Archive of the writer Jason Schwartz
Politics, Science and Harm Reduction
Jan 20, 10
- (by Jason Schwartz)
1 comment
- Controversy Alley
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…
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The problem of free will in addiction
Jan 20, 10
- (by Jason Schwartz)
1 comment
- Controversy Alley
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, kind of determinism), at least in 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 due or that result from…
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“I Want Heidi Fleiss To Get Well … But I Don’t Think Celebrity Rehab Is The Solution”
Jan 20, 10
- (by Jason Schwartz)
2 comments
- Controversy Alley
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…
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Addiction treatment afflicted with Baumol’s cost disease
Jan 20, 10
- (by Jason Schwartz)
2 comments
- Controversy Alley
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.
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Words used to describe substance-use patients can alter attitudes, contribute to stigma
Jan 17, 10
- (by Jason Schwartz)
1 comment
- Controversy Alley
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…
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Comparing Outcomes of ‘Voluntary’ and ‘Quasi-Compulsory’ Treatment of Substance Dependence in Europe
Jan 9, 10
- (by Jason Schwartz)
0 comments
- Controversy Alley
Another study finding that coerced treatment is just as effective as voluntary treatment.
This is important for drug courts, employers and families.
It also raises important questions about the utility of
the stages of change for treatment placement. The conventional wisdom is that less motivated people should not be provided higher levels of care. These findings suggest that treatment outcomes are not a good argument for this approach.
This should be of limited comfort, though. The treatment system
fails to attract too many people and relies too much on external coercion.
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Heroin for dummies
Jan 9, 10
- (by Jason Schwartz)
0 comments
- Controversy Alley
Responses to this will be interesting to watch. I’m certain that people who object will be accused of moral panic or something like it.
I’m open to non-judgmental outreach harm reduction for the purpose of building relationships and gradually engaging people into recovery.
I’d like to know how these materials are being used. Are they in the hands of hopeful recovery-informed outreach workers who are building relationships and building motivation to recover? Or, something else?
I’ve been thinking about a model of recovery-oriented harm reductionthat would address the historic failings of abstinence-oriented and harm reduction…
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NIAAA Official Says Alcoholism ‘Isn’t Usually’ a ‘Chronic, Relapsing Disease’
Jan 9, 10
- (by Jason Schwartz)
0 comments
- Controversy Alley
Jacob Sullum enjoys a gotcha moment with Mark Willenbring.
After reading the
original article, I don’t see this as the Perry Mason moment that Sullum does. The article suffers from the same problem that many articles on the subject do–it does a poor job of distinguishing when we’re talking about DSM dependence and when we’re talking about DSM abuse. The implications for each are vastly different. Most people with DSM abuse will find that their problems eventually resolve on their own or when other primary problems are resolved. For those with DSM dependence, the conventional wisdom has been that they…
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Fear Mongers Attack a NYC Harm Reduction Pamphlet that Saves Lives
Jan 9, 10
- (by Jason Schwartz)
0 comments
- Controversy Alley
As I said, I can imagine circumstances where this could have some value in preventing illness and facilitating recovery, but I suspect that the people producing these materials do not share my goal of recovery.
I do not oppose harm reduction, if it’s aligned with the goal of facilitating recovery.
I understand that there is scientific evidence demonstrating that HR reduces disease transmission and other health problems, but some of these advocates are very…
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Rising alcohol addiction costs ‘could cripple the NHS’
Jan 9, 10
- (by Jason Schwartz)
0 comments
- Controversy Alley
A reader (thanks Foppe) shared
this article with me about the burden addiction is placing on Britain’s NHS.
I have a couple of reactions. This could be looked at as a simple reporting of facts on a public health issue. But, why do we never hear stories about cardiac disease crippling health systems? Cancer? Other diseases?
The answers that pop into my mind are that the health system (and society) doesn’t consider addiction as being under their purview, they don’t feel ownership of the problem. There are a lot of reasons for this, including the existence of a categorically segregated and that,…
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The dangers of overconfidence
Dec 19, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Support for twelve-step programs’ emphasis on powerlessness?
It doesn’t end there. In a third study, the researchers contrived to influence beliefs about self-control by giving student smokers a bogus implicit test of impulse control. Later, the students were challenged to watch the film “Coffee and Cigarettes” whilst abstaining from smoking. They were promised a greater cash reward the more difficult they made the challenge for themselves. In this case, students given bogus test feedback indicating they had high self-control were more likely to opt for greater temptation - holding the cigarette in their hand rather than having it on the desk…
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Who me?
Dec 19, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
A lack of perceived need for treatment is still a key reason for the low rate of treatment in people with alcohol-use disorder and for the lack of progress in reducing the scale of this problem, according to an analysis of recent large surveys in the United States.
In the National Survey on Drug Use and Health (NSDUH) dataset, 7,009 respondents met the diagnostic criteria for an alcohol-use disorder (dependence or abuse), among whom 89.6 percent said they did not perceive a need for treatment or counseling for their alcohol use in the…
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What happens when free treatment is offered?
Dec 19, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Early returns from a Massachusetts initiative offering free smoking cessation treatment:
When Massachusetts began offering virtually free treatments to help poor residents of the state stop smoking in 2006, proponents hoped the new Medicaid program would someday reap benefits.
But state officials never expected it would happen so soon.
New state data show a steep drop in the smoking rate among poor people. When the program started, about 38 percent of poor Massachusetts residents smoked. By 2008, the smoking rate for poor residents had dropped to about 28 percent, a decrease of about 30,000 people in two and a half years, or one…
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Mental-health parity laws require oversight
Dec 19, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
- Costs associated with parity were in line with, or even below, the projections.
- Most health plans responded to the parity law by lifting limits on the annual number of days allowed for inpatient treatments and the number of visits allowed for outpatient treatment.
- Concerns arose over the use of “medical necessity” clauses to authorize treatments and control costs. Medical necessity is typically defined as the need to supply a service for a condition that could endanger life or cause significant illness, suffering or disability and for which there is no adequate, less costly…
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an abuse of human rights
Dec 19, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
An opinion piece in
the Guardian makes a powerful indictment of the use of methadone in U.K. prisons. (I’m not clear whether the controversy is about methadone maintenance or methadone detox in prisons. I see both referenced.)
In a jail recently, I watched a slow, shuffling queue of men in the rain. The sight of these addicts lining up outside the dispensary for their drugs must be one of the saddest and most shameful in our prison estate, yet giving them drugs is now the cornerstone of policy throughout western Europe – the argument being that we should accept that the addicted…
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Less harmful than alcohol?!?!
Dec 19, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
The Boston Globe offers a good summary of the recent U.K. row over drug classification:
In the long and tortured debate over drug policy, one of the strangest episodes has been playing out this fall in the United Kingdom, where the country’s top drug adviser was recently fired for publicly criticizing his own government’s drug laws.
…
The list, printed as a chart with the unassuming title “Mean Harm Scores for 20 Substances,” ranked a set of common drugs, both legal and illegal, in order of their harmfulness - how addictive they were, how physically damaging, and how much they threatened society. Many drug…
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A. Thomas McLellan

I had no idea that McLellan has been so personally affected by addiction:
But the loss of his younger son, who overdosed on anti-anxiety medication and Scotch last year at age 30 while his older son was in residential treatment for alcoholism and cocaine addiction, changed his perspective.
“That’s why I took this job,” said Dr. McLellan, who was sworn in as the deputy director of the Office of National Drug Control Policy in August. “I thought it was some kind of sign, you know. I would never have done it. I loved all the people I’ve worked with, I loved my life. But I…
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Gradualism
Dec 6, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley

Addiction Professional shines a light on Scott Kellogg and his Gradualism model. I’ve mentioned him several times in this blog and he has been kind enough to link to me on his website.
Two months ago Kellogg established a website (http://gradualismandaddiction.org) that he hopes will serve as a vehicle for discussion around a more nuanced approach to treatment. He says that after he began using the term “gradualism,” he noticed that practitioners in non-abstinence based initiatives in Europe in the 1970s had used the term “gradual change” to describe what they were trying to instill in persons with substance use problems.
A Gestalt-trained…
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Stigma and community
Nov 6, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
I read this Ta-Nehisi Coates post yesterday on domestic violence, responsibility, individual agency, community, shame, isolation and empowerment. It’s really stuck with me. Very heavy, heady stuff in a very short post.
It got me thinking about some of the mechanisms of addiction and stigma, and the healing mechanisms of the recovering community. He points out the empowering aspects of a community of oppressed people and the responsibility this community confers upon its members.
Further along these lines, Bill White has a new paper on stigma, addiction and methadone. It poses some interesting challenges to the recovering community. How do we reduce the…
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Almost impossible to ignore
Nov 4, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Creative Commons, image by "lapolab"
An interesting explanation of dopamine’s function–distinguishing drive and motivation from pleasure and reward:
In the emerging view, discussed in part at the Society for Neuroscience meeting last week in Chicago, dopamine is less about pleasure and reward than about drive and motivation, about figuring out what you have to do to survive and then doing it. “When you can’t breathe, and you’re gasping for air, would you call that pleasurable?” said Nora D. Volkow, a dopamine researcher and director of the National Institute on Drug Abuse. “Or when you’re so hungry that you eat something disgusting, is…
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Lozenge/Patch Combo Best for Kicking Butts
Nov 3, 09
- (by Jason Schwartz)
4 comments
- Controversy Alley
Creative Commons, by isabel bloedwater
Encouraging findings for people trying to quit smoking:
Smokers are more than twice as likely to quit if they use the nicotine patch along with nicotine lozenges—compared to lozenges or patches alone, buproprion (Xyban), buproprion plus the lozenges or placebo. The trial was the largest study ever to compare these approaches head to head, and included 1,504 smokers.
All of the treatment groups did better than placebo—but the effect was strongest for the patch/lozenge combination, 40% of whom successfully kicked the habit. Smokers using this combo were not only more likely to quit, but also less likely to have…
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Recovery pandemic
Nov 3, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
holy cow, it’s happening to you too.
Androcles writes a nice post on the infectious nature of recovery and hope.
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Substance Abuse Prevention Dollars and Cents
Nov 3, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Creative Commons, by AMagill
From a recent government report:
1.1. Costs of Substance Abuse
Studies have shown the annual cost of substance abuse to the Nation to be $510.8 billion in 1999 (Harwood, 2000). More specifically,
- Alcohol abuse cost the Nation $191.6 billion;
- Tobacco use cost the Nation $167.8 billion;
- Drug abuse cost the Nation $151.4 billion.
Substance abuse clearly is among the most costly health problems in the United States. Among national estimates of the costs of illness for 33 diseases and conditions, alcohol ranked second, tobacco ranked sixth, and drug disorders ranked seventh (National Institutes of Health [NIH], 2000). This report shows that programs designed…
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Massive, Risky and Expensive
Nov 3, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Mark Kleiman responds to pushback on some of his alternatives to incarceration:
The suggestion that various non-punitive programs might control crime, and that doing so was preferable, ceteris paribus, to controlling crime by inflicting damage on offenders, met with an especially furious response, mostly centered on the phrase “liberal social engineering.” But the project of putting 1% of the adult population behind bars — an incarceration rate five times as high as any other advanced democracy, and five times as high as the U.S. ever had before 1975 — is itself a massive, massively risky, and expensive social-engineering project, and no less…
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British Drug Classification
Nov 3, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Andrew Sullivan offers a clear and concise summary of the an initiative to reclassify drugs (the classifications are used to determine criminal penalties).
Take the question of alcohol and tobacco out of the discussion and it seems quite sensible. Add alcohol and tobacco back and you have a firestorm. Is this about being too soft on drugs, or is this about protecting the status of alcohol and tobacco?
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Wounded Systems of Care
Nov 3, 09
- (by Jason Schwartz)
0 comments
- Controversy Alley
Creative Commons, by jumpinjimmyjava - iKIVA …. you can KIVA too
We spend a lot of time talking about recovery-oriented systems of care. Important, but should we first look at facilitating recovery for our systems of care?
Peapod writes about healing treatment systems (systems, not clients). She draws from a recent Bill White document about the Philadelphia experience and describes a critical juncture:
In Philadelphia in 2004, they decided to tackle the things that were wrong in their services. They did a giant exercise in information gathering, something they called a ‘fearless inventory’ after the AA fourth step. You can see the detail here:
They uncovered…
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