No room for drunks

A familiar story in Boulder. Clearly there needs to be a safe place for everyone, but I wouldn't pile on the dry shelters. Part of maintaining a safe place may mean excluding some people. The community just needs to create alternative spaces for those people or, where resources already exist, improve coordination to be sure that they get to the right place.

The death of three homeless men on the icy streets of Boulder last winter - including two who apparently had been barred from the county homeless shelter for drinking - has prompted an urgent effort to avoid a similar tragedy next winter.

Activists for the homeless in Boulder County have also been critical of the shelter's policy of excluding people who are drunk.

But Boulder is not alone. Nearly every shelter in the Denver area, citing the safety of other residents, bans intoxicated people.

Policies toward alcoholics vary among area shelters, but only the Denver Rescue Mission will take in people who are obviously drunk. Others, known as "damp" shelters, will allow people who have had a few drinks to stay.

Many, though, won't allow anyone inside who shows signs of drinking.

"Our shelter is sober," said Neal Hogan of the Salvation Army, which runs the 300-bed Crossroads shelter for single men. Hogan said many of his clients are struggling with addictions and didn't need to be exposed to drunkenness.

'Nothing is magical'

The Baltimore Sun has an interview with the new director of the Open Society Institute. Nothing earth-shattering here, but the institute has always gotten a lot of attention for its harm reduction efforts, so it's good to see him focus on treatment. He even expresses support for treatment as harm reduction.

My experience in the health department shows that if you treat addiction, you have all these other spillover effects, not just on crime, but on HIV rates, on hospitalizations, on emergency room visits. In Boston, something like 30 percent of the calls that came in for emergency medical services involved either mental health or addiction-related issues. They are brought to emergency rooms, which is an incredible inefficiency and waste. Imagine if someday the EMS system could accurately triage people and take those needing it to the mental health or addiction treatment systems.

Study Finds Cocaine, Pot in Rome's Air

I was going to make a crack about a celebrity hitting Rome, but decided it was in poor taste:

Researchers may have figured out what makes la vita so dolce in Rome. A report from Italy's National Research Council released Thursday found that there are traces of cocaine and cannabis in the air of the Eternal City.
Read the rest here.

[Hat tip: Jim]

Scientists find drug to banish bad memories

I've posted before about the role of memory circuits in addiction. It looks like there may have been another step forward in research to manage memory reconsolidation. More than a little creepy, but worth keeping an eye on.

It failed to bring Jim Carrey happiness in the award-winning film Eternal Sunshine of the Spotless Mind, but scientists have now developed a way to block and even delete unwanted memories from people's brains.

Researchers have found they can use drugs to wipe away single, specific memories while leaving other memories intact. By injecting an amnesia drug at the right time, when a subject was recalling a particular thought, neuro-scientists discovered they could disrupt the way the memory is stored and even make it disappear.

Read the rest here.

[via dailydose.net]

Quitting smoking makes you happier

One more reason to quit smoking:

New survey results from Cancer Research UK, published today, should allay the fears of smokers who think giving up will make their lives a misery.

Of more than 850 ex-smokers surveyed, the vast majority reported feeling happier having beaten their addiction. Only a tiny fraction said they felt less happy.

Researchers Identify Alcoholism Subtypes

What's your type?

Analyses of a national sample of individuals with alcohol dependence (alcoholism) reveal five distinct subtypes of the disease, according to a new study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).

“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” notes first author Howard B. Moss, M.D., NIAAA Associate Director for Clinical and Translational Research. “We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes. More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes.”

“Clinicians have long recognized diverse manifestations of alcoholism,” adds NIAAA Director Ting-Kai Li, M.D, “and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not. The classification system described in this study will have broad application in both clinical and research settings.” A report of the study is now available online in the journal Drug and Alcohol Dependence.

Here are the subtypes:

Young Adult subtype: 31.5 percent of U.S. alcoholics. Young adult drinkers, with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, and who rarely seek any kind of help for their drinking.

Young Antisocial subtype: 21 percent of U.S. alcoholics. Tend to be in their mid-twenties, had early onset of regular drinking, and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder, and anxiety problems. More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one-third of these alcoholics seek help for their drinking.

Functional subtype: 19.5 percent of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.

Intermediate Familial subtype: 19 percent of U.S. alcoholics. Middle-aged, with about 50 percent from families with multigenerational alcoholism. Almost half have had clinical depression, and 20 percent have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent ever sought treatment for their problem drinking.

Chronic Severe subtype: 9 percent of U.S. alcoholics. Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine, and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.

Does anyone else detect a whiff of countertransferance?

How Greenland curbed alcohol abuse

An interesting alcohol policy story from Greenland:

Alcohol abuse causes tremendous damage in Greenland...

But the solution chosen by Greenland's government for its most remote communities is not prohibition, which it acknowledges does not work, and only encourages bootlegging and the binge drinking of hard liquor. It's to ban hard liquor, but allow the sale of beer and wine.

Qaanaaq, a community of 800 near Thule on Green­land's west coast, is following this path after the government recently agreed to lift a two-month ban on alcohol.

The ban was prompted by a sociologist's report that described a community where alcohol abuse was so rampant children were often afraid to return home because their parents were drunk day and night.
...
Across Greenland, alcohol consumption has dropped dramatically since booze bans were lifted in many communities in 1982. At that time, residents consumed, on average, 22 litres of alcohol each year. That has since dropped to 13 litres.

That's still a lot compared to Canada, where the average resident drinks only eight litres of alcohol a year. But it's a huge improvement for Greenland, says Bodil Poulsen, an alcohol abuse worker with Greenland's health department.

Acetaminophen safe in abstinent alcoholics

From Reuters:

Alcoholics undergoing rehabilitation can safely use the maximum recommended daily dose of acetaminophen (Tylenol) without damaging their livers, study results suggest.

Isolated case reports have linked severe liver damage among alcoholics who abruptly stopped using alcohol and were treated with acetaminophen. Theoretically, the period of greatest risk would be right after they stopped drinking, based on various biochemical changes that take place.

...

"No participant suffered acetaminophen-related liver injury," the authors report.

Dart and his team point out that their findings can not be generalized to all alcoholic patients. They did not include patients with liver disease severe enough to impair liver function, patients who continued to drink alcohol, or individuals affected by either intentional or unintentional overdoses.

They worry that if told to avoid acetaminophen, patients who drink alcohol would be likely to use aspirin or other nonsteroidal anti-inflammatory medications, such as ibuprofen (Motrin, Advil), which are far more risky.

Psychiatrists Top List in Drug Maker Gifts

From the New York Times:

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.
...
Officials in Maine and Vermont said they would try to compare reports of payments to doctors with Medicaid records to explore how marketing practices might influence prescribing by doctors in ways that increased costs to taxpayers.

“What we want to be able to do is overlay the prescribing information that we have with the drug detailing information,” said Jude Walsh, special assistant to the governor of Maine, John E. Baldacci. “If we see that doctors in a certain southern county in the state are prescribing a lot of a drug and getting a lot of detailing for that drug, that could lead to some record reviews to see what’s happening.”

Addiction experts say video games not an addiction

Contrary to anecdotal evidence from college dorms and parents of adolescent boys, the APA makes a decision on video game "addiction". It appears that Super Mario will not need to be scheduled by the DEA.

Doctors backed away on Sunday from a controversial proposal to designate video game addiction as a mental disorder akin to alcoholism, saying psychiatrists should study the issue more.

Addiction experts also strongly opposed the idea at a debate at the American Medical Association's annual meeting.

Read the rest here.

The New York Times reports that global drug production and consumption is stable at the moment.
[hat tip: Matt]

Bong hits for Jesus

For those who don't know, the U.S. Supreme Court ruled that a school was within it rights to limit student speech when it confiscated a student's banner that said "bong hits for Jesus."

The Wall Street Journal highlighted some of Justice Stevens comments that compared the war on drugs, as it relates to marijuana, to prohibition:

...“Although this case began with a silly, nonsensical banner, it ends with the Court inventing out of whole cloth a special First Amendment rule permitting the censorship of any student speech that mentions drugs, at least so long as someone could perceive that speech to contain a latent pro-drug message,” he writes. “Our First Amendment jurisprudence has identified some categories of expression that are less deserving of protection than others—fighting words, obscenity, and commercial speech, to name a few.” Justice Stevens then mentions some “personal recollections” that have influenced his view that it’s unwise to create special rules for drug- and alcohol-related speech:

“. . . The current dominant opinion supporting the war on drugs in general, and our anti-marijuana laws in particular, is reminiscent of the opinion that supported the nationwide ban on alcohol consumption when I was a student. While alcoholic beverages are now regarded as ordinary articles of commerce, their use was then condemned with the same moral fervor that now supports the war on drugs. The ensuing change in public opinion occurred much more slowly than the relatively rapid shift in Americans’ views on the Vietnam War, and progressed on a state-by-state basis over a period of many years. But just as prohibition in the 1920’s and early 1930’s was secretly questioned by thousands of otherwise law-abiding patrons of bootleggers and speakeasies, today the actions of literally millions of otherwise law-abiding users of marijuana, and of the majority of voters in each of the several States that tolerate medicinal uses of the product, lead me to wonder whether the fear of disapproval by those in the majority is silencing opponents of the war on drugs. Surely our national experience with alcohol should make us wary of dampening speech suggesting —however inarticulately — that it would be better to tax and regulate marijuana than to persevere in a futile effort to ban its use entirely.

. . . In the national debate about a serious issue, it is the expression of the minority’s viewpoint that most demands the protection of the First Amendment. Whatever the better policy may be, a full and frank discussion of the costs and benefits of the attempt to prohibit the use of marijuana is far wiser than suppression of speech because it is unpopular.

Fentanyl: A Free Press Special Report

The Detroit Free Press is running a 15 part series on fentanyl in the Detroit area.

Smoking rate has plummeted in New York City

This is significant because there have been a lot of reports that smoking reduction efforts have hit a wall in recent years:

New York City's smoking rate has plummeted since a comprehensive program against smoking was launched in 2002, according to findings issued today in the national Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR). The 2006 rate was nearly 20% lower than the 2002 rate -- a decline that represents 240,000 fewer smokers. The City's rate for 2006 is the lowest on record (17.5%), and lower than all but five U.S. states (California, Washington, Idaho, Utah and Connecticut). Over the past year, smoking decreased among men (from 22.5% to 19.9%) and among Hispanics (from 20.2% to 17.1%). These large declines followed a year-long ad campaign aimed at prompting more smokers to quit.

Read the rest here.

Is video game addiction a psychiatric disorder? AMA report seeks to declare it one

Oy vey.

Backlash on bipolar diagnoses in children

I tried to pull excerpts from this but had too difficult a time finding stuff to excise. Consider this a teaser and take the time to read the full article:

No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital.

From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder as a disease that begins in young adulthood, but now some diagnose it in children scarcely out of diapers, treating them with powerful antipsychotic medications based on Biederman's work.

"We need to treat these children. They are in a desperate state," Biederman said in an interview, producing a video clip of a tearful mother describing the way her preschool daughter assaulted her before the child began treatment for bipolar disorder. The chief of pediatric psychopharmacology at Mass. General, he compares his work to scientific break throughs of the past such as the first vaccinations against disease.

But the death in December of a 4-year-old Hull girl from an overdose of drugs prescribed to treat bipolar disorder and attention deficit hyperactivity disorder has triggered a growing backlash against Biederman and his followers. Rebecca Riley's parents have been charged with deliberately giving the child overdoses of Clonidine, a medication sometimes used to calm aggressive children. Still, many wondered why a girl so young was being treated in the first place with Clonidine and two other psychiatric drugs, including one not approved for children's use. Riley's psychiatrist has said she was influenced by the work of Biederman and his protege, Dr. Janet Wozniak.

"They are by far the leading lights in terms of providing leadership in the treatment of children who have disorders such as bipolar," said J. W. Carney Jr., lawyer for Dr. Kayoko Kifuji, a Tufts-New England Medical Center psychiatrist who temporarily gave up her medical license after Riley died on Dec. 13, 2006. "Dr. Kifuji subscribes to the views of the Mass. General team."

Part of the criticism of Biederman speaks to a deeper issue in psychiatry: the extensive financial ties between the drug industry and researchers. Biederman has received research funding from 15 drug companies and serves as a paid speaker or adviser to seven of them, including Eli Lilly & Co. and Janssen Pharmaceuticals, which make the multi billion-dollar antipsychotic drugs Zyprexa and Risperdal, respectively. Though not much money was earmarked for bipolar research, critics say the resources help him advance his aggressive drug treatment philosophy.

Numerous psychiatrists say Riley's overdose suggests that bipolar disorder is becoming a psychiatric fad, leaving thousands of children on risky medications based on symptoms such as chronic irritability and aggressiveness that could have other causes. Riley's father, for example, had only recently returned to the home after being accused of child abuse, according to police. Since the girl's death, state officials have stepped up a review of the 8,343 children taking the latest antipsychotic medications under the Medicaid program for conditions including bipolar disorder, to be sure the treatment is appropriate.

Psychiatrists too often prescribe th
ese medications, which carry side effects such as weight gain and heart disease risk, without addressing problems in the children's lives, said Dr. Gordon Harper, director of child and adolescent services at the state Department of Mental Health. He likened the approach to "tuning the piano while the subway is going by."

Aggressive treatment
Biederman's critics chide him for not speaking out against misuses of a diagnosis that he has helped inspire. Among leading authorities on bipolar disorder, the Mass. General team has proposed the most aggressive treatment for the broadest group of children, they say, and Biederman should take responsibility when treatment goes wrong. At a conference on bipolar disorder at Pittsburgh's Point Park University last weekend, one speaker, Dr. Lawrence Diller, a California behavioral pediatrician, contended that Biederman bears some blame for Riley's death.

"I find Biederman and his group to be morally responsible in part," said Diller, whose popular book, "Running on Ritalin," accused psychiatrists of over treating another childhood condition, attention deficit hyperactivity disorder. "He didn't write the prescription, but he provided all the, quote, scientific justification to address a public health issue by drugging little kids."

Biederman rejects the idea that Riley's death is a cautionary tale, accusing critics of exploiting a tragedy to fan fears about psychiatry, a profession that has long faced prejudice. "The fact that she had XY drug or XY treatment is irrelevant to what happened. . . . If this child had the same outcome from treatment for asthma or seizures, we wouldn't have this frenzy," said Biederman in an interview at Mass. General's Cambridge mental health clinic.

Though Biederman acknowledges that distinguishing bipolar disorder from ordinary crankiness and flights of fancy in young children is challenging, he insists there is no ambiguity in the patients at his practice. "People have to wait a long time to see me or my colleagues. . . . It's not that somebody comes to me after their child has a temper tantrum. They do things for years that are dangerous. These are things that profoundly affect the child," said Biederman, putting them at risk of academic failure or even suicide.

Biederman dismisses most critics, saying that they cannot match his scientific credentials as co author of 30 scientific papers a year and director of a major research program at the psychiatry department that is top-ranked in the "US News & World Report" ratings.

The critics "are not on the same level. We are not debating as to whether [a critic] likes brownies and I like hot dogs. In medicine and science, not all opinions are created equal," said Biederman, a native of Czechoslovakia who came to Mass. General in 1979 after medical training in Argentina and Israel. He now lives in Brookline.

Read the rest here.

Exploring the process of recovery through patient testimonials

Relapse predicted by profanity and unoriginal sharing? I guess my recovery is more miraculous than I realized.

Does Stimulant Treatment for ADHD Increase Risk of Drug Abuse?

It depends. (Keep in mind that lower levels of dopamine D2 receptors has been associated with addiction.):

After two months of treatment, and again after eight months, the scientists performed positron emission tomography (PET) scans to measure the levels of dopamine D2 receptors, a type of brain receptor important for experiencing reward and pleasure that has been linked to pleasure and drug abuse. After the eight-month treatment, animals were also tested for their propensity to self-administer cocaine.

Rats given the 2mg/kg dose of methylphenidate were significantly less likely to press a lever to self-administer cocaine, and received fewer self-initiated infusions of the drug following eight months of treatment than the lower-dose group or the control rats.

The changes observed in brain chemistry were specific to the age and duration of methylphenidate treatment: Specifically, after two months of treatment, brain scans revealed that both groups of treated rats had lower levels of dopamine D2 receptors in their brains than did control animals.

In contrast, after eight months of treatment, the brain scans revealed elevated levels of dopamine D2 receptors in treated rats compared with controls, with the higher-dose treatment group showing the highest level of D2 receptors. In the control group, D2 receptor levels declined with age. Research at Brookhaven and elsewhere has suggested that low levels of dopamine D2 receptors may increase the likelihood of drug abuse, while elevated levels of dopamine D2 receptors may attenuate the propensity to abuse drugs.

Read the rest here.

Substance abuse care environment "toxic" for people in recovery

Substance Abuse and Mental Health Care Environment "Toxic" for Persons in Recovery and Those Working in the Field (PDF, 1 page)
[hat tip: CCSA.ca]

Best anti-pot ad ever Redux

Message board reactions to The best anti-pot ad ever:

Anti-marijuana ads by stoners and for stoners? Bud-blazer Seth Stevenson gives the latest weed-whacking ads an "A" for effectiveness, declaring the newest campaign The Best Anti-Pot Ad Ever. He lauds these ads for steering away from the alarmism of previous spots, and sticking to the more modestly realistic claims that pot can cause aliens to steal your girlfriend or maybe disappoint your dog. Color me dubious that the same primal fears which sell toothpaste and deodorant—getting dumped and making a poor impression—will have any special cachet with the stoner set.

The merits of this argument, however, get lost in the haze of smoke rising from Slate's basement apartment, The Fray. Legions of readers seem to be lit up over the mere concept of opposing marijuana use. Rather than discouraging stoners, the ads have only incensed them. Buried among the tirades for legalization, there are some rather astonishing testimonials—one poster claims to have risen from his wheelchair and surfed the swells of hurricanes under the curative powers of the magic herb. I'm not saying he didn't... but his story lends credibility to mnloft's harrowing tale of a teenage son literally gone psycho under the influence of weed. Doesn't every stoner know one kid who couldn't quite hack it?

Amidst all the swirling color, some actual discussion of the article and the ads has taken place. First-time Frayster, eek223, provides a fairly representative reaction to the ads from a teenaged perspective—apparently, low-budget isn't "hip" with the upcoming generation. bluebird makes a solid point that all such commercials inspire the inevitable adolescent question: "Who's 'The Man' behind the curtain?" (If this point interests you, check out this post from Melvyl.) Based on her personal experience, queentutt figures mass-media might as well be broadcasting from the dark side of the moon, given how poorly it connects with contemporary kids. In a reasonably fair critique of Stevenson's article, figgyforcurt worries about short-term memory loss among anti-drug advertisers:

This article would've been better written if it explored the dilemma of sending mixed messages to kids by drastically changing "brand messaging." Think about it. One year ago, an anti-marijuana ad tells kids they're going to get high and kill a toddler, and the next year, an ad tells them they'll be uninteresting. If I were a teen and I'd seen both sets of ads, I'd dismiss both, because I'd see through the fact that a thinking man on the other end of the ad is trying to tell me why something is bad but can't figure out why exactly it is bad. This is the "fundamental mistake" this writer made in writing this article, dismissing the fact that those old ads do exist, and have impacted teens. Failing to consider that no matter how effective these ads appear, they must be considered as inconsistent in the larger framework of the anti-marijuana ad context.

Personally, I'd hope the best way to scare cynical teens straight would involve showing them the perils of earnest drug culture—NORML parties. In the meantime, responsible adults would be welcome in the Ad Report Card Fray. If you don't show up, someone's kids will be getting the unchallenged word on drugs from folks like this...GA …