Choice Theory Conference

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

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

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

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

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

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

LifeRing in New Living (NY)

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

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

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

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

Class war in California counseling

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

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

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

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

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

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

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

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

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

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

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

Don't drink that marshmallow

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

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

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

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

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

No Such Thing as a Bad Person Addicted to Alcohol

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

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

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

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

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

First call

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

Seattle police chief tapped as 'Drug Czar'

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.  

End Stage

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

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

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

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

Genetics of mental illnesses: More is Less

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

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

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

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

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

Genetics: The more we see, the less there is

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

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

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

Spirituality strikes out

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

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

Invitation to Guest Authors

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

Confrontation Therapy, R.I.P.

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

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

....

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

...

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

...

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

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

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

Abstinence leads to rapid brain repair

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.

Humility R Us [NOT]

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

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

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

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

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

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

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

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

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

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

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

Alcohol Killed 'The Prophet'

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.

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.

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.

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?

War of the drugged

From the Guardian (U.K.):

The army today admitted that cocaine was becoming the "drug of choice" for British service personnel.

Colonel John Donnelly, who has responsibility for army discipline, said a significant increase in drug taking by soldiers could be linked to stress induced by the demands of combat operations.

More on this topic.

Whine tasting

It had to come to this.

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

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

Dual diagnoses have same root?

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

Don't wait till kids are in middle school

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

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

Marijuana smoke nastier than cigs

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

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

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

99 per cent wouldn't use drugs if legal

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

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

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

Evolution at work

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

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

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

A good question

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

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

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

Surprising finding about youth drinking (NOT)

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

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

College profs modeling alcoholism for students?

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

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

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

CIA up to its old tricks?

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

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

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

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

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

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

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

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

Alcoholocaust

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

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

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

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

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

Cartoon of the week

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

Well said

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

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

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

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

Triggers in your ear

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

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

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

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

Choice Philosophy Gets a Boost

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

Mile wide and an inch deep

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

The cleaned-up version:

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

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

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

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

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

Gender-specific response even in rats

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

Recovery of Cognitive Abilities

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

Rays of hope from Recovery Summit

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

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

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

Why some alcoholics find it hard to quit smoking

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

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

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

Another Court Rules that AA/NA are Religious

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

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

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

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

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

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

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

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

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

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

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

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

[On Spring Break]

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

Canada prof surprised by 12-step religious content

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

Reviews Pan Bill W bio-drama

March 6, 2007, N.Y. Post:

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

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

Read full review

Broadway World.Com's reviewer writes:

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

Smart move, A.A.

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

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

Source.

Belgium ups the ante with cig warnings

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.

Prisoners take hostage for nicotine

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

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

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

Anonymity is only for the anonymous

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

Bhutan: South Asia's alcoholism capital

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

State Dept drug report plays politics

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

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

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

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

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

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

New drug turns meth to almond extract

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

Research: impulsive rats quicker to do cocaine

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

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