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Health
continued
to ask your physician questions about
your condition. That's one of the things
doctors are there for and that's one of
the first rules about being a smart
patient.
According to Sharon Rainey, patient
relations coordinator at the Health
Center's largest outpatient facility,
Reichert Health Building, it might be a
good idea for patients to bring a paper
and pencil with them to the doctor's
office. That way, if you'd like, you can
write down questions before your visit
and you can take notes if necessary.
"Now, more than ever, patients are
less inhibited about speaking up if they
have questions, but many are still afraid
to bother the doctor or ask questions,"

Rainey says. "Pencils and paper are an
excellent way to make sure that patients
cover all the questions they may have
related to their condition."
Dr. Carman agrees.
"Patients should feel comfortable
with their doctor and they should call
when they need to," he says. "Notes can
be helpful, but it's also important for the
physician to structure the conversation
to each individual patient. I tend to
draw pictures and write notes for my
patients. I also have handouts, as do
other physicians, to make sure every-
thing is explained fully."
Dr. Carman stresses that calling your
doctor isn't bothersome if you have a
question or a concern. However, it is
important that you understand your
doctor may not always be available to
talk to you at the time of your call, but

he or she will call you back as soon as
possible.
"Doctors aren't always available to
talk to callers right away because we
may be seeing patients," Dr. Carman
says. "If we stopped to talk every time
we were called, we'd get so far behind,
the patients in the waiting room would
never get in to see us."
The remedy: Let the person who an-
swers the phone know why you're call-
ing. And be specific. Often the nurse can
help you. If you're calling for an ap-
pointment, make sure you make clear
what the problem is. The doctor will
then know how much time to allot for a
thorough appointment.
Being healthy is our own responsibil-
ity. But when we do get sick, it's impor-
tant we work with our doctor to assure a
speedy recovery. C --Scott Adler

17 I Can Cope (coping with cancer)
18 Chronic Pain Outreach

19
20
24

Hypertension Screening
Volunteering at CMHC-
Informational Meeting
Cardiac Rehab Spouse Support Group

SJMH Discharge Center
SJMH Education Center
Reichert Health Building
SJMH Education Center
Arbor Health Building
SJMH Discharge Center
SJMH Education Center
Arbor Health Building
Arbor Health Building
Arbor Health Building
SJMH Discharge Center

24 I Can Cope (coping with cancer)
25 Breast-feeding Class*
26 Foot Care Services*
30 Free Health Screenings
-Hypertension
-Vision & Glaucoma Screening
31 I Can Cope (coping with cancer)

7:30-9:30 p.m. (Call
995-3873 to register)
7:30-8:30 p.m. (Call
434-0671 for more
information )
1-3 p.m.
6:30-7:30 p.m.
7-8:30 p.m. (Call
572-5213 for more
information)
7:30-9:30 p.m. (Call
995-3873 to register)
7:30-9 p.m.
(Call 572-3675
to pre-register)
1-5 p.m.
1-5 p.m.
1-5 p.m.
7:30-9:30 p.m. (Call
995-3873 to register)


Cocaine: From Pleasure to Pain

M ark first tried cocaine three
years ago at a company party. He
continued using cocaine periodically
because it made him feel good. His sex
drive increased, as did his energy, men-
tal ability, self-confidence and con-
centration, which helped him perform
better at work. Two years ago Mark won
the "Salesman of the Year" award. Life
couldn't have been better.
Today Mark has no job, no money, no
energy, no interest in relationships and
no self-respect.
His case is not unusual. He couldn't
see the extent of his problem until it de-
stroyed everything he had ever worked
for. Drug addicts often deny they have a
problem, but cocaine users are even
more likely to get hooked without real-
izing their addiction, says Steven Hnat,
an expert in the diagnosis and treatment
of cocaine dependency and lead
therapist of Catherine McAuley Health
Center's Cocaine Treatment Service.
"Most cocaine addicts indulge peri-
odically and might go two weeks be-
tween binges," says Hnat. "They don't
think of themselves as being addicted
because often they don't feel the need
for cocaine."
A difficult habit to kick
However, studies have shown it is
harder to kick the cocaine habit than
any other drug habit. Cocaine addicts

generally seek professional help within
two to four years of cocaine use, com-
pared to six years for heroin addicts and
16 years for alcoholics. Hnat adds that
many people define addiction as using
large amounts of a drug on a daily basis,
but it should be viewed in terms of loss
of control of use, compulsive pattern of
use and continued use in spite of ad-
verse consequences.
"Cocaine use isn't
increasing only in other
parts of the country,
it's increasing right here
in our own conimunity."
-Neil Carolan
Director,
Chemical Dependency Program
Hnat was instrumental in beginning
the new Cocaine Treatment Service
at the Health Center as part of the
Outpatient Services of the Chemical
Dependency Program. As the first
comprehensive outpatient treatment
service in the Washtenaw County area
for cocaine-dependent persons, it is
based on a model of treatment he has
used successfully for many years with
other types of chemical dependencies.

Says Neil Carolan, director of the
Chemical Dependency Program, "We
recognized early on the special needs
of cocaine-dependent people, which
spurred development of our Cocaine
Treatment Service. Cocaine use isn't
increasing only in other parts of the
country, it's increasing right here in our
own community."
The Cocaine Treatment
Service
The first phase of the program is a
comprehensive evaluation of the co-
caine user and family to determine the
pattern and history of use. If cocaine
dependency is indicated, the individual
participates in intensive outpatient treat-
ment for one month, four nights a week,
3 hours a night along with those ad-
dicted to other drugs.
The next phase is the cocaine-spe-
cific treatment, in which participants
meet at least once a week individually
with a therapist and once a week in a
group for a minimum of seven months.
For the first half of this phase, as well as
during the intensive one-month outpa-
tient treatment, the focus is on how not
to use cocaine.
"We talk a lot about how to get
through the next day or make it until the
next meeting without using cocaine,"
says Hnat.
continued on page 7

Cocaine
continued
During the last half of this phase,
more attention is paid to interpersonal
relationships. Exercise and nutrition
are also integral components of the
program.
After completing the program, indi-
viduals have the option to continue with
group therapy for another six months
or with individual psychotherapy.
Few drop-outs
Thus far, the retention rate in the pro-
gram is high in comparison to other
cocaine programs. Hnat attributes this
to their strict accountability of patients'
use of drugs and free time. Many cur-
rent patients have unsuccessfully tried
to kick their cocaine habit in other inpa-
tient treatment programs.
Says Glenn Kagan, assistant director
of the Chemical Dependency Program,
"We recognize both the increasing prev-
alence of cocaine use in our community
and the need to focus on the unique
problems and treatment issues of co-
caine users." This commitment has led
to a proposal and recent approval to
conduct research on the use of specific
drugs to reduce cocaine addicts' crav-
ings and their incidence of relapse.
Why cocaine?
Why has cocaine become so popular?
Accessibility is one answer. The price of
cocaine is dropping and, in its crack

form (a distilled form of cocaine that
can be smoked), cocaine sells for as lit-
tle as $5 a pipeful, making it available to
more people. Hnat says they are seeing
more and more adolescents addicted to
cocaine.
But even with its increased availabil-
ity, why are so many people turning to
cocaine despite its risks? Hnat cites the
media as playing a significant role be-
cause of its emphasis on the glamorous
aspects of cocaine, such as the feelings
of increased sexual desire and power.
"Many news stories are about people
who are so different than the average
person that no one can identify with
them," explains Hnat. "So it's easy for
people to deny their problem."
Hnat also believes professionals in all
areas give mixed messages about co-
caine. Some argue that cocaine is not
addictive, but in fact, it is very addictive,
according to Hnat.
"Coke users develop a tolerance for
the drug very quickly," he says. "Because
of that they have to use more and more
to get high." These highs are inevitably
followed by increasingly severe feelings
of fatigue and depression, which often
lead to the person's indulging in alcohol
or other drugs to relieve distress."
Another problem, according to Hnat,
is that some people in the health and
counseling professions are presently
unable to recognize the symptoms of
cocaine use. Withdrawal symptoms in-
clude exhaustion, irritability, sleepiness,
loss of energy and an intense craving for

more cocaine. Long-term complications
run from malnutrition to strokes to hep-
atitis to various psychiatric conditions,
depending on the purity and form of
the drug taken, how it is taken and the
frequency of use. Sexual and physical
abuse may also indicate heavy cocaine use.
For more information about the Co-
caine Treatment Service or to get into
the program, located at Maple Health
Building on the west side of Ann Arbor,
call 662-4610 or check the appropriate
box on the return mail card. If you think
you might have a cocaine problem, you
will be scheduled for an initial evalua-
tion within two or three days of your call.
Says Hnat, "We recognize that gener-
ally when people call, they are in the
middle of a crisis and need help right
away.
Cocaine is a killer. Help is available
to you or your loved ones before it's too
late. Call us now. ED
-Ruth Mlaharg

7