Albert Hofmann, the Father of LSD, Dies at 102

A little history lesson on LSD. Albert Hofmann, the scientist who discovered it, just died:

Dr. Hofmann first synthesized the compound lysergic acid diethylamide in 1938 but did not discover its psychopharmacological effects until five years later, when he accidentally ingested the substance that became known to the 1960s counterculture as acid.

He then took LSD hundreds of times, but regarded it as a powerful and potentially dangerous psychotropic drug that demanded respect. More important to him than the pleasures of the psychedelic experience was the drug’s value as a revelatory aid for contemplating and understanding what he saw as humanity’s oneness with nature. That perception, of union, which came to Dr. Hofmann as almost a religious epiphany while still a child, directed much of his
personal and professional life.

“It happened on a May morning — I have forgotten the year — but I can still point to the exact spot where it occurred, on a forest path on Martinsberg above Baden,” he wrote in “LSD: My Problem Child.” “As I strolled through the freshly greened woods filled with bird song and lit up by the morning sun, all at once everything appeared in an uncommonly clear light.

“It shone with the most beautiful radiance, speaking to the heart, as though it wanted to encompass me in its majesty. I was filled with an indescribable sensation of joy, oneness and blissful security.”

...

It was during his work on the ergot fungus, which grows in rye kernels, that he stumbled on LSD, accidentally ingesting a trace of the compound one Friday afternoon in April 1943. Soon he experienced an altered state of consciousness similar to the one he had experienced as a child.

On the following Monday, he deliberately swallowed a dose of LSD and rode his bicycle home as the effects of the drug overwhelmed him. That day, April 19, later became memorialized by LSD enthusiasts as “bicycle day.”

Dr. Hofmann’s work produced other important drugs, including methergine, used to treat postpartum hemorrhaging, the leading cause of death from childbirth. But it was LSD that shaped both his career and his spiritual quest.

“Through my LSD experience and my new picture of reality, I became aware of the wonder of creation, the magnificence of nature and of the animal and plant kingdom,” Dr. Hofmann told the psychiatrist Stanislav Grof during an interview in 1984. “I became very sensitive to what will happen to all this and all of us.”

...

But he was also disturbed by the cavalier use of LSD as a drug for entertainment, arguing that it should be treated in the way that primitive societies treat psychoactive sacred plants, which are ingested with care and spiritual intent.

After his discovery of LSD’s properties, Dr. Hofmann spent years researching sacred plants. With his friend R. Gordon Wasson, he participated in psychedelic rituals with Mazatec shamans in southern Mexico. He succeeded in synthesizing the active compounds in the Psilocybe mexicana mushroom, which he named psilocybin and psilocin. He also isolated the active compound in morning glory seeds, which the Mazatec also used as an intoxicant, and found that its chemical structure was close to that of LSD.

During the psychedelic era, Dr. Hofmann struck up friendships with such outsize personalities as Timothy Leary, Allen Ginsberg and Aldous Huxley, who, nearing death in 1963, asked his wife for an injection of LSD to help him through the final painful throes of throat cancer.

...

Though Dr. Hofmann called LSD “medicine for the soul,” by 2006 his hallucinogenic days were long behind him, he said in the interview that year.

“I know LSD; I don’t need to take it anymore,”...

Bill introduced in U.S. House to legalize marijuana

Dirk Hanson at Addiction Inbox has the details on a new bill by Barney Frank that would legalize marijuana.

Drug Policy extremes

How to have a crappy debate about drug policy.

Just pick two ideologues. In this case, someone from the Heritage Foundation and someone from Reason Magazine, owned by the Reason Foundation. All heat and no light.

Stigma

800 people attend a meeting to obstruct the establishment of an addiction treatment program.

An unintended consequence of an Vancouver's emphasis on harm reduction with the message that addicts can't and/or don't want to recover?

Risk of depression dims hopes for anti-addiction pills

Unsuprising news about unintended effects of pharmacotherapies for addiction.

The pills worked in a novel way, by blocking pleasure centers in the brain that provide the feel-good response from smoking or eating. Now it seems the drugs may block pleasure too well, possibly raising the risk of depression and suicide.

More on HR

Last week I missed an op-ed weighinh in against HR. The writer closes with this thought:

Many organizations offer the rationalization that drug use is part of our lives and will not go away. That is probably true, as it is true that most people who use recreational drugs or drink will not become addicted.

But there are those who are addicted and whose lives are in trouble. For them, continued use can and will ultimately prove to be disastrous.

It is a courageous act for an individual to face their problems and attempt to make the changes necessary to break free of their addiction. It's not an easy transition to make.

We, as a society, should do everything possible to assist them on their road to recovery. Everything, except create the illusion that only going half way down that road is all it takes.

Today, another writer offers a less certain opinion:

...I have come to realize, slowly and painfully, that complete abstinence may be out of reach for some. The all-or-nothing approach of abstinence advocates neglects the needs of many substance users who may fall somewhere in between.

This is obviously true--some people with addiction, even those who recieve treatment, will die of their addiction. The problem is that we don't know who will recovery and who will not. After 14 years in this field, I am unable to predict those who will recover and those who will not. Further, my instincts are repeatedly proven wrong. This being the case, the only solution is to treat all addicts as though they can recover. This is not an argument against HR, rather it's an argument in favor of making recovery-oriented services available to all who want them. It is also important that systems recognize that many who do not want recovery-oriented services may be making this decision due to an absence of hope, and it is the system's responsibility impart hope and encourage clients to seriously consider all of the best treatments available. (Just as we would do with a cancer patient facing difficult treatment with uncertain outcomes.)

The writer does maintain a conclusion that I can agree with:

All said, I am still not sure where I stand on harm reduction. I know that abstinence is the ideal.

I appreciate someone talking about their struggle with the matter. I've steadily grown more wary of people expressing what Anne Lamont referred to as "excessive certitude".

Point/Counterpoint on Legalization

I'm afraid to say I don't find either of these very persuasive.

Sullum assumes that alcohol prohibition has been a great success. I'm not advocate of prohibition, but clearly, we suffer from a lot of alcohol-related problems. Stimson argues that Reagan's drug policy has been a success? He's being gamey with the 50% number. I'm not sure where he gets it, but it's very misleading. Does he think skyrocketing incarceration rates for drug crimes is a sign of success?

Too bad we keep getting this Crossfire style of debate by the ideological extremes. I'm more and more convinced that there is no problem-free (or, even low-problem) drug policy. Every drug policy brings problems with it. The questions are which problems we're willing to live with and how we can best minimize those problems.

Abstinence vs. Harm Reduction redux

Sara McGrail sent a kind comment to yesterday's post. I thought I'd post her entire comment to make it more visible:

Hey, thanks for blogging my blog - and you're right, I am an exponent of harm reduction. I totally agree with your assertion about raising expectations - as long as those expectations that we strive for are the clients and not just the service's or the worker's. For me, the difficulties in raising aspiration in any sustainable way while labelling the individual an addict or considering their drug use solely an illness are manifest

The context and orientation of services is as you say, critical. While the impetus for change is directed from a political level, its all too easy to negate the choices made by the individual. A focus on criminalising or pathologising drug use is problematic and shifts the emphasis away from individual aspiration, hope and recovery. This is sadly the environment within which many services operate - and in my view a continuing block to a full menu of useful interventions (and particularly those focussed on reintegration) for many individuals experiencing problems with substance use.

Harm reduction is a dynamic philosophy that I do not in any way see being in opposition to abstinence. Good harm reduction requires at its core a recognition of individual volition and self direction as well as an understanding of the impact of environment and culture on the choices available. However the philosophy of harm reduction is vulnerable when there is a shift in the definition of harm from an individual one to a societal or political. Community wide gains from harm reduction are best achieved incrementally through numerous successful individual interventions rather than centrally mandated programmes. Centrally funded harm reduction initiatives need to be cautiously managed to ensure the drive for acceptance of the philosophy (ie through attaching crime outcomes) does not overpower the individual intervention. These comments are of course specifically relevant to the UK situation where harm reduction has been accepted for some time. Where harm reduction is less well developed, different approaches may be more appropriate.

Going to feed the dog now. Have a grand weekend.

Sara

I agree that it is important that we not view all heavy drinking or illegal drug use as addiction. The U.S. had its excesses with this in the 1980s when every kids who's Mom found a bag of weed in their sock drawer was diagnosed with substance dependence. I also agree that the clinician should not be prescribing goals, however when we offer clients services that are filled with hope and success stories, they choose recovery. (Skeptics should visit our detox facility.) As for the difficulty of raising aspirations within the context of addiction as an illness, I don't see it. We don't see hope as incompatible with other illnesses and I don't see a nonjudgemental review of the diagnostic criteria as harmful labeling. Personally, I think that viewing an addict outside of that framework frames them as self-destructive hedonists, making it more a matter of character than health.

However, I think she's put her finger on the crux of much of the tension between many HR advocates and recovery advocates. If you view drug users as engaging in a lifestyle choice, recovery advocates look like evangelical temperance zealots driven by moral judgement and panic. If you view it as brain disease characterized by loss of control, then long-term strategies that are focused on controlled use or limited to reducing harm constitute professional neglect--similar to treating only the symptoms of a serious chronic illness when treatments to facilitate full recovery (Even if only for a sizable portion.) are available.

The super adventure club helps kids say "no"

Score one for Scientology. I feel a little queasy.

Abstinence vs. harm reduction

Though this writer presents herself as having no attachment to a particular treatment approach, she's clearly a harm reduction advocate. However, she does a good job making the both/and argument and recognizes that motivation and client preferences often change frequently.

What she fails to address is that context and the culture of services have enourmous influence on the addict's choices and motivation. Does the system subtly and patronizingly discourage abstinence as unrealistic? Does the system reject and judge clients who are unwilling to embrace lifelong abstinence? Does is offer unwaivering hope for full recovery and honestly review options with clients?

Drug-free treatment has historically failed to accept addicts who were not ready to embrace abstinence and harm reduction providers too often define the addict by their illness and place so much emphasis on accepting them as they are that there is no emphasis on what they can become. We know that radical transformation is possible--we see it every day. A system should accept and provide services to support incremental change, but it must not damn them with low expectations, it must not be satisfied with reducing risk for harm, and must offer hope and support for full recovery.

I have to confess, I have no little trouble fathoming how on earth we have ended up here, once again engaged in the obsessive navel gazing that is the debate about whether the focus of treatment should be abstinence or maintenance?

Its just not a question that I can identify with, because people experiencing drug treatment need the opportunity to choose the interventions that work best for them. This might change through someone’s drug using career, with needle exchange, drop in, prescribing, inpatient and community detox and residential or community rehabilitation services coming into play at different points for different people. Sometimes, as we know, people will not move through these interventions in any convenient linear mapable way, but may well drift in and out of treatment over a protracted period of time

Of course as long as they stay for at least 13 weeks we’re all absolutely cool about it.

So is the aim abstinence? Yes. Is it maintenance? Yes. Do we need Harm Reduction? Yes. Is prevention important? Yes.

There is no right or wrong answer and really there should be no debate about this. There is no “one size fits all” solution to the problems people who use drug face. I have as little time for people who say everyone needs a script as I do for those who say everyone needs to go to a fellowship group.

Limbic System Preconsciously Activated by Drug and Sexual Cues

An explanation of why recovering people can't count on being able to see a relapse coming:

The human brain responds to recognizable signals for sex and drugs of addiction by activating the limbic reward circuitry. To determine whether the brain responds in similar ways to these signals even when they are "unseen" -- i.e., presented in a way that prevents their conscious recognition -- researchers in an NIDA-funded study tested the brain response to cocaine, sexual, aversive, and neutral cues (33 milliseconds duration each) in 22 male patients with cocaine dependence. Brain response to each visual cue was measured by magnetic resonance imaging (MRI).

• Cocaine-related images triggered the emotional centers of the brains of patients, even when subjects were unaware they had seen anything.
• Greater brain activity to “unseen” cocaine cues predicted a stronger positive response to visible versions of the same stimuli in later testing.

Comments by Tommie Ann Bower, MA
Results of this study supports years of anecdotal evidence that relapse can be triggered outside of awareness. As with any new finding, the generalizability of these results will depend on additional studies. In the long run, the complicated nature of craving in the brain must be further understood. In the short run, clinicians must redouble efforts to educate patients about the specific triggers for craving, to activate awareness, and to redirect impulses to use.

Increasing D2 Receptors Works On Cocaine, As On Alcohol

Addiction has been linked to a deficiency of dopamine D2 receptors. It appears that scientists have found a way to increase the number of these receptors in the brains of rats:

"By increasing dopamine D2 receptor levels, we saw a dramatic drop in these
rats' interest in cocaine," said lead author Panayotis (Peter) Thanos, a
neuroscientist with Brookhaven Lab and the National Institute on Alcohol Abuse
and Alcoholism (NIAAA) Laboratory of Neuroimaging. "This provides new evidence
that low levels of dopamine D2 receptors may play an important role in not just
alcoholism but in cocaine abuse as well. It also shows a potential direction for
addiction therapies."

The D2 receptor receives signals in the brain triggered by dopamine, a
neurotransmitter needed to experience feelings of pleasure and reward. Without
receptors for dopamine, these signals get "jammed" and the pleasure response is
blunted. Previous studies at Brookhaven Lab have shown that chronic abuse of
alcohol and other addictive drugs increases the brain's production of dopamine.
Over time, however, these drugs deplete the brain's D2 receptors and rewire the
brain so that normal pleasurable activities that stimulate these pathways no
longer do - leaving the addictive drug as the only way to achieve this
stimulation.

The current study suggests that cocaine-dependent individuals may have
their need for cocaine decreased if their D2 levels are boosted. Thanos' lab
previously demonstrated dramatic reductions in alcohol use in alcohol-preferring
rats infused with dopamine D2 receptors (see: http://www.bnl.gov/discover/Winter_06/alcohol_1.asp). Thanos
hypothesized that the same would hold true with other addictive drugs.

The researchers tested this hypothesis by injecting a virus that had been
rendered harmless and altered to carry the D2 receptor gene directly into the
brains of experimental rats that were trained to self-administer cocaine -- the
same technique used in the earlier alcohol study. The virus acted as a mechanism
to deliver the gene to the nucleus accumbens, the brain's pleasure center,
enabling the cells in this brain region to make receptor proteins themselves.

The scientists examined how the injected genes affected the rats'
cocaine-using behavior after they had been taking cocaine for two weeks. After
receiving the D2 receptor treatment, the rats showed a 75 percent decrease in
self-administration of the drug. This effect lasted six days before their
cocaine self-administration returned to previous levels.

Gratitude lists

AA sponsors have known about the power of gratitude lists for decades. (Thank goodness mine did.) This study had participants list 5 items daily for 13 days.

The effect of a grateful outlook on psychological and physical well-being was examined. In Studies 1 and 2, participants were randomly assigned to 1 of 3
experimental conditions (hassles, gratitude listing, and either neutral life events or social comparison); they then kept weekly (Study 1) or daily (Study 2) records of their moods, coping behaviors, health behaviors, physical symptoms, and overall life appraisals. In a 3rd study, persons with neuromuscular disease were randomly assigned to either the gratitude condition or to a control condition. The gratitude-outlook groups exhibited heightened well-being across several, though not all, of the outcome measures across the 3 studies, relative to the comparison groups. The effect on positive affect appeared to be the most robust finding. Results suggest that a conscious focus on blessings may have emotional and interpersonal benefits.

[via: cognitive daily]

New Calif. Ballot Initiative Expands Treatment, Builds on Prop 36

I've noticed lately that the Drug Policy Alliance appears to be trying to balance their agenda with the concerns of people who are sympathetic to their message on criminalization of addiction, but fear radical decriminalization.

This looks like another very big step in that direction. It's good to see them taking a both/and approach.

Recovering the Oxford House

New funding for Oxford Houses in Illinois. Researcher Leonard Jason is the leading researcher of this kind of sober housing:

The two studies released by the group in 2006 showed drug abstinence rates
of 65 to 87 percent among recovering addicts who lived communally in the
self-supporting Oxford House system. The results bucked prior notions that a
majority of recovering substance users relapsed after treatment.

Jason’s reasoning is simple. "If you have someone who is dealing with
substances and drugs and then they get released back to the same family and
neighborhoods that might have high levels of substance abuse and you don’t
provide them any types of support, the likelihood is that many of those people
will relapse," he said. "If you provide housing, opportunities for employment,
peer support—you can reduce that rate by half."

Ferrari, a Vincent DePaul Distinguished Professor, credited the Oxford
House system’s success to the reality that "a sense of home is very important
for people" and that the method respects the "individuality and dignity" of each
person who lives in an Oxford House.

The article also offers this mouthful:

"Oxford Houses are controversial because they are showing that people can take
care of themselves. [Oxford House residents] don’t need the medical community."

Couldn't the same be said for much of the professional resistance to 12 step programs?

The Neurobiology of Free Will and Drug Addiction

Norah Volkow on the evolving understanding of the neurobiology of addiction.

A good headline is worth 1000 words

Scientists Say Methadone-Like Treatment for Cocaine Addiction Possible

Free trade and Drug Policy

I'm so glad the ONDCP is apolitical, aren't you?

[via dailydose.net]

Campus recovery center provides 'sober support'

University of Texas' innovative (but long-standing) student support program is explained in this article. Why don't any Michigan universities have a program like this?

After an attempted suicide, stints in a hospital and psychiatric ward, substance abuse, a nervous breakdown and two months in a rehabilitation center, Britney Salyer found sobriety at UT.

The marketing senior got involved in University Health Services' Center for Students in Recovery when she returned to UT after leaving a rehabilitation center.

"I went into rehab with no intentions of quitting anything," she said. "But I got introduced to the program, stuck around at UT and got back into the swing of things."

The center provides counseling services and sober social networks for University students, whether they are in treatment, have gone through rehabilitation or need sober support to avoid addiction.

Substance abusers become acclimated to dealing with life and relationships with drugs or alcohol. Laura Jones-Swann, the center's alcohol and drug education coordinator, said the program teaches life skills that help students mend relationships.

"I used to not be able to do class presentations without downing a drink," Salyer said. "It took me a while to regain my steam, but now I don't feel overwhelmed or nervous at all."

UT is one of seven universities in the country that provides programs for recovering students. The program

began in 2002 with seven students and now has 50, but Jones-Swann said she still knows all of the students' names.

"I stay connected to the students through our Wednesday night meetings where we talk about relationships and just get really, extremely honest with each other," she said.

If a student is absent from the meetings for more than two weeks, she said, she sends them an e-mail to check in.

Students who experience organizational hazing, particularly episodes of forced binge drinking, often seek services at UHS.

The most recent study of alcohol-related deaths on college campuses, conducted in 2001, found that 1,700 college students died from unintentional alcohol-related injuries and deaths that year. UT officials said this emphasizes the importance of preventative measures taken by the University.

After 26 months of sobriety, death is not an alternative for Salyer, as it once was.

"It took either rehab, jail or death to get me to quit," she said. "As long as I am willing enough to go into the program and be open about things, then I'll be OK."

Alcohol across the lifespan

The National Institute on Alcohol Abuse and Alcoholism has posted a 5 year plan to address alcohol use across the lifespan.

Alcohol and Other Drug Abuse Among First-year College Students

This document examines the problem of problem drinking among freshman college students. It looks at the scope of the problem and potential responses. While it's focus is pretty narrow, it offers a lot of helpful information for other communities as well.

National surveys find that about two in five U.S. undergraduates engage in heavy drinking, which is typically defined as having five or more drinks in a row at least once in a two-week period. According to survey data compiled by the Core Institute in 2004, 45.3 percent of freshmen nationally can be classified as heavy drinkers. The same data indicate that 17.7 percent are heavy and frequent drinkers, meaning that they engaged in at least one episode of heavy drinking in the previous two weeks and drank on three or more occasions per week.

The negative consequences associated with college alcohol use are legion, including personal injury, physical illness, high-risk sexual behavior, and death. Research estimates that 1,700 college students ages 18–24 die annually from alcohol related unintentional injuries. Nearly 80 percent of those deaths are associated with driving after drinking. In 2001, just over 10 percent of college students reported being injured, while 8 percent reported having unprotected sexual intercourse because of their drinking.

It also offers detailed guidelines for keeping first year students safe:

Provide Alcohol-free Options.

• Create and promote alcohol-free events for fi rst-year students.
• Support student clubs and organizations that are substance-free.
• Create and promote service learning and volunteer opportunities.
• Require community service work as part of the academic curriculum.
• Open or expand hours at a student center, recreation facilities, or other alcohol-free settings.
• Promote consumption of nonalcoholic beverages and food at events.

Create a Healthy Normative Environment.

• Offer a greater number of substance-free residence halls.
• Promote faculty-student contact.
• Require students to meet regularly with academic adviser.
• Require students to meet regularly with resident assistant.
• Employ older resident assistants.
• Prohibit fraternity and sorority rush for fi rst-year students.
• Require students to take more morning and Friday classes.

Restrict Alcohol Availability.

• Require all social events during orientation to be “dry.”
• Require fi rst-year students to live on campus.
• Disseminate responsible host guidelines for both on- and off-campus parties.
• Install a responsible beverage service program.
• Train alcohol servers and managers to stop service to underage or intoxicated students.
• Train alcohol servers and managers in the latest techniques and technologies for recognizing false IDs.
• Eliminate residence hall delivery of alcohol purchases.
• Advertise food and activities, such as dancing or sports, rather than drinking as the focus of the event.

Restrict Marketing and Promotion of Alcohol.

• Ban alcohol promotions with special appeal to underage drinkers.
• Ban advertising of high-risk promotions.

Strengthen Policy Development and Enforcement.

• Review campus alcohol and other drug policies and strengthen where necessary.
• Disseminate campus alcohol and other drug policies and publicize their enforcement.
• Require on-campus functions to be registered.
• Impose tough penalties for possessing a fake ID.
• Enforce minimum legal drinking age laws.

Increase ID checks at on-campus functions and parties.

Use decoy operations at campus pubs and on-campus functions.

Increase ID checks at off-campus bars and liquor stores.

Use decoy operations at retail alcohol outlets.

Enforce seller penalties for sale of liquor to minors.

• Support local and state enforcement in imposing driver’s license penalties for minors violating alcohol laws, and in changing driver’s licensing procedures and formats.
• Notify parents of their children’s rules violations.

The sting of poverty

This article is a little off topic for this blog, but it addresses what many of Dawn Farm's client's confront. We talk a lot about our clients as "multiple problem clients", and that one of the reasons they end up in our programs is because of the number of problems they face as well as their intensity and complexity.

Imagine getting A bee sting; then imagine getting six more. You are now in a position to think about what it means to be poor...

When we're poor, Karelis argues, our economic worldview is shaped by deprivation, and we see the world around us not in terms of goods to be consumed but as problems to be alleviated. This is where the bee stings come in: A person with one bee sting is highly motivated to get it treated. But a person with multiple bee stings does not have much incentive to get one sting treated, because the others will still throb. The more of a painful or undesirable thing one has (i.e. the poorer one is) the less likely one is to do anything about any one problem. Poverty is less a matter of having few goods than having lots of problems.

Poverty and wealth, by this logic, don't just fall along a continuum the way hot and cold or short and tall do. They are instead fundamentally different experiences, each working on the human psyche in its own way. At some point between the two, people stop thinking in terms of goods and start thinking in terms of problems, and that shift has enormous consequences. Perhaps because economists, by and large, are well-off, he suggests, they've failed to see the shift at all.

If Karelis is right, antipoverty initiatives championed all along the ideological spectrum are unlikely to work - from work requirements, time-limited benefits, and marriage and drug counseling to overhauling inner-city education and replacing ghettos with commercially vibrant mixed-income neighborhoods. It also means, Karelis argues, that at one level economists and poverty experts will have to reconsider scarcity, one of the most basic ideas in economics.

"It's Econ 101 that's to blame," Karelis says. "It's created this tired, phony debate about what causes poverty."