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.…

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

• 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

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…

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…

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…

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…

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…

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

• 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

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…

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…

. . . of time and capital.

The truth.

Technorati Tags: prevention, recovery, kids, parenting

“Nice People Use Drugs“

What is there to say? Of course it’s true. But there are a lot of statements that are true but make for terrible public education slogans. I suspect this agency is very concerned about HIV prevention. (I am too and have no problem with condom distribution.) What would they think of the slogan, “Condom users get HIV”? It’s true that some condom users still get STDs, and it’s probably even true that most people who acquire HIV through sex used condoms sometimes, but it’s a terribly misleading statement isn’t it?

It’s clear that they view drug use as a lifestyle…

Bill White has published another comprehensive monograph, this time it’s Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation. This, along with the his monograph, Recovery Management and Recovery Oriented Systems of Care: Scientific Rationale and Promising Practices should be considered essential reading for anyone working in the field.

I may have more to say after an opportunity to dig into it.

Technorati Tags: addiction, recovery, AA, research

A reminder of the social costs of alcohol.

Not to be interpreted as a call for prohibition, but keep this in mind the next time someone points to the success of alcohol legalization and regulation as a model for drugs.

Technorati Tags: alcohol, policy

Pro and con.

Same old, but less freak show-ish

Technorati Tags: marijuana, policy, legalization, decriminalization, drugs

Who’d of thought?

Technorati Tags: addiction, recovery

Empower yourself? With naloxone?

This can only be serious within a palliative framework or one that views addiction as a lifestyle choice. In this framework, even a worker’s hope for freedom from addiction is considered judgment-laden.

From the presentation: “For many of our clients overdose is a fact of life…”

Preventing death is a good thing, but there is NOTHING about recovery or treatment in the presentation. NOTHING.

It reminds me of a story last year about Vancouver, where a client said, “the only way to quit drugs is to move far from Vancouver’s Downtown Eastside, where there are scores of services for addicts.” He feels his…

• New National Report Shows Substantial Disparities in the Levels of Substance Abuse and Mental Illness Problems Experienced among the States
• Could Youth Drug Use Be Making a Comeback?
• Report: Smoking declines as alcohol, drug use hold steady
• Anti-Cocaine Drug Fails in Trial
• Addict on methadone for 18 years

Technorati Tags: research, prevention, policy, prevalence, vaccine, methadone

Another study finding that psychiatric problems typically follow alcohol problems rather than the other way around. This suggests that, more often than not, psychiatric problems are secondary to alcohol problems.

Technorati Tags: mental illness, dual duagnosis, alcohol

Good news! Another study suggesting that parents do have influence over their child’s alcohol use–even when their peer group uses alcohol. Influence isn’t the same as control, but it’s something.

Abstract: This study used latent growth mixture modeling to identify discrete developmental patterns of heavy drinking, perceived parental disapproval of substance use, and association with peers who drink from early to late adolescence among a sample of 5591 youth. We also examined associations among these trajectories to determine how the development of heavy drinking relates to the development of perceived parental disapproval of substance use and association with peer drinkers, both separately…

This study surveyed medical inpatients receiving treatment for a medical problem other than alcoholism. Among risky drinkers, higher Perception of Problems scores were associated with more drinking at follow-up, while higher Taking Action scores were associated with less drinking.

This is interesting, has some limitations, in my view. First, the subjects were offered treatment. I suspect that those with higher Taking Action scores accepted the offer of treatment. If so, were their improvements an artifact of readiness to change or participation in treatment? Second, the study appears to lump people meeting criteria for DSM Abuse and DSM Dependence. Are these outcomes a…

I just learned about Phoenix Multisport. I only know what it says on the website, but it looks like an amazing example of the diversity within and the potential of the recovering community. The recovering community (as wells as the tribes within it) never fails to inspire me.

The New York Times follows heroin’s trail in Ohio:

Paul Coleman, the director of Maryhaven, the largest rehabilitation center in the region, said the percentage of patients reporting opiates, principally heroin, as their preferred drug — whether it is smoked, inhaled or injected — grew to 68 percent last year from 38 percent in 2002.
. . .
In Ohio, for instance, heroin-related deaths spread into 18 new counties from 2004 to 2007, the latest year for which statistics are available. Their numbers rose to 546 in that period, from 376 for 2000 to 2003.
. . .
The share of heroin-related prosecutions among federal drug…

CASA has pulled together a report that attempts to capture all of the costs of substance abuse in federal, state and local governments.

The report says that Michigan spends 18.2% its entire budget on substance abuse and addiction and its consequences. Only 0.2% goes to prevention and treatment.

If you line in another state, you can find its info here.

Technorati Tags: spending, treatment, prevention, michigan

…most men have bound their eyes with one or another handkerchief, and attached themselves to some one of these communities of opinion. This conformity makes them not false in a few particulars, authors of a few lies, but false in all particulars. Their every truth is not quite true. Their two is not the real two, their four not the real four: so that every word they say chagrins us and we know not where to begin to set them right. ~ Emerson

Oy. What is there to say about this? Where to begin?

New research?

Co-occurring disorders are proof that addiction isn’t…

More discussion of pot (and other drug) policy:

• Comment: Get real, drug czars by Robin Room
• What Would Happen if Marijuana Were Decriminalized? A Freakonomics Quorum

Technorati Tags: marijuana, policy

Here’s a presentation with audio from Bill White in the U.K.

I’m glad to see that he’s addressing palliative care models. I’ve seen similar talks from him on several occasions and this is new to me. I mentioned in an earlier (and controversial) post that his description of MMT was different from my experience.

Treatment providers have long been troubled by the psychiatricizing of addiction. The mental health system is far larger and far more powerful. Fear of being “colonized and devoured” led to a kind of hunkering down that bred unhealthy skepticism (As opposed to healthy and appropriate skepticism.) of research, new…