Is the U.S. Government's Quitting Policy Killing Smokers?

A provocative take on the nicotine replacement therapy as a smoking cessation strategy. The website has a strong bias for quitting smoking cold turkey, but this seems well sourced. Well worth the time it takes to read it. I'd love to see a retort. Highlights here:

Surveys from California (2003), Minnesota (2002), Quebec (2004), London (2003), Maryland (2005), UK NHS (2006) and Australia (2006) all report absolutely no advantage for quitters using pharmaceutical quitting aids over cold turkey quitters. In fact, in the Australian study, among patients of 1,000 family practice physicians, cold turkey was twice as effective as NRT or bupropion (Zyban/Wellbutrin).

But how can this be? What about those clinical studies the government and its industry partners cite in support of their 'double your chances' assertion? What Leavitt, Gerberding, Collins and Husten do not mention is that clinical NRT studies were not blind as claimed.

If they haven't read a June 2004 study by Mooney, they should. Mooney reviewed 73 allegedly double-blind NRT studies and declared that the limited number of studies assessing blindness were not generally blind as claimed because 'subjects accurately judged treatment assignment at a rate significantly above chance.' In other words, a significant number of study participants knew whether they were getting a drug or placebo. This knowledge makes suspect any difference in success rates.

NAADAC Rates Lawmakers On Addiction Issues

NAADAC has developed a voter's guide so that you can find out how your elected officials have voted on legislation that impacts treatment and recovery.

Methadone programme fails 97% of heroin addicts - U.K.

From Scotland:

The study, by Glasgow University’s Centre for Drug Misuse Research, has shown that the vast majority of addicts on the £6.5m-a-year heroin-replacement programme are still taking illegal drugs years later. According to the study, which followed 695 drug users from 33 addiction centres across Scotland, 97% were still taking methadone or illegal drugs three years after receiving their first dose.

Neil McKeganey, who led the research, has blamed the programme’s failure on the policy in Scotland, which aims to stabilise addicts’ drug use rather than getting them permanently off drugs, as in England. Methadone treatment is supposed to wean addicts off drugs by slowly decreasing the amount prescribed. However, in some cases drug abusers are kept on a steady dose to avoid a return to heroin once the dosage drops.

Bad news. McKeganey has been an outspoken critic of their methadone programs for some time but I've never seen any accusation that he's cooking his numbers. It's noteworthy that the ir programs appear to be long term detox rather than the U.S. goal methadone maintenance.

New Nonmedical Users of Prescription Pain Relievers Outnumbered New Marijuana Users

SAMHSA reports that:

Misuse of prescription drugs is second only to marijuana as the nation’s most prevalent drug problem, and the annual average number of people using pain relievers non-medically for the first time exceeds the number of new marijuana users according to a study released today by the Substance Abuse and Mental Health Services Administration (SAMHSA). Most young people aged 12 to 17 get these drugs from friends or family members, not the Internet.

The most troubling aspect of this is the fact that prescription opiates are expensive and people who begin to develop problems with them often start using heroin as a less expensive alternative.

Is AA Effective?: Wall Street Journal vs Cochrane Collaboration

STATS.org weighs in on the Wall Street Journal's criticism of the Cochrane Collaboration's recent review of research on 12 step facilitation (TSF). In my opinion, the STATS author has a bias against 12 step recovery and specialty addiction treatment. (I'll acknowledge a bias in favor of both.) Some examples:

• Her statement about 12 step "baggage".
• Her lame attempt at fair criticism. ("Yet it is important not to dismiss 12-step programs entirely.") Why is it necessary to "dismiss" 12-step recovery at all? Can't one affirm the value of other paths to recovery without dismissing 12-step programs?
• Her tendency to link TSF and specialty treatment to Synanon.

She's also a disease model skeptic and has written (here and here) about her negative personal experiences with 12 step recovery (dismissing her depression, pushing religion, etc.) and determination that her addiction was self-medication.

Unfortunately, she's the only journalist I'm aware of that specializes in analyzing addiction treatment and drug policy. Her point of view is valuable, but it's not unbiased.

The Cochrane review is accurate in that studies looking at relatively short term outcomes of various treatment approaches find little or no advantage for one over another. This is important but doesn't paint a complete picture. These studies (as do all treatment studies) focus only on recovery initiation. We know relatively little about recovery maintenance. Study after study finds that 12-step attendance is related to higher rates of abstinence. This could simply be an artifact of motivation, but it's probably much more complicated than that. There's a lot of diversity in treatment quality, intensity, duration, combinations of approaches, etc. There's a shift toward disease management models that will emphasize long term outcomes and recovery maintenance, not just recovery initiation.

We've got a lot to learn, but here's some of what we know:

• Is 12-step effective at initiating recovery? - YES
• Are other approaches effective at initiating recovery? - YES
• Is 12-step involvement associated with maintaining abstinence? - YES
• Are other approaches associated with maintaining abstinence? - I haven't seen the evidence.
• Do 12-step programs work for everyone? - NO
• Does anything work for everyone? - NO
• Are there other paths to recovery? - YES
• Do some people initiate recovery with one approach and maintain recovery by other means? - YES

We should continue to research 12-step recovery and other approaches. Learning more about the factors that contribute to the benefits of 12-step involvement might help in developing recovery maintenance strategies to help people who won't attend 12-step groups or don't benefit from 12-step groups -- and of course, approaches without the "baggage" that troubles the writer.

Computer dusting product changed to curb inhalant abuse

The CBC reports:

An unpalatable additive is being added to computer dusting products in an attempt to discourage aerosol inhalant abuse, a consumer electronics company announced Thursday.

This is interesting because just yesterday I received an email pointing out that youtube.com has a lot of videos of kids using this stuff to get high.

AA and other meetings benefit variety of alcoholics

A PIRE study found that:

Researchers studied 227 recovering alcoholics following treatment, and found that greater attendance of AA or other meetings resulted in improved rates of abstinence or in less intensive alcohol consumption in the event of relapse. These beneficial effects were not influenced by gender, religious preferences, psychiatric disorders or whether the patient had prior attendance at AA or other groups.

Adolescent Brains Are Insensitive To Alcohol For A Short Time, But At Great Cost

Another study on the effects of alcohol on adolescents:

Whereas brain development during adolescence may initially serve to "safeguard" youth from certain effects of alcohol such as intoxication and hangover, it will also likely make them more vulnerable to the longer-term effects of alcohol.

Even though the adolescent brain has the capacity to adapt to an alcohol challenge, this will likely come at great cost as valuable cerebral resources are redirected from the important role of brain development to instead adapting to an alcohol challenge, and then restoring the system back to status quo once alcohol is eliminated or the challenge is removed.

Smoking Cessation Therapy May Be Harmful For ICU Patients

Suprising findings from another new study:

...researchers found that smokers admitted to the ICU who received nicotine replacement therapy (NRT) during their stay had a higher risk of death than smokers who did not receive NRT.

College Kids Choose Adderall over Ritalin for Illicit Use

From a new study:

More than 75% of college students who reported using prescription stimulants illicitly last year chose amphetamine-dextroamphetamine products, like Adderall, over methylphenidate products, like Ritalin. ... the primary motives for illicit use were to enhance academic performance, while less than a third of illicit users intended to get high or experiment with these stimulants. However, alarmingly, approximately 40% of these students had snorted prescription stimulants.

Alcoholism May Cause Decreased Density Of Neurons In The Orbitofrontal Cortex

Another study finds that alcoholism appears to damage a region of the brain that is heavily involved in decision-making processes and emotional and motivational behavior.

Media Rarely Notes When Alcohol Plays Role In Violent Crimes And Accidents

A new study finds alcohol's harms underreported:

While alcohol is linked to 34 percent of motor vehicle accidents, only 12.8 percent of television stories, 19.2 percent of newspaper articles, and 22.2 percent of magazine articles about such accidents mentioned the use of alcohol, the study revealed.

For stories about fatal accidents not involving motor vehicles, alcohol was mentioned in 1.4 percent of television reports, 4.8 percent of newspaper stories and 13.6 percent of magazine articles. However, statistics suggest 31 percent of these accidents involve the use of alcohol.

Estimates suggest alcohol plays a role in 31 percent of homicides, but it is mentioned in only 2.6 percent of television reports, 7.3 percent of newspaper accounts, and 5.6 percent of magazine reports of violent crime, with even lower percentages in the reporting of homicides.

What lifts people out of addiction?

As founder and medical director emeritus of Gateway Rehabilitation Center, Dr. Twerski spoke last month at the center's Recovery Breakfast, on the topic 'Will Chemical Blockers Eliminate the Need for AA?' Here are his comments.

Smokers are ordered to quit if they want surgery

A British health authority is to become the first to penalize smokers by taking them off waiting lists for surgery. The Independent reports.

Pot News

Four recent news items about pot:

• Colorado has a ballot proposition to decriminalize possession of an ounce or less of marijuana. An editorial page makes a case against it.
  
• A medical marijuana advocate talks about medical marijuana's use in California where it has been legal for 10 years.
• A British columnist argues that pot is more dangerous than heroin.
• A reader accuses the above columnist of exaggerating.
  

Statin drugs may protect smokers' lungs

Cholesterol fighting drugs may decrease smokers decline in lung function. But they do not prevent lung cancer.

Cocaine Epidemic Feared As Cocaine Deaths Nearly Double In Florida Over Past 5 Years

Is there going to be a new surge in cocaine use? The description gives the impression that , much like the late 1970s and early 1980s, there's a surge in powder cocaine use among some affluent groups.

Warning over vodka snorting fad

I've heard of putting alcohol in some dark places, but this is the first I've heard of vodka snorting.

Early Use Of Nicotine Could Increase Susceptibility For Life-long Addiction

A new study concludes that early exposure to nicotine may cause brain changes that increase the likelihood of becoming addicted later in life.

There have been a growing number of studies with similar findings, mostly coming out of NIDA. It makes sense and the science seems pretty good, but I have a nagging feeling that this is the gateway theory 2.0. Along these lines, earlier this week I heard these studies invoked by someone making the case for resurrecting D.A.R.E.

Altered Perception Of Reward In Human Cocaine Addiction

A new study identifies a possible neurological mechanism to explain cocaine addiction's power to interfere with rational decision making. Anecdotally, I don't hear stories about heroin addicts giving their car to the dopeman, the way you do about cocaine addicts.

...in one study, subjects were given a monetary reward for their performance on an attention task. Subjects were given one of three amounts (no money, one cent, or 45 cents) for each correct response, up to a total reward of $50 for their performance. The researchers also asked the subjects how much they valued different amounts of monetary reward, ranging from $10 to $1000.

More than half of the cocaine abusers rated $10 as equally valuable as $1000, "demonstrating a reduced subjective sensitivity to relative monetary reward," Goldstein said.

"Such a 'flattened' sensitivity to gradients in reward may play a role in the inability of drug-addicted individuals to use internal cues and feedback from the environment to inhibit inappropriate behavior, and may also predispose these individuals to disadvantageous decisions -- for example, trading a car for a couple of cocaine hits. Without a relative context, drug use and its intense effects -- craving, anticipation, and high -- could become all the more overpowering," she said.

Hail the revelation

The always pithy 12 step and disease model critic, Stanton Peele, weighs in on the celebrity rehab backlash.

Alcoholics Anonymous: It works, even if science is lacking

A smart retort to a study that cast some doubt on the effectiveness of AA.

New Recovery: Acid and Alcohol Don't Mix

This post about the recently published paper on the history of LSD treatment for alcoholism does a great job of summarizing the positive points from another post on the subject by Nick Johnstone.

I posted info on the paper last week and thought hard about posting a link to Nick Johnstone's comments. I decided not to. Not because of his negative comments about AA. Rather, it was this:

...The cure for alcoholism isn't group meetings or drugs: it's for the alcoholic to genuinely want to stop drinking. That's why George Best is dead and I'm still here. Nobody and nothing can stop an alcoholic from drinking except the resolute decision of the individual.

I didn't stop when family, friends, girlfriends, work colleagues, psychiatrists and counselors pleaded with me to get help. I didn't stop when I started spitting up blood, having to leave work early because of the previous night's drinking, when my hands trembled at breakfast, when I started having blackouts or when I started regularly vomiting blood.

No, I stopped when I vomited a scary amount of blood, started hallucinating flocks of blue birds flying around my bedroom after a day and a half without a drink, was shaking head to toe and couldn't stand up because I was so sick. I stopped when I was admitted into A&E at the age of 24 with internal bleeding. I stopped when I found myself lying in a hospital bed, terrified that I was going to die.

Erika Dyck should forget about LSD or any other quick-fix "cures". If an alcoholic doesn't want to stop drinking, then it's a lost cause.

It's my experience that this attitude is common among the general public, pundits, even professional helpers. Worst of all, I hear it frequently from recovering people themselves.

This reasoning suggests that all it takes to recover is a decision. And that when recovery doesn't take root, it's because the decision to quit was never made. By this circular reasoning every addict or alcoholic who continues to use or dies of their addiction, did so only because they did not decide that they'd suffered enough. It inevitably leads to the conclusion that they lack the character to choose to quit.

The reality is that most addicts and alcoholics make genuine decisions to quit regularly. If subjected to a polygraph, they'd pass with flying colors while saying that they want to quit forever. The problem is that, in this area, their will is impaired.

Interview with Antonio Maria Costa, U.N. Drug Czar

Antonio Maria Costa says marijuana, also known as cannabis, is an even bigger threat to society than heroin and cocaine. Video here.

Avoiding potential misuses of addiction brain science

The scientific journal Addiction has an editorial on the potential unintended consequences of addiction brain science. Here are some of the current and potential problems that they identified:

Simplistic interpretations of this model of addiction have been used to justify heroic treatment interventions in the brain's function, such as ultra-rapid opiate detoxification and, recently, neurosurgery for heroin dependence.

If addicts suffer from a brain disease, then it may also be argued that they need to be coerced legally into treatment because they are incapable of acting in their own best interests. Universal childhood vaccination against drugs could come to be seen as a morally justified 'public health' measure to prevent an epidemic of 'chronic brain disease'.

...if genetic and neuroscience research is seen as justifying the view that 'alcoholism' is a categorical disease entity, then one can expect the alcohol industry to argue that social policies should identify the minority of people who are genetically vulnerable to alcohol dependence so that the rest of the population can use alcohol with impunity.

It will also be important to avoid folk genetic understandings of addiction undermining social policies that are effective in reducing drug use, drug-related harm and addiction. Research in behaviour genetics, as well as epidemiology and sociology show that drug use and addiction are affected by social and environmental factors.

...[researchers] need to make clear that addiction is not a Mendelian disorder, i.e. it is not the case that if you have 'the gene' you will become addicted and if you do not then you will not. Instead, addiction is most likely to be a polygenic disorder that results from interactions between the environment and the effects of a large number of genes...

If taken too literally, the 'brain disease' model of addiction may also undermine the capacity of neuroscientists to conduct the type of research on which the model is based. Bioethicists in the United States have argued, for example, that addicts lack the capacity to give free and informed consent to participate in: (1) experimental neurobiological studies of addiction [e.g. using positron emission tomography (PET) scans] that involve giving drugs of dependence to addicts; and (2) clinical trials of injectable heroin as a treatment for opioid dependence.

I share the concerns of the bioethicists mentioned in the article. Experiments involving giving drugs to addicts seem more than a little unseemly and the bar for approving such studies should be very high. There ought to be expectations that the study will provide significant advances in understanding and treating addiction, and the subjects should continuously be given every possible opportunity to recover. (e.g. - Active linkage to high quality treatment even if it disqualifies them as a subject.)

Bar workers show health benefits after smoking banned

New evidence that indoor smoking bans yield significant health benefits:

The non-smoking workers participating in the study filled in questionnaires about their lung symptoms, took lung function tests and gave blood samples.

Before the ban, nearly 80 per cent — 61 people — reported respiratory symptoms such as wheezing, shortness of breath, coughing and phlegm or sensory symptoms such as red eyes and a runny nose.

One month after the ban went into effect, the number reporting such symptoms dropped by about a third, to 41 people...

...After two months of a smoke-free policy, about 47 per cent of participants reported symptoms, down 32 percentage points from when the study began.

Marijuana Campaign Refutes the Drug Czar

Drug Czar John Walters and a decriminalization advocate talk about a ballot initiative in Nevada that seeks to decriminalize possession of marijuana in quantities of less than one ounce.

Personally, I found the decriminalization advocate more credible. I've got serious concerns about decriminalization, but I find the ONDCP's hysteria just as troubling as legalization advocates arguments that it's harmless.

These things should be agreeable to any reasonable person on either side:

* Most people who use marijuana do so without problems.
* Some people will develop a problem. (Again, we tend to focus way too much on the drug when the brain of the user.)
* Early exposure to alcohol and drugs appears to be linked to higher rates of drug and alcohol problems.

Dutch Conservatives Crack Down on Coffee Shops

What impressed me about this article was not that the Dutch government is cracking down on coffee shops. (For the record, I'm agnostic on their drug policy. Sweden and the Netherlands both appear to have found policies that work for them.) Rather, this statement leaped out at me:

For international travelers, Amsterdam has long served as a kind of nirvana. Considered a forward-thinking capital light years ahead of the rest of the world, much of the city's exceptional status is due its coffee shops -- essentially marijuana bars -- where smoking pot is perfectly legal. Coupled with other liberal sex and drug laws that have ensured a level of tolerance no European city can rival, Amsterdam has acted for many as a role model of what an enlightened 21st-century city should be.

"Nirvana"?
"...a forward-thinking capital light years ahead of the rest of the world"?
"...a role model of what an enlightened 21st-century city should be."?

All because of the drug policy that permits the purchase and use of marijuana in coffee shops? I'm afraid that this reveals more about the writer than about Amsterdam. I know a lot of people who love the city for the art, food, history and culture. Some have hit the coffee shops but most are either neutral about those districts or see them as an unfortunate aspect of the city.

For the record, I'm agnostic on their drug policy. I'm no expert on international drug policy, but it's clear that there is no such thing as a perfect drug policy. Both permissive and restrictive drug policies have inherent problem, the question seems to be which problems you're more willing to live with. Sweden and the Netherlands both appear to have found imperfect policies that work for them.

Study offers new hope for kids with fetal alcohol syndrome

Exciting news for kids with fetal alcohol syndrome:

Children with fetal-alcohol brain damage, once thought beyond recovery from their often debilitating condition, can develop at the same level as normal children if they get constant mental stimulation and nurturing in their first two years

Marijuana's active chemical may be Alzheimer's fighter

Marijuana may be helpful in treating alzheimer's:

In lab experiments, investigators from Scripps Research Institute in La Jolla, California, found THC appears to block an enzyme in the brain that causes plaque to form more effectively than approved drugs.

Rehab backlash

There have been several articles and columns lashing out at the apparent cynical use of rehab for scandal management and/or avoidance of accountability. Let's hope it remains limited to the rich and famous.

In Slaying the Dragon, Bill White recounts that in the late 1800's and early 1900's, there was a thriving recovery and treatment movement. One of the factors that led to the demise of this movement was the perception that these facilities were havens for the rich.

Here are just a few (Some may require free registration. Try bugmenot.com if you'd rather not register):

• The Pittsburgh Tribune-Review
• Slate
• The Financial Times
• The Seattle Post-Intelligencer
• The Hill
• The Cleveland Plain Dealer
• The Austin American-Statesman

The New Republic also ran a piece on whether the Foley scandal is bad for alcoholics.

LSD treatment for alcoholism gets new look

Those of you who've read Pass It On will remember that Bill Wilson participated in some of these LSD experiments.

The attempt to replicate the findings sounds like masochism in the name of research:

Published in the Quarterly Journal for Studies on Alcohol, the 1962 study was received with much skepticism. One research group in Toronto tried to replicate the results of the study, but wanted to observe the effect of LSD on the patients in isolation, so they blindfolded or tied up the patients before giving them the drug. Under such circumstances, the Toronto researchers determined LSD was not effective in treating alcoholism.

If you're a DF employee and would like a copy of the article, let me know.

Munchies, Brownies, Eyedrop Shelf Talkers Support Marijuana

Coming to a grocery store near you?

Genetics and Alcoholism

Here's a pair of articles about recent genetic discoveries about genetic factors implicated in alcoholism. (here and here)

'Broken': A Conversation with William Cope Moyers

Here's a William Cope Moyers interview about his new book.

There's growing concern about the glut of recovery memoirs coming out. Do these tell-all memoirs with the Oprah and Larry King rounds improve societal understanding and acceptance or do they come off as self-serving and breed more scorn than empathy? What would be the impact of high profile relapses, especially piled on the heap of politicians and celebrities using addiction, treatment and recovery as part of their image rehabilitation.

The 12 & 12 says, "we couldn't be a secret society, but we couldn't be a vaudeville circuit, either." It feels a little like we may be veering toward the latter.

Below are some of his comments on anonymity:

Q: One of the biggest ideas in the book is your closing notion about Alcoholics Anonymous — and the suggestion that public understanding about addiction might be better if alcoholics were a little less anonymous. Could you explain to our readers a little bit about what you mean by that?

A: I stand up and speak up all the time, and I never do it as a person who is enrolled in or a member of a specific recovery group. I always do it as William Cope Moyers, an addict and alcoholic, who got well because I got four treatments. I believe strongly in the principal of anonymity as it relates to who might be standing up and speaking out. But I do believe as advocates, we can stand up and speak out and still protect that sacred tenet of the anonymity of the 12 steps. Because as I say in the book, I'm in the 12 steps. That's what keeps me sober.

When I stand up and speak out, I never represent AA. I don't speak for AA. But for me not to have mentioned how I recovered today would have been like a long-distance runner not talking about his program of training. So I break my anonymity of the book. . . . Part of my call is to stand up and put a human face not just on the problem , but also the solution, the solution to recovery. To stay underground only (increases) the stigma, and it's a stigma that's allowing people to die.

I couldn't agree more that there is room in the 12th tradition for people to identify as recovering and engage in advocacy, but he really pushes the limits. He also seems to miss that the 12th tradition is as much about the welfare of the individual as it is about the welfare of the fellowship. From the 12 & 12:

...anonymity is real humility at work. It is an all-pervading spiritual quality which today keynotes A.A. life everywhere. Moved by the spirit of anonymity, we try to give up our natural desires forpersonal distinction as A.A. members both among fellow alcoholics and before the general public. As we lay aside these very human aspirations, we believe that each of us takes part in the weaving of a protective mantle which covers our whole Society and under which we may grow and work in unity.

"Diet" cocktails are more intoxicating

There similar reports a couple of months ago, but this one has more specifics:

Blood alcohol levels peaked at around the same time -- 30 minutes after having the drink -- regardless of which mixer was used. The difference, however, was that alcohol levels surged higher with the low-calorie mixer: to 0.05 percent, on average, versus 0.03 percent with the sugar-sweetened mixer.

In some jurisdictions, this would mean the difference between driving legally and driving drunk, according to the study authors, led by Dr. Christopher K. Rayner of Royal Adelaide Hospital.

The difference in peak blood alcohol levels was "striking," the researchers write, and it shows that a drink's alcohol content isn't the only factor people should consider.

Medicaid Will Pay for Addiction Screening; Advocates Seek AMA Action, Too

On its face, this is clearly a good thing. Two big caveats. First, it does nothing about the already detected AOD problems that we see every day. Second, and probably more important, the quote below suggests that this may provide fuel for the current migration from specialty addiction treatment providers to mental health programs:

Goplerud told Join Together that the new codes would be "essential for expansion of SBI in public-sector programs," such as community health centers, Indian Health Service clinics, public hospitals, community mental-health centers, and migrant health centers. "It gives a financial base for the sustainability of these programs,"

Integrating Nicotine Dependence into Treatment: Saving Lives by Treating the 'Other' Addiction

The author does a great job making the case for addressing smoking more aggressively. Any DF employees who'd like to work on this issue should contact me.

Communal Housing Settings Enhance Substance Abuse Recovery

This abstract is very brief, but it reports on the effectiveness of sober housing:

Oxford Houses are democratic, mutual help–oriented recovery homes for individuals with substance abuse histories. There are more than 1200 of these houses in the United States, and each home is operated independently by its residents, without help from professional staff.

In a recent experiment, 150 individuals in Illinois were randomly assigned to either an Oxford House or usual-care condition (i.e., outpatient treatment or self-help groups) after substance abuse treatment discharge. At the 24-month follow-up, those in the Oxford House condition compared with the usual-care condition had significantly lower substance use, significantly higher monthly income, and significantly lower incarceration rates.

B.C. going to pot, study shows

British Columbia has been the North American leader in harm reduction. Is there a relationship to its high rates of marijuana use? I'm not a marijuana alarmist. My biggest concern would be whether they have a declining age of first use of marijuana.

They seem to have categorized addition as a lifestyle choice and publically express pessimism about recovery. Could this combination of policy and attitudes create conditions for increases social drug use? Might this effect be mitigated or eliminated by recovery-focused harm reduction? I suspect so.

Heroin overdoses could increase significantly due to higher Afghan opium crop, UN drugs chief warns

Heroin purity could shoot back up. (No pun intended.)

DNA Highly Promising Predictor For Successful Treatment Of Alcoholics

Another interesting study:

According to Dutch researcher Wendy Ooteman, the biological and genetic characteristics of alcoholics can predict which drugs will best suppress the desire to drink. Naltrexone and acamprosate are drugs that are supposed to suppress the desire for a drink. The researcher investigated which patient characteristics were responsible for predicting the drug that would work best.

The article claims that clinical characteristics are poor predictors of naltrexone/acomprosate response and that biological and genetic factors are better predictors. We'll see. I'm not an expert, but it seems that naltrexone studies most often find a modest response in people with low severity alcohol problems. Acomprosate seems to be less consistent.

What's more interesting is that we may be drifting back toward a typology of addition. This could be good or bad - time will tell.

Schwarzenegger Signs Bill Allowing Shorter Parole in Exchange for Drug Treatment

Another California program to get people into treatment and out of the criminal justice system: (Requires free registration. If you don't want to register, try BugMeNot.)

Hoping to reduce the number of Californians who cycle in and out of prison, Gov. Arnold Schwarzenegger has quietly signed a bill allowing nonviolent ex-convicts to earn their way off parole early by completing an intensive drug treatment program.

It sounds like California is way ahead of the curve, but anecdotal reports from clients suggest that California is way tougher on possession than Michigan.

Helping Smokers Quit: A Role for Smokeless Tobacco?

This paper promoted the use of snus as a form of harm reduction to address the harms associated with smoking.

I felt that three things were striking about the paper:

1. First, it presents harm reduction as late in coming to tabacco related health problems. I've always thought of nicotine replacement (gum, patch, lozenges, inhaler, etc.) as harm reduction and I've always thought of it as one of the leading or early harm reduction successes.
2. Second, it takes a very pessimistic view of smoking cessation.
3. Third, it pits harm reduction against smoking cessation. This stark dichotomy seems unnessesary.

It turns out that the organization has a long history of taking on the tobacco industry, but it also is not the independent body that is claims to be. They accept money from chemical, oil, alcohol and food producers, and their research has a reputation of being favorable to these interests. Is it possible that they've made peace with the tobacco industry?

N.J. moves to end ban on over-the-counter syringes

This article provides a national view of harm reduction efforts focused on HIV/AIDS reduction.

The sidebar table is interesting, but keep in mind that it is AIDS cases, not new HIV infections. In Michigan, in 2004, 12% of new HIV infections were attributed to injection drug use.

Study Offers New Clues To Brain-stomach Interaction In Overeating

New brain research on overeating:

By looking at how the human brain responds to "fullness" messages sent to the brain by an implanted device that stimulates the stomach, the scientists have identified brain circuits that motivate the desire to overeat in the obese -- the same circuits that cause addicted individuals to crave drugs. The scientists have also verified that these circuits play a critical role in eating behaviors linked to soothing negative emotions.

This could be an important finding for people with eating disorders. I have to admit that it makes me a little uneasy. I fear that we may find that these brain differences for various problems are far more common than once thought. I fear first, that the brain science of addiction will be rendered far less persuasive, and second, that the these brain differences will come to be understood as neurobiological adaptations caused by the person's behavior.

Bill White has expressed some anxiety about the field's embrace of genetic causes and NIDA's brain disease push. My impression is not that he has any serious doubts, rather that he's seen too many previous theories crumble as new science emerges. He's also voiced concern about the possibility of genetic screening - that it could lead to discrimination and that screening could be negative for people who've identified themselves as addicted. What would it mean for someone that is sober 20 years to receive a negative genetic screen?

'Lean,' A New Hip High

There's nothing new about lean/barr/purple drank/syrup. People have been misusing codeine for a long time and the resurgence of its use in Houston started in the late 1980s.

What's interesting about this is this "screwed culture", in which codeine cough syrup is central. It has its own music, language, clubs, etc. It has a lot of parallels with the psychedelic acid subcultures of the 60s.

It's a great example of a tribe within the culture of addiction.

Scandal and Rehab

It's too bad that entering addiction treatment has become the standard method for politicians and celebrities to avoid accountability.

Mark Foley, Jason Blair, Mel Gibson and Bob Ney are just a few examples. It often feel like a cynical attempt to avoid accountability and ennoble their suffering.

What does this do to public understanding of addiction? Nothing good I think. It also resurrects important questions of personal responsibility and addiction.

I'm expecting that we'll see Foley on Larry King talking about his experiences and suggesting that he wasn't really responsible for his actions because of his alcoholism, but that he is nobly taking full responsibility for them. It will turn people's stomachs and further stigmatize addiction and treatment. Let's hope we avoid the spectacle.