Does Alcohol Involvement Increase the Severity of Intimate Partner Violence?

A pretty intuitive finding. That domestic violence is more severe when alcohol is present.

Study Says Drinking with Your Kids Doesn't Prevent Abuse

Join Together reports:

Dutch teens who were allowed to drink alcohol at home drank more outside the home than their peers and -- along with other teens who drank -- were at increased risk of developing alcohol problems, according to researchers from Radboud University Nijmegen.

The study authors tracked 428 Dutch families with two children ages 13-15. They found that teens who drank at home also drank more on their own, and vice-versa, suggesting that teen drinking begets more teen drinking regardless of setting.

"The idea is generally based on common sense," said researcher Haske van der Vorst. "For example, the thinking is that if parents show good behavior -- here, modest drinking -- then the child will copy it. Another assumption is that parents can control their child's drinking by drinking with the child."

However, the study demonstrated that, "If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence, they should try to postpone the age at which their child starts drinking," said van der Vorst.

The research was published in the January 2010 issue of theJournal of Studies on Alcohol and Drugs.

Injection center coverage

Slate has a couple of dispatches on "Vancouver's experiment with helping addicts get high"

A commentary accuses opponents of "contempt for science"

I don't oppose harm reduction but, like this blogger, I see no reason why a recovery orientation could not be introduced in every harm reduction service.

The zeal for insite and contempt for critics make me wonder what their feeling would be about programs that distribute sleeping bags to homeless people to prevent frostbite and exposure deaths? These programs exist and there's one in my community.

Of course, there's one important difference. They engage in considerable advocacy, and not for more sleeping bags or tents, but for housing.

UPDATE: Peapod mentioned "evidence" below. Along the lines of his comment, we could produce studies and reams of evidence that sleeping bag distribution prevents frostbite and reduce exposure deaths, right? Does that make it the right thing to do? Maybe. Does that make it an adequate response? No. Does that mean that, in the establishment of priorities, it should trump other responses? No.

ONDCP talks recovery

New Drug Policy Approach Focuses on the Vital Role of Recovery. See page 2.

Good news

2010 Federal Budget Boosts Funding for Mental Health and Substance Abuse Programs

AA and depression

From Addiction:

ABSTRACT
Rationale Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA's effects.

Methods Using lagged, controlled, hierarchical linear modeling and mediational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA's proximal effect on reducing concurrent drinking.

Conclusions AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

Cocaine Vaccine Hits Snag

Over at Addiction Inbox, Dirk Hanson reports on findings from a trial of the new cocaine vaccine and provides a succint description of its mechanism:

Some cocaine addicts appear willing to risk overdose in order to defeat a new cocaine vaccine, a recent study has shown.

The study, which appeared in the Archives of General Psychiatry, demonstrated that the TA-CD vaccine could blunt the effects of cocaine in some, but not all, patients. The vaccine works by causing the production of antibodies, which attach themselves to cocaine molecules, making the molecules too big too pass effectively through the blood-brain barrier.

Of 115 addicts involved in the study, only 38 % produced sufficient antibodies to dull the effects of cocaine, Rachel Saslow of theWashington Post reported. And among the high-antibodies group, only 53 % stayed free of cocaine 50 % of the time. “Immunization did not achieve complete abstinence from cocaine use,” said Thomas Kosten of Baylor college of Medicine, one of the authors of the paper.

Moreover, in some of the study participants for whom antibodies made cocaine a disappointing high, researchers found cocaine levels in the body to be as much as ten times higher than previous levels of usage—an obvious attempt to overcome the vaccine’s effectiveness. There were no overdoses, according to Kosten.

Politics, Science and Harm Reduction

Macleans has an interesting column making the case for the role of politics in decisions about programs like Insite:

...each person’s own opinions on federalism may not line up neatly with his views on drug policy. Indeed, if you are a strong centralist when it comes to Confederation AND you loathe the Harper government, or you’re just a centralizer who favours harm reduction, it seems to me that the Insite controversy has painted you into a rather awkward corner.

As far as I can tell, we are not having the kind of debate that would force such a person to say “I hate that those anti-science Conservative nutbars are trying to crush Insite, but they certainly have the right to do so.” Nor are we hearing from decentralizing socons who might say “I sure hate the idea of doctors getting paid good money to hover over diseased vermin while they irrigate their veins with poison, but as much as I like the Prime Minister, he should damn well stay out of B.C.’s business.”

I would add that this fundamental constitutional question is all the more important because, unlike many fellow libertarians and supporters of harm reduction, I don’t really believe that the value of safe-injection clinics is something that can be settled by a simple appeal to the authority of science. Science is well-placed to answer narrow, specific measurement questions about drug policy: “Did Insite reduce the number of overdose deaths in the region between years X and Y?”, for example. By answering such questions, it can provide the material for a broader assessment of the worth of such programs. But it cannot decide by fiat.

Insite has to be judged by its effects on many groups of citizens—not just the drug users who visit Insite, but the drug users who don’t and won’t; the families and loved ones of both groups of addicts; the dealers; the cops; the ordinary people who live near the clinic, and elsewhere in the region; the B.C. government, its treasury, and its taxpayers. (An environmentalist, or a Lorax, would even say that the non-human world should have a voice.) Within none of these groups are the effects simple or quantifiable by means of a single number, and all of the groups may have different claims to moral consideration, claims that there can be no universal agreement on. Moreover, the integrity of the criminal law and the public’s respect for it do count for something—maybe not much, but not zero—in this equation. The defender of Conservative policy would argue that this makes us all parties to the controversy, even outside B.C.

In short, science can’t provide us with a simple, scalar Benthamite answer to the net utility of Insite. To oppose Insite is not to be opposed to “science”, though a lot of scientists like Insite. Whether the clinic ought to exist is a question well-suited to be answered by political means: public and private argument, consensus-building, horse-trading, the consulting and balancing of moral principles, et cetera. Since this is the case, the question of what political unit should have the power to make the decision—the federation, or the province—is both crucial and urgent.

The problem of free will in addiction

Philosophy bites has an interview with Thomas Pink on free will that I think touches on points important to thinking about addiction.

It's my anecdotal sense that much of the resistance to the disease model comes from concerns about free will. Specifically, that the disease model suggests a loss of free will (or, a kind of determinism), at least in this one area of the addict's life. The problem here is this: if the person is not in control of their behavior, how can we hold them accountable or assign blame for the bad things that they they do or that result from their AOD use? This isn't a small matter. This kind of accountability is an important social glue.

This podcast (18 minutes) does a good job exploring the matter of blame and free will, but, more importantly, addresses the apparent incompatibility between free will and determinism by suggesting that we conceptualize them improperly.

A helpful metaphor is offered: If a machine has two controllers (one controller representing deterministic factors and the other representing free will), does that mean that only one controller works? Or, is it possible that they both are capable of controlling the machine?

Here and Now with A. Thomas McLellan

Here and Now has a good, brief interview with A. Thomas McLellan.Hea

Not on the same side

Doctors criticise ‘reckless’ drug abuse guidance

"I Want Heidi Fleiss To Get Well ... But I Don't Think Celebrity Rehab Is The Solution"

I don't usually post this kind of thing, but I've always had a soft spot for Juliana Hatfield. I think she's a little too kind to Dr. Drew.

I think money -- and the possibility of renewed visibility leading to future job offers -- is the only legitimate, honest motivation for anyone to go on "C.R." (Celebrity Rehab) I suspect that another reason people do go on the show -- disregarding the fact that they are so drug- and booze-addled that they simply cannot make any rational or intelligent decisions about anything -- is that they crave attention and fame. These people -- especially these people -- will never get clean unless they disappear; out of Hollywood, off of TV.

Addiction treatment afflicted with Baumol's cost disease

I'd never heard of this guy or "Baumol's cost disease", but it makes a lot of sense and is has difficult implications for the future of of addiction treatment, particularly for providers that serve indigent populations or focus on offering affordable care.

Update: I got a few questions about this. The implication for programs is that, because there is little or no chance for gains in efficiency, programs must make more money every year just to maintain the status quo. Prices are just about the only lever that programs have.

Words used to describe substance-use patients can alter attitudes, contribute to stigma

This study highlights something that's always troubled me about efforts to frame addiction as a chronic illness, that it could be more likely to increase stigma rather than decrease it.

Part of the appeal of the acute model is that it offers a narrative of permanent transformation. There are two concerns about the disease model that I hear over and over again that contribute to stigma.

The first concerns personal responsibility--that if we accept the disease model and destigmatize addiction, we're letting people off the hook for bad decisions. This concern focuses on behavior prior to recovery and the chronic model offers nothing new to address these concerns.

The second concern is that addicts and alcoholics don't change and that recovery either isn't a realistic possibility for most addicts or that recovery doesn't mean what advocates say it means. Some argue that alcoholics will never really quit, others might argue that the real problem is character and when you sober up a drunken horse thief you still have a sober horse thief. This fear of recidivism (or the expected persistence of anti-social behavior that's attributed to all addicts) contributes to disease model resistance and stigma. The acute model's narrative of permanent transformation, offers a (too often false) response to this fear. The chronic model's emphasis on lifelong vulnerability contributes to these fears that recovery is temporary and unstable.

Some will invest a lot of time in micro-examining word usage to improve "messaging". I don't think that this is the answer. I believe the problem is that our message is incomplete. What we say about the illness of addiction isn't the problem. The problem is that we have very little to say about recovery.

For this reason, Bill White wrote a piece calling for research into the neurobiology of recovery. It's well worth the time to read it.