Sunday, December 31, 2006

Chocolate and naloxone

I heard about this tonight while watching Super Size Me and immediately looked it up because I was skeptical.

Drewnowski tested the theory on 41 women, bingers and normal eaters. They were offered their favorite foods, from pretzels and jelly beans to chocolate chip cookies and chocolate ice cream. Half received injections of naloxone, a drug used to treat heroin overdoses because it blocks brain opiate receptors. The rest got a placebo of salt water.

Naloxone made bingers eat notably less - 160 fewer calories per meal, Drewlowski reported in the American Journal of Clinical Nutrition. Their chocolate consumption dropped in favor of lower-fat foods like popcorn. When asked to rate their favorite foods again, chocolate dropped.

It makes sense but it sounds too good to be true and I couldn't believe I hadn't heard it before. Here's the original article. It seems that everything discussing the matter points to this single article. Does any one know if it's been replicated?

Friday, December 29, 2006

Fight the stupor: Teen Care takes sobriety to school

A horrible headline but it's interesting that Hawaii has treatment in every high school:

All public high schools and some middle schools in Hawaii have alcohol and drug treatment programs, and the 2005 Legislature provided $1.8 million to expand services to 21 middle schools on Oahu, four on the Big Island and three in Maui County.

...

Keith Yamamoto, chief of the state Health Department's Alcohol and Drug Abuse Division, said funding for adolescent alcohol and drug treatment programs in schools this fiscal year totals $6.5 million, including the new appropriation. Schools receive $10,000 to $90,000 for the program, depending on their size, he said.

Changing tactics: Recovery programs crucial to winning drug war

A Kentucky paper discusses an alternative to the war on drugs:

No one thinks drug abuse is OK. The question is how best to fight it.

There are signs that the answer is shifting toward fighting drug abuse one person at a time, helping users recover, preventing others from getting hooked.

It's slow, it's personal, it's expensive. But without it, history and economics say, we are doomed to failure.

Thursday, December 28, 2006

Vendor's reefer sadness

The LA Times reports on municipalities wrestling with the growth of the medical marijuana trade and how this trade should be conducted:
Kevin Reed launched his medical marijuana business two years ago, armed with big dreams and an Excel spreadsheet.

Happy customers at his Green Cross cannabis club were greeted by "bud tenders" and glass jars brimming with high-quality weed at red-tag prices. They hailed the slender, gentle Southerner as a ganja good Samaritan. Though Reed set out to run it like a Walgreens, his tiny storefront shop ended up buzzing with jazzy joie de vivre. Turnover was Starbucks-style: On a good day, $30,000 in business would walk through the black, steel-gated front door.

Today, the 32-year-old cannabis capitalist is looking for a job, his business undone by its own success and unexpected opposition in one of America's most proudly tolerant places. Critics in nearby Victorian homes called Reed a neighborhood nuisance. Although four of five San Francisco voters support medical marijuana, the realities of dispensing the contentious medicine have proved far more controversial.

It has been 10 years since California approved Proposition 215 — the Compassionate Use Act — becoming the first state to define marijuana as a medicine. The 389-word act aimed to ensure seriously ill Californians the right to use marijuana. But it said nothing about how they might get the drug — and left ample regulatory ambiguity.

Today, about 200,000 Californians have a doctor's permission to use cannabis, which they can obtain through more than 250 dispensaries, delivery services and patient collectives — 120 of them in Los Angeles County alone. Medical marijuana, activists say, has become a $1-billion business.

The impact of alcohol-specific rules, parental norms about early drinking and parental alcohol use on adolescents' drinking behavior

Good news for parents. A new study in the Journal of Child Psychology and Psychiatry and Allied Disciplines finds that alcohol-specific rules and parental alcohol use are related to alcohol use by their children.
Background: The present study explores the role of having rules about alcohol, parental norms about early alcohol use, and parental alcohol use in the development of adolescents' drinking behavior. It is assumed that parental norms and alcohol use affect the rules parents have about alcohol, which in turn prevents alcohol use by adolescent children.

Methods: Longitudinal data collected from 416 families consisting of both parents and two adolescents (aged 13 to 16 years) were used for the analyses.

Results: Results of structural equation modeling show that having clear rules decreases the likelihood of drinking in adolescence. However, longitudinally alcohol-specific rules have only an indirect effect on adolescents' alcohol use, namely through earlier drinking. Analyses focusing on explaining the onset of drinking revealed that having strict rules was related to the postponement of drinking initiation of older and younger adolescents. Further, parental norms about adolescents' early drinking and parental alcohol use were associated with having alcohol-specific rules. Parental norms were also related to adolescents' alcohol use.

Conclusions: The current study is one of the first using a full family design to provide insight into the role of alcohol-specific rules on adolescents' drinking. It was shown that having strict rules is related to postponement of drinking, and that having alcohol-specific rules depends on other factors, thus underlining the complexity of the influence of parenting on the development of adolescents' alcohol use.

Families Against Drug Addiction March Downtown

Mothers appear to be emerging as some of the most visible allies in advocating for treatment, recovery and greater public awareness. There are groups like this popping up all over the country.

Wednesday, December 27, 2006

Join Together's Top Stories of 2006

2006: Year in Review

Parity Doesn't Raise Insurance Costs, Study Says
Mandating that insurance policies treat addiction and mental health on par with other illnesses does not raise health costs according to a comprehensive new study that also found that parity did not result in greater utilization of services when coupled with managed care. 03/31/2006

Study Shows Most Treatment Effective Against Alcoholism
A complex study of alcoholism treatment medications and counseling has found that most standalone and combined therapies were effective in promoting short-term abstinence, with only the drug acamprosate (Campral) proving to be disappointing. 05/05/2006

Town Hall Meetings Tackle Underage Drinking
A series of more than 1,200 town-hall meetings on underage drinking held in late March and April largely succeeded in their main goal of raising community awareness about the problem of youth alcohol use. 05/09/2006

Panel Debates Merits of Age 21 Drinking Law
The proposal to lower the U.S. minimum drinking age from 21 to 18 may be, in the words of New Hampshire State Liquor Commissioner John Byrne -- a 'third rail.' But that doesn't mean that many alcohol sellers, and perhaps some state liquor officials, wouldn't like to see it happen. 06/14/2006

Panel Calls for States to Take Lead on Addiction Policy
Citing the 'almost incalculable' toll that alcohol and other drug addiction takes on society, a Join Together policy panel called on states to take a leadership role in addressing the need for more drug treatment and prevention. 06/26/2006

Mission Accomplished in War on Drugs?
A mostly overlooked newspaper article recounting a recent meeting of seven former U.S. drug czars put forth an interesting proposition: the U.S. war on drugs has already been won. We spoke with three czars who remember the meeting differently. 08/04/2006

Annual National Survey on Drug Use Released
The annual National Survey on Drug Use and Health was released this week and, as usual, whether the report represented good or bad news on drug-use trends largely depends on which statistics you pull from the sprawling findings. 09/08/2006

Medicaid Will Pay for Addiction Screening; Advocates Seek AMA Action, Too
Starting in January 2007, the federal Medicaid program will pay for screening and brief intervention programs for alcohol and other drug addiction. 10/05/2006

Aaron's House: Building a Legacy of Recovery and Hope
Usually, stories like Aaron Meyer's have a sadly predictable arc: A young man or woman gets hopelessly involved with alcohol or other drugs and dies of an overdose, suicide, or in a drug-related accident. Aaron's story, however, is different. 010/27/2006

Ballot Questions: Marijuana Legalization Fails in Colorado, Nevada; Ohio Passes Comprehensive Smoking Ban
Voters from California to Florida made their decisions on ballot questions related to alcohol, tobacco and other drugs, handing a victory to health groups in Ohio on the issue of public smoking and defeating a bid to make Colorado and Nevada the first U.S. states to legalize the possession of marijuana. 11/08/2006

The Case For Lowering Legal BAC Levels Even More
All 50 states, the District of Columbia and Puerto Rico now make it a crime to drive with a blood-alcohol concentration of .08 percent or more. And, a new review of research from around the world makes a case for lowering the limit even more. 11/22/2006

Going for STOP: Congress Passes First Major Underage-Drinking Law
A bill that's being called an important first step towards addressing the national problem of underage drinking was approved by both the U.S. Senate and House this week, and heads to President Bush's desk for approval.12/08/2006

Afghan heroin surge

The LA Times reports that the DEA is denying a surge in heroin from Afghanistan in spite of an internal memo released by Senator Feinstein:
Heroin-related deaths in Los Angeles County soared from 137 in 2002 to 239 in 2005, a jump of nearly 75% in three years, a period when other factors contributing to overdose deaths remained unchanged, experts said. The jump in deaths was especially prevalent among users older than 40, who lack the resilience to recover from an overdose of unexpectedly strong heroin, according to a study by the county's Office of Health Assessment and Epidemiology.

...

According to a Drug Enforcement Administration report obtained by The Times, Afghanistan's poppy fields have become the fastest-growing source of heroin in the United States. Its share of the U.S. market doubled from 7% in 2001, the year U.S. forces overthrew the Taliban, to 14% in 2004, the latest year studied. Another DEA report, released in October, said the 14% actually could be significantly higher.

Poppy production in Afghanistan jumped significantly after the 2001 U.S. invasion destabilized an already shaky economy, leading farmers to turn to the opium market to survive.

Not only is more heroin being produced from Afghan poppies coming into the United States, it is also the purest in the world, according to the DEA's National Drug Intelligence Center.

Despite the agency's own reports, a DEA spokesman denied that more heroin was reaching the United States from Afghanistan. "We are NOT seeing a nationwide spike in Afghanistan-based heroin," Garrison K. Courtney wrote in an e-mail to The Times.

He said in an interview that the report that showed the growth of Afghanistan's U.S. market share was one of many sources the agency used to evaluate drug trends. He refused to provide a copy of DEA reports that could provide an explanation.

The agency declined to give The Times the report on the doubling of Afghan heroin into the U.S. A copy was provided by the office of U.S. Sen. Dianne Feinstein (D-Calif.), a member of the Senate Caucus on International Narcotics Control.

This potent heroin, which the DEA says sells for about $90 a gram in Southern California, has prompted warnings from some officials who deal with addicts that they reduce the amount of the drug they use. Many addicts seeking the most euphoric high employ a dangerous calculation to gauge how much of the drug they can consume without overdosing. An unexpectedly powerful bundle of heroin, therefore, can be deadly.

"I tell people, 'If you're using it, only use half or three-quarters of what you used to,' because of the higher potency," said Orlando Ward, director of public affairs at the Midnight Mission on Los Angeles' skid row.
[via: New Recovery]

Monday, December 25, 2006

IBM Worker Says He Was Fired For Chat Room Addiction

More details about the internet addiction lawsuit that I posted about a couple of weeks ago. Again, this is noteworthy because it looks like the court may weigh in on whether internet addiction is a disability or medical condition that employers need to accommodate.

Long before law, she was face of needle exchange

Good news in New Jersey's new needle exchange law:
The new law includes $10 million to expand drug-treatment options for needle exchange participants.

Sunday, December 24, 2006

Experience Sculpts Brain Circuitry to Build Resiliency to Stress

A sense of mastery (real or perceived) not only affects the response to that stressor, but also future stressors.

It's long been known that experiencing control over a stressor immunizes a rat from developing a depression-like syndrome when it later encounters stressors that it can't control. Now, scientists funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), have unraveled the workings of the brain circuitry that inoculates against such hard knocks – the circuitry of resilience.

Control not only activated the brain's executive hub, the prefrontal cortex, but also altered it so that it later activated even when the stressor was not controllable. This activation turned off mood-regulating cells in the brainstem's alarm center. The immunizing effect was so powerful that even a week later, when confronted with an uncontrollable stressor, the cells behaved as if the stressor was controllable and the rat was protected.

"It's as if the original experience with control leads the animal to later have the illusion of control even when it's absent, thereby producing resilience in the face of challenge," explained NIMH grantee Steven Maier, Ph.D., University of Colorado. "The prefrontal cortex is necessary for processing information about the controllability of stressors as well as applying this information to regulate responses to subsequent stressors."

I wonder if this helps explain two phenomena that we all witness in treatment and recovery:

  • The description of "lack of control over a stressful situation" describes the life of an addict experiencing loss of control. We are all aware of the understandable symptoms of depression and the demoralization in which many people enter recovery. Maybe this explains one of the mechanisms for this depression and one of the mechanisms of the emotional rehabilitation that happens in recovery. We've all heard sponsors and counselors tell newcomers to "do the next right thing" in spite of their fear.
  • Second, I wonder if this helps explain those that appear to be relatively immune to stress. We've all seen addicts who face death and disaster and walk away relatively stress-free. They fail to experience that motivational crisis, "moment of clarity" or deflation necessary to take stock and decide to pursue a radical change in course. Could perceived mastery over early stressful experiences create excessive resiliency?
[via TxDirector.com]

Friday, December 22, 2006

Overall Youth Drug Use Down in 2006, But Survey Sees Trouble Brewing with Inhalants, Prescription Drugs, Smoking

The latest Monitoring the Future drug use survey numbers are out and much of the news is good:

The survey of 50,000 8th-, 10th- and 12th-graders found that the overall percentage of U.S. youths using alcohol or other drugs declined modestly in 2006, continuing a decade-long trend. Since the mid-1990s, past-year use of marijuana has fallen 36 percent among 8th-graders, 28 percent among 10th-graders, and 18 percent among 12th-graders. That led Bush administration drug czar John Walters to cite a "substance-abuse sea change among American teens."

"They are getting the message that dangerous drugs damage their lives and limit their futures," said Walters, director of the Office of National Drug Control Policy (ONDCP).

...

Use of marijuana, the nation's most commonly used illicit drug, has been the main focus of the ONDCP's antidrug media campaign. Not surprisingly, federal officials this week celebrated the fact that past-month use of marijuana reported by MTF survey participants has fallen 26 percent since 2001, from 16.6 percent of teens in 2001 to 12.5 percent in 2006. NIDA Director Nora Volkow called this finding "great news."

Some of the researchers are expressing concern about some of the findings:

The University of Michigan, which produced the report, took a more nuanced view, noting that while there was little evidence of increased drug use, reported overall declines in adolescent drug use were relatively small, and that use of many drugs -- including inhalants, LSD, powder cocaine, crystal methamphetamine, heroin, and club drugs like Ketamine, Rohypnol, and GHB -- did not decline at all.

Lloyd Johnson, Ph.D., principal investigator of the study, expressed particular concern about a decline in perceived risk of using inhalants. Use of inhalants did not increase in 2006, according to the study, but inhalant use has been rising among American youth in recent years. "Perceived risk is often a leading indicator of changes in actual use," said Johnston. "So when we see a change like this, we take it as an early warning of trouble ahead."

Misuse of prescription drugs, which also has risen sharply in recent years, did not increase in 2006, but remained at "unacceptably high levels,"... About 9 percent of 2006 survey respondents said they had used prescription narcotic drugs like OxyContin and Vicodin within the past year, and between 4 and 7 percent of 8th- to 12th-graders said they had used over-the-counter cold medicines -- typically containing dextromethorphan -- to get high.
...

University of Michigan researchers also sounded an alarm about youth smoking, saying the MTF findings indicate that the trend toward lower smoking rates among children in their early and middle teens has ended. While current daily smoking has fallen by half among 12th-graders and more than half among 8th- and 10th-graders since the mid-1990s, no further declines were reported in the 2006 survey among 8th- and 10th-graders (daily smoking declined slightly among 12th-graders, from 13.6 percent in 2005 to 12.2 percent in 2006).

Perceived risk of smoking also has leveled off, which researchers said could be due to slackening public attention and publicity about the dangers of smoking. On the other hand, lifetime use of cigarettes has declined by about half among 8th-graders, by 40 percent among 10th-graders, and by 30 percent among 12th-graders since the mid-1990s. Overall smoking rates among all three grades are at an all-time low, and disapproval of smoking among teens is still rising among teens.


Dynamic Drug Policy

An editorial in the new issue of Addiction questions the static drug policy models that dominate current policy debates:

Drug researchers have long understood that there can be long-term waves of greater and lesser drug use and that upswings can involve epidemic-like spread. These and other dynamics discussed below imply that policy ought to vary over the course of a drug use cycle, but drug policy debates have not yet internalized this perspective.

...

Because drug problems vary in these complex ways, it seems plausible that drug policy should vary over time as well; yet it is rare to hear someone couch their drug policy recommendations in these terms. This is striking and more than a little troubling. It suggests that the mental models guiding policy discussions implicitly superimpose a static framework on an intrinsically dynamic phenomenon, akin to popular nostrums for get-rich-quick investing that never vary even as economic conditions change over the business cycle.

It is not clear why policy is not discussed more often in dynamic terms. Perhaps disciplinary boundaries and stove-piped bureaucracies create single-issue advocacy. Perhaps both the health and criminal justice perspectives favour individual-level analyses. Whatever the reasons for their absence to date, dynamic perspectives on drug policy are, in fact, possible.

What are the policy implications? The author discusses the stage-specific limitations and strengths of several approaches:

Preventing an initiation in the early stages of an epidemic is tremendously valuable, because it short-circuits a chain reaction that would have involved many people. (In technical terms, the reproductive rate at that point would have been large.) However, primary prevention cannot be timed to react to a burgeoning epidemic because of intrinsic lags. For example, the median age of cocaine initiation in the US is 21 years, but students in school-based prevention programmes are younger, often only 13 years old. Therefore, if school-based prevention interventions were to have any hope of affecting cocaine initiation dramatically, the ideal time to have run them would have been in the early 1970s, 8 years before the peak in initiation. However, no one knew in 1970 that there was a cocaine epidemic brewing. Conversely, the vast majority of cocaine consumed from 1985 to 2005 was consumed by people who were already older than 13 years in 1985. For instance, over 85% of people the Treatment Episode Data Set (TEDS) records as receiving treatment for cocaine between 1992 and 2003 were born before 1973. Consequently, prevention programmes initiated around the time the cocaine epidemic became salient could not possibly have had a dramatic effect on use over the next generation, regardless of how effective they were.

Treatment also has limited ability to stave off a burgeoning epidemic, because early in the epidemic most users do not have a treatable medical condition. Precise estimates are not available because population-level estimates of treatment need exist only for recent years, but need for treatment is correlated with average duration of use. In 2003, 39% of respondents reporting past-year cocaine use to the US Household Survey had been using for 10 or more years. In 1979, the peak year for cocaine initiation, that proportion was just 3%. For drugs that are not injected, the role of harm reduction strategies is similarly limited when most users are not experiencing significant harms with their use.

Enforcement's effectiveness at suppressing drug use declines markedly as the size of a drug market grows. However, enforcement has unique ability to focus its effects in both space and time. If a crack house opened next door, neither funding school-based prevention nor additional treatment slots would bring rapid relief. Parking a patrol car in front of the crack house would at least displace the activity. Similarly, assume treatment was five times more cost effective than incarceration at reducing drug use. Incarceration could still be twice as cost effective at reducing drug use this year—because incarceration's effects on drug use are concentrated in the present whereas treatment's effects may be spread over a decade or more. Hence, these models suggest that supply control programmes may have a unique capacity to disrupt the contagious spread of a new drug, but limited ability to eradicate established markets. (Enforcement may also be able to displace established markets into less destructive forms, such as forcing visible street dealing to convert to discreet meetings arranged by cell phone.)

Harm reduction offers particular advantages later in the epidemic cycle, when use has stabilized at high endemic levels. For injectable drugs in countries with low violence and few street markets, harm reduction may focus on syringe exchange programmes, supervised injection rooms and training ambulance crews to treat overdose. For drugs that are not injected and which are supplied through violent street markets, harm reduction may focus instead on using enforcement to target the minority of dealers who cause the greatest social harm. In either case the premise is that, with or without the harm reduction, the flow of new people into problem drug use will be modest, so reducing harmfulness of drug use has few drawbacks. That may not be a safe premise early in an epidemic, when there are feedbacks that can amplify small shocks to the system into dramatic effects on its trajectory.

I'm not sure I agree with the author's assumptions about the strengths and limitations of he various approaches, but he makes a compelling argument:
  • that the static models currently being debated and advanced all have their place in policy;
  • they are all inadequate by themselves;
  • and, that there isn't even a correct formula because the needs, opportunities, crises, etc. are constantly changing.

New Smoking Cessation Resource for Treatment Providers

IRETA just released a new publication called Smoking Cessation Treatment and Substance Use Disorders. It's makes the case for addressing nicotine addiction in treatment and talks about the challenges and offers some strategies for integrating smoking cessation and going tobacco-free.

Wednesday, December 20, 2006

A Complicated Kindness: Vancouver’s Heroin Prescription Trial Raises Research Ethics Concerns

Silly me.

I thought that an op-ed exploring ethical concerns related to an experimental heroin maintenance program may raised questions about the lack of accessible abstinence-based treatment, the palliative approach to a treatable condition, the stigmatization of heroin addiction as untreatable, or, maybe even questions of informed consent for a study offer people with a brain disease their poison.

I was too optimistic. The concerns revolve about the high admission threshold and the time-limited nature of the study--which, actually sounds like a legitimate concern. If you're going to assume the role of supplier, there are some ethical concerns about cutting off the supply.

Treatment response by primary drug of abuse: Does methamphetamine make a difference?

Another study challenges the conventional wisdom that meth addiction is harder to treat than addictions to other drugs.

Biggest U.S. Cash Crop: Marijuana

This report has gotten a ton of press this week. The report says that marijuana follows only corn and soybeans in Michigan with a value of $324 million.

I'll be interested in seeing analysis from disinterested third parties. NORML's interests are obvious and I'm suspicious of the federal estimates that this report is based on due to a history of hyping statistics to shape policy and fight for funding. If the federal estimates are correct, there is almost 1.2 ounces of weed grown for every man, woman and child in the U.S.

Tuesday, December 19, 2006

Sobering Vacation

Expensive, luxury treatment programs are quickly becoming the highest profile treatment programs. This, combined with the Foley/Gibson/Kennedy coverage, is troubling when one considered the historical cycles of public backlash against treatment programs perceived as havens for the rich.
Each sumptuous bed here at a retreat called Promises has been fitted with Frette linens and a cashmere throw. The elongated pool beckons as does the billiard room beyond, tucked into the Santa Monica mountains overlooking the Pacific Ocean.

But not just anyone can come to this exclusive getaway -- and really, not many would want to. Promises is an addiction-treatment center that caters to a mix of celebrities, corporate chiefs, their families and people who want to live like them.

Promises is part of a growing niche in the burgeoning business of addiction treatment: centers that are truly, deeply luxurious. With more than a dozen recovery centers in this seaside village, Malibu has become the center of the high end of the industry -- perhaps logically, given its resort-like location, enclaves of celebrity homes and proximity to Los Angeles, a city whose primary industry is rife with partying and free-flowing cash. California law has helped by allowing rehab centers to be located in residential neighborhoods if they have no more than six beds.

At Renaissance, where a staff of 50 caters to a dozen patients, one bedroom suite for a single resident measures 2,000 square feet -- as big as many three-bedroom homes. Another center, Harmony Place, will supply personal concierges and pedicures if patients ask. A few miles north of Promises on the Pacific Coast Highway, Passages offers surfing instructors. Clients stroll around in swim trunks chatting on cellphones in a sprawling sea-view mansion that is hard to distinguish from a luxury resort.

Brain repairs alcohol damage, scans suggest

More evidence that cognitive functioning improves with abstinence.

Sometimes, the Why Really Isn’t Crucial

Something that I can heartily agree with Sally Satel about. Disease model critic Sally Satel explains that insight is overrated as a path to recovery:

Reconstructing the story of one’s life is a complicated business... What scientists call hindsight bias kicks in when we try to figure out the causal chain of events leading to the current situation. We may well come up with a tidy story but, inevitably, it will contain large swaths of revisionist history. It’s not that we bias ourselves deliberately; it happens because the mind tends to make events in the past appear comprehensible and orderly. We forget the uncertainties that might have beset us as we struggled in real time.

Narratives are shaped also by a natural tendency to focus on information that confirms theories we already hold....

If our own accounts of our actions are often so slanted and embellished, is composing them simply a misbegotten quest? Surely not. To a therapist, the attempt signals that patients are aware that they have a problem worthy of attention. And the narratives themselves can help them make sense out of confusion. This, in turn, can diminish anxiety and exaggerated guilt. Such relief might be sufficient in and of itself for some, or, depending on the goals of therapy, it could embolden a patient to make further healthy adjustments.

But the grail-like search for insight can also backfire when it becomes a way for patients to avoid the hard work of change.
Hat tip: New Recovery

Who's Next: Nora Volkow--Newsweek

Nora Volkow, the Director of NIDA, made Newsweek's Who's Next list for the year. The article gives an overview of her work.

She talks a little about the role of dopamine and the effects of stress on the number of dopamine receptors. When I posted her talk this weekend I forgot to mention this. It provokes some interesting questions about the role of stress in relapse and addiction onset.

Sunday, December 17, 2006

Alcohol Policies Really Matter

Timely commentary on alcohol policy from Join Together. It's concise, so I'm posting the whole thing.
Alcohol Policies Really Matter
December 15, 2006

Commentary
By David Rosenbloom

Today we report on the deadly results of Finland's decision to slash alcohol taxes: after two years, alcohol related illness and accidents have replaced heart disease as the leading cause of death among men aged 18 to 65.

There are other national social experiments that are getting similarly bad results. Pubs and bars in England can now stay open almost around the clock. The resulting violence in many town centers, as drunk young men and women spill into the streets, has become a national scandal.

New Zealand lowered its legal drinking age to 18 a few years ago and watched alcohol-related car crashes and deaths among teenagers increase sharply, reversing years of steady decline.

These are sobering reminders that policies about price and availability of alcohol really matter. When the United States raised the minimum drinking age to 21 between 1981 and 1984, there was an immediate drop in deaths from alcohol related accidents in young people; it has stayed near this lower level for 20 years, saving about 1,000 lives a year. The states with the highest beer taxes have significantly lower rates of teenage binge drinking and associated harms than the states with the lowest beer taxes.

Reasonable laws, effectively enforced, save lives. Poor laws -- such as the ridiculously low alcohol taxes in most U.S. states -- cost lives.

I urge all our readers to send Join Together reports about the mistakes in Finland, England and New Zealand to their state and local leaders, reminding them that they have the power to kill or save young people when they adopt new alcohol policies.

David Rosenbloom is the Director of Join Together.

Cold turkey plan for Scots addicts

The Labour Party in Scotland is rolling out a new drug policy. I've posted several times about their treatment system, which pushes methadone and successfully detoxes very few people.

The new policy has a couple of good points, including abstinence based treatment and accountability for reducing wait times:

One senior Labour figure said: "Our view is that there is a place for methadone but it should not be about people being parked on it and then left for years. There has to be an aim of getting them drug-free. Yes, we will help them but they have got a responsibility. People have just thought up till now that they have a right to methadone and that's it."

The insider added: "We feel very strongly that this agenda has been run by a fairly narrow range of people and not enough attention is being paid to people and their families. It is time to shift the balance away from them".

Justice Minister Cathy Jamieson is understood to be furious over the lengthy wait addicts are being forced to endure in order to get into rehabilitation, and is now pressing Health Minister Andy Kerr to put pressure on health boards.

It also has some points that are less recovery focused, including searching prison visitors and having addicts talk to kids about drug use.

Saturday, December 16, 2006

Drug Addiction: Neurobiology of Disrupted Free Will

Nora Volkow, the Director of NIDA gives a talk about the neurobiology of addiction. (RealVideo)

UPDATE: I watched the entire video and, while it can be a challenge to follow, it is well worth the time. Her talk adds a lot to the brain research of the last decade, presenting a model that includes the cumulative effects of at least three brain areas/functions.
  • The role of the primitive limbic and reward systems in directing survival drives toward drug use.
  • The role of memory circuits in determining the importance/power of the expected reward. She explains the importance of this in development of addiction and relapse. In the context of relapse, she talks about the power that neutral stimuli can have on dopamine levels and activating the limbic system.
  • The role of impairment in the orbital frontal cortex in determining the contextual costs and benefits. This impairment can even tilt the scales toward the reward when it risks survival and competing limbic drives should be protecting the addict. (Explaining the experience of the addict who says "I don't want to do it anymore. I don't enjoy it anymore and I know it's ruining my life. I don't understand why I keep doing it.")
Like I said above, it's well worth the time. She appears to have enough direct clinical experience with addicts that she is able to illustrate the neurobiology with real world clinical examples. Also, On several occasions I recalled Big Book passages that fit perfectly with what Dr. Volkow described.

Hat tip: New Recovery

Friday, December 15, 2006

Alcohol Ban Eyed on N.Y. Commuter Rails

I remember as a kid watching men take the train home from NYC with a Q in a brown paper bag. (I suspect that this was more powerful than any ad.) Those days may be coming to an end.

Virtually Addicted

It appears the courts may weigh in on the legitimacy of "internet addiction."
...cases like Pacenza's, which involve Internet misuse, may no longer be quite so simple, thanks to a growing debate over whether Internet abuse is a legitimate addiction, akin to alcoholism. Attorneys say recognition by a court—whether in this or some future litigation—that Internet abuse is an uncontrollable addiction, and not just a bad habit, could redefine the condition as a psychological impairment worthy of protection under the Americans with Disabilities Act (ADA).

Relapse rates after lung/liver surgery

Two stories about relapse rates following surgery. One about relapse rates following lung cancer surgery:
The U.S. study of 154 smokers who had surgery to remove early stage lung cancer found that, within 12 months after their surgery, 43 percent of them had picked up a cigarette at some point and 37 percent were actively smoking. Sixty percent of patients who started smoking again did so within two months after their operation.
The second reports encouraging numbers about relapse rates following a liver transplant:
During the first year after transplantation, 22% of subjects had at least 1 drink, 10% had at least 1 heavy drinking episode,* and 5% returned to frequent drinking.** By the fifth post-transplant year, 42% had at least 1 drink, 26% had at least 1 heavy drinking episode, and 20% returned to frequent drinking.
Maybe I'm a hypersensitive to stigma, but I wonder is Forbes would have run an article about patient behavior following heart transplants--compliance rates with diet, exercise and medication.

Thursday, December 14, 2006

Drugs: why we should medicalise, not criminalise

This sounds so rational. When you read the whole column, it's also wrapped in the language of social justice. However, her arguments are so flawed that it's difficult to know where to begin.

Of course we should try to get drug addicts off their drugs. It is good that waiting times are now shorter for rehabilitation. But treatment doesn’t work unless users really, really want to give up. And even then, they often relapse because the cravings are so strong. So it is not surprising that enforced treatment and rehabilitation is so unsuccessful. A National Audit Office report on the Government’s Drug Treatment and Testing Order, a court-administered mandatory programme for addicts, found that 80 per cent of offenders were reconvicted within two years.

It is much more sensible to prescribe a maintenance dose for addicts, which they must take under supervision so they cannot sell it on, until they are ready to try to give up. That way, they can attempt to lead a normal life, to refrain from crime, to stay off the streets, even to hold down a job, until they can wean themselves off the drugs.

Among the flawed assumptions are that:

  • addicts don't want help;
  • treatment is only helpful if they're in the "action" or "preparation" stage of change;
  • the failure of their lousy treatment system means treatment doesn't work;
  • legalization would be a panacea for consuming countries and producing countries;
  • crime should be the measuring stick for the effectiveness of drug policy;
  • abstinence focused treatment is ineffective;
  • doing more would be too expensive;
  • we have to choose between legalization and maintenance
I'm struggling to find the words, but I also find it troubling that among some HR advocates there is something resembling a fetishizing of heroin addiction or vicarious derivation of street credibility. While speaking to some harms, they fail to grasp the pain and demoralization that addicts experience when they call it an illness but treat it like a lifestyle choice. Why such half-measures when addiction is concerned? Why is the case for treatment on demand framed as a symptom of some kind of moral panic? I suppose I am guilty of moral alarm at the "suble bigotry of low expectations." (Now, now, principles before personalities.)

Ban may help some butt out

Speaking of prohibition, here are some findings from public smoking bans in the heart of tobacco country:

A new study says anti-smoking laws may make it easier to quit smoking.

The study done by the University of Kentucky College of Nursing showed a 31.9 percent decrease in the number of adult smokers in Fayette County in the months following the April 2004 passage of Lexington's anti-smoking law, from 25.7 to 17.5 percent.

That compared to virtually unchanged rates of smokers in Boone, Kenton and three other Kentucky counties that had no smoking bans. The percentage of smokers remained at 27.6 percent in those counties throughout the course of the study, which looked at Center for Disease Control and Prevention public domain data from 2001 to 2005.

Dr. Ellen Hahn, of the College of Nursing, said researchers expected some decline in Fayette. But "we did not expect this magnitude."

Hahn said the decline in smoking was uniform regardless of economic status.

"Across the board, there were fewer smokers," she said.

Happy anniversary! Alcohol prohibition ended on December 5, 1933 – but could it be effective today?

The American Journal of Public Health ran an editorial on prohibition. Here's a summary:
...prohibitions can be a public health option, but effectiveness might vary depending on the type of banned object or activity and, most importantly, depending on historical context. “Historical context” means that prohibitions could work in one place but not another, in one time but not another, and in one population but not another (Tyrrell, 1997). Blocker argues that for prohibitions to succeed, the aim should not be a legislation of morals and not a regulation of economy, but should be a concern for public health. He argues that prohibitions can succeed when widespread public consensus is behind a prohibition and its enforcement. For example, regarding passive smoking laws or illicit drugs, at least partial prohibitions are in place today and are driven by strong public support. Further, the author explains that qualities of the banned articles (e.g., the conditions of production, the value to an illicit trade, or the ability to conceal the article) will affect the success of prohibitions. Health and social costs but also potential benefits of prohibitions and effects on both the individual and the society at large are important to consider.

Wednesday, December 13, 2006

Speed a promising treatment for ice addiction: expert

More hope and optimism from Australia. About these "hard-core users" for whom there is no "good alternative"--were they ever offered treatment on demand of reasonable intensity and duration?

John Grabowski, from the University of Texas, will be the keynote speaker at a conference in Sydney today on ice use.

Speed, or dex-amphetamine sulphate, poses a high risk of dependency and abuse.

The conference has been called by the NSW Government and is being attended by government representatives from around Australia and international experts.

Dr Grabowski said one of the most promising treatments for ice, or meth-amphetamine - associated with intense violent and psychotic episodes among habitual users - was the drug commonly known as speed. He said dex-amphetamine was already widely used for the treatment of Attention Deficit Disorder and research suggested it could stabilise Ice users.

Dr Grabowksi said that while there were political difficulties in using a legal form of a drug to combat its illegal use, research was showing sufficiently positive results to move forward. Just as methadone, a form of opiate, was used for the treatment of heroin addiction, so the use of speed may become acceptable for the treatment of Ice addiction.

He said there was probably no other way to deal with some hard-core users creating problems for police and hospitals. "There is a population for which I don't see any good alternative," he said.

Tuesday, December 12, 2006

The other war we can't win

Neal Peirce, of the Washington Post Writers Group, weighs in on the war on drugs:
Pick your week or month, the evidence keeps rolling in to show this country's vaunted ``war on drugs'' is as destructively misguided as our cataclysmic error in invading Iraq.

There are 2.2 million Americans behind bars, another 5 million on probation or parole, the Justice Department reported on Nov. 30. We exceed Russia and Cuba in incarcerations per 100,000 people; in fact no other nation comes close. The biggest single reason for the expanding numbers? Our war on drugs -- a quarter of all sentences are for drug offenses, mostly nonviolent.

So has the ``war'' worked? Has drug use or addiction declined? Clearly not. Hard street drugs are reportedly cheaper and purer, and as easy to get, as when President Richard Nixon declared substance abuse a ``national emergency.''

...We'd be incredibly better off if we had treated drugs as a public health issue instead of a criminal issue -- as the celebrated Nobel Prize-winning economist, Milton Friedman, in fact advised us. Friedman, who died last month at 94, witnessed America's misadventure into alcohol prohibition in his youth. ``We had this spectacle of Al Capone, of the hijackings, the gang wars,'' wrote Friedman. He decried turning users into criminals: ``Prohibition is an attempted cure that makes matters worse -- for both the addict and the rest of us.''

...Race remains a disturbing factor: The federal penalty for crack cocaine, favored in poor black neighborhoods, remains 10 times that for regular cocaine, more popular among whites.

...The United States professes values of freedom, tolerance and love for peace. Yet now, in its drug laws, its wholesale incarceration practices and increasingly in its international drug practices, the country lurches in a polar opposite direction.
Consensus appears to be growing that the war on drugs has failed and that explosive growth in incarceration is unacceptable. That seems to be an easy point to make these days. The difficult question is what our policy should look like. There are a lot of options and models--all come with their own advantages and problems. Sweden and the Netherlands have both been pointed to as models and they have radically different approaches to drug policy. Neither is problem-free and neither would satisfy everyone. The question becomes which problems do we want to live with?

Congress raises buprenorphine patient limit

The 2000 legislation that authorized doctors use of buprenorphine for outpatient opiate detox limited doctors to a maximum of 30 patients. Last week, congress passed legislation that would raise the limit to 100 patients. Our own Carl Levin co-sponsored the bill.

Monday, December 11, 2006

Going for STOP: Congress Passes First Major Underage-Drinking Law

The Sober Truth on Preventing (STOP) Underage Drinking Act made it out of conference and has been passed by the House and Senate.
"Passage of the STOP Act represents a long-overdue acknowledgment of the need to do more as a nation to address the harm caused by underage drinking," said George Hacker, director of the alcohol policies project at the Center for Science in the Public Interest (CSPI), a strong supporter of the bill. "Unlike illicit drugs, there has been no credible national plan to combat alcohol problems, by far the greater health and safety drag on our nation. That is a huge gap that must be filled, and the STOP Act is a step in the right direction."

Major provisions of the STOP Act include a $1-million annual national media campaign on underage drinking; $5 million in grants to help community coalitions address underage drinking; $5 million in grant funding to prevent alcohol abuse at institutions of higher education; requiring the Department of Health and Human Services (HHS) to produce an annual report on state underage-drinking prevention and enforcement activities; establishing a federal interagency coordinating committee on underage drinking; and authorizing $6 million for research on underage drinking.

"Congress has never passed a bill on underage-drinking before," David Jernigan, executive director of the Center on Alcohol Marketing and Youth (CAMY) at Georgetown University, told Join Together. "HHS has never been required to keep an eye on the issue to this extent. The annual report will be a great tool and will keep [underage drinking] from falling off the agenda."

Many facets of the bill were based on the recommendations found in the "Reducing Underage Drinking: A Collective Responsibility" report, released in 2003 by the Institute of Medicine and the National Academy of Sciences.

"Through the hard-hitting public-service ads funded under the measure, parents will get a strong message about the dangers of underage drinking," said Rep. Lucille Roybal-Allard (D-Calif.), the lead sponsor of the measure along with Rep. Tom Osborne (R-Neb.).

Hopefully this will have at least some of the intended effects, however that last paragraph about hard-hitting ads makes me cringe. The feds have a well established pattern of investing heavily in ad campaigns that are ineffective and sometimes associated with increased use. We still know little about how to prevent drug and alcohol problems, so I'd expect mistakes. The problem is that they hide these problems and deny they exist. I'd have no problem with ads if they measure their impact, change as needed and learn from their mistakes. Maybe this campaign will be better because it's not being managed by the ONDCP. We can hope.

Treatment and prevention critic/gadfly Stanton Peele offers his view on the new act.

Opiate Addicts Find Fewer Hospital-Run Detox Beds Available

Michigan is not alone in the decline of treatment and detox services:
Addicts who overdose on heroin or other opiates are likely to land first in a hospital emergency room, where doctors can often save them from brain damage or death.

For many of those who want to get clean, the next step is a hospital-run drug detoxification program. There, patients are physically and emotionally prepared to move into a long-term recovery program.

But with fewer detox beds available, some of Long Island's hardest-core opiate addicts are finding it harder to take that crucial step. St. Catherine of Siena Medical Center in Smithtown shut its 12-bed unit in July 2005, and Southside Hospital in Bay Shore shut its 10-bed unit in April.

According to the New York State Office of Alcohol and Substance Abuse Services, these closures followed two others at Long Island hospitals in 2002 and 2003. All told, the number of beds reserved for the sickest addicts has dropped 69 percent in the last four years, from 81 beds in 2002 to just 25 in 2006.

Hat tip - New Recovery

Ice addicts flood injection rooms

A safe injection center in Australia is experiencing unanticipated problems with meth addicts:

Injecting centre medical director Ingrid van Beek said eight per cent of the 220 addicts using the centre each day were injecting ice - more than twice the number 18 months ago.

"Ice changes people's behaviour in such a dramatic way and can be quite scary,'' she said. '

"People become incredibly strong and quite aggressive, and that's what makes the impact of this drug greater.''

Staff had undergone additional training to manage abusive behaviour among ice addicts and to identify the early signs of psychosis, Ms van Beek said.

"Staff have to be aware of how to manage that sort of crisis situation, and our staff are specially trained in that.''

Ms van Beek said that if people showed sings of emerging psychosis, they were counselled and not allowed to enter the centre.

The Sunday Telegraph approached several addicts outside the injecting centre who admitted to using ice inside.

One man said staff did not check the type of drug he injected.

"I just don't tell them. They don't care; they just write you down on a piece of paper,'' he said.

"You just say, `I'm doing hammer (heroin)' and go boom, boom quickly. Just keep it quiet.''

Another addict, calling himself Ace, said: "Hell yeah, bro, it's a proper sealed joint in there with security guards and all. You can do what you want.

"It's amnesty once you cross the door; cops can't touch you.''

A security guard at the Mansions nightclub, across the road, said ice users were often seen stumbling on to the street, drug-fuelled and aggressive.

"They must be on ice - they're screaming and ranting and raving,'' he said.

Sunday, December 10, 2006

Methadone Substitute: New And Cheaper Way To Treat Heroin Addiction

A cheaper and safer alternative to methadone. How does it compare to buprenorphine?
In contrast to methadone --which comes in liquid not tablet form -- dihydrocodeine is much easier to store and comes under less stringent regulations because it is not as toxic and less likely to cause a fatal overdose. It is estimated that whereas methadone treatment can cost almost £1,500 annually per patient, the cost of dihydrocodeine is £713.

Friday, December 08, 2006

Anti-drinking ads: Give it to 'em straight

Snarky commentary on government ad campaigns to discourage alcohol, drug and tobacco use. [Update: Just to clarify. The article may be snarky, but this substance of its criticism is fair.]
...the government's anti-marijuana ads are ineffective and might be making certain teens more likely to use marijuana. A 2002 study, for instance, found, "little evidence the Media Campaign has a direct, favorable effect on youth" and "those who were more exposed to the (ads) tended to move more markedly in a 'pro-drug' direction." More recently, a non-NIDA study by researchers at Texas State University-San Marcos found that college students who viewed the ads developed more positive attitudes toward marijuana than those who did not.

The results are not surprising. Research shows what doesn't work: "Scare-based" tactics, "just say no" platitudes and messages that are over-the-top or do not conform to people's perceptions and experiences. Paternalistic messages trigger rebellion. Repetitious warnings not to use drugs give people the false sense that all their peers are using drugs. And messages that distort the truth cause listeners to reject prevention messages....

In contrast, the anti-smoking "Truth" campaign has been highly successful. The ads don't talk down to teens or even tell them not to smoke. They basically say smoke if you want to, but it's stupid. And you'll have bad breath. And you won't to be able to run without gasping for breath. That's effective. Cornell University's anti-binge-drinking "smart woman" campaign is also promising. It avoids paternalistic messages not to drink and teaches students how to use good judgment and avoid high-risk drinking behavior.

Thursday, December 07, 2006

Study Questions Marijuana As Gateway Drug

Much has been made of this study and, frankly, I don't get it.

I'm no defender of the gateway theory, but this feels like a straw man. First of all, all of the kids in the study were underage. Were gateway advocates arguing that underage tobacco and alcohol use were not troubling?

I guess it does make the case that marijuana deserves no special status over alcohol and tobacco as a danger to kids.

NIDA Meth Report

NIDA recently issued an updated report on methamphetamine. PDF here.

Wednesday, December 06, 2006

"Recovery Impatience"

Let's hope that the concept of "recovery impatience" does not catch on. Keep in mind that this is in the context of a country with a big emphasis on methadone and 60% of the methadone recipients have expressed a preference for abstinence based treatment.

“We are now seeing the emergence of a culture of “recovery impatience”: the demand for people to move quickly to a drug-free lifestyle while denying the significance of other factors – such as low income and life in neglected communities – which make rapid achievement to a drug-free life impossible for the majority,” she said.

“The combination of totally unrealistic expectations, along with the demonisation of drug users, is having a trickle-down effect on practice, with “firmer” responses becoming more acceptable.

“We are in danger of harking back to the days when those seeking treatment were labelled as feckless and chaotic, deemed as having given up their right to be involved in their own treatment or to be treated with the dignity, respect and quality of care afforded other vulnerable groups in society.”

Click here for drug offenders

The latest in stigmatization and bad policy born from meth hype:
"It lets the community know that there’s someone like this in their community, because the likelihood of them going back and doing it again is high," said Georgia state Rep. Mike Coan, who is spearheading meth registry legislation. "It’s no different, really, from the sex offender (registry). If there’s one living near me, I want to know it."

Tuesday, December 05, 2006

Medicaid Plan Prods Patients Toward Health

West Virginia has started a Medicaid plan that will provide penalties for unhealthy behaviors and incentives for health behaviors. (Free registration required. Go to bugmenot for a login if you do not wish to register.)

This is something that I've posted about before (here and here) and we'll probably see more of this approach in the coming years.

Ignoring doctors’ orders may now start exacting a new price among West Virginia’s Medicaid recipients. Under a reorganized schedule of aid, the state, hoping for savings over time, plans to reward “responsible” patients with significant extra benefits or — as critics describe it — punish those who do not join weight-loss or antismoking programs, or who miss too many appointments, by denying important services.

...In a pilot phase starting in three rural counties over the next few months, many West Virginia Medicaid patients will be asked to sign a pledge “to do my best to stay healthy,” to attend “health improvement programs as directed,” to have routine checkups and screenings, to keep appointments, to take medicine as prescribed and to go to emergency rooms only for real emergencies.

“We always talk about Medicaid members’ rights, but rarely about their responsibilities,” said Nancy Atkins, state commissioner of medical services.

...Those signing and abiding by the agreement (or their children, who account for a majority of Medicaid patients here) will receive “enhanced benefits” including mental health counseling, long-term diabetes management and cardiac rehabilitation, and prescription drugs and home health visits as needed, as well as antismoking and antiobesity classes. Those who do not sign will get federally required basic services but be limited to four prescriptions a month, for example, and will not receive the other enhanced benefits.

...the new plan has stirred national debate about its fairness and medical ethics. A stinging editorial in The New England Journal of Medicine on Aug. 24 said it could punish patients for factors beyond their control, like lack of transportation; would penalize children for errors of their parents; would hold Medicaid patients to standards of compliance that are often not met by middle-class people; and would put doctors in untenable positions as enforcers.

“What if everyone at a major corporation were told they would lose benefits if they didn’t lose weight or drink less?” said a co-author of the editorial, Dr. Gene Bishop, a physician at Pennsylvania Hospital in Philadelphia.

Denying mental health aid to those who do not sign seems especially counterproductive, Dr. Bishop said in an interview.

“If you think about the people least able to do simple things like keep appointments and take all their medications,” she said, “people with mental health and substance abuse problems are right up there.”

Reducing substance use improves adolescents school attendance

That reducing substance use improves adolescents school attendance seems obvious, but one of their points about the significance of it isn't:
Because years of completed schooling is highly correlated with long-term social and economic outcomes, the possibility that reductions in substance use may improve school attendance has significant implications for the cost-effectiveness of substance abuse treatment and other interventions designed to reduce adolescents' substance use.

Injection Drug Use Up Among Younger Heroin Treatment Clients

Injection Drug Use Up Among Younger Heroin Treatment Clients

Since 1995, the percentage of primary heroin treatment admissions ages 29 and younger who reported injection as their usual route of administration has increased steadily, from 53% to 72% in 2004.

At the same time, the percentage of older heroin treatment admissions (age 30 and older) who reported injection as their usual route of administration has decreased from 82% in 1992 to 59% in 2004.

One possible explanation for this trend is that younger heroin users perceive less social stigma and/or risk of contracting HIV/AIDS associated with injecting drug use than do their older counterparts.

I find this stigma theory doubtful. I'd guess it has more to do with fluctuations in purity. Prior to 1995, smoking or snorting heroin wasn't much of an option due to low purity--injecting was the only efficient method. As the cut improved in the mid to late 1990's the threshold for heroin initiation dropped when new users could smoke or snort it without violating injection taboos. Those who develop more serious addictions are likely to progress to injection. As purity increased, existing injection user who were less severely addicted or were less price sensitive could switch to lower risk snorting or smoking.

NIDA Identifies Gene Variants Believed to Contribute to Nicotine Addiction

New NIDA nicotine research:
Smoking behaviors, including the onset of smoking, smoking persistence (current smoking versus past smoking), and nicotine addiction, cluster in families. Studies of twins indicate that this clustering partly reflects genetic factors. To identify those genes that could potentially contribute to nicotine dependence scientists combined a comprehensive genome-wide scan with a more traditional approach that focuses on a limited number of candidate genes, using unrelated nicotine-dependent smokers as cases and unrelated non-dependent smokers as controls. A candidate gene has one or more variant forms, which, according to current scientific evidence, appear to be linked to a genetic disease.

“When two teenage friends experiment with smoking at the same age, one can become addicted and the other might not,” says NIDA Director Dr. Nora D. Volkow. “We want to know why. This systematic survey of the genome coupled with the ongoing identification of variants in candidate genes brings us closer to understanding what factors increase a person’s risk of transitioning from experimentation to nicotine addiction.”

Debate on abstinence

A horrifying excerpt from a debate in a British treatment provider magazine. (It's at the bottom of both pages.) I don't completely understand the context--whether they are debating a "motion" in a binding way for the specialty society that publishes the magazine or if it's a devise for a magazine column.

One of the participants proposed that detox is dangerous due to the possibility of reduced tolerance and unintentional overdose in the event of a relapse. Harm reduction advocates used to argue that they represented a needed choice philosophy in working with addicts. The is the worst kind of pessimistic paternalism disguised as compassionate pragmatism--and there's nothing representing real choice.
...Detox can be dangerous and is not very often successful. Death rates are higher in recently detoxed patients.

Many people request detox but we need to recognise that maintenance is a very worthwhile option. Maintenance patients need our support – including psychological support – and harm reduction has to be our goal.

The NTA says rehab providers have to provide mechanisms for rapid referral into maintenance programmes. Getting people off drugs is dangerous.

Bill Nelles,founder of The Alliance,said: ‘Let’s take the morality out of drug treatment and put the humanity back in’. Judy Bury [GP] said it is our job as GPs to keep people alive until they are ready to change.

There’s not much evidence for long-term effectiveness of detox,but it can reduce tolerance. People cannot do abstinence when they walk in the service. The move toward abstinence-based treatment is dangerous and will increase drug-related deaths.

Monday, December 04, 2006

'No-Knock' Drug Raids Challenged After Shooting of Elderly Woman

'No-Knock' Drug Raids Challenged After Shooting of Elderly Woman

The killing of a 92-year-old Atlanta woman during a police drug raid has led to new questions about the practice of "no-knock" raids...Police say the "no-knock" raids -- where police simultaneously announce their presence and break down doors -- are necessary to prevent suspects from destroying evidence. But the tactics have led to a number of innocent homeowners being killed, often after mistaking police for robbers and using a gun to defend themselves.

Johnston was reportedly frightened of intruders, keeping a gun for protection, barring her windows and adding extra locks as drug dealers moved into her neighborhood. The raid was based on a tip from an anonymous informant, who later recanted a statement that he had purchased drugs in Johnston's house.

Her death has led Atlanta officials to weigh the pros and cons of no-knock raids; 50,000 such raids took place last year nationwide, up from 3,000 in 1981. About 40 bystanders have been killed in such raids, the Cato Institute said.

..."The question that society has to answer is: How much risk are we willing to take in order to get violent drug dealers, knowing we're going to make mistakes and shoot innocent people?" said David Moran of the Wayne State University Law School in Detroit.

...About 80 percent of no-knock raids are conducted in drug cases. "A lot of drug-dealing goes on in the African-American community, and most African-Americans would like to see the drug dealers moved," said David Bayley, a criminologist at the University at Albany in New York. "As anybody would, they're against unjustified shootings, but they're not all that opposed to police working in a hard-edged way against people who are destroying their security."

Medical marijuana bill dies

No medical marijuana in Michigan this year.

Children Born to Prenatal Smokers More Likely to Smoke Later in Life

An interesting study from Australia. It would be interesting to see this investigated in the context of an adoption study.
A study of 3,000 mothers and their children found that children of the 1,000 women who smoked during pregnancy were three times as likely to become smokers themselves by age 14. They also were twice as likely to become smokers after age 14.

Thursday, November 30, 2006

Smokers must quit, not cut back

Another reason to quit:
Smokers eager to cut the risk of dying early from tobacco-related illnesses must quit completely, researchers said on Tuesday, because cutting down — even by half — is not enough.
The article contains a sidebar that promotes pharmaceutical smoking cessation treatments only. I also noticed on local news that some of the local smoking Great American Smoke Out events had names like "Don't go cold turkey." These bring to mind post from several weeks ago about a website complaining about the push for NRT.

Ecstasy Can Cause Brain Damage Even After First Use, Study Says

At first glance, this report sounds like a ONDCP press release, but it the researcher's from Amsterdam and it's being presented by a staid medical society. Stereotypes suggest it's credible.

Low doses of the drug were linked to subtle changes in the architecture of brain cells 18 months after first use... While extensive use has already been shown to harm neurons in the brain, causing depression, anxiety and memory loss, this is the first study to identify the risk of brain damage among those who have taken only a few doses.

"We don't know if it's reversible or permanent,'' said Maartje de Win, a radiology resident at the University of Amsterdam, in a telephone interview today. "People should know there might be some consequences for them even after incidental use.''

Problems with 'Addiction Transfer'

This article, along with my earlier post, further illuminate the need for clearer conceptual boundaries for addiction. What are the differences between addictive behavior patterns and compulsive behaviors? How do we know what's secondary to emotional or other problems and what is the result of a primary neurobiological condition causing loss of control? Where does it leave us if brain imaging studies find neurological patterns unique to gamers or frequent tanners?
For an emerging number of weight-loss surgery patients, giving up comfort food means guzzling Southern Comfort. Or hitting the mall instead of McDonald's, even though creditors are calling. Researchers call this behavioral shift "addiction transfer,"...

"The problem is that many people who have surgery haven't been in therapy to address the issues behind their eating disorder," says Kathryn Friedman Sloan, a licensed mental-health counselor in Palm Beach Gardens. "Most of them are emotional eaters, and when you take that away, they're left with 'what do I do with my emotions?' "

An upcoming Bariatric Times article focuses on addiction transfer.

"It's probably been about the last year and a half to two years that it's been coming out in the research," says coauthor Cynthia Alexander, a psychologist at Cleveland Clinic Florida in Weston. "We've started warning people that they have to be on the lookout. I've stepped up what I do in support groups and through education so that this doesn't happen to our patients.

"There are millions of people who've had surgery who are dealing with this and want to bring it to light."

U.S. Myths About Methamphetamine

A good summary of myths about methamphetamine. To my knowledge, this post does a good job presenting the facts. However, it should be remembered that there are smaller regions around the country, often rural, that have been hit very hard by meth. They've had serious increases in crime and burdened their child protective service systems. While the problem is serious and real in these communities, when considered statistically on a national scale, the problem is relatively small. This doesn't mean that it shouldn't be addressed in a serious manner, but it does suggest that there has been a lot of hype.

Diluting addiction

Two more examples of the dilution of the concept of addiction, one with tanning and the other with video games. Further, these are not just using "addiction" in a colloquial way. They're attempting to apply it in a serious, clinical manner.

Online games: Hobby or addiction?

Tanning Addiction:Could people be taking tanning too far?

Wednesday, November 29, 2006

The Weighty Responsibility of Drinking for Two

I've seen several recent articles about drinking alcohol during pregnancy. They've apparently been prompted by sightings of pregnant celebrities drinking. The New York Times runs an article on the subject today. All of the articles I've seen recently present moderate drinking as an increasingly gray area. (Free registration required. Use www.bugmenot.com if you don't want to register.)

Tuesday, November 28, 2006

Recovering Alcoholics With Poor Sleep Perceptions Will Likely Relapse

A study from local researchers. The headline overstates the findings from this 18 subject study. They found that subjective impressions of sleep were better predictors of relapse that objective measures of sleep. Does this suggest that CBT could be an important strategy for treatment complaints of insomnia?

"Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night," said Conroy. "The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking."

"In other words," added Timothy A. Roehrs, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital, as well as professor of psychiatry and neurobehavioral sciences at Wayne State University School of Medicine in Detroit, "alcoholics perceive their sleep is disturbed and that is the reality. The clinician should pay attention to the alcoholic's sleep complaints as the complaint of poor sleep predicts relapse. Previous studies had shown that PSG findings predict relapse; this study now shows a complaint is sufficient."

Drug Addicts in Today's Films Don't Always Find Redemption

Analysis of Hollywood's new spate of addiction movies. They have female central characters, provide no resolution and offer only guarded hope. They're characterized as offering realism. Do they? They definitely offer stories that ring true for some addicted women. However, as the reviewer points out, the films end the recovery narrative at day one. Not a pretty picture and a lot of uncertainty. I suppose real and complete are not the same thing.

Methadone Hydrochloride Public Health Advisory

The FDA issued a Methadone Public Health Advisory about the potential for accidental overdose in pain management patients.

20 Tips to Help You Cope With Holiday Stress Smoke Free

20 Tips to Help You Cope With Holiday Stress Smoke Free:
Fa-la-la-la-ugh! The holiday season is a stressful time of year for most people. For those of us who are working to quit smoking, the holidays can be especially challenging. Use these tips to help you manage holiday stress smoke free...

Bid to End Smoking in House Speaker's Lobby

From Join Together:
With an accelerating national trend to limit indoor smoking, a member of the incoming Democratic leadership in Washington wants to ban smoking in the House Speaker's Lobby...
...Waxman has tried for years to end smoking in the area -- a refuge for House members seeking to avoid the press -- but was always rebuffed by the House GOP leadership. House Majority Leader John Boehner (R-Ohio) often smoked in the lobby.

The House Office Building Commission, consisting of the Speaker, majority leader and minority leader, would have to make the policy change; Boehner will be minority leader in the new Congress.

Only House members are allowed to smoke in the Speaker's Lobby; rooms in the House's Longworth and Cannon office buildings have also been designated as smoking areas. House members also may allow smoking in their own offices and in committee offices.

The District of Columbia recently banned smoking in all public spaces in the city, but Congress is exempt from the law.

When Don’t Smoke Means Do

When Don’t Smoke Means Do - New York Times:
Philip Morris has adopted the role of good citizen these days. Its Web site brims with information on the dangers of smoking, and it has mounted a campaign of television spots that urge parents, oh so earnestly, to warn their children against smoking. That follows an earlier $100 million campaign warning young people to “Think. Don’t Smoke,” analogous to the “just say no” admonitions against drugs.

All this seems to fly against the economic interests of the company, which presumably depends on a continuing crop of new smokers to replace those who drop out or die from their habit. But in practice, it turns out, these industry-run campaigns are notably ineffective and possibly even a sham. New research shows that the ads aimed at youths had no discernible effect in discouraging smoking and that the ads currently aimed at parents may be counterproductive.

...The most exhaustive judicial analysis of the industry’s tactics, by Judge Gladys Kessler of the Federal District Court for the District of Columbia, concluded that the youth smoking prevention programs were not really designed to effectively prevent youth smoking but rather to head off a government crackdown. They are minimally financed compared with the vast sums spent on cigarette marketing and promotion; they are understaffed and run by people with no expertise; and they ignore the strategies that have proved effective in preventing adolescent smoking. The television ads, for example, do not stress the deadly and addictive impacts of smoking, an emphasis that has been shown to work in other antitobacco campaigns.

Sunday, November 26, 2006

Two responses to heroin prescription in England

First, The Sunday Times ran an Op-Ed proposing that the real solution to the drug problem is to legalize drugs. He makes a strong case that Britain's war on drugs is failing but it's hard not to believe that he's hyping the danger posed by addicts under current drug policy (stabbings and murders). He also threw in this point about Britain trying to do treatment on the cheap:
Roberts pointed out that the much vaunted treatment by methadone substitution has not worked, with a cure rate of barely 3%. Since local authorities must pay for treatment from their discretionary budgets, they are going for the cheaper methadone substitution option, as result of which more costly residential places in heroin treatment centres lie empty. Yet to the nation the latter programme, costing £12,000 a place but with a success rate of more than a third, is far better value for money.
One of the problems with many of these arguments is the failure to acknowledge the problems associated with major changes in drug policy. There appear to be serious problems and shortcomings in every drug policy, the real question is which problems societies are willing to live with.

Next, The Scotsman runs an Op-Ed arguing that while heroin prescription may be financially seductive, it amounts to giving up on addicts. She goes further, suggesting that "the move would be aimed at providing relief not so much to the heroin addicts themselves as to the beleaguered communities who bear the brunt of their habit" and wondering "By so cynically presenting the prescription of free heroin in terms of profit and loss, aren't we reducing human life to an exercise in accounting?" She also wonders what might happen if the country seriously invested in treatment.

Saturday, November 25, 2006

Heroin Prescription in England

Here are a threesome of articles (here , here and here)about a push for heroin prescription programs in England.

Two things are striking to me. First, the focus of the advocates is almost entirely on crime reduction with a little lip service to the needs of addicts. They also make difficult to believe claims about heroin addicts criminal activity. Suggesting that your average heroin addict makes £45,000 through crime to feed his/her habit and commits an average of 432 crimes to do so. That's $87,000. If you assume that they spend 80% of their income on heroin, they'd make almost $109,000 a year. Not too shabby. Another states that an addict using £100 of heroin a week generates £150,000 of criminal activity per year, that's $290,000.

Second, they repeatedly refer to this as "treatment." You may be able to make the case for that term, but palliative care seems more appropriate. The implication is pretty clear, they are on the addict equivalent of hospice. They've been diagnosed as incapable of recovery.

It's also worth mentioning that the U.K. relies heavily on methadone for treatment. A Scottish study recently found that a large majority of the addicts receiving methadone would have preferred to be receiving abstinence focused treatment.

Thursday, November 23, 2006

Disclosure Of Advertising Tactics Reduces Odds Kids Will Drink

This study suggests that kids will be less likely to drink if they're taught about the motives and tactics of alcohol advertisers. It's an interesting approach--nobody likes to be played. However there's a big leap between 6th graders (Alcohol use is still a hypothetical for most of them). filling out a questionnaire a short time after five consecutive days of instruction (Sounds a little like a quiz, where a kid might be inclined to give the correct answer.) and their choices 4 and 5 years later. Hopefully they do some long-term follow up.

Recovery Kentucky Update

Republican Kentucky Governor, Ernie Fletcher, started an initiative called Recovery Kentucky that will create 10 regional centers to serve homeless addicts and alcoholics. The centers include a damp shelter, a detox, treatment and transitional housing. They just broke ground on another new center. This one is for women only. All of the centers are based on The Healing Place or The Hope Center.

Wednesday, November 22, 2006

Prescription Opioid Abuse More Prevalent Than Heroin, Canadian Study Reveals

Prescription Opioid Abuse More Prevalent Than Heroin, Canadian Study Reveals:
A new study conducted in seven Canadian cities reveals that prescription opioids, and not heroin, are the major form of illicit opioid use. These findings raise questions about the current focus of Canada's drug control policy and treatment programs.

Should lottery tickets carry addiction warnings?

Should lottery tickets carry addiction warnings?:
Imagine buying a lottery ticket stamped with the words: 'Warning: Gambling can lead to a dangerous addiction that can harm your relationships, work and finances.'

Far-fetched? Perhaps not. An addictions expert at Dalhousie University in Halifax has called on the federal government to put some sort of warning labels on lottery tickets, similar to the ones on tobacco products.

No Proven Programs to Help Teens Quit Smoking, Review Finds

No Proven Programs to Help Teens Quit Smoking, Review Finds:
A large new review of studies on teen-age smoking finds there is no solid evidence about how to help adolescents kick the habit once they have started.

Because one-third of smokers take their first cigarette at age 14 and almost 90 percent before age 21, most previous studies of youth tobacco use have concentrated on prevention, not cessation.

“There is not yet sufficient evidence to test the effectiveness of smoking-cessation programs for adolescents, although some approaches show promise,” according to review authors led by Gill Grimshaw at the University of Warwick in Coventry, England.

Family Docs Join the Drug War

Family Docs Join the Drug War:
In the war on drugs, the White House has tried just about every weapon—punitive policy, rehab programs, ads featuring fried eggs. For its next strike, it has some new recruits: family doctors. Seventeen states currently have simple, federally funded drug-and-alcohol-screening programs in place at major trauma centers. The Office of National Drug Control Policy is now trying to take the idea into general practitioners' offices nationwide.

Do drug warriors really think parents matter?

A libertarian perspective on the ONDCP and teen drug testing:
In September of this year, the House of Representatives did pass the “Student and Teacher Safety Act of 2006.” The act mandates sweeping and intrusive federal search policies for local school districts “if the search is conducted to ensure that classrooms, school buildings, and school property remain free of all weapons, dangerous materials, or illegal narcotics.”

The bill would deny certain federal funds (issued under the Elementary and Secondary Education Act of 1965) to localities that fail to implement the mandate, thus forcing school districts to choose between parental involvement in search policies and federal dictates.

As for ongoing disregard for parents, last year John Walters, the federal “Drug Czar,” came to Denver to release the 2006 National Drug Control Strategy, which includes federal grants for random (read coerced) student drug testing.

According to ONDCP, “To allow a potentially drug-using student to join activities that the student finds desirable (sports, chorus, band, driving to school, etc.) with no penalty is to disserve that student and to enable his or her entry into drug use.”

So to federal drug war bureaucrats, a “potentially drug-using student” is any student not yet drug tested by the government. This sends a very powerful message to young people — mainly that before you can engage in “desirable activities” you must first prove your purity to the state through the collection and examination of your urine.