Controversy Alley
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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Attraction AND Promotion?
Yesterday Lou heard this Al-Anon promo on the radio (video after the break). Like her, I appreciate the pro-active approach. Especially with alcohol abuse on the rise since the recession hit more than a year ago. The comments on her post range and I, too, am wondering your thoughts about this. Blogger Indigo’s comment appealed most to me–that the ads are a good approach, noting that we have more tools available now than when meetings originally began. Why not use them to promote a message that could help people get into recovery–and dissolve the taboos surrounding the disease?
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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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Posted in Controversy Alley, Sober Salon | 1 Comment »
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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Social Broadcast Precautions
So here we are, in the 21st century, plugging into online recovery. Most Americans spend a fair portion of the day docked at their computers, for various reasons. Work, facebook, email, recovery blogging, facebook, more facebook. Trust me. I study this stuff.
I found a couple of articles today that discuss how easily we share private matters through online social networks. And how that can come back to haunt us. Over here in our sphere of the world, recovery bloggers try to maintain anonymity while discussing life shattering, personal matters. Matters that involve ugliness, taboos, crime, love, divorce, loss, addiction and…
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An app a day….
We know that “We are everywhere.” New technology from Ann-e helps addicts utilize, support and connect with the recovery network.
From About.com:
You are in recovery, but you have a sudden urge to pick up. You are away from your home base and your 12-step contacts, but you need to talk to someone, anyone who understands. You feel isolated and you need to connect with someone else in recovery.
Now, there’s a app for that. 
Annie’s idea for a peer-to-peer phone application was inspired from a shopping encounter where she recognized an addict’s need for help and the loneliness many addicts feel when…
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So, How Much Do Addictions Cost Us In Dollars?

…studies compiled by various government health agencies show that the five most-chronicled “hard” addictions — alcohol, drugs, tobacco, gambling and eating disorders — are what society truly pays for. Those maladies cost taxpayers and businesses $590 billion annually, primarily in lost productivity and government-assisted medical treatment. That’s about 5% of the national debt. And it doesn’t count the sometimes bankrupting amounts of money those people personally spend on drugs, liquor, cigarettes or at the craps tables. Economically, those purchases are treated as pure transfer payments, no different than any other form of shopping….
Now, if those issues cost that much, why…
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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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