Some skeptical of new anti-drug campaign

This article reports that The Partnership for a Drug Free America has recently started an ad campaign to raise awareness about addiction as a disease and reduce stigma. It's being criticized for characterizing addiction as a disease.

Not a big surprise. The Partnership's message often seems to fuel the drug hysteria that created and maintains the war on drugs. However, this campaign is clearly focused on stigma reduction and appears right on target.

What I found striking in this article was one of the sources of criticism. I expected to see Stanton Peele, he's a frequent, strident and highly visible critic of the disease model. I was surprised to see Ethan Nadelmann from the Drug Policy Alliance, a big advocacy organization that seeks to end the war on drugs be decriminalizing drug use. It is also the country's largest harm reduction advocacy organization. Here's what he says:

"If we define drug addiction as a disease, does that mean that every cigarette smoker has a disease?" asked Ethan Nadelmann, executive director of the Drug Policy Alliance, which seeks to end the war on drugs.

Addiction, Nadelmann said, typically occurs when someone's dependence on a substance causes problems for themselves and others. The line between recreational use and addiction is too open for interpretation in his book.

"Right now some people say one to two drinks a day if you're over 50 is great for the heart," he said. "On the other hand, others say if you need one to two drinks a day, you're addicted."

What reputable expert or organization says that one or two drinks a day means your addicted? What a ridiculous straw man argument! I was surprised to see Nadelmann taking such a public position against the disease model. He usually seems to avoid these issues and sticks to advocating harm reduction and decriminalization. We've always suspected that much of their advocacy work is based on the believe that what we call addiction is really just a lifestyle choice that should be respected.

Recovery From Comorbid Illness More Common Than Expected

Findings from an evaluation of 10-year outcomes show that despite some conventional—and professional—wisdom to the contrary, patients with schizophrenia and substance abuse can recover over time.

Stimulant maintenance is a good beginning

More on the Mayor of Vancouver's proposal to start a stimulant maintenance program.

A new report on ASA discharges

This report provides some analysis of national data about people who left treatment against professional advice in 2003.

Methadone Pioneer Dr. Vincent P. Dole Dies

Methadone pioneer Dr. Vincent P. Dole died this week. It's worth remembering that methadone started out as one component of some comprehensive bio-psycho-social treatment programs. Unfortunately, many (especially in our area) have devolved into dosing clinics that offer no meaningful treatment and no vision of recovery.

Mayor seeks drug maintenance for drug addicts (Vancouver, BC)

The mayor of Vancouver is calling for a stimulant maintenance program. I've heard calls for heroin maintenance programs, but this is the first time I've seen a call from a politician for a stimulant maintenance program.

Vancouver has a "four pillar" response to their drug problem. It's good that they are espousing a comprehensive approach to the problem, but they seem to be much more invested in the harm reduction pillar than the treatment and recovery pillar. These programs are often promote in the name of choice, unfortunately they don't offer any more choices than the abstinence focused programs that they criticize.

Amid heroin deaths, authorities debate drug that stops overdose

At least we're not alone. The fentanyl OD deaths have hit Boston. They're considering distributing naloxone, but not a word about treatment.

U.S. Cigarette Sales Reach Lowest Point in More Than 50 Years

U.S. smoking continues to decline. However, over 85% of our clients smoke, and research consistently demonstrates that it negatively impacts their recovery.

Once-Weekly Opiate Treatment with Buprenorphine/Naloxone Called Effective

Once a week Buprenorhine found effective.

New Recovery Management Monographs

The Northeast Addiction Technology Transfer Center just released two new recovery management monographs. The first is about linking treatment to communities and the second is on building resilience.

IV Drug Users Don't Cope Well When Others Overdose, Study Finds

Here's a summary of a study examining responses to overdoses:

A study of IV drug users in Baltimore found that more than two-thirds had witnessed an overdose. But only two-thirds of those called 911 for emergency medical help, and even then, they delayed making the call by five minutes or more.

Often, witnesses to an overdose tried their own remedies, such as walking the victim around, shaking them or inflicting pain, and one in four injected a home-made solution of salt water in an attempt to reverse the overdose, said Robin Pollini, Ph.D., lead author of the study, which appears in the September issue of the American Journal of Preventive Medicine.

Most witnesses did not call 911 promptly because they thought the victim could be revived without help, but many reported fearing involvement by the police

Two Studies on 12-Step Groups

A new study finds that mentally ill alcoholics and religious skeptics benefit equally from 12-Step Programs.

Another reviews studies on AA and concludes that 12 Step Facilitation is no more effective than other treatment methods. Here's an article providing a little background discussion.

Principles of Drug Abuse Treatment for Criminal Justice Populations

The National Institute of Drug Abuse (NIDA) has just released a now booklet on treating people in the criminal justice system.

Interventions to Facilitate Smoking Cessation

This article provides a good overview of smoking cessation interventions. It's got a handy table that provides information on the evidence base and quit rates for various interventions.

More on methadone

An article I linked to in my last post referred to Neil McKeganey as a critic of methadone. I wasn't sure that was a fair characterization, but this editorial makes it clear that he is a critic. While he's sometimes dismissed as a critic, I haven't seen criticism of the methodology of his studies. This editorial is worth a read. Here's an excerpt:

Methadone will undoubtedly continue to play a role in our drug-treatment services, but not as a drug provided for ever-increasing numbers of users for ever-lengthening periods, with little or no expectation of their eventual recovery.There is in the world of drug-abuse treatment a division between public knowledge and private knowledge, exemplified in the following conversation. I was speaking recently with one of the UK's top medical advisers on drug addiction. We were discussing methadone when he said that if his daughter had a heroin problem, he would do all he could to get her into a residential programme.

"When I am prescribing methadone in my day-to-day work," he said, "I know in my heart of hearts it is not a solution to the individual's drug problem but the only option I have for the majority of addicts I am seeing".

There is a simple truth here but one that is rarely shared, namely that methadone has all too easily become the drug-addiction treatment for the masses. There are no superstar heroin addicts or drug-dependent doctors signing themselves up for long-term methadone programmes. Residential rehabilitation is the gold-standard treatment for those who can afford it or those who are lucky enough to get it on the state.

Our masses, however, need more than the cheapest treatment if they are to live a life that is not dictated by the rhythms of their drug addiction. What they need are fewer drugs and greater support in their attempts at remaining drug free. And that is no quick fix.

Injecting crack cocaine is surprisingly common

While we're talking about a relatively small number of people, I've definitely been hearing more clients report injecting crack cocaine in intake interviews over the last year.

Methadone: Curse or cure?

This article does a decent job of presenting one addict's experience with methadone and a couple professional's opinions on it. Unfortunately the discussion is limited to opinions. One statement that leaped out at me is this:

"I hear that from a lot of health-care professionals too, who don't have a lot of faith in it, you know, because (addicts) want that methadone. But, you know, they're not sticking something in their arm. There's so much hepatitis and HIV out there and it's dangerous. So, maybe it is another drug. The harm-reduction drug works very effectively for the majority of people," she says.

Opposition to it is based on addicts wanting it? That's a pretty reductionist characterization of those who don't have faith in it. It's also based on an assumption that could well be false. A U.K. study found that 60% of methadone clients would prefer to be in abstinence focused treatment.

Anti-heroin project transforms towns

A story about the impact of treatment on a drug ravaged community. It's pretty vague about the treatment provided. I suspect it's methadone but could be naltrexone or buprenorphine.

PRESS RELEASE: Free Site Offers Real Help for Friends and Loved Ones Hooked on Drugs

I saw this press release and wanted to take this opportunity to give you a heads up about press releases like this and the occasional news stories based on them.

I can't confirm it yet, but I suspect that this press release is linked to Narconon (they have a program in Michigan), a treatment program tied to the Church of Scientology. The address was previously used by a Scientology linked business, Scientology has a large base in Clearwater, and the name listed in the press release (although it is a pretty common name) is associated with Scientology.

Narconon and the church issue dozens of press releases like this every year, they also have dozens of websites. Many of these press releases and website appear to hide their association to Narconon and try to get you to call an 800 number. Even when you talk with someone, you can't count on getting straight answers. I once took a call from Stone Hawk and they denied any affiliation or basis in Scientology.

I also see this press release strategy used by Hythiam. The company that has licensed PROMETA, a protocol of prescription drugs and nutritional supplements.

It's easier to be skeptical of a press release, but these press releases are often written as news stories and sometimes lazy journalists or publications will print them with little or no editing.

Pot doesn't lead to heroin

More discussion of the recently published studies on marijuana.

Telephone counselling for smoking cessation

More good news about a simple, cost effective way to help people stop smoking:

Authors' conclusions:Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.

Homeless Admissions to Substance Abuse Treatment: 2004

SAMHSA just released a report on homeless admissions to treatment in 2004. No surprises.

• Homeless admissions are up from 10% in 2000 to 13% in 2004.
• Homeless people were more than twice as likely to have ad 5 prior treatment admissions.

State may face dearth of drug and alcohol counselors

A story from Columbus, Ohio on the the coming shortage of addiction counselors.

On the same subject, here's a Bill White article about a coming leadership crisis in addiction treatment.

Homeless Alcoholics in Seattle Find a Home

Here's an NPR story the program that houses drinking alcoholics in Seattle. The story makes it clear that they've given up hope that these people can get better. I'm all for housing them, but put some expectations on the client (participation in some form of treatment and/or mutual aid groups) and keep working to facilitate recovery.

Impact of practitioner's training in the management of alcohol depende

This study finds marked differences in outcomes between doctors with training in alcoholism versus those without. The average amount of training among the group of trained doctors was only 10 hours.

Trained GPs proved better i) in the attempt at abstinence, with 67% patients becoming sober vs. 47% in a comparison sample and ii) in repeat attempt at abstinence in the event of relapse, with an average 2.99 vs. 1.31 attempts per patient.

Companies Must Stop Fraudulently Promoting Laser Therapy as a Treatment to Quit Smoking, Public Citizen Tells FDA

Public Citizen is asking the FDA to prevent the promotion of laser therapy as a smoking cessation treatment. More here.

Help Seeking Quadruples Likelihood of Abstinence; Dawson

Here's a summary of a recent study on the impact of seeking help on the likelihood of abstinence. People who sought help had more severe and more numerous problems, but they were significantly more likely to recover than people who did not seek help. I went to the article and founce no mention of whether the person sought help because of external pressures (like courts).

Even though they had more comorbidity and therefore were at risk for worse outcomes, seekers of formal and informal treatment had better odds of recovery from alcohol dependence.

Searching for Strategies to Help the Homeless

NPR's Morning Edition is running a series on chronic homelessness. Today's segment talked about the importance of supportive housing and addressing "root causes of homelessness" like mental illness and addiction. This was a controversial assertion in Ann Arbor 10 years ago, it is less controversial now. A representative from the Rockefeller Foundation talked about what a mistake it is to provide housing without also addressing these root causes.

Tomorrow's segment is on the housing program in Seattle that I posted about recently. It provides permanent housing for chronic alcoholics, apparently without any expectations that they try to recover.

Addiction careers and the natural history of change

The British National Treatment Agency for Substance Misuse (NTA) recently released a research report about addiction careers and natural change. Looking at addiction careers is a pretty new area of research and represents a shift toward looking at addiction as a chronic condition. When one starts to look at addiction this way, one possible outcome of treatment is a reduction in addiction careers.

Highlights from the report include:

• A table of the "capture rates" of different drugs. How many people that try it eventually become addicted.
• Discussion of the concept of natural recovery.
• Discussion of the impact on maintenance interventions on careers.
• The impact of treatment on careers.

It's a great primer on "natural recovery." We known for years that most people recover without treatment, we're just now beginning to explore how these people change and why others are unable to change without help.

BTW - The NTA website is building a library of reports like this. Many are very good and concise. Worth browsing.

Smoking To Blame For More Than Half Of Difference In Men's Mortality Risk Across Class Lines

Quit smoking to stick it to the man!:

The direct correlation between lower socioeconomic status and mortality risk is well known, but a new study by the University of Toronto and the University of Oxford is the first to determine that more than half the difference in risk of death between men in the highest social strata and those in the lowest can be attributed to smoking.

My Marijuana Post

A reader makes a fair criticism:

Just a comment that from a prevention advocate's point of view (the ones who are creating the "firestorm",) the potential innate harm of a drug is not limited to or defined by whether or not someone becomes addicted to it. E.g. It's well documented that cannabis impairs driving skills, esp the ability to stay in a lateral lane. If my son smoked dope and was killed or injured in a car accident, or was hit by someone who had been smoking dope, all I would care about is that my son was injured or killed; I wouldn't much care whether or not the use resulted from a chemically dependent limbic system or a poor choice. [Some friends] once did a workshop for parents on marijuana, and several legalization advocates showed up to argue and it was turning into a circus until a local student who was attending as part of a class assignment stood up and said she had a 2 year old son she had not planned to have and she ever would have slept with the father if she hadn't been high on marijuana. Those are the kinds of consequences that are hard to measure and do not result only from addiction, they result from use.

My point (poorly made), was not that addiction is the only harm or only important harm that might result from marijuana use. Rather, that both sides seize upon these kinds of findings and stretch the truth to make their case.

Cannabis in the News

A recent marijuana study concluded that there was no link between smoking marijuana and lung cancer. This set off a firestorm - cannabis advocates argued that it's safe; anti-drug activists argued that it's still dangerous. One of the recent studies that they seized upon concluded that marijuana use in rats was linked to heroin use. This brought retorts criticizing these activists of reviving the "gateway theory". Now there's a new study linking marijuana smoking to pre-cancerous cells in smokers' lungs.

My problem with all of this is that it focuses far too much on the drug (the drug's dangerous - the drug's not dangerous) and not enough on the relationship between the drug and the brain of the user. Clearly, most adults who use marijuana are not and will not become addicted. However, people with the wrong limbic system will develop problems.

Safe Injection Rooms in the News

There have been several recent articles about supervised injection centers. Here's a recent one praising an Australian center and another from today asking hard questions about the same center.

Personally, I'm underwhelmed with the referral rates. The first article cites more referrals than the second, I'm not sure where the discrepancy comes from. They also don't clearly define "referral." Is it a passive referral, "call this number"; or an active referral, "we'll take you directly to the detox center right now"? There's a big difference. Whatever the definition or the number, the best scenario is a 1.7% referral rate. I don't know what a good referral rate would be, but I'm not impressed.

In Vancouver, there's concern about the future of the supervised injection center because its license is about to expire and the new prime minister opposes the site. At the same time, there have been several articles about the addition of 30 beds to the site. I don't have a clear understanding of their purpose. They say they are for people waiting for treatment. I guess it would operate like a shelter for them? But, isn't an injection center a lousy place to shelter someone who's decided to stop using? Don't they have any social detoxes or shelters with recovery support services?

First recovery center breaks ground in Kentucky

The State of Kentucky has broken ground on a women's recovery center. This is part of Governor Fletcher's "Recovery Kentucky" initiative. (Here's an NPR story on it.) He plans to open 10 regional recovery centers that provide sheltering, transitional housing and recovery support for up to 2 years.

Colorado University-Boulder creates the Center for Students in Recovery

Colorado University-Boulder creates the Center for Students in Recovery. College recovery support programs are beginning to pop up around the country. Texas Tech was the pioneer.

From an older story about the Texas Tech program:

Since the inception of the program, only one student out of 600 who have received scholarship aid has flunked out. Even more impressive is the fact that these recovering students maintain a grade point average of 3.58, well above the university-wide average of 2.85, and 95 percent of the participants have stayed clean and sober.

New study emphasizes the importance of relationships

A study published in the August 2006 issue of the journal Addiction attempted to study the impact of treatment program relationships on treatment outcomes. No suprise, it found that treatment relationships based on acceptance and constructive social relationships resulted in better outcomes. Here are the highlights from the abstract. Let me know if you want a copy of the entire article:

Aims This study presented and tested a model of behavior change in long-term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance-based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the development of these factors.

Conclusions Patients from treatment programs with an affiliative relationship network are more likely to respond adaptively to internal states associated previously with substance use, develop constructive social relationships and achieve long-term treatment benefits.

Park to be site of sober revelry - Ann Arbor

Soberfest 2006! Sunday! Sunday! Sunday! See you there!

Join Together withdraws PROMETA article

On July 3rd I posted an entry about a study using Hythiam's PROMETA protocol for methamphetamine addiction. I told you about their sketchy sales tactics and to expect to hear more about them. Well, this morning's Join Together email included the announcement below stating that they withdrew their summary of the study from their site.

EDITOR'S NOTE
The June 30 research summary Anti-Anxiety Drug Said to Help Meth Addicts, which appeared in the July 3 edition of JT Direct, has been withdrawn from our service. It reports preliminary uncontrolled results from off label use of a medication approved for a condition that is not addiction. The FDA has not approved this treatment modality, nor has it been supported by peer reviewed NIH research.

Project Prevention

Project Prevention just announced its "2006 In '06" campaign. Project Prevention was formerly known as CRACK (Children Requiring A Caring Kommunity). Their goal for 2006 is to pay 2006 addicts to get sterilized or get some form of long term birth control. According to their website, they have a chapter in Detroit.

The group's founder, Barbara Harris, is reported to have said:

We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children …

She's also quoted as saying the following:

My mind has changed as far as the women go. When I first started the program I was just so angry with these women. I thought they were scum. But during these years I've had the opportunity to meet many of these women, and eventually realized that my anger is more toward society. If the government had common sense, they would spend more money on drug treatment—then they'd be spending less on caring for these babies. People tell me I should be spending my money on treatment programs and I tell them for every [addicted child] I can prevent from being conceived, there's four million dollars that can be used for drug treatment.

I'm all for preventing drug affected pregnancies. However, we know that the biggest barriers to a meaningful community response are stigma and hopelessness. It seems clear to me that this group's reductionist message - that addicted women are irresponsible, unloving baby machines - only makes the problem worse.

New and improved SAMHSA website

Substance Abuse and Mental Health Services Administration overhauled their website. It was badly needed. Hopefully their wealth of materials will be easier to sort through.

The Not-Quite-So-Grim Neurology of Teenage Drinking

Here is another perspective on the story about the impact of age of first use from a few days ago. The writer argues that the early drinking and future alcohol dependence is caused by environmental factors and hereditary predisposition rather than early drinking cause future alcohol problems.

The author has a pretty strong bias against the disease model and believes that most addiction is self-medication (listen to minute 33:45).

I think she's right that the coverage of this overstates the likelyhood that alcoholism can be "caught" by early exposure. But, she is probably just as guilty of understating the potential impact of early exposure, completely excluding any mention of research on early drug exposure and brain plasticity.

Chantix Quadruples Smoker's Chances Of Quitting Successfully

A new drug from Pfizer shows promising results. The results don't include comparison to nicotine replacement therapy. The results seem to underscore that whatever your method, there's hope for quitting smoking.

The study lasted one year. Here are some facts from that study:

-- 44% of those on Chantix were not smoking at 12 weeks
-- 29.5%% of those on Zyban were not smoking at 12 weeks
-- 18% of those on a placebo were not smoking at 12 weeks
-- 22% of those on Chantix did not smoke from week 9 to 52
-- 16% of those on Zyban did not smoke from week 9 to 52
-- 8.4% of those on a placebo did not smoke from week 9 to 52

Another study, from the Unversity of Wisconsin included 1,027 volunteers, all of them smokers who wanted to quit. Results were almost the same as the ones above.

The third study involved people in seven countries - 1,900 smokers who wanted to quit. All of them took Chantix for the first 12 weeks, after which 1,236 (65%) were still not smoking. The 1,236 quitters were then divided into two groups: One group continued taking Chantix while the other took a placebo. This continued for another 12 weeks. At the end of the 24-week period:

-- 70.5% of those on Chantix were not smoking
-- 49.6% of those on a placebo were not smoking

Cellphone prevents drunk dialing

Does this qualify as harm reduction?

The disparity on crack-cocaine sentencing

This compelling Op-Ed calls for reforming the cocaine sentencing disparity created by the Anti Drug Abuse Act:

Defendants convicted with just 5 grams of crack cocaine, the weight of 5 sugar packets, were subject to a five-year mandatory minimum sentence. The same penalty was triggered for powder cocaine only when an offense involved at least 500 grams.

Twenty years later, the aftermath of these laws is sobering. More than 80 percent of the defendants prosecuted for a crack offense are African-American, despite the fact that more than two-thirds of crack users are white or Hispanic. By and large, these defendants are not the kingpins of the drug trade. Data from the US Sentencing Commission document that 73 percent of crack defendants had only low-level involvement in drug activity, such as street-level dealers, couriers, or lookouts. The commission also has found that crack cocaine sentences are the single most significant factor contributing to racial disparity in federal sentencing.

The Grim Neurology of Teenage Drinking

A new study (NY Times registration is free. If you don't want to register, go to www.bugmenot.com.) affirms what we've learned over the last 10 to 15 years about the importance of postponing age of first use:

47 percent of those who begin drinking alcohol before the age of 14 become alcohol dependent at some time in their lives, compared with 9 percent of those who wait at least until age 21. The correlation holds even when genetic risks for alcoholism are taken into account.

"We definitely didn't know 5 or 10 years ago that alcohol affected the teen brain differently," said Dr. White, who has also been involved in research at Duke on alcohol in adolescent rats. "Now there's a sense of urgency. It's the same place we were in when everyone realized what a bad thing it was for pregnant women to drink alcohol."

Homeless Alcoholics Receive a Permanent Place to Live, and Drink

Take the time to read this. (NY Times registration is free. If you don't want to register, go to www.bugmenot.com.) It's a very sad story.

It talks about the application of the "housing first" approach with chronic alcoholics. Reasonable people can disagree on the merits of using the approach with this population, but whatever one's ideology, this is a difficult thing to imagine celebrating. The article made no reference to any efforts to facilitate recovery among the people in the apartments. I hope that there are some efforts and that the reporter failed to include those efforts in the story. Again, reasonable people can disagree about the merits of a "housing first" approach with these people, but it would be unconscionable to give up on trying to help them recover.

Meth addicts reduce drug use with new treatment

This article* PROMETA. PROMETA is a protocol for combining certain prescription drugs and nutritional supplements. PROMETA protocols are owned and sold by Hythiam, Inc. Hythiam is in the midst of a major publicity and sales push.

Dawn Farm and the local drug court have had several very aggressive sales calls. They've gotten so aggressive, pushing and smarmy that I had to ask the sales person to stop calling and not to come to our facilities. It's worth noting that a lot of their sales pitch was focused on the value of their stock.

You're going to see their name popping up everywhere. PROMETA may represent the best pharmacology available today, but it appears that all of their drugs could be precribed by any knowledgeable doctor.

* Post updated 7/4/06 due to bad link. The story was corrected after it was initially posted.

Remission and Relapse in the General Population

This study suggests that most people who develop alcohol problems resolve them without any professional help. Keep in mind that this is a non-clinical population.

Panel Calls for States to Take Lead on Addiction Policy

Michael Dukakis is chairing a panel of government officials, treatment providers and recovery advocates. They recently released a report that calls for states to take lead on addiction policy:

...states bear many of the costs of alcohol and other drug addiction, spending an estimated 13 percent of their budgets on addiction-related problems.

However, the report noted, 'Less than four percent of this is spent on prevention and treatment, while more than 96 percent pays for the avoidable social and physical consequences that result from our failure to apply what we know about how to prevent and treat substance-use problems.' These costs include child-welfare, prison, court, police, and Medicaid expenditures for treating medical problems related to addictive illnesses.

recommendations include that states do the following:

develop a statewide strategy that includes all agencies affected by drug and alcohol problems

increase accountability for all state agencies working on issues related to addiction

educate lawmakers about the costs of alcohol and other drug addiction to improve their participation in policymaking

train judges to address alcohol and other drug use among defendants and improve coordination with treatment services

create a state alcohol and other drug policy advisory board, answerable to the governor and lawmakers, that includes representatives from the recovering community and civic leaders

The whole report is available here. It's not an exciting read, but it is worth downloading.

Reports suggest declines in drug production and use

I'm of the opinion that we focus too much on supply and enforcement, nut here's some good news on those fronts:

• DEA meth lab seizures are down 30%.
• Job applicant drug tests suggest meth use is down and overall positive tests are at a 17 year low.
• The United Nations reports that opium poppy production is down 22%.
• The U.N. also reports that cocaine consumption is down in North and South America, but up in Europe.

Addicts need treatment: Given proper help and support, most will recover

The Ann Arbor News ran an Other Voices piece by me. It was really visible - above the fold, a big headline and a big graphic. Hopefully it will motivate some people to take some action.

Lawmakers back jail terms for drug offenders despite Prop. 36

I wrote something about this a few weeks back. Proposal 36 in California was passed by California voters in 200 and required that the state offer treatment as an alternative to jail or prison for most nonviolent drug offenders.

Ballot mandated funding for Prop. 36 ended this year and the California legislature had to decide what to do. They've passed new funding for it but want to allow short, instant jail sentences for probation violators. The Drug Policy Alliance is prepared to fight them on any incarceration for relapses.

Alcohol-related Liver Disease Numbers Double In Ten Years, UK

Over the past couple of years, there has been a lot of coverage of drinking problems in England. It's been hard to know how much of it is hysteria and how much of the concern is legitimate. This article provides some hard data suggesting that there is significant growth in alcohol related problems.

• Alcohol-related liver disease hospital admissions in the UK have doubled in ten years
• total deaths related to alcoholic liver disease rose by 37%, according to NHS figures.
• In 2004/5 35,400 people were admitted to hospital with an alcohol-related liver disease.
• In 2004/5 21,700 people were admitted to hospital for alcoholic poisoning, versus 13,600 in 1994/5.
• in 2005 25% of 11-15 year old children had had an alcoholic beverage during the previous seven days of being surveyed.
• 33% of men and 25% of women, aged 16-24 had been on a binge drink once during the previous seven days of being surveyed.

I was unable to find precisely analogous numbers for the U.S. I did find that the numbers for past 30 days use of alcohol is 17% for 8th graders and 33% for 10th graders.

Cognitive Behavioral Therapy Appears More Effective Than Sleep Medication For Treating Insomnia

This study provides more good news for people suffering from insomnia (a relatively common problem for people in early recovery). The study supports the findings from a Harvard study that was published last year. Cognitive behavioral therapy appears to be a safe, effective treatment for many people suffering from insomnia.

Ten-Year Recovery Outcomes for Clients With Co-Occurring Schizophrenia and Substance Use Disorders

This study finds good news for schizophrenics with alcohol problems. At 10 year follow up 65% had no signs of a substance use disorder.

The study is much more focused on mental illness than on substance use problems. As usual it's also vague about the nature of the substance use problems. I went to the full article and it does not specify DSM abuse vs. dependence. Either way, this study offers hope.

One other interesting note:

"clients who received clozapine during the early years of the study experienced highly significant improvements in substance abuse outcomes compared with those on other antipsychotic medications."

Expert Blogs The Principles - George Bush, Alcoholic - Part 1 on Yahoo! Health

Initially, I was happy to find this blog on recovery. And, being no fan of Bush, I don't mind reading criticism of him.

Then I grew more uncomfortable with the writer's judgment. Over the past few days I've grown to resent this guy's use of 12 step recovery as a club to beat Bush with. Although the blogger doesn't identify with a particular 12 step group, I am very uncomfortable with his fusion of partisan politics and recovery principles. I suppose I could give him the benefit of the doubt and assume that he'll take the same approach with Howard Dean, but his criticism fits too neatly with the current partisan debate. It's also worth noting that the author has a new book out. Is it a coincidence that he'd stir up this controversy now?

This comment from the blog does a good job summing up my feelings:

"I for one see no such novelty or originality in your comments. You have merely taken some simple spiritual tenants of a 12 step recovery program and applied them in a way that is meant to touch people's political nerves. This is the very antithesis of what such tenants are meant for. Shame, shame, shame, Patrick. You have mixed politics and spirituality in such a way to get yourself noticed."

County Housing Program Wins National Award

This program seems to take a slightly different approach than what we have locally or the national approaches I hear about.

Most housing programs subscribe to a housing first model that provides housing first, and then focuses on addressing problems like addiction or mental illness. This has the advantage of assuring housing, but may lower expectations and leverage to promote change. The other approach (like our transitional housing) might be called sobriety contingent housing. These programs have the advantage of setting high expectations but people generally return to homelessness if they relapse. This program seems to provide treatment contingent housing. It would be interesting to see how many people a program like this can move into recovery. I suppose the questions is whether it draws the best from both or just lowers the bar and overemphasizes the role of treatment in recovery.

Fewer kick light cigarette habit

The American study that this article reports on found that "light" cigarette smokers were 50% less likely to quit.

While we've known for some time that light cigarettes are not safer, this runs against the conventional wisdom. I think most people would have guessed that smokers of "stronger" or unfiltered cigarettes would fare the worst.

It would be interesting to see some analysis of possible reasons for this. Is it based on gender? The article mentions that most of the light cigarette smokers are women. Does switching to light cigarettes represent a commitment to smoking by trying to do it more safely? (However misguided this notion is.)

Jury deadlocks in baby's meth death case

What a sad story. I think I've heard about this case before, but this is the first time I paid attention to it. Seem like a case of prosecutorial overreaching. I'm a little surprised that we heard from recovery advocates on this case.

Nicotine Drink Touts Alternative to Smoking

There's not a whole lot to say about this one.

Undo This Legacy of Len Bias's Death

Today's Washtington Post ran this opinion peice on mandatory minimums for drug possession. The rates of incarceration are actually more shocking than thay present:

• Federal prison inmates whose most serious conviction was a drug crime rose from 4,749 in 1980 to 77,867 in 2004. (1540%) Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics. Available: http://www.albany.edu/sourcebook/ [Retrieved 7/3/05].
  
• State prison inmates whose most serious conviction was a drug crime rose from 19,000 in 1980 to 246,100 in 2001. (1195%) Source: Prisoners in 2002 & Prisoners in 1994, Bureau of Justice Statistics. Available: http://www.ojp.usdoj.gov/bjs/pubalp2.htm#Prisoners [Retrieved 7/3/05]
• Jail inmates whose most serious charge was a drug crime rose from 20,420 in 1983 to 155,249 in 2002. (660%) Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics. Available: http://www.albany.edu/sourcebook/ [Retrieved 7/3/05].
• From 1986 to 1999 the average term drug offenders entering prison could expect to serve rose from an average 30 months to 66 months. (120%) Source: Federal Drug Offenders, 1999 with Trends, 1984-99, Bureau of Justice Statistics. Available: http://www.ojp.usdoj.gov/bjs/abstract/fdo99.htm [Retrieved 7/3/05]

Many states, including Michigan, have eased or repealed mandatory minimum sentences. With tight state budgets and explosive growth in prison costs, these state level efforts have been bipartisan.

UW Tests Tobacco Addiction Vaccine

There were two stories recently about addiction vaccines. This first is about tobacco addiction vaccine trial that is about to begin. The second reports on the findings from a cocaine vaccine study. We will probably be seeing a lot more of these vaccines in the coming years. The goal of these drugs is to create an immune response that would prevent the effects of the drug.

People in Recovery Make Good Employees

This is a great story. Getting out success stories like this is so important in reducing the stigma associated with addiction. Employers need to hear over and over again from their peers that recovering people are worth taking a chance on.

Dramatic Increase in National Treatment Admissions for Meth Coincides with Increase in Criminal Justice Referrals

This report about the dramatic increase in methamphetamine treatment admissions is the latest is a series of volleys about how serious the meth problem is. Last week we saw the Sentencing Project's release of a report claiming that Meth use is rare.

They have provoked a lot of discussion here, here, and here.

I think there's truth in what all of them say: Has there been hysteria? No doubt. Was this same kind of hysteria about crack very harmful? Definitely. Is meth ravaging some communities? Sure. Has meth use grown quickly in the last decade? Absolutely. At this point, does the meth problem compare to heroin, cocaine and alcohol? No way.

Deal to Curb Sales of Paraphernalia Sours

It's too bad that this fell through. It could have been a model for win-win deals between community groups and liquor stores. Especially in light of this recent study finding a relationship between the presence of liquor stores and neighborhood violence.

Electric therapy trial for heroin - Scotland

My initial reaction was that this is another example of professional pessimism. But, Neil McKeganey generally seems like a very well informed, recovery-focused advocate for addicts. I was a little surprised to see him supporting it. It looks like the electrical pulse is very mild and the treatment is in the same ballpark as acupuncture.

Still, one has to ask, does it make sense to spend money on this research when Scotland has 6 month waiting lists to get treatment and methadone is the treatment of choice in spite of heroin addicts' preference for abstinence-based treatment?

I suppose it shouldn't be a surprise that a researcher supports research.

House Appropriations Committee Approves Spending Bill for Programs in the Departments of Labor, Health and Human Services, and Education

From the Legal Action Center:

On June 13th, the full House Appropriations Committee approved the FY 07 spending bill for programs in the Departments of Labor, Health and Human Services, and Education (Labor-HHS). Programs providing drug and alcohol education, prevention, and treatment services and conducting scientific research on alcoholism and drug addiction, would receive the following appropriations under the House Appropriations Committee-approved bill, which are unchanged from the House Labor HHS Subcommittee-approved spending bill:

• The Substance Abuse Prevention and Treatment Block Grant would receive $1.834 billion, a $75.4 million increase over both FY 2006 funding and the President's budget request.
• The Center for Substance Abuse Treatment would receive $326.7 million, representing a $72.2 million cut from last year's funding and nearly $48 million less than the President's budget request.
• The Center for Substance Abuse Prevention would receive $195.8 million, a $3 million increase over FY 2006 funding, but $15.2 million more than the President's budget request.
• The Safe and Drug Free Schools and Communities State Grants program would receive $310 million, despite being slated for elimination in the President's budget; this represents a $36.5 million cut from last year's funding.
• The National Institute on Drug Abuse (NIDA) would receive $995 million, a $5 million cut from last year, which is equal to the President's budget request.
• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) would receive $433 million, also equivalent to the President's budget request, a $2.6 million cut from last year's funding.

Additionally, funding through the Department of Labor for the President's Prisoner Reentry Initiative would be completely eliminated under the House Appropriations Committee-approved Labor HHS spending bill. The Department of Labor had received $19.6 million last year, the same amount the President requested for the program to receive in his FY 2007 budget. The House Labor HHS spending bill did not include any funding for this program through the Department of Labor. The Department of Justice, which received $5 million for the President's Prisoner Reentry Initiative last year, is a part of a different spending bill that has not yet been approved by the Appropriations Committee.

Under the House Appropriations Committee-approved Labor HHS spending bill, the Ryan White Care Act, which funds health and supportive services for people living with HIV/AIDS, would receive a $70 million increase over last year's funding. The additional funding is intended to help States provide medications to individuals with HIV/AIDS. In addition, the House Labor HHS spending bill would also provide $63 million for a new HIV testing initiative at the Centers for Disease Control and Prevention.

It is unclear when the Full House will consider the Labor-HHS spending bill. Although a vote in the House was scheduled for the week of June 19th, the vote was delayed and it has been reported that the vote may not occur until after the November mid-term elections. Additional information about funding amounts in the Labor HHS spending bill approved by the House Appropriations Committee can be found here.

Addiction on NPR

Today's Science Friday on NPR discussed addiction. Guests included the head of the National Institute of Drug Abuse, Nora Volkow and other researchers and "practitioners." I put practitioners in quotes because I'm guessing that these people have very limited client contact.

At any rate, the discussion focused on the addicted brain. I've never really felt like I've had a firm grasp of the neurobiology of addiction. This was good. It was simple enough to understand, but not obvious or a waste of time.

They'll have a podcast up soon, so you can download it and listen to it on an MP3 player or burn a CD and listen to it whenever you get the chance. If you want a CD of it, let me know.

Vancouver Police won't attend drug overdoses

This seems like an easy way to increase the likelyhood that drug users will call 911 if another user ODs.

Does anyone know if local police attend 911 calls involving an OD? If so, do they routinely make arrests?

Detox drug is Georgia's new habit

This is news to me. I did not know that there was any serious misuse potential with buprenorphine. I poked around a little and confirmed that there are problems with buprenorphine misuse in Finland and France. (I also found reports that widespread buprenorphine treatment has reduced overdoses by 79% in France.)

I wasn't able to find a lot of information on the effects or how it's used. I wondered if it is largely people just trying to avoid getting dopesick, but it appears that they inject it and use it with benzos.

I also found the following facts related to Finland:

• Buprenorphine was officially introduced in 1999.
  
• In 2002, 34% of heroin addicts reported buprenorphine as a secondary drug.
• By 2002, bupreneorphine became more common than heroin as the primary reason for entering treatment.
• In 2002, of those reporting buprenorphine as their primary problem, only 21% reported heroin as a secondary drug.
• By 2002, there were more buprenorphine seizures than heroin seizures.
• Heroin deaths are down significantly and there are very few buprenorphine deaths.
  

Finland may be an abberation in degree, but France appears to be having significant diversion issues too. (IV diversion rates of 20%.)

I'd love to hear what our doctor and drug rep friends have to say about this. Does it have the misuse potential that these reports suggest? Even if it does, it appears to result in significantly less harm.

Marc Schuckit

Jim Balmer has the opportunity to see Marc Schuckit speak about co-occurring psychiatric disorders today. You can read more about Dr. Schuckit is Jim said that everything Dr. Schuckit said supports our approach to the matter.

Jim passed along this interview as a worthwhile read.

You can learn more about Dr. Schuckit here.

Program targets families to halt addiction cycles

This program, run by the Jim Gilmore Jr. Community Healing Centers of southwestern Michigan seemed worth drawing attention to. Addressing the needs of families and children affected by their loved one's addiction has always been a shortcoming of most treatment programs, us included. There are lots of reasons, some legitimate, others less legitimate. However, we're doing more than ever in our programs -- Daybreak's family counseling; residential's family programs and family counseling; parenting groups; supervised child visits; countless phone calls with distraught family members; and the community education program.

California Sees Greatest Drop In Drug Prisoners Among Large State Prison Systems

The Justice Policy Institute issued findings today about Prop 36, the California ballot initiative that mandated non-violent drug offenders be offered the opportunity for treatment before incarceration.

Some of the key findings by researchers are:

• The rate of incarceration for drug-possession offenses has gone from 89 per 100,000 California adults in December 2000 to 58 in December 2005—a 34.3 percent decrease.
• While opponents of the initiative warned that Proposition 36 might lead to an increase in violent crime, CaliforniaÂ’s violent crime rate has declined since 2000 at a rate higher than the national average.
• Since 2000, spending on drug treatment in California doubled.
• Since 2000, California has experienced a larger increase in drug treatment clients than the rest of the country.
• Proposition 36 and drug court completion rates are comparable.
• The effectiveness of using incarceration to prevent drug use and treatment relapse is not conclusive.
• Proposition 36 is saving the state hundreds of millions of dollars.

The ballot initiative's funding expires this year, so we should be hearing more about the outcomes of the initiative in the coming months. There was a lot of criticism 5 years ago, but I hear much less now. Hopefully this experiment will provide a path out of the war on drugs.

TIP 45: Detoxification and Substance Abuse Treatment

SAMHSA has issues a new TIP (Treatment Improvement Protocol) on Detoxification and Substance Abuse Treatment. I haven't read it yet, so I can't comment on most of it.

TIPs tend to be hit or miss -- a few are terrific (especially when you consider that they are free!) and many are of little value. They're done by committees and often end up watered down or representing the biases of the committee.

I did glance at the co-occurring section and thought it looked like a mixed bag. (Maybe something for everyone on the committee?) It starts off emphasizing high rates of psychiatric illness in alcoholics and mentions "underlying psychiatric disorders", but also suggests postponing psychiatric diagnoses several weeks (if possible), discusses substance-induced psych symptoms, and encourages a conservative approach to prescribing psychotropics. Importantly, at first glance, it fails to distinguish between DSM abuse and DSM dependence.

I think highly of the committee chair, Normal Miller. I'm unfamiliar with most of the rest of the committee. It seems heavily skewed towards psychiatrists and other M.D.s. It looks like there are very few practitioners on the panel. Let me know what you think about it.

Tobacco giants test smoke-free products

It looks like the tobacco companies are shifting gears to deal with concerns about second hand smoke, and the growing number of laws and policies restricting smoking.

Ramstad reaches out to colleague recovering from addiction

Now we know who Pat K.'s sponsor is.

More importantly, the article also provides some good news on the status of parity. (If you don't know what parity is, here's a mental health parity policy brief I wrote for the state medical society. ) It appears that they have enough votes to pass parity, but the house leadership won't allow a vote. Maybe parity will pass when there is a change in house leadership.

We can hope.

Lawmakers Take Gentler Approach to Crank than Crack

It's good to see that we're not making some of the same mistakes that were made with the explosion of crack cocaine use in the 1980s. During the 1980s and 90s incarceration rates for drug crimes skyrocketed and sentences got longer, from our Recovery is everywhere press kit:

• Federal prison inmates whose most serious conviction was a drug crime rose from 4,749 in 1980 to 77,867 in 2004. (A 1540% increase.) Source: Maguire, Kathleen and Ann L. Pastore, eds. Sourcebook of Criminal Justice Statistics
• State prison inmates whose most serious conviction was a drug crime rose from 19,000 in 1980 to 246,100 in 2001. (A 1195% increase.) Source: Prisoners in 2002 & Prisoners in 1994, Bureau of Justice Statistics
• Jail inmates whose most serious charge was a drug crime rose from 20,420 in 1983 to 155,249 in 2002. (A 660% increase.) Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics
• From 1986 to 1999 the average term drug offenders entering prison could expect to serve rose from an average 30 months to 66 months. (A 120% increase.) Source: Federal Drug Offenders, 1999 with Trends, 1984-99, Bureau of Justice Statistics

The suspicions of racism are unfortunate, but as Bill White points out, racism is a part of the history of drug policy in the U.S.

Federal overdose report written by industry insider

This report from the Charleston Gazette is troubling. I've been seeing a steady stream of reports about methadone overdoses across the country for the last couple of years. I don't pretend to know a lot about it -- I wouldn't be surprised that there are serious problems with the management of methadone programs, I also wouldn't be surprised if it's media hype similar to the "worst drug ever" stories about methamphetamine.

Whatever the case, hiring a highly visible advocate with obvious business interests to write your investigative report is a bad move.

Happy Birthday Alcoholics Anonymous!

Thousands of recovering alcoholics converged on Akron, Ohio this weekend to celebrate the 71st anniversary of the founding of Alcoholics Anonymous on June 10th, 1935. There are many paths to recovery, but the founding of AA marks the beginning of the modern recovery movement and AA continues to be the most well worn path to recovery. Here's an article summarizing the founding of AA.

National Youth Risk Behavior Survey: 1991-2005

The Center for Disease Control just published the results of the National Youth Risk Behavior Survey. There is some good news and some bad news. Alcohol use, smoking, inhalant use, suicide attempts and sexual activity are all down among high school students since 1991. The bad news is that cocaine and marijuana use are up.
One reason that this is particularly important is that we know that earlier alcohol use is associated with high rates of dependence.

Cannabis Withdrawal Syndrome No Pot Dream

I'd imagine that Cannabis Withdrawal Syndrome could turn into a pretty controversial addition to the DSM. There's been a growing body of research to support this, but the real question is how significant the withdrawal syndrome is. I've read comparisons to withdrawal from nicotine. It seems like the primary value would be to normalize the anxiety and depression for the client and professional helper, making it clear that it is temporary, to be expected, and not cause for diagnosing a mood or anxiety disorder.

GOP heavyweights back Pat K as some call for resignation

This is very nice to see:

Among the Washington Republicans who have written letters of support to Kennedy (D-R.I.) are Defense Secretary Donald H. Rumsfeld, former House Speaker Newt Gingrich and former Minnesota Gov. Tommy Thompson, a source said. Kennedy is also being backed up by a trio of GOP congressmen: Rep. Jim Ramstad (R-Minn.), Rep. Tom Feeney (R-Fla.) and Rep. Lamar Smith (R-Texas).

It would be heartening at any time, but especially during this time of nasty partisanship.

Drug-Related Deaths Hit 10-Year Low in Baltimore

Baltimore has always gotten a lot of attention for their use of harm reduction strategies. This article points out that they appear to have simultaneously made huge increases in treatment availability:

In the past decade, the city's slots for drug treatment for uninsured or under-insured residents rose 62 percent, from 5,136 to 8,295. Funding for drug treatment nearly tripled, from $18 million in 1996 to $53 million last year. In 2005, 23,000 people received drug treatment in publicly supported clinics -- a total of about 28,000 "treatment episodes."

I hope that there is some recovery-oriented research going on there. I spoke to Bill White a while ago and he was telling me about some research that they are starting in Philadelphia. The city has always done annual city-wide surveys to measure the incidence of mental illness, drug problems, drug use and other problems. His project is going to integrate questions that will measure the incidence of addiction recovery throughout the city. They will then saturate areas without much community-based recovery capital and monitor the impact. It'd be interesting to learn more about the impact that the increase on treatment spending has had on the city.

Safe injection site leads to detox

This article reports on a letter to the editor run in yesterday's New England Journal of Medicine about a study of the safe injection site in Vancouver. The main findings reported in the letter were: 1) 18% of the study subjects entered a detox program during the follow-up period; 2) More frequent use of the site and having contact with an addiction counselor at the site were associated with entering detox. The median follow-up period was 344 days.

I've got a few thoughts.

First, why is 18% good? What's the natural rate of opiate addicts seeking detox? If I was operating a needle exchange or injection site (I know, hard to imagine. Don't worry, it won't happen this week.), would I be satisfied with 18% entering detox? I think I'd be pretty disappointed.

Second, I'm not sure why it's surprising that more frequent use of the site and contact with an addiction counselor were associated with entering detox. Wouldn't more frequent use of an injection site be an indication of concern about one's health, and wouldn't you expect this to be associated with entering detox? It's worth noting that subjects had to be repeat users of the site to be selected for the study. Same thing with seeing the addiction counselor. Also, the study got this information by looking at admissions records of detoxes in the city, not by following-up on referrals from the injection site. So, we don't even know if the detox admission is related to an intervention or referral from the injection site.

I don't doubt that, under the right circumstances, something like this could be an effective outreach to get difficult to engage people into treatment and recovery. However, this seems like case of the "subtle bigotry of low expectations." Maybe it's related to the fact that the researchers are primarily interested in HIV/AIDS. I don't want to put words in their mouths, but their expectations of addicts may be low and maybe any effects other and HIV transmission reductions are seen as a bonus rather than an expectation or prerequisite for success.

Cue-Induced Cocaine Seeking and Relapse Are Reduced by Disruption of Drug Memory Reconsolidation

Neuroscience like this is over my head and usually doesn't catch my attention until it's dumbed down for social workers like me, but this interesting. It's been clear for some time that the limbic system is an important factor in addiction. This primitive part of the brain plays important roles in things like anger, fear, sex drive, hunger, thirst, pleasure and memory. One particular function that's often ascribed to the limbic system is forming and storing "highly charged emotional memories."

This study took cocaine addicted rats and infused a special protein into the limbic system of the rats. This protein is believed to interfere with with the limbic system's memory formation and consolidation. All of the addicted rats were given cocaine after the infusion. The rats receiving the protein infusion were much less likely to relapse into drug-seeking behavior, and the effect seemed to last for weeks.

Very interesting, although the idea of toying with our memory is more than a little frightening. Too bad rats can't tell us if they're having any unintended side effects.

Advocacy link

Jess A. passed along the following link and message:

Easy way for people to contact Powers That Be on the topic:
http://www.jointogether.org/getinvolved/actionalerts/
contact-your-us-congressmen.html
- includes a link for congressperson contact info.

Drug experts advise extra precautions in heroin use

Okay. This will be my last post on the topic for a while.

Maia at the Huffington Post is bemoaning the U.S. failure to adopt more harm reduction practices. Meanwhile, the recent fentanyl scare has hit Pittsburgh and "drug experts" are advising extra precautions for heroin users and suggesting keeping Narcan handy. The only mention of treatment is this single sentence at the end of the article: "Ideally, overdose patients could immediately get into long-term, intensive treatment programs, but the demand far exceeds availability."

It's not that I disagree with the call for more harm reduction. What I differ on is priority that HR advocates place one things like needle exchanges and Narcan distribution. In 2004 there were 93 new HIV infections due to injection drug use in Wayne, Macomb, Oakland, Monroe, St. Clair and Lapeer counties. So far this year there have been more than 130 overdose deaths in Wayne County alone. We currently have addicts lined up asking for treatment and help getting into recovery and they get nothing or are underserved in a way this is not dissimilar to undertreating a bacterial infection with 3 days of antibiotics when 10 days is indicated. We should provide treatment, HIV prevention interventions, and overdose prevention interventions. However, if people currently seeking recovery are denied adequate help, we should give them the help they are asking for first.

Letter to the editor

I finally stopped complaining and did something. Below is a letter to the editor that I submitted to the local papers. I also sent copies of it to the Governor and my Michigan and U.S. legislators. What are you going to do?

 

==============================================

 

I am writing in response to the series of articles on the recent opiate overdoses in Wayne County. The most troubling aspect of this story has been exemplified by the coverage -- there has been almost no mention of treatment.

 

More than 600 scientific papers have concluded that treatment for drug addiction works. Relapse rates for addiction treatment are lower than treatment for asthma and hypertension, and equivalent to type 2 diabetes. Patient compliance rates for addiction treatment are better than patient compliance rates in the treatment of asthma and hypertension. Treatment is also cost effective. Studies by the RAND Corporation and UCLA both found that every $1 spent on addiction treatment saves $7 in other costs like medical, human service and criminal justice system costs.

 

Unfortunately, there's a treatment shortage in Detroit and the rest of the metro area. Addicts seeking help are routinely provided with inadequate treatment. People who are homeless and have several complicating problems are offered treatment that is not intense enough, does not help them with basic shelter needs, and too short in duration. The result is not unlike treating a bacterial infection with 3 days of antibiotics when the patient needs 10 days. Undertreated patients end up more sick than they were before treatment, they become more difficult to treat, the patient becomes more hopeless, and the community reaches the conclusion that treatment doesn't work and that these people are a waste of resources. In addition to all of this, untreated addiction destroys the lives of the addicts, does incalculable harm to families and children, and costs the community huge sums of money.

 

I am amazed and appalled that this crisis has not prompted a highly visible effort to offer treatment and the hope of recovery to opiate addicts in the community. There have been numerous mentions of education efforts in response to this spate of overdoses, but no push for treatment and recovery. Budgets are tight and treatment budgets have not been increased in more than 15 years in some communities, but we can't afford not to respond to this crisis in a meaningful way. Recovery is a reality. There are thousands of recovering people in the Detroit metro area, many of whom once seemed hopeless. Given the proper help and support, most addicted people will recover and start contributing to community life. 

 

How many people will have to die before we increase treatment funding and pass addiction treatment parity legislation? If we are judged by the way we treat our neighbors, we will be judged harshly for the way we are treating our suffering addicted brothers and sisters. 

 

 

Jason Schwartz

Livonia, MI

 

Natural Remission and Relapse

The study that this summarizes seeks to expand understanding of natural remission and relapse. They found that natural recovery (sometimes called spontaneous recovery) is common. People who received help, either through professional treatment or a mutual aid group, were more likely to achieve remission status and were less likely to relapse. The people who remitted without help tended to drink less, had fewer current drinking problems and negative life events and relied less on avoidance coping and drinking to reduce tension. It's also worth noting that the study was not limited to people with alcoholism or dependence. Participants only had to meet criteria for an alcohol use disorder, so they could meet criteria for abuse or dependence. This is important because you would expect much higher rates of remission and much lower rates of help seeking among people who are "abusers."

Rep. Patrick Kennedy Holds a News Conference

Rep. Patrick Kennedy held a press conference yesterday, his first since his treatment episode. It's too bad that he's the most prominant face of addiction and recovery in the national political scene. I wish him well, but he's not very inspiring. Paul Wellstone was a big loss for advocacy efforts. Jim Ramstad seems like he might be a more effective advocate if he got more attention.

Drug czar announces major bust in bad heroin supply

The Drug Czar says that he thinks they've disrupted the primary source of the fentanyl that has cause all the overdoses. We'll have to wait and see.

Determinants of 12-step group affiliation and moderators of the affiliation–abstinence relationship

No surprise. This study, entitled Determinants of 12-step group affiliation and moderators of the affiliation–abstinence relationship, found that 12-step attendance was associated with abstinence. This finding is repeated over and over again. What was more interesting was that being "less religious" and "younger." In professional helping circles, 12-step groups are often criticized for their religiosity and it is frequently suggested that they may not be appropriate for people who don't self-identify as Christian. It is also frequently suggested that they are inappropriate for younger people.

What Are Harm Reduction Advocates Doing Right?

My reason for posting this article on advocacy efforts for needle exchanges in N.J. is not to draw attention to this particular story, but to ask what harm reduction advocates are doing right. My inbox is filled every day with harm reduction stories and relatively few about treatment and recovery.

Why is it that, every day, all over the country, there are huge lines of people trying to get treatment at health departments like the Herman Keifer building in Detroit (this guy is camping out in Delaware in a line to wait for treatment), and no one seems to care? There have been more than 140 overdoses in Wayne County in the first 4 months of the year and no one appears to be demanding more access to treatment? Yet, every day there are several stories about the need for needle exchanges. How do they get this soapbox on a daily basis? What can we learn from these advocates? Are there harm reduction advocates that we can persuade to emphasize treatment access into their messages?

What Alcohol Does to a Child

This TIME article on the effects of drinking during pregnancy is important. As my wife and I have been at an age where lot of people we know are having babies, we're amazed at how many people (non-alcoholics) continue to drink and smoke through their pregnancy. And, they're telling us that their OB/GYN says it's ok to have a drink or two. Scary. It's a good thing that this story is running in such a widely read magazine.

The Top 10 Things I Know About Drugs

Here's a provocative anti drug war manifesto from the Drug Policy Alliance, the most prominent harm reduction advocacy and drug decriminalization group in the U.S. There's a lot to agree with. Unfortunately, they resort to an advesarial with us/against us approach, for example: "People who prohibit clean syringes to reduce the spread of HIV have blood on their hands."

Would it helpful to say that needle exchange advocates who do little to promote treatment and recovery have blood on their hands due to overdoses and drug related crimes? Our support/opposition to needle exchanges is conditional. Just like treatment programs, there are good ones and bad ones. And, there are contexts in which they make a lot of sense and contexts where other needs should be considered first.

And then there's this:

6. Smoking five cigarettes is better than smoking 20. Using marijuana is better than using heroin. Many well-intentioned people think drugs are terrible and abstinence is always the answer.... Some people who have struggled with heroin have been able to quit heroin, but still use marijuana. Our criminal justice system and many in the abstinence-only treatment world would view this as a failure and send the marijuana smoker to jail. I say congrats on giving up heroin. Keep it up.

Is reduced tobacco use a good thing? Sure, especially knowing that people who cut down are more like to eventually quit. But, continued use is still harmful.

Is marijuana less harmful/dangerous than heroin? Sure. (However, people focus far too much on the drug when, in the case of addiction, the problem is in the brain of the user.) Are there people out there who have switched from heroin to marijuana? I don't doubt it. However, they're the exception to the rule, so why focus on that particular anecdote?

Gradualism is a concept we can support, but we know the pain and misery caused by addiction - and we know that full recovery is possible when communities provide addicts the support that they need to recover.

I guess we get a pretty clear sense of their values related to drug policy, recreational drug use, and HIV. Unfortunately, I don't get a sense of their values related to addiction and recovery. It makes it hard to believe that they care much about addicts.

New Issue of Addiction Messenger

The new issue of Addiction Messenger focuses on creating a living treatment plan. It's something that we all struggle with and the article provides some helpful tips.

Zurich Policy Makes Heroin 'Loser Drug,' May Stop Use

This article and this article and discuss an article in The Lancet reporting very striking reductions in the estimates of new heroin users in Switzerland. These reductions are attributed to Switzerland's medicalization policy of drug replacement, usually methadone or buprenorphine but occasionally heroin. The first article provides a little more history than any others I've seen. It notes that Zurich was coming off of explosive growth in new users when the study started. This program could be considered a form of treatment on demand and would have been more impressive if they had aggressively promoted drug-free treatment as well and moved more people into recovery (I'm not sure that that didn't promote drug-free treatment, but they clearly weren't successful at moving people into recovery). It will be interesting to watch the response to this study and see what the use patterns are like for other commonly misused drugs since drug use patterns often shift dramatically over decades.

Residential video game addiction treatment

It appears that the dilution of the disease model is complete. We've all heard of video games being referred to as an addiction, but now there's a four to eight week residential treatment program.

What does this kind of thing do to public acceptance of the disease model as applied to drug and alcohol addiction?
Does the over-application of the concept render it meaningless?
Does it increase or reduce the stigma associated with drug addiction?

Sponsor, Recovery Coach, Addiction Counselor: The Importance of Role Clarity and Role Integrity

Sponsor, Recovery Coach, Addiction Counselor: The Importance of Role Clarity and Role Integrity - Bill White recently released this paper. It does a great job discussing the differences between the emerging role of recovery coach and the well established roles of counselor and sponsor.

High-dose nicotine patch therapy for smokers with a history of alcohol dependence

High-dose nicotine patch therapy for smokers with a history of alcohol dependence: 36-week outcomes - It's helpful to know that higher doses of nicotine did not make a difference, but even more helpful is yet another finding that quitting smoking is associated with better alcoholism treatment outcomes.