Alcohol: The Most Anti-Social Drug

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]

Recover and Be Killed

[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.

If Alcohol Were Invented Today

[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."

Stone Sober -- and Absolutely Fascinating

[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.

Some Progress on Campus

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.  

Treatment promo research results

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.

Well said, in Washington

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

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.  

Genetics: The more we see, the less there is

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.

Abstinence leads to rapid brain repair

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?

"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

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.

Alcohol Killed 'The Prophet'

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

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

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!

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.

Girl, 8, asks cops for help with drunken mom

"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.

Whine tasting

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.

Don't wait till kids are in middle school

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.

Evolution at work

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.