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.

12 Steps to Stopping Terror

WTF???

CNBC?

CNBC has a gallery of medical marijuana.

Maybe major policy changes are closer than we think?

Perverse incentives created by alcohol taxes

Here's a great example of the perverse incentives created by tax revenue from alcohol sales and a strong lobby that prevents increases in alcohol taxes.

Is this what we want for marijuana?

• In Georgia, Connecticut, Indiana, Texas, Alabama and Minnesota, lawmakers are considering legislation this year that would end the ban on Sunday liquor sales. All but 15 states sell booze on Sundays.
• In Nebraska, a state lawmaker has proposed allowing beer to be consumed in state parks as a way to boost tourism.
• Other states, including Utah, are considering allowing the sale of liquor on Election Day.

In fairness, the article does point out that several states are considering alcohol tax hikes, but the list includes California, which seems to have shot down the idea.

Pot polls

Nate Silver has a more sober and analytical take on the recent Rasmussen poll.

[via Andrew Sullivan]

Taxes, alcohol and drugs

A California Assemblyman is looking to a marijuana tax help address their budget woes. It's a common argument and I think it's a bad one. I've repeatedly made it clear that I'm not a marijuana alarmist, but commercialization and taxation of tobacco and alcohol have been wrought with serious problems. Their lobbies are extremely powerful and the alcohol lobby has been very successful at keeping taxes low. With all of California's budget problems, there is no alcohol tax increase in their budget accord. In Michigan, the worst economy in the country, the beer tax has not increased since 1966. Worse, they rely on problem drinkers and underage drinkers for a substantial portion of their profits.

If we eventually legalize and tax it, let's hope that they go for the moon and tax it high. There's lots of evidence that high taxes reduce alcohol consumption and alcohol related problems.

I've said it before, but I think Mark Kleiman has the best solution.

Pot legalization

Mark Kleiman directs us to a new poll on the subject with only a 6% margin against legalization.

His analysis of the poll:

Rasmussen doesn't give the wording, and the accompanying article is written largely from a pro-legalization viewpoint (Rasmussen tends to lean libertarian).

Under the circumstances, I'd be skeptical, but the CBS/NYT poll in January got comparable results: in response to "Do you think that the use of marijuana should be made legal or not?" 41% said "legal" and 52% said "not legal." Current support for legalization is at what seems to be an all-time high, but the numbers are consistent with the long-term trend in Gallup polling.

Predictions about Obama's policy direction:

Note that these numbers come against the backdrop of relentless official anti-pot propaganda: not just from the drug czar's office, DEA, and the DARE program, but even from the National Institute on Drug Abuse. That suggests that a President who decided to change the message might not hit a stone wall. And the age breakdown suggests that the trend is likely to continue as the cohorts that grew up without pot leave the voter pool.

Obviously, this isn't something the Obama Administration is going to jump on, but I wouldn't be surprised to see a big move late in a second Obama term or sometime in the term of his successor (assuming the Democrats keep winning elections). If I had to quote odds, I'd say about even money on legalization within fifteen years. As with the repeal of alcohol prohibition and the creeping legalization of gambling, I'd expect it to be presented at least in part as a revenue-raising measure.

His opinion on the matter:

Substantively, I'm not a big fan of legalization on the alcohol model; a legal pot industry, like the legal booze and gambling industries, would depend for the bulk of its sales on excessive use, which would provide a strong incentive for the marketing effort to aim at creating and maintaining addiction. (Cannabis abuse is somewhat less common, and tends to be somewhat less long-lasting, than alcohol abuse, and the physiological and behavioral effects tend to be less dramatic, but about 11% of those who smoke a fifth lifetime joint go on to a period of heavy daily use measured in months.) So I'd expect outright legalization to lead to a substantial increase in the prevalence of cannabis-related drug abuse disorder: I'd regard an increase of only 50% as a pleasant surprise, and if I had to guess I'd guess at something like a doubling.

So I continue to favor a "grow your own" policy, under which it would be legal to grow, possess, and use cannabis and to give it away, but illegal to sell it. Of course there would be sales, and law enforcement agencies would properly mostly ignore those sales. But there wouldn't be billboards.

That beautifully-crafted policy has only two major defects that I'm aware of: it wouldn't create tax revenue, and no one but me supports it. On the drug-warrior side of the argument, even those who can read the handwriting on the wall won't dare to deviate from the orthodoxy. As we did with alcohol, the country will lurch from one bad policy (prohibition) to another (commercial legalization). I just hope the sellers are required to measure the cannabinoid profiles of their products and put those measurements on the label.

The drug war and incarceration

Though this in no way justifies the drug war, it's contribution to the prison population is often overestimated:

Myth No. 2: Low-level drug offenders drive prison population growth. It is popular, perhaps almost mandatory, to blame the boom on the War on Drugs. But it is just not true. Only 20 percent of inmates in prisons (as opposed to jails) are locked up for drug offenses, compared with 50 percent for violent crimes and 20 percent for property offenses; most of the drug offenders are in prison for distribution, not possession. Twenty percent is admittedly much larger than approximately 3 percent, which was the fraction of prisoners serving time on drug charges in the 1970s. But if we were to release every prisoner currently serving time for a drug charge, our prison population would drop only from 1.6 million to 1.3 million. That's not much of a decline, compared with the total number of people in prison in the 1970s—about 300,000.

In fact, the war on drugs does play a role in the prisoner increase. But it's an indirect one. State "predicate felony" laws, for example, impose longer sentences on offenders with prior records: A drug conviction may not send someone to prison, but it will make him serve more time for any future crime he commits. This suggests that simply tackling long drug sentences, as reformers in New York state have done, may miss the real problem.

One interesting point for context: the number of people incarcerated for drug crimes is now approaching the total prison population in the 1970s.

4 takes on the new Drug Czar

The Stranger has 4 takes on the new drug Czar. Here's an excerpt from one:

Kerlikowske has also overseen a shift in drug policy from enforcement to treatment. Most notably, he allowed the Get Off the Streets program to hatch in the Central District in 2006. That year, then-lieutenant John Hayes (now a captain) set up a table in an open-air drug market where people with criminal warrants could visit for referrals to housing, health, and human services without risking arrest.

"That was, at that time, a very edgy approach, and the chief was willing to let one of his people staff the program," says City Council member Nick Licata, who soon pushed for legislation to fund the project. "It was at a stage where Gil could have stopped it, but he allowed it to go forward."

Although he isn't going to legalize pot, drug czar Kerlikowske could push to lift the federal ban on funding needle exchanges, stop the medical-pot raids in California, overhaul spending on antidrug commercials, and enthusiastically seek funding for drug-treatment programs.

The larger brilliance of Obama's pick for drug czar isn't just that Kerlikowske is open to new strategies, but that he is first and foremost a cop. Nobody can claim that Kerlikowske is a public-health nut who doesn't know the impact of drugs on the streets. Like many Americans, he agrees that drugs should be illegal. But he understands that both enforcement and public health have their place, and he's willing to take a look at new approaches when enforcement alone has failed.

[via Andrew Sullivan]

More on the power of gratitude

Bob Sutton posted a link to the abstract below:

This study tests whether gratitude predicts psychological well-being above both the domains and facets of the Five Factor Model. Participants (N=201) completed the NEO PI-R measure of the 30 facets of the Big Five, the GQ-6 measure of trait gratitude, and the Scales of Psychological Well-being. Gratitude had small correlations with autonomy (r = .17), and medium to large correlations with environmental mastery, personal growth, positive relationship, purpose in life, and self-acceptance (rs ranged from .28 to .61). After controlling for the 30 facets of the Big Five, gratitude explained a substantial amount of unique variance in most aspects of psychological well-being (requivalent = .14 to .25). Gratitude is concluded to be uniquely important to psychological well-being.

Gratitude also improves sleep quality.

College Fraternity Sober Monitors

Fraternities and the university collaborate on a harm reduction approach to unsafe drinking at fraternity parties:

The Interfraternity Council is looking to bring a fresh approach to social responsibility through a redesigned Sober Monitor Training Program.

The program will provide members of the Greek community with the skills necessary to hold safer parties and handle alcohol-related situations that may arise at parties. At all fraternity parties a designated number of brothers is required to remain sober throughout the night. IFC president Ari Parritz said a priority of his will be to have most first-year members attend the program so they’ll know what to do when it’s their turn to be a sober monitor.

...
“My goal for this program is to have every new member — that is, the individuals generally responsible for the operation and conduct of our social events — complete it by February of 2010,” Parritz said in an e-mail interview. “Our community trusts these individuals with the safety and conduct of our social events; as such, they should be trained by professionals, and never be placed in a situation where they are unsure what to do.”

Desprez said there have been three training sessions so far this semester, with each session having between 10 and 40 people in attendance. There are plans to have eight to 12 sessions conducted by the end of the semester, she said.

The training program includes conversations and demonstrations on blood alcohol content, recognizing different levels of intoxication, alcohol-related laws, risk management issues, conflict management skills, and emergency protocol, Desprez said.

Nausea Drug Shows Promise Against Opioid Addiction

This could be good news. Buprenorphine has been a really good tool but we are seeing increasing misuse of it. Something that's effective in reducing suffering and has no misuse potential would be great.

The Limits of Shame

Andrew Sullivan picks up on a debate about shame's influence on behavior:

Adam Serwer responds to Dreher's post on stigmatizing having children out of wedlock:

Conservatives regularly overestimate the beneficial effects of shame. Shame provokes response in the form of impulse, not long term planning. A person who
is ashamed isn't going to think, "I'd better get a degree" or "I'd better get married," they're going to think in the short term about what they can do to rectify their sense of self-worth.

How do you see people--men in particular--act when they're ashamed? You rarely see them do something like get married or get a fantastic job; usually they're going to hurt or exploit someone, make them feel as low as they do--this is the lesson learned by the shamed from the shamer, regardless of the lesson the shamer thinks they're teaching the shamed.

I'm not sure it's possible to encourage beneficial social behavior without in some ways discouraging destructive behavior. The key is emphasis. And a little positive reinforcement often goes a long way.

I'm not interested in entering this debate (in this space any way), but this issue of shame is relevant. I've posted before on people like Sally Satel, who are worried that the disease model will erode stigma (that's a good thing!!!) and lower the threshold for people to misuse drugs and alcohol.

BTW - I've been watching the debate about Ta-Nehisi's posts unfold for the last week. Good reading.