More on the new Drug Czar candidate

The New York Times ran an article about the latest Drug Czar candidate. Not very quotable, so read the whole thing.

New residential treatment completion numbers

• Treatment completion among clients discharged from long-term residential treatment was also highest among those reporting primary alcohol abuse (46 percent), but lowest among those reporting primary cocaine abuse (33 percent) or primary opiate abuse (35 percent)
  
  
• As educational level increased, the proportion of client discharges completing either short-term or long-term residential treatment increased

Still making Dawn Farm look good.

What these numbers don't report is probably more important. I care a lot about how many people complete residential treatment at Dawn Farm, but that's only part of the picture.

What do they do after treatment? Do they maintain involvement in mutual aid groups? Do they attend aftercare?

What about the people who don't complete residential? Do we maintain a relationship with them? If residential was not a good fit for this person, at this time, do we connect them with another service that will better meet their needs and preferences? If residential was they right place for them, are we able to get them back into residential?

Addiction recovery is a long game, not a short one; addiction is a chronic illness, not an acute one. Successfully completing treatment is like successfully responding to a heart attack--it's a significant victory, but any long term success relies on taking medication, compliance with dietary guidelines and compliance with exercise recommendations. Completing treatment should be viewed in the same manner and treatment services should be structured to provide long-term support in maintaining recovery and long-term monitoring to help prevent relapse and re-intervene quickly when relapse does occur.

Neighborhood-based strategies

I often hear arguments that the cost of incarceration makes it sensible to invest in individuals and service delivery systems to keep people out of prison.

This suggests that neighborhood-based strategies could be a very effective strategy.

Nationwide, an estimated two-thirds of the people who leave prison are
rearrested within three years. A disproportionate number of them come
from a few urban neighborhoods in big cities. Many states spend more
than $1 million a year to incarcerate the residents of single blocks or
small neighborhoods.

Some of Mark Kleiman's points from yesterday's post lead in the same direction:

5. We can help by shrinking our domestic markets. Offenders under
criminal justice supervision account for half of all hard-drug
consumption. Hawaii's Judge Steven Alm has shown that frequent testing
and swift, automatic, but relatively mild sanctions can sharply reduce
methamphetamine use among probationers. This is a cheap solution that
also actually shrinks the population behind bars by reducing both
probation revocations and arrests for new crimes. But it works only if
the authorities can organize themselves to deliver the sanctions.

Carefully adapted to local conditions, testing-and-sanctions can be
extended nationwide, to every probationer and parolee, and everyone
released on bail, who has an illicit-drug problem. The current practice
of forcing large numbers of drug users into treatment, with
incarceration as the alternative, wastes resources. Voluntary treatment
should be more broadly provided. Coerced drug treatment should be
reserved for those who don't respond to the threat of short jail stays.

...

8. Flagrant retail drug markets still devastate too many American
neighborhoods, especially poor urban areas where African-Americans and
Latinos live. Imprisoning half the young men in those neighborhoods is
neither useful nor just, but that's the result of routine street-level
drug enforcement. Since every dealer arrested makes room for a
replacement, we're just running on a treadmill. "'Drug kingpins,"' too,
are replaceable. We now keep 500,000 drug dealers behind bars at any
one time; there wouldn't be a significant rise in drug abuse if that
number were halved. There are smarter and less brutal things to do.

9.One practical alternative to routine drug law enforcement is to
break up markets with as few arrests as possible. This was an approach
first used in High Point, North Carolina, and is now being tried out in
dozens of places nationwide. Identify all the dealers in a market,
build cases against them, and warn all of them, simultaneously, that
they have a choice of stopping -- right now -- or going to prison. If
that threat is made convincing, most dealers quit and there's enough
capacity to arrest and imprison the rest. When all the dealers in a
neighborhood quit or get sent away at once, the market is gone, and a
little bit of enforcement will keep it from coming back. Committed
users still get their drugs, discreetly, but crime drops and the
residents get their streets back. Can this general approach work
elsewhere? Try to find out.

Advice for the new Drug Czar

Here's an abridged list of suggestions from Mark Kleiman. (Please take the time to read the whole thing here.)

1. Talk to Americans as if we are thinking adults.

2. You'll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don't believe it. There is no coherent strategy.

3. "Drug czar" is a silly title. We're not fighting a war, you don't have czar-like powers, and the last actual czar who fought an actual war got clobbered. You're stuck with the title. But don't get sucked in to the rhetoric of "'enemies"' and "'victory."' The drug problem isn't like that.

4.There are some real "'drug wars"' raging: in Afghanistan, in Colombia, and in northern Mexico.

5. We can help by shrinking our domestic markets. Offenders under criminal justice supervision account for half of all hard-drug consumption.

6. Treatment needs to be more accessible and more accountable.

7. Engage family doctors, internists, emergency room personnel, and mental health counselors to identify and address their patients' drug problems.

8. Flagrant retail drug markets still devastate too many American neighborhoods, especially poor urban areas where African-Americans and Latinos live. Imprisoning half the young men in those neighborhoods is neither useful nor just...

9.One practical alternative to routine drug law enforcement is to break up markets with as few arrests as possible.

10. Prescription pain-killers and stimulants are now traded hand-to-hand among middle school and high school students. So far, no one has a convincing idea about how to deal with the problem. Get someone thinking about it.

11. All these measures bring one common injunction: Take public management seriously.

12. Our data collection systems are pathetically ill-matched to the actual drug problem.

New Drug Czar

This is the first I've seen about Seattle Police Chief Gil Kerlikowske being appointed as Drug Czar.

The article says almost nothing about his positions on drug policy.

Girls more resilient than boys in troubled households

Here's a brief report on a study finding that girls are 4 times more resilient than boys in overcoming adversity at home, such as a heroin addicted parent.

The details are sketchy and the study isn't posted on the journal's webpage yet. I'll try to get more info and do another post on it.

Contingency Management for Smokers

I've bristled before at the use of incentives for addicts. I worry that it smacks of "the subtle bigotry of low expectations."

However, I saw this post on incentives for smokers and was confronted with the fact that we use a financial incentives for employees at Dawn Farm and have for more than 15 years.

I'll have to digest this for a while.

Rockefeller Laws: An End in Sight

Good news:

The New York Legislature finally seems poised to overturn the infamous Rockefeller drug laws. The impending change comes too late for the tens of thousands of low-level, nonviolent drug offenders who wasted away in prison because of mandatory sentencing policies when they should have been given treatment and leniency. But after years of building support for reform, legislative leaders now have it within their power to make wholesale changes in this profoundly destructive law.

Read the rest here.

Foundation advocates heroin maintenance

This is why a trial in some far off place matters.

[hat tip: dailydose.net]

Bad news

Last week I noted that, in spite of spending on health care, the stimulus bill offered little for treatment advocates to get excited about.

One bit of good news in the bill was increases in Byrne grants. These grants are often used to fund drug courts. The new compromise bill has eliminated those increases.

"Culture-wars Kabuki"

Mark Kleiman dissects the medical marijuana fight.

Economy Killing Abusive Teen Programs

From Mother Jones:

In just the last few weeks, the notorious Tranquility Bay program in Jamaica, Spring Creek Lodge in Montana, and Pathway Family Center in Detroit and Ohio have all been shuttered.

No darvocet for you!

An FDA panel recommends that it be pulled off the market.

UPDATE: CNN appeared to have removed the story. Here's another story from the Washington Post.

Amphetamines vs. Methamphetamines

Mental Floss explains (kind of) the difference between amphetamines and methamphetamines.

Dual diagnosis is an expectation, not an exception?

It's been conventional wisdom in the U.S. that most addicts and alcoholics also have a mental illness.

Not so in Canada.

Researchers 'Astonished' by Anorexia Death Rates

Researchers followed a cohort of 6000 patients with anorexia:

Out of the cohort studied, 265 died during the 30-year follow-up. The most frequent causes of death were suicide (responsible for 32 percent of the deaths), anorexia (19 percent of the deaths), and cancer (11 percent of the deaths). The remaining 38 percent of deaths were caused by other illnesses or by homicide. The average age at death for the 265 anorexia patients who died was 34.

The researchers also compared findings for their anorexia patients during the 30-year follow-up period with those of the general Swedish population. For example, compared with the general population during this time, anorexia subjects were 19 times more likely to have died from psychoactive substance use, primarily alcohol use, 14 times more likely to have died from suicide; 12 times more likely to have died from respiratory diseases, 11 times more likely to have died from urogenital diseases, five times more likely to have died from gastrointestinal diseases, and two times more likely to have died from either cardiovascular disease or from cancer.

Altogether, anorexia patients were six times more likely to have died during the 30-year follow-up period than was the general population.

Smoking May Prime Adolescents for Depression

From jointogether.org:

New animal research from Florida State University suggests that smoking during adolescence may increase the risk of depression during adulthood, Medical News Today reported Jan. 29.

Researcher Carlos Bolaños-Guzmán and colleagues injected adolescent rats with either nicotine or saline solution for 15 days, then tested the rats' responses to stressful and rewarding situations both during and after exposure.

The study showed that even a single day's worth of nicotine exposure during adolescence led to rats experiencing lower sensitivity to natural rewards and enhanced sensitivity to stressful situations.

Administering either nicotine or antidepressants during adulthood caused the depression symptoms to disappear, the researchers found.

"These data suggest that adolescent exposure to nicotine results in a negative emotional state rendering the organism significantly more vulnerable to the adverse effects of stress," Bolaños said.

The results were published online Dec. 17, 2008 in the journal Neuropsychopharmacology.

Let'em go?

This week's Newsweek has a story on an out-of-the-box approach to low level drug dealers:

In a 2004 experiment in High Point, N.C., Kennedy got the cops to try a new way of cleaning up the corners. They rounded up some young dealers; showed a videotape of them dealing drugs; and readied cases, set for indictment, that would have meant hard time in prison. Then they let the kids go. Working with their families, the police helped the dope dealers find job training and mentors. The message, which spread quickly through the neighborhood, was that the cops would give kids a second chance—but come down aggressively if they didn't take it. The police won back trust they had lost long ago (if they ever had it). After four years, police in High Point had wiped the drug dealers off the corner. They compared the numbers to the prior four years and found a 57 percent drop in violent crime in the targeted area.

[via: jointogether.org]

Medical marijuana DEA raids to end

Obama brings some sense DEA priorities, though I don't understand the need to wait for a new DEA head:

White House Spokesman Nick Shapiro reacted to new Drug Enforcement Administration (DEA) raids at medical cannabis collectives in California, saying he expects President Obama to end that policy when a new DEA Administrator is seated. “The president believes that federal resources should not be used to circumvent state laws, and as he continues to appoint senior leadership to fill out the ranks of the federal government, he expects them to review their policies with that in mind," Shapiro said.

No treatment stimulus

I avoid politics here and I can't begin to wrap my head around the stimulus bill, but, if you're spending a lot on health care, it seems like it would make sense to invest in a long neglected sector that can expect an increase in demand during a economic downturn.