What do you believe about your clients?

A great set of questions for self-evaluation that focus on the worker's ability to see and work with client strengths.

Cognitive performance enahncement

Head to head articles for and against the acceptability of people taking methylphenidate to enhance performance. The against column offers an interesting ethical argument:

Drug enhancements will be available disproportionately to those with financial means. If enhancements are helpful in getting ahead in a competitive world, then the haves would avail themselves of yet another advantage over the have nots. Clearly, many inequities in education, material goods, and social class, not to mention more fundamental inequities in health care, nutrition, shelter, and safety, already give the socioeconomically lucky disproportionate advantages. However, acknowledging the existence of disturbing inequities does not justify blithely adding more.

Matters of choice can evolve into forces of coercion. Implicit pressures to better one’s position in some perceived social order would find a natural conduit in cognitive enhancements. Such pressures increase in "winner take all" environments, in which more people compete for fewer and bigger prizes.

Technorati Tags: methyphenidate, enhancement, ethics, policy

The sky doesn't fall in

More on Portugal's decriminalization strategy:

Some question aspects of the system, but what Portugal's controversial experiment has demonstrated is that, if you take the crime out of drug use, the sky doesn't fall in.

Technorati Tags: policy, drugs, portugal, decriminalization

Tab dump

• AMA meeting: More to do on tobacco control
• Outpatient alcoholism treatment - 24-month outcome and predictors of outcome
• Healthcare Reform Must Prioritize Treatment for Addictions, Mental Health, Report Says
• Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment
  

Technorati Tags: tobacco, outpatient, treatment, policy, buprenorphine, methadone

Marlboro Country

Legal, taxed, regulated and still an enormous illicit industry.

21

I'm not dead set against lowering the drinking age, (see here) but I find it odd that in making the argument to lower the drinking age, John McCardell offers very troubling statistics without any serious interest in their cause:

at one major university, student visits to the emergency room for alcohol-related treatment have increased by 84 percent in the past three years. Between 1993 and 2001, 18-to-20-year-olds showed a 56 percent jump in the rate of heavy-drinking episodes. Underage drinkers now consume more than 90 percent of their alcohol during binges. These alarming rates have life-threatening consequences: each year, underage drinking kills some 5,000 young people and contributes to roughly 600,000 injuries and 100,000 cases of sexual assault among college students.

These increases occurred during a period with no changes in the legality of drinking for people under 21. Seems strange to blame the drinking age in that context, no? Particularly when countries with lower drinking ages are experiencing similar trends. One might argue that lowering the drinking age has little or no effect but, again, it seems inconsistent to blame it. Shouldn't be more interested/curious/concerned about the causes of this?

Interestingly, a study suggests that the 21 drinking age reduces binge drinking except in college students.

New research from Washington University School of Medicine in St. Louis has found substantial reductions in binge drinking since the national drinking age was set at 21 two decades ago, with one exception -- college students. The rates of binge drinking in male collegians remains unchanged, but the rates in female collegians has increased dramatically. The report was published in the July issue of the American Academy of Child and Adolescent Psychiatry. Core message: The drinking age is having a beneficial impact; reducing it would be a mistake.

Again, begging the question, "What's going on with college students to explain this 'dramatic increase' in recent years?"

Technorati Tags: alcohol, binge drinking, policy, underage drinking, amythest

THIQ all over again

A 2004 study carried out at the University of Colorado found that around 15 per cent of Caucasians have a genetic variant, known as the G-variant, that makes ethanol behave more like an opioid drug, such as morphine, with a stronger than normal effect on mood and behaviour. This variant seems randomly distributed among the population: it emerged through mutation, although the factors affecting its selection remain unknown since, like all genes, it does not operate in isolation. . . . The Colorado study tested the DNA of moderate-to-heavy drinking students to determine whether they had the G-variant gene. They were divided into two groups accordingly, before having alcohol injected directly into the bloodstream (to eliminate differences in absorption rate). Those with the G-variant produced a slightly different version of what is known as the mu-opioid protein, which elicits a stronger response in the brain. As a result they reported stronger feelings of happiness and elation after their shot of alcohol. This initial euphoria is usually followed by a longer state of relaxation, lasting several hours.

This feels a little too close to THIQ (#36). We'll see if it holds up to scientific scrutiny.

Technorati Tags: research, alcoholism, genetics

Ouch

I hate to say it, but I think we're going to be seeing more of this.

When I clicked the link, I was expecting to see it focus exorbitant salaries in boutique treatment programs. It's a little surprising that this is happening in the program with so much public funding. The current market is rewarding programs with entrepreneurial spirits and that is a double-edged sword. It can be good because it rewards programs that respond aggressively to community need rather than waiting for someone to hand them capital. The downside is obvious, from this article. It can foster an unhealthy emphasis on financial matters that has led to the demise of many programs over the last century.

Technorati Tags: history, exploitation, treatment

U.N World Drug Report

The United Nations Office on Drugs and Crime World Drug Report was released yesterday. The section, "Confronting unintended consequences: Drug control and the criminal black market" is an interesting read. Section 2.1 "Why illicit drugs should remain illicit" squarely and intelligently takes on the pro-legalization argument. It paints a broader picture of the problem than any of the other policy articles I have seen. It also offers a holistic set of responses which are less focused on prosecuting individuals and more focused on macro interventions that address criminal consequences of prohibition at a systemic level. The report notes that "a small share of the user population appears to consume the bulk of the drug supply"; a perfect case for access to treatment for that small segment of the population .

A couple of highlights from the press release:

First, drug use should be treated as an illness. “People who take drugs need medical help,not criminal retribution,” said Mr. Costa. He appealed for universal access to drug treatment. Since people with serious drug problems provide the bulk of drug demand, treating this problem is one of the best ways of shrinking the market.

Second, he called for “an end to the tragedy of cities out of control.” In the same way that most illicit cultivation takes place in regions out of government control, most drugs are sold in city neighbourhoods where public order has broken down. “Housing, jobs,education, public services, and recreation can make communities less vulnerable to drugs and crime”.

Hijack the drug trade?

Does this strike anyone else as naive? In writing about the FDA's new powers to regulate tobacco, more specifically the FDA's power to regulate nicotine yields, Saletan says:

This is what drug warriors don't understand: There's always market competition, whether you like it or not. Prohibition just means that the competition is between legal and illegal products. To beat illegal products in an already-addicted market, you need sufficiently attractive legal alternatives. Then, by regulating and manipulating the legal products, you can ratchet down the harm and addiction. That's how you bring the market under control.

Come on. If we took this approach to other drugs there wouldn't be a massive black market? I suspect we'd end up with two markets, a legal one for adult recreational users and an illegal one for kids and addicts--kids because they couldn't buy it legally and addicts because they wouldn't be sated by the reduced yield stuff. We'd be back where we are.

BTW - I don't consider myself a "drug warrior". I generally don't think anyone should be incarcerated for personal use or possession. Drug courts are about as warrior-like as I get. But, I find myself asking, when did the options for drug policy become regulation or mass incarceration?

I also never cease to be astonished that none of these writers acknowledge the context inadequate access to adequate treatment.

Technorati Tags: drugs, policy, tobacco, regulation, FDA

The power of expectancy

A study of medications (and placebo) for alcoholism finds that expectancy is a better predictor of outcomes than the medication (or placebo) that they are prescribed:

Double-blind placebo-controlled trials are intended to control for the impact of expectancy on outcomes. Whether they always achieve this is, however, questionable.

Reanalysis of a clinical trial of naltrexone and acamprosate for alcohol dependence investigated this issue further. In this trial, 169 alcohol-dependent patients received naltrexone, acamprosate or placebo for 12 weeks. In addition to being assessed on various indices of alcohol dependence, they were asked whether they believed they received active medication or placebo.

While there were no differences in outcomes between treatment groups, those who believed they had been taking active medication consumed fewer alcoholic drinks and reported less alcohol dependence and cravings. That is, irrespective of actual treatment, perceived medication allocation predicted health outcomes.

My spin on this is that hope has significant influence on outcomes and that if you can't treat them with hope, you shouldn't treat them at all.

Technorati Tags: treatment, medication, alcoholism, expectancy, hope

The Myth of the Rational Market

This is the cure for our contemporary cultural worship of economics and hopefully for its creep into "behavioral economics" and thinking about addiction.

Technorati Tags: addiction, economics

Tab dump

• Assessing Parolees' Health Care Needs and Potential Access to Health Care Services in California (Health Care Needs Are High, but Mental Health and Drug Treatment Needs Are Even Higher)
• Advertising may lead to increased alcohol consumption
• More College Students Dying from Drinking, NIAAA Reports
  
• Dad's Drinking Predicts Teen Imbibing, Study Finds
  

Technorati Tags: prevention, parole, alcohol

A little Michigan context

This article in The Nation about the war on drugs offers a little context related to spending on incarceration in Michigan:

Over the past three decades, California has tripled the number of prisons it operates, has more than quintupled its prison population and has gone from spending $5 on higher education for every dollar it spent on corrections to a virtual dead-heat in spending. That puts it in the same boat as Michigan, Vermont, Oregon, Connecticut and Delaware--all of which, according to estimates by the Pew Charitable Trust, spend as much or more on prisons than on colleges. California is also under federal court order to implement costly improvements in the delivery of medical and mental healthcare services in prisons and to release close to a third of the prison population--about 55,000 inmates--to improve conditions for those remaining behind bars.

Alcohol and Suicide

N.Y.T. article on the relationship between alcohol and suicide. It is interesting to note the suicide rate in the military and the prevalence of alcohol abuse.

Tab dump

Public support

• Addiction touches almost everyone
• Poll: Americans Want Addiction Treatment in Healthcare Reform

Harm Reduction

• “Recovery should also be a goal, not simply harm reduction”
• Handing heroin to addicts
• Heroin addicts’ families in Southampton get emergency drug kits

Policy

• A Drug War Inside the Government
  
• Addicts commit crime to get help
• War on tobacco is merely posturing
• A Drug War Truce? 
• Calif. Legalization Advocates Focus on 2010 Ballot
  

Families

• Heroin addicts’ families in Southampton get emergency drug kits
• Addiction affects others, particularly family members
• Parental Involvement in Preventing Youth Substance Use
  

Treatment

• Addicts commit crime to get help
• Emerging Issues in the Use of Methadone
• Help for addicts may come in form of questions
• “Hijacking recovery” and learning from mental health