More on the new Canadian drug plan

65% for prevention and treatment (including culturally specific treatment) doesn't exactly sound Draconian:

The Conservative government's new $63.8-million, two-year drug strategy could be worse, but it could be better.Fully half the money will go toward beefing up treatment for addicts. Since health and social services are mainly a provincial responsibility, however, that money will go mainly to development of national benchmarking - so that evaluations can be consistent across the country - and extra programs for aboriginals. The main burden of helping addicts remains with the provinces.Another $10 million will go to prevention - ad campaigns and brochures to remind people, especially young people, how damaging addiction is. "Drugs are dangerous and destructive," Prime Minister Stephen Harper said, unveiling the plan. "If drugs do get hold of you, there will be help to get you off them."

Based on American experience, mandatory minimum sentences don't seem like a wise move, but why not start lobbying and negotiating instead of calling them idiots.


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Special report: Under-age drinking (U.K.)

Independent Online Edition >England is also experiencing problems with underage drinking. In England 18 year olds can purchase alcohol and 16 year olds can drink alcohol in s restaurant, if the alcohol was purchased by a parent.

Amid growing concerns over 24-hour drinking, soaring rates of liver disease and police forces unable to cope with drunken disturbances on the streets, an exclusive Independent on Sunday investigation today reveals the dramatic rise in children admitted to hospital because of alcohol-related illnesses.

The biggest increase is seen among girls under 16 years old, with a 25 per cent increase between 2002/03 and 2004/05. And the problem is getting worse: hospital admissions for under-18s are at their highest since records began, and the average amount children are drinking every week has doubled since 1990.

Professor Mark Bellis, director of the Centre for Public Health at Liverpool John Moores University and a government adviser on alcohol-related issues, said: "The numbers of underage drinkers in hospital for alcohol-related conditions are substantial but it is only the tip of the iceberg. Many more children are admitted for problems not recorded as alcohol. The admissions include everything from being involved in violence to teenage pregnancies. For every one youth admitted due to alcohol consumption there are many more whose health suffers through excessive alcohol consumption."

The ages of children admitted to hospital for alcohol-related problems are getting lower. The number of eight-year-old-boys who drink has doubled from 5 per cent in 1995 to 10 per cent in 2005. The number of 11-year-old girls who drink has increased from 15 per cent in 1995 to 25 per cent in 2005. Many experts believe country is in the grip of a hidden epidemic - one that, like alcoholics themselves, the country is in denial about.

...

Last year police introduced exclusion zones around the beaches of Polzeath and Rock after residents complained of underage drinking and fighting. Dubbed the "Costa del Sloane", the beaches are a magnet for children from public schools.

A senior policeman with Devon and Cornwall constabulary also spoke out about the underage drinking culture after a mob of 100 youths - some as young as 12 - were caught at a mass boozing session in Falmouth.

The startling rise in underage drinking is already beginning to have repercussions on public health and will continue to do so for future generations unless something is done to curb the alcohol consumption of British children, campaigners say.

Frank Soodeen of the charity Alcohol Concern said: "A recent government report on alcohol-related deaths showed that the biggest group was men and women aged 35-54 - which is far younger than ever before. Clearly it's beginning to catch up at an earlier stage, which is very worrying. Generally the highest proportion a few years ago was well above that age group."

The most serious of these health problems is liver cirrhosis. People in their 20s and 30s are now ending up with serious liver problems which, until recently, were normally seen in people twice those ages.

Professor Ian Gilmore, president of the Royal College of Physicians and a liver specialist at the Royal Liverpool Hospital, said: "Cirrhosis of the liver has increased tenfold since the 1970s. There is a big concern about the rise in deaths from cirrhosis among young people. I think we are going to see big increases in people in their 20s and 30s being diagnosed with liver cirrhosis."

David Mayer, chair of the UK Transplant Liver Advisory Group, warned that young drinkers are storing up a problem for the future and are likely to require his services in years to come. "People have more money and more opportunity to drink from an earlier age and therefore their livers are exposed to chronically high alcohol levels. We are concerned that it's becoming an epidemic. It does take many years to develop cirrhosis, but if you start drinking at an early age you are going to see problems sooner rather than later."

With such a marked increase in child drinking, campaigners are furious over the lack of provision offered to young people such as Hayley in helping to tackle their problems. There are even calls for drying-out clinics to be set up specially for young people.

But Professor Bellis argues that we need to help children long before it reaches that stage. "Waiting until children develop alcohol problems means their health, their education and ultimately their life prospects have already begun to suffer. We need a major shift in our national attitudes towards alcohol."

Caroline Flint, the public health minister, last week claimed that the Government is tackling the problem through "targeted enforcement" - reducing sales to under-18s by bars, off-licences and retailers - as well as education on substance abuse.

But campaigners blame the drinks industry for promoting alcohol as "sexy" to the young. Mr Soodeen said: "The drinks industry plays a big part in the whole issue. We really need to be cutting off the supply to young people. Unfortunately, the drinks industry has been very effective in persuading the Government that a 'voluntary health' approach is the way forward. We find it odd that so much of the packaging on alcopops seems juvenile and the alcohol industry has yet to come up with a credible explanation."

[via: Alcohol and Drugs History Society]

Plan to vaccinate babies against drugs

The U.K.'s Daily Mail recently ran a story on a plan to vaccinate children for cocaine, heroin and tobacco. The vaccine would prevent any effects from the drugs and therefore prevent any addiction.

A group called the Transform Drug Policy Foundation has written a response on their blog. They argue that: Drug vaccines don’t really work; Giving drug vaccines to children is profoundly unethical; Even if vaccines worked it wouldn’t prevent problematic drug use, or offending.

I find it pretty unlikely that there would be any significant steps in this direction in the near future. I think it's far more likely that drugs like this will be tried with people who have developed problems before their used in preventative strategies.

'Drinko': Anatomy of an Advocacy Campaign

Join Together breaks down the campaign that get Target, Kohl's and Linens 'n Things to stop selling drinking games.

Study: H.S. Teenage Binge Drinking Common Link To Greater Risky Behaviors

A new report on the prevalence of teen binge drinking and the harms associated with it:

The latest study published in the January issue of "Pediatrics" based on the Centers for Disease Control (CDC) study indicates that binge drinking is common among high school students and is linked to a greater participation in several other risky behaviors.

The new study conducted by CDC scientists, Binge Drinking and Associated Health Risk Behaviors Among High School Students, found that 45 percent of high school students admittedly reported to alcohol consumption within the last month. The survey found that 64 percent of these students also reported binge drinking.

Binge drinking is defined as consuming five or more alcoholic drinks in a row within a few hours of time.

The study found that the probability of teenage binge drinkers to be tempted to get involved in other risky behaviors was much higher than that of the nondrinking teens.

These risky behaviors included sexual activity, smoking and physical fighting to name a few.

Although those students who denied any binge drinking were involved in many of the other risky behaviors, the extent to which they were involved was much lower than those students who admitted to binge drinking.

According to CDC researcher, Jacqueline Miller, MD, "Our study clearly shows that it's not just that students drink alcohol, but how much they drink that most strongly affects whether they experience other health and social problems."

The CDC researchers indicated the following comparisons between nondrinking and binge drinking teenagers from their study, with teen binge drinkers being:

• Greater than five times more likely to be sexually active with one or more partners.
• Smokers with 19 times more likelihood to smoke cigarettes.
• Almost four times as likely to engage in physical fights.
• Eleven times more likely to become a passenger in a vehicle being driven by another who has been drinking alcohol.
• Almost four times more likely to date rape or a victim of violence by the opposite sex.
• Four times more likely to attempt suicide.
• At greater risk to use drugs, such as marijuana and cocaine.

The survey also indicated that binge drinking among these teenagers was more common with boys than girls.

The binge drinkers self-admittedly reported poorer grades in school as well.

Overall, the survey included reports of both public and private school students across the entire U.S.

Youngest Drinkers Likelier To Use Alcohol For Stress Relief As Adults

A new study reports on the impact of one risk factor for problem substance use:

The younger someone starts drinking alcoholic beverages, the more likely he or she is to reach for a drink to relieve stress when older, a large new study suggests.

...

Respondents were asked whether they had experienced 12 different types of stressful events in the previous year, such as death of a family member or close friend, unemployment for more than a month, financial crises, legal problems or disruption of a marriage or romantic relationship.

Average daily consumption of alcohol increased by 19 percent with each additional stressful event experienced among those who started drinking at 14 or younger compared with 3 percent among those who took their first drink at 18 or older.

After adjusting for other factors that might be related to the amount of alcohol consumed, the researchers said "the association between stress and volume of consumption was significant only for early initiators."

This Is Your Brain on Drugs, Dad

In an Op-Ed in the New York Times, Mike Males calls for an end to "the obsession with hyping teenage drug use." I have the same reaction every time I read something from him. He always does a good job arguing that we while our attention is on drugs, sex and violence among youth, the biggest problems in these area are adults.

Among Americans in their 40s and 50s, deaths from illicit-drug overdoses have risen by 800 percent since 1980, including 300 percent in the last decade. In 2004, American hospital emergency rooms treated 400,000 patients between the ages 35 and 64 for abusing heroin, cocaine, methamphetamine, marijuana, hallucinogens and “club drugs” like ecstasy.

Equally surprising, graying baby boomers have become America’s fastest-growing crime scourge. The F.B.I. reports that last year the number of Americans over the age of 40 arrested for violent and property felonies rose to 420,000, up from 170,000 in 1980. Arrests for drug offenses among those over 40 rose to 360,000 last year, up from 22,000 in 1980. The Bureau of Justice Statistics found that 440,000 Americans ages 40 and older were incarcerated in 2005, triple the number in 1990.

...

In 1972, the University of Michigan researchers who carry out Monitoring the Future found that just 22 percent of high school seniors had ever used illegal drugs, compared to 48 percent of the class of 2005. Yet as that generation has aged, it has been afflicted by drug abuse and its related ills — overdoses, hospitalizations, drug-related crime — at far higher rates than those experienced by later generations at the same ages.

However, I get the sense that his intention is for the reader to be more alarmed about adult behavior and less alarmed about youth behaviors. I tend to be more alarmed about both young people and adults. He also (unintentionally?) makes the case that the problem is worse than we realize:

When releasing last week’s Monitoring the Future survey on drug use, John P. Walters, the director of the Office of National Drug Control Policy, boasted that “broad” declines in teenage drug use promise “enormous beneficial consequences not only for our children now, but for the rest of their lives.” Actually, anybody who has looked carefully at the report and other recent federal studies would see a dramatically different picture: skyrocketing illicit drug abuse and related deaths among teenagers and adults alike.

While Monitoring the Future, an annual study that depends on teenagers to self-report on their behavior, showed that drug use dropped sharply in the last decade, the National Center for Health Statistics has reported that teenage deaths from illicit drug abuse have tripled over the same period [emphasis added]. This reverses 25 years of declining overdose fatalities among youths, suggesting that teenagers are now joining older generations in increased drug use.

Everything I've read by Males is thought provoking and worth reading. I just always feel that he's successful in making his case about adults but fails to persuade me that we're overly concerned about young people.

The impact of alcohol-specific rules, parental norms about early drinking and parental alcohol use on adolescents' drinking behavior

Good news for parents. A new study in the Journal of Child Psychology and Psychiatry and Allied Disciplines finds that alcohol-specific rules and parental alcohol use are related to alcohol use by their children.

Background: The present study explores the role of having rules about alcohol, parental norms about early alcohol use, and parental alcohol use in the development of adolescents' drinking behavior. It is assumed that parental norms and alcohol use affect the rules parents have about alcohol, which in turn prevents alcohol use by adolescent children.

Methods: Longitudinal data collected from 416 families consisting of both parents and two adolescents (aged 13 to 16 years) were used for the analyses.

Results: Results of structural equation modeling show that having clear rules decreases the likelihood of drinking in adolescence. However, longitudinally alcohol-specific rules have only an indirect effect on adolescents' alcohol use, namely through earlier drinking. Analyses focusing on explaining the onset of drinking revealed that having strict rules was related to the postponement of drinking initiation of older and younger adolescents. Further, parental norms about adolescents' early drinking and parental alcohol use were associated with having alcohol-specific rules. Parental norms were also related to adolescents' alcohol use.

Conclusions: The current study is one of the first using a full family design to provide insight into the role of alcohol-specific rules on adolescents' drinking. It was shown that having strict rules is related to postponement of drinking, and that having alcohol-specific rules depends on other factors, thus underlining the complexity of the influence of parenting on the development of adolescents' alcohol use.

Overall Youth Drug Use Down in 2006, But Survey Sees Trouble Brewing with Inhalants, Prescription Drugs, Smoking

The latest Monitoring the Future drug use survey numbers are out and much of the news is good:

The survey of 50,000 8th-, 10th- and 12th-graders found that the overall percentage of U.S. youths using alcohol or other drugs declined modestly in 2006, continuing a decade-long trend. Since the mid-1990s, past-year use of marijuana has fallen 36 percent among 8th-graders, 28 percent among 10th-graders, and 18 percent among 12th-graders. That led Bush administration drug czar John Walters to cite a "substance-abuse sea change among American teens."

"They are getting the message that dangerous drugs damage their lives and limit their futures," said Walters, director of the Office of National Drug Control Policy (ONDCP).

...

Use of marijuana, the nation's most commonly used illicit drug, has been the main focus of the ONDCP's antidrug media campaign. Not surprisingly, federal officials this week celebrated the fact that past-month use of marijuana reported by MTF survey participants has fallen 26 percent since 2001, from 16.6 percent of teens in 2001 to 12.5 percent in 2006. NIDA Director Nora Volkow called this finding "great news."

Some of the researchers are expressing concern about some of the findings:

The University of Michigan, which produced the report, took a more nuanced view, noting that while there was little evidence of increased drug use, reported overall declines in adolescent drug use were relatively small, and that use of many drugs -- including inhalants, LSD, powder cocaine, crystal methamphetamine, heroin, and club drugs like Ketamine, Rohypnol, and GHB -- did not decline at all.

Lloyd Johnson, Ph.D., principal investigator of the study, expressed particular concern about a decline in perceived risk of using inhalants. Use of inhalants did not increase in 2006, according to the study, but inhalant use has been rising among American youth in recent years. "Perceived risk is often a leading indicator of changes in actual use," said Johnston. "So when we see a change like this, we take it as an early warning of trouble ahead."

Misuse of prescription drugs, which also has risen sharply in recent years, did not increase in 2006, but remained at "unacceptably high levels,"... About 9 percent of 2006 survey respondents said they had used prescription narcotic drugs like OxyContin and Vicodin within the past year, and between 4 and 7 percent of 8th- to 12th-graders said they had used over-the-counter cold medicines -- typically containing dextromethorphan -- to get high.
...

University of Michigan researchers also sounded an alarm about youth smoking, saying the MTF findings indicate that the trend toward lower smoking rates among children in their early and middle teens has ended. While current daily smoking has fallen by half among 12th-graders and more than half among 8th- and 10th-graders since the mid-1990s, no further declines were reported in the 2006 survey among 8th- and 10th-graders (daily smoking declined slightly among 12th-graders, from 13.6 percent in 2005 to 12.2 percent in 2006).

Perceived risk of smoking also has leveled off, which researchers said could be due to slackening public attention and publicity about the dangers of smoking. On the other hand, lifetime use of cigarettes has declined by about half among 8th-graders, by 40 percent among 10th-graders, and by 30 percent among 12th-graders since the mid-1990s. Overall smoking rates among all three grades are at an all-time low, and disapproval of smoking among teens is still rising among teens.

Dynamic Drug Policy

An editorial in the new issue of Addiction questions the static drug policy models that dominate current policy debates:

Drug researchers have long understood that there can be long-term waves of greater and lesser drug use and that upswings can involve epidemic-like spread. These and other dynamics discussed below imply that policy ought to vary over the course of a drug use cycle, but drug policy debates have not yet internalized this perspective.

...

Because drug problems vary in these complex ways, it seems plausible that drug policy should vary over time as well; yet it is rare to hear someone couch their drug policy recommendations in these terms. This is striking and more than a little troubling. It suggests that the mental models guiding policy discussions implicitly superimpose a static framework on an intrinsically dynamic phenomenon, akin to popular nostrums for get-rich-quick investing that never vary even as economic conditions change over the business cycle.

It is not clear why policy is not discussed more often in dynamic terms. Perhaps disciplinary boundaries and stove-piped bureaucracies create single-issue advocacy. Perhaps both the health and criminal justice perspectives favour individual-level analyses. Whatever the reasons for their absence to date, dynamic perspectives on drug policy are, in fact, possible.

What are the policy implications? The author discusses the stage-specific limitations and strengths of several approaches:

Preventing an initiation in the early stages of an epidemic is tremendously valuable, because it short-circuits a chain reaction that would have involved many people. (In technical terms, the reproductive rate at that point would have been large.) However, primary prevention cannot be timed to react to a burgeoning epidemic because of intrinsic lags. For example, the median age of cocaine initiation in the US is 21 years, but students in school-based prevention programmes are younger, often only 13 years old. Therefore, if school-based prevention interventions were to have any hope of affecting cocaine initiation dramatically, the ideal time to have run them would have been in the early 1970s, 8 years before the peak in initiation. However, no one knew in 1970 that there was a cocaine epidemic brewing. Conversely, the vast majority of cocaine consumed from 1985 to 2005 was consumed by people who were already older than 13 years in 1985. For instance, over 85% of people the Treatment Episode Data Set (TEDS) records as receiving treatment for cocaine between 1992 and 2003 were born before 1973. Consequently, prevention programmes initiated around the time the cocaine epidemic became salient could not possibly have had a dramatic effect on use over the next generation, regardless of how effective they were.

Treatment also has limited ability to stave off a burgeoning epidemic, because early in the epidemic most users do not have a treatable medical condition. Precise estimates are not available because population-level estimates of treatment need exist only for recent years, but need for treatment is correlated with average duration of use. In 2003, 39% of respondents reporting past-year cocaine use to the US Household Survey had been using for 10 or more years. In 1979, the peak year for cocaine initiation, that proportion was just 3%. For drugs that are not injected, the role of harm reduction strategies is similarly limited when most users are not experiencing significant harms with their use.

Enforcement's effectiveness at suppressing drug use declines markedly as the size of a drug market grows. However, enforcement has unique ability to focus its effects in both space and time. If a crack house opened next door, neither funding school-based prevention nor additional treatment slots would bring rapid relief. Parking a patrol car in front of the crack house would at least displace the activity. Similarly, assume treatment was five times more cost effective than incarceration at reducing drug use. Incarceration could still be twice as cost effective at reducing drug use this year—because incarceration's effects on drug use are concentrated in the present whereas treatment's effects may be spread over a decade or more. Hence, these models suggest that supply control programmes may have a unique capacity to disrupt the contagious spread of a new drug, but limited ability to eradicate established markets. (Enforcement may also be able to displace established markets into less destructive forms, such as forcing visible street dealing to convert to discreet meetings arranged by cell phone.)

Harm reduction offers particular advantages later in the epidemic cycle, when use has stabilized at high endemic levels. For injectable drugs in countries with low violence and few street markets, harm reduction may focus on syringe exchange programmes, supervised injection rooms and training ambulance crews to treat overdose. For drugs that are not injected and which are supplied through violent street markets, harm reduction may focus instead on using enforcement to target the minority of dealers who cause the greatest social harm. In either case the premise is that, with or without the harm reduction, the flow of new people into problem drug use will be modest, so reducing harmfulness of drug use has few drawbacks. That may not be a safe premise early in an epidemic, when there are feedbacks that can amplify small shocks to the system into dramatic effects on its trajectory.

I'm not sure I agree with the author's assumptions about the strengths and limitations of he various approaches, but he makes a compelling argument:

• that the static models currently being debated and advanced all have their place in policy;
• they are all inadequate by themselves;
• and, that there isn't even a correct formula because the needs, opportunities, crises, etc. are constantly changing.

Going for STOP: Congress Passes First Major Underage-Drinking Law

The Sober Truth on Preventing (STOP) Underage Drinking Act made it out of conference and has been passed by the House and Senate.

"Passage of the STOP Act represents a long-overdue acknowledgment of the need to do more as a nation to address the harm caused by underage drinking," said George Hacker, director of the alcohol policies project at the Center for Science in the Public Interest (CSPI), a strong supporter of the bill. "Unlike illicit drugs, there has been no credible national plan to combat alcohol problems, by far the greater health and safety drag on our nation. That is a huge gap that must be filled, and the STOP Act is a step in the right direction."

Major provisions of the STOP Act include a $1-million annual national media campaign on underage drinking; $5 million in grants to help community coalitions address underage drinking; $5 million in grant funding to prevent alcohol abuse at institutions of higher education; requiring the Department of Health and Human Services (HHS) to produce an annual report on state underage-drinking prevention and enforcement activities; establishing a federal interagency coordinating committee on underage drinking; and authorizing $6 million for research on underage drinking.

"Congress has never passed a bill on underage-drinking before," David Jernigan, executive director of the Center on Alcohol Marketing and Youth (CAMY) at Georgetown University, told Join Together. "HHS has never been required to keep an eye on the issue to this extent. The annual report will be a great tool and will keep [underage drinking] from falling off the agenda."

Many facets of the bill were based on the recommendations found in the "Reducing Underage Drinking: A Collective Responsibility" report, released in 2003 by the Institute of Medicine and the National Academy of Sciences.

"Through the hard-hitting public-service ads funded under the measure, parents will get a strong message about the dangers of underage drinking," said Rep. Lucille Roybal-Allard (D-Calif.), the lead sponsor of the measure along with Rep. Tom Osborne (R-Neb.).

Hopefully this will have at least some of the intended effects, however that last paragraph about hard-hitting ads makes me cringe. The feds have a well established pattern of investing heavily in ad campaigns that are ineffective and sometimes associated with increased use. We still know little about how to prevent drug and alcohol problems, so I'd expect mistakes. The problem is that they hide these problems and deny they exist. I'd have no problem with ads if they measure their impact, change as needed and learn from their mistakes. Maybe this campaign will be better because it's not being managed by the ONDCP. We can hope.

Treatment and prevention critic/gadfly Stanton Peele offers his view on the new act.

Anti-drinking ads: Give it to 'em straight

Snarky commentary on government ad campaigns to discourage alcohol, drug and tobacco use. [Update: Just to clarify. The article may be snarky, but this substance of its criticism is fair.]

...the government's anti-marijuana ads are ineffective and might be making certain teens more likely to use marijuana. A 2002 study, for instance, found, "little evidence the Media Campaign has a direct, favorable effect on youth" and "those who were more exposed to the (ads) tended to move more markedly in a 'pro-drug' direction." More recently, a non-NIDA study by researchers at Texas State University-San Marcos found that college students who viewed the ads developed more positive attitudes toward marijuana than those who did not.

The results are not surprising. Research shows what doesn't work: "Scare-based" tactics, "just say no" platitudes and messages that are over-the-top or do not conform to people's perceptions and experiences. Paternalistic messages trigger rebellion. Repetitious warnings not to use drugs give people the false sense that all their peers are using drugs. And messages that distort the truth cause listeners to reject prevention messages....

In contrast, the anti-smoking "Truth" campaign has been highly successful. The ads don't talk down to teens or even tell them not to smoke. They basically say smoke if you want to, but it's stupid. And you'll have bad breath. And you won't to be able to run without gasping for breath. That's effective. Cornell University's anti-binge-drinking "smart woman" campaign is also promising. It avoids paternalistic messages not to drink and teaches students how to use good judgment and avoid high-risk drinking behavior.