Tab dump

Sorry for all the recent tab dumps. Enjoying summer with my kids, work is busy and having a hard time keeping up with the blog.

• Methadone users 'more likely to carry on injecting'
• Pilot Alcoholism-Treatment Program Targets Gays
• Effects of Voucher-Based Intervention on Abstinence and Retention in an Outpatient Treatment for Cocaine Addiction: A Randomized Controlled Trial
• Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs
• The tripod of recovery (Food for thought about assessing a person's spiritual dimension.)
• Using propensity scores to adjust for selection bias when assessing the effectiveness of Alcoholics Anonymous in observational studies
• Meaning-Centered Therapy (A great reminder of how deficit focused assessment can get.)

Technorati Tags: methadone, lgbt, contingency management, alcoholism, therapy, treatment, addiction, policy

Susie Q?

Not a surprise if you spend time talking with people who receive treatment in medically oriented programs:

...these days, the use of Seroquel is growing in popularity in a different group: men and women living on the margins who simply want a good night’s rest.

“Seroquel puts you to sleep,’’ said Luis Lopez, 28, a patient at Men’s Addiction Treatment Center in Brockton who used to buy Seroquel tablets from drug dealers. “We all know from the streets that’s how it works.’’

The street use of Seroquel as a sedative is yet another example of how many prescription drugs cross over into the illicit drug market, creating incentives for dealers to illegally obtain the drug and dangers for users ignorant of its side effects. If misused, doctors say, Seroquel can heighten the risk of diabetes, heart and blood pressure problems, involuntary twitches, and rapid weight gain.

Technorati Tags: seroquel, psychiatry, insomnia

Treatment out of reach

Most Americans say they could not afford addiction treatment if they or a family member needed it.

Technorati Tags: addiction, treatment, health care

If Marijuana Is Legal, Will Addiction Rise?

Five points of view on this question. A good read.

Technorati Tags: policy, marijuana, legalization, addiction

Tab Dump

• We've made a list  of the Best Addition Treatment Blogs
• A Lower Drinking Age?
• Baltimore Credits Treatment for Decline in Overdose Deaths
• Evil weed or useful drug?
• Bill Would Allow Federal Funding For Needle Exchange Programs
  

HOPE for the criminal justice system

Drawn from Mark Kleiman's new book:

So Alm devised a new plan. He asked the probation officers to select a group of seemingly incorrigible scofflaws, probationers just one slipup shy of a revocation hearing. Every time one of them missed or flunked a drug test (or broke any other probation rule) he would land in court—and in jail—right away. Alm enlisted the help of prosecutors and public defenders to ensure that a hearing could be held within forty-eight hours of a violation. He corralled the federal fugitive task force to chase down anyone who refused to come into court. To cut down on paperwork, he eliminated the long report, documenting a long history of misconduct, that had previously been required from a probation officer before a revocation hearing. In its place, he substituted a two-page fill-in-the-blanks form, which dealt with only a single missed or dirty test or other violation.

Then, instead of "revoking" probation and condemning the offender to years in prison, Alm would "modify" probation, sending the offender to jail for a few days and then releasing him back to probation supervision. Alm reasoned that a brief stint behind bars would make the probationer more cooperative when he returned to his officer’s caseload.

The probation officers feared that Alm’s proposal would be impossibly burdensome, but they agreed to give it a try. Alm held a contest among the officers to name the program, and the winning entry was "Hawaii’s Opportunity Probation with Enforcement," or HOPE.

HOPE started with thirty-four chronic violators. On the advice of the public defender, Alm brought them into court for what he called a "warning hearing," with the defense counsel and the prosecutor present. He explained that, for them, the era of warnings was over. "If you fail a drug test, if you fail to meet with your probation officer when you are supposed to, or you fail with other terms of your probation … you will go to jail," runs Alm’s script for such proceedings. "All of your actions in life have consequences, good or bad." Later, Alm added a new twist to the program: random drug testing, with each probationer required to call in to a hotline every weekday morning to learn whether that was his day to be tested.

Everyone braced for a flood of missed and failed tests and the consequent sanctions hearings. But then something strange happened: in the first two weeks, only five of the thirty-four broke the rules. The overall rate of missed and failed drug tests dropped by more than 80 percent. Before the program started, the HOPE group had more than twice the noncompliance rate of the comparison group; that’s how they were chosen. HOPE reversed that picture, with program participants testing positive at less than one-quarter the rate of the comparison group. The high level of compliance made the workload perfectly manageable for everyone involved, and Alm was able to expand HOPE to 135 probationers without hiring more people.

Despite tighter monitoring and "zero-tolerance" sanctioning, HOPE participants averaged about the same number of days in jail as the comparison group: about twenty days over the course of a year. But they had only a third as many revocations and were sentenced to only a third as much prison time: on average, 110 days per probationer, as compared to 300 days.

Then Hawaii expanded the program, and it kept working....

...In addition, HOPE has achieved something rare in the American criminal justice system, proving that it is actually possible to enforce the conditions of "community corrections" programs: probation and its cousin, parole. (Probationers are offenders who have been placed under supervision instead of being sent to prison; parolees are monitored in the community after serving part of their prison term.) This discovery has major policy implications. After twenty-five years of "tough on crime" orthodoxy, American politicians are urgently searching for workable alternatives to mass incarceration. The fiscal crisis has state governments scrambling to pay for prison systems that take a bigger share of state budgets than anything but health care and education. Senator Jim Webb is seeking to enact major criminal-justice reforms, reasoning that a system that holds one in 100 adults behind bars and has a 60 percent recidivism rate could probably be improved. Yet while mass incarceration has been under criticism, scant attention has been devoted to the inadequacies of the alternatives, probation and parole. In every state those systems are woefully underfunded and overburdened, unable to enforce their own rules or to prevent most of their clients from sliding back into criminal life. All of the other "community corrections" options—drug diversion programs, treatment courts, community service, home detention—depend on the probation system for their enforcement. As long as probation remains ineffective, any requirement imposed on an offender by the court is, in reality, no more than a helpful hint.

Without a functioning community-corrections system, the current enthusiasm for prison reform is likely to wither and fade. That’s what makes Judge Alm’s Hawaiian experiment so important. The biggest and cheapest opportunity to lower both incarceration and crime rates is to transform probation from a minor nuisance to the probationer into a real system of "outpatient corrections," capable of monitoring and reforming the behavior of vast numbers of offenders.

Technorati Tags: crime, incarceration, policy

Not four pillars. One shaky toothpick.

Criticism of Vancouver's implementation of their four pillar model:

SFU psychology professor emeritus Bruce Alexander writes that it "provides no way of assigning funding priorities to diverse agencies, all competing for scarce public resources," so agencies "seem to work at cross-purposes."

Dr. Meldon Kahan, director of addictions medicine at St. Joseph's Hospital in Toronto, believes harm reduction is often code for giving up.

"If strategies such as safe-injection sites and heroin clinics aren't connected with treatment options, then they become 'palliative care' -- they have given up on patients ever recovering from their addiction and are attempting to keep patients safe while they continue to use drugs. The latter goal is fine, but the 'giving up' on patients is not," says Kahan, an associate professor of family medicine at the University of Toronto who has written books on addiction and has visited the Downtown Eastside.

Vancouver police union president Tom Stamatakis has charged that funding favours harm reduction over the other pillars, creating just "one shaky toothpick" — "a strategy that's doomed to fail."

Technorati Tags: vancouver, harm reduction, policy, drugs

U.N. Drug Report Admits Policy Problems, But Slams Legalization Talk

Join Together's coverage of a recent UN drug policy report includes some of the smartest debate I've seen in a while:

The 2009 report opens with an acknowledgment that calls for exploring alternatives to drug prohibition have grown as more policymakers and the public have concluded that current drug-control policies have failed. However, the report blasts calls for legalizing and taxing currently illegal drugs as "unethical and uneconomical," comparing the idea to putting a tax on "other seemingly intractable crimes like human trafficking."

The UNODC parries the economic argument for legalization as "naive and myopic," saying that only rich countries would even have a chance of effectively regulating the drug market. 

"Why unleash a drug epidemic in the developing world for the sake of libertarian arguments made by a pro-drug lobby that has the luxury of access to drug treatment?" Costa wrote in the report's executive summary. "Drugs are not harmful because they are controlled -- they are controlled because they are harmful; and they do harm whether the addict is rich and beautiful, or poor and marginalized."

"Proponents of legalization can't have it both ways," said Costa. "A free market for drugs would unleash a drug epidemic, while a regulated one would create a parallel criminal market. Legalization is not a magic wand that would suppress both mafias and drug abuse. Societies should not have to choose between protecting public health or public security: they can, and should do both."

Jack Cole, executive director of Law Enforcement Against Prohibition (LEAP), said Costa "would have you believe that the legalization movement is calling for the abolition of drug control. Quite the contrary, we are demanding that governments replace the failed policy of prohibition with a system that actually regulates and controls drugs, including their purity and prices, as well as who produces them and who they can be sold to."

"The U.N. drug czar is talking out of both sides of his mouth," added Ethan Nadelmann, executive director of the Drug Policy Alliance (DPA). "On the one hand he admits global drug prohibition is destabilizing governments, increasing violence, and destroying lives. But on the other hand he offers facile arguments dismissing the need for serious debate on alternative drug policies."

Technorati Tags: UN, policy, legalization

Plenty on pot

Mother Jones has quite a bit on pot policy.

First, The Drug War, By the Numbers offers a pair of graphs on spending and arrests. We saw massive cuts in spending during the Clinton years. Unfortunately, this included cuts in spending on demand reduction.

Next, This Is Your War on Drugs offers their editorial analysis of the issue:

What would a fact-based drug policy look like? It would put considerably more money into treatment, the method proven to best reduce use. It would likely leave in place the prohibition on "hard" drugs, but make enforcement fair (no more traffickers rolling on hapless girlfriends to cut a deal. No more Tulias). And it would likely decriminalize but tightly regulate marijuana, which study after study shows is less dangerous or addictive than cigarettes or alcohol, has undeniable medicinal properties, and isn't a gateway drug to anything harder than Doritos.

Finally, The Patriot's Guide to Legalization, investigates several big questions related to pot policy in a pretty sober manner:

On virtually every subject related to cannabis (an inclusive term that refers to both the sativa and indica varieties of the marijuana plant, as well as hashish, bhang, and other derivatives), the evidence is ambiguous. Sometimes even mysterious. So let's start with the obvious question.

DOES DECRIMINALIZING CANNABIS HAVE ANY EFFECT AT ALL? It's remarkably hard to tell—in part because drug use is faddish. Cannabis use among teens in the United States, for example, went down sharply in the '80s, bounced back in the early '90s, and has declined moderately since. Nobody really knows why.

Slate V visits the serious business of a medical marijuana expo:


Technorati Tags: marijuana, policy, legalization, decriminalization

What do you believe about your clients?

A great set of questions for self-evaluation that focus on the worker's ability to see and work with client strengths.

Cognitive performance enahncement

Head to head articles for and against the acceptability of people taking methylphenidate to enhance performance. The against column offers an interesting ethical argument:

Drug enhancements will be available disproportionately to those with financial means. If enhancements are helpful in getting ahead in a competitive world, then the haves would avail themselves of yet another advantage over the have nots. Clearly, many inequities in education, material goods, and social class, not to mention more fundamental inequities in health care, nutrition, shelter, and safety, already give the socioeconomically lucky disproportionate advantages. However, acknowledging the existence of disturbing inequities does not justify blithely adding more.

Matters of choice can evolve into forces of coercion. Implicit pressures to better one’s position in some perceived social order would find a natural conduit in cognitive enhancements. Such pressures increase in "winner take all" environments, in which more people compete for fewer and bigger prizes.

Technorati Tags: methyphenidate, enhancement, ethics, policy

The sky doesn't fall in

More on Portugal's decriminalization strategy:

Some question aspects of the system, but what Portugal's controversial experiment has demonstrated is that, if you take the crime out of drug use, the sky doesn't fall in.

Technorati Tags: policy, drugs, portugal, decriminalization