Disability payments may spur drug abuse

This is old news to our detox staff:

Paying out certain types of government aid in a monthly lump sum appears to fuel a spate of harmful and often fatal drug binges, according to a new study in a forthcoming issue of the Journal of Public Economics that links the monthly arrival of disability checks with a sharp rise in drug related hospitalizations and deaths. The findings by researchers at the University of California, Santa Cruz and Texas A&M University suggests that spreading out aid payments over several weeks could be a way to relieve some of the stress on hospitals and health care workers who struggle to handle the monthly surge.

The analysis found that in California, the 23 percent increase in drug-related hospital admissions that occurs in the first five days of any given month is driven largely by the arrival of Supplemental Security Income (SSI) and Social Security Disability Income (DI) payments. In particular, hospital deaths among SSI recipients increase 22 percent at the beginning of the month.

Quitting on Impulse May Be Smokers' Best Bet

What does this mean for the transtheoretical stages of change?

Smokers are often told the best way to nix their habit is to have a game plan, including a quit day and a quit strategy. But could that advice be counterproductive?

In a recent study putting that question to the test, smokers who quit spontaneously -- without advance planning -- had a greater chance of succeeding than those who planned ahead. The results, published in the British Medical Journal, seem to flout traditional smoking-cessation guidance.

Dr. Michael Siegel, a professor of social and behavioral sciences at Boston University who examines tobacco control policies and smoking behavior, said the findings make a lot of sense.

"Planned quit attempts are implemented gradually and thus the level of motivation is probably rather low," he said. "But these unplanned, sudden attempts probably reflect some sentinel event or great tension that precipitates a very high level of motivation to quit. And thus these attempts are more successful," he reasoned.

Study authors Robert West and Taj Sohal liken the unplanned quit attempt to what mathematicians call "catastrophe theory." The idea is simply this: As tensions build up, even small triggers can lead to sudden and dramatic shifts in action. In nature, such forces might lead to, say, an avalanche. In much the same way, a smoker becomes disgusted with his habit, creating tension that, eventually, triggers a split decision to kick the habit.

...

Thomas Glynn, director of cancer science and trends and director of international tobacco programs at the American Cancer Society in Washington, D.C., said the research is intriguing.

"What this study does is certainly require us to take a step back and look at different decision-making styles that people have," he said. But without further study bearing out these results, the cancer society would not consider revisiting its smoking cessation advice. "We certainly wouldn't want to do it on the basis of one study, particularly one that's based on retrospective data," he added.

For their study, the researchers compared data on 918 smokers who had made at least one quit attempt with the experiences of 996 successful former smokers. Almost half -- 48.6 percent -- of smokers said their most recent quit attempts were made without previous planning, and these spontaneous attempts were more likely to succeed for at least six months.

In fact, the odds of quitting successfully for at least six months were higher for unplanned quit attempts than for those that involved some pre-planning.

Presuming their theory is correct, the researchers propose that public health campaigns focus on what they dub the "3 Ts" -- creating motivational tension in smokers, triggering action in those who are on the cusp of change, and supporting them with treatment, such as nicotine patches and counseling.

Everything above makes a lot of sense but the ellipses replaced this:

Siegel said the study points to the need to focus on motivating smokers to want to quit. He said there's been too much emphasis on promoting pharmaceutical aids to help people quit. "If we can get smokers motivated enough, they will succeed in quitting, regardless of the mechanism."

Really? The reason people are unsuccessful quitting is that they are not sufficiently motivated? This doesn't doesn't fit countless anecdotal experiences and seems to suggest that the blame lie with the addict.

Herbal sleeping pills contain prescription meds

One more reason for those in recovery to be careful about herbal remedies.

Why do drug dealers live in their mother's basements?

This doesn't have much to do with addiction, but the author of Freakonomics pokes holes in our cultural mythology about drug dealers and wealth.

The syringe in the sandbox

A call for needle exchange reform in San Francisco. More background info here.

The soul of harm reduction

Several experts were asked "what harm reduction means to me."

Highlights below:

I regard harm reduction as a subversive way of performing medicine: doing outreach work, sharing knowledge with users, empowering them, care and cure in a more human, respectful and humble way, inventing a model which not only concerns drug use, but also transforms my whole practice

The magnificent work people who injected drugs in New York in the late 1970s and early 1980s did to figure out that they were under attack by an insidious disease - long before science figured it out.

Their success, in spite of continual assaults on their dignity and autonomy by media, politicians and police, in figuring out how to reduce their risk of acquiring or passing on this new disease - long before public health or others did much of anything.

The creativity of users (and their saying “We Are Human”) as they organised activist groups to pressure service providers and governments to help them when they need it and to respect their dignity and autonomy at all times.

To me, harm reduction means love, passion and care to all human beings who live with us ... I have graduated from university twice - once from a medical university in Shiraz (my home town) and once from the street university with all the people who use drugs and live with drugs. To me, the most efficient and noble experience was having the chance to be with people on the streets – to live with them and learn from them. Now they are my best friends and my best teachers whenever I need. I feel for the first time in my life that now I have a meaningful dream to live with

I had to smile when I was asked to write this short piece of what harm reduction means to me. Harm reduction for me has become more than something I do at work. It is a philosophy that I have adopted to guide how I deal with many sides of my life and I practice it not only professionally but maybe more importantly in my home. I am a single parent with three teenage children - two girls (11 and 15 years old) and a son of 13....

I have created a non-judgmental environment in my home where my children are comfortable sharing with me what is going on in their lives. HIV and drugs have been a regular topic of discussion in my kitchen for years! Condoms have always been around our house and are not seen as something weird or external - my children know what they are for. I have educated them to be peer educators in terms of drugs, sexual health, and HIV - so that when they hear misinformation from their friends they are able to provide the correct information. They know that I would rather that they did not use any substances, but we have also discussed each substance (including tobacco, ganja, crack and alcohol) and they know the harms associated with each. Instead of preaching sexual abstinence with my children, I have discussed with them the physical and mental health benefits of postponing intercourse to a later age and we have discussed other strategies for satisfying a partner through ‘outer-course’ (politically correct word for ‘mutual masturbation’ or ‘heavy petting’ - as it was called when I was 14!). If they chose penetrative sex, then they know that any boy who refuses to use a condom is not worth having sex with.

The age of sexual consent is 16 in Saint Lucia. As they turn 16, I will let them use the guest apartment under the house for their conjugal visits rather than have them go out to a car or beach where rape is a possibility.

For most drug users, harm reduction – not abstinence – is the only chance to survive. Harm reduction relieves them from the humiliating consequences of prohibition (at least those who have not been deterred). Harm reduction enables them to save their lives and live them free of contempt and humiliation. Harm reduction means to lead a constant fight against people’s need to reassure themselves of their superiority by stigmatising those who deviate from normality. Harm reduction forms a lively counterbalance to the exaggerated sense of duty and hostility to pleasure originating from puritan ideology. Harm reduction supports people who do not want to suffocate in a puritan corset but who strive for a life with intense experiences, even if their attempts often ended in failure.

Chantix and mental illness

Something to keep an eye on:

The August issue of the American Journal of Psychiatry included two letters reporting single cases of worsening of symptoms of schizophrenia and mania, while they were taking the new smoking cessation medication, Chantix (varenicline).

It's Not Fair. It's Not Working,

The ACLU has started a campaign to end the 100:1 crack cocaine sentencing disparity.

Diary Of A Mad Voter: In Search Of A Presidential Candidate Who Will “Just Say No”

DARE, the DEA, the War on Drugs, the presidential campaign, and apparently genuine concern about drug misuse. Jessica Peck Corry covers a lot of ground in this column.

Highlights:

While we don’t have the money to treat drug addiction, we do have the money to send users to prison.

...I respectfully request that the government refrain from putting a bong in the hands of my children.

The New Science of Addiction

A great educational website about addiction. It focuses on neurobiology but also covers a few other areas. Make sure to check out Mouse Party.
[Hat tip: Jim]

Anxiety, depression, and heavy drinking

From Addictive Behaviors:

Abstract

The Transtheoretical Stages of Change Model specifies that when the costs outweigh the benefits of substance abuse, the resulting discomfort can be a catalyst for change. The current study evaluated the roles of depression and anxiety in motivating readiness to change current drinking behaviors. Results from regression analyses of self-report data from 233 undergraduate hazardous drinkers indicated that higher levels of depression and anxiety were associated with elevated readiness to change. Additionally, study findings showed that when considered together, anxiety accounted for more of the individual differences in alcohol change readiness than depressive symptoms. Study results were discussed in the context of existing models of change readiness and implications for further research and clinical practice.

Not all that surprising if you follow the literature. In spite of trends to characterize every psychiatric symptom as a co-occurring disorder, these symptoms are not always noxious and may indicate intact reality testing and internal strengths rather than pathology.

Boozy Brits face disease timebomb

An update on British drinking habits and liver disease:

"There's been a frightening increase in alcoholic liver disease in recent years," said Dr. Ian Gilmore, president of the Royal College of Physicians.

Deaths from cirrhosis in Britain increased dramatically over the past two decades, while they fell steadily everywhere else in the Western world, according to government statistics.

In England and Wales, 17.5 deaths of every 100,000 men were due to cirrhosis in 2002, up from 8.3 in 1987. And in Scotland, the increase was even more dramatic: 16.9 cirrhosis deaths per every 100,000 men in 1987 to 45.2 per 100,000 in 2002.

By comparison, the overall U.S. cirrhosis rate has fallen from 15 deaths per 100,000 in 1973 to nine per 100,000 in 2004. In the European Union, the rate in the early 1980s was about 20 per 100,000 deaths; by 2004, it had fallen to 13 per 100,000. Neither the U.S. nor the EU provided a breakdown between men and women.

Addiction: Moral Failing or Disease?

ABC News provides some coverage of Senator Biden's efforts to change federal language related to addiction:

Under the Recognizing Addiction as a Disease Act of 2007, which Biden sponsored, the National Institute on Drug Abuse will become the National Institute on Diseases of Addiction, and the National Institute on Alcohol Abuse and Alcoholism will become the National Institute on Alcohol Disorders and Health.

However, it also reports on a pseudo-debate about the nature of addiction. Guess which experts question the disease model? Sally Satel and Scott Lilienfeld. (More here, here and here.)

There is no raging debate among experts. Overwhelmingly the disease model is accepted. There are a few gadflies like these two and Stanton Peele and Jeffrey Schaler who pop up every time the media needs to create conflict in a story.

Gone camping.

No blogging for a few days.

The Economics of Addiction

I understand the intellectual argument, but I don't understand how any human being can buy this.

Is rushing out to buy dope that killed your friend rational? Do they really believe that there's a rational dimension to using drugs so frequently in such large quantities that the addict loses his/her home, family, health, career, hopes, dignity, etc? Do they not get that people kill themselves in despair because of their inability to quit?

This seems to be a great theory if you place supreme value on cleverness or or if you are invested in believing that addiction is a choice.

Worker Substance Use and Workplace Policies and Programs

No surprise here. Food service and construction workers have the highest rates of drug and heavy alcohol use.

Faith-based initiative backfires

From the Christian Science Monitor:

Once upon a time God, with some federal funding, was going to do so much.

In his early years, President Bush promoted funding for faith-based groups in order to blast social problems with the power of religious belief by unleashing the "armies of compassion." Bush predicted that his faith-based initiative would be his great legacy. And it does send an estimated $2 billion to religious charities.

But the campaign, ignored by Congress and challenged in court, has dropped off the White House talking points. After a brief mention in the 2006 State of the Union address, it was left out entirely this year.

The initiative did leave another legacy: It gave spirituality a bad name in social-service circles.

Read the rest. It provides an interesting perspective on spirituality and treatment.

Addicted to prisons

California may be close to establishing a cap in their prison population. This has the potential to force serious drug policy reform.

On july 23, two U.S. District Court judges ordered the convening of a three-judge panel to consider releasing prisoners from California's alarmingly overcrowded state prison system. The judges' move raises the possibility that a specific cap on the state's prison population will come into place within the next few weeks or months.

...

The governor should order the early release of nonviolent parole violators and require parole officials to review whether community-based measures can address the risks posed by future technical violators. Special legislation to allow early release of nonviolent offenders who are within a few months of completing their sentences also should be considered.

Even these measures will not be enough to free the state from its chronic overuse of prison. To do this, the governor must come before the people and speak the truth about our penal code with his trademark frankness. These are laws written by and for "girlie men." We must learn to address serious social problems, like drug addiction, homelessness and threatening gang behavior, without indiscriminate recourse to prison. The governor should appoint a sentencing commission staffed with independent experts on crime and law enforcement to overhaul sentencing laws, with a mandate to reduce our reliance on prisons.

Which to treat first: Comorbid anxiety or alcohol disorder?

This article does a pretty good job outlining the problems and the potential relationships between symptoms:

The most common understanding of this comorbidity is that having an anxiety disorder predisposes one to develop an alcohol or substance use disorder via self-medication—using alcohol or drugs to modulate anxiety and negative affect. However, substance use disorder experts have argued that the social, occupational, and physiologic effects of substance use can generate new anxiety symptoms in vulnerable individuals. In other words, physiologic and/or environmental disruptions from chronic alcohol or substance use could promote conditions and circumstances in which anxiety symptoms are more likely to emerge or worsen.

Although DSM-IV-TR does not delve into the causes of mental disorders, it states that substance use can cause or “induce” an anxiety syndrome with symptoms that resemble or are identical to those of the various anxiety syndromes that are not related to substance disorder.

Alternatively, the idea that a third factor can serve as a common cause for both conditions fits with the view that substance use disorder and anxiety disorder can be phenotypic expressions of a common underlying genetic/physiologic liability.

Finally, these models are not mutually exclusive. Anxiety symptoms or substance use could cause or aggravate the other.

It also covers the possibilities in the sequence of symptoms (with a little psychiatric bias):

Anxiety disorder typically begins before a substance use disorder in comorbid cases, although some studies have reported the opposite pattern or roughly simultaneous onset of both disorders.

Using a prospective method in college students, we found that the risk of developing alcohol dependence for the first time as a junior or senior more than tripled among students who had an anxiety diagnosis as a freshman. We also found, however, that students who were alcohol dependent as freshman were 4 times more likely than other freshman to develop an anxiety disorder for the first time within the next 6 years.

In short, having either an anxiety or alcohol disorder earlier in life appears to increase the probability of developing the other later. This finding supports the idea that the types of associations that link pathologic anxiety and substance use vary among individuals and, perhaps, within individuals over time.

All of this seems to really come down to good, conservative diagnostic practice.

Today in pot history

The Freakonomics Blog acknowledges the 70th anniversary of the Marihuana Act of 1937.