Two reasons quitting smoking is hard

First, this research finding from Yale:

When cigarette smokers first stop smoking the number of nicotine receptors in the brain is significantly higher when compared to non-smokers, which may explain why it is so tough to quit...

Second, the tobacco companies are making it harder for you to quit:

All tobacco brands have been increasing the nicotine dosage in each cigarette steadily during the last six years, says a report from the Massachusetts Department of Public Health. The overall increase has been about 10% during 1998-2004.

Marlboro, the most popular brand, has been steadily raising the dosage in each cigarette. Kool, a popular menthol brand, has had its nicotine dose increased by 20% in six years.

Ethicist says safe-injection sites are obligation

An ethicist speaks up on Vancouver's safe-injection sites:

"In my view it would not be acceptable simply to say 'we don't agree with drug abuse," Somerville said Monday.

"It can't be simply, 'We have a political platform and our platform is nobody is going to be helped in any way in terms of drug addiction behaviour or illness.' That would be wrong in my view."

My impression of the criticism to the safe-injection center is that there are two camps. First, there are those who are indiferent to the fate of addicts and view addiction as a moral failing. The second group (I hope the bigger group.) are concerned about the center as a pessimistic response and wish to see recovery and treatment as the centerpeice of the response to addiction. They want to see more done, not less.

Her statement paints all critics as members of the first camp, unfairly, I think.

"In a lot of the cases we haven't been successful in use reduction," Somerville said. "They're going to use these drugs whether or not we try to stop them. And so the question becomes, 'If that's the case what do we need to do ethically in terms of harm reduction?'"

Haven't we been unsuccessful in harm reduction in a lot of cases? Haven't users of HR services died of their addiction, gotten sick, and made others sick?

Maybe the solution is to provide recovery-focused HR services and increase access to treatment and recovery support services.

NIH Researchers Complete Unprecedented Genetic Study That May Help Identify People Most at Risk for Alcoholism

The human genome mapping project has set the stage for advancing understanding of many illnesses. It's well established through twin and other studies that there are genetic components to addiction. Hopefully this article represents the beginning of similar advances in understanding the multiple genetic factors in addiction.

"Previous studies established that alcoholism runs in families, but this research has given us the most extensive catalogue yet of the genetic variations that may contribute to the hereditary nature of this disease," says NIDA Director Dr. Nora D. Volkow. "We now have new tools that will allow us to better understand the physiological foundation of addiction."

NIDA researchers found genetic variations clustered around 51 defined chromosomal regions that may play roles in alcohol addiction. The candidate genes are involved in many key activities, including cell-to-cell communication, control of protein synthesis, regulation of development, and cell-to-cell interactions. For example, one gene implicated in this study the AIP1 gene is a known disease-related gene expressed primarily in the brain, where it helps brain cells set up and maintain contacts with the appropriate neighboring cells. Many of the nominated genes have been previously identified in other addiction research, providing support to the idea that common genetic variants are involved in human vulnerability to substance abuse.

Relapse often part of alcoholic's recovery

Here's a pretty good article on relapse and addiction as a chronic illness. It manages to avoid the typical "relapse is part of recovery" or "it's a relapsing illness."

Failing the addicted

Here is a tough article on the failure to serve addicts in Victoria, B.C. and a tougher column on the same subject.

These articles could be written about any community in southeastern Michigan.

Here are highlights from both pieces:

The Vancouver Island Health Authority has failed in its responsibility to provide addiction services, we suggested Saturday, and its failures have increased the homeless and panhandling on Victoria's streets...

The Archie Courtnall Centre, where Barale had been based, was opened almost two years ago to provide short-term services for all psychiatric patients needing urgent help. Instead it has been swamped with those struggling with addictions.

Those patients need to be stabilized and then referred to detox and treatment centres. But VIHA has only seven adult detox beds in the capital region, not nearly enough treatment spaces and no supported residential beds to help them stay sober, Barale says. (VIHA plans to open 30 supported residential living beds for people dealing with mental illness and addiction in the region this year.) The critique is damning and credible.

The concerns have all been raised by others, including the terrible cruelty involved in turning away addicts seeking treatment knowing that the result will be continued drug use.

Strung out on cocaine or crystal meth, they pile up in the comfortable waiting room chairs of the new Archie Courtnall psychiatric facility and wait for help.

Psychiatrists say they aren't qualified to deal with these patients' addictions, homelessness or diseases, and can't cope with their numbers. But they don't know what else to do.

"It's unethical to discharge them," Dr. Anthony Barale, departing clinical director of the Archie Courtnall Centre said Wednesday.

With only seven Victoria adult detox beds, which often have a waiting list, Barale said psychiatrists don't have anywhere to send the unexpected flood of addicted people.

When social workers and nurses can't find facilities in town to place the addicted patients, Barale said he just breaks the rules and lets them stay.

"We let them detox here, spend five, six, seven days even though the [four] beds are three-day placements [intended for the mentally ill]."

Sometimes these individuals just sleep or "wear it off" while sitting in the waiting room. Some are put in the facility's two secure rooms designed for mentally ill people who may harm themselves or others.

Rocks and Powder: Will Congress Fix Drug Sentencing?

A few weeks ago I wrote a post about a new bill designed to reduce the disparity between sentences for crack and powder cocaine possession.

Slate.com has a new article that focuses on the inter-branch governmental significance of the legislation. It provides some good background. Here are the highlights:

The 100-to-1 penalty ratio dates from 1986, when lawmakers established mandatory minimum sentences in response to widespread fear of a crack epidemic. For years judges have railed against the heavy crack sentences as unfair, and Congress has considered amending them before. What's different this time is that the judges are doing more than complaining. Seizing on a Supreme Court decision that expanded their discretion over sentencing, judges have justified less harsh punishments for some crack offenders by trumpeting the sentencing scale's many faults. And rather than ignoring the judges or trying to silence them, Congress may actually be listening, for a change...

Federal judges have long blasted the 100-to-1 ratio for punishing street-corner crack peddlers more harshly than major powder traffickers. But the biggest judicial gripe has been that the disproportionate penalties treat African-Americans unfairly. Blacks account for 80 to 90 percent of defendants convicted of crack offenses; whites and Hispanics for more than 70 percent of powder offenders. In 1992, one federal appellate judge said that the 100-to-1 ratio "makes the war on drugs look like a 'war on minorities.' "...

Then last year the Supreme Court issued a blockbuster ruling on sentencing, United States v. Booker. In Booker, the court found that mandatory sentencing guidelines violate a defendant's constitutional right to a jury trial (by requiring courts to assign a sentence based on facts found by judges, after the jury has issued a conviction). The federal sentencing guidelines, mandatory since they went into effect in 1987, became merely "advisory." Many trial judges saw Booker as authorization to renew the attack on the 100-to-1 ratio because of its impact on black defendants...

But three appellate courts around the country have refused to go along. They have thrown out the reduced sentences for crack offenders...

The proposed change to the crack-vs.-powder sentencing scale doesn't reflect a newfound lenient disposition. Recalibrating the 100-to-1 ratio is an easy call because the crack penalties have become an embarrassment. Still, it's nice to see a group of Republican and Democratic lawmakers taking a cue from the judiciary. The legitimacy of both branches is enhanced if they are seen as engaging each other rather than constantly clashing.

If you have any doubts about the importance of the issue, here are some highlights from an earlier post:

• Federal prison inmates whose most serious conviction was a drug crime rose from 4,749 in 1980 to 77,867 in 2004. (1540%) Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics. Available: http://www.albany.edu/sourcebook/ [Retrieved 7/3/05].
  
• State prison inmates whose most serious conviction was a drug crime rose from 19,000 in 1980 to 246,100 in 2001. (1195%) Source: Prisoners in 2002 & Prisoners in 1994, Bureau of Justice Statistics. Available: http://www.ojp.usdoj.gov/bjs/pubalp2.htm#Prisoners [Retrieved 7/3/05]
• Jail inmates whose most serious charge was a drug crime rose from 20,420 in 1983 to 155,249 in 2002. (660%) Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics. Available: http://www.albany.edu/sourcebook/ [Retrieved 7/3/05].
• From 1986 to 1999 the average term drug offenders entering prison could expect to serve rose from an average 30 months to 66 months. (120%) Source: Federal Drug Offenders, 1999 with Trends, 1984-99, Bureau of Justice Statistics. Available: http://www.ojp.usdoj.gov/bjs/abstract/fdo99.htm [Retrieved 7/3/05]

Cutting Alcohol's Cost

From Forbes:

What is striking is that the GWU researchers don't recommend counseling only alcoholics, who require years of treatment, but also people who aren't addicts but simply drink too much.

"Since there are so many more people who drink in hazardous or harmful amounts, about 60% of the costs of alcohol to society are from people who are not dependent," says Eric Goplerud, who heads an alcohol abuse program at GWU called Ensuring Solutions. "There are people who drink even though they have sore stomachs, or drink and get into a fight and get hurt or engage in unprotected sex."

Each year, alcohol abuse costs the United States an estimated $185 billion, according to the National Institute on Alcohol Abuse and Alcoholism. But only $26 billion, 14% of the total, comes from direct medical costs or treating alcoholics. Almost half, a whopping $88 billion, comes from lost productivity--a combination of all those hangovers that keep us out of work on Monday mornings, as well as other alcohol-related diseases.

The distinction that this article makes between dependence and misuse is rare. It's easy to hear reports about substance abuse, drug abuse and alcohol abuse and assume they are talking about addiction. You find the same thing with articles (even research) about co-occurring problems. (Ex. - 20% of people with [fill in the blank] also have alcohol problems.)

There's a big difference! The implications for the cause, pattern, duration and intervention are huge. Keep an eye on those terms and don't make assumptions.

Chanting the mantra of harm reduction

About midway through the International AIDS Conference, Dr. Mark Wainberg, the bookish-looking AIDS scientist from Montreal and the meeting's co-chair, found himself in the thick of a chanting demonstration of prostitutes.

As the sex workers and their supporters, including a statuesque Indian transvestite, shouted out for legalization, Dr. Wainberg shouted along. As they punched the air in defiance, the respected microbiologist punched, too.

At this massive and extraordinary conference, supporting such causes is almost compulsory. As is speaking out for the rights of injection drug addicts, lamenting the plight of the overlooked transsexual and tolerating promiscuity, so long as that multiple-partner sex involves condoms.

I keep telling myself that I will lay off the HR stories for a while, but I can't stop myself from sharing stories like this. This was the International AIDS Conference and it gives an important peek into who drives drug policy discussions. With the drug warriors and these people dominating drug policy discussions, is there any hope?

Recovering people and loved ones of addicts need to step up to promote humane, recovery-oriented policies. I want injection drug user's human rights protected too, but a major component of that would be access to recovery and recovery support services.

Mayor Sullivan Wimps out on Drug Treatment

Finally. Someone calls Vancouver's mayor out on his apparent indifference to recovery.

Here's the mayor's attitude toward addiction recovery:

Now, addicts are like me. [Note: The mayor is quadrapalegic due to a skiing accident when he was 19.] They have a disability. And they will always have this disability. It is a waste of time and money to pretend to them and to ourselves that they will ever change. So what we should do is make them more comfortable! Remove the criminality, give them their drugs and let them choose what they do and want to do next.

Yesterday I posted a link to his comments about responding to street begging:

Because most of the people causing trouble in downtown Vancouver are those with drug addictions, said Sullivan, the backbone of his approach to the problem is innovative approaches to drug addiction.

"We know drug maintenance programs have worked fabulously in other jurisdictions to significantly reduce crime and street disorder," Sullivan said.

You may ask why I care about Vancouver when we live 3000 miles away? Well, Vancouver is seen as an innovator in responding to addiction. Local government officials and activists regularly point to Vancouver as a model for responding to addiction and it's manifestations in the community. Our fear all along has been that we'd experience exactly what is happening in Vancouver. In order to win acceptance of the harm reduction programs, lip service is given to treatment and recovery. Once the HR programs are created, momentum for anything else dies. People begin saying that addiction is an unsolvable problem and now that the once highly visible addicts are out of the community's hair, few people care.

It's not that we oppose HR programs in principle. We'd support recovery-oriented HR programs or programs that espouse gradualism. The biggest barrier is the context of the program. You can't have recovery-oriented HR if there are months long waiting lists for treatment and sober housing.

This was the first article in a three part series. The second shares his experience as the director of a treatment program. The third addresses the barriers to creating new treatment programs in B.C.

Crime, Incarceration and Addiction

Nora Volkow (Director of NIDA) has an Op-Ed in today's Washington Post on crime, addiction and treatment.

Psychiatric News has an article about the sad state of treatment for inmates.

Truth about ecstacy's unlikely trip from lab to dance floor

A history of ecstasy's pharmaceutical development and emergence as a misused substance. Dispells some oft repeated urban legends.

Recovery-Oriented Harm Reduction?

Between the 25 anniversary of AIDS and questions about the future of Vancouver's safe injection center, there are tons of articles on harm reduction lately. There's one characterizing opponents of needle exchanges as indifferent to addict deaths, another finding that a crack paraphernalia distribution program cut disease transmission but increased drug use, another proposing drug maintenance programs as a response to street begging, and a few in support of the safe injection center. (Here, here and here.)

These are just a fraction of the articles that have come through my inbox lately. I was thinking this morning about all of this and was experiencing my usual frustration at the consistent failure to mention recovery and treatment (in that order) in these articles. It occurred to me that the article Jim and I wrote a few years ago was really a call for recovery-oriented harm reduction. This should be non-controversial, no? I suppose that the big point of contention is that we have a big prerequisite--community conditions that support recovery.

Underage Binge Drinking Lowest in Areas of D.C., Detroit, Los Angeles, Utah, Tennessee, Maryland; Highest in Parts of North Dakot

I posted a link to this report recently, but I missed the fact that Detroit is one of the regions with the lowest underage drinking in the U.S.

I wonder how the suburbs fared. If my fuzzy memories of high school are any indication, not well.

Bloomberg Puts 125 Million Dollars Into Anti-Smoking

Michael Bloomberg has already been working to reduce smoking and second hand smoke in NYC by increasing tobacco taxes and implimenting smoking bans. Now he's donating $125 million to reduce smoking.

Illicit drug trade fuelling HIV infections

CTV.ca | Illicit drug trade fuelling HIV infections: expert:

There are also a range of drug rehabilitation programs, notably methadone for heroin users, that have proven successful, he said....

Wodak said the United States has the highest incidence of AIDS in the industrialized world, roughly five times greater than second-place Spain, in part because of its failure to control HIV among injection drug users.

Yet the opposition in the United States prevents these pragmatic approaches being spread throughout the world.

While progress is being made in the fight against HIV/AIDS, the disease is still spreading faster among injection drug users than harm reduction programs needed to slow transmission, he said.

To be sure, harm reduction is one important tool to reduce HIV transmission. However, reading this article would lead one to believe that injection drug use is the leading cause of HIV transmission in the U.S.--not true. Injection drug use accounts for 12% of infections and sex with an injection drug user accounts for 3%.

New Alcohol Test Promises Longer Detection Window -- But Not Precision

This new test could be a very important innovation for monitoring alcohol use. Jim King knows quite a bit about it and I'm sure that he would welcome questions.

Methadone survives four decades of tough politics

This article briefly chronicles four decades of public skepticism about methadone.

Bill White and others have argued that methadone has been a victim of unfair bias. It's hard to argue that they are wrong. However, I don't hear methadone advocates reflect on what criticisms may be legitimate. All critics tend to be characterized as irrational. Too often, particularly in southeastern Michigan, methadone treatment's focus is palliative rather than recovery-focused and therefore contributes to despair and stigma.

Exploring the Link Between Substance Use and Abortion: The Roles of Unconventionality and Unplanned Pregnancy

This is an interesting study and it challenges the stereotype that addicts are irresponsible baby mills. The study appears to find that unplanned pregnancy and abortion are related to "unconventionality" rather than substance use. They found that "unconventionality" was also related to substance use. An example of the saying that "correlation does not equal causation."

Addiction and the DSM-V

The journal Addiction has just released a special issue: Diagnostic Issues In Substance Use Disorders: Refining the Research Agenda--Guest editors: John B. Saunders and Marc A. Schuckit

The issue addresses diagnostic issues/controversies such as the impact of neurobiology, the impact of culture, the DSM vs. the ICD, co-occurring disorders, addiction subtypes, and non-substance "addictions." Lots of fun for addiction geeks!

Any DF staff should let me know if you would like reprints of any of the articles.

READERS RESPOND: War on Drugs (Part 1)

From JTO:

We received an unprecedented number of passionate, thoughtful responses to "Mission Accomplished" in War on Drugs? A representative sampling begins below, the first in a three-part series.

More on the "myth of the addict gene"

A reader comments on my last post:

The anti-disease concept crusaders seem to ignore that environmental/psycho-social influences are proven to change the biochemistry of the brain. E.g. PTSD and sexual abuse have been shown to produce some of the same biochemical markers in the brain nake-up and chemistry that are present in addiction so small wonder there’s a correlation.

A lecturer I heard at a neonatal/pediatric pain management conference I attended a few years is a pioneer in neonatal pain research (Dr. Anand.) In one of his rat studies he demonstrated that rat pups exposed to minor but repetitive pain stimuli (i.e. neonatal stress) had many brain changes and associated behaviors as adult rats. One of the brain changes was a marked increase in the NMDA receptors (know to be associated with addiction as well as ADHD) and one of the behavior changes was a MARKED increase in alcohol preference – from 10% in the control to 90% (or as he put it in his melifluously accented voice, “The rats were really hitting the bottle.”) Sure sounds like a brain phenomena to me, whether it’s environmentally and/or genetically and/or otherwise induced.

There clearly is concensus building about the brain being central to addiction. However, the question that I rarely see address is this--assuming that addiction is a brain problem, are addicts born with a different brain, or is it created by drug use, life experience, etc?

My biggest problem with the trend I addressed in the previous post is the motives of the critics. If you're offended by the war on drugs, attack that. If you want social mores and policy to create space for social drug use, make that case. It's not neccesary to attack the disease model to make their case. (I've got the same problem with people who characterize all excessive drug or alcohol use as a disease.) If they really question the disease model on scientific evidence, by all means, speak up. However, I suspect that too often there are other motives.

AlterNet: DrugReporter: The Myth of an 'Addict Gene'

The alternative liberal media has been running more and more articles like this one about the "myth of the addict gene." I suspect that there the following are at least a few reasons for these criticisms of the disease model, 12 step recovery, and any legal restrictions on drug possession or use:

• First, there is a strong anti-drugwar sentiment. Many of these writers and activists are rightly horrified by the appalling increases in incarceration for drug offenses. They want to shift policy toward harm reduction and decriminalization of drug use and possession.
• Second, there is anger at social mores and drug policy that characterizes all drug use as pathology and/or criminality. I'm of the opinion that they go too far in the other direction and seek to characterize all drug use as a lifestyle choice.
• Third, there is suspicion of 12 step group's spirituality.
• Fourth, there are privacy concerns about all genetic testing.

There's a way in which the article is a straw man argument. I don't know of anyone who argues that there is a single gene that wholly determines whether one becomes an addict. We know from twin studies that genetics play an important role in the etiology of addiction. Evidence that addiction is a brain disease continues to grow, as well as evidence that multiple genes are involved. Even advocates of addiction as a purely biogenic problem would concede that environmental factors influence the onset, course, severity and treatment response of addiction.

Oliver Stone's movie and how the 9/11 rescue really happened

This article about Oliver Stone's 9/11 movie tells an interesting story that didn't make it into the movie. Recovery is everywhere:

Whatever the filmmakers' reasons, they missed one of the more remarkable aspects of this rescue story. Chuck Sereika, a man with no training in collapsed-building rescue and extrication, risked his life that day for men he had never met. Sereika said he was sure he would die when he crawled in. Unlike the police and firefighters who without hesitation sacrificed everything—and I in no way discount their selfless acts—Sereika was not called to duty by his unit. He arrived on his own accord. He was a paramedic, but his license had expired and he had left that life behind as he sought treatment for addiction problems. But he grabbed his medic sweatshirt and his cell phone and headed down to Ground Zero to see if he could apply a few splints or perform minor triage. He never imagined that he would be involved in one of the few and most memorable rescues of Sept. 11.

Substate Estimates from the 2004 NSDUH, SAMHSA Office of Applied Studies

This document looks at drug and alcohol use by 340 regions withing the U.S. I've skimmed it and here are a couple if interesting findings:

• Of the 15 regions with the highest rates of illicit drug use, three are in Michigan.

• The region with the highest percentage of people consuming alcohol is Washington D.C.'s wealthiest ward. (politicians?)

Challenge one: Deciding to fight addiction Challenge two: Paying for it

This is another article in the Silent Treatment series that I linked to earlier this week. This article discusses the erosion of insurance coverage for treatment. Unfortunately, it doesn't address the barriers facing uninsured addicts.

Demystifying CBT: Effective, easy-to-use treatment for depression and anxiety

Here is a good primer on CBT for depression and anxiety.

Checkup System Catches Relapse Early and Facilitates Return to Treatment

This is an important article that supports our approach of maintaining engagement and reconnecting clients with services when it's needed:

Supplementing regular recovery checkups with motivational interviewing and active linking to treatment can get relapsing patients back into treatment sooner and help them stay longer, report NIDA-funded researchers. In the 2 years following treatment, patients who received the additional interventions were three times as likely to reenter treatment as others who received assessments only.

Court-Mandated Treatment Works as Well as Voluntary

Regardless of their impetus for participating in drug treatment—internal drive or external pressure—men had similar outcomes in the long term.

This has been found over and over again. It's a big wrinkle in the idea that treatment needs to be matched to the stages of change.

Nicotine shows promise as treatment against Parkinson's disease

Nicotine may be good for something after all.

Imaging Study May Help Point Toward More Effective Smoking Cessation Treatments

This study may help explain why nicotine has the highest "capture rate" of commonly used drugs.

Results of a new imaging study, supported in part by the National Institute on Drug Abuse (NIDA), National Institutes of Health, show that the nicotine received in just a few puffs of a cigarette can exert a force powerful enough to drive an individual to continue smoking. Researchers found that the amount of nicotine contained in just one puff of a cigarette can occupy about 30 percent of the brain’s most common type of nicotine receptors, while three puffs of a cigarette can occupy about 70 percent of these receptors. When nearly all of the receptors are occupied (as a result of smoking at least 2 and one-half cigarettes), the smoker becomes satiated, or satisfied, for a time. Soon, however, this level of satiation wears off, driving the smoker to continue smoking throughout the day to satisfy cigarette cravings.

Smoking marijuana in public: the spatial and policy shift in New York City arrests, 1992-2003

This article about marijuana arrests in NYC got a lot of attention yesterday. I recently posted a link to an article bemoaning the state of drug policy research. I conceded that it's a problem but argued that it cuts both ways. This paper is an example of that. It is full of speculation and heavily laden with the ideology of the writers.

For example, they seem skeptical of the quality-of-life policing approach in NYC (often referred to as the broken windows model) and equate it with zero-tolerance. This is a pretty reductionist description that is often used by critics and "tough on crime" politicians. The broken windows approach is a policing strategy that strategically focuses on relatively minor, highly visible offences that contribute an atmosphere of disorder (turnstyle jumping, graffiti, prostitution, litter, etc.). The theory asserts that reducing these crimes will result in reductions in more serious crimes. This approach was used in NYC and is credited with huge drops in crime. The approach was adopted by the transit authority in 1990 and then by the NYC police department in 1993, explaining the study's finding that arrest shifted from the transit police to the NYPD. Critics argue that the NYC drops in crime were during a period where crime dropped nationwide and reductions are due to multiple interacting factors rather than one law enforcement approach. Supporters argue that NYC experienced a far larger reduction in crime than other big cities and that the difference is largely due to the application of the broken windows model. Two books that look at the issue from different perspectives are Freakonomics and The Tipping Point.

At any rate, considering the publication and the tenor of the article, I suspect that they authors are advocates of decriminalization and view marijuana use as a lifestyle choice the the government shouldn't interfere with. Reasonable people can disagree on these issues. (Personally, I'm concerned about potential increases in early exposure and applying Budweiser's marketing strategies to newly legalized marijuana.) I'd hope that the kinds of legal penalties that are enforced are relatively mild (fines?) but I also support addressing public consumption of marijuana.

Bill seeks to cut disparity in cocaine case sentences

Four senators have introduced the Drug Sentencing Reform Act of 2006 which would reduce the disparity between mandatory minimum sentences for crack and powder cocaine:

That disparity in federal sentencing guidelines is currently 100-to-1. It would be reduced to 20-to-1 under a measure introduced yesterday by Republican Sens. Jeff Sessions of Alabama and John Cornyn of Texas and Democratic Sens. Mark Pryor of Arkansas and Ken Salazar of Colorado.

They argue that crack is more dangerous and should be more severely punished than powder cocaine:

The crack/powder sentencing disparity -- which has resulted in higher incarceration rates for blacks convicted of drug crimes -- long has been targeted by groups such as the Leadership Conference on Civil Rights and the American Civil Liberties Union.
In 2000, more than 84 percent of those sentenced for crack cocaine distribution were black, while 9 percent were Hispanic and 5 percent were white. By contrast, 30 percent of those sentenced for powdered cocaine were black, 50 percent were Hispanic and 15 percent were white.

The senators are trying to reduce the sentencing disparity between crack and powdered cocaine, but not remove it.

"Crack is a more dangerous commodity," Mr. Sessions said. Although powdered cocaine is usually snorted, crack is usually smoked. Mr. Sessions said crack is more addictive and causes more paranoia and violence than powdered cocaine.

It's good to see the disparity reduced, but maintaining any disparity makes little sense to me. Historically, we know that societal beliefs about which drugs are dangerous are influenced by factors other than science and objectivity.

Road to recovery

This story is part of a collection of articles developed by a program named silent treatment.

It's a public education project that focuses on raising awareness about addiction, treatment and recovery. They have written a series of stories that they are offering to newspapers for publication. Hopefully we'll be seeing more of them.

College Students Play it Safe: New Study Shows Protective Behaviors Reduce Risk of Injury

This study celebrates the fact that a majority of college students employ "protective behaviors"

The NCHA contains a list of 10 potentially protective behaviors, including alternating non-alcohol with alcohol beverages; determining, in advance, not to exceed a set number of drinks; choosing not to drink alcohol; using a designated driver; eating before and during drinking; having a friend keep track of consumption; keeping track of one's own consumption; pacing drinks to one or fewer per hour; avoiding drinking games; and drinking non-alcohol look-alikes.

If someone showed me evidence, I'd be willing to beleive that concerns about binge drinking on campuses may have been hyped in recent years. But show me some numbers that alcohol related harms have been stable or decreased. The use of these protective factors as an indication of the state of campus drinking is pretty underwhelming.

"Mission Accomplished" in War on Drugs?

Seven previous drug czars say that the war on drugs has been won.

Self-medication?

This study looked at sex, drug use and depression in adolescents:

"Overall, sex and drug behavior predicted an increased likelihood of depression, but depression did not predict behavior. Among girls, both experimental and high-risk behavior patterns predicted depression. Among boys, only high-risk behavior patterns increased the odds of later depression. Depression did not predict behavior in boys, or experimental behavior in girls; but it decreased the odds of high-risk behavior among abstaining girls (RRR=0.14) and increased the odds of high-risk behavior (RRR=2.68) among girls already experimenting with substance use"

Fentanyl-Laced Heroin Demand Reduction Forum - ONDCP

Very disappointing. I was pleased to see that the spate of fentanyl ODs prompted a demand reduction forum. From a quick review of the notes, it looks like this focused on fentanyl as a prescription drug (weren't these people heroin addicts?), pharmacology and interdiction. No discussion of the current treatment shortage.

Drugs and prohibition

A commentary on drug policy as a magnet for bad research.
Very true, research on addiction and drug policy does consistently appear to reflect the biases of the writer. This writer focuses on the anti-drug warriors, but the problem clearly runs in both directions and right that the root of the problem is people reductionist approach the problem, usually in a way that's suited to their worldview.

Antidepressant Discontinuation Syndrome

I thought that these articles might be helpful for a lot of you. Both are on "Antidepressant Discontinuation Syndrome." The first is scholarly and the second is a patient handout.

Some skeptical of new anti-drug campaign

This article reports that The Partnership for a Drug Free America has recently started an ad campaign to raise awareness about addiction as a disease and reduce stigma. It's being criticized for characterizing addiction as a disease.

Not a big surprise. The Partnership's message often seems to fuel the drug hysteria that created and maintains the war on drugs. However, this campaign is clearly focused on stigma reduction and appears right on target.

What I found striking in this article was one of the sources of criticism. I expected to see Stanton Peele, he's a frequent, strident and highly visible critic of the disease model. I was surprised to see Ethan Nadelmann from the Drug Policy Alliance, a big advocacy organization that seeks to end the war on drugs be decriminalizing drug use. It is also the country's largest harm reduction advocacy organization. Here's what he says:

"If we define drug addiction as a disease, does that mean that every cigarette smoker has a disease?" asked Ethan Nadelmann, executive director of the Drug Policy Alliance, which seeks to end the war on drugs.

Addiction, Nadelmann said, typically occurs when someone's dependence on a substance causes problems for themselves and others. The line between recreational use and addiction is too open for interpretation in his book.

"Right now some people say one to two drinks a day if you're over 50 is great for the heart," he said. "On the other hand, others say if you need one to two drinks a day, you're addicted."

What reputable expert or organization says that one or two drinks a day means your addicted? What a ridiculous straw man argument! I was surprised to see Nadelmann taking such a public position against the disease model. He usually seems to avoid these issues and sticks to advocating harm reduction and decriminalization. We've always suspected that much of their advocacy work is based on the believe that what we call addiction is really just a lifestyle choice that should be respected.

Recovery From Comorbid Illness More Common Than Expected

Findings from an evaluation of 10-year outcomes show that despite some conventional—and professional—wisdom to the contrary, patients with schizophrenia and substance abuse can recover over time.

Stimulant maintenance is a good beginning

More on the Mayor of Vancouver's proposal to start a stimulant maintenance program.

A new report on ASA discharges

This report provides some analysis of national data about people who left treatment against professional advice in 2003.

Methadone Pioneer Dr. Vincent P. Dole Dies

Methadone pioneer Dr. Vincent P. Dole died this week. It's worth remembering that methadone started out as one component of some comprehensive bio-psycho-social treatment programs. Unfortunately, many (especially in our area) have devolved into dosing clinics that offer no meaningful treatment and no vision of recovery.

Mayor seeks drug maintenance for drug addicts (Vancouver, BC)

The mayor of Vancouver is calling for a stimulant maintenance program. I've heard calls for heroin maintenance programs, but this is the first time I've seen a call from a politician for a stimulant maintenance program.

Vancouver has a "four pillar" response to their drug problem. It's good that they are espousing a comprehensive approach to the problem, but they seem to be much more invested in the harm reduction pillar than the treatment and recovery pillar. These programs are often promote in the name of choice, unfortunately they don't offer any more choices than the abstinence focused programs that they criticize.