Blog Archive

March is National Nutrition Month Mar 1st, 2023

Today about half of all American adults have one or more chronic diseases, often related to poor diet. The 2015-2020 Dietary Guidelines for Americans emphasizes the importance of creating a healthy eating pattern to maintain health and reduce the risk of disease. Everything we eat and drink—the diet plan we make day...

February is National Heart Health Month Feb 1st, 2023

Heart disease doesn’t happen just to older adults. It is happening to younger adults more and more often. This is partly because the conditions that lead to heart disease are happening at younger ages. High rates of obesity and high blood pressure among younger people (ages 35-64) are putting them...

January is Healthy Resolutions Month Jan 1st, 2023

It is a new year, and that means it's time for a new you! Most people make their midnight toast on New Year's Eve with a resolution in mind. For some people it's about better household budgeting, for others it's quitting smoking, and for even more, it's losing the weight...

Top Strategies to Make the Holidays Healthier Nov 1st, 2022

When you are trying to lose or manage your weight, the holidays can be tough. Tempting foods and social pressure can easily derail your best intentions. Our Health Coaches have shared their favorite strategies for navigating the challenges of the season. Find a few that work for you and you...

Addressing weight regain after bariatric surgery Oct 16th, 2022

Bariatric surgery results in superior short and long-term weight loss outcomes and improvements in obesity-related comorbidities compared to nonā€surgical treatments. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a weight loss expert and offers accurate diagnosis and state-of-the-art weight management including Mounjaro and Wegovy. To learn more, contact the office in Atlanta, Georgia or request...

What Are Anti-Obesity Medications and How Do They Work? Oct 15th, 2022

The magic pill has been the Holy Grail since oral medications were first invented. Imagine taking one pill and waking up the next day completely cured of whatever ails you. While many pills do, in fact, perform small feats of magic in helping us manage medical issues, the overnight sensation...

If It's Not My Thyroid Then What Is It? Oct 15th, 2022

Fatigue, weight gain, mood swings, poor concentration, memory issues, sweating, heart palpitations – your internet search says these are all symptoms of thyroid disease…but what happens when thyroid blood tests are actually normal? At Atlanta Endocrine Associates, Dr. Scott Isaacs is a thyroid expert and offers accurate diagnosis and state-of-the-art treatment. To...

Responding to Women’s World Critics Oct 5th, 2022

Important facts about the Woman’s World Article: I did not know my image would appear on the cover of the magazine. I was not asked to approve the title. I do not approve of the title that appears below my photo. The intent of the article is to debunk false...

Hepatic Hypothyroidism is Not a Thyroid Disorder Sep 26th, 2022

Hepatic Hypothyroidism is not a thyroid disorder. Also known as “intrahepatic hypothyroidism,” it describes the state within an injured fatty liver with dysfunctional thyroid hormone receptors (thyroid hormone resistance) & high reverse T3 from altered expression of deiodinases. Hepatic hypothyroidism can be misdiagnosed as Hashimoto’s or a T-3 conversion problem...

Treatment of Hepatic Hypothyroidism Sep 26th, 2022

Hepatic hypothyroidism is not a thyroid disorder and is not treated with thyroid medications, thyroid supplements, or a thyroid diet. Hepatic hypothyroidism can be misdiagnosed as Hashimoto’s or a T-3 conversion problem by functional medicine leading to these inappropriate treatments. Technically, hepatic hypothyroidism is called intrahepatic hypothyroidism because it defines...

10 Steps to Healing a Hypothyroid Liver Sep 4th, 2022

Hepatic hypothyroidism is not a thyroid disorder. Hepatic hypothyroidism also known as "intrahepatic hypothyroidism" is when an injured fatty liver is resistant to otherwise normal thyroid hormones. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a thyroid and fatty liver expert and offers accurate diagnosis and state-of-the-art treatment of hepatic hypothyroidism. To...

Medical Gaslighting and Hypothyroidism: You May Have Hepatic Hypothyroidism Sep 4th, 2022

Hepatic hypothyroidism is not a thyroid disorder. Hepatic hypothyroidism - also known as "intrahepatic hypothyroidism" - is when an injured fatty liver is resistant to otherwise normal thyroid hormones. Medical gaslighting occurs when hepatic hypothyroidism is misdiagnosed as a Hashimoto's or a thyroid hormone conversion problem by functional medicine. At...

The Thyroid Diet Won’t Help Hepatic Hypothyroidism Aug 26th, 2022

The thyroid diet won’t help hepatic hypothyroidism because it is not a thyroid disorder. In fact, thyroid diets don’t even help people who do have a thyroid disorder because you can’t eat for your thyroid. Hepatic hypothyroidism can be misdiagnosed as a thyroid disorder by functional medicine leading to inappropriate...

Fatty Liver and Your Heart Aug 15th, 2022

Worldwide rates of obesity have reached pandemic levels. Excess body fat, especially belly fat or visceral adipose tissue increases the changes for fatty liver disease also known as non-alcoholic fatty liver disease, or NAFLD. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver expert and offers accurate diagnosis and state-of-the-art treatments. To learn...

ELF is a New Test to Assess Fatty Liver Fibrosis Risk Aug 15th, 2022

The ELF Test stands for Enhanced Liver Fibrosis. This test was approved by the FDA in 2021 as a prognostic test for patients with a progressive form of fatty liver disease known as NASH with advanced fibrosis. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver expert and offers accurate diagnosis and state-of-the-art...

Tirzepatide vs. Semaglutide (Mounjaro vs. Wegovy) Aug 10th, 2022

Many people are asking me what is better for weight loss, Mounjaro (tirzepatide) or Wegovy (semaglutide). Tirzepatide (Mounjaro) is a new medication recently approved for the treatment of diabetes but has not yet been approved to treat obesity (we expect this to come soon.) At Atlanta Endocrine Associates, Dr. Scott Isaacs is...

2022 Update: Medications for Weight Loss  Aug 6th, 2022

Most people who have used medications to help them lose weight report making better decisions about food, thinking about it less, and feeling more in control. These medications work best when you use them with planned meals, exercise, and other healthy behaviors. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a weight...

How to Get Mounjaro (tirzepatide) for $25 Aug 4th, 2022

Tirzepatide (Mounjaro) is a new medication recently approved for the treatment of diabetes, but it has shown incredible results for weight loss, even for people who do not have diabetes. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a weight loss expert and offers accurate diagnosis and state-of-the-art weight management including Mounjaro. To learn more,...

Hepatic Hypothyroidism Aug 1st, 2022

Many people struggle with weight gain, fatigue, symptoms of a thyroid disorder or Hashimoto’s thyroiditis but are told thyroid function is normal. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a hepatic hypothyroidism expert and offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia...

What You Need to Know About Fatty Liver Jul 16th, 2022

Fatty liver or nonalcoholic fatty liver disease (NAFLD) is a disorder in which too much fat builds up in the liver. Nonalcoholic steatohepatitis (NASH) occurs when that extra fat causes inflammation and scarring of the liver. If severe enough, NASH can lead to cirrhosis or liver cancer, potentially requiring a...

Mounjaro Savings Card Help Jul 1st, 2022

Tirzepatide (Mounjaro) is a medication approved for the treatment of diabetes, but it has shown incredible results for weight loss, even in people who do not have diabetes. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a weight loss expert and offers accurate diagnosis and state-of-the-art weight management including Mounjaro. To...

Deciding on a Weight Loss Medication Jul 1st, 2022

The disease of obesity affects more than 93 million Americans and the numbers continue to increase. At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. Many diseases are associated with obesity such as type 2 diabetes,...

How to Get a Prescription for Mounjaro (a.k.a Tirzepatide) Jun 8th, 2022

Tirzepatide (Mounjaro) is a medication approved for the treatment of type 2 diabetes. At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. Even though the approved indication is only for diabetes, newly released research...

Tirzepatide is a New Medication for Diabetes and Weight Loss Jun 7th, 2022

Tirzepatide (Mounjaro) is known as a dual incretin agonist or a “twincreatin” because it works on the receptors for 2 hunger hormones GIP and GLP-1. At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. A study...

My Honor Serving as Medical Reviewer for EndocrineWeb May 1st, 2022

It has been my honor to serve as a medical reviewer for EndocrineWeb since 2017. This website is designed for medical professionals to learn about important topics in the fields of endocrinology, diabetes, metabolism, and obesity medicine. All the content goes through a rigorous, independent medical review process. As an...

Proud to Serve on The Global NASH Council Jan 30th, 2022

It is my honor to have been selected as an endocrinologist to serve on the Global NASH Council, a professional organization composed primarily of hepatologists. It is known that fatty liver disease is the liver manifestation of type 2 diabetes and the metabolic syndrome and that endocrinologists are the front...

Long-term hormonal and metabolic adaptations to weight loss Sep 29th, 2021

Maintaining long-term weight loss through diet and exercise can be nearly impossible, especially for people with severe obesity. At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. Studies have shown that even with intensive behavioral...

7 Steps to Healing a Hypothyroid Liver Sep 1st, 2021

A healthy liver is vital for optimal thyroid hormone function. Follow these 7 steps to cure hepatic hypothyroidism. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver expert and offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. Step 1: Detox and cleanse the...

Semaglutide (wegovy) is now FDA-approved as a weight loss medication Jun 6th, 2021

The long-awaited approval of semaglutide 2.4 mg weekly injection for weight loss has been considered a “game-changer” by obesity experts. At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. This is because the weight loss in clinical...

Plenity is a New FDA Cleared Supplement for Weight Loss Jun 6th, 2021

Plenity is an FDA cleared supplement for weight management made from naturally derived cellulose and citric acid. At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. Three capsules are taken twice a day, 20 minutes before lunch...

Comparing Anti-Obesity Medications Jun 5th, 2021

Medications for obesity management have a long history. Treatments dating back to the 18th century included soap and vinegar mixed with a variety of purgatives. In the late 19th and early to mid-20th century, thyroid hormone, dinitrophenol, and amphetamines were used as treatments until negative side effects became apparent. In...

9 Ways to Stay on Your Diet while Traveling Jan 1st, 2021

Being away from home and your typical routine can present challenges for staying on the diet. That just means it will take a little extra planning to make sure you have what you need to continue losing weight. We have put together some winning strategies that will support your continued...

Resolving to Change? You May Have to Begin Again…and Again Jan 1st, 2021

“I'm going to start saving... meditating... getting more sleep... lose weight.” Each January, many of us resolve to make changes that will improve the quality of our lives in some way.  At Atlanta Endocrine Associates, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia...

How to Stay Motivated through the Tough Times Nov 16th, 2020

Sometimes, you’re on a roll with your diet and exercise/weight loss, but other times… not so much. How do you stay motivated at times like that? How do you stay committed? How do you maintain a sense of control when you don’t see the weight loss you were hoping for...

How Does Having a Fatty Liver Impact Your Health? Oct 1st, 2020

Fatty liver or nonalcoholic fatty liver disease (NAFLD) is a disorder in which too much fat builds up in the liver. Nonalcoholic steatohepatitis (NASH) occurs when that extra fat causes inflammation and scarring of the liver. If severe enough, NASH can lead to cirrhosis or liver cancer, potentially requiring a...

How to Make Healthy Eating Easier Sep 23rd, 2020

At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver and hepatic hypothyroidism expert and offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. How to Make Healthy Eating Easier Wouldn’t it be great if the day you started a diet, you stopped craving...

The 5 Key Components of Setting SMART Goals Sep 2nd, 2020

We’ve probably all said at one time or another “I want weight loss,” “I want to be more active,” or “I’d like to eat better.” So how do you get there? How do you make that thing happen? How do you achieve permanent weight loss? When you set out to...

Do you have a fatty liver? Aug 3rd, 2020

At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver and hepatic hypothyroidism expert and offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online. Do you have a fatty liver? NAFLD (pronounced na-ful-dee) or Non-Alcoholic Fatty Liver Disease is the most common type of...

Stop Relying on Willpower to Lose Weight Jun 1st, 2020

Willpower is a limited resource, but when you’ve got healthier routines, you’ve got something better than willpower. You’ve got skill-power! We all face difficult diet scenarios every day. All it takes is a trip to the office break room to put your entire day’s success in jeopardy! The best way...

Change is Hard – So Let’s Make it Easier! May 1st, 2020

Have you ever thought, “I know what I need to do, I just have to do it!”? Moving from the “knowing” to the “doing” is such a common barrier for all of us because, let’s face it, change is hard. And when it comes to making changes for weight loss?...

Take Control of Your Hunger Hormones to Lose Weight Fast Apr 4th, 2020

Overeating is not due to lack of will power or personal weakness. Overeating is caused by out of control hunger hormones. Trying to control your hunger can be a lot like trying to control your breathing. Yes, you can slow your breathing for a while, but eventually, your biological drive...

Fatty Liver Disease: The Hidden Epidemic Feb 29th, 2020

Nonalcoholic fatty liver disease, or NAFLD (pronounced na-ful-dee) is one of the most widespread and yet frequently underdiagnosed diseases in the United States and worldwide. Fatty liver disease is the number one cause of chronic liver disease in the U.S. and will soon surpass hepatitis C as the top cause...

Your Insider’s Guide to HMR Lingo Feb 15th, 2020

You may have noticed that we use a lot of abbreviations and expressions here at HMR. These language "shortcuts" help to quickly explain some important program concepts so you can easily internalize them. The goal is that they’ll become mini mantras that stick with you. Here’s your Insider’s Guide to...

Belviq Withdrawn from the US Market Due to Potential Cancer Risk Feb 14th, 2020

On February 13, 2020 The U.S. Food and Drug Administration (FDA) requested that the manufacturer of Belviq, Belviq XR (lorcaserin) voluntarily withdraw the weight-loss drug from the U.S. market because a safety clinical trial shows an increased occurrence of cancer with long term use. The drug manufacturer, Eisai has submitted...

HMR Ranked #1 for Fast Weight Loss for Fifth Consecutive Year Jan 7th, 2020

U.S. News & World Report has ranked the HMR program offered at Atlanta Endocrine Associates the #1 Best Fast-Weight Loss Diet for 2020. It’s the fifth consecutive year that HMR’s intensive, yet simple program has held the first-place position. More Speed, More Motivation, More Skills Fast weight loss all comes...

4 Tips for Keeping Your New Year Resolutions Jan 7th, 2020

The New Year often starts with resolutions – we resolve to lose weight, exercise more, eat healthier, or sleep more – but, change is hard. Where do you even begin? We’ve got you covered! Here are our favorite tips for achieving success with your goals: START SMALL: Small Changes Every...

How Much Weight You Can Expect to Lose in HMR if You Stay “In the Box” Oct 1st, 2019

The short answer is you can lose a lot of weight fast. Staying in the box means being fully compliant with the HMR weight loss program. And when this is done, you can expect to have consistent weight loss week after week. The weight loss numbers in the chart below...

The Myth of Slow and Steady Weight Loss Sep 1st, 2019

If you want to lose weight, and you’re thinking that “slow and steady” is the way to go, you’re not alone. When it comes to dieting, many people believe that moderation and balance is a more sustainable approach long term. However, research suggests fast, healthy weight loss can be far...

Why Meal Replacements Work Aug 1st, 2019

Fewer people than ever prepare their own meals at home. And in our busy lives, who can blame us? But let’s consider the consequence of convenience on our collective waistlines: One study concluded that the average restaurant meal in the U.S. had an average of 1,205 calories - for the...

New Meds on the Block Apr 18th, 2019

GLP-1 agonists and SGLT2 inhibitors are among the newest diabetes medications and they do more than just lower blood sugar.   If you have diabetes you are not alone. Type 2 diabetes is one of the top health issues in the United States today. 1.5 million Americans are diagnosed with...

About the HMR Program for Weight Management™ Apr 10th, 2019

Lose weight fast and build healthier routines that last with HMR® (Health Management Resources), a clinically proven diet and lifestyle-change program specially designed to help people who want to lose a lot of weight.   More than just a diet, all-inclusive HMR plans also provide the education, support, and accountability...

Is Your Allergy Medication Making You Gain Weight? Mar 19th, 2019

Allergy season is here. We are experiencing record pollen counts this year and you may be experiencing symptoms like runny nose, sneezing, and watery eyes. Many people treat seasonal allergies with over-the-counter antihistamines, but did you know that these medications could be making you gain weight?  Studies have shown that...

7 Ways to Get Physical Activity Mar 18th, 2019

Physical activity, also known as “exercise” is something that’s easy to miss if any roadblock comes in the way. Everyone knows the health benefits of regular physical activity but making it a daily habit can be a challenge. Find different types of physical activity so that there is always something...

# 1 Again! Jan 2nd, 2019

HMR Named No.1 for Fast Weight Loss for 4th Consecutive Year U.S. News & World Report has ranked the HMR program offered at Atlanta Endocrine Associates the #1 Best Fast-Weight Loss Diet for 2019. (41 different diet plans were evaluated.) It’s the fourth consecutive year that HMR’s intensive, yet simple...

How to Outsmart Food Triggers and Traps Jan 1st, 2019

Let’s face it, changing your eating habits is difficult. And we live in an environment that’s filled with temptations! If you want to have a successful weight loss program, it is important to learn how to outsmart food triggers and traps. If you want to make positive changes that last,...

Decision-Free Meal Replacement Diet Kickstarts Stagnant Weight Loss Dec 28th, 2018

A new study known as the OPTIWIN study found that a decision-free weight loss meal replacement program was an effective intervention providing the current standard-of-care behavior and lifestyle treatment for obesity. A weight-loss program using total meal replacement improved response rate by 60% compared to a standard food-based diet. The...

HMR® at Home Dec 27th, 2018

HMR at Home is a weight loss and lifestyle-change program intended to help you lose weight quickly and keep it off by developing healthy habits that. There are 2 diet plans with weekly group phone coaching and digital coaching through the HMR app. The Digital Healthy Solutions Plan is the...

Mindfulness-Based Eating Helps People Lose Weight Dec 20th, 2018

A new study published in the Journal of Clinical Endocrinology and Metabolism found that mindfulness-based eating helps people lose weight.  The study found that people in an intensive weight loss program who received training on mindfulness-based eating strategies lost more weight than those who did not receive the training. The...

HMR® Digital Weight Loss Plan and Phone Coaching Now Available Dec 12th, 2018

Just in time for January weight-loss resolutions, we are making our intensive “in-person” diet and lifestyle change program available as a digital option, allowing even more people to participate. Using the program developed by HMR, people can now lose weight in person, or on their own from the comfort of...

Yo-Yo Dieting Linked to Increased Risk for Early Death Dec 9th, 2018

A recent study published in the Journal of Clinical Endocrinology and Metabolism has found that yo-yo dieting, or weight cycling, is associated with an increased risk of premature death. The study found that as weight fluctuation increased, the overall risk of death was also increased.  You can read the study...

Thyroid Supplements Can Do More Harm Than Good Aug 24th, 2018

I have seen many patients who take thyroid supplements with the good intention of improving the functioning of their thyroid gland and overall health. Unfortunately, thyroid supplements can have the opposite effect.There are two types of ingredients in thyroid supplements. The first are ingredients that contain iodine. The ingredients listed...

How a Diabetes Medication Became a Weight Loss Medication Jul 16th, 2018

Liraglutide Injection (Saxenda) is the newest weight loss medication on the market today. But this “new” medication has an old history. Liraglutide has been sold under the name Victoza for the treatment of type 2 diabetes for many years. Liraglutide is a synthetic version of the hormone glucagon-like peptide-1 (GLP-1)....

A Diet Plan to Lose Weight Fast Jun 27th, 2018

I am pleased to announce that the HMR Program for Weight Management has been chosen by Reader’s Digest as the top diet plan for fast weight loss.Health Management Resources (HMR) made the top of the list of best diet plans because you can lose up to 66 pounds in 26 weeks...

Consumer Marketing and Obesity Jun 21st, 2018

A new study by the Hudson Institute has evaluated the links between obesity and consumer marketing. The study was the first to investigate the differences in attitudes towards eating, healthy living habits, mindsets, and food buying behaviors in people with obesity and those with normal weight.Important findings of the study:62%...

Very Low-Calorie Diets Can Reverse Diabetes May 27th, 2018

I recently presented research at the 2018 Annual Meeting of the American Association of Clinical Endocrinologists in Boston, Massachusetts demonstrating the benefits of very low-calorie diets (VLCDs).  VLCDs have made a resurgence in the past few years. This is because they can be as effective as gastric bypass surgery for...

Obesity Pharmacotherapy and Alice and Wonderland: Which Cake Will Make You Smaller? May 25th, 2018

At the 2018 annual meeting of the American Association of Clinical Endocrinologists in Boston, Dr. W. Timothy Garvey spoke on strategies for using weight loss medications. Dr. Garvey discussed 4 general principles: Why use weight loss medications? When should weight loss medications be prescribed? What are the therapeutic targets of...

Which HMR diet program is right for you? May 12th, 2018

At Atlanta Endocrine Associates and the HMR Weight Loss Program we are here to help you attain your weight loss goals. But we know that everyone is an individual and what works for one person, may not work for another. HMR has multiple diet options to suit your needs and...

Top Five Reasons Most Diets Fail Apr 17th, 2018

If weight loss was as simple as cutting back on high-calorie foods, more dieters would find success at keeping weight off. Most plans take an approach to dieting that fails to address issues vital to losing weight permanently. Top Five Reasons Most Diets Fail The average person who goes on...

Sweet Tooth Gene Linked to Lower Body Fat Apr 13th, 2018

Researchers from the University of Exeter Medical School in the United Kingdom recently conducted a study looking at sugar cravings and the hormones that are associated with body fat. They analyzed health records, blood samples and genetic information for 450,000 people in the UK. The researchers found that people with a...

What is the best diet for weight loss? Apr 11th, 2018

There is intense debate about what diet is the most effective for weight loss — high protein, low fat or a balanced approach. In fact, there are now dozens if not hundreds of popular diets which are all based on varying amounts and percentages of carbohydrates, proteins and fat. We...

New Research Questions Traditional Treatments for Thyroid Disorders Apr 10th, 2018

Yet another study has found that treating thyroid disorders is not as straightforward as once thought. The latest research by Joseph Meyerovitch, MD, of Schneider Medical Center, Ramat Hasharon, Israel has shown that treating borderline low thyroid levels is associated with increased risk for death in people over the age...

Medical Treatment for Food Addiction Apr 6th, 2018

Several recent studies have elucidated the connection between food addiction and obesity (although normal weight people can also struggle with food addiction). Brain imaging and other studies show the effect of compulsive overeating and reward centers of the brain. The same brain centers that are triggered by cocaine and heroin...