most of the people that get into treatment for opiates are white. On average, white people have more money, better insurance, less stigma and more access to treatment. Of course more of the people in treatment are white people. It’s this second point that really bothers me.

The heroin epidemic is not new. I’ve said so many times. Richard Pryor had a huge problem with cocaine, and it unfortunately played out in the national spotlight in the early 1980’s. He discussed his cocaine problem and how white people got caught up in it during one of his shows:

“Y’all remember?  Y’all used to drive through our neighbor hoods and shit and go, ‘Oh, look at that.  Isn’t that terrible.’ Then you’d get home, right, and your 14 year old’d be fucked up, and you’d go, ‘OH MY GOD!  IT’S AN EPIDEMIC!’..”

For decades, poor and minority communities have been ravaged by heroin use. Little was done to help and the plight of the addicted in those groups got worse. As a result, the economic and living conditions of their communities deteriorated as well. Addicted people are very likely to have addicted kids and the plague spread. Regardless of one’s moral views of this subject (or the value you place on poor and/or minority lives), there can be no mistaking the devastating economic costs of letting addiction spread and thrive. It has effected white suburbia in the 21st century, and now schools, parents, the media, law enforcement and politicians are noticing and attempting to take action.  Richard Pryor saw this happen 30 years ago with cocaine and spoke about it.

Paul Mooney has talked about this type of thing as well, but he gave a more apt-fitting name (or meme) to it:

The great political comedian Paul Mooney made his bones by laying in the cut between American democratic ideals and American behavior.  A mentor and inspiration to his friend Richard Pryor, Mooney’s stock-in-trade is a canny ability to thread the truth between ongoing and established hypocrisies — to make us see the pathologies that are still at the core of our decision-making and societal array.

One of his best routines involves the “nigger wake-up call,” that signal moment when the rest of America finally understands something, and comes to resent and acknowledge that which black and brown America has internalized and tolerated for generations

This last section was copied verbatim from David Simon’s post “The Nigger Wake-Up Call”, which he published last summer after the NSA home-spying revelations.

Regardless of race and class, we need to address the heroin and other opiates epidemic. If we only address it in the white and wealthy communities, then we have done a terrible, terrible job. We need to make sure that we implement sound policies and create excellent programs for all.

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Addendum (6/13): Here is a story from today about a drug sweep that recently took place in Northern NJ. As you can tell by the photos, an overwhelmingly majority of those arrested are young and white. Unsurprisingly, they will be offered treatment instead of incarceration. Another salient fact is that despite the changing demographics of heroin use, people travel into desolated inner cities to buy their drugs. If we don’t address the problem in the inner cities, those markets will continue to function and the work that is done in the suburbs will be ultimately fruitless.

The end of the article touches upon another sore subject: for those that live in Paterson (largely poor, largely minority), they don’t get that option. Their option is jail.

09Jun/14

Counties sue Big Pharma over ultra-addictive painkillers and their “campaign of deception”

In the middle of May, the counties of Orange and Santa Clara in California filed a 100 page lawsuit against Big Pharma for “false advertising, unfair business practices and creating a public nuisance.” The LA Times ran a very good article on it. Some highlights:

(1) The lawsuit alleges the drug companies have reaped blockbuster profits by manipulating doctors into believing the benefits of narcotic painkillers outweighed the risks, despite “a wealth of scientific evidence to the contrary.”

(2) The complaint accuses the companies of encouraging patients, including well-insured veterans and the elderly, to ask their doctors for the painkillers to treat common conditions such as headaches, arthritis and back pain.

(3) The widespread prescribing of narcotics has created “a population of addicts” and triggered a resurgence in the use of heroin, which produces a similar high to opiate-based painkillers, but is cheaper, the suit says.

(4) In Orange County, where the lawsuit alleges there is a painkiller-related death every other day, Dist. Atty. Tony Rackauckas said he decided to pursue the case “as a matter of public protection.” The primary goal, Rackauckas said in an interview, is “to stop the lies about what these drugs do.”

The five companies named in the lawsuit are: Actavis, Endo Health Solutions Inc., Johnson & Johnson’s Janssen Pharmaceuticals, Purdue Pharma, and Teva Pharmaceutical Industries’ Cephalon Inc.

The most egregious offender is Purdue Pharma, the company that created Oxycotin in 1996 and has aggressively (and perhaps recklessly) marketed it ever since. In 2007, Purdue Pharma agreed to pay $635 million to settle charges that it had overstated Oxycotin’s benefits and understated it’s addictive qualities. While the fine may seem large, the Wall Street Journal estimates that annual sales of Oxycotin are about 2.8 billion dollars.  The fine amounted to about 20% of one year’s annual Oxycotin revenue. Clearly, this did not dissuade Purdue Pharma from their negative practices. Some other concerns involving Purdue Pharma:

(1) In 2013, the FDA denied generic versions of Oxycotin. This allowed Purdue Pharma to keep the patent and continue to rake in billions of dollars a year.

(2) Also in 2013, Purdue Pharma announced that they had received FDA approval to sell transdermal buprenorphine. Because of the explosion in opiate addiction over the last dozen or so years, there have been more and more people getting treatment and getting medication-assisted treatment. Buprenorphine (most common trade names are Suboxone or Subutex) is one of the best two medications for opiate addiction. Purdue Pharma is looking to capitalize on this market, which ironically (bitterly), they helped to create. If Purdue Pharma was a black male, the headlines would say that Purdue Pharma robs and kills people.

In the beginning of June, Chicago filed a similar suit against Big Pharma as well. It made headlines in NJ because Johnson & Johnson was one of the companies named. Here is a clip of a TV report about if from June 3rd.

Chicago Mayor Rahm Emanuel released a statement regarding the lawsuit:

“For years, big pharma has deceived the public about the true risks and benefits of highly potent and highly addictive painkillers in order to expand their customer base and increase their bottom line…It’s time for these companies to end these irresponsible practices and be held accountable.”

I expect that more counties, cities and perhaps states will follow these examples. Big Pharma is wealthy and employs a number of very smart lawyers. If the battles against the deceptive and negative practices of Big Tobacco provide a template, than this fight may be played out in the courts for  the next 5 to 20 years. It won’t help the person who is addicted or about to get addicted, but it might benefit kids born in 2014.

06Jun/14

Non-medication remedies for ADHD

I’ve written a lot about ADHD. I have a policy piece about it on my site, which you can read here.

Miami University has taken these criticisms to heart and has created a new policy in which any student that seeks ADHD meds is required to do the following first:

(1) Students at Miami University who seek medication for ADHD must first go through an initial phone screen.

(2) They then attend a “brain booster” workshop, which lasts for 90 minutes. At the workshop, they receive a planner to help them organize their time, and are instructed in how to use it. They receive tips about time management, such as using their cell phone to keep track of appointments.

(3) Students are told how to improve their sleep, hygiene, minimize distractions, and improve their study skills and reduce procrastination. Italics are mine. Sleep problems cause so many other issues. People with sleeping problems are more likely to have physical or mental health problems, and vice versa.

(4) Several weeks after attending the workshop, students fill out a goal completion worksheet to demonstrate how well they have adopted the skills and behaviors they learned.

(5) If they decide to go ahead with an evaluation for ADHD, they attend another hour-long workshop, which is required even for students who have been prescribed ADHD medication in the past. They learn how to keep their medications safe in a college setting, and avoid misusing or diverting them. Only after they have attended both workshops can they see Dr. Hersh. “We slow down the process to screen out the people who just want a quick fix,” he explained.

It’s a fantastic process and I applaud them. I hope more schools follow suit.

You can read the full article here.

05Jun/14

A few must-reads about incarceration in America

Two articles and two books that anyone who is interested in criminal justice policy (or addiction policy…or education policy) should read.

In December of 1998, Eric Schlosser‘s piece The Prison Industrial Complex appeared in The Atlantic. Mr. Schlosser is more well-known for his book (and the 2006 movie) Fast Food Nation (the topic about the food industry in America deserves several posts or another website – in my next life). It paints a disturbing portrait about the move to the privatization of prisons and what that means for people who go to court and the inmates who are incarcerated. It very much predicted situations like this (you should really click on that and read the horrible story about a judge who sentenced kids to a prison in Pennsylvania – he earned kickbacks from the owners of the prison for keeping it full).

The Caging of America by Adam Gopnik was published in the January 30, 2012 The New Yorker. It is what I consider to be the best single article on our prison system to date.

Ted Conover published New Jack in 2000. This review of it by Kathy Robbins appeared in Publishers Weekly:

Stymied by both the union and prison brass in his effort to report on correctional officers, Conover instead applied for a job, and spent nearly a year in the system, mostly at Sing Sing, the storied prison in the New York City suburbs. Fascinated and fearful, the author in training grasps some troubling truths: “we rule with the inmates’ consent,” says one instructor, while another acknowledges that “rehabilitation is not our job.” As a Sing Sing “newjack” (or new guard), Conover learns the folly of going by the book; the best officers recognize “the inevitability of a kind of relationship” with inmates. Whether working the gallery, the mess hall or transportation detail, the job is both a personal and moral challenge: at the isolation unit (“the Box”), Conover begins to write up his first “use of force” incident when a fellow officer waves him away. He steps back to offer a history of the prison, the “hopelessly compromised” work of prison staff and the unspoken idealism he senses in fellow guards. Stressed by his double life and the demands of the job, caught between the warring impulses of anthropological inquiry and “the incuriosity that made the job easier,” Conover struggles but nevertheless captures scenes of horror and grace. With its nuanced portraits of officers and inmates, the book never preaches, yet it conveys that we ignore our prisons–an explosive (and expensive) microcosm of race and class tensions–at our collective peril.

Michelle Alexander published The New Jim Crow in 2010. This blurb from her website does an excellent job describing her masterpiece:

…today an extraordinary percentage of the African American community is warehoused in prisons or trapped in a parallel social universe, denied basic civil and human rights—including the right to vote; the right to serve on juries; and the right to be free of legal discrimination in employment, housing, access to education and public benefits. Today, it is no longer socially permissible to use race explicitly as a justification for discrimination, exclusion, and social contempt. Yet as civil-rights-lawyer-turned-legal-scholar Michelle Alexander demonstrates, it is perfectly legal to discriminate against convicted criminals in nearly all the ways in which it was once legal to discriminate against African Americans. Once labeled a felon, even for a minor drug crime, the old forms of discrimination are suddenly legal again. In her words, “we have not ended racial caste in America; we have merely redesigned it.”

04Jun/14

A Mother Shares Her Pain

This is a moving story about a woman whose son was killed by a drunk driver in 1998. On June 2, she spoke at North Hunterdon High School.

I think that these kind of prevention programs are helpful – one never knows how they will resonate with attendees. I do think that schools should hold follow up discussions over the next few weeks after programs like these. The North Hunterdon-Voorhees Regional High School district has a pair of excellent student assistance counselors (SAC’s) that organize quality programs. More schools should follow their lead.

You can read the article here.

03Jun/14

Big Pot Problems in Colorado

I was not surprised to see this headline in the New York Times yesterday:

After 5 Months Of Sales, Colorado See the Downside of the Legal High

A few quick quotes and points from the article:

(1) “I think, by any measure, the experience of Colorado has not been a good one unless you’re in the marijuana business,” said Kevin A. Sabet, executive director of Smart Approaches to Marijuana, which opposes legalization. I’ve written about Kevin Sabet and his amazing book Reefer Sanity before. You’ll see his name in more and more articles over the next few years.

(2) The industry has generated $12.6 million in taxes and fees so far, though the revenues have not matched some early projections. I wrote about this before. Click here.

(3) “Every major institution said this would be horrible and lead to violence and blood in the streets,” said Brian Vicente, one of the authors of Amendment 64, which legalized marijuana in Colorado. “None of that’s happened. The sky did not fall.” This is both hyperbole and a lie. No one, as far as I’m aware of, predicted “blood in the streets.” What we did predict was that more kids would try marijuana, more people would get addicted to marijuana and that the revenues would not be what was projected.

(4) Many of Colorado’s starkest problems with legal marijuana stem from pot-infused cookies, chocolates and other surprisingly potent edible treats that are especially popular with tourists and casual marijuana users.

On Colorado’s northern plains, for example, a fourth grader showed up on the playground one day in April and sold some of his grandmother’s marijuana to three classmates. The next day, one of those students returned the favor by bringing in a marijuana edible he had swiped from his own grandmother.

“This was kind of an unintended consequence of Colorado’s new law,” said John Gates, the district’s director of school safety and security. “For crying out loud, secure your weed. If you can legally possess it, that’s fine. But it has no place in an elementary school.”

So far this year, nine children have ended up at Children’s Hospital Colorado in Aurora after consuming marijuana, six of whom got critically sick. In all of 2013, the hospital treated only eight such cases. I wrote about this before too. Click here.

(5) Even supporters of legalization such as Mr. Vicente say Colorado needs to pass stricter rules about edible marijuana. He said the state was racing up a sharp learning curve.

“Marijuana was illegal for 80 years,” Mr. Vicente said. “Now it’s legal, and everyone’s just trying to figure out how to approach these new issues.” Exactly. Let Colorado and Washington be the petri dishes. Let them see what works and doesn’t work. There is no need to pass any other marijuana laws in other states for the next three years.

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Addendum (6/3/2014): More unintended consequences and policy implications: Legalized marijuana and workplace testing

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Addendum #2 (6/5/2014): The New York Time’s Maureen Dowd’s bad edible marijuana experience in Colorado was detailed here.

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Addendum #3 (6/6/2014): Marijuana coffee. That makes no sense. It will be sold in Washington.

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Addendum #4 (6/7/2014): Marijuana for your dog. Here is a story that describes how marijuana helped a dog stop having seizures. Dogs are popular (almost as popular as babies and veterans), and so if you go against marijuana in this instance, you are also going against dogs. It’s an animal interest story planted to swing people off the fence towards the marijuana industry.

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Addendum #5 (6/9/2014): Marijuana is leading to more car crashes and 12% of fatal accidents now involve pot. Colorado has seen a huge increase since 2009 (when the first medical marijuana dispensary opened in that state). We can’t really call this unintended consequences of medicalization & legalization, because a number of us have called it for years.

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Addendum #6 (6/25/2014): More data about the increased number of people arrested while driving under the influence of marijuana can be found here. I have to say it again: I told you so.

 

03Jun/14

Locking up the mentally ill

There was an article two weeks ago in the New York Times about the rising number of mentally ill inmate attacks on prison staff at Rikers Island. It is not a particularly good article, as it addresses the wrong problem, but you can read it here.

What is particularly interesting is the reactions to the article.

A letter to the editor from the May 30th New York Times:

As a former Rikers Island mental health worker, I found that although your article spotlights the challenges in providing mental health treatment behind bars, the larger question is why the mentally ill — specifically, those with schizophrenia, bipolar disorder and dementia — are being treated in a jail setting to begin with.

When the big state psychiatric hospitals were shuttered decades ago, it was with the promise that they would be replaced with smaller, community-based supervised housing — something that never materialized.

Most of the psychiatrically impaired have been arrested on minor offenses, like trespassing, as in the case of the homeless vet who recently “baked to death” in his cell.

Making good on the long-awaited promise of outside support and supervision would likely reduce the number of low-level transgressions that lead to arrest, would mean humane care for our most fragile citizens, and would go a long way in reducing jailhouse chaos.

MARY E. BUSER
Brooklyn, May 22, 2014

The writer, a psychiatric social worker, was an assistant mental health chief at Rikers in the Giuliani administration.

And these from June 1:

To the Editor:

Re “End Mass Incarceration Now” (editorial, May 25):

For nearly five decades, I have worked with formerly incarcerated men and women. Two things guided me to reach the conclusion that our prison system is an exercise in institutional futility.

First, the system almost never allows the inmate to consider the factors that led him or her to addiction and/or crime. In fact, to survive in that dehumanized subculture, you have to continue the behavior and thinking that lead to imprisonment.

Second, virtually nothing in jail or prison prepares a person for re-entry to society. One man described it best, saying: “I had to put on coats of armor to survive in prison. Someone has to teach me to remove those cloaks of protection so I can function in society.”

The bottom line, reflected in the country’s high recidivist rate, is that the prison system is contributing to antisocial behavior. We have to be more creative in how and why we incarcerate, and whom.

DAVID ROTHENBERG
New York, May 25, 2014

The writer is the founder of the Fortune Society.

To the Editor:

One salient fact was not mentioned in your editorial: the percentage of those incarcerated who suffer significant mental illness. This fact was revealed in your coverage of Rikers Island (front page, May 22), which reported that nearly 40 percent of those prisoners were mentally disabled.

Have we emptied our mental health facilities only to have former patients end up in jails and prisons? Is that where they belong?

Is it better to have the mentally ill controlled by prison guards rather than by psychotherapists, and by fire hoses rather than by therapy and drugs?

Is their incarceration not a national disgrace?

MARTIN TOLCHIN
Washington, May 25, 2014

The writer, a former reporter for The New York Times, is a trustee of the Bazelon Center for Mental Health Law.

To the Editor:

As a professor of criminal justice and a researcher who has spent 40 years examining the long-term effects of mass incarceration on prisoners and society, I believe that the concept of redemption must play a much larger role.

Redemption — the ability finally to forgive — is consistent with a positive notion of the human condition. The alternative is to continue to lock people up for extended sentences with little regard for how this is crushing American society financially and spiritually.

Countless inmates (arrested for both nonviolent and violent crimes) pose no discipline problems within the prison system. After years of being incarcerated, many have redeemed themselves. Their behaviors have changed, and yet they are not released. At some point, keeping such a person locked up becomes simply cruel.

If given the opportunity, incarcerated people can change and show transformation and growth through such means as earning a high school equivalency diploma, staying off drugs, getting back with their families, connecting with their children, and connecting with the families of victims.

But can the public forgive such people and offer them a second chance to become productive citizens, instead of their remaining costly, endless drains on our resources?

STAN STOJKOVIC
Milwaukee, May 28, 2014

The writer is dean and a professor at the Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee.

To the Editor:

The problem with prison overcrowding is that prison operation is becoming a new major moneymaker, at the expense of the most vulnerable.

The Corrections Corporation of America was formed in 1983, during a Reagan privatization moment, and since then, the business of running our federal, state and local prisons has been slowly passed on to private companies whose goal is to have all their jail beds filled to keep the wheels of commerce churning profits.

Many of these companies hire out the inmates to provide essentially slave labor for manufacturers, paying the inmates little or nothing — slave wages.

It’s hard to stop a moneymaking operation once the shareholders are happy. Sounds like another great financial successful story.

JACK HICKEY
Peterborough, N.H., May 25, 2014

31May/14

Two recent articles on prisoners in Baltimore and how marijuana causes brain damage

This was supposed to be posted back on April 16, but it got lost in the shuffle. I’m releasing it now without edits.

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I’ve posted a lot in the last two days, so I’ll just link to these articles with minimal comments.

Jeffrey Tobin posted this about prisoners at a Baltimore McDonalds on The New Yorker’s website today. He discusses how prison is a ubiquitous experience in certain parts of America.

This article from NBC news reports that even casual use of marijuana causes brain damage. The news is more grim for heavy users (those that use 3x a week or more).