Drug Mafioso Heads Afghan Anti-Narcotics Ministry

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.

Sliding into Iraqistan

[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

[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

[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

[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

[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.

Class war in California counseling

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.

Seattle police chief tapped as 'Drug Czar'

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

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.  

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.

Back from Iraq with a monkey on their back

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"

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.

Sponsors rat on pigeon

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?

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.

99 per cent wouldn't use drugs if legal

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.

CIA up to its old tricks?

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.

Another Court Rules that AA/NA are Religious

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.

Belgium ups the ante with cig warnings

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

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.