New Recovery

Walk Away from Temptation

2011-01-07T16:10:00.000-08:00

The singer Paul Simon's composition, "There Must be Fifty Ways to Leave Your Lover," also holds true for leaving your addictive substances. If you ask a group of people who've gotten free of the monkey on their back what they do when they feel a craving coming on, you'll wish you knew shorthand to write down all the different solutions that work for somebody. "Take a deep breath!" "Count to 100." "Call a sober friend." "Go to a meeting." "Drink a glass of cold water." "Touch your sober talisman." "Do a meditation." And so on.

Now comes a roundup of studies in the New York Times -- thanks, Dr. Joe Mott for pointing me to it -- highlighting evidence in favor of one of the simplest ways to leave your demon: walk away. A series of studies completed in the past five years demonstrates the empowering effect of locomotion. A brisk but not strenuous walk of as little as 15 minutes enabled study subjects to turn their backs on substances they craved.

Why does walking work? The Times' science writer doesn't try to answer. Three hypotheses come to mind immediately: endorphins, distraction, and Aristotle.

Exercise, as is well known, causes the body's glands to manufacture and release endorphins. Endorphins are often called the body's own morphine; they are native opioids that take away pain and make you feel good. If you've seen the smile on the face of a bicyclist or a runner, you've seen a natural endorphin high.

So, taking a brisk walk as a device for rejecting an external drug makes sense on the theory of substitution. You allow the soft hand of your inborn neurochemistry to scratch your itch instead of the bloody claws that some liquor company, tobacco cartel, or other drug syndicate has cooked up to ensnare you. Substitution of a harmless, wholesome gratification for an addictive fix is a basic recovery strategy with a very wide range of applications.

But endorphin substitution may not be the whole story, or may not be the story at all. People vary in their rate of endorphin production, and the studies in the current report don't include blood samples that measure endorphin levels. Daniel Goleman, the brilliant popularizer of the Emotional Intelligence concept, highlights the famous marshmallow experiment, destined to take its place alongside Pavlov's dog as one of the foundational studies in psychology.

The experimenter puts a marshmallow on a dish in front of a child and says that he, the experimenter, must leave the room for a few minutes. The child is free to eat the marshmallow; but if the child waits until the experimenter returns, the experimenter will add a second marshmallow, and the child can have both.

In the original study, the children who ate the one marshmallow ended up, years later, dropping out of school, stuck in low-wage jobs, in trouble with the law, divorced, etc., while the children who resisted and waited for the double reward became valedictorians, chief executives, senators, etc. (I exaggerate wildly, of course, but that was the general drift of the results.)

Goleman's follow-up studies tried to find out how the children who waited for the two marshmallows were able to resist the marshmallow sitting in front of them. His results threw out various genetic and characterological hypotheses. Resisting the lure of the sugary treat, he found, is a teachable skill. The children who succeeded did so by distracting themselves. They took their eyes off the item and played some game or walked around the room. In short, they derailed the train of craving by setting their minds busy with some other concern. Goleman concluded that any child could learn to do this, vastly increasing their chances of success later in life.

So, the effectiveness of walking may be due partly or even wholly to the distraction effect. We set our minds to working our legs, keeping our balance, choosing a path, managing our breath, and all the other efforts required for effective ambulation, and in the process the craving fades away in the rear view mirror.

Then also, there's Aristotle, one of the ancient founders of the scientific method. Aristotle, not being an Athenian, could not own property there, and therefore taught his followers on a public walkway. His philosophical school came to be known as the Peripatetics -- the walkers. Ever since, walking has become linked in legend with stimulation of the inquisitive, analytical mind.

Why this should be so, if it is so, remains hazy, but we know that the mind and the body are a unity, and no one should be deeply surprised that ambulation might stimulate cogitation. And rational thinking certainly would lead one to avoid putting addictive substances into the body.

Does walking help avoid cravings because of substition? Or because of distraction? Or via the Aristotle effect? Or all the above? We don't have the answers yet. But we don't need to know why something works in order to benefit. For decades, doctors didn't know why Aspirin or acupuncture worked to relieve pain, yet both helped millions. Perhaps you can cogitate on the reasons as you amble.

Next time you feel a craving coming on, walk away from it. It works!

[Originally published in hellowellness.in]

Drug Mafioso Heads Afghan Anti-Narcotics Ministry

2010-12-07T09:43:00.000-08:00

Afghan President Hamid Karzai nominated, and the Afghan Parliament overwhelmingly approved, the appointment of Zarar Ahmad Moqbel as Minister of Counter Narcotics this past January. Moqbel is "associated with the drug mafia," according to U.S. Ambassador to Afghanistan Karl Eikenberry in a secret cable to Washington released Dec. 2 by Wikileaks.org, the whistleblower website. Eikenberry wrote about Moqbel:

He is perhaps the worst of the candidates. Former Deputy Interior Minister and MP Helaludin Helal claimed to us January 11 that Moqbel was supported by the drug mafia, to include Karzai’s younger half-brother Ahmed Wali Karzai and Arif Khan Noorzai.

Moqbel received the highest number of votes of any of the cabinet nominees. The 249 members of the Afghan Parliament, known as the Wolesi Jirga, saw the vote as an opportunity to solicit "donations" -- typically, in the form of envelopes containing cash -- to their upcoming re-election campaigns. Druglord Moqbel, according to Eikenberry's sources, set a record for such donations, paying Jirga members from about $8,000 to $15,000 (in U.S. dollars) each. Source.

Moqbel replaced General Khodaidad, whom Eikenberry described in an earlier cable as "a very good partner for U.S. counternarcotics efforts." Source.

Moqbel had previously headed the Afghan Interior Ministry, a "byword for corruption and incompetence," according to a British security official quoted in the London paper, The Guardian. Source. The Interior Ministry's "culture of corruption and incompetence" aroused an international uproar two years ago, forcing President Karzai to sack Moqbel. Now Moqbel is back, heading the counter-narcotics effort in a country where opium and its derivative, heroin, is the No. 1 export, accounting for more than half of the country's GNP, according to United Nations figures. Source. Afghanistan is the source of about 90 per cent of the world's heroin supply.

Two weeks after Moqbel's appointment to the Counter Narcotics post, deputy-level U.S. diplomatic and military officials in Kabul met to consider "possible courses of action" that they may use "against criminal and corrupt Afghan officials in an effort to change their behavior." The group, titled the "Nexus-Corruption Leadership Board," adopted a set of recommendations including:

(1) no public meetings with the official (and no photos), and no high-profile public visits from CODELs and other dignitaries; (2) no giving or receiving of gifts; and (3) restrictions on opportunities for corrupt officials to participate in U.S.-funded training, travel, and speaking engagements.

These recommendations, according to Ambassador Eikenberry in a confidential cable released by Wikileaks, are aimed to "end tacit American support for corrupt Afghan officials" and to attempt to change their behavior. Source. Among the highly placed Afghan officials "believed to be corrupt," the cable names Colonel Abdul Razziz, who controls a major border crossing with Pakistan, President Karzai's half-brother Ahmed Wali Karzai, and Asadulla Sherzad, the chief of police. Eikenberry adds that more direct measures, such as firing the corrupt officials or putting them in jail, are not on the agenda "due to lack of capacity and lack of political will."

The Afghan Major Crimes Task Force, which has jurisdiction over corruption cases, has only four vetted prosecutors and only a small number of investigators, Eikenberry complained in another cable published by Wikileaks. Source. Its limited capacity is a "major challenge to successful prosecution." It has no influence in the provinces. Source. Aside from the narcotics traffic, Afghan officials are busy "embezzling public funds, stealing humanitarian assistance, and misappropriating government property," forming "a graphic picture of criminal enterprise masquerading as public administration." Source.

Responsibility for protecting the opium traffic lies at the top, with President Karzai, according to General Dan McNeill, then commander of the international force supporting the Afghan government. McNeill told visiting director of the U.S. Office of National Drug Control Policy John Walters in March 2007 that

the missing ingredient in the counter-narcotics effort was Karzai. Despite some public statements, he had failed to take a real stand. Karzai needed to keep his support base happy, and as a result, he placated many of those involved in the drug business, especially in the west and south of the country. However, by not taking the issue on, Karzai was tacitly signaling his OK for poppy production.

Source. McNeill added that prosecution of high-level officials in the drug trade was useless under the circumstances.

To Walters’ question on going after high value targets, McNeill said it was necessary to prosecute a few to keep faith with the general public. But he was skeptical it would have any real effect on the trafficking networks, as those arrested would simply be replaced by others.

Source. Efforts to eradicate poppy cultivation frequently became only another opportunity for corruption. Asadullah Khalid, the governor of Kandahar province, used members of the police force to do the eradication work, allowing him to pocket the funds allocated to hire local labor for the job. And, according to Major General Ton Van Loon, the Dutch commander in the province, Asadullah "has been careful to eradicate only those fields not controlled by powerful people in the Province." Source.

The total acreage devoted to poppy growing in 2010 remained unchanged from 2009, according to a September 2010 United Nations report. Source. Eradication in 2010 was at the lowest level since recording began in 2005. But the amount harvested dropped by 48 per cent, due to a late-season fungal blight. The drop in quantity led to a spike in prices, and observers predicted that the high opium price, combined with a drop in the price of wheat, an alternative crop, would attract many more farmers to grow opium in this coming year.

Alcohol: The Most Anti-Social Drug

2010-11-07T19:38:00.000-08:00

This week's Lancet, the British medical journal, drives a silver spike into the heart of the undead myth that alcohol is the lubricant of sociability and good fellowship. A systematic comparative ranking of 20 different addictive drugs found that alcohol is the most harmful drug, more harmful than heroin, crack cocaine, and methamphetamines.

The study, by an industry-independent panel of scientific experts, ranked drugs in terms of their harm to the user and their harm to others.

Heroin, crack, and methamphetamine scored higher than alcohol in harm to the user. But alcohol's score on the scale of harm to others was double that of heroin and crack, the next leading chemicals, so that when the scores of harm to others and harm to self were combined, alcohol led the sordid parade of harmful consequences by nearly twenty points.

A key point in alcohol marketing is social bonding. Alcohol is said to promote romantic linkups, male bonding, business networking, and general friendly togetherness. It's sold as the antidote to the isolation, alienation, and competitiveness that make so many people feel lonely even in crowds. The industry spends billions every year trying to persuade us that if we'd all drink together, we'd all be happy together.

Not so, found the panel of medical experts. The group evaluated the harm each drug caused to others in terms of physical and psychological injury, crime, environmental damage, family adversities, international damage, economic cost, and damage to community. The panel also ranked social harms such as the loss of tangibles and loss of relationships.

Alcohol led all other drugs in measure of injury to others, family adversities, economic cost, and harm to the community. In other words, the person under the influence of alcohol caused the most bloodshed, broken families, and other mayhem to economic and social life.

The Lancet study corroborates other, similar studies conducted by other scientists independent of the alcoholic beverage industry, and cited in the Lancet article. This relatively recent group of studies moves beyond older research which looked at drug consequences more narrowly, in terms of a single factor, such as drug-related deaths.

The finding that alcohol is a more harmful drug in society than heroin and crack cocaine upsets some deep seated stereotypes. We've been taught to identify the "drug problem" with hard drug users, and we've been led to believe that most of these are black and socially marginal.

This research says that society's drug problem is really first and foremost an alcohol problem, and that you'll find the most dangerous drug addicts among outwardly respectable middle class whites.

That isn't really news to those who have attended most any addiction recovery support group meeting. How many stories of hospital visits, court dates, divorces, abandoned children, lost jobs, and other chaos do you need to hear before you realize that the slick TV ads for alcoholic beverages are lies?

Even in parts of the recovery subculture, the alcoholics have tended to turn up their noses at the heroin and crack addicts. This elitist bias underlies the segregation of the legacy support groups into separate alcohol and "narcotics" branches. (Modern groups such as LifeRing include both alcohol and other drug users.) Now science is turning this conceit upside down.

True, the heroin and crack users have nothing to be proud of. But the drug that really tears apart the bonds of society doesn't come in a syringe or a pipe, it comes in a bottle.

[First published in hellowellness.in on Nov. 7 2010]

Motivating Motivation

2010-10-30T14:17:00.000-07:00

[Originally posted on hellowellness.in on Oct. 29 2010]

Everyone concerned with addiction recovery knows the importance of motivation. As Darlene, a heroin addict portrayed in Dr. Lonny Shavelson’s wonderful book Hooked, tells her psychiatrist, “You can talk at an addict until you’re blue in the face, but if they don’t want to get clean, they’ll tell you to f**k off.” Almost every treatment modality works if the patient is motivated; nothing works at all if the patient isn’t.

A group of counselors and researchers grouped under the umbrella label of Motivational Interviewing has been working for a couple of decades on cracking the secret of motivation, and they’ve shown a series of positive results. Their latest success comes in the highly challenging area of weight loss.

Weight control is probably more difficult than getting free of alcohol and other addictive drugs because abstinence is not an option. You can very well live without alcohol and other addictive drugs, and abstinence creates a bright line that can guide your every step. But you can’t live without food, and threading your way through the maze of conflicting nutritional advisers can defeat the most dedicated mind.

Doctors, the researchers noted, frequently talk to their patients about weight. But how the doctor talks to the patient makes a crucial difference.

Doctors who assumed the traditional role of authority, who used a confrontational approach, who appeared to judge the patient, or who pushed unasked-for advice, had no positive effect whatsoever on patients’ motivation, the study found. Their weight was almost exactly the same as patients whose doctors never raised the issue with them. In other words, doctors who used the conventional authoritative approach were wasting their time.

By contrast, doctors who used an approach based on Motivational Interviewing fired up their patients’ motivation, and such patients registered a weight loss of 3.5 pounds at follow-up three months later.

A basic principle of Motivational Interviewing is that real change in feeling and behavior can only come from the patient, not from the doctor. The key to success, therefore is to elicit and to support the patient’s own inner desire to change. The doctor accepts the patient’s shortcomings without judgment. The patient’s successes, no matter how small, merit recognition and praise. The physician does not pose as an authority, but as an ally and collaborator.

Dr. Kathryn Pollak, Ph.D. of Duke University, lead author of the study, commented that the physician’s traditional role as expert dispenser of pills or advice has its utility in treating acute distress, but is ineffective in changing patients’ attitudes and motivating long-term, sustainable behavior change.

“When it comes to behavior change, the patient is the expert, not the doctor. The whole point is to help the patient solve the problem himself. Doctors have to see the difference between behavioral counseling and the rest of their job,” Dr. Pollak said.

The study appears in the October issue of the Journal of Preventive Medicine.

LifeRing groups are abstinence-based, but the Motivational Interviewing approach is deeply congruent with the LifeRing pathway to recovery from alcohol and other drug addiction. The strategic pathway to recovery is empowerment of the sober self, which means recognition and support of the recovering person’s own inner desire to change. I’ve written about this approach in detail in my book Empowering Your Sober Self, for those who wish to know more about it.

Sliding into Iraqistan

2010-10-30T14:15:00.000-07:00

[Originally posted 29 Oct 2010 on hellowellness.in]

Drug use among the Karzai government forces in Afghanistan is old news. That country is, after all, the world’s leading producer of opium, and high government officials, including the President’s brother, are widely believed to be among the kingpins in the heroin trade. Now comes a report, in Monday’s New York Times, that government troops in Iraq have been sliding in the same direction. Reporters Timothy Williams and Omar al-Jawoshy write from Baghdad:

“A growing number of Iraqi security force members are becoming dependent on drugs or alcohol, which has led to concerns about a significant addiction problem among the country’s armed services as the insurgency remains a potent force and American troops prepare to depart at the end of next year.”

The reporters’ sources estimate that in some regions of Iraq, as many as half the officers and soldiers, including high-ranking officers, use drugs and/or alcohol while on duty. Based on dozens of interviews, they write that alcohol and drug use among Iraqi police and military “has become increasingly common and appears to have grown significantly during the past year or so.”

Some of the troops use drugs “to help us forget that we are hungry.” Others use drugs to subdue their anxiety, fatigue, and boredom. Officers look the other way because drug use makes some of the fighters fearless in combat. It also makes them reckless. Drug use was believed involved in recent incidents where Iraqi forces massacred civilians and also turned on one another. Generally, the growing drug use contributes to lack of discipline and cohesion.

The units with the biggest drug habits appear to be those with the most challenging assignments: manning checkpoints in contested areas, and members of special forces teams that do night raids, assassinations, and other “counter-terrorist” work. The article leaves the impression that Iraqi forces are not prepared to perform this kind of work when their minds are clear.

The Times article says nothing about drug use among American and other allied forces in the country. We already know from other sources that numerous GI’s have come home from the Iraqi theatre with serious substance abuse problems. Significant drug use by British troops has also been documented.

The Times’ reporters unfortunately have nothing to report about the drug situation among the “insurgent” forces, other than to speculate that some “insurgent” groups are helping to import the drugs from Afghanistan and other countries, with transparent motives. But commerce is not necessarily also consumption. Are the resistance fighters, unlike the government forces, capable of doing what they do with minds unimpaired by addictive substances? It would be an interesting chapter in the study of guerrilla warfare to know how the use of addictive substances by one side or another, or both, affects the methods of the struggle and its ultimate outcome.

The spread of drug use on the scale that the Times article reports could not occur without the complicity of the highest command. Iraq does not have the domestic drug production capacity of an Afghanistan or a Colombia, but abundant opportunities for profit exist whenever there is widespread consumption. To the bulging catalogue of corruption already compiled by the principals of the current Iraqi ruling groups, a new chapter on drug trafficking will need to be added.

Looking at world events through the lens of the addiction issue is, for an American, a bitter experience. Here I sit, more than 18 years clean and sober, having invested the better part of my life in building a new roadway out of addiction, and I see my government spending my tax money (and the blood of my compatriots) propping up a set of foreign regimes that grow fat on building more roads into addiction.

Recover and Be Killed

2010-10-30T11:36:00.000-07:00

[Originally published 29 Oct 2010 on hellowellness.in]

Trying to get clean and sober is a pathway to a new life in most places, but in some cities of Mexico it’s a ticket for getting killed. Gunmen believed to be narco gangsters this week stormed into a drug rehab center in Tijuana, found 13 patients watching a movie, lined them up on the floor, and murdered them with machine gun fire.

A few days later, masked gangsters invaded a car wash in the central Mexican city of Tepic, not far from the tourist destination Puerto Vallarta. They sprayed employees and customers with automatic weapon fire. Most of the murdered car wash workers were recovering addicts.

The border town Ciudad Juarez has seen a streak of massacres in drug rehab centers. Minutes after the mass murder in the rehab center in Tijuana, a narco voice was heard on the police radio saying that this was “a taste of Juarez.”

Public speculation as to the narco gangster’s motives in targeting people in recovery ranged widely. A New York Times reporter guessed that the rehab centers were used as a refuge by former gang members trying to get away from the criminal syndicates. A Mexican official speculated that the Tijuana attack was retaliation for the authorities’ seizure and burning of 134 metric tons of marijuana the previous week. El Blog del Narco, the semi-clandestine online kiosk for narco-related information and disinformation, is silent on the topic of motive.

A more likely explanation is commercial. One has to remember that the drug business is a business, and a business depends on customers. From the narco standpoint, people who seek recovery from drug use are dissatisfied customers who not only step outside the market but stand as living testimony, human Yelps, for the defects of the product. In the supercharged atmosphere of the Mexican drug war, that’s reason enough to kill them.

I write this in Oakland, California, a city whose city council this year approved a far-reaching measure to regulate and tax medical marijuana. City leaders are also on record in support of Proposition 19 on the California state ballot, a measure that would legalize, regulate, and tax marijuana possession and cultivation, medical or not. The measure has drawn worldwide attention, including notably in neighboring Mexico.

Both the Mexican government and the U.S. administration under President Obama have come out against Prop. 19. Obama’s position appears to be part of his general unfortunate slide toward appeasement of the conservatives. Mexican President Felipe Calderon’s position is an understandable reluctance to make a 180 degree turn from his efforts at military suppression of the wars between his country’s drug cartels. If one of the major export crops he is trying to stamp out suddenly becomes legal in its primary market across the border, he will look at first like a fool.

Legalization of marijuana in circumstances like these has never been done before, and nobody can say with assurance what will happen. Political leaders prefer the devil they know to the devil they don’t. But many analysts believe that legalization in California will deal a harsh commercial blow to the Mexican cartels. California already grows its own marijuana, said to be of much higher potency and quality than the Mexican variety. If the local cultivation is legalized, the Mexican product may become practically unsaleable here. The Mexican president may find that the passage of Prop. 19 puts him for the first time in the driver’s seat.

For myself, I have long ago made the choice to abstain from alcohol, marijuana, tobacco, and other addictive drugs, and I persist steadfastly in that decision. In my experience, the vast majority of people who have personal experience with these drugs have gotten free of them, or wish they could (and they can). Nevertheless, in the upcoming California election, I will cast my vote in favor of Prop. 19. The prohibition of marijuana has not worked. Young people can score marijuana more easily than alcohol. Prosecutors have used the laws not to break the distribution networks, but to persecute minority youth for petty infractions resulting in major prison terms. The “war on drugs” has been a scandalous waste and abuse of taxpayer resources that would be better devoted to education, prevention, and treatment.

Pain Relief Without Addiction: Walking the Tightrope

2010-10-30T11:27:00.000-07:00

[Originally published on hellowellness.in on 29 Oct. 2010]

Roger T., a middle-aged systems analyst, showed up at a LifeRing recovery support group looking for help with addiction to painkillers. Years earlier he had been a passenger in an auto collision which left him with chronic pain in his lower back and hips. His doctors had prescribed the standard opiates, and this had provided him with some relief, but over time he needed larger and larger doses. He said he had been taking 300 Vicodins® per day. He knew he had to stop the drugs -- but he couldn’t live with the pain.

Not only patients but also their physicians have to walk a tightrope between pain and addiction. A hot case in point is the jury trial involving Dr. Sandeep Kapoor, the 42-year old Hollywood internist and physician to celebrity model Anna Nicole Smith. Smith died of a drug overdose in 2007. Dr. Kapoor and two other defendants were not charged in her death -- this was ruled accidental -- but were charged with conspiracy to provide her with excessive quantities of pain medications while knowing she was an addict.

In other words, Dr. Kapoor was charged with crossing the line from medical helper to drug pusher. It’s an issue that inflames hundred-year old wounds on the U.S. medical community. With the passage of the Harrison Act in 1914 and regulations and court decisions shortly thereafter, the federal government severely limited physicians’ professional freedom to prescribe analgesic medications. They could prescribe opiate painkillers only in tapering doses, and their good faith professional medical judgment was ruled irrelevant.

In the following decades, the US Treasury Department indicted more than 25,000 physicians for prescribing opiates; some 3,000 went to jail, and more than 20,000 were forced to pay fines. It was a shameful period, and it has left enduring scars on modern medical practice. The California statute under which Dr. Kapoor was charged is a direct descendant of this period. These laws have chilled physicians’ treatment of patients with chronic pain problems.

The Harrison Act rested on paranoia about anarchists, radicals, criminals, and foreigners -- especially Chinese -- who were (wrongly) seen as the typical opiate users of their day. Scratch any subscriber to what passes as public opinion in the US today and you’ll find, not far beneath the surface, a similar identification of drug users with social undesirables.

All of that goes on the scrap heap when a celebrity is involved. As everyone familiar with the criminal justice system in the U.S. must be aware, celebrities are above the law, particularly the law of addictive substances. Lindsey Lohan, Mel Gibson, Paris Hilton ... all would be locked up for years if their names were Smith, Jones, and Johnson. And so here. With Anna Nicole Smith, a genuine neon blazing celebrity at the center of the trial -- even more dazzling a presence in death perhaps than in life -- the judge found ample justification for her possession, post mortem, of more than 1,500 pills. In a phrase that will reverberate in courtrooms for years, Judge Perry T. Fine admonished the jury, "The number of pills is not a determinative factor in this case. Please keep that in mind.”

The jury did. After 13 days of deliberations it returned yesterday a verdict of “not guilty” for Dr. Kapoor. It found, in other words, that Ms. Smith was not “addicted” and that Dr. Kapoor’s prescription of opiate painkillers was medically justified in view of her many and severe symptoms of pain and anguish.

Dr. Kapoor still faces a lengthy process of rehabilitating his reputation and defending possible attacks on his medical license. But he will not go to prison.

With this courtroom victory, physicians who specialize in the difficult art of pain management -- a small and endangered species -- will breathe a long overdue sigh of relief.

Most of these physicians are members of the American Society of Addiction Medicine (ASAM), a highly respected and conservative professional body of providers who more or less successfully navigate the tightrope of giving pain relief without enabling addiction, every working day.

But there is also a fringe element of medical opportunists who will prescribe whatever the patient asks for, so long as the check is good. And there are well-intentioned general practitioners with zero schooling in addiction medicine whom the experienced opiate addict plays like a violin.

There are no easy answers to pain. I have had conversations in LifeRing meetings with a number of people like Roger T. who suffer from chronic pain, medically managed with conventional opiate-based pharmaceuticals. They tell me that they have learned to recognize when they are crossing the boundary from pain relief into seeking euphoria. Unfortunately that insight came only after multiple boundary crossings with harmful consequences. I have also talked with chronic pain sufferers who have found relief through hypnosis, meditation, special exercises, nutrition, and other alternative approaches. Pharmaceutical research is also hinting at new types of analgesics that do not involve the classic addictive brain circuits, as the opiates do.

Obtaining pain relief without falling into addiction is one of the most difficult challenges for professional and patient alike. One thing seems certain. There will be more progress if this problem is left in the hands of providers and patients, without massive interference from uninformed legislators and political appointees, frequently with demagogic motives. To that extent, the jury’s verdict freeing Dr. Kapoor is an important step forward, and Judge Fine deserves recognition for a well-reasoned set of jury instructions.

If Alcohol Were Invented Today

2010-10-30T11:19:00.000-07:00

[Originally posted on hellowellness.in 29 Sept 2010]

The word 'alcohol' was coined around 1540 by an Arabic chemist to describe the fine powder, or 'kohl,' used to stain or paint the eyelids. Two centuries later, British writers borrowed the word to describe the intoxicating essence of wine -- an ironic twist, since the original Arabic chemist was very likely a Muslim and, as such, forbidden to drink it.

If alcohol were invented today, international law would class it with the controlled substances, alongside opium, heroin, cocaine and the like. The World Health Organization (WHO), in its most recent comprehensive report, writes:

Alcohol is a psychoactive substance with a known liability to produce dependence in humans and animals. If considered in the frame of the 1971 Convention on Psychotropic Substances, alcohol would qualify for scheduling as a substance that “has the capacity to produce a state of dependence, and central nervous system stimulation or depression, resulting in hallucinations or disturbances in motor function or thinking or behaviour or perception or mood”, and for which “there is suffi cient evidence that the substance is being … abused so as to constitute a public health and social problem warranting the placing of the substance under international control.”

The propensity to produce "dependence" -- a bland synonym, in this context, for the more controversial term "addiction" -- is the red flag that sets apart this relatively small class of drugs, including alcohol, from the millions of other known chemical compounds. They are addictogenic.

The exact molecular mechanism of addictogenesis is still the focus of scientific investigation in several countries. But the fact of its occurrence is beyond dispute. The WHO report says, "The direct actions of alcohol on the brain and sustained alcohol exposure lead to longer–term molecular changes in the brain known as neuroadaptation." That is, a number of neural pathways in the brain are altered to form a strongly self-reinforcing habitual behavior pattern that leads to adverse consequences for the organism.

Among the pathways by which alcohol enters the brain is the brain's indigenous opioid system -- the same doorway by which the opiates such as heroin and codeine pass into the neural network.

Wherever alcohol is introduced into a country on a large scale, there one finds the rise of alcohol addiction (alcoholism). The WHO world surveys find a strong correlation between the level of alcohol consumption in a country, and its prevalence of alcohol dependence. Statistically, more than three quarters of the dependence rate is correlated with the level of consumption, and this trend is even stronger in "developing" countries, among which the WHO report specifically names India.

Alcohol marketing generates alcohol use. Alcohol use generates alcohol addiction. Alcohol addiction then sustains the alcohol market.

In any country where alcohol use has become established, writes the WHO, a small minority of drinkers consume the bulk of the alcohol sold. "A typical finding is that half of the alcohol consumed is consumed by 10% of the drinkers." In the U.S., some reports indicate that 10 per cent of the drinkers drink 80 per cent of the alcohol.

Imagine, then, that by some magic pill you could convert the 10 per cent into non-drinkers. The alcoholic beverage market would crash more profoundly and disastrously than the mortgage and financial markets in our recent meltdown.

The alcoholic beverage industry worldwide is absolutely built on alcohol addiction. One has to say it; there is no way to sugarcoat it.

Recently, after I outlined these economic facts to a person newly in recovery from alcoholism, she exclaimed, "But that's so illogical!"

Of course, it's utterly illogical. We have grandfathered alcohol and tobacco into the category of legal substances, even though the combined death toll from these two drugs is perhaps 15 times greater than the toll from all of the drugs proscribed as illegal.

So, we have prisons full of people caught using or selling negligible quantities of drugs whose total impact on society is relatively small, while the pushers of mega-quantities of lethal addictive substances that kill as many people each year as die in major wars, floods and earthquakes sit in luxurious offices with princes, prime ministers, and police chiefs on their speed dials.

Meditation can provide lucidity at times of mental turmoil. My friend who exclaimed at the illogicality of current addiction policy became agitated and, for a while, I feared that the mental stress would tilt her toward relapse. I suggested meditation, and she calmed down. The next day we met and I asked for her thoughts.

She said that after thinking it through, she was more determined to remain free of addictive substances than ever. Said she, "I don't like being used."

The Easiest Way to Quit: Don't Start

2010-10-30T11:12:00.000-07:00

[Originally posted on hellowellness.in 29 Sept. 2010]

The placid canal that winds through Paris' Tenth Arrondissement is a social gathering place for the young. On the warm nights of early September, we saw hundreds of twenty-somethings, or perhaps a bit younger and older, sitting in small groups on the banks, chatting, flirting, and in some cases smoking and drinking. There also we saw uniformed Paris police officers, unarmed and with a relaxed gait, ambling among the groups, chatting, and passing out some literature. I got a copy. The main item is a 16-page pamphlet titled "Alcohol" (in French, of course), almost small enough to fit into a pocket, and liberally illustrated with cartoons in a popular style showing characters speaking in Parisian argot. The pamphlet is an easy-to-digest, humorously presented short course in the physiology and psychology of alcohol. It doesn't try scare tactics, but it asks hard questions, and concludes with information on where to get help. The pamphlet appears to be the product of a wide collaboration between a number of nonprofit groups together with the French Ministry of Health. There are several French associations concerned with alcoholism: Alcohol Assistance (http://www.alcoolassistance.net), Croix Bleue (http://www.croixbleue.fr/), and Vie Libre (http://www.vielibre.org/) are among the best known. Each of these combines recovery support with prevention work; that is, they provide mutual aid groups for the already addicted and also engage in advocacy and education efforts to prevent addiction in the first place. We happened to be present in Berlin on the "Day for Alcohol-Damaged Children." Unprepared, we missed all of the day's events, but the plastic grocery bag from the local supermarket carried, on one side, a big ad for the cause, "Alcohol for kids -- not in our bag!" Berlin is a "sobering" city in many ways. Museums and many other public buildings still show pockmarks and craters of bullet hits on their facades. Plaques and statues honoring resistance heroes murdered by the Nazis dot the city. A main attraction is the Holocaust Memorial. It consists of rectangular blocks of dark gray concrete, a bit larger in surface area than a coffin, hundreds of them, of varying heights, with narrow passageways between. This stark minimalist simplicity goes on for a full city block. Walking among these endlessly repetitive monoliths conveys the monstrosity of the genocide more powerfully than any baroque monument of the 19th century ever could have done. Berlin knows how to build monuments! In the United States alone, we lose nearly six million lives to addictive substances every decade. The holocaust from tobacco alone exceeds the grim toll of the death factories at Auschwitz and Birkenau. At 50 bodies to a car, it would take a freight train more than 2000 cars long to carry each year's victims of alcohol in the U.S. alone. The worldwide totals are untallied. It's important, of course, to provide support to those whose brains have already been hijacked by the addictive substances. If caught early enough, treated effectively, and given unfailing support, all can recover. But providing recovery support alone is like rescuing the survivors of the concentration camps. The larger social task, one that takes the cooperation of a broad range of nonprofits, for-profits, and government, is prevention. As Jane Brody, health editor of the New York Times, pointed out earlier this summer, the most effective way for an individual to escape addiction is not to commence using the substances in the first place. A life free of addictive substances brings numerous benefits in terms of wellness, prosperity, and longevity -- and it means never having to quit.

The Drive to Thrive

2010-10-30T11:08:00.000-07:00

[Originally published Sept. 4 2010 on hellowellness.in]

The great majority of young people who experience the death of a parent, divorce, emotional or physical abuse, substance abuse, mental illness, developmental disabilities, and similar ordeals end up OK. They recover, form healthy relationships, have good marriages, and become productive citizens. That, at least, is the finding of numerous studies in a diversity of cultures, summarized by the researcher Bonnie Benard at the outset of her book on Resiliency.

I shouldn’t have been surprised. I lost my father before I was born, I survived bombing raids, childhood malnutrition and diseases, numerous changes of home, several addictions, and I’m OK. And I’m not alone. I know lots of people with worse experiences who survived -- we all do.

How did we manage? What is the secret of our marvelous ability to spring back from adversity?

Resiliency, writes the author, is a creature with four legs. First, the resilient person is able to win approval from others. Perhaps only from one other, but that is enough. Second, the resilient person is resourceful, inventive, able to solve problems, to make and execute plans, and adapt to changed circumstances. Third, the resilient person displays autonomy. They are goats rather than sheep. Finally, the resilient person has a sense of purpose. It may be a spiritual or secular purpose, but it gives them a sense of orientation in space and time, a reason for being alive.

With this in mind, I reflected back on my experience in overcoming my addictions to alcohol and other drugs, and I began to understand more deeply how I succeeded in freeing myself from these shackles.

In my recovery from addiction, I participated in a support group network that systematically provides its members with social approval, the first leg of resiliency. In these groups, the basic principle is that all participants have a sound and healthy core, which we call the Sober Self, and that our work consists of affirming and empowering that positive quality within ourselves. In the jargon of social science, our groups are “strength-based.”

I was surprised, early on, that nobody in these groups wagged a finger at me and told me what I had to do. On the contrary, I was expected to figure it out for myself. I was advised to think, to marshal my inner resources, to be inventive, to solve my particular problems, to make a personal recovery plan, and to adapt my personality to clean and sober living. Motivated in this way, I developed the second leg of resiliency.

My group work always aimed to enhance my power to survive as a clean and sober person outside the group. I came to believe that the group was a useful support, and I enjoyed -- and still enjoy -- the fellowship and good humor that prevails within the circle. But no one ever tried to make me dependent on the group, to substitute group addiction for substance addiction. On the contrary, my group experience was and is a school for personal autonomy, the third pillar of resiliency.

Finally, my participation in my support group network restored to my mind a sense of purpose, mislaid somewhere during the depths of my addiction. I began to feel that I was useful in some modest way to others who had been similarly lost. I developed connections with other people, the key ingredient of a sense that one’s life has meaning.

Thanks to Benard’s book, the secret of my recovery from addictions -- a journey which I thought impossible before I began it -- is no longer so mysterious. Benard writes that the qualities that make up resiliency are hardwired into the human makeup, and all that is required to foster more recoveries is to remove the barriers and enhance the protective factors for our innate drive to thrive.

Stone Sober -- and Absolutely Fascinating

2010-10-30T11:05:00.000-07:00

[Originally published Sept. 4 2010 on hellowellness.in]

Jerry was at dinner with his ex-wife and his 12-year old daughter. A fragile web of emotions spun across the table. He felt delighted to be with his daughter, who looked happy to be with him, and his ex, for once, was not interfering. The waiter suggested a glass of wine. Jerry demurred. He so enjoyed being exactly as he was that he didn’t want even the mild alteration in mood brought on by a glass of Chardonnay.

Jerry is an emotionally intelligent man who knows from experience that even a small amount of alcohol will induce emotional and cognitive distortions. He does not drink because he treasures the natural chemistry of his feelings.

The talk show host Dick Cavett once asked Katherine Hepburn whether she had ever used drugs or indulged alcoholically. The actress’ reply is a classic: “Cold sober, I find myself absolutely fascinating.”

This sounds a bit narcissistic, which is only natural for a famous actress, but it has a core meaning with universal validity. Cold sober, we are all of us worthy of esteem and interest, if we only take time to get to know ourselves.

Gillian E., a British artist living in San Francisco, recalls an idyllic moment: a beautiful beach, a glorious setting sun, a gentle breeze, a charming man beside her, and a glass in her hand. In the glass: fresh sparkling water. She asked herself, would I rather have alcohol instead? The answer came back to her loud and clear: “No way. This is just perfect the way it is. Drinking alcohol would interfere with this beautiful clarity that I feel, and would just get in the way.”

Some time ago, I made an illegal left turn and got caught. In traffic school, the instructor showed a video of people driving their cars on an obstacle course that required precision steering and quick reaction times. They did well. Then they were given one drink. Their performance deteriorated, big time. They were surprised -- they didn’t feel drunk. But the trail of knocked-over traffic cones behind them didn’t lie.

Such anecdotes are among the small building blocks of an emerging secular argument for complete abstinence from alcohol. I mean, abstinence for healthy people, for everyone, not only for people who are already addicted to the stuff. A secular case for abstinence is called for because it’s obvious that great numbers of people ignore religious prohibitions against alcohol, where they exist; and such prohibitions are altogether lacking in most flavors of the Christian faith, as an excellent article on Christianity and Alcohol in Wikipedia points out.

Not so very long ago, the media were filled with advertisements for the supposed social and psychological benefits of cigarettes. We were given to understand that if we smoked, we would relieve our stress and we would become more attractive to other attractive people. Cigarette smoking was painted as an essential glue of happy social relationships. We now know better. Most educated people in the U.S. no longer smoke.

A similar awakening needs to happen with alcohol. Alcohol as stress relief -- bunk. Alcohol as social lubricant -- more bunk. Alcohol as a sex magnet -- nonsense. Alcohol as an essential part of pleasant social togetherness -- not true. All lies, promoted by a multi-billion dollar industry totally lacking in ethics.

Alcohol and wellness are polar opposites. Wellness includes emotional intelligence, self-esteem, mental clarity, and fine coordination of the senses with the muscles. Alcohol is a poison with a destructive impact on all the above. It’s time for a cultural awakening, for a new appreciation of our sober selves, for an affirmation of our inborn capacities for healthy and happy living.

Exercise for the Choice Muscle

2010-10-30T11:01:00.000-07:00

[Originally posted Sept. 4 2010 on hellowellness.in]

My friend Alex saw the Light. He made the Big Decision not to drink any more. Ever. On the way home from church, he passed his favorite liquor store. He made the small decision to turn into its parking lot.

My friend Sandy had had it with drugs. While walking in the park, she made the Big Decision to get clean. At the edge of the park, she could turn left or right. She decided to turn left, where she usually ran into her dealer.

Moral: the Big Decisions need the support of the small decisions, or they crash. The old alcoholic support groups came close to this lesson with the slogan, “One day at a time.” But at the beginning, it’s more like one minute at a time, or even one second. What matters is the choices we make while the clock ticks. The small decisions.

Addiction is the enemy of decision-making. Addiction is dictatorial. As we saw in my previous blog entry, chronic use of addictive substances impairs the brain’s synaptic plasticity. Major brain circuits become rigid, sclerotic, like arthritic joints. Our decision-making muscles become enfeebled.

De-addiction, it follows, must exercise the choice circuits in the brain. We need to give the prefrontal cortex, the center of executive functionality that makes our brains anatomically human, a steady progression of challenges to think, weigh, and choose. Repeating slogans and formulas or reciting memorized life stories won’t do a thing for our decision-making organ. Only persistent decision-making exercise will strengthen its capacity.

Let’s begin with the body. Do I have externally visible marks of my substance use? Do I have red veins in my face, drug stains on my fingers, receding gums, puncture marks, etc.? Do I have hidden body damage, such as liver damage, heart problems, malnutrition, etc? Is my diet what it should be? Am I getting the exercise I need? Are my teeth properly cared for? Is my mental state satisfactory? And if not, what exactly should I do about all of that? What is my plan?

Let’s consider my immediate surroundings. Are there drugs (including alcohol) in my home? In my car? At school or work? Do I have objects that trigger thoughts of drinking/using in my environment? Where are the ‘hot spots’ of danger in my daily travels, and how can I avoid them? Make a map!

How do I spend my time? What about the people with whom I associate? What is the condition of my emotional life? Is my lifestyle helpful to my recovery, or not? What aspects of my personal history are assets to my new life, and what aspects drag me back? Am I prepared to handle the many mixed messages about drinking/using in my culture? Is my treatment and support group program optimum for my needs? Am I prepared to handle near-relapse situations? Make a plan!

Our LifeRing meetings focus on the small decisions that people make from day to day. In my years of attending LifeRing meetings, I’ve heard literally thousands of detailed, particular questions that have challenged all kinds of people in recovery. I’ve distilled and organized these questions into nine major topic areas and put them into a workbook, Recovery by Choice. It’s an exercise book for the prefrontal cortex. It’s like a body-building gym on paper. Your sober self enters as a 90-lb weakling, and comes out as buff as Aniruddha.

[The reference is to Aniruddha Bose, a founder of hellowellness.in]

Stiffness of the Mind

2010-10-30T10:53:00.000-07:00

[Originally posted Sept. 4 2010 on hellowellness.in]

If the brain is like a muscle, then the onset of addiction is like rheumatism -- a growing stiffness and pain with movement. That, at least, is the finding of a group of international researchers based in France, and published in a recent issue of Science.

The scientists studied what happens in the brains of rats when exposed to various addictive substances. Rats and scores of other species from the great apes down to tiny worms and fruit flies, can be turned into addicts by infusing their bloodstreams with the addictive substance. Researchers either hook up the animals to intravenous tubes that inject the drug, or they confine the animals in a vapor chamber where the air is infused with the substance. It doesn't take long before the animals display a set of behaviors and physiological symptoms that we humans know all too well, if we have alcoholics or other drug addicts in our family or friendship circles.

The fact that animals can readily be turned into addicts, by the way, is important evidence that it's the substance, and not some qualities in the person's psychology, that makes addicts of us. Despite the creative work of Walt Disney's animators, rodents don't have human personality profiles, and they probably don't suffer from spiritual maladjustment. Quite a few theories blame the person's emotional and spiritual deficiencies for the onset of addiction. The animal experiments teach that there's a neurobiological process at work. The molecules in the substance are like so many little vandals in the brain, hammering, bending, mutilating and wrecking the intricate circuits of the most complex apparatus on earth -- one that we all carry between our ears.

What long-term use of the addictive substances does, the researchers found, is to decrease synaptic plasticity. Synapses, of course, are the connections between brain cells. Connections are the rails on which our thoughts and feelings run. When we process a new experience, the brain cells rewire themselves to integrate the new elements into our existing web of ideas and emotions. The power of brain cells to form new connections, their plasticity, is the foundation of all kinds of learning. A brain with high synaptic plasticity is like a body that's flexible, loose, limber, toned -- the kind we love to see jogging in the park or performing acrobatic feats on television.

So, the next time you hear somebody use slang terms like "let's get hammered" or "stupid" or "stoned," take it as a neurobiological reality. The chronic use of addictive substances such as alcohol, cocaine, etc. creates stiffness in the brain cells, even while it tends to take away men's stiffness elsewhere in the anatomy (but that's another story). A kind of mental rigidity sets in; the ability to learn and to adapt declines; the person's mind becomes unresponsive to new ideas and feelings. Does this describe anyone you know?

[For more details, read Kasanetz et al., "Transition to Addiction is Associated with a Persistent Impairment in Synaptic Plasticity," Science 328:5986 pp. 1709-1712.

Genetics: DNA Causation Unravels

2010-10-01T20:11:00.000-07:00

In several earlier posts here, I quoted from scientific journals reporting on the findings of modern genetic research -- or rather, the surprising absence of such findings. For the first time ever, science has the tools to find out exactly where the genes are that we have long believed underly major diseases. What the tools are telling us is that the supposed genetic causality isn't there, or it's much weaker than previously thought. We can now say with confidence that the "alcoholism gene" does not exist; that the genetic contribution to alcoholism, such as it is, is spread over an as yet unknown number of genes, each of which has only a minute influence, and that this influence is profoundly mixed up with and moderated by environmental factors.
Now the current issue of Scientific American (Oct. 2010) reports similar findings for genetic research into a broad range of other diseases. In its article, "Revolution Postponed: the Human Genome Project has failed so far to produce the medical miracles that scientists promised," the journal describes a growing realization in the scientific community that the old model of genetic science, where variations in specific genes cause specific illnesses, has very limited validity. The journal quotes David Goldstein, director of the Center for Human Genome Variation at Duke University, one of the major research centers:

It's an astounding thing that we have cracked open the human genome and can look at the entire complement of common genetic variants, and what do we find? Almost nothing. That is absolutely beyond belief.

Another researcher, David Botstein of Princeton, describes the effort to map disease-causing genetic variations as an experiment that had to be done in order to know that it did not work. It was, he said, "a magnificent failure."

Walter Bodmer, a pioneer of the modern genomics research effort, says that the effort to find genetic variants that cause major diseases is a biological dead end. "The vast majority of [common] variants have shed no light on the biology of diseases."

These findings are profoundly upsetting long-held beliefs about genetic causality and forcing scientists to rethink the whole model of what genes do. The old model which saw DNA as a kind of computer program that determines the fate of the organism is out the window. The processes are much more complex and involve a great deal more interaction with the environment than had been previously thought.

The takeaway for people who have serious issues with alcohol and/or other addictive substances is: don't blame your genes. Your genes are OK. Your DNA will be just as happy, and very likely much happier, when you stop hammering your brain cells with addictive substances.

Some Progress on Campus

2010-08-29T08:06:00.000-07:00

I happened to be visiting Ramapo College in New Jersey the other evening and, in a hallway outside a counseling office, passed this display of literature aimed at reducing college drinking. Didn't have a chance to meet the counselor or ask questions, but it looked like a big step forward from my college days (eons ago). The bulletin board display points out that a large majority of students think that college students are heavy drinkers, whereas in fact, most students drink lightly. The false expectation likely promotes heavy drinking behavior and the accurate survey tends to put on the brakes. The display also includes handouts on alcohol and related issues. If material of this kind, backed by a proactive counseling staff and supported by the administration, had been available in my day, I might (might) have been spared three decades of alcoholic drinking.

Empowering Your Sober Self -- the Class

2010-05-28T09:01:00.000-07:00

As I noted here earlier, Prof. Arthur McCullough in Belfast announced a class on Empowering People Against Addictions at Queens University's Open Learning Centre. Now Prof. McCullough kindly sent me an email with a short report on how the session went:

Dear Martin,

The course Empowering People Against Addictions - 5 weekly two-hour sessions at Queen’s University Belfast Open Learning Centre – was completed last night. Its main inspiration is its recommended text Empowering Your Sober Self. ...

As described in the Open Learning Programme, for Spring 2010: OLE1097 - “This course is about how and why people get into addictions, and about how to get out of them. It covers major areas of addiction such as alcohol, drugs, gambling, sex; and related ones, such as isolation, suicide, physical and mental illness. Discussions involve perspectives in science, culture and society, and will focus on the recovery model.

There were 16 students mostly community, care and social work professionals or semi-professionals. About a quarter had had addictions. It’s been an exciting and interesting course, with LifeRing a point of departure all along. Two of the students say they are interested in a LifeRing in Belfast, and are in touch with Dennis Stefan (Dublin), who is interested and very willing to help. I think it could be very valuable here. Every member of the course thinks so. ...

I thank Prof. McCullough, who appends this short bio:

Arthur McCullough was a Researcher in Organizational Studies at the University of Bradford, and Bradford Management Centre. He was Senior Lecturer at the University of Ulster, and later Head of its Department of Sociology and Social Anthropology. He is currently an Open Learning Tutor at Queen’s University Belfast providing courses on World Cinema, Tribal Art, Irish Art, Sacred Places Objects and Art in the Province of Ulster, and Empowering People against Addictions.

Needless perhaps to add, I hope that other educators find a place for Empowering Your Sober Self in their addiction-related classes.

Nice short book review

2010-05-07T17:41:00.000-07:00

A tip of the hat to James in Ireland who posted a review of Empowering Your Sober Self on the goodreads.com website, here.

Catch me on Audrey's Show

2010-04-14T22:49:00.000-07:00

Last August I had the privilege of being a guest on the Audrey Chapman show; see my blog post about it. Today I had the honor of being invited back for a second appearance. We recorded it today, and it'll air on Saturday, April 24 at 8 a.m. Eastern Standard Time, on WHUR-FM at 96.3 -- heard up and down the East Coast from Florida to New Jersey -- and via the Internet at http://www.whur.com.
Audrey has a great touch. I've not had the pleasure to meet her in person, but if I were looking for a counselor to tell my troubles to, Audrey would be high on my list. She's empathetic, she's widely read and well informed, and she has a knack for getting to the core of an issue in a heartbeat. Try and catch the program; it'll run about 45 minutes, and it's focused on my new book, Empowering Your Sober Self.

Ireland Leads the Way

2010-04-07T15:15:00.000-07:00

A number of people have told me that my new book, Empowering Your Sober Self, would make a good classroom text in addiction recovery, but no one has done it -- until now. The pioneer is Arthur McCullough, BSc, BSSc, MA, at the Queen's University in Belfast. The University has announced a new class beginning April 28, as follows:

Empowering People Against Addictions
[OLE1097]
Arthur McCullough, BSc, BSSc, MA

5 weekly sessions on Wednesdays 7.00 pm to 9.00 pm, starting 28 April

This course is about how and why people get into addictions, and about how they can get out of them. It covers major areas of addiction such as alcohol, drugs, gambling, sex; and related ones, such as isolation, suicide, physical and mental illness. Discussions involve perspectives in science, culture and society, and will focus on the recovery model.

Recommended Textbook: Empowering your Sober Self, Martin Nicolaus, (Jossey-Bass. A Wiley Imprint).

5 CATS Points (Level 1)

(concession rate £19.00)

Full Price: £30.00

Here's the link if you want to sign up. I'm grateful to Dennis S., LifeRing area convenor for Ireland, for spotting this web item and alerting me to it.

New criteria for addiction

2010-04-02T16:58:00.000-07:00

The DSM -- Diagnostic and Statistical Manual -- defines the disorders that the psychiatric profession officially recognizes. Where a patient has insurance coverage, the treatment professional needs to fit the client's issues into one of the recognized categories in order to obtain payment. Thus the DSM is much like a statement of the law, which is why the making of each new edition of the DSM has been compared to the making of laws and sausages -- the less you see, the more you'll have respect. A participant in the making of the current edition, years ago, told me that it was like a smoke-filled room in old Chicago, with the loudest egos battering each other into submission. This year, the creators of the DSM-V have broken with that sordid tradition by opening a public window into the current state of the draft. Dr. Nora Volkow, the director of the National Institute of Drug Abuse (NIDA) recently sent an email blast to just about everyone concerned with addiction to publicize the current draft and solicit comment.
I have been tied up with other work and have not had a chance to review the material. Fortunately, LifeRing convenor Lloyd E. has stepped into the breach, and has composed the following comment, for which I am grateful to him:

Diagnostic criteria for the medical conditions commonly known as alcoholism and addiction will be significantly changed in the new DSM-5. The Diagnostic and Statistical Manual of Mental Disorders is produced by the American Psychiatric Association and is the standard diagnostic tool used by doctors and insurance companies.

The DSM-5 Substance-Use Disorders Workgroup is recommending that the currently separate categories of substance abuse and dependence be dropped in favor of a single disorder of graded clinical severity.

The DSM-4 used the terms “abuse” and “dependence” in an attempt to blunt the stigma of addiction, but they have proved untenable and misleading. The term “dependence” is problematic because it encourages people to associate addiction to withdrawal symptoms rather than the obsessive nature of drug cravings. And it is difficult to see why the word should be used for the ongoing condition of someone who is having success in recovery. The term “abuse” has been criticized because it is a moral, not a medical, term. And really, it is the addicted person who is abused, not the drug. The new criteria will suggest a single continuum, instead of two discrete conditions.

The distinct diagnoses of substance dependence and abuse will be replaced by a single Substance-Use Disorder with varying severity. The disorder will have a subcategory for each of the popular drugs such as Alcohol-Use Disorder or Amphetamine-Use Disorder.

It is important to remember that the DSM is only a diagnostic tool. It is not concerned with the biology or etiology of addiction. It does not preclude that specific biological changes may occur in the brain, but it bases diagnosis on behavioral criteria because the biology of the brain is not well enough understood and is not accessible to clinicians.

DSM-5 will identify Substance-Use Disorder as “a maladaptive pattern of substance use leading to clinically significant impairment or distress.” The lists of manifestations previously given for abuse and dependence will be combined into one list. If a person manifests two or three items, a diagnosis of “moderate” Substance-Use Disorder is given. For four or more, the disorder qualifies as “severe.” The presence of cravings, or strong desires use a specific substance, is proposed as an additional manifestation not present in DSM-4. For those in recovery the disorder is characterized as being in various stages of remission from Early-partial to Sustained-Full remission.

The APA is soliciting comments until April 20, 2010. The DSM-5 will be published in May 2013.

Substance-Use Disorder:

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:

1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

3. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

4. tolerance, as defined by either of the following:

a. a need for markedly increased amounts of the substance to achieve intoxication or desired effect

b. markedly diminished effect with continued use of the same amount of the substance

(Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.)

5. withdrawal, as manifested by either of the following:

a. the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

b. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.)

6. the substance is often taken in larger amounts or over a longer period than was intended

7. there is a persistent desire or unsuccessful efforts to cut down or control substance use

8. a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

9. important social, occupational, or recreational activities are given up or reduced because of substance use

10. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

11. Craving or a strong desire or urge to use a specific substance.

Severity specifiers:

Moderate: 2-3 criteria positive

Severe: 4 or more criteria positive

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 4 or 5 is present)

Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 4 nor 5 is present)

Course specifiers (see text for definitions):

Early Full Remission

Early Partial Remission

Sustained Full Remission

Sustained Partial Remission

On Agonist Therapy

In a Controlled Environment

For more details, click to the APA Call for Comments site.

Treatment Journal Reviews Empowering Your Sober Self

2010-01-10T21:43:00.000-08:00

The current issue of Alcoholism Treatment Quarterly contains a review of my book Empowering Your Sober Self. The reviewer, who is none other than the distinguished scholar William L. White (Slaying the Dragon and other works), writes, in conclusion:

In Empower Your Sober Self, Nicolaus has created an engaging text for individuals seeking recovery and for service professionals wanting a greater understanding of LifeRing’s core ideas and recovery support strategies. Empower Your Sober Self also includes the voices of many LifeRing members whose personal stories illustrate key points in the book.

The discussions in this book include some of the more controversial issues in the addictions field. Nicolaus outlines positions on these issues clearly and forcefully and in ways that help distinguish LifeRing Secular Recovery from 12-step programs and from other 12-step alternatives. This book is intended to inform rather than convert. Not everyone will agree with the ideas and approaches set forth here, but for the past decade, individuals and families have used LifeRing Secular Recovery as an effective framework to initiate and maintain long-term recovery from life-impairing addictions. Those recoveries are cause for celebration, and this book details how they did it. Those seeking a solution to alcohol and other drug problems and professionals assisting people with such problems will find great value in Empower Your Sober Self.

This strikes me as a fair and even-handed assessment and I'm grateful to the writer. It's also a good sign that the journal, which goes to the more research-minded echelons of the treatment profession and to academics, has taken note of this book. Hopefully, the review -- and the book, for those who will read it -- will persuade a larger number of treatment professionals to include LifeRing meetings in their referral pool.

For a PDF copy of the complete review, click here.

P.S. I've cross-posted this item in my LifeRing Convenor Blog.

Private Outpatient for Opiates, Done Right

2009-11-11T21:21:00.000-08:00

Prescription drug abuse, especially by young people, is on the rise, and opiates like Vicodin and Oxycontin rank high on the list. People with chronic pain all too often end up addicted to their medications. People who got into heroin or other opiates for recreational use or to self-medicate some psychic hurt frequently find themselves in deeper waters than they ever intended. We meet all these people, among others, in LifeRing meetings, and one of the big concerns for them is anti-addiction medications. In the past, the most common medication to treat opiate addiction was methadone. Methadone continues in use, but buprenorphine (byou-pruh-NOR-feen) is the new kid on the block, and both physicians and patients are picking up on it because it's easier to administer, has fewer side effects, and less potential for abuse than methadone. Buprenorphine is being used both to detox the person addicted to opiates and in some instances as a maintenance regime.

It isn't easy for the person who wants to address an opiate addiction to find proper care. Apart from a few outstanding practitioners like Dr. Howard Kornfeld in Mill Valley, the patient who is without Kaiser coverage may not find any place to go.

That's slowly changing, as both physicians and patients become educated about new addiction pharmacology. One of the bright signs of change in the field is the opening of Reliance Center in San Francisco. Located on the third floor of the beautiful old 450 Sutter Street building, a block north of Union Square, this new outpatient clinic brings together a very high powered medical and counseling staff in a comfortable, almost living room atmosphere.

Putting physician and counselor on the same team tells me that these folks really "get it." You need both the medical doctor and the empathetic psychological advisor to deal with an addiction. I had the opportunity to meet and to look up the resumes of the key staff. Dr. Carrie Schuman, Medical Director, has treated people with opiate dependence for more than 25 years. She's a leading member of the California Society of Addiction Medicine and a member of the national addiction medicine group. This physician knows what she's talking about when it comes to opiate addiction, and she also projects a warm, caring, nonjudgmental attitude. On the counseling side, there's Lubov Smith, a Licensed Marriage and Family Therapist, who comes to the Reliance Center from years as Executive Director of the Henry Ohloff Centers, one of the oldest addiction treatment programs in the area. She's bright, funny, and very knowing. If I had an opiate addiction issue, I'd put myself into the hands of this team without hesitation. Check them out at http://reliancecenter.com.

Professionals who include pharmacological tools in their recovery approach are often pleasantly surprised to learn that abstinence support groups exist that are open to patients who are taking these medications. More than ten years ago, the medical director of a local treatment facility complained to me about the "G**damn 12-step sponsors who interfere with my treatment plans." Although AA co-founder Bill W. was personally very positive about anti-addiction medications, the organization he founded contains a strong streak of anti-medication Luddites, who in many instances tell the recovering person to throw away their anti-depressants and other prescription drugs, or they're not really considered "sober." That hasn't changed in the past ten years, judging by recent stories I've heard. And so, when a support group like LifeRing comes along, with a more evidence-based approach, physicians' interest perks up.

In the past few years, LifeRing has mounted exhibit tables at conferences of addiction counselor groups such as NAADAC and CAADAC and at APA events (American Psychological Association). If we can raise the money -- it costs at least $1000 to exhibit at one of these events -- we hope to exhibit next year also at ASAM and CSAM -- the American and California Societies of Addiction Medicine. With our evidence-based supportive approach to anti-addiction pharmacology, LifeRing should get a positive reception from these professional groupings.

Goodbye Genetics, Hello Epigenetics

2009-11-07T16:10:00.000-08:00

For the first time in history, science now has tools that can definitively answer long-standing questions about the role of genetics as the cause of diseases. So far, the results have been devastating for believers in genetic causality. The better we can see, the less genetic causality we find.

I've previously summarized the minimalist findings of modern genetics research for a number of psychiatric disorders, including addiction, here and here in this blog, and in my book, Empowering Your Sober Self.

Now comes another blockbuster study, this time of schizophrenia, a disease commonly believed to have a strong genetic component. According to the November issue of Scientific American, summarizing a recent report in Nature, "three crack teams of investigators pooled genomic data from 8,000 schizophrenics of European ancestry but could lay claim to only a handful of weak genetic risk markers."

By contrast, says the same article, epidemiologists have been able to find significant correlations between schizophrenia and environmental and cultural conditions. Growing up as an immigrant or as a racial minority in a big city, particularly in densely populated and troubled neighborhoods, is a significant risk factor for the disease.

These studies have given a boost to the field of epigenetics -- the study of how environmental conditions evoke or overwrite genetic predispositions. The primitive notion that our DNA is our destiny is giving way to the understanding that our genes do nothing until they are activated. Environmental conditions (including not only the chemicals that enter our body but also the decisions we make, the people we hang with, and the stress we undergo) determine whether a gene gets turned on or off. Our genetic array is like a keyboard, and our interaction with the world governs what melody gets played on it.

By coincidence, a recent issue of Counselor, the magazine for addiction professionals, features an article, "Epigenetics Has Come to the Addiction Field," by Mike Taleff, Ph.D. Taleff's main point is that it's not genetics that makes a person an alcoholic or other addict. It is the repeated consumption of alcohol and other drugs that programs a person's genetic material to crave the drug and prioritize its consumption.

This epigenetic understanding, says Taleff, can help a recovering person shed some common myths, such as the belief that "they are somehow morally, bad, defective, or otherwise flawed. Often, this kind of thinking gets in the way of recovery." Epigenetics teaches, by contrast, that becoming addicted "has little to do with your moral character." Addiction is a result of the programming that addictive substances perform on your brain.

Many questions remain to be settled before science can claim that we have a comprehensive understanding of the causes of addiction. But progress is being made. For decades, addictionology was stuck in the belief that the alcoholic/addict's disorder was genetically programmed. Thanks to the enormous strides made by genetic science in the past decades, with the deciphering of the human genome and the subsequent advances, we can now say with considerable certainty that genetics supplies only a weak explanation at best. Now we need to turn our eyes toward the epigenetic factors: environment, culture, and above all the neurochemical properties of the addictive substances themselves.

Cover story

2009-11-07T15:22:00.000-08:00

The cover of my new book -- Empowering Your Sober Self -- is going to appear as a prop in the forthcoming made-for-TV movie "Sins of the Mother." According to the synopsis, the heroine, Kim, postpones writing her Ph.D. thesis to go live with her mother, a recovering alcoholic. To establish the mother's character, the camera scans the books on her coffee table, and lingers on "Empowering Your Sober Self."

Just so you know, this is not a paid product placement. A member of the film staff ran across the book in a bookstore and asked my publisher for permission to feature it as a prop. The movie will air on Lifetime Television. Date not yet known. The producer is Mother Road Productions Ltd in Vancouver BC.

Oh, and a review of my book, by William L. White, will appear in the next issue of Alcoholism Treatment Quarterly. White also wrote the preface for my book, and it is expected that the review will closely track the preface. It will not mention the cover.

What If There Were LifeRing Treatment?

2009-09-03T23:32:00.000-07:00

[I'm cross-posting this item both here and in my LifeRing Convenor blog. Lately I've been posting a lot more to the convenor blog than here.]

Quite a few recovering people in various treatment programs have expressed the wish that LifeRing filled more than an hour in their week. The desire for "more LifeRing" is especially strongly felt in programs where the other hours consist of heavy-duty 12-step lectures and meetings.

Of course, there is no such thing as a LifeRing treatment program, and there probably oughtn't to be. We are a peer-to-peer support group, and should always remain that. So much of our fundamental approach is premised on horizontal support dynamics that the introduction of vertical relationships -- inevitable in today's insurance-dominated treatment settings -- would bring about wrenching distortions. Still, wouldn't it be liberating if today's treatment professionals saw their role as not only facilitating 12-step involvement but also facilitating LifeRing involvement? Whatever works best for the client?

For treatment professionals in Northern California, an opportunity to learn the basics of LifeRing is coming on Saturday, Sept. 19. Thanks to sponsorship by CAADAC, the California association of addiction professionals, I'll be presenting an all-day workshop at the LifeRing Service Center in downtown Oakland. I'll be selecting material from Empowering Your Sober Self (my new book), from the Recovery by Choice workbook, from How Was Your Week (our convenor handbook) and from other sources. This six-hour program is aimed at treatment professionals, and six hours of Continuing Education credit, plus an hour of Professional Development credit, are offered. However, space permitting, any interested person, including of course any LifeRing participant, is welcome to take part. It only costs $10.

Here's a page with details about the venue, parking, meals, etc. Hope to see you there!

On the Air with Audrey Chapman

2009-08-08T06:43:00.000-07:00

It was my great pleasure this morning to appear via telephone on the Audrey Chapman show, broadcast in the Washington DC area on WHUR-FM at 96.3 and via the Internet at http://www.whur.com. Audrey is a relationship specialist who has written several books on love and its problems. She's active as a writer and speaker and also maintains a busy counseling practice. She talks with radio listeners every Saturday morning from 8 - 10 am (5 -7 a.m. my time), and her show is said to have a huge morning audience up and down the East Coast.

From the first words, you can see why Audrey has such a following. She's calm, she's clear, she's relaxed; she projects empathy without judgment. You immediately feel comfortable talking to her, telling her your problems. She also sees right to the heart of an issue. She couldn't have had much time to read my new book, but she clearly understood the main points. Her questions were relevant and moved the conversation forward.

Audrey thrives on the freshness and urgency of listener calls. And her callers didn't disappoint. In just a few conversations, much of the huge panorama of addiction problems in the society was laid out before us. A grown up woman was concerned with the drinking of the auntie who raised her. A mother was troubled by her teenage son's drinking. A father worried that his own drinking was leading his son into alcoholism. And so on. Addiction is an enormous problem, and there are people everywhere struggling with it.

We don't yet have LifeRing meetings in the D.C. area, but I had the opportunity to tell listeners about www.lifering.org, our website. I was pleased that Audrey asked me to stay on into the second hour of her show. There was still much more that could have been said, and I had to bite my tongue once or twice when callers pushed concepts and solutions that have very limited utility. But I loved the live interaction, and I could see myself engaged in a longer and very interesting conversation with Audrey on some other occasion. She's smart and she has an open mind and a great way with people.

Check out her website at audreychapman.com.

Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery

2009-07-07T20:58:00.001-07:00

Jacqueline Foreman (right) interviews me on Your Mental Health Talk Radio about my new book, here:

Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery

The program aired July 7 2009 at 5 pm Pacific Time.

Treatment promo research results

2009-06-23T18:19:00.000-07:00

From the treatmentgap.org website:

Most Americans know someone personally who is addicted to alcohol or drugs and they are worried about access people have to affordable treatment. And, most people support including treatment in national health care reform. These opinions are shared across the board—regardless of race, age, income and geographic location.

Results of a new national poll conducted by Lake Research Partners for the Closing the Addiction Treatment Gap initiative confirm what we suspected: Most Americans know someone personally who is addicted to alcohol or drugs and they are worried about access people have to affordable treatment. And, most people support including treatment in national health care reform. These opinions are shared across the board—regardless of race, age, income and geographic location.

Among the key findings of the national poll, conducted by Lake Research Partners:

• Three-quarters of Americans (76%) know someone personally who has been addicted to alcohol or drugs. Personal experience with addiction spans all demographic groups.

• Half of Americans (49%) do not think they would be able to afford the costs of treatment if they or a family member needed it. This concern about affordability is highest among Americans with incomes under $50,000 (67% say they would not be able to afford treatment).

• Three-quarters (75%) of Americans are concerned that people who are addicted to alcohol or drugs may not be able to get treatment because they lack insurance coverage or cannot afford it.

• Nearly three-quarters (73%) support including alcohol and drug addition treatment as part of national health care reform to make it more accessible and affordable. This support cuts across all demographic groups.

• Two-thirds of Americans (68%) also support increasing federal and state funding for alcohol and drug prevention, treatment, and recovery services.

The finding that three quarters of Americans know someone personally who has been addicted to alcohol or drugs confirms what many recovering people find through personal experience: when you broach the subject, practically every person you talk to has a story about someone who is or was addicted.

Not researched in this study, which was funded by treatment industry interests, is how many Americans know someone for whom addiction treatment did not work. The industry not only has an affordability gap, it has a credibility gap.

They laughed at him

2009-06-14T17:18:00.000-07:00

A little while ago, a gentleman -- let's call him "Guy" -- phoned to say that he had just read my book and wanted to start a LifeRing meeting. Guy said he is more than 20 years clean and sober in AA, and is one of the better known AA speakers in his region.

He happened to go to his favorite recovery bookstore, and this title, Empowering Your Sober Self, "jumped out at me." He bought it and over the next 24 hours read it straight through. He said he had been reading recovery literature for nearly 30 years and nothing had resonated with him enough to pick up the phone and call the author, until this book.

He said he liked AA enormously but after more than 20 years, he felt it was always the same thing, and it wasn't going anywhere, and he wanted the challenge of moving forward. The LifeRing concept really spoke to him.

He wanted to start a LifeRing meeting in his area, and he outlined a plan to go speak with some head people at a number of treatment programs with which he was familiar, having often spoken there, in order to get a room and referrals. Of course, I encouraged him, but at the same time I cautioned him that his enthusiasm might not be shared by some of his AA friends.

And so it was. At the first program where he spoke with the chief, he was told that the facility's board of directors was unlikely to go with anything other than 12 step.

He then took the book to his home group, and presented a share about the "A" and the "S" -- the addict self and the sober self. He said, "They laughed at me." They agreed about the "A" but they couldn't wrap their minds around the concept that there was an "S" -- a sober self -- inside the alcoholic's head. His talk met with sarcasm and ridicule.

It reminds me of Gandhi's famous saying:

"First they ignore you, then they ridicule you, then they fight you, then you win."

To his everlasting credit, Guy wasn't intimidated. He's going to speak to other treatment professionals. I shared with him that a number of senior people in 12-step programs have been expressing interest in the LifeRing option. He's now reading How Was Your Week in order to prepare for the convenor role. He's making plans to come visit Northern California in September so he can see LifeRing meetings first hand.

A Reader Writes With More Reading

2009-06-14T16:53:00.000-07:00

One of the readers of this blog was kind enough to email me with the following information, which I pass on as received:

mr. nicolaus,

i'm a regular reader (& sometime commenter) of your "new recovery" blog. i'm writing to draw your attention to a few items i think might be of interest to you:

1 - the april/may 2009 issue of "Free Inquiry" magazine ran a great piece by Steven Mohr entitled "Exposing The Myth of Alcoholics Anonymous"; "Free Inquiry" is the first American publication to take AA head-on in a long, long time & the article is thorough & even-handed (unfortunately, you have to pick up a hard copy as the contents aren't available online)

2 - Dr. Harriet Hall (www.sciencebasedmedicine.org, www.skepdoc.info) ran a blog post on the above article & gave an MD's view of the article & the organization (http://www.sciencebasedmedicine.org/?p=490); i thought that might be of interest as well

3 - at my request, Dr. Hall visited & commented on a blog post at www.mentalhelp.net (http://www.mentalhelp.net/poc/view_doc.php?type=weblog&id=700&wlid=5&cn=14); the "editorial comment" to her post was -- putting it mildly -- elusive & openly condescending to any lay critique of AA; again, i was hoping this might be of interest of to you & that you might want to lend your voice to the discussion.

in any case, i thank you for your time & wish you all the best with your book. i'll be visiting the blog & www.unhooked.com regularly.

warmest regards,

peter [Name withheld]

donewithaa.wordpress.com

Choice Theory Conference

2009-05-31T21:48:00.000-07:00

It was my privilege yesterday to attend the Choice Theory Education Conference at the Hilton in Sacramento. I staffed a LifeRing literature table there, met with LifeRing convenors and future convenors, attended some of the sessions, and met some of the leading figures in the choice movement.

Georgellen Hofine, one of the oldest students of Choice Theory founder Dr. William Glasser (photo), personally welcomed me to the gathering. LifeRing keynote speaker and DVD author Dr. B. J. Davis was the closing speaker on the conference program, and I much enjoyed listening to his presentation and chatting with him informally.

Choice Theory advocates Resa Stendel Brown and Jack Harnden spoke about the application of Choice Theory in education. Author Mike Rice gave a talk on addiction. B. J. Davis, in addition to his own discussion of Choice Theory in addiction treatment settings, introduced a DVD showing how Reality Therapy (an earlier name for Choice Theory) was applied in a prison setting.

I took time out to meet and chat with convenors of the LifeRing meetings in Placerville and one of the Sacramento locations. One of the conference participants expressed determination to start a LifeRing meeting in Lodi. Two of the treatment professionals in attendance spoke of plans to start LifeRing meetings at their centers in the Sacramento area.

It was a very positive crowd, including quite a few people with an interest in addiction recovery, and I should have brought more books, as Empowering Your Sober Self sold out by noon.

The only shadow over the event was the news that Dr. Glasser himself, who had been scheduled as keynote speaker, had been admitted to the hospital with a cardiac issue. There is as of this writing no further news on his condition.

LifeRing in New Living (NY)

2009-05-31T19:09:00.000-07:00

An excerpt adapted from Chapter 2 of my new book (Empowering Your Sober Self) appears in the April issue of New Living, a free 20-p health and wellness newspaper published in Stony Brook NY and distributed in the New York City area and Long Island.

This chapter from my book contains a set of tips and exercises designed to help the person who wants to stop using addictive substances to move across the gap from contemplation to action. They include visualization, laughter, self-forgiveness, reframing, exercise, and other attitude-builders. I wrote a 900-word excerpt for the paper.

The editors took some minor liberties with the chapter. They took the sentence, "Becoming drug or alcohol-free can exhilarate you and enable you to accomplish great things in life," and added the phrase "... and perhaps, more importantly, give you gratitude and humility, two spiritual qualities hard to find in most people."

OK, I may not be the most original writer in the world. But I try not to stoop to moth-eaten cliches like "gratitude and humility." But it's good to have the article in the paper, with a plug for the book, and a plug for the two LifeRing meetings in Long Island; and I guess there's a small price to pay for that. I am humbly grateful.

Class war in California counseling

2009-05-20T11:43:00.000-07:00

In California you need a license to fix cars, cut hair, paint fingernails, give massages, and much else. But not to provide addiction treatment. You can be a high school dropout with a history of petty crime and mental hospital stays, and you may find work as a counselor treating people who suffer from addiction. There are in fact a substantial number of high school dropouts working as front-line counselors in the field today.

Yet, at the same time, the addiction counseling industry insists, almost with one voice, that addiction is a disease. Just like diabetes, atherosclerosis, hypertension, and the rest. Now, if addiction is a disease, then addiction treatment must be a branch of medicine. No?

How many other branches of medicine do you know where the front-line treatment providers -- the physicians and RNs who hold the patient's recovery in their hands -- are high school dropouts? Or high school graduates, without more? Or have junior college degrees, only? There are none. Addiction treatment is way out of line, far, far below the standard of the rest of medicine -- if in fact it deserves the name "medicine" at all.

To be sure, there are quality treatment programs where addiction professionals are held to the same high standard as other providers. At the Kaiser Chemical Dependency Recovery Programs, for example, there is supervision by an MD, and each of the counselors has a professional license or certification as a Licensed Clinical Social Worker, Marriage and Family Therapist, Registered Nurse, or a similar qualification that requires graduate level education and thousands of hours of supervised training. But these islands of quality are, unfortunately, just islands.

Several organizations in California have been trying for years to pass legislation that would require standards of training, education, licensure and certification for addiction counselors comparable to those in other clinical professions. The current effort is Senate Bill 707. It is a complex piece of legislation and I won't try to analyze it here in detail. What's most interesting about it, really, is the controversy that surrounds it.

On the one hand, there are voices crying that it doesn't go far enough. Today's email, for example, brings a post from Dennis W., a member of the board of one of the counselors' organizations, complaining that the draft bill is so watered down as to be useless. It puts counselors with a GED and 350 hours of counseling experience on the same level as those who have a master's degree in addiction studies. He says that the bill in this form "will continue to keep the addiction service profession in California the sub-standard field that all other states in the US look down upon."

On the other hand, the bill has been the target of a barrage of attacks charging that it goes too far. If it passes, say these voices, program costs will rise, programs will go out of business, and counselors by the thousands will be out of jobs. What's that about?

The current newsletter of one of the other addiction professionals' organizations explains:

Simply put, associations representing program owners are attempting to defeat the measure by “scaring” counselors from supporting it. The truth is, they’ve opposed every bill put forward to recognize your professionalism. More than half of the states have licensure and none of their treatment systems were shut down due to licensure or certification. Standards for counselors improves salaries, raises treatment outcomes and reduces the strains on public sector treatment as addicts seek treatment from private practitioners.

So there you have it. It's class war. On one side, the counselors who aspire to professional status and to the salaries, benefits, and respect that come with it. On the other side, associations representing owners of treatment programs whose profit rate depends on filling their staff rosters with people who have little education, training, or other claims to professional advancement.

Now you can begin to understand a little more clearly why much of the addiction industry is so heavily invested in the 12-step approach. The 12-step approach does not require much in the way of professional education. If you've done the steps and you can repeat a basic set of slogans for any occasion, you're qualified to "carry the message" to others. Of course, you're not supposed to be getting paid for doing that, but you're being paid so little as a counselor that you might as well be doing it for free. If Karl Marx were looking at this, he might say that the 12-step organizations continuously generate a "reserve army of labor" for the treatment industry -- a flood of workers willing to work for substandard wages and under substandard conditions. And this "reserve army" necessarily depresses the wages and conditions of the whole labor force. No wonder, then, that the owners' associations oppose the counselors' campaign to pass laws that would upgrade professional standards.

Don't drink that marshmallow

2009-05-14T11:52:00.000-07:00

The marshamallow experiments are famous by now, thanks in large part to Daniel Goleman's Emotional Intelligence books, and their relevance to addiction seems obvious. In 1968, Stanford psychology prof Walter Mischel presented four-year olds with a marshmallow and the choice: Eat it now, or wait 15 minutes and get two. The kids who could delay the gratification ended up, a decade and more later, with higher SAT scores, higher graduation rates, better jobs -- in short, twice as many of the marshmallows life had to offer.

It was often believed that the kids who could delay gratification did so thanks to more "will power." Mischel -- according to a helpful and informative summary in this week's New Yorker, by Jonah Lehrer -- analyzed what this "will power" really consisted of. He paid very careful attention to what went through the delaying kids' minds as they resisted the bait. They succeeded because they had methods of distracting their minds from the lure. They covered their eyes, or played hide-and-seek under the desk, or sang songs. "Their desire wasn't defeated -- it was merely forgotten." The key, Mischel found, was not to resist the marshmallow -- that didn't work --- but to avoid thinking about it.

In further experiments, Mischel found that children could be taught cognitive tricks that helped them distract themselves. Even reducing the intensity of the temptation by pretending that the marshmallow was only a picture of a marshmallow or that the marshmallow was really a cloud worked for some children.

Mischel and other researchers Lehrer quotes are skeptical of finding a genetic basis for the ability to delay gratification. Too many genes are involved in even the simplest aspects of personality. The cutting edge of research lies in classroom curricula that teach self-distraction, and in educating parents to cultivate simple cognitive skills in children. Says Mischel:

"We should give mashmallows to every kindergartner... We should say, 'You see this marshmallow" You don't have to eat it. You can wait. Here's how.'"

No Such Thing as a Bad Person Addicted to Alcohol

2009-05-06T16:41:00.000-07:00

Had the pleasure today to hear and meet Charles D. Appelstein, author of No Such Thing as a Bad Kid and other works expounding the strength-based approach to working with at-risk youth.

Charlie was keynoter at the 12th annual Northern California Tobacco, Alcohol, Drug Educator and Youth Development Conference at UC Berkeley, where I staffed a LifeRing exhibit table. He's a fun speaker, gets the audience laughing, chanting, and singing, all the time delivering key points of a message that is in many respects revolutionary.

When a teacher or counselor begins work with troubled kids -- also "trouble kids" -- the key thing is attitude, Charlie began. The successful attitude, he said, is "I believe in you. You are a great kid. You can do great things." This attitude transfers to the kid; it makes the kids feel good about themselves, it gives them hope, and it inspires them to change for the better.

Afterward we chatted about addiction treatment, and I told him that LifeRing was one of the strength-based approaches in this field. He expressed great interest. We also exchanged books; he gave me his and I gave him mine.

I also had the opportunity to chat with Tom Herman of the State Department of Education, Dr. Alex Stalcup of the New Leaf Treatment Center, Ralph Cantor of the local County Office of Education, and a number of substance abuse program administrators, teachers, cops, and others in and around K-12 education who are concerned with the drug issue. The message that there's a secular, strength-based addiction recovery support network out there was welcome news to many ears.

First call

2009-04-30T10:43:00.001-07:00

Had the first telephone call today from an arms-length reader of Empowering Your Sober Self, my new book. A counselor in San Diego called on the 800 line to say he had a number of clients who were not responding to 12-step and this looked like just the right approach for them. Wanted to know were there local meetings (not yet) and how they could connect with us (online). "Very glad to see you exist. This is much needed."

Seattle police chief tapped as 'Drug Czar'

2009-03-04T15:47:00.000-08:00

Rumors last month that Rep. Jim Ramstad was headed for the post of 'Drug Czar' proved unfounded, as Pres. Obama has reportedly nominated Seattle Police Chief Gil Kerlikowske for the post, instead. Kerlikowske has earned generally positive reviews, but it's too early to say, if he's confirmed by the Senate, what he's likely to do as top commander of the 'war on drugs.' Obama is on record that this 'war' has been a colossal failure. There's grounds for hope that Kerlikowski will redirect the mission of this cabinet-level office more toward treatment, prevention, and a public health approach, rather than the nightstick-and-prison medicine that has prevailed. For an eloquent statement advocating such a change in mission, read Victor Capoccia's op-ed in the Baltimore press, here. Capoccia is head of the Closing the Addiction Treatment Gap initiative.

Well said, in Washington

2009-01-24T13:13:00.001-08:00

The Bush years, by wide consensus, were a dismal era for science. But by a strange paradox, some bright stars emerged in what is normally a dismal field under any administration: addiction science.

One is the brilliant Nora Volkow, who brings a rare mix of research experience, clear thinking, and leadership ability to the National Institute on Drug Abuse (NIDA).

Another is Mark Willenbring, Director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). In a letter to the current New Yorker (the one with the cartoon of Obama as George Washington on the cover), Willenbring precisely skewers a piece that this normally astute mag published in its December 1 issue. The article, titled "Special Treatment," by Amanda Fortini, featured a Los Angeles area deluxe treatment facility.

After a string of well-worn 12-step platitudes about addiction and the difficulties of recovery, the owners of the facility claimed that in essence treatment could make no difference, everything depended on the addicted person's motivation. So why bill the client for clinical services on top of the normal cost of luxury room and board?

Willenbring's letter goes directly for the jugular. He writes that the piece:

... shows the irony that paying more does not guarantee access to the most current therapies... The program that Fortini describes appears to base its services on a treatment model that is more than thirty years old .... Although clients may or may not receive some benefit, they are vulnerable to unnecessary relapse risk if more contemporary treatments are not also made available. For example, research funded by the National Institutes of Health has identified several medications that reduce relapse in early recovery from alcohol dependence. Newer behavioral approaches, such as cognitive-behavior therapy and motivational interviewing, also increase recovery and provide alternatives to the traditional Twelve Step approach (which in updated form is also effective). This menu of services makes possible truly individualized treament and increases client choice and engagement, but only if people have access to it.

The treatment program Fortini described in her article was so clinically clueless and bereft of ideas that the piece might have been a subliminal parody. It isn't often that I get to cheer somebody in Washington for saying the right stuff. Could this be the beginning of a change we can believe in?

Congratulations to Barack Obama

2009-01-21T09:39:00.000-08:00

As a college student at Wesleyan in '61 (or was it '62?) I joined with other white students to team with groups of black students from Howard University in an effort to integrate lunch counters in Glen Burnie, a suburb of Baltimore. In some places we sat indefinitely without being served; in one, we were served coffee with salt in it; at another they locked the doors as we approached. When we picketed the segregated local movie theatre, a mob of white men surrounded us as sheriffs watched. A providential cloudburst scattered the crowd and allowed us to escape.

On the night of election day in 1964, I arrived at the civil rights movement headquarters in Jackson, Mississippi, to begin a few months of volunteer work. Nearly everyone was glued to the TV set to see whether the Democratic Party would seat the elected black delegates running under the banner of the Freedom Democratic Party. The answer was, no.

These and other memories came upwelling as I watched the inauguration of Barack Obama. The party that wouldn't seat elected black delegates had nominated a black man for president. A man whose father would not have been served at DC area restaurants 60 years ago was taking the oath of office. Indeed, there has been some changes.

This morning's San Francisco Chronicle editorializes that Obama's new approach is "grounded in sobriety and hard work." The "sobriety" that's meant here is, I assume, the metaphorical kind -- a pragmatic, realistic attitude -- and not the literal kind, meaning abstinence from alcoholic drink. Yet there's a connection to reflect on, here.

For me, personally, my time of active engagement in the civil rights movement was largely a time when my alcoholism (acquired in my freshman year in college) was in remission. Engagement in life-changing work was hugely more interesting than drink. My drinking habit only bloomed large during the years of reaction that followed, when it seemed that everything we had done was being undone. Pessimism, despair, lack of hope were the atmosphere in which this illness flourished. And I'm not the only one. Is it an accident that the drug problem grew larger in rough proportion as conditions for the poor and middle class in America stagnated and deteriorated?

Barack Obama's own history with alcohol and other drugs offers a refreshing contrast to that of his predecessor in office. Obama has freely and openly admitted experimenting with drugs as a youth, but then stopped; he is trying to quit, or has quit, smoking. What a contrast to the history of "W," whose claimed mid-life alcohol salvation story is widely believed to be a sham that covered up more than it revealed, notably a long history of cocaine use, some say.

I've not yet seen anything in the way of Obama's statements so far that gives a clue to his specific policies on alcoholism and other addictions. The federal government has many levers to pull and many dollars to spend in this area. On general principles, I assume that Obama will support the recent extension of parity in the treatment of mental health and addiction treatment. I assume that the federal agencies in this area will continue to be funded.

The open questions in my mind are (a) War on Drugs, and (b) Federal excise taxes on spirits and tobacco. We need "change we can believe in" in the "war on drugs," a criminal exercise in hypocrisy and racial/economic persecution that is long overdue for radical reform. An even more telling mark of Obama's mettle will be whether he supports Congressional action to raise the excise taxes on liquor and tobacco. Public health advocates have long maintained that raising these taxes is the single most effective measure to reduce the social impact of these two most murderous addictive drugs. Needless to say, the pillars of corporate greed stand deeply dug in on this issue.

The largest opening in the clouds under this new administration will be in the area of improving living standards and reducing inequities for the poor and middle class. If the real and emotional environment of ordinary people in this country becomes infused with progress and hope, the problems of alcohol and other drugs will recede as if of their own accord. It will take some time, but if the new administration succeeds in this largest and most difficult of goals, we will, in fact, see a new era of "sobriety" in both senses of the word.

Congratulations to President Barack Obama, and best wishes for the future.

P.S. To date, the White House Office of National Drug Control Policy remains under an interim head, Patrick Ward, a Bush appointee who has held the post a bit over a year. Obama's choice of Rep. Jim Ramstad to become the new Drug Czar has run into heavy fire for Ramstad's ties to abusive "faith-based" programs, his policy positions on prevention, and his ties to a massive investor fraud. Read Maia Szalavitz's blog blast and the Drug Policy Alliance editorial. Ramstad is not change, he's MOTSOS.

End Stage

2008-11-01T18:02:00.000-07:00

Is nothing sacred? Michael Shermer, Scientific American's Skeptic columnist, reports in the November issue that one of the icons of psychology, the five stages of grief, has been debunked.

Launched by Elizabeth Kubler-Ross in her book On Death and Dying (1969), the model of denial-anger-bargaining-depression-acceptance is one of the most widely known paradigms in modern psychology. But, according to Shermer's sources, there appears to be no evidence that most people most of the time go through most of those stages in that order, or any other order.

The five stages of grief, along with similar "stage" theories, Shermer says, satisfy people's craving for simplicity and predictability. Unfortunately, the scientific basis for them is just not there. And they can also impose feelings of guilt and shame on people who are not feeling what they think they should. And, in today's world, people who follow the simple "stages" narrative are the exception, while diversity and individual variation are the rule.

Good grief! What's next? Are we going to learn that there is no evidence that most people recovering from addiction go through a certain well known set of steps?

Genetics of mental illnesses: More is Less

2008-10-28T14:34:00.000-07:00

Genetic research into psychiatic disorders appears to be undergoing a systemic deflation not unlike that in the financial markets. As I posted a couple of weeks ago, a survey article in the then-current Scientific American showed that genetic studies of human intelligence had labored mountainously and brought forth a 0.4 per cent mouse. Today comes a special issue of Nature Neuroscience dedicated to the neuropsychiatric diseases, and it's the same story. The initial radiant hope that today's mega-billion dollar genetic research apparatus would nail the culprit genes responsible for schizophrenia, autism, bipolar disorder, or depression, has dimmed to a faint glimmer. The more we can see, the less we find.

In the roundup article, Steven Hyman (Department of Neurobiology, Harvard) works hard at sounding upbeat, but has little to work with. Family studies, rich in anecdotal material, suggest that autism, schizophrenia, bipolar illness, and major depression must have major genetic components. Therefore it should be a simple matter to find the genes, and then to develop medications that target those genes.

Over the past two decades, however, efforts to identify risk-conferring alleles for the common forms of neuropsychiatric disorder have largely been unrewarding. Despite the significant role for genes highlighted by aggregate measures of their influence (Table 1), the underlying genetics of common neuropsychiatric disorders has proved highly complex, as attested by unpredictable patterns of segregation in families, lack of Mendelian ratios in twin studies and serious difficulties in replicating genetic linkage studies.

Anecdotes notwithstanding, the given illness frequently appears in people without the suspected genetic traits, fails to appear in people with the traits, and appears in people with other traits believed to be associated with an entirely disparate disorder. Current technology can easily identify "highly penetrant" genetic variations that cause a narrow subset of disorders, such as some types of Alzheimer's disease and macular degeneration, but the candidate genes involved with the most common psychiatric disorders make only a very slight dent in the etiology. It doesn't help that the clinical definitions of the psychiatric disorders tend to lack objective physiological markers, so that diagnosis rests ultimately on clinicians' opinions, which may vary widely.

Neither Hyman's article nor the remaining items in the special issue of Nature Neuroscience focus on addictive substance abuse, but you could substitute "alcoholism" into the paragraphs just quoted and come out with the same result. I've summarized the research on that topic in my forthcoming book. By April, when the book comes out, it should be amply clear that the deflation of the genetic myth in alcoholism is only part of a larger panorama of reassessment. The better our genetic research tools become, the more clearly we can see, the more obvious it becomes that we cannot blame our genes for our disorders, nor can we hope for a magic pill to set us right. It's just not going to be that easy.

Genetics: The more we see, the less there is

2008-10-16T22:30:00.000-07:00

In the concluding chapter of my forthcoming book (link), I look at the evidence for an alcoholism gene. My research showed that the more powerful our tools become, the less we find in the way of genetic causality. Modern genetic research has wiped away any basis for the idea that alcoholism is a genetically transmitted disease. The most that can be said is that some people appear to inherit a lower responsiveness to alcohol, so that if they drink, they must drink more to get the same high. For details, see my book, due out in April.

Now comes an article in Scientific American, by science journalist Carl Zimmer, reporting on modern research into the genetics of intelligence. Here too, the conventional wisdom has been that genes play a major role. But when the most powerful computer-assisted research tools are turned on the human genome, the supposed genetic factor all but evaporates. Intelligence turns out to depend very weakly on a diversity of genes. The most influential of these genes contributes just 0.4 per cent (less than one half of one per cent), and this gene is believed to influence also a variety of other cell functions -- so that it is not specific to intelligence as such.

Much of the myth of genetic causality rests on twin studies. This is true both in alcoholism and in intelligence research, as well as in other fields (for example, autism). Zimmer cites research showing that twin studies involving affluent families show a strong apparent genetic influence, while similar studies involving twins from poorer families show virtually no genetic factor at work. The modern molecular genetic studies suggest that the apparent genetic influence reported in some twin studies may be a chimera due to false methodological assumptions. Twin studies have been severely criticized, and some scientists consider them junk. The SciAm article is in the October 2008 issue at p. 68; a link is (temporarily) here.

Spirituality strikes out

2008-10-16T21:57:00.000-07:00

Two controlled trials of the effect of spirituality on addiction recovery showed no improvement for the patients given spiritual guidance as part of the usual treatment regimen, either in their addiction recovery or in their spiritual practices. In fact, in one trial, the patients provided with spiritual guidance made less progress in overcoming depression and anxiety than the patients not given spiritual treatment.

Details are in the Journal of Substance Abuse Treatment, July 25 2008. The abstract is here. Thanks to David Kaiser Ph.D. for flagging the item.

Invitation to Guest Authors

2008-02-24T20:45:00.000-08:00

Guest authors are invited to contribute to this blog. I have to take another break until the end of June. I'm working on a book with a June 30 deadline.

Confrontation Therapy, R.I.P.

2008-02-19T22:31:00.001-08:00

Two of my favorite scholars have combined to write a powerhouse of an article that everyone interested in addiction treatment will want to read. William R. Miller, co-author of the Handbook of Alcoholism Treatment Approaches (reviewed here), and William L. White, author of the monumental history Slaying the Dragon (reviewed here), have written what hopefully will be an obituary for an era, entitled "Confrontation in Addiction Treatment." It's in Counselor Magazine. Here are a few snippets from this substantial, strongly researched and comprehensive treatment:

The use of confrontational strategies in individual, group and family substance abuse counseling emerged through a confluence of cultural factors in U.S. history, pre-dating the development of methods for reliably evaluating the effects of such treatment. Originally practiced within voluntary peer-based communities, confrontational approaches soon extended to authority-based professional relationships where the potential for abuse and harm greatly increased. Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate.

....

Early claims of the superior effectiveness of confrontation and counterclaims that it was ineffective and potentially harmful relied primarily on statement of opinion buttressed by anecdotes. With the emergence of more science-grounded treatment approaches in the 1980s and 1990s came studies that began to tip the scales of this debate. Two recent reports, however, suggest that confrontation still has its proponents. A 2001 study on staff attitudes toward addiction treatment found that 46 percent of those surveyed agreed that “confrontation should be used more” (Forman, Bavasso & Woody, 2001); and a 2004 ethnographic survey of adolescent addiction treatment in the United States commonly encountered programs that were “explicitly designed to demean and humiliate” (Currie, 2004).

...

There never has been a scientific basis for believing that people with substance use disorders, let alone their family members, possess a unique personality or character disorder. Quite to the contrary, research on virtually any measure reflects wide diversity of personal characteristics among people with addictions, who are about as diverse as the general population, or as snowflakes. Studies of defense mechanisms among people in alcohol treatment have found no characteristic defensive structure, and higher denial was specifically found in a clinical sample to be associated not with worse, but with better treatment retention and outcomes (Donovan, Hague & O’Leary, 1975).

...

Reviewing four decades of treatment outcome research, we found no persuasive evidence for a therapeutic effect of confrontational interventions with substance use disorders. This was not for lack of studies. A large body of trials found no therapeutic effect relative to control or comparison treatment conditions, often contrary to the researchers’ expectations. Several have reported harmful effects including increased drop-out, elevated and more rapid relapse, and higher DWI recidivism. This pattern is consistent across a variety of confrontational techniques tested. In sum, there is not and never has been a scientific evidence base for the use of confrontational therapies.

If you've ever been exposed to confrontation therapy, or have a confrontational counselor now, by all means read this article, sure to be reprinted in textbooks and to become a classic.

If there's one defect in it, it's in glossing over the confrontational therapy element in AA itself. Dr. Harry Tiebout, whose psychiatric theorizing framed the confrontational approach, was hugely influential on Bill Wilson, and he was not alone. Dr. Silkworth echoed the theme, with his advice to Wilson to "give them the medical business, and give it to them hard." The "medical business" meant to convince the alcoholic that he was suffering from an incurable fatal illness. This revelation was designed to attack and to "shatter" the alcoholic's defenses, to "deflate" his ego, and render him hopelessly dependent on his "physician." The very first clause of step one, the foundation of the whole edifice, "powerless over alcohol," expresses a confrontational strategy, as thousands of counselors have found out in practice. To be fair, this is not the only element in AA; there are other strands that tend to counterbalance it. But the article is certainly wrong in claiming, as it does, that there is no attack therapy strand in AA at all. -- This cavil aside, the article is a masterful piece of work, by two giants in the field. Highly recommended.

Abstinence leads to rapid brain repair

2008-02-06T01:01:00.000-08:00

Abstinence leads to rapid repair of gross brain damage seen in alcohol dependent persons, according to a review of neuroimaging studies by a group of Japanese researchers.

In uncomplicated alcoholic patients, a high incidence of cortical shrinkage and ventricular dilatation were reported using brain CT scans. In older alcoholics, prefrontal gray matter deficits were especially marked when compared with younger alcoholics. Reversibility of brain shrinkage is a common neuroimaging finding in patients with alcohol dependence.

Regrowth of shrunken brain areas was particularly vigorous during the first month of abstinence, the scans showed. Besides the gray matter, areas "with significantly greater recovery in abstainers were the temporal lobes, thalamus, brainstem, cerebellum, corpus callosum, anterior cingulate, insula, and subcortical white matter." Follow-up studies showed that the regrowth was not simply due to rehydration.

The study appeared in the Dec. 2007 issue of the Japanese Journal of Alcohol Studies and Drug Dependence. The abstract is here.

Brazil study: Does AA really work?

2008-02-06T00:36:00.000-08:00

"Do Alcoholics Anonymous groups really work? Factors of adherence in a Brazilian sample of hospitalized alcohol dependents." -- That's the title of a study in the current issue of the American Journal of Addiction, published by a American Academy of Psychiatrists in Alcoholism and Addiction. A team of researchers headed by M.B. Terra followed 300 alcoholics committed to three hospitals in Puerto Allegre, Brazil. Results (from the abstract):

AA adherence was below 20%. The main factors reported by patients as reasons for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. Although AA is considered an effective intervention for alcoholism, its adherence rate was excessively low. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.

The result of this study is unsurprising; essentially the same finding was made in a meta-analysis almost two years ago reported in the Cochran Report (Source) What's noteworthy here is that patients were asked their reasons. It would be useful if the various threads in the responses (objections to the 12-step approach on the one hand, denial on the other) were explored in more depth and an attempt made to untangle them.

2007 Darwin Award Nominee: Alcohol Division

2008-01-24T15:55:00.000-08:00

Michael was an alcoholic. And not an ordinary alcoholic, but an alcoholic who liked to take his liquor... well, rectally. His wife said he was "addicted to enemas" and often used alcohol in this manner. The result was the same: inebriation.

The machine shop owner couldn't imbibe alcohol by mouth due to a painful throat ailment, so he elected to receive his favourite beverage via enema. And tonight, Michael was in for one hell of a party. Two 1.5 litre bottles of sherry, more than 100 fluid ounces, right up the old address!

When the rest of us have had enough, we either stop drinking or pass out. When Michael had had enough (and subsequently passed out) the alcohol remaining in his rectal cavity continued to be absorbed. The next morning, Michael was dead.

The 58-year-old did a pretty good job of embalming himself. According to toxicology reports, his blood alcohol level was 0.47%.

In order to qualify for a Darwin Award, a person must remove himself from the gene pool via an "astounding misapplication of judgment." Three litres of sherry up the butt can only be described as astounding. Unsurprisingly, his neighbors said they were surprised to learn of the incident. Source. Thanks, John C. (Goathouse) for the item.

Humility R Us [NOT]

2008-01-13T21:50:00.000-08:00

It's been six years since AA Trustee Dr. George Vaillant's article in the AA Grapevine, saying that "It doesn't hurt at the level of the GSO for AA to have humility and understand that 60 per cent do it without AA." Source. He was talking about the research finding that 60 per cent of alcoholics who achieve at least five years of abstinence do it without using AA.

It's been six years, and Vaillant's plea for humility has either not been heard or already forgotten. In this months' issue of Addiction Professional, columnist Carlton Erickson reports that "fourteen experts" recently met at a "consensus conference" in Rancho Mirage CA to define "recovery," and came up with a definition that includes an implied endorsement for "peer support groups such as AA and practices consistent with the 12 Steps and 12 Traditions."

In other words, judging by Erickson's column, if you're part of the majority that are staying sober without AA you're not considered in recovery. But if you're a chain-smoking Big-Book thumper whose entire social, moral, and intellectual life is wrapped up in AA meetings, then you're a model of recovery. The mind boggles.

The panel's full report, published in the Journal of Substance Abuse Treatment, is considerably more balanced than Erickson's column makes it seem. The report says that "the founders of AA recognized that there were many paths to the same position ... and did not suggest that their specific methods were the only means to attain the overall goal." (Thanks Jason Schwartz for forwarding the full article.) The panel considered but expressly rejected the definition of recovery as "abstinence attained through adherence to 12-step principles."

That's progress. But the plug for AA and the 12 steps is highlighted in the report, and Erickson's column picked up on that highlight, as most hurried readers will.

This endorsement is completely gratuitous. It comes in the absence of any evidence cited in the report showing either (a) superior efficacy of 12-step over other paths in reaching long-term sobriety, or (b) a positive association between long-term participation in 12-step groups and measures of "personal health and citizenship."

The report admits that no validated instrument for measuring "personal health and citizenship" exists. Then what scientific ground is there for making the claim?

The implied beneficial effect of AA participation on "personal health" is indefensible given the notorious prevalence of nicotine addiction among AA members. The report takes note of the nicotine problem, including "significant rates of emphysema, cancer, and other terminal health conditions associated with these products among those otherwise in recovery" (read: in AA). But come to the bottom line, the panel tucked tail between legs and "considered it best to remain silent on tobacco use within the sobriety component of the recovery definition."

The next line is lovely: "It is admitted that there is no clinical justification for this position."

The claim that long-term AA participation enhances "citizenship" is equally dubious. The cited ground for it is the AA homilies for doing service, "giving back." But this "service," to the limited extent people actually do it, is in the nature of recruiting for the AA organization. AA has no outward-directed community service component on the order of the Masons, Shriners, Rotarians, and many other groups. So where does "citizenship" come in?

Trying to come up with a definition of recovery is a laudable project. The panel notes that recovery science (as distinct from addiction science) is a poorly developed field, and that the lack of a validated definition of 'recovery' is a significant obstacle. But when you enter the gates of science, the motto is "lasciare ogni sospetto" -- here drop all hesitation, abandon all fear. So long as recovery scientists keep genuflecting to the sacred cow in the room, little progress and considerable dung is to be expected.

Alcohol Killed 'The Prophet'

2008-01-07T07:43:00.000-08:00

The excellent New Yorker continues its literary war on the alcohol-as-muse delusion. In the Jan. 7 issue is a thumbnail bio of Kahlil Gibran, author of the huge bestseller, The Prophet. After the success of this book, Gibran took to drinking heavily. Eight years after The Prophet, having produced nothing further of note, he died of cirrhosis of the liver, at age 48.

Bankrupt Tobacco Firm Floats Whiskey-Flavored Cigs

2007-12-28T10:50:00.000-08:00

Whiskey-flavored cigarettes and cigarette papers dosed with vanilla to disguise the stink of the smoke are among the "new technology" being marketed now in Quebec by JTI MacDonald, a Japan-based cigarette company that is in bankruptcy proceedings.

Public health advocates are up in arms. Read more here. Thanks, Michael W., for the item.

If liquor doesn't get you, nicotine will

2007-12-21T20:15:00.000-08:00

Last week's New Yorker had a bio of Malcolm Lowry, a lauded writer whose alcoholism claimed him at age 47; see my blog note, "Alcoholocaust," below. This week's mag covers iconic short story writer Raymond Carver (What We Talk About When We Talk About Love), also an alcoholic, but one who got sober in 1977, and stayed that way. But he kept smoking. He once said that he was only "a cigarette with a body attached to it." Lung cancer claimed him at age 50.

The mag's Lowry story took the author down a notch or two by suggesting that his wife was actually responsible for much of the greatness in Under the Volcano. The mag continues on its debunking tear by demonstrating beyond reasonable doubt that the savage blue pencil of Carver's editor Gordon Lish was responsible for creating the terse, minimalist style that made Carver famous.

Score: New Yorker 2, theory that alcohol helps the creative juices flow, 0.

Oh, and don't miss the cartoon on p. 68. A bar patron drinking coffee to a neighbor with a cocktail: "Been there, drunk that." I'd copy it here but I worry about overstretching the boundaries of the "fair use" doctrine.

Let them drink Grand Marnier!

2007-12-21T19:43:00.000-08:00

A proposal out of Tacoma to "treat" chronic street alcoholics by banning the sale of cheap wine caught the fancy of S.F. Chronicle columnist C.W. Nevius last week. The scheme is simple: in a defined "alcohol impact zone," stores are banned from stocking Thunderbird, Boone's Farm, Royal Gate, Takaa, and similar cheap rotgut.

If the homeless alkies want to buy Cabernet Sauvignon or Grey Goose, that's ok.

Public health authorities in Tacoma laud the idea, citing reduced emergency room admissions and other medical costs. That's not surprising. The same thing happened nationwide during Prohibition.

The logic by which Nevius calls this simple class-based Prohibition scheme "treatment" escapes me. It's just one more aspect of the ubiquitous economic bias that Prof. Merrill Singer describes so vividly in his recent book, "Drugging the Poor," reviewed here.

Back from Iraq with a monkey on their back

2007-12-16T23:26:00.001-08:00

Jon Marshall's News Gems website writes:

"ABC News' investigative team, led by Brian Ross, worked with six graduate journalism students to discover whether troops returning home after serving in Iraq are facing the same battles with drug addiction as soldiers did when they came back from Vietnam. For their series, "Coming Home: Soldiers and Drugs," the students traveled across the country from Fort Carson in Colorado to Fort Bragg in North Carolina to examine the accuracy of the Army's assurances that drug abuse among ex-combatants isn't growing. Their findings:

Many of this country's bravest men and women who volunteered to defend America in a time of war have come home wounded -- physically and mentally -- and are turning to illicit drugs as they adjust to normal life, according to soldiers, health experts and advocates." Source.

The five programs are available online here.

Afghan farmers see through "drug war"

2007-12-16T23:04:00.000-08:00

Recent U.S. initiatives to eradicate poppy fields in selected areas of Afghanistan, on the Colombian model, have met with growing resistance by Afghan farmers, according to a briefing paper by the Afghanistan Research and Evaluation Unit (link):

"The view that the government is willing to deepen the poverty of some of its rural population for the sake of a ban on opium poppy cultivation further alienates the rural population. The belief of many farmers that those enforcing the ban and eradicating their crop are themselves actively involved in the opium trade makes matters worse; so does the perception of widespread bribery and the sense that eradication targets the vulnerable and ignores the crops of those in positions of power and influence."

Afghan farmers are seeing that the eradication efforts are aimed mainly at growers or dealers who are competitors to the growers and dealers connected with the Afghan government and its sponsors. A secondary aim of eradication may be to reduce the over-all supply in order to maintain prices. The Afghan farmers are seeing firsthand what the "war on drugs" is all about and they're not buying into it. The study's authors caution that Afghan farmers will continue to grow the poppy until they're presented with a reasonable alternative -- and none is in sight.

Girl, 8, asks cops for help with drunken mom

2007-12-16T22:21:00.000-08:00

"Help me. My mother is drunk, and she crashed her car," said an 8-year old Tampa FL girl to troopers last week who were checking on a car wreck.

With the girl inside, the mother had sideswiped two other vehicles before hitting a parked car head-on and coming to a stop. The girl got out of the wreck, unhurt, and approached the first officer on the scene.

"Ever time she drinks she gets like this," said the girl. The mother was booked for drunk driving, child abuse, and related charges. Source.

Sponsors rat on pigeon

2007-12-16T21:18:00.000-08:00

Two Alcoholics Anonymous sponsors took the witness stand in federal court in Des Moines IA recently to denounce their former sponsee, Thomas Vasquez, as "a pathological liar" lacking "the capacity to be honest." Source.

Vasquez probably deserved the slams. He was a paid government informer trying to build a case of extortion against incumbent Democratic state senator Matt McCoy. A Bushie federal prosecutor brought the transparently political case. The jury threw it out after less than two hours of deliberation, including lunch.

But ... should AA sponsors be testifying as character witnesses against their former sponsee? Isn't that against some rule?

War of the drugged

2007-12-16T20:57:00.000-08:00

From the Guardian (U.K.):

The army today admitted that cocaine was becoming the "drug of choice" for British service personnel.
Colonel John Donnelly, who has responsibility for army discipline, said a significant increase in drug taking by soldiers could be linked to stress induced by the demands of combat operations.
More on this topic.

Whine tasting

2007-12-16T20:51:00.000-08:00

It had to come to this.

The California Republican Party issued two press releases attacking the California Democratic Party for spending campaign money on a wine tasting fundraiser.

The Democrats shot back, pointing out that the Republicans spent four times as much on wine for their events, plus sending untallied bottles of a rare vintage to major donors. Source.

Dual diagnoses have same root?

2007-12-16T20:17:00.000-08:00

Substance abuse and mental illness very commonly go together. One hypothesis to explain the correlation is to see the patient using alcohol/drugs to medicate the mental disorder. Another view sees the mental disorders as the symptoms of excessive drug/alcohol ingestion. Now comes Dr. Andrew Chambers and his researchers at the U of Indiana Medical school with a study that suggests both theories are wrong. Based on experiments with adult rats, Chambers found that both substance abuse and mental disorders probably stem from a malfunction in the amygdala, a small region within the brain that plays a role in numerous processes, including the memory of emotionally charged events. Read details. Read blogger Jason Schwartz's piece on the same issue, here.

Don't wait till kids are in middle school

2007-12-16T17:42:00.000-08:00

A study of underage drinking finds a big jump in alcohol use in children between the fifth and sixth grades, and suggests that waiting to deal with an alcohol issue in the home until the child is in middle school is too late. Source.

The researchers urge parents to "talk to their kids about alcohol" when the kids are ten or eleven, or earlier. But talking alone isn't going to cut it, if the parents themselves are setting bad models of alcohol use in the home. The research really suggests that if one or both of the parents have an alcohol problem, the time to deal with it (at the latest) is when the kid is still in primary school.

Marijuana smoke nastier than cigs

2007-12-16T17:36:00.000-08:00

Dec. 14, 2007 -- New research from Canada shows that some toxins may be more abundant in marijuana cigarettes than tobacco cigarettes.

The researchers burned 30 marijuana cigarettes and 30 tobacco cigarettes on a machine in their lab, measuring levels of chemicals in the smoke.

Ammonia levels were up to 20 times higher in marijuana smoke than in tobacco smoke. Levels of hydrogen cyanide and nitrogen-related chemicals were three to five times higher in marijuana smoke than in tobacco smoke. Read more.

99 per cent wouldn't use drugs if legal

2007-12-16T17:26:00.001-08:00

A recent poll of 1000 U.S. adults asked if they would use "hard" drugs such as cocaine or heroin if they were sold legally. More than 99 per cent said they would not. Source.

The numbers undercut the argument of "war on drugs" supporters that drug prohibition is a necessary dam against widespread drug use.

Quite the contrary, says David Borden, CEO of StopTheDrugWar.org. For example, rates of marijuana use in the Netherlands, where it's sold legally in "coffee shops," are only about half those in nearby France, where marijuana use is an arrestable offense.

Evolution at work

2007-12-16T17:02:00.000-08:00

A drunk man in Thailand stopped to urinate and poked his member through a crack in a fence.

On the other side of the fence, a vigilant puppy spotted this invading one-eyed albino rat, and promptly sank its teeth into it.

Doctors at the hospital said the member "should still be useful" to the man in the future. Source.

A good question

2007-12-16T16:56:00.000-08:00

A new policy in New Jersey allows cops to ask drinking drivers who served them their last drink. Source.

Some bar owners are upset because existing law already makes barkeepers liable for serving patients who are drunk.

Cops answer that the question helps them spot bars that ignore the law.

Surprising finding about youth drinking (NOT)

2007-12-16T16:43:00.000-08:00

A study of 11,000 persons in London found that teens who drank to excess (4 drinks or more per session, once a week or more often) were twice as likely to snag a criminal conviction by age 30. They were also much more likely to become alcoholics, to use hard drugs, and to become homeless. Source.

The study is being used as fodder for an Australian provincial government campaign to crack down on youth drinking. A worthy cause, no doubt, but did the study control for factors such as family income, education, and environment?

College profs modeling alcoholism for students?

2007-12-16T16:25:00.000-08:00

College students' drinking excesses continue to make news. A prof at R.Y.S. (wherever that may be) points out in his or her blog that the students may just be copying their profs.

"Can we acknowledge that there is a huge amount of alcoholism in academia? Not the cute Dudley Moore kind, but the kind that makes us less sharp and ends our lives early? I'd imagine every one of us knows a colleague who needs a mid-morning 'refresher' or who always smells slightly of drink. I remember seeing my supervisor trying to be inconspicuous checking all the (empty) wine bottles at a reception, hoping there was a glass left in one of them, and finally making a glass by combining all the remnants red and white wine that were left. I remember drinking with him at a local bar until well past midnight (having started at four). And is there any function in academia that doesn't involve alcohol?"

Read the whole thing. Good point. A college administration trying to cope with its students' alcohol excesses needs also to look in the mirror. It'll be hard to get a handle on student conduct if the faculty's drinking is out of control.

CIA up to its old tricks?

2007-12-16T15:58:00.000-08:00

A tantalizing hint that the CIA is up to its old tricks (flying drugs from conflict zones) surfaced in the crash landing of a Gulfstream II business jet in Mexico Sept. 24.

The Florida-based craft carried somewhere between three and six tons of powder cocaine, and either no heroin or up to one ton of heroin, depending on which estimates one believes.

The flight originated in Colombia and was destined for Florida with a stopover in Cancun.

Blogger FrostFireZoo.com reports that the serial number of the craft matches those of a plane used by the CIA on at least three occasions in the rendition of terrorism suspects from Guantanamo to other countries to be tortured.

A Mexican journal accused Mexican and U.S. political authorities of hypocrisy for waging a so-called "war on drugs" on the one hand, and being heavily invested in the lucrative drug trade, on the other.

Foxfire.com observes that the amount of drugs said to be on the plane diminished with every official Mexican press release on the incident, and speculates that the subtracted amounts disappeared back into the market.

The photos of the crash scene, above, originated with Mexican press sources. For a video with commentary on EVTV, click.

P.S. Aug. 26 '08: Someone has removed the photos of the crash scene from this blog, and from the original source website as well. However, a video containing the same or similar still photos is still available online here: http://www.evtv1.com/player.aspx?itemnum=10106 -- See them before they're gone.

Alcoholocaust

2007-12-15T10:54:00.001-08:00

If you have illusions about the role of alcohol in creativity, read "Day of the Dead" by D.T. Max on p. 76 of the Dec. 17th issue of the New Yorker. It's a thumbnail bio of Malcom Lowry, author of "Under the Volcano" (1947), hailed as one of the top twelve English novels of all time; he was considered the heir of James Joyce. He died ten years afterward, after passing out from massive quantities of alcohol and barbiturates. He was 47.

The chronicle of his marriage and collaboration with Margerie Bonner is a tortuous, gruesome story of love, hate, help, hurt, rescue and revenge. Bonner, who edited and rewrote Lowry's texts daily, almost certainly contributed the discipline and warmth that raised "Under the Volcano" above the rambling, two-dimensional symbolism that was Lowry's best unassisted effort. He was consumed with rage at everything and everyone; his violent tirades drove all their friends away.

She tried for years to get him to cut down or stop his drinking, but ended up matching him bottle for bottle, and when he finally found a doctor who got him to take a break (using aversion therapy), she refused to stop, and dragged him down again.

Much of the article deals with the theory that she murdered him, for which many women acquaintances and critics applauded her. It's a thin case. British local authorities, who conducted the inquest, pinpointed asphyxiation by aspiration of vomit as the cause of death. That's not murder. But it hardly matters. Lowry was bent on death by alcohol sooner or later. During one of his few lucid moments, he described his own life as an "alcoholocaust."

If a movie is ever made of this marriage, it should be on a double bill with "Pollock," and made required viewing for young artists considering careers in alcoholism and addiction: don't go there.

Cartoon of the week

2007-11-11T10:08:00.000-08:00

From the Nov. 12 New Yorker (which consistently, over time, has published the best addiction cartoons, to my knowledge):

Well said

2007-11-11T09:31:00.000-08:00

Sometimes fiction writers (but aren't we all?) say it better than authors of solemn research monographs. In the Fiction section of the current New Yorker, writer Alice Mattison describes a character, Jerry, who, at dinner with his ex-wife and his daughter, shook his head when they suggested a glass of wine:

"... he so enjoyed being exactly as he was that he didn't want even the mild alteration in mood brought on by a glass of Chardonnay."

Well said! "So enjoyed being exactly as he was"!

On this topic, see also Katharine Hepburn, and (much more obliquely) Stereo Sue, or the Quale of Sobriety, both below. Thank you, writer Alice Mattison, for this brilliant little gem, one of several in her story.

Triggers in your ear

2007-11-08T09:56:00.000-08:00

Recovering people trying to minimize environmental cues about drinking and drugging should consider staying away from rap music and country music. Rock music, once believed the major gateway to drug abuse, is relatively safe.

Researchers who looked at the bestselling songs in several genres from 2005 found that 37 percent of top country songs featured references to drugs or alcohol, compared to just 14 percent of rock songs. Rap was worst with 77 percent. Source.

A short list of songs about drinking/drugging and NOT drinking/drugging is here, and a long collection of the same is here.

Researchers didn't, but should, look at classical music also. Item No. 1 for my mute-button list is Mahler's Das Lied von der Erde -- an operetta that celebrates being drunk and depressed. Oh, and what about that line in Beethoven's Ninth about being "drunk with fire"? LOL.

Choice Philosophy Gets a Boost

2007-11-08T01:27:00.001-08:00

A new publication by William L. White and Ernest Kurtz gives a boost to the principle that persons in recovery deserve a choice (a LifeRing motto, see the top of the start page of www.unhooked.com). Read about it in the LifeRing Convenor blog, here.

Mile wide and an inch deep

2007-11-04T01:02:00.000-07:00

Someone said Baptism in the South is a mile wide and an inch deep. Here's an example:

The cleaned-up version:

JOHNSON CITY – A Bristol Virginia Baptist preacher arrested in Johnson City in July pleaded guilty Thursday to driving under the influence.

Tommy Tester, 58, of 17425 Hobbs Road, Bristol, Va., was sentenced to 11 months and 29 days, suspended to 24 hours in jail, 16 hours of which he has already served. He will also have to spend 24 hours picking up litter.

Tester, the minister of Gospel Baptist Church, also entered a “best interest” plea to a charge of indecent exposure and was sentenced to five months and 29 days, suspended to probation.

Police said Tester, who was wearing a skirt, pulled up in his vehicle to Belmont Carwash, got out and urinated in a wash bay in view of children. Source.

The unexpurgated version here. -- Thanks, Kelly C., for the tip

Gender-specific response even in rats

2007-11-04T00:47:00.000-07:00

As if to illustrate again what Women for Sobriety founder Jean Kirkpatrick preached decades ago about people, a recent study found different responses to alcohol in female v. male rats. A group of rats selectively bred to be heavy drinkers were exposed to changes in their lights-on v. lights-off schedule, like employees who work rotating shifts, to test the effect of this stress on their drinking. The male rats subjected to the shifting schedule decreased their alcohol intake; the female rats slightly increased theirs. Details.

Recovery of Cognitive Abilities

2007-11-04T00:11:00.000-07:00

A study of sober alcoholics in their sixties or later, who had been abstinent for an average of about 15 years, found no cognitive impairment or other brain functioning defect. Details in Alcoholism: Clinical and Experimental Research, November '07. -- Thanks, Deena B., for the tip.

Rays of hope from Recovery Summit

2007-11-03T23:46:00.000-07:00

A Recovery Summit under the auspices of the federal Substance Abuse and Mental Health Services Administration (SAMHSA) convened with little fanfare in the winter of 2005, and its report has now been released. Among the "Guiding Principles":

There are many pathways to recovery. Individuals are unique with specific needs, strengths, goals, health attitudes, behaviors and expectations for recovery. Pathways to recovery are highly personal, and generally involve a redefinition of identity in the face of crisis or a process of progressive change. Furthermore, pathways are often social, grounded in cultural beliefs or traditions and involve informal community resources, which provide support for sobriety. The pathway to recovery may include one or more episodes of psychosocial and/or pharmacological treatment. For some, recovery involves neither treatment nor involvement with mutual aid groups. Recovery is a process of change that permits an individual to make healthy choices and improve the quality of his or her life.
Recovery is self-directed and empowering. While the pathway to recovery may involve one or more periods of time when activities are directed or guided to a substantial degree by others, recovery is fundamentally a self-directed process. The person in recovery is the “agent of recovery” and has the authority to exercise choices and make decisions based on his or her recovery goals that have an impact on the process. The process of recovery leads individuals toward the highest level of autonomy of which they are capable. Through self-empowerment, individuals become optimistic about life goals.
Recovery involves a personal recognition of the need for change and transformation. Individuals must accept that a problem exists and be willing to take steps to address it; these steps usually involve seeking help for a substance use disorder. The process of change can involve physical, emotional, intellectual and spiritual aspects of the person’s life.
Recovery is holistic. Recovery is a process through which one gradually achieves greater balance of mind, body and spirit in relation to other aspects of one’s life, including family, work and community.
Recovery has cultural dimensions. Each person’s recovery process is unique and impacted by cultural beliefs and traditions. A person’s cultural experience often shapes the recovery path that is right for him or her.
Recovery exists on a continuum of improved health and wellness. Recovery is not a linear process. It is based on continual growth and improved functioning. It may involve relapse and other setbacks, which are a natural part of the continuum but not inevitable outcomes. Wellness is the result of improved care and balance of mind, body and spirit. It is a product of the recovery process.
Recovery emerges from hope and gratitude. Individuals in or seeking recovery often gain hope from those who share their search for or experience of recovery. They see that people can and do overcome the obstacles that confront them and they cultivate gratitude for the opportunities that each day of recovery offers.
Recovery involves a process of healing and self-redefinition. Recovery is a holistic healing process in which one develops a positive and meaningful sense of identity.
Recovery involves addressing discrimination and transcending shame and stigma. Recovery is a process by which people confront and strive to overcome stigma.
Recovery is supported by peers and allies. A common denominator in the recovery process is the presence and involvement of people who contribute hope and support and suggest strategies and resources for change. Peers, as well as family members and other allies, form vital support networks for people in recovery. Providing service to others and experiencing mutual healing help create a community of support among those in recovery.
Recovery involves (re)joining and (re)building a life in the community. Recovery involves a process of building or rebuilding what a person has lost or never had due to his or her condition and its consequences. Recovery involves creating a life within the limitation imposed by that condition. Recovery is building or rebuilding healthy family, social and personal relationships. Those in recovery often achieve improvements in the quality of their life, such as obtaining education, employment and housing. They also increasingly become involved in constructive roles in the community through helping others, productive acts and other contributions.
Recovery is a reality. It can, will, and does happen.

That's a far better synopsis than one could have expected. Particularly laudable is the recognition, at the top of the list, that "there are many pathways to recovery." Equally enlightened is the acknowledgment that recovery is, at bottom, self-directed and empowering. LifeRing has been making those fundamental points as loud and clear as we are able. It's heartening to hear a gathering of recovery mavens at the national level articulate the same liberating concepts. Even though author William L. White wasn't listed as an author in the report's preface, it sounds a lot like White's New Recovery Movement advocacy. -- Thanks Don Phillips for the tip.

Why some alcoholics find it hard to quit smoking

2007-09-24T19:52:00.000-07:00

Joe P. from New Jersey said in an email to unhooked.com:

"The reason most Alcoholics find it so hard (to quit smoking) is because they get NO support from AA members, they tell them not to worry, just don't drink. That way of AA (Majority members, mostly Nicotine Addicts, even though there are a lot of others who say the same thing) is the way of Death!"

Joe should know, he is a long time member of AA who supports Nicotine Anonymous.

Another Court Rules that AA/NA are Religious

2007-09-13T07:49:00.001-07:00

A recent court case ruled that a parolee can sue a parole officer for damages if the parole officer requires the parolee to attend 12-step groups such as Alcoholics Anonymous or Narcotics Anonymous when this violates the parolee's religious or non-religious beliefs.

The case is titled Inouye v. Kemna, issued Sept. 7, 2007. The full text of the opinion is here. The court that issued the decision is the Ninth Circuit of the United States Courts of Appeal. The court's ruling is the law in California, Oregon, Washington, Arizona, Montana, Idaho, Nevada, Alaska, Hawaii, Guam, and the Northern Mariana Islands.

Ricky Inouye was imprisoned in Hawaii after conviction on drug charges, and served his time. As a Buddhist, he objected to participating in 12-step treatment programs because of their religious nature. After his release, he sued his parole officer, Nanamori, for giving him the "choice" of AA/NA meetings or prison.

When that case came to trial in the federal court in Hawaii, Nanamori argued that he, a parole officer, could not have known whether AA/NA are "religious" because the law on that issue was foggy at the time he ordered Inouye to participate (2001). If the issue was unclear, Nanamori was immune from suit. Nanamori won on that issue in the lower federal court in Hawaii. Inouye (or rather his son Zenn, Ricky having meanwhile died) appealed to the Ninth Circuit.

The Ninth Circuit's opinion makes short work of the claim that the law was fuzzy on the religious nature of AA/NA. The court points to virtually identical cases decided before 2001 by the federal courts of appeal for the Seventh Circuit (Illinois, Indiana, Wisconsin) and the Second Circuit (New York, Connecticut, Vermont), in addition to a string of similar cases in lower federal courts and in state courts, all with the same result. The "unanimous conclusion" of these courts was that coercing a person into AA/NA or into AA/NA based treatment programs was unconstitutional because of their religious nature. Because the law on this issue was "uncommonly well settled," Nanamori cannot claim immunity.

Accordingly, the Ninth Circuit sent the case back to the lower federal court in Hawaii to decide how much, if anything, Nanamori has to pay Inouye's estate in monetary damages.

The court's ruling means that criminal justice officers -- or, arguably, any agents of the state, local, or federal government within the bounds of the Ninth Circuit -- can be sued for damages if they ignore a client's religious or anti-religious objections and coerce the person to attend 12-step meetings or 12-step based treatment programs.

What should prisoners, parolees, and criminal justice officers do in response to this ruling?

(1) Prisoners and parolees who have problems with the religious content of 12-step programs should stand up for their beliefs and make their objections heard, loud, clear, early, and on paper. In this case, Ricky Inouye won in part because he wrote letters and filed suit promptly after he was coerced into 12-step programs. He held to his position consistently, and enlisted legal help as soon as possible. Prisoners and parolees need to make it clear both in words and deeds that they earnestly want to remain clean and sober, that they are willing to participate in alcohol and other drug treatment programs and to attend support groups, but that the religious content in the 12-step programs violates their constitutionally protected beliefs and interferes with their recovery. Prisoners and parolees can match these words with actions by demanding referral to non-religious (secular) treatment options, if they exist, and by taking the initiative to organize secular support groups, such as LifeRing, on their own.

(2) Officials in the criminal justice system (and other government officials with coercive powers over addiction offenders) need to offer their clients a choice between religious and secular treatment programs and support groups. The "choice" between AA/NA or prison offends the constitution, and officers who insist on it need to check their professional liability insurance. Government officials can help themselves as well as their clients by sending the message to treatment programs that the programs must embody a secular track along with the 12-step track, or risk losing referrals. Officials need to inform themselves and their clients about the availability of secular support group alternatives, such as LifeRing. Where clients take the initiative to organize such support groups, officials need to be cooperative and provide a level playing field when it comes to rooms, publicity, literature, referrals, and other resources. In an appropriate case, officials may take the lead in initiating secular support groups themselves.

The Ninth Circuit decision ruffles some feathers because it contradicts the belief of many AA/NA members that the 12-step approach is "spiritual not religious." Of course, these words can have many meanings. But as far as the First Amendment of the US Constitution is concerned, the 12-step approach is clearly religious, and the Ninth Circuit only joins a "march of unanimity" of other courts who have come to the same conclusion.

The basic thrust of this line of cases is that the constitutional guarantee of freedom of and from religion extends over the whole of the United States, including the ever-expanding areas enclosed by prison walls. Since such a large proportion of prisoners are there because of drug and/or alcohol abuse, this recent ruling serves as an important refresher. Jails and prisons, notoriously in California, are overcrowded and in deplorable condition. The Ninth Circuit's decision says that the freedom of religious belief or disbelief must not go down the drain along with so many other elements of civilized penal treatment.

[On Spring Break]

2007-04-01T19:13:00.000-07:00

Sometimes life overwhelms blogging. These past few weeks my days and nights have been so filled with work, love, and remodeling -- not necessarily in that order -- that there hasn't been time to keep up with the blog. I haven't even had time to watch the 14-part HBO addiction marathon. I'll be back when things settle down. -- Marty N.

Canada prof surprised by 12-step religious content

2007-03-20T23:25:00.000-07:00

Prof. Larry Moran in the Department of Biochemistry at the University of Toronto (photo) wrote in his blog that he read the articles about Alcoholics Anonymous in the March issue of Readers Digest (Canada) and then read the text of the twelve steps, and was "surprised at how religious AA must be. They must think that most alcoholics are Christians." This led to a lively exchange of comments, which see.

Reviews Pan Bill W bio-drama

2007-03-20T22:59:00.000-07:00

March 6, 2007, N.Y. Post:

Who would have guessed a drama about the founders of Alcoholics Anonymous would be the laugh riot of the year? But that's the unfortunate result of "Bill W. and Dr. Bob," the well-intentioned but haplessly executed effort written by novelist Stephen Bergman and clinical psychologist Janet Surrey that opened last night.

What should have been a powerful and inspirational story plays instead like a drunken road-show version of "The Producers."

Read full review

Broadway World.Com's reviewer writes:

A program note for Stephen Bergman and Janet Surrey's Bill W. and Dr. Bob advises us that performance of the work does not imply affiliation with nor approval or endorsement from Alcoholics Anonymous World Services, Inc.

Smart move, A.A.

Doing for alcoholism what Reefer Madness did for drug abuse (or at least what its New World Stages neighbor Sealed For Freshness does for Tupperware), Bill W. and Dr. Bob is a frightfully melodramatic bio-drama which uses the same kind of character-probing sensitivity one might find in a driver ed movie to tell the story of two men who, in dealing with their own demons, developed the treatment techniques that would birth Alcoholics Anonymous.

... The authors turn their heroes and everyone around them into cardboard cutouts ... while I can't imagine anyone feeling inspired or enriched by this misdirected corn, I know a few more evenings like this could have me swearing off theatre for a while.

Source.

Belgium ups the ante with cig warnings

2007-03-20T22:36:00.000-07:00

Cigarette packs sold in Belgium will soon have vivid pictures of the harm that smoking does, along with text warnings.

The pictures are not for the faint-hearted. One shows a man with a swollen-red tumour protruding from his neck. "Smoking can lead to a slow and painful death," reads the advice underneath. Another shows a smoker in a prison cell clutching bars made of cigarettes. The moral of the story? "Smoking is addictive. Don't start." Other pictures the Belgian government plans to rotate over the next three years show toothless gums, blackened lungs and open-heart surgery.

Canada already uses pictorial warnings along with text. Other European countries are expected to follow suit.

EU Health Commissioner Markos Kyprianou, introducing the new policy, said: "Pictorial warnings are a cost effective public health measure, which not only serve as a prominent source of health information, but are also likely to reduce tobacco use in the population." More.

Drug problem in Afghanistan getting worse, UN says

2007-03-20T22:15:00.000-07:00

NEW YORK: Despite efforts by the Afghan government and the international community, the drug control situation in the country is worsening, the International Narcotics Control Board (INCB) said in its annual report.

The production of illicit opium poppy in Afghanistan reached a record 6,100 tons in 2006, up almost 50 percent from the previous year, the report said.

Due to a rising level of Afghan opiate trafficking, the Vienna-based UN drug control watchdog added, the neighbouring countries are now faced with a wide range of problems, "such as organized crime, corruption and relatively high illicit demand for opiates."

Moreover, the drug abuse by injection is increasingly becoming one of the main factors behind the widely spread of HIV/AIDS in some areas of the region. Source.

Prisoners take hostage for nicotine

2007-03-20T22:07:00.000-07:00

JOHNSON CITY, Tennessee -- Two inmates housed in a smoke-free prison took a guard hostage and then released him and returned to their cells when given cigarettes.

Billy Grubb, 32, and Bradley Johnson, 25, attacked the guard Monday night, said Howard Carlton, warden of the Northeast Correctional Complex. Both are in prison for murder.

Prisons across the state are instituting no-smoking policies after the Legislature passed a law banning smoking in state buildings. -- Source

Anonymity is only for the anonymous

2007-03-12T07:17:00.000-07:00

Once again Alcoholics Anonymous has lent its name to the publicity thirst of another bratty celebrity. This time it's Britney Spears, whose publicist let the world know that she was given a pass from her upscale Malibu treatment program to attend an AA meeting. E.g. Source. Millions of 7-year old girls will now make a mental note to become alcoholics and get their names in the paper by going into rehab and to AA. It's great promotion for AA and for the celebs. But it reinforces the two-class system in AA. If you're in the celebrity class, your AA membership glitters like a glass pebble in a brightly lit goldfish bowl. If you're not a "name," you're in the dark. Anonymity is only for the anonymous. What would Bill W. say?

Bhutan: South Asia's alcoholism capital

2007-03-11T00:11:00.000-08:00

Bhutan has the highest per capital alcohol consumption of any country in South Asia, says a World Health Organization report, and alcoholism is becoming one of the leading causes of death there. Source.

State Dept drug report plays politics

2007-03-10T23:09:00.000-08:00

The U.S. State Department report on the worldwide illegal drugs trade issued March 1 reads like a political propaganda bulletin more than a real research report. Regimes that have Bush administration support, such as Colombia and Afghanistan, get patted on the head for their alleged drug control efforts, while heads of state that give Bush hell (as in Venezuela, Bolivia, and others) get blasted for alleged complicity in the dirty business.

The facts remain -- and the report admits -- that Colombia produces 90 per cent of the world supply of cocaine, and Afghanistan supplies more than 90 per cent of the heroin, and both are close allies of the Bush administration. Neither Colombia nor Afghanistan could achieve anything remotely near this kind of market domination without at least the active benevolence of their respective governments.

The report, which runs to 9 megabytes in PDF online (Vol. 1 here and Vol. 2 here), shows its political bias most transparently in the summary on Afghanistan. While admitting that Afghan opium production increased 25 per cent last year, the report claims that heroin stemming from Afghan opium is distributed almost exclusively in Europe, Russia, the Middle East and Asia. It claims that most of the heroin sold in the U.S. comes from poppies grown in Colombia and Mexico, which together account for only four per cent of the world supply.

The State Department strains credulity when it asks us to believe that the huge U.S. heroin demand is fed by this relative trickle of supply. The report says in one passing sentence that "Heroin produced from Afghan opium also finds its way to the United States" (Vol. 1, p. 19) but makes no effort to quantify this grudging admission.

The presence of Afghan heroin in the United States is a political landmine for the Bush administration. The bumper crops of opium recorded in Afghanistan since the invasion are unmistakably the administration's baby. To protect the administration, the State Department, the U.S. Drug Enforcement Administration and the White House Office of National Drug Control Policy all repeat the fairy tale that Afghan heroin in the U.S. is insignificant. But local police and treatment staff in many parts of the U.S. know better. Search this blog under "Afghanistan" for a selection of local news stories, many of them from the heartland, about heroin addiction and overdose deaths due to the high-potency white powder heroin made in Afghanistan under the protection of American troops by a regime propped up with American taxpayer dollars.

WHAT war on drugs?" As Gandhi reportedly said about Western civilization, "I think it would be a good idea."

New drug turns meth to almond extract

2007-03-09T22:49:00.000-08:00

A newly discovered drug with the catchy name YX1-40H10 can convert methamphetamine to benzaldehyde, a common food additive with an almond flavor, scientists at the Scripps Research Institute in California claim. If it passes a series of safety and efficacy tests, the new compound could be administered to people who have taken methamphetamine to neutralize the drug in the body. Source.

Research: impulsive rats quicker to do cocaine

2007-03-09T22:27:00.000-08:00

Rats who rank high in impulsivity -- the abstract doesn't make clear how that was measured -- are more likely to self-administer intravenous cocaine than their less impulsive peers, a group of scientists at Cambridge University has found. The study, led by Jeffrey W. Dalley, is significant because it found that the impulsive rats had a substandard set of dopamine receptors before being exposed to cocaine, thus supporting the hypothesis that dopamine receptor deficiency is a precondition, rather than a result, of chronic stimulant consumption. The study appears in the March 2 issue of Science. Abstract.

While the study sheds light on stimulant use, this model will not transfer so easily to other drug use profiles, particularly opiates and depressants such as alcohol.

IndyCar racer busted for DUI

2007-03-09T21:47:00.000-08:00

IndyCar Series driver A.J. Foyt is facing charges for driving under the influence of alcohol in Mecklenburg County, North Carolina.

The 22-year-old, who lives in Huntersville, N.C., was arrested on December 10 after running a stop light. He was released after posting a $1,000 bond, and will have to appear in court on April 9 to answer to the DUI charges. Source.

New Recovery blog reader Taylor M., who contributed this item, writes:

It will be interesting to see how the IRL handles this- especially given how backwards they are about tobacco and how much alcohol sponsorship is worth to the racing industry in general. It is interesting to note that drinking alcohol at all is generally considered a no-no in pro racing, most drivers only drink on the podium. There are some notable exceptions (Kimi Raikkonen ) but mostly it's frowned upon even if alcohol sponsorship isn't.

Brief skills training is effective to curb college drinking

2007-03-01T01:38:00.000-08:00

A study in Swedish colleges, where over-use of alcohol is widespread, showed that a Brief Skills Training Program was effective in reducing alcohol consumption over a two-year period.

Students were randomly assigned to a brief skills training program (BSTP) with interactive lectures and discussions, a twelve-step–influenced (TSI) program with didactic lectures by therapists trained in the 12-step approach, and a control group. More than three quarters of the students were rated "high risk" on an alcohol consumption score.

At follow-up two years later, the high-risk students who had received the BSTP program showed significantly better outcomes than high-risk students who had undergone TSI. The TSI students did no better than the control group.

The study results are in the March issue of Alcoholism: Clinical and Experimental Research. Abstract.

UK: "Restricted" report urges Rx heroin

2007-02-27T07:20:00.000-08:00

The government should consider providing free heroin to hard-core addicts through the National Health Service as a way to reduce crime, says a top-level report by the UK Home Office.

Marked "restricted" because of its controversial recommendations, the document was leaked to The Independent.

There is mounting evidence that trying to restrict the supply of drugs is impossible, says the document. Even if partially successful, supply restriction merely drives up the price of drugs and drives addicts to commit more crimes.

The report comes in a setting where cheap and potent Afghan heroin in unprecedented volume has been flooding into the UK from all ports of entry.

"There is a strong argument that prohibition has caused or created many of the problems associated with the use or misuse of drugs. One option for the future would be to regulate drugs differently, through either over-the-counter sales, licensed sales or doctor's prescription." Source.

For a historical review of similar policy recommendations, see the Transform Drug Policy web site.

Methadone abuse a growing killer

2007-02-27T07:01:00.000-08:00

When given in small, controlled doses, methadone is a well-documented treatment for heroin addiction. But taken in larger doses, without adequate medical supervision, and in combination with other drugs, methadone can be a drug of abuse, addiction, and death.

A federal government study found that nationwide methadone-related deaths climbed to more than 3,800 in 2004 from about 780 in 1999. Among all narcotic-related deaths in 2004, only cocaine killed more people in the United States than methadone. More from the Baltimore Sun.

Canada Readers Digest publishes "12 Steps to Nowhere"

2007-02-26T11:38:00.000-08:00

The Canada edition of Readers Digest has published an abbreviated version of award-winning journalist J. Timothy Hunt's article "Twelve Steps to Nowhere," which originally appeared in Toronto's Saturday Night magazine (offprint here). The piece is the author's personal story of recovery from severe alcoholism -- a recovery in which the author thoroughly investigated but strongly rejected the 12-step approach. Although some 60 per cent of successful recoveries from alcoholism occur outside of and without AA (Source), few and far between are the published personal narratives of non-AA recoveries. Readers Digest's publication of Hunt's compelling autobiographical essay hopefully signals a more evenhanded attitude toward all recovery pathways (at least north of the border). Read the piece in Readers Digest.

Drug dealers high on Bush pardon list

2007-02-26T10:56:00.000-08:00

"George W. Bush Likes Those Drug Dealers When It Comes To Pardons," says the Eye on Washington blog. Citing a complete listing of pardons in Wikipedia, the blog says that 14 of 113 Bush presidential pardons were for convicted dealers of marijuana, hashish, cocaine, methamphetamine and other drugs. Source.

Monkeys demonstrate nicotine reward

2007-02-26T10:04:00.000-08:00

Squirrel monkeys in cages will press a lever up to 600 times to get a shot of nicotine, researchers at the National Institute on Drug Abuse (NIDA) have found. The study demonstrates that nicotine has the same rewarding effect in nonhuman primates as other drugs of addiction. Source.

Moderation group said to be booze industry front

2007-02-26T09:50:00.000-08:00

The organization DrinkWise Australia, which was established to promote responsible drinking, claims to be independent, despite receiving millions of dollars from the alcohol industry whose representatives make up half its 12-member board.

The organisation received $5 million in Federal Government funding last year to raise awareness of alcohol misuse and "change the drinking culture in Australia". However, DrinkWise's credibility is now being questioned following the resignation of the chairman of its research advisory committee and accusations it is a front for the alcohol industry. More.

Nicotine, cocaine, heroin lead to similar brain damage

2007-02-26T09:38:00.000-08:00

A study of the brain tissue of deceased former smokers has found chemical alterations similar to the brain damage that cocaine and opiates cause in laboratory rats, according to researchers at the National Institute on Drug Abuse (NIDA). Abstract. Discussion.

U.S. docs more likely to warn minorities about drinking

2007-02-26T09:21:00.000-08:00

American doctors are twice as likely to warn African-American and Hispanic patients about drinking and drug use than white patients, a study by Harvard professor Kenneth Mukamal, M.D. (photo) has found.

"Yet blacks are less likely to be binge drinkers than whites," he said.

"It would be naive to disregard the possibility of racial bias or stereotype toward blacks and Hispanics in medical settings and assume that the difference in who gets counseling about alcohol use is coincidental," said one commentator.

Doctors should be asking about alcohol use, but should be asking about it across the board, Mukamal said. Details.