Addiction and Recovery News

Not four pillars. One shaky toothpick.

2009-07-07T17:52:00.001-04:00

Criticism of Vancouver's implementation of their four pillar model:

SFU psychology professor emeritus Bruce Alexander writes that it "provides no way of assigning funding priorities to diverse agencies, all competing for scarce public resources," so agencies "seem to work at cross-purposes."
Dr. Meldon Kahan, director of addictions medicine at St. Joseph's Hospital in Toronto, believes harm reduction is often code for giving up.
"If strategies such as safe-injection sites and heroin clinics aren't connected with treatment options, then they become 'palliative care' -- they have given up on patients ever recovering from their addiction and are attempting to keep patients safe while they continue to use drugs. The latter goal is fine, but the 'giving up' on patients is not," says Kahan, an associate professor of family medicine at the University of Toronto who has written books on addiction and has visited the Downtown Eastside.
Vancouver police union president Tom Stamatakis has charged that funding favours harm reduction over the other pillars, creating just "one shaky toothpick" — "a strategy that's doomed to fail."

Technorati Tags: vancouver, harm reduction, policy, drugs

U.N. Drug Report Admits Policy Problems, But Slams Legalization Talk

2009-07-06T20:12:00.001-04:00

Join Together's coverage of a recent UN drug policy report includes some of the smartest debate I've seen in a while:

The 2009 report opens with an acknowledgment that calls for exploring alternatives to drug prohibition have grown as more policymakers and the public have concluded that current drug-control policies have failed. However, the report blasts calls for legalizing and taxing currently illegal drugs as "unethical and uneconomical," comparing the idea to putting a tax on "other seemingly intractable crimes like human trafficking."
The UNODC parries the economic argument for legalization as "naive and myopic," saying that only rich countries would even have a chance of effectively regulating the drug market.
"Why unleash a drug epidemic in the developing world for the sake of libertarian arguments made by a pro-drug lobby that has the luxury of access to drug treatment?" Costa wrote in the report's executive summary. "Drugs are not harmful because they are controlled -- they are controlled because they are harmful; and they do harm whether the addict is rich and beautiful, or poor and marginalized."
"Proponents of legalization can't have it both ways," said Costa. "A free market for drugs would unleash a drug epidemic, while a regulated one would create a parallel criminal market. Legalization is not a magic wand that would suppress both mafias and drug abuse. Societies should not have to choose between protecting public health or public security: they can, and should do both."
Jack Cole, executive director of Law Enforcement Against Prohibition (LEAP), said Costa "would have you believe that the legalization movement is calling for the abolition of drug control. Quite the contrary, we are demanding that governments replace the failed policy of prohibition with a system that actually regulates and controls drugs, including their purity and prices, as well as who produces them and who they can be sold to."
"The U.N. drug czar is talking out of both sides of his mouth," added Ethan Nadelmann, executive director of the Drug Policy Alliance (DPA). "On the one hand he admits global drug prohibition is destabilizing governments, increasing violence, and destroying lives. But on the other hand he offers facile arguments dismissing the need for serious debate on alternative drug policies."

Technorati Tags: UN, policy, legalization

Plenty on pot

2009-07-06T20:04:00.001-04:00

Mother Jones has quite a bit on pot policy.

First, The Drug War, By the Numbers offers a pair of graphs on spending and arrests. We saw massive cuts in spending during the Clinton years. Unfortunately, this included cuts in spending on demand reduction.

Next, This Is Your War on Drugs offers their editorial analysis of the issue:

What would a fact-based drug policy look like? It would put considerably more money into treatment, the method proven to best reduce use. It would likely leave in place the prohibition on "hard" drugs, but make enforcement fair (no more traffickers rolling on hapless girlfriends to cut a deal. No more Tulias). And it would likely decriminalize but tightly regulate marijuana, which study after study shows is less dangerous or addictive than cigarettes or alcohol, has undeniable medicinal properties, and isn't a gateway drug to anything harder than Doritos.

Finally, The Patriot's Guide to Legalization, investigates several big questions related to pot policy in a pretty sober manner:

On virtually every subject related to cannabis (an inclusive term that refers to both the sativa and indica varieties of the marijuana plant, as well as hashish, bhang, and other derivatives), the evidence is ambiguous. Sometimes even mysterious. So let's start with the obvious question.

DOES DECRIMINALIZING CANNABIS HAVE ANY EFFECT AT ALL? It's remarkably hard to tell—in part because drug use is faddish. Cannabis use among teens in the United States, for example, went down sharply in the '80s, bounced back in the early '90s, and has declined moderately since. Nobody really knows why.

Slate V visits the serious business of a medical marijuana expo:

Technorati Tags: marijuana, policy, legalization, decriminalization

What do you believe about your clients?

2009-07-03T21:48:00.001-04:00

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

2009-07-03T21:44:00.001-04:00

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 thosewith financial means. If enhancements are helpful in gettingahead in a competitive world, then the haves would avail themselvesof yet another advantage over the have nots. Clearly, many inequitiesin education, material goods, and social class, not to mentionmore fundamental inequities in health care, nutrition, shelter,and safety, already give the socioeconomically lucky disproportionateadvantages. However, acknowledging the existence of disturbinginequities does not justify blithely adding more.
Matters of choice can evolve into forces of coercion. Implicitpressures to better one’s position in some perceived socialorder would find a natural conduit in cognitive enhancements.Such pressures increase in "winner take all" environments, inwhich more people compete for fewer and bigger prizes.

Technorati Tags: methyphenidate, enhancement, ethics, policy

The sky doesn't fall in

2009-07-03T21:08:00.001-04:00

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

2009-06-30T12:56:00.001-04:00

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

Marlboro Country

2009-06-30T07:39:00.003-04:00

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

21

2009-06-30T07:00:00.001-04:00

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

2009-06-29T16:05:00.001-04:00

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

2009-06-29T15:33:00.001-04:00

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

2009-06-25T20:51:00.001-04:00

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?

2009-06-24T21:46:00.001-04:00

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

2009-06-24T10:08:00.002-04:00

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

2009-06-23T21:15:00.001-04:00

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

2009-06-23T13:12:00.001-04:00

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

2009-06-23T09:18:00.001-04:00

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

2009-06-19T22:24:00.000-04:00

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

2009-06-19T10:14:00.001-04:00

Public support

Harm Reduction

Policy

Families

Treatment

Control

2009-06-17T23:51:00.001-04:00

I found this article interesting. I am hesitant to compare addiction to a concentration camp or to the financial crisis, but there are some parallels with regard to loss of control. The article helps explain the often elusive and difficult task of accepting the loss of control of AOD use and the powerlessness identified in the 12 steps. It reaffirms the need for client involvement in the treatment process and touches on the illusion of control that many of us struggle with. It also prompted me to think about the control issues that clients deal with in residential treatment. The author notes that “a false sense of control can be beneficial.” I would also add that it can kill you.

Drugs Won

2009-06-16T11:50:00.002-04:00

In his Sunday op-ed piece in the NYT titled “Drugs Won the War” , Kristof joins the growing mass of voices calling for drastic rethinking of our current archaic and ineffective drug policy. He emphasizes three points; the enormous prison population, the empowering of the criminal enterprise and the huge financial cost associated with our failed policy. He voices a need for a “liberalization” of narcotics policy. In his blog, On the Ground, he presents a more concise summary of his viewpoint, in which he admits that he does not know which policies he favors, but that decriminalization and then perhaps legalization and taxation should be explored.

He does mention lack of treatment briefly in discussing the disparity between the funds we spend on interdiction, policing and imprisonment and the money we spend on treatment. He suggests that prevention policy similar to the public health campaigning that we have used with cigarettes should be examined as is proposed by the former presidents of Mexico, Brazil and Colombia in their Drugs and Democracy policy paper.

It is great that this is getting coverage in the main stream media. The growing consensus is that a drastic change is needed, yet it is hard not to be cynical about our ability to make meaningful one, just look at the healthcare debate.

I am no expert. This is a tough policy area, and as Jason has frequently mentioned, there is no perfect solution. The options that are most frequently presented seem almost always to emphasize legalization and taxation or decriminalization. Why not more emphasis on treatment, prevention, community building etc…? Let’s start discussing the human costs along with the financial ones.

No One Deserves to Die by Overdose

2009-06-14T20:55:00.003-04:00

No One Deserves to Die by Overdose . . . so true.

But it is also true that everyone deserves an opportunity to recover--the help they need, when they need it and a community/system that treats them with HOPE as well as compassion.

Number of times the word treatment appears in this article=0
Number of times the word recovery appears in this article=0

The writer says, "We need to accept the reality that people will always use drugs. . .". Again, true. However, why is Alternet so averse to acknowledging the reality that we are letting people die of untreated/undertreated addiction? If we were talking about suffering/harm related to treatable cancer, would it be enough to advocate for pain management but not treatment? Why is palliative care enough for this population? Why?

Baclofen for cocaine addiction

2009-06-14T09:10:00.001-04:00

:-(

Spontaneous vs. planned attempts to quit

2009-06-14T08:58:00.003-04:00

Robert West, the editor of Addiction and critic of the stages of change, has published another study finding that the stages of change are not a prerequisite for change. One of the important implications of this is dinging the predictive value of the the stages of change.

I view this as important because faith in the predictive value of the stages of change has become a post hoc way to blame the client for failure or blame the system for not guarding the gate well enough and create justifications for new barriers to anything more intensive that traditional outpatient care.

. . . the odds of a "spontaneous" quit attempt lasting for 6 months or longer were twice that of preplanned attempts.

20 years later

2009-06-14T08:38:00.004-04:00

A recently published study paints a pretty grim picture (for men in particular) and reinforces an abstinence orientation:

AIMS: The aim of this study was to evaluate long-term outcomes in alcohol-dependent patients following outpatient treatment and gender differences in drinking outcome and mortality. METHODS: A 20-year longitudinal prospective study was done with interim analyses at 1, 5 and 10 years. Of the original sample of 850 patients, 767 (90%) were located 20 years later and 393 of these were interviewed. 273 (32%) patients died during the intervening period and 101 (12%) no longer wished to participate in the study. Drinking status was assigned based on the 12 months prior to the follow-up interview. RESULTS: At the 20-year follow-up, 277 (32.6%) of the 393 patients for whom drinking status could be assigned were abstinent (defined never drinking or drinking on less than occasion per month and never more than four drinks/drinking occasion.), 29 (3.4%) were controlled drinkers and 87 (10.2%) were heavy drinkers. Controlled drinking was the least stable category, with 23% continuing from year 5 to year 10 in that category, and 10% continuing in that category from year 10 to year 20. Mortality was higher (39.1%) in those who had been categorized at year 5 as heavy drinkers compared to those who had been categorized as controlled drinkers or abstinent. Abstinent patients reported fewer alcohol-related problems and better psychosocial functioning than heavy drinkers. Women achieved higher abstinence rates (47.2% versus 29.0%, P = 0.005) and had lower mortality (22.4% versus 34.5%, P = 0.03) than men. CONCLUSIONS: Over the long-term, abstinence is the most frequent and stable drinking outcome achieved and is associated with fewer problems and better psychosocial functioning. Controlled drinking is rarely achieved and sustained. Women appear to do better than men in the long term.