Abortion linked to drugs, alcohol abuse

Another harm associated with drug addiction:

Young women who have abortions are more likely to drink heavily and abuse hard drugs, an Australian study has found.

...

The study tracked 1,122 young women who were born at the Mater hospital in the early 1980s, finding that 21 years on, about one-third had an abortion.

Those who had an abortion were three times more likely to also abuse hard drugs, like heroin, methamphetamines and glue, than the women who had either had no pregnancy or those who had a child.

They were also twice as likely to be a binge drinker or an alcoholic, and 1.5 times more likely to suffer depression, delegates at the World Psychiatric Association (WPA) conference in Melbourne were told.

Sleepiness drug 'helps ice addicts'

Back to the future! A stimulant to treat stimulant addiction.

Next they'll be researching the effectiveness of benzos for treating alcoholism.

Tale of Three Medics

ABC News has a story on soldiers developing drug and alcohol problems as they return to the U.S. The story will also air on 20/20 this Friday night.

Youth addictions are up, study finds

What I find shocking is not the increase, but how grossly undertreated addiction has been among young people in Detroit. 42?

The number of young Detroiters treated for substance-abuse addictions -- from alcohol to marijuana to crack cocaine and heroin -- increased sharply in the past three years, according to a public health study released Tuesday.

In 2003, 42 people ages 12 to 18 were treated. A year later, the number rose to 179. Last year it was 377.

New parity estimate

A new Congressional Budget Office estimate of the costs associated with Paul Wellstone Mental Health and Addiction Equity Act of 2007:

We estimate that the direct costs of the additional services that would be newly covered by insurance because of the mandate would equal about 0.4 percent of employer-sponsored health insurance premiums compared to having no mandate at all.

Irish priests fear driving bans over altar wine

Clergy, Eucharist and OUIL:

Celebrating more than one mass a day may push Roman Catholic priests over the alcohol limit if tougher drink driving rules come into effect in Ireland, a leading clergyman said on Friday.

Altar wine is an essential part of the eucharist, the ritual in which Catholics believe the priest turns bread and wine into the body and blood of Jesus Christ. A priest drinks a small amount of the wine during the mass.

Under proposed Irish legislation, the limit of 80 milligrams of alcohol per 100 millilitres of blood is expected to be tightened but no new level has yet been specified.

Because the ranks of the Catholic clergy are thinning out, priests -- especially in rural areas -- often drive to several churches on Sunday to say mass for congregations who have no resident clergy.

"You could be over the limit trying to travel between maybe two or three churches on a Sunday morning and coming back again," Father Brian D'Arcy told Reuters.

D'Arcy is a broadcaster and rector of the Passionist Monastery in Enniskillen, Northern Ireland, where similar changes have also been proposed.

He said wine prepared for use in services had to be consumed and throwing it away was blasphemous.

Dr. Drug Rep

A psychiatrist writes about the influence of drug company money on his judgment and integrity.

Relapse Among Individuals in Remission From Alcohol Dependence

From Alcoholism: Clinical and Experimental Research

Background: There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period.

Methods: This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders.

Results: By Wave 2, 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with 27.2% of low-risk drinkers and 7.3% of abstainers. Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were 14.6 times as great for asymptomatic risk drinkers and 5.8 times as great for low-risk drinkers. The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low-risk drinkers. Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse.

Conclusions: Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.

[via: Alcohol Reports]

European Drug Trends

Cocaine and meth appear to be hitting Europe. It will be interesting to watch the impact of these trends on their drug policies.

It’s not either/or, it’s both/and.

From Barack Obama:

When I’m president, we will no longer accept the false choice between being tough on crime and vigilant in our pursuit of justice. Dr. King said: “It’s not either/or, it’s both/and.” We can have a crime policy that’s both tough and smart. If you’re convicted of a crime involving drugs, of course you should be punished. But let’s not make the punishment for crack cocaine that much more severe than the punishment for powder cocaine when the real difference between the two is the skin color of the people using them. Judges think that’s wrong. Republicans think that’s wrong, Democrats think that’s wrong, and yet it’s been approved by Republican and Democratic presidents because no one has been willing to brave the politics and make it right. That will end when I am president.

Medical Marijuana

Medical marijuana will be on the ballot in Michigan.

Chantix concerns

The FDA has issued an Early Communication About an Ongoing Safety Review
Varenicline (marketed as Chantix).

I don't recall - I must have slept well

The New York Times Magazine ran a story on the sleep industrial complex. Of course, a big segment of that are medications:

...In one six-week trial, for example, people taking Ambien every night fell asleep, on average, only 23 minutes faster than those taking the placebo. They spent 88 percent of their time in bed asleep, as opposed to 82 percent. Given that their objectively measured improvements are frequently this meager, why do sleeping pills create incommensurate feelings of having slept so well?

A popular theory is that one of the pill’s side-effects is actually contributing to their success. Most sleeping pills are known to block the formation of memories during their use, creating amnesia. This is why people who endure freaky side-effects — so-called “complex sleep-related behaviors” like getting into a car and driving or ravenously eating, all while asleep — don’t remember those events. Yet this amnesia could be quite beneficial, suggests Michael Bonnet, a professor of neurology at Wright State University Boonshoft School of Medicine in Dayton, Ohio. “How do you know you slept last night?” Bonnet asked me. A night of lousy, interrupted sleep, he points out, is easy to remember. “It’s full of memories, noise and pain, and heat and rolling around and obtrusive thoughts and worries — all of these various stimuli.” And we may continue to register such things even while asleep, making sleep vaguely unrefreshing. But a good night of sleep, Bonnet went on to say, “is always the antithesis to all those things, which is oblivion.” A sleeping pill, Bonnet speculates, in addition to encouraging sleep chemically in the brain, also “erases all of these thoughts that we use to define ourselves as being awake. The pill knocks them all out, and the patient says, ‘Hey, I must have been asleep because I don’t remember anything.’ ”

Drug-company representatives and consultants I spoke to confirm that their pills can create this mild form of amnesia but disagree that it contributes any significant benefit. “That is not my understanding of how Ambien works,” Dario Mirski, a psychiatrist and spokesman for Ambien’s manufacturer, Sanofi-Aventis, told me. It is difficult to find a clinical trial in which Z-drug takers drastically overestimated how long they slept.

Andrew Krystal, a Duke University psychiatrist and consultant to pharmaceutical companies like Sepracor, Lunesta’s manufacturer, acknowledges an apparent discrepancy in studies between small, objectively recorded improvements and the large percentage of subjects who end up feeling that a pill alleviated their insomnia. But because insomnia is complaint-based, he explained to me, an insomniac is cured when he stops complaining.

Interestingly, studies looking at sleep disturbance in alcoholics and relapse have found that sleep disturbance is not a great predictor of relapse, but distress over sleep disturbance is a predictor. What does that suggest?

Prohibition

From a friend of a friend:

I am presently reading the book, “Paying the Tab: The Costs and Benefits of Alcohol Control,” by Philip J. Cook, Professor for Public Policy at Duke University. The book, just published by Princeton University Press, is excellent. It examines in detail the problem of alcohol consumption and abuse in the United States from the colonial era to the present. It is even handed, beautifully and clearly written, even in the presentation of knotty statistical data, meticulously researched, and heftily footnoted (25 pages of references.) It is simply the best overview of alcohol abuse I have ever read.

It punctures some myths and some favorite ideas:

EVERYONE KNOWS THAT PROHIBITION DIDN’T WORK
Prohibition was a failure in the sense that it lost popular support, but it was associated with a sharp reduction in alcohol consumption, alcoholism, incidences of domestic abuse due to alcohol, drunken driving, and especially cirrhosis of the liver (which fell by 50%). These facts are indisputably documented in the book.

DISTILLERS WOULD BE OH SO HAPPY IF EVERYONE “DRANK RESPONSIBLY.”
If that happened, they would go out of business. 80% of alcohol is consumed by 20% of the drinking population. Most alcohol is consumed by alcohol abusers. This 80/20 rule, which holds for other consumer products as well, was discovered in France, and seems to hold for alcohol consumption in all countries.

A LARGE PROPORTION OF THE AVERAGE HOUSEHOLD INCOME IS SPENT ON ALCOHOL
Alcohol sales in the US for the year 2001 amount to 128 billion dollars. That amounts to less than 2% of personal consumption expenditures that year.

EVERYONE DRINKS
We hear this from AA newcomers, and it is completely false. Over 50% of the population in the US consume so little alcohol (less than one drink per month at the most) that they may be called nondrinkers. 35% of the US population did not have even a single drink of alcohol in 2000! Again, this fact is convincingly documented.

ALCOHOL ABUSE IS MOST PREVALENT IN LOWER INCOME AND UNDEREDUCATED FAMILIES
Most alcohol is consumed by families earning $80 000 a year or more. Most is consumed by those with some college education. Black Americans consume much much less alcohol than Hispanics (50% less) who drink less than Caucasians.

GET HIM OR HER INTO THE RIGHT PROGRAM, AND THE DRINKING PROBLEM IS SOLVED
The author discusses the many different treatment modalities for alcohol abusers, and is very bullish on AA. However, for most alcohol abusers, nothing seems to work. If you are sober in AA, you should be effusive in your gratitude.

MOST ALCOHOL PROBLEMS ARE CAUSED BY ALCOHOLICS
This, strangely, does not seem to be true. To quote the author: “The reason is the ‘preventive paradox’ ---- while problems are concentrated among long-time heavy drinkers who are in enough trouble that they might be persuaded (or coerced) into seeking treatment, the bulk of alcohol related problems are diffused among the much larger group.”

GOVERNMENT EFFORTS TO CONTROL CONSUMPTION WILL INEVITABLY FAIL
The clear conclusion is that even modest government efforts to limit supply can reduce alcohol consumption. Prohibition drastically limited consumption in the lower classes (while not making a dent in the drinking habits of the affluent, who felt entitled.)

What is the author’s personal investment in this issue? Well, he holds his cards close to his vest (as he should, this being a scholarly study) but his dropping occasionally adages like, “Denial is not a river in Egypt,” will cause the cognoscenti to nod.

Settling into harm reduction

Here's an appeal for a shift toward abstinence in the U.K. It describes what's happened to recovery in a system focused on harm reduction.

via www.dailydose.net

Treatment for internet addiction!

Jump Up Internet Rescue School

5 Armies Hopped Up on Drugs

I've read about the other four, but I don't know what to think about number five. Hash is not the drug I'd give someone I was sending off to war.

A Hidden Epidemic

The Washington Post has a great op-ed on smoking among people with mental illness:

Virtually everyone knows about the connection between smoking and health. Smoking causes 440,000 deaths a year in the United States (50,000 of which are from exposure to secondhand smoke) and 5 million worldwide. It shortens smokers' lives by 10 to 15 years, and those last few years can be a miserable combination of severe breathlessness and pain.

But few are aware that smoking is concentrated among people with mental illness, often compounded by substance-abuse disorders such as alcoholism. Go to most Alcoholics Anonymous meetings, and the room will be so full of smoke that you can cut it with a knife. Ask the members, and they will tell you that it was much easier to stop drinking than to stop smoking. Indeed, nicotine, the addictive component of tobacco smoke, is as habituating as cocaine or heroin, and it has a similar effect on chemical receptors in the brain.

The facts about smoking and mental illness are stark. Almost half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illness. (emphasis added) This is because so many people who have mental illnesses smoke (50 to 80 percent, compared with less than 20 percent of the general population) and because they smoke so many cigarettes a day -- often three packs. Furthermore, smokers with mental illness are much more likely to smoke their cigarettes right down to the filters.

His comments about AA wouldn't be accurate around here. Certainly, smoking rates among AA members are very high, but I think most meetings are non-smoking. I haven't been to a smoking meeting in close to 10 years.

New York to ban smoking in treatment centers

Good for New York, but I thought New Jersey did this. If you know something I don't, tell me in comments:

For decades, addiction-treatment programs have honed in on drug and alcohol abuse and shrugged at patients' near-universal use of tobacco.

But faced with growing awareness about the power of nicotine addiction and that smoking kills more people than all other addictive drugs combined, New York officials have decided the state can no longer afford to ignore smoking.

"The entire field has struggled with the really incorrect notion that treating nicotine addiction would be really a hardship on the chemically addicted," said Karen Carpenter-Palumbo, commissioner of the state Office of Alcoholism and Substance Abuse Services.

In July, New York will become the first state in the nation to ban smoking at all its chemical dependence prevention and treatment programs, including those that treat gambling addiction.

In Florida, Addicts Find an Oasis of Sobriety

The New York Times recently printed an article about Delray Beach, Florida, and its high concentration of recovering alcoholics. They make it sound weird by seeking comments from gadfly Stanton Peele. I suppose it could be a little weird, but isn't it a nearly universal instinct to surround oneself with people with similar identities? Is the high concentration of LGBT people in Ferndale a sign of pathology?

I've never been there, but I'm pretty confident that Peele is engaging in his usual hyperbole and misrepresentation with his statement about these people "cutting [themselves] off from the outside world." Many of these people were probably cut off from the outside world in their addiction and are rejoining the rest of the world with the support of a community and environment that affirms and celebrates their recovery.

Drugs, Alcohol and Homelessness

From a new Gallup poll:

More than eight in 10 people surveyed believe abuse of alcohol and drugs is the major cause of homelessness.

The public gets it. Now, what to do about it? In the context of the collapse of the American addiction treatment system, the intersection of homelessness and addiction stands out as the biggest challenge in addressing chronic, high severity severe addiction.

Dopamine and alcoholism

Time magazine's science writer simplifies a recent study on neurobiology and alcoholism:

It's already known that addictive drugs, including alcohol, trigger a rush of dopamine. Getting that literal rush is such a powerful reward that it's a big part of the reason addicts go back to drugs, even though they know objectively that it's a truly bad idea.

Now comes a paper in the Journal of Neuroscience that adds another key piece to the addiction puzzle. Nora Volkow, director of the National Institute on Drug Abuse, long with several colleagues, used brain-imaging studies to look at the dopamine responses of alcoholics—not to alcohol, but to a different drug, methylphenidate, better known by its trade name Ritalin. In normal subjects, the drug causes a spike in dopamine in the brain's prefrontal cortex.

But in alcoholics, the study found, that spike is significantly muted. Says Volkow: "It could explain why alcoholics encounter a decrease in the ability to experience pleasure from everyday activities." In essence, they've been overstimulating their dopamine systems for so long with alcohol that their brains have become numb. It also explains why so many relapse into drinking; it's the one way they can experience any sort of pleasure.

House and Senate Agree on Addiction Budget; Veto Expected

From JoinTogether.org:

A House-Senate conference committee has approved a FY2008 budget plan that calls for spending $1.779 billion on the Substance Abuse Prevention and Treatment Block Grant and increasing the budgets of the Center for Substance Abuse Prevention (CSAP), Center for Substance Abuse Treatment (CSAT), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

President Bush is expected to veto the measure, however.

The block-grant funding represents a $20-million increase over the $1.759 million appropriated in FY2007, falling roughly between the figures approved by the House and Senate in their respective budget bills for the Departments of Labor, HHS, and Education. The National Association of State Alcohol and Drug Abuse Directors (NASADAD) reported that the committee bill did not include language tying funding to a set of National Outcome Measures -- which many in the field objected to.

...

The one big budget loser was the state grants portion of the Safe and Drug-Free Schools and Communities program, which conference negotiators decided to fund at $300 milllion, down from $346.5 million in 2007.

President Bush's veto threat stems from the fact that the budget plan is $9.8 billion more than his request, according to NASADAD. The Labor/HHS funding plan was combined in conference with the budgets for the Veterans' Affairs department and the Military Construction budget -- with supporters betting that Bush would be loathe to veto funding for veterans and the military -- but Senate Republicans succeeded in de-linking the funding measures in a floor vote this week, casting the fate of the Labor/HHS bill in further doubt.

Should drugs be decriminalised?

BMJ has published for and against commentaries on legalizing drugs. The introduction says a lot:

Recent government figures suggest that the UK drug treatment programmes have had limited success in rehabilitating drug users, leading to calls for decriminalisation from some parties.

Not suprising that they've had limited success--their efforts have been very limited, especially for drug-free treatment.

via dailydose.net

Panel May Cut Sentences For Crack

Long overdue:

An independent panel is considering reducing the sentences of inmates
incarcerated in federal prisons for crack cocaine offenses, which would make
thousands of people immediately eligible to be freed.

The U.S. Sentencing Commission, which sets guidelines for federal
prison sentences, established more lenient guidelines this spring for future
crack cocaine offenders. The panel is scheduled to consider today a proposal to
make the new guidelines retroactive.

Should the panel adopt the new policy, the sentences of 19,500 inmates
would be reduced by an average of 27 months. About 3,800 inmates now imprisoned
for possession and distribution of crack cocaine could be freed within the next
year, according to the commission's analysis. The proposal would cover only
inmates in federal prisons and not those in state correctional facilities, where
the vast majority of people convicted of drug offenses are held.

It also addresses the disparate racial impact of the law. Good read.

via dailydose.net

On the Bottle, Off the Streets, Halfway There

Another housing first program for chronic alcoholics:

Early last year, some people, not cops, tracked Daryl down at the sobering center, where he had slept off a drunk 360 times in one calendar year. They were from a homeless outreach organization and they had some news, good for a change.

The organization had just built a 75-unit residence for homeless chronic alcoholics at 1811 Eastlake Avenue, and was offering rooms to the frailest and costliest to the system, as determined by time spent in the sobering center, the emergency room and jail. The idea: provide them first with housing and meals, gain their trust, then encourage them to partake of the available services, including treatment for chemical dependency.

No mandatory meetings or church-going. And one more thing, crucial to all: You can drink in this place.

Welcome, Daryl. A month later: Welcome, Ed.

“I damn near bawled,” Ed recalls.

The $11 million project has endured the angry complaints of some that it uses public money to enable, even reward, chronic inebriates. And Bill Hobson, the director of the Downtown Emergency Service Center, has met that anger with some of his own.

First, he says, the complaints reflect no understanding of the grip of alcoholism: Do you really think these men and women would rather live on the streets? Second, the cost to the public appears to have dropped as the number of visits to the emergency room, jail and the sobering center has plummeted.

Finally, he asks, what kind of equation of humanity is this: Since you refuse to stop drinking, since you refuse to address your disease, you must die on the streets.

“These guys have nothing going for them,” he says. “They could not be more dispossessed.”

Reasonable people can disagree on these matters, but these articles always seem to focus on what is not required of program participants, they never seem to focus on what it required or expected of service providers. Here's what I had to say earlier this year about a PBS segment on a homeless addict provided housing with no contingencies:

I had several reactions to the segment. First, had Footie ever been provided with comprehensive treatment of and adequate dosage, duration? Why no contingencies? Maybe his housing shouldn't be contingent upon abstinence, but how about participation in treatment? If the fear is that this might be a set-up, how about reviewing it at monthly or quarterly intervals so that a bad week does not put him back on the street? Why not at least make it recovery-focused? If this approach is good for Footie and raises his functioning and quality of life to his potential, who's functioning and quality of life might be reduced to something below their potential? At Dawn Farm, we see some clients who would probably benefit greatly from a recovery-focused housing program that is not contingent upon abstinence. However, how many of clients who are currently in full recovery would have settled into an apartment like Footie's and never achieved stable recovery and a full, satisfying life? Many, I think.

UPDATE: This isn't to say it shouldn't be done, but rather how to go about it in a way that doesn't lower the bar for all homeless addicts and fail to address what caused their homelessness. Maybe one way to approach it is to ask, "Absent their addiction, would this person still be likely to be homeless?" In the case of Footie, the answer is "probably so". In the case of most of our homeless clients, the answer is "unlikely".

Of course, another big question is how to prioritize services in the context of scarce resources.

The Physiology of Addiction by Dr. Carl Christensen

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sweets or cocaine?

I get the attraction to sweets, but not addicted rats choosing sugar over cocaine. The article suggests that it enhances understanding of attraction to sweets and obesity, but is there expected to be any value in understanding or treating drug addiction. If anyone can enlighten me, feel free to do so in comments.

Researchers have learned that rats overwhelmingly prefer water sweetened with saccharin to cocaine, a finding that demonstrates the addictive potential of sweets.

Offering larger doses of cocaine did not alter the rats' preference for saccharin, according to the report.

Scientists said the study, presented this week in San Diego at the annual meeting of the Society for Neuroscience, might help explain the rise in human obesity, which has been driven in part by an overconsumption of sugary foods.

In the experiment, 43 rats were placed in cages with two levers, one of which delivered an intravenous dose of cocaine and the other a sip of highly sweetened water. At the end of the 15-day trial, 40 of the rats consistently chose saccharin instead of cocaine.

When sugar water was substituted for the saccharin solution, the results were the same, researchers said.

Further testing the rat sweet tooth, scientists subjected 24 cocaine-addicted rats to a similar trial. At the end of 10 days, the majority of them preferred saccharin.

"Intense sweetness is more rewarding to the rats than cocaine," said coauthor Magalie Lenoir of the University of Bordeaux in France.

Lenoir said mammalian taste receptors evolved in an environment that lacked sugar and so were not adapted to the high concentrations of sweets found in the modern diet. Excess sugar could increase levels of the brain chemical dopamine, she said, leading to a craving for sweets.

Cocaine also increases dopamine, she said, but through a different brain mechanism.

Effect of On-Site 12-Step Meetings on Outcomes among Outpatient Clients

Onsite 12 step meetings improve outpatient treatment outcomes:

On-site 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post-treatment year. Holding 12-step meetings on-site is a low-cost strategy that programs should consider to foster post-treatment remission maintenance.

I'm a little ambivalent about this, only because it would be so easy to have a lame meeting that serves the treatment program rather than the recovering community. It's my experience that this is the case more often than not. A case of the good being the enemy of the best. Easy to do. Doing it is good. But, doing it really well is not easy.

via alcoholreports.blogspot.com

Celebrating drugs

One third of hit songs mention alcohol, drug use:

Primack and his team, who presented their findings at a medical meeting, looked at the top 279 songs on the Billboard charts in 2005. They found that 33 percent made references to alcohol and drug use.

Nearly 80 percent of rap songs mentioned substance use, followed by 37 percent of country music lyrics, 20 percent of R&B/hip-hop and 14 percent of rock songs. Only 9 percent of pop songs referred to drug or alcohol use.

The researchers only included songs that clearly referred to using drug and alcohol. They also named the substances which included alcohol, marijuana, cocaine, prescription drugs, inhalants, hallucinogens, and substances of unknown origin.

"If someone says, 'I had one of those pills,' and you don't really know what that was, we call that non-specific," Primack explained in an interview.

via ccsa.ca

Drug inflation

No mention of heroin or other opiates. My impression is that heroin prices are stable or down. Also, we've seen a downturn in cocaine admissions, continuing increases in heroin and other opiates, and we still see very few meth admissions.

Prices for cocaine and methamphetamine have risen for the fourth quarter in a row, a trend law enforcement officials say indicates supply has dropped.

The price for a pure gram of cocaine increased 47% since October 2006. The price of a pure gram of methamphetamine jumped 84%, says a report out Thursday by the Drug Enforcement Administration.

...

A gram of pure cocaine cost about $137 in September, up from $93 in October 2006, according to a DEA database that analyzes seized illegal drugs. A gram of pure methamphetamine cost $245 in September, up from $133 in October 2006. The DEA uses the database to gauge illegal drug markets. High prices and low purity generally indicate a short supply. Dealers often use filler ingredients to stretch a drug supply.

via dailydose.net

Landmark study on SUD and depression in teens

A breathless press release is hyping the findings in a new study:

The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or a placebo, along with cognitive behavioral therapy (CBT) focused on substance abuse rather than depression.

"The weekly, individual cognitive behavioral therapy helps adolescents improve their decision-making skills as well as their coping, communication, and drug-refusal skills," added Riggs. "It also helps adolescents learn ways to avoid high-risk situations and increase their motivation and involvement in pro-social activities that are incompatible with drug use."

The study found fluoxetine combined with CBT was well-tolerated and had greater efficacy than the placebo with CBT on the Childhood Depression Rating Scale-Revised but not on the Clinical Global Impression Improvement measure of treatment response. Drug use and conduct disorder symptoms decreased significantly in both the fluoxetine and placebo treatment groups but there was no difference between fluoxetine and placebo treatment on either variable. The rate of treatment retention/completion (84 percent) was higher and reduction in drug use similar to that reported for other evidence-based substance treatment modalities in adolescents with less psychopathology.

Then there's this pearl:

The higher than expected rate of treatment response (CGI-I) in the placebo + CBT (67 percent) as well as the fluoxetine + CBT (76 percent) treatment group may indicate that CBT contributed to depression treatment response, despite its focus on substance abuse. Adolescents whose depressions remitted (regardless of medication group assignment) significantly decreased their drug use whereas drug use did not decrease in those whose depressions did not remit.

Ton anyone who is familiar with the literature, it should be no shock that depression would respond to CBT, even if it's substance abuse focused CBT. Further, anyone familiar with the literature would know that depressive symptoms generally improve dramatically in the first 3 to 6 weeks of abstinence, without any treatment for mental illness.

A remarkable conclusion:

"An important clinical implication of these results may be that in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may significantly improve or remit without antidepressant pharmacotherapy," said Riggs.

Given that conclusion, why isn't the headline, "CBT very effective for treating depression in youth with SUDs"? Or, "Fluoxetine provides modest benefit for depressed teens with SUDs"?

UPDATE: Other possible headlines: "Substance abuse treatment effective for depression in teens", "Psychiatric treatment unnecessary for most depressed teen substance abusers"

They're all accurate, right? They're all also very different. Does this demonstrate that scholarly journals are used professional advocacy tools? At minimum, it's evidence that they reflect the assumptions and biases of that discipline.

Virtual drug dens!

A new spin on cue extinction therapy.

Insomnia

More support for non-pharmacological treatment of insomnia--a common problem among recovering addicts:

For people with chronic insomnia, studies show that simple behavioral and psychological treatments work just as well, and sometimes better, than popular medications, according to a report in The Journal of Family Practice.

The medical journal Sleep last year reported on five high-quality trials that showed cognitive behavioral therapy helped people suffering from insomnia fall asleep sooner and stay asleep longer. Another American Journal of Psychiatry analysis of 21 studies showed that behavioral treatment helped people fall asleep nearly nine minutes sooner than sleep drugs. In other measures, sleep therapy worked just as well as drugs, but without any side effects.

The behavioral strategies for better sleep are deceptively simple, and that’s one reason why many people don’t believe they can make a difference. One of the most effective methods is stimulus control. This means not watching television, eating or reading in bed. Don’t go to bed until you are sleepy. Get up at the same time every day, and don’t nap during the day. If you are unable to sleep, get out of bed after 15 minutes and do something relaxing, but avoid stimulating activity and thoughts.

So-called sleep hygiene is also part of sleep therapy. This includes regular exercise, adding light-proof blinds to your bedroom to keep it dark and making sure the bed and room temperatures are comfortable. Eat regular meals, don’t go to bed hungry and limit beverages, particularly alcohol and caffeinated drinks, around bedtime.

Finally, don’t try too hard to fall asleep, and turn the clock around so you can’t see it. Watching time pass is one of the worst things to do when you’re trying to fall asleep.

Pot, Tobacco and Youth

A new study challenges some assumptions about marijuana use by adolescents:

A study of more than 5,000 youngsters in Switzerland has found those who smoked marijuana do as well or better in some areas as those who don't, researchers said Monday.

But the same was not true for those who used both tobacco and marijuana, who tended to be heavier users of the drug, said the report from Dr. J.C. Suris and colleagues at the University of Lausanne.

The study did not confirm the hypothesis that those who abstained from marijuana and tobacco functioned better overall, the authors said.

In fact, those who used only marijuana were "more socially driven ... significantly more likely to practice sports and they have a better relationship with their peers" than abstainers, it said.

"Moreover, even though they are more likely to skip class, they have the same level of good grades; and although they have a worse relationship with their parents, they are not more likely to be depressed" than abstainers, it added.

It did not explain the reasons behind the apparent effect.

The researchers also found that those who smoked tobacco were more likely to be heavy users and that those who started before the age of 15 were more likely to be heavy users and misuse alcohol.

This has been trumpeted as proof that marijuana is harmless (here and here). Surely, its harm is hyped. But, this is one study, it appears to be something of an outlier, and skipping class and worse relationships with parents are not insignificant (I'm not suggesting that corelation is causation.). It would be interesting to see this done in a longitudinal study and to see if the findings hold. Of course it would also be good to see the study replicated.

Arch Pediatr Adolesc Med. 2007;161(11):1042-1047.

Recovery is everywhere

From the New York Times:

As he coaches one of the highest-ranked high school soccer teams in the country, Martin Jacobson also battles hepatitis C, a disease he contracted in an earlier life as a drug addict.

Mass. plans new heroin overdose program

It looks like Massachusetts is moving ahead with their narcan distribution plan. (Previous post here.)

Massachusetts officials next month will begin distributing kits to heroin addicts that include medication to treat overdoses.

Advocates say the kits will help treat overdoses quickly, safely and without fear of addiction, and will be beneficial in a state where more people die from heroin than firearms.

...

"It's a remarkably safe drug," said Dr. Peter Moyer, medical director for Boston's fire, police, and emergency medical services. "I've used gallons of it in my life to treat patients."

Heroin and other opiates killed 544 people in Massachusetts in 2005, more than double the number killed by firearms.

Strong demand and low prices make heroin a popular street drug in New England. At $5 or $6 for a small bag, heroin can cost less than a six-pack of beer.

"It's the perfect storm in all the wrong directions. We talk about availability, price, and potency of the drug," said Kevin Norton, president of CAB Health & Recovery Services, which will work with the state to provide Narcan in cities and towns on the North Shore.

State Public Health Commissioner John Auerbach, who started the Boston kit distribution program when he worked for the city, emphasized that treatment is still the state's priority.

What does it mean to say that treatment is still the state's priority? Do they have adequate treatment on demand?

Why You Should Be Skeptical About "Scientific" Studies

Bob Sutton offers a graphical explanation of why you should be skeptical of scientific studies:

Philly Needle-exchange angers neighbors

Another community voicing concern about a needle exchange.

This case might be interesting to watch. Philadelphia is in the process of transforming it's mental health and addiction treatment systems into a comprehensive, recovery-oriented system of care. If any community is capable of creating a recovery-oriented needle exchange, it might be Philly.

Passive smoking rates drop by 95% among hospitality workers

Early returns from an indoor smoking ban in England:

The study for charity Cancer UK and carried out by the Tobacco Control Collaborating Centre in Warwick found non-smoking hospitality workers had four times less cotinine - a byproduct of nicotine and an indicator of tobacco smoke exposure - in their saliva in August than they had in June.

They calculated that, on average, employees' exposure was the equivalent to smoking 190 cigarettes a year before the legislation, and that this had fallen to the equivalent of around 44 cigarettes since.

via dailydose.net

Opiate addiction in England

Two stories about opiate addiction in England. One that challenges the efficacy of methadone and another that suggests drug-free recovery is not possible.

via dailydose.net

Comment on "A rare head to head"

This comment from a friend seemed worth posting, just to make sure everyone sees it:

An important addition seems important here. Chantix + ongoing skill building and social support, is the combination that is getting results at 52 weeks. At 6 months, without any social support, the return to smoking rate remains high. I was just in the audience as Dr. Gonzales presented an unpublished study that showed a pattern of slips and relapses for up to 6 months, then stability.

The ongoing studies continue to show us that recovery from tobacco use is a process, not typically a "cessation" event. I think the time is ripe for addiction professionals to enter the tobacco treatment arena. We have much to offer.

Wendy Croze BA, CAC-R, TTS