Webb on prison reform

Glenn Greenwald commends Senator Jim Webb for trying to bring attention to our incarceration rates and the need for prison reform. (Though I'm sick of the blogosphere hyperventilating over Obama's response to the question about pot legalization.) Here's an excerpt from a speech Webb gave last week:

The elephant in the bedroom in many discussions on the criminal justice system is the sharp increase in drug incarceration over the past three decades. In 1980, we had 41,000 drug offenders in prison; today we have more than 500,000, an increase of 1,200%. . . .

In many cases these issues involve people’s ability to have proper counsel and other issues, but there are stunning statistics with respect to drugs that we all must come to terms with. African-Americans are about 12% of our population; contrary to a lot of thought and rhetoric, their drug use rate in terms of frequent drug use rate is about the same as all other elements of our society, about 14%. But they end up being 37% of those arrested on drug charges, 59% of those convicted, and 74% of those sentenced to prison by the numbers that have been provided by us. . . .

It's a great post. Too difficult to pull quotes from. Take the time to read the whole thing.

Bill White in the UK

Bill White recently visited with some recovery advocates in the UK. There are several reactions posted at Wired in to recovery. Here's an interesting one on the cultural gap between the US and the UK:

I think I am right is saying that being welfare dependent carries more social stigma in the US than it does here. I think what I am trying to say is that there is a different social context for self-help and mutal aid and therefore recovery.

In the UK’s welfare state, there is a large body of middle class professionals (including drugs workers) who are charged with managing the lower orders of addicts. They may unwittingly “infantilse” the people in their care when they say things like, “You’re not ready for detox”.

I was reminded of something that was said to me a few years ago in a heated debate about harm reduction. “Sometimes, liberal minded people do the wrong things for the right reasons and their conservative opposites end up doing the right things for the wrong reasons”.

I'm still chewing on this and I don't really buy the right/wrong reasons--I think there are people with good and bad motives on both ends of the political spectrum. I started to write more, but I'll leave it at that.

Mexico's drug war

The Boston Globe's photo blog, the big picture, has a collection of imaged from Mexico's drug war.

No kidding

Sleep Drug, Sometimes Used as Study Aid, Might Be Addictive

Grow your own

Mark Kleiman modifies his grow your own proposal for pot policy:

That then suggests yet another option: in addition to allowing production for one's own use or for gift, perhaps the law could allow the formation of consumer-owned co-operatives, limited in size, barred from advertising and from selling other than by mail-order. Each co-op would be required to produce its own material rather than buying it from manufacturers or wholesalers. That system would provide much though not all of the convenience, choice, and potential tax revenue of the alcohol model, without creating an another addiction-promotion industry.

He also explains his rationale. Read the whole thing.

Creative solutions

What is there to say? I would really like to stop posting this stuff.

Every day, in the shadow of Parliament Hill, 30 homeless alcoholics are fed, housed and served drinks, each hour on the hour, between early morning and evening.

That this "managed alcohol" program run by Ottawa's Inner City Health Inc. in the ByWard Market, is effective, is beyond dispute. For one thing, it has saved the local health-care system in the neighbourhood of $3.5 million by reducing or eliminating its clients' frequent visits to hospital emergency rooms. For another, it has dramatically improved the quality of life for a group of people many would view as beyond hope.
...
It may seem counterintuitive to give addicts what is making them sick, but the Inner City Health program demonstrates it can help them live healthier, happier and less disruptive lives. Despite the fact that they are kept "buzzed" all day as a Citizen reporter put it, they are actually drinking less -- maybe two-thirds less -- than they would have been on the street. They can't panhandle while on the program and must meet strict requirements, which they agree to. And the fact is many homeless alcoholics can't quit. The best that can be done is to manage their addiction.
...
Many people think residential treatment is the only option for drug addicts. Muckle disagrees. "We have to change the assumptions and provide other kinds of help than we do." For some, residential treatment programs will be entirely ineffective, she says, mainly because they don't last long enough to make a real difference. A long, slow process that includes group therapy, harm reduction programs and some place to live, would have a better chance of succeeding.

One more thought about this and Staying Alive. The people give lip service to recovery, but all they talk about is how few people will recover, how damaged these people are and how the rest of us just don't get it. How can they really advocate for recovery when they have so little hope for the people they work with?

I honestly don't go looking for it. I rely on saved searches for keywords like substance abuse, drugs, alcohol, addiction, etc. This stuff just keeps coming.

Call for stories

From The Second Road:

April is Alcohol Awareness month. The Second Road will showcase a recovery story everyday during the month of April. They want to applaud those living in recovery while helping to bring awareness to addiction and to also make people aware of the strong community of support that exists.

TSR wants to salute the people who are battling alcoholism; as a child, a parent, a spouse, sibling, or as an addict. Be it 22 years or 2 days, they want to hear from the people making the decision to start a new path?to take the second road. TSR hopes this showcase will inspire not only those who are living in desperation, wrestling with the will to get sober, but also encourage those already working a program.

Community, support and inspiration are necessary on the road to recovery. If we can heighten the awareness of this disease, hopefully we can lower the amount of people living in pain.
Please, make YOUR voice heard. Submit your story to alix@thesecondroad.org.

TSR will feature more than one story a day, granted they receive enough submissions. If anyone would like to videotape their story, TSR will also showcase it on their YouTube page, with the other recovery speakers, at http://www.youtube.com/user/thesecondroad.

The power of expectancy

A study of naltrexone, acamprosate and placebo found that the treatment group they were in did not predict outcomes. What did predict outcomes was whether they believed that they were receiving an actual drug rather than placebo.

Background: Double-blind placebo-controlled trials are intended to control for the impact of expectancy on outcomes. Whether they always achieve this is, however, questionable. Methods: Reanalysis of a clinical trial of naltrexone and acamprosate for alcohol dependence investigated this issue further. In this trial, 169 alcohol-dependent patients received naltrexone, acamprosate or placebo for 12 weeks. In addition to being assessed on various indices of alcohol dependence, they were asked whether they believed they received active medication or placebo. Results: While there were no differences in outcomes between treatment groups, those who believed they had been taking active medication consumed fewer alcoholic drinks and reported less alcohol dependence and cravings. That is, irrespective of actual treatment, perceived medication allocation predicted health outcomes. Conclusions: These results highlight the differences between treatment administration in clinical trials and standard medical practice, a discrepancy that may sometimes decrease the validity of these types of trials.

You could also refer to expectancy as hope.

When hope heals

From Ode magazine:

An experiment: Two groups of rats receive transplants of malignant tumors and are given electric shocks. One of them can avoid the shocks by pushing on a lever; the other can't. In the group that can avoid the shocks, the immune system does its job, counterattacks and eliminates the cancer cells in 64 percent of the animals. In the other group, animals soon get discouraged, the immune cells are paralyzed and the cancer spreads in a few weeks. Only 23 percent of the rats reject the tumor.

Is that why Paul died—because he suddenly felt powerless to escape the "shocks" he got from his disease? [Paul, who had managed his illness for years, died 2 years after being told he had 2 years to live.] Cancer seems to develop faster and more aggressively in patients who have less control over the inevitable stress of existence, which seems to be one of the reasons support groups prolong survival. Now what could be more stressful than being told there's no hope of a cure? At the University of California, Los Angeles, Assistant Professor Steve Cole demonstrated that among AIDS patients on tri-therapy, the treatment benefits those who remain calm facing life's difficulties far more than those who have trouble controlling their stress. In the latter group, the virus spreads four times as fast.

But who will explain that to patients? Almost every week I hear patients tell me how they've received "death sentences" from their oncologists. These pronouncements are made with the greatest confidence, as if statistics were certainties. Studies like Cole's are almost never mentioned. Yet patients really need them. Because I've already made this mistake myself, I suspect doctors are more afraid of giving false hope than of talking about the worst that can happen. To guard against this Western-style voodoo, patients often need to know more than their doctors about what they can do to help themselves—beginning by placing more hope in their bodies than medicine is prepared to give them.

What role does hope play in addiction? An large role, I suspect. Scott Miller has found that expectancy accounts for 15% the variance in treatment outcomes.

“If you want to treat an illness that has no easy cure, first of all, treat them with hope” -- George Vaillant

Comments on Staying Alive

I got this comment about the CBC video:

Thank you so much for posting this! It really put some faces on all the talk we've had about harm reduction.

Don't get me wrong, I can see the importance of the social connections that Insite is providing for individuals. At the same time, what I found most disturbing was the situation with the woman, Shelley, who came to Insite to relapse.

I felt like with her life on the line, couldn't they do a little more to help her? Helping her get a hold of some pharmacies? Hooking her up with some non-methadone treatment?

I think one can be non-judgmental and say "You deserve sobriety" at the same time.

So, I finally watched the whole thing and here is my stream of consciousness:

Q: "How do you know if they're ready?"
A: "It's a judgment call. We know them..."

What does this mean? How about letting them tell you when their ready?

How on earth do people start recovery above the injection center? This place is the hub of the heroin user tribe of the culture of addiction.

Shelley - how about a little case management for Shelley? How about helping her get her prescription filled or a  getting her dose as an alternative to using heroin? Is it really reducing her harm when she predictably ends up tricking in the alley a day later? Was their passivity in the face of her relapse about her needs or about their personal philosophy? I'm not suggesting use of force, yelling or shaming, but she was in a temporary emotional crisis and was about to make a decision with profound long-term consequences.

Gabor Mate - "Addiction is not a moral failing" Correct. But our communal response to addiction is a moral failing. This place is a well equipped pit of despair. How can one offer hope in a place like this with people who expect you to fail at any attempt to recover.

The worker - I'm sorry. Maybe he's wonderful and in this for all the right reasons, but I can't shake the feeling that the work is self-ennoblizing, a source of vicarious excitement and is more about their world-view, their needs and their image. Acceptance of people "where they are at" does not mean treating them with the message that there's nothing wrong with staying where they are at forever. How about accepting them for what they can become?

Video fun

The A/V Geeks have posted scores of old videos, including the following:

[via kottke.org]

This is an emergency

One family writes about the impact of marijuana addiction in their family. (Skeptics - Stop focusing on the drug and think in terms of the response of the individual to the drug.)

Highlights here:

And for the last four years, this is how it's been. Two steps forward, two steps back. We effectively remain where we have been since it started.

This is cannabis. It stops you, it rips out normal reactions, normal kindness, normal motivation. It draws a line and you stand patiently behind it. And this is why we have broken one of the most serious prohibitions facing any writer. You Do Not Write About Your Children. Yes, your kids might enter your work now and then in charming disguise but you do not ever lay out their genuine, raw problems on the page. You fictionalise them, you do not present it up-front and true. There is a glass-fronted box in the corner of every writer's room, protecting the real lives of their children: Smash Only In Case Of Emergency.

...

Imagine if you could wave a wand and instantly all the spliffs and baggies were transformed into bottles of gin. You leave for work on Wednesday morning and suddenly you see kids on the way to school with a quarter of Gordon's sticking out their rucksack; at Thursday lunchtime, you see them sharing a swig of Tanqueray at the bus stop. And if you saw that daily, all around you, you would say there's a genuine problem. Except it's worse than that.

...

Their arguments - some ill-informed, some plain vitriolic - have all rested on an implicit belief that "a bit of pot" simply does not cause this kind of aggression, this sort of abuse. Yes, they say, if this was a heroin addict, nicking your stereo, your jewellery and flogging it down the pub, that would be credible. And they're right, you don't need to flog a stereo for a spliff - it costs less than a pint. And anyway, cannabis makes you mellow - stoners are hippies, laid back, docile to a fault. We used to smoke it, they imply, and we just giggled.

That was then. Skunk is GM cannabis. Evidence from the Forensic Science Service suggests that skunk cannabis (otherwise known as sinsemilla) is remarkably stronger than ever before. It is unquestionably different, definitely stronger. In skunk, the active ingredient, THC (tetrahydrocannabinol), has been ramped up significantly. But perhaps more importantly, this has been achieved at the cost of another component of naturally occurring cannabis, CBD (cannabidiol). And some scientists are starting to think that CBD has antipsychotic properties - something to offset the THC in old-fashioned marijuana but absent in skunk.

Heroin maintenance (again)

Is England considering adopting Denmark's heroin maintenance approach?

Some might think this initiative is not surprising in a country with a historical tradition of progressive, social democratic policies....

"Five years ago I decided I would not participate in yet another debate on drugs," recalls Preben Brandt, the chairman of the Council for Socially Marginalised People and an advocate of the policy. "It was too emotional, with different groups being very aggressive."

"The counter-argument was always 'you kill people by giving heroin' or 'with this initiative, you are telling people that taking heroin is OK'," he says. "It is very difficult to have a rational debate when you are arguing against beliefs."

The turning point came when results became available from experiments trialling the policy in other European countries, including Switzerland and the Netherlands. "The politicians became convinced that it could help those with the most severe drug problems," says Mads Uffe Pedersen, the head of the Centre for Alcohol and Drug Research at the University of Aarhus. "You could not argue against the (positive) findings."

"The debate became more practical," agrees Brandt. "It was about what policies worked and which ones did not. It was no longer about morality."

Attitudes towards drugs addicts improved too. "Drug addicts in Denmark are less stigmatised," says Brandt. "They are no longer perceived as criminals who are a danger to society. They're seen as patients who have a disease they need help with. The new scapegoats in Denmark are the foreigners."

I doubt this is near in England. And, call me crusty, but I find it difficult to believe that the motives here are to help addicts and that stigma has been reduced by a policy premised on the assumption that addiction is untreatable.

Involuntary treatment bill in West Virginia

I find this very frightening, though I empathize with families who wish they had this option.

Insite on CBC

CBC has a program on Vancouver's supervised injection center.

Drug War = Culture War?

A friend, Matt, wondered if the premise of this Frank Rich column will have implications for drug policy:

What has happened between 2001 and 2009 to so radically change the cultural climate? Here, at last, is one piece of good news in our global economic meltdown: Americans have less and less patience for the intrusive and divisive moral scolds who thrived in the bubbles of the Clinton and Bush years. Culture wars are a luxury the country — the G.O.P. included — can no longer afford.

I don't think that the drug war has traditionally been part of the abortion/homosexuality/sexuality-in-pop-culture culture wars, but pro-legalization advocates seem to be enjoying a great deal of success in moving it to that category. I wince at this categorization--the culture wars tend to impose false binary choices and I suspect it would lead to very bad policy.

Conservative outcast David Frum wades into the matter, but his point seems to be to challenge hippie dope smoking peaceniks to consider the violence involved in the marijuana trade next time they light up. It's an old tune. Acknowledge some of the costs of the drug war, and frame drug use as an immoral decision without examining the morality of the policy itself.

I don't know what "the" solution is and I'm skeptical of anyone who claims to know. There are losts of changes we could make--shifting the the emphasis of our policy from incarceration to treatment and supervision. However, no drug policy is going to solve the drug problem, Every policy will bring new problems and decrease other problems. It really comes down to which problems we're willing to live with. A lot of us have strong opinions and would like to decide the right policy, but our political process requires some measure of concensus. (Even if it's limited.)  I suspect that the only way to get there is to identify the relevant values and debate how the options fit within these values. If the debate ends up getting framed in the context of the culture war, this will be impossible.

Anxiety and Alcohol

A new study focuses on the neurobiological relationship between anxiety and alcohol use.

It offers a possible mechanism for vicious cycle of alcohol use leading to anxiety and this anxiety leading to more alcohol use.

The researchers found that short-term alcohol exposure increased the number of dendritic spines in certain regions of the amygdala, producing anti-anxiety effects. Alcohol-dependent animals eventually developed a tolerance to the anxiety-lowering effects of alcohol.

The researchers traced the anti-anxiety effect to the production of a particular protein, Arc, in response to a nerve growth factor called BDNF that is stimulated by alcohol exposure. BDNF is vital in the functioning and maintenance of neurons.

When alcohol was withheld from animals that had been chronically exposed, they developed high anxiety. Levels of BDNF and Arc -- and the number of dendritic spines -- were decreased in the amygdala. But the researchers were able to eliminate the anxiety in the alcohol-dependent animals by restoring BDNF and Arc to normal levels.

Pandey suggested that an initial easing of anxiety may encourage people to begin to use alcohol, while for chronic users, a lack of alcohol provokes high anxiety, creating a need to continue drinking to feel normal.

I think we need to know a lot more about this anti-anxiety effect before going off the races with anxiety as a pathway to alcoholism.

Def Jam on Drug Policy

Russell Simmons praises moves by the New York legislature to roll back the Rockefeller Drug Laws.

Betty Ford

Alix at The Second Road gives us a heads up about a PBS show on Betty Ford.

Here's Bill White's salute to her from a couple of years ago:

In the decades following the repeal of Prohibition, American women faced a unique cultural double bind. They were targeted for unrelenting product promotion by the alcohol, tobacco, and pharmaceutical industries at the same time social stigma increased for addicted women. Only a few women of prominence (e.g., public health pioneer Marty Mann and actresses Lillian Roth and Mercedes McCambridge) braved such stigma to publicly acknowledge their recoveries from alcoholism, while women struggling with narcotic addiction, such as jazz singer Billie Holiday, broke into public visibility only when they were arrested or died.

In such a climate, unknown numbers of women lost their dreams and their lives to alcoholism and other addictions. Many sought help only in the latest stages of their illnesses, with many dying early in their recoveries as a result of medical disorders spawned from prolonged years of secret addiction to alcohol and other drugs. It could justifiably be claimed that these women died not from addiction, but from stigma.

Recovery advocates during the mid-20th century dreamed of a day when a woman of unprecedented prominence would go public with her recovery story and by doing so forever shatter America's stereotype of the alcoholic as a depraved skid row wino. That dream was about to come true in a way that would forever demarcate "before and after" in the history of addiction and recovery among American women.

Courageous announcement

In April 1978, former President and First Lady Gerald and Betty Ford announced to the nation that Mrs. Ford had sought treatment and was recovering from addiction to alcohol and other drugs. That moment stands as the height of destigmatization of alcohol and other drug problems in America. Here stood one of the most prestigious women in the United States and, at a more personal level, a woman deeply respected and revered by the American public for her independence, spunk, and candor. We had sensed earlier as a citizenry that this was a woman who cared about us and would tell us the truth. She had demonstrated those traits by openly sharing her battle with breast cancer and using that experience to educate us as a nation. And here she was again standing with her husband and family talking to us about recovery from alcoholism and drug dependence.

In doing so, Betty Ford and her family, as they had done before, found a way to elevate their personal crises to a higher level of meaning and purpose. In 1978, Betty Ford did for alcoholism what a few years later a famous actor, a beloved professional athlete, and a brave young boy would do for AIDS. She put a face on alcohol and drug dependency that shattered the public stereotype of the alcoholic and in that moment brought us all a step closer to telling the truth about how these problems had touched our own lives.

The manner in which Mrs. Ford initiated her recovery process was also significant in that it challenged the popular notion that nothing could be done to stop addiction until the person who was addicted had personally hit bottom and reached out for help. News that Betty Ford's daughter, Susan Ford, had initiated a formal family intervention process that resulted in Mrs. Ford's admission to treatment and opened the doorway to her recovery conveyed three crucial lessons to the nation: 1) There is hope for families facing addiction; 2) The family can play a catalytic role in the recovery process; and 3) Individual family members and the family as a whole need to recover from the effects of addiction. Mrs. Ford, President Ford, and Susan and the other Ford children offered themselves as living proof of those propositions.

Chicken or the Egg?

From a press release about a study in the Archives of General Psychiatry:

Although numerous studies have linked alcohol problems and depression, whether the relationship is causal or whether there is a common underlying factor remains unclear, they said.

To explore the issue, they examined data from the Christchurch Health and Development study, which followed 1,055 individuals born in New Zealand for 25 years from birth.

...

In an attempt to determine causality, the researchers tested three statistical models on the data:

• One in which both disorders increased risk of the other in a feedback loop
• One in which major depression caused alcohol problems
• One in which alcohol problems caused major depression

The model that fit best was the one that assumed that alcohol problems caused major depression.

"The underlying mechanisms that give rise to such an association are unclear," the researchers said. "However, it has been proposed that this link may arise from genetic processes in which the use of alcohol acts to trigger genetic markers that increase the risk of major depression."

"In addition," they said, "further research suggests that alcohol's depressant characteristics may lead to periods of depressed affect among those with alcohol abuse or dependence."

Stress related to social, financial, and legal problems stemming from alcohol use might also increase the risk of depression, they said.

Add the Economist's voice to the chorus

The Economist weighs in on drug prohibition. (Again.) Not surprising, given their Libertarian leanings.

I like that they refer to legalization as the "least bad" option. This frames the discussion in a more honest way, though their presentation of the risks/benefits are simplistic and suffer from excessive certitude. (Note that they're advocating the legalization of ALL drugs.)

They also make the assumptions that one would expect from a publication devoted to free markets:

Prohibition has failed to prevent the proliferation of designer drugs, dreamed up in laboratories. Legalisation might encourage legitimate drug companies to try to improve the stuff that people take.

I do not share their faith that free markets would be a good thing for the drug trade.

Something is clearly happening. Chatter on the topic is growing. Let's hope for reform, but let's hope it's done in a thoughtful and realistic way. The status quo is unacceptable, but the distance between the status quo and legalization is vast.