News and recovery-oriented commentary about current controversies, emerging trends and research findings related to drug and alcohol addiction, treatment and recovery.
Smokers eager to cut the risk of dying early from tobacco-related illnesses must quit completely, researchers said on Tuesday, because cutting down — even by half — is not enough.
The article contains a sidebar that promotes pharmaceutical smoking cessation treatments only. I also noticed on local news that some of the local smoking Great American Smoke Out events had names like "Don't go cold turkey." These bring to mind post from several weeks ago about a website complaining about the push for NRT.
Ecstasy Can Cause Brain Damage Even After First Use, Study Says
At first glance, this report sounds like a ONDCP press release, but it the researcher's from Amsterdam and it's being presented by a staid medical society. Stereotypes suggest it's credible.
Low doses of the drug were linked to subtle changes in the architecture of brain cells 18 months after first use... While extensive use has already been shown to harm neurons in the brain, causing depression, anxiety and memory loss, this is the first study to identify the risk of brain damage among those who have taken only a few doses.
"We don't know if it's reversible or permanent,'' said Maartje de Win, a radiology resident at the University of Amsterdam, in a telephone interview today. "People should know there might be some consequences for them even after incidental use.''
This article, along with my earlier post, further illuminate the need for clearer conceptual boundaries for addiction. What are the differences between addictive behavior patterns and compulsive behaviors? How do we know what's secondary to emotional or other problems and what is the result of a primary neurobiological condition causing loss of control? Where does it leave us if brain imaging studies find neurological patterns unique to gamers or frequent tanners?
For an emerging number of weight-loss surgery patients, giving up comfort food means guzzling Southern Comfort. Or hitting the mall instead of McDonald's, even though creditors are calling. Researchers call this behavioral shift "addiction transfer,"...
"The problem is that many people who have surgery haven't been in therapy to address the issues behind their eating disorder," says Kathryn Friedman Sloan, a licensed mental-health counselor in Palm Beach Gardens. "Most of them are emotional eaters, and when you take that away, they're left with 'what do I do with my emotions?' "
An upcoming Bariatric Times article focuses on addiction transfer.
"It's probably been about the last year and a half to two years that it's been coming out in the research," says coauthor Cynthia Alexander, a psychologist at Cleveland Clinic Florida in Weston. "We've started warning people that they have to be on the lookout. I've stepped up what I do in support groups and through education so that this doesn't happen to our patients.
"There are millions of people who've had surgery who are dealing with this and want to bring it to light."
A good summary of myths about methamphetamine. To my knowledge, this post does a good job presenting the facts. However, it should be remembered that there are smaller regions around the country, often rural, that have been hit very hard by meth. They've had serious increases in crime and burdened their child protective service systems. While the problem is serious and real in these communities, when considered statistically on a national scale, the problem is relatively small. This doesn't mean that it shouldn't be addressed in a serious manner, but it does suggest that there has been a lot of hype.
Two more examples of the dilution of the concept of addiction, one with tanning and the other with video games. Further, these are not just using "addiction" in a colloquial way. They're attempting to apply it in a serious, clinical manner.
I've seen several recent articles about drinking alcohol during pregnancy. They've apparently been prompted by sightings of pregnant celebrities drinking. The New York Times runs an article on the subject today. All of the articles I've seen recently present moderate drinking as an increasingly gray area. (Free registration required. Use www.bugmenot.com if you don't want to register.)
Recovering Alcoholics With Poor Sleep Perceptions Will Likely Relapse
A study from local researchers. The headline overstates the findings from this 18 subject study. They found that subjective impressions of sleep were better predictors of relapse that objective measures of sleep. Does this suggest that CBT could be an important strategy for treatment complaints of insomnia?
"Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night," said Conroy. "The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking."
"In other words," added Timothy A. Roehrs, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital, as well as professor of psychiatry and neurobehavioral sciences at Wayne State University School of Medicine in Detroit, "alcoholics perceive their sleep is disturbed and that is the reality. The clinician should pay attention to the alcoholic's sleep complaints as the complaint of poor sleep predicts relapse. Previous studies had shown that PSG findings predict relapse; this study now shows a complaint is sufficient."
Drug Addicts in Today's Films Don't Always Find Redemption
Analysis of Hollywood's new spate of addiction movies. They have female central characters, provide no resolution and offer only guarded hope. They're characterized as offering realism. Do they? They definitely offer stories that ring true for some addicted women. However, as the reviewer points out, the films end the recovery narrative at day one. Not a pretty picture and a lot of uncertainty. I suppose real and complete are not the same thing.
Fa-la-la-la-ugh! The holiday season is a stressful time of year for most people. For those of us who are working to quit smoking, the holidays can be especially challenging. Use these tips to help you manage holiday stress smoke free...
With an accelerating national trend to limit indoor smoking, a member of the incoming Democratic leadership in Washington wants to ban smoking in the House Speaker's Lobby... ...Waxman has tried for years to end smoking in the area -- a refuge for House members seeking to avoid the press -- but was always rebuffed by the House GOP leadership. House Majority Leader John Boehner (R-Ohio) often smoked in the lobby.
The House Office Building Commission, consisting of the Speaker, majority leader and minority leader, would have to make the policy change; Boehner will be minority leader in the new Congress.
Only House members are allowed to smoke in the Speaker's Lobby; rooms in the House's Longworth and Cannon office buildings have also been designated as smoking areas. House members also may allow smoking in their own offices and in committee offices.
The District of Columbia recently banned smoking in all public spaces in the city, but Congress is exempt from the law.
Philip Morris has adopted the role of good citizen these days. Its Web site brims with information on the dangers of smoking, and it has mounted a campaign of television spots that urge parents, oh so earnestly, to warn their children against smoking. That follows an earlier $100 million campaign warning young people to “Think. Don’t Smoke,” analogous to the “just say no” admonitions against drugs.
All this seems to fly against the economic interests of the company, which presumably depends on a continuing crop of new smokers to replace those who drop out or die from their habit. But in practice, it turns out, these industry-run campaigns are notably ineffective and possibly even a sham. New research shows that the ads aimed at youths had no discernible effect in discouraging smoking and that the ads currently aimed at parents may be counterproductive.
...The most exhaustive judicial analysis of the industry’s tactics, by Judge Gladys Kessler of the Federal District Court for the District of Columbia, concluded that the youth smoking prevention programs were not really designed to effectively prevent youth smoking but rather to head off a government crackdown. They are minimally financed compared with the vast sums spent on cigarette marketing and promotion; they are understaffed and run by people with no expertise; and they ignore the strategies that have proved effective in preventing adolescent smoking. The television ads, for example, do not stress the deadly and addictive impacts of smoking, an emphasis that has been shown to work in other antitobacco campaigns.
First, The Sunday Times ran an Op-Ed proposing that the real solution to the drug problem is to legalize drugs. He makes a strong case that Britain's war on drugs is failing but it's hard not to believe that he's hyping the danger posed by addicts under current drug policy (stabbings and murders). He also threw in this point about Britain trying to do treatment on the cheap:
Roberts pointed out that the much vaunted treatment by methadone substitution has not worked, with a cure rate of barely 3%. Since local authorities must pay for treatment from their discretionary budgets, they are going for the cheaper methadone substitution option, as result of which more costly residential places in heroin treatment centres lie empty. Yet to the nation the latter programme, costing £12,000 a place but with a success rate of more than a third, is far better value for money.
One of the problems with many of these arguments is the failure to acknowledge the problems associated with major changes in drug policy. There appear to be serious problems and shortcomings in every drug policy, the real question is which problems societies are willing to live with.
Next, The Scotsman runs an Op-Ed arguing that while heroin prescription may be financially seductive, it amounts to giving up on addicts. She goes further, suggesting that "the move would be aimed at providing relief not so much to the heroin addicts themselves as to the beleaguered communities who bear the brunt of their habit" and wondering "By so cynically presenting the prescription of free heroin in terms of profit and loss, aren't we reducing human life to an exercise in accounting?" She also wonders what might happen if the country seriously invested in treatment.
Here are a threesome of articles (here , here and here)about a push for heroin prescription programs in England.
Two things are striking to me. First, the focus of the advocates is almost entirely on crime reduction with a little lip service to the needs of addicts. They also make difficult to believe claims about heroin addicts criminal activity. Suggesting that your average heroin addict makes £45,000 through crime to feed his/her habit and commits an average of 432 crimes to do so. That's $87,000. If you assume that they spend 80% of their income on heroin, they'd make almost $109,000 a year. Not too shabby. Another states that an addict using £100 of heroin a week generates £150,000 of criminal activity per year, that's $290,000.
Second, they repeatedly refer to this as "treatment." You may be able to make the case for that term, but palliative care seems more appropriate. The implication is pretty clear, they are on the addict equivalent of hospice. They've been diagnosed as incapable of recovery.
It's also worth mentioning that the U.K. relies heavily on methadone for treatment. A Scottish study recently found that a large majority of the addicts receiving methadone would have preferred to be receiving abstinence focused treatment.
Disclosure Of Advertising Tactics Reduces Odds Kids Will Drink
This study suggests that kids will be less likely to drink if they're taught about the motives and tactics of alcohol advertisers. It's an interesting approach--nobody likes to be played. However there's a big leap between 6th graders (Alcohol use is still a hypothetical for most of them). filling out a questionnaire a short time after five consecutive days of instruction (Sounds a little like a quiz, where a kid might be inclined to give the correct answer.) and their choices 4 and 5 years later. Hopefully they do some long-term follow up.
Republican Kentucky Governor, Ernie Fletcher, started an initiative called Recovery Kentucky that will create 10 regional centers to serve homeless addicts and alcoholics. The centers include a damp shelter, a detox, treatment and transitional housing. They just broke ground on another new center. This one is for women only. All of the centers are based on The Healing Place or The Hope Center.
A new study conducted in seven Canadian cities reveals that prescription opioids, and not heroin, are the major form of illicit opioid use. These findings raise questions about the current focus of Canada's drug control policy and treatment programs.
Imagine buying a lottery ticket stamped with the words: 'Warning: Gambling can lead to a dangerous addiction that can harm your relationships, work and finances.'
Far-fetched? Perhaps not. An addictions expert at Dalhousie University in Halifax has called on the federal government to put some sort of warning labels on lottery tickets, similar to the ones on tobacco products.
A large new review of studies on teen-age smoking finds there is no solid evidence about how to help adolescents kick the habit once they have started.
Because one-third of smokers take their first cigarette at age 14 and almost 90 percent before age 21, most previous studies of youth tobacco use have concentrated on prevention, not cessation.
“There is not yet sufficient evidence to test the effectiveness of smoking-cessation programs for adolescents, although some approaches show promise,” according to review authors led by Gill Grimshaw at the University of Warwick in Coventry, England.
In the war on drugs, the White House has tried just about every weapon—punitive policy, rehab programs, ads featuring fried eggs. For its next strike, it has some new recruits: family doctors. Seventeen states currently have simple, federally funded drug-and-alcohol-screening programs in place at major trauma centers. The Office of National Drug Control Policy is now trying to take the idea into general practitioners' offices nationwide.
In September of this year, the House of Representatives did pass the “Student and Teacher Safety Act of 2006.” The act mandates sweeping and intrusive federal search policies for local school districts “if the search is conducted to ensure that classrooms, school buildings, and school property remain free of all weapons, dangerous materials, or illegal narcotics.”
The bill would deny certain federal funds (issued under the Elementary and Secondary Education Act of 1965) to localities that fail to implement the mandate, thus forcing school districts to choose between parental involvement in search policies and federal dictates.
As for ongoing disregard for parents, last year John Walters, the federal “Drug Czar,” came to Denver to release the 2006 National Drug Control Strategy, which includes federal grants for random (read coerced) student drug testing.
According to ONDCP, “To allow a potentially drug-using student to join activities that the student finds desirable (sports, chorus, band, driving to school, etc.) with no penalty is to disserve that student and to enable his or her entry into drug use.”
So to federal drug war bureaucrats, a “potentially drug-using student” is any student not yet drug tested by the government. This sends a very powerful message to young people — mainly that before you can engage in “desirable activities” you must first prove your purity to the state through the collection and examination of your urine.
Between March of 2004, and April 30, 2005, approximately 320 people were referred for addiction treatment, the report said.
About 600 addicts use the clinic every day.
In its second year, there were 197 overdoses at the health facility, but no deaths.
600 visits a day and only 320 treatment referrals? And, no explanation as to whether they are passive referrals or active linkages.
The CMAJ article is here. It cites this July Drug and Alcohol Dependence article and reports "More than800 [community resource] referrals were made per quarter, and about 40% of referralswere for various forms of addiction treatment." This is clearly much higher than the Globe and Mail reported and higher than I remembered from the original article, so I checked the source which reported total community resource referrals of 434, 379, 554 and 804 for each quarter.
It's also worth noting that there is a significant treatment shortage in Vancouver. Treatment is one of the city's "four pillar" approach, but it's been reported that there has been no action on this pillar. Vancouver's Mayor, who is disabled from a ski accident uses a wheelchair, has publicly expressed doubt about capacity of addicts to recover, suggesting that they/we just need to accept their addiction in the same way he's had to accept his disability.
Vancouver is regularly pointed to as a model response to addiction. Here's a video on the program:
Austin is responding to the problem of public intoxication with a recovery-focused approach. It's good to see when the tide is pushing on the direction of wet shelters. Those shelters may be an important element of a complete continuum of services, but when the complete continuum does not exist and people are asking for recovery-oriented services, Austin's approach and programs like The Healing Place make a lot of sense.
A Golden couple can't smoke in the townhouse they own after a judge ruled last week that their condominium association can prohibit smoking in their four-unit building.
'This is my home, and I worked for it,' Colleen Sauve said Wednesday. 'I can't relax and have a cigarette in my own home. If I do, I'll get fined.'
Sauve and her husband, Rodger, who are both smokers, filed suit in March after the Heritage Hills #1 Condominium Owners Association amended its bylaws to ban smoking. A judge recently ruled against them.
The association was responding to complaints from the Sauves' next-door neighbor, Penny Boyd, about smoke odor seeping into her unit.
Legislation approved Tuesday afternoon by San Francisco's Board of Supervisors will have police put the enforcement of marijuana laws on the bottom of the priority list, although prohibitions remain for marijuana sales in public, possession by minors or use by motorists.
Bush recently announced the nomination of a new SAMHSA head. I was unable to find much. NAMI and other advocacy websites have the nomination posted in their news section without comment.
Cline is currently the Oklahoma Secretary of Health and commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services. He previously served as a healthcare policy fellow at SAMHSA, and clinical director of the Cambridge Youth Guidance Center.
* a $1-million annual national media campaign on underage drinking (similar to the White House's national antidrug media campaign, primarily aimed at marijuana);
* $5 million in grants to help community coalitions address underage drinking. This program would be run by the Substance Abuse and Mental Health Services Administration in consultation with the Office of National Drug Control Policy.
* another $5 million in grant funding to prevent alcohol abuse at institutions of higher education;
* an annual report on state underage-drinking prevention and enforcement activities. The report would judge state efforts based on such factors as whether they have adequate laws in place regarding underage alcohol use, possession, and consumption; comprehensive and well-enforced server-liability laws; compliance checks on alcohol retailers; server training; laws to deter adults from providing alcohol to minors; and if states have graduated drivers-license programs.
* establishing a federal interagency coordinating committee on underage drinking; and
* authorizing $6 million for research on underage drinking, including gathering data on the involvement of alcohol in unnatural deaths among 12- to 20-year-olds.
Dallas struggles with heroin use among pre-teens | Chron.com - Houston Chronicle
This could just be hype or an isolated pocket, but it's probably worth noticing to see if it pops up elsewhere. Dallas middle school kids have been snorting a combination of heroin and crushed Tylenol PM that they call "cheese." I normally don't post these kinds of stories, but this one had some actual numbers:
Dallas' three private treatment centers for youngsters can't keep up with the demand for bed space and are placing underage drug users on waiting lists. Part of the problem is that the city has bed space for just 58 children, officials said...
The Phoenix Academy has received more than 40 referrals in the last few months. Nexus Recovery Center Inc. in Dallas and Dallas County's juvenile services department also show an increased number of "cheese" addiction cases. Timberlawn Mental Health System has treated one to two youths each week for "cheese" use, chief executive officer Craig Nuckles said.
One of our most infamous contemporary laws is the 100-1 difference in sentencing between crack cocaine and powder cocaine. Under federal drug laws, prison sentences are usually tied to the quantity of drugs the defendant trafficked. For example, selling 5,000 grams of powder cocaine (about a briefcase full) gets a mandatory 10-year prison sentence, but so does selling only 50 grams of crack cocaine (the weight of a candy bar).
Working for the House Judiciary Committee in 1986, I wrote the House bill that was the basis for that law. We made some terrible mistakes.
Drug sentences are on the national agenda again because civil rights supporters are justifiably outraged that almost all federal crack prosecutions involve people of color. Indeed, for years no whites were prosecuted for crack offenses in many federal courts, including those in Los Angeles, Chicago, Miami, Denver, Dallas or Boston.
Now that Washington is awash in rare bipartisan logic about evaluating the goals and strategies of the Iraq War, the same reasoning should apply to the other conflict America is hopelessly mired in: the war on drugs.
The parallel between the two is undeniable.
Like Iraq, the drug war has been pressing ahead at enormous cost and destruction without a pause for an honest assessment of whether the tactics are working, or will ever work.
More than one-quarter of patients receiving publicly funded substance abuse detoxification will have a second detoxification readmission within a year. But if patients receive substance abuse treatment on two or more days within 30 days of discharge from a detoxification admission, time to subsequent relapse and readmission lengthens by 40 percent...
You are not mistaken in believing that drugs are a scourge that is devastating our society. You are not mistaken in believing that drugs are tearing asunder our social fabric, ruining the lives of many young people, and imposing heavy costs on some of the most disadvantaged among us. You are not mistaken in believing that the majority of the public share your concerns. In short, you are not mistaken in the end you seek to achieve.
Your mistake is failing to recognize that the very measures you favor are a major source of the evils you deplore...
Alcohol and tobacco cause many more deaths in users than do drugs. Decriminalization would not prevent us from treating drugs as we now treat alcohol and tobacco: prohibiting sales of drugs to minors, outlawing the advertising of drugs and similar measures. Such measures could be enforced, while outright prohibition cannot be. Moreover, if even a small fraction of the money we now spend on trying to enforce drug prohibition were devoted to treatment and rehabilitation, in an atmosphere of compassion not punishment, the reduction in drug usage and in the harm done to the users could be dramatic.
This plea comes from the bottom of my heart. Every friend of freedom, and I know you are one, must be as revolted as I am by the prospect of turning the United States into an armed camp, by the vision of jails filled with casual drug users and of an army of enforcers empowered to invade the liberty of citizens on slight evidence.
Friedman, who died today, was influential among libertarian conservatives in opposing the war on drugs. I find some of his arguments naive, for example, the idea that addicts wouldn't have invented crack in a decriminalized environment. This line of argument suggests that opium eaters wouldn't have devised unintended uses for the syringe. I also question his dysphoric vision of jails full of casual drug users.
In spite of my disagreements (on this and a lot of other matters), his letter to Bill Bennett is full of conviction and compassion and demonstrates that reasonable people can disagree. While I doubt his vision of casual drug users in jails, what we have is every bit as troubling--jails and prisons full of sick people suffering from untreated addiction. You also can't have 4 digit increases in incarceration for drug crimes without first intensely stigmatizing the target population. He was also correct that the war on drugs has been a disaster and it's past time for serious discussion about alternatives. I have serious concerns about decriminalization, but there's precious little discussion about alternatives to the war on drugs and decriminalization.
Sixty percent of those polled favored higher premiums for smokers while 30 percent felt the obese should pay more.
Good thing they didn't ask about premiums for drug addicts. I'm sure that we'll be hearing about this in upcoming polls. These kinds of incentives may well be coming, particularly as workers shoulder more of their health insurance costs. There are good arguments for providing incentives for healthy choices, but their's also dangers: creating barriers to getting and maintaining coverage; further stigmatizing already stigmatized groups; and, punishing diseases (say, addiction) rather than encouraging healthy behaviors (receiving treatment).
I normally try to keep this blog focused specifically on drug and alcohol addiction, but this story so vividly illustrates the need for parity that I wanted to share it. Here are the key points, but take the time to read the whole thing.
Though eating disorders affect some 11 million people in the United States, according to the National Eating Disorders Association, only 11 states have laws explicitly mandating that insurers cover their treatment. Thirty-four states require general mental health coverage, though insurance companies have a lot of leeway in how they define "mental disorders” and some may not cover anorexia or bulimia. The result is many families sinking into medical debt. “Wherever I go, I hear the same stories—families depleting their retirement accounts, going through life savings, taking second mortgages on their homes because insurance companies won’t pay for their child’s coverage,” says Lynn Grefe, head of the National Eating Disorders Association, a Seattle-based advocacy group. “I don’t think I can think of a state where I don’t hear these stories, and families just don’t know how to get out of this hole.”
That denial of coverage is why Dawn Beye, with the help of a vast team of medical and legal experts, filed a class-action lawsuit Nov. 8 against Horizon Blue Cross on behalf of the residents of New Jersey, New York and Pennsylvania—maintaining that her daughter’s and other similarly situated patients' illnesses are “biologically based” and should be covered under the laws of all three states. The company disagrees, saying anorexia is a product of one’s environment rather than genes—and therefore not covered by the state laws. At stake, says Beye, are lives—as more than 10 percent of the nation’s 8 million anorexics will die from their disease, according to the National Eating Disorder Association.
It began with one recovering alcoholic's effort to make amends.
But William Beebe's apology for sexually assaulting a fellow college student in 1984 landed him on the path to prison and launched an investigation that could lead to additional arrests.
Beebe apologized last year to his victim as part of the 12-step Alcoholics Anonymous program. On Tuesday, he pleaded guilty to one count of aggravated sexual battery for his actions during a Phi Kappa Psi fraternity party at the University of Virginia.
There are articles every day on "internet addiction. This one caught my attention because of this reference to the APA considering internet addiction for inclusion in the next DSM.
The APA is considering whether to take up this issue when it updates its official manual of psychiatric disorders in 2012, said William E. Narrow, associate director of the association's division of research. If such behaviors begin affecting a person's life and 'they feel like they can't stop, [then] that's the type of thing that we would start to have concerns about,' Narrow said. It's also important to consider, 'Are there any other disorders that can account for the behavior?'
This is of concern for a couple of reasons that immediately come to mind: dilution of the conceptual boundaries of addiction could have significant impact on public acceptance of the disease model and clinical practices; and a bloated DSM would complicate mental health and substance abuse parity initiatives.
This study investigates the impact of social phobia on adherence to and outcomes 6 months following standard alcohol treatment and Alcoholics Anonymous (AA) group meetings among alcohol-dependent patients with and without social phobia. In a cohort study, 300 detoxified alcohol-dependent individuals in Porto Alegre, Brazil, were interviewed during, as well as 3 and 6 months after hospital detoxification. At both follow-up points, treatment adherence was low and relapse rates were high among patients with and without social phobia, and no significant differences were seen between the two groups of patients in relapse, adherence to AA, or adherence to psychotherapy. Findings from this sample suggest that although alcohol-dependent patients with social phobia showed a tendency for less adherence at AA and felt less integrated with their AA group, social phobia comorbidity was not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.
Take another crack at that cocaine law - Los Angeles Times: ONE OF OUR MOST infamous contemporary laws is the 100-1 difference in sentencing between crack cocaine and powder cocaine. Under federal drug laws, prison sentences are usually tied to the quantity of drugs the defendant trafficked. For example, selling 5,000 grams of powder cocaine (about a briefcase full) gets a mandatory 10-year prison sentence, but so does selling only 50 grams of crack cocaine (the weight of a candy bar).
Sheriff's Race Could Hinge on Support For Drug Education
The Washington Post recently reported on a Maryland Sheriff's race in which support for DARE became a central issue. The article provides a good overview of DARE and the politics that surround it. The challenger who made DARE a campaign issue, Tim Cameron, won the race.
THE number of people drinking themselves to death has doubled since the '90s, new figures revealed yesterday as experts warned an even bigger alcohol disease time-bomb was on the way.
The blame has been placed squarely on increasing binge drinking, with the traditional image of the lonely alcoholic drinking every day described by experts as 'dated.'
They say people who had not viewed themselves as having a problem had found prolonged drinking sessions, despite being spaced apart, have fatally damaged their bodies.
