Is the U.S. Government's Quitting Policy Killing Smokers?

A provocative take on the nicotine replacement therapy as a smoking cessation strategy. The website has a strong bias for quitting smoking cold turkey, but this seems well sourced. Well worth the time it takes to read it. I'd love to see a retort. Highlights here:

Surveys from California (2003), Minnesota (2002), Quebec (2004), London (2003), Maryland (2005), UK NHS (2006) and Australia (2006) all report absolutely no advantage for quitters using pharmaceutical quitting aids over cold turkey quitters. In fact, in the Australian study, among patients of 1,000 family practice physicians, cold turkey was twice as effective as NRT or bupropion (Zyban/Wellbutrin).

But how can this be? What about those clinical studies the government and its industry partners cite in support of their 'double your chances' assertion? What Leavitt, Gerberding, Collins and Husten do not mention is that clinical NRT studies were not blind as claimed.

If they haven't read a June 2004 study by Mooney, they should. Mooney reviewed 73 allegedly double-blind NRT studies and declared that the limited number of studies assessing blindness were not generally blind as claimed because 'subjects accurately judged treatment assignment at a rate significantly above chance.' In other words, a significant number of study participants knew whether they were getting a drug or placebo. This knowledge makes suspect any difference in success rates.

NAADAC Rates Lawmakers On Addiction Issues

NAADAC has developed a voter's guide so that you can find out how your elected officials have voted on legislation that impacts treatment and recovery.

Methadone programme fails 97% of heroin addicts - U.K.

From Scotland:

The study, by Glasgow University’s Centre for Drug Misuse Research, has shown that the vast majority of addicts on the £6.5m-a-year heroin-replacement programme are still taking illegal drugs years later. According to the study, which followed 695 drug users from 33 addiction centres across Scotland, 97% were still taking methadone or illegal drugs three years after receiving their first dose.

Neil McKeganey, who led the research, has blamed the programme’s failure on the policy in Scotland, which aims to stabilise addicts’ drug use rather than getting them permanently off drugs, as in England. Methadone treatment is supposed to wean addicts off drugs by slowly decreasing the amount prescribed. However, in some cases drug abusers are kept on a steady dose to avoid a return to heroin once the dosage drops.

Bad news. McKeganey has been an outspoken critic of their methadone programs for some time but I've never seen any accusation that he's cooking his numbers. It's noteworthy that the ir programs appear to be long term detox rather than the U.S. goal methadone maintenance.

New Nonmedical Users of Prescription Pain Relievers Outnumbered New Marijuana Users

SAMHSA reports that:

Misuse of prescription drugs is second only to marijuana as the nation’s most prevalent drug problem, and the annual average number of people using pain relievers non-medically for the first time exceeds the number of new marijuana users according to a study released today by the Substance Abuse and Mental Health Services Administration (SAMHSA). Most young people aged 12 to 17 get these drugs from friends or family members, not the Internet.

The most troubling aspect of this is the fact that prescription opiates are expensive and people who begin to develop problems with them often start using heroin as a less expensive alternative.

Is AA Effective?: Wall Street Journal vs Cochrane Collaboration

STATS.org weighs in on the Wall Street Journal's criticism of the Cochrane Collaboration's recent review of research on 12 step facilitation (TSF). In my opinion, the STATS author has a bias against 12 step recovery and specialty addiction treatment. (I'll acknowledge a bias in favor of both.) Some examples:

• Her statement about 12 step "baggage".
• Her lame attempt at fair criticism. ("Yet it is important not to dismiss 12-step programs entirely.") Why is it necessary to "dismiss" 12-step recovery at all? Can't one affirm the value of other paths to recovery without dismissing 12-step programs?
• Her tendency to link TSF and specialty treatment to Synanon.

She's also a disease model skeptic and has written (here and here) about her negative personal experiences with 12 step recovery (dismissing her depression, pushing religion, etc.) and determination that her addiction was self-medication.

Unfortunately, she's the only journalist I'm aware of that specializes in analyzing addiction treatment and drug policy. Her point of view is valuable, but it's not unbiased.

The Cochrane review is accurate in that studies looking at relatively short term outcomes of various treatment approaches find little or no advantage for one over another. This is important but doesn't paint a complete picture. These studies (as do all treatment studies) focus only on recovery initiation. We know relatively little about recovery maintenance. Study after study finds that 12-step attendance is related to higher rates of abstinence. This could simply be an artifact of motivation, but it's probably much more complicated than that. There's a lot of diversity in treatment quality, intensity, duration, combinations of approaches, etc. There's a shift toward disease management models that will emphasize long term outcomes and recovery maintenance, not just recovery initiation.

We've got a lot to learn, but here's some of what we know:

• Is 12-step effective at initiating recovery? - YES
• Are other approaches effective at initiating recovery? - YES
• Is 12-step involvement associated with maintaining abstinence? - YES
• Are other approaches associated with maintaining abstinence? - I haven't seen the evidence.
• Do 12-step programs work for everyone? - NO
• Does anything work for everyone? - NO
• Are there other paths to recovery? - YES
• Do some people initiate recovery with one approach and maintain recovery by other means? - YES

We should continue to research 12-step recovery and other approaches. Learning more about the factors that contribute to the benefits of 12-step involvement might help in developing recovery maintenance strategies to help people who won't attend 12-step groups or don't benefit from 12-step groups -- and of course, approaches without the "baggage" that troubles the writer.

Computer dusting product changed to curb inhalant abuse

The CBC reports:

An unpalatable additive is being added to computer dusting products in an attempt to discourage aerosol inhalant abuse, a consumer electronics company announced Thursday.

This is interesting because just yesterday I received an email pointing out that youtube.com has a lot of videos of kids using this stuff to get high.

AA and other meetings benefit variety of alcoholics

A PIRE study found that:

Researchers studied 227 recovering alcoholics following treatment, and found that greater attendance of AA or other meetings resulted in improved rates of abstinence or in less intensive alcohol consumption in the event of relapse. These beneficial effects were not influenced by gender, religious preferences, psychiatric disorders or whether the patient had prior attendance at AA or other groups.

Adolescent Brains Are Insensitive To Alcohol For A Short Time, But At Great Cost

Another study on the effects of alcohol on adolescents:

Whereas brain development during adolescence may initially serve to "safeguard" youth from certain effects of alcohol such as intoxication and hangover, it will also likely make them more vulnerable to the longer-term effects of alcohol.

Even though the adolescent brain has the capacity to adapt to an alcohol challenge, this will likely come at great cost as valuable cerebral resources are redirected from the important role of brain development to instead adapting to an alcohol challenge, and then restoring the system back to status quo once alcohol is eliminated or the challenge is removed.

Smoking Cessation Therapy May Be Harmful For ICU Patients

Suprising findings from another new study:

...researchers found that smokers admitted to the ICU who received nicotine replacement therapy (NRT) during their stay had a higher risk of death than smokers who did not receive NRT.

College Kids Choose Adderall over Ritalin for Illicit Use

From a new study:

More than 75% of college students who reported using prescription stimulants illicitly last year chose amphetamine-dextroamphetamine products, like Adderall, over methylphenidate products, like Ritalin. ... the primary motives for illicit use were to enhance academic performance, while less than a third of illicit users intended to get high or experiment with these stimulants. However, alarmingly, approximately 40% of these students had snorted prescription stimulants.

Alcoholism May Cause Decreased Density Of Neurons In The Orbitofrontal Cortex

Another study finds that alcoholism appears to damage a region of the brain that is heavily involved in decision-making processes and emotional and motivational behavior.

Media Rarely Notes When Alcohol Plays Role In Violent Crimes And Accidents

A new study finds alcohol's harms underreported:

While alcohol is linked to 34 percent of motor vehicle accidents, only 12.8 percent of television stories, 19.2 percent of newspaper articles, and 22.2 percent of magazine articles about such accidents mentioned the use of alcohol, the study revealed.

For stories about fatal accidents not involving motor vehicles, alcohol was mentioned in 1.4 percent of television reports, 4.8 percent of newspaper stories and 13.6 percent of magazine articles. However, statistics suggest 31 percent of these accidents involve the use of alcohol.

Estimates suggest alcohol plays a role in 31 percent of homicides, but it is mentioned in only 2.6 percent of television reports, 7.3 percent of newspaper accounts, and 5.6 percent of magazine reports of violent crime, with even lower percentages in the reporting of homicides.

What lifts people out of addiction?

As founder and medical director emeritus of Gateway Rehabilitation Center, Dr. Twerski spoke last month at the center's Recovery Breakfast, on the topic 'Will Chemical Blockers Eliminate the Need for AA?' Here are his comments.

Smokers are ordered to quit if they want surgery

A British health authority is to become the first to penalize smokers by taking them off waiting lists for surgery. The Independent reports.

Pot News

Four recent news items about pot:

• Colorado has a ballot proposition to decriminalize possession of an ounce or less of marijuana. An editorial page makes a case against it.
  
• A medical marijuana advocate talks about medical marijuana's use in California where it has been legal for 10 years.
• A British columnist argues that pot is more dangerous than heroin.
• A reader accuses the above columnist of exaggerating.
  

Statin drugs may protect smokers' lungs

Cholesterol fighting drugs may decrease smokers decline in lung function. But they do not prevent lung cancer.

Cocaine Epidemic Feared As Cocaine Deaths Nearly Double In Florida Over Past 5 Years

Is there going to be a new surge in cocaine use? The description gives the impression that , much like the late 1970s and early 1980s, there's a surge in powder cocaine use among some affluent groups.

Warning over vodka snorting fad

I've heard of putting alcohol in some dark places, but this is the first I've heard of vodka snorting.

Early Use Of Nicotine Could Increase Susceptibility For Life-long Addiction

A new study concludes that early exposure to nicotine may cause brain changes that increase the likelihood of becoming addicted later in life.

There have been a growing number of studies with similar findings, mostly coming out of NIDA. It makes sense and the science seems pretty good, but I have a nagging feeling that this is the gateway theory 2.0. Along these lines, earlier this week I heard these studies invoked by someone making the case for resurrecting D.A.R.E.

Altered Perception Of Reward In Human Cocaine Addiction

A new study identifies a possible neurological mechanism to explain cocaine addiction's power to interfere with rational decision making. Anecdotally, I don't hear stories about heroin addicts giving their car to the dopeman, the way you do about cocaine addicts.

...in one study, subjects were given a monetary reward for their performance on an attention task. Subjects were given one of three amounts (no money, one cent, or 45 cents) for each correct response, up to a total reward of $50 for their performance. The researchers also asked the subjects how much they valued different amounts of monetary reward, ranging from $10 to $1000.

More than half of the cocaine abusers rated $10 as equally valuable as $1000, "demonstrating a reduced subjective sensitivity to relative monetary reward," Goldstein said.

"Such a 'flattened' sensitivity to gradients in reward may play a role in the inability of drug-addicted individuals to use internal cues and feedback from the environment to inhibit inappropriate behavior, and may also predispose these individuals to disadvantageous decisions -- for example, trading a car for a couple of cocaine hits. Without a relative context, drug use and its intense effects -- craving, anticipation, and high -- could become all the more overpowering," she said.