Middle Class Relaxing With Marijuana

A variety of middle-class people are making a conscious but careful choice to use marijuana to enhance their leisure activities, a University of Alberta study shows.

A qualitative study of 41 Canadians surveyed in 2005-06 by U of A researchers showed that there is no such thing as a 'typical' marijuana user, but that people of all ages are selectively lighting up the drug as a way to enhance activities ranging from watching television and playing sports to having sex, painting or writing.

"For some of the participants, marijuana enhanced their ability to relax by taking their minds off daily stresses and pressures. Others found it helpful in focusing on the activity at hand," said Geraint Osborne, a professor of sociology at the University of Alberta's Augustana Campus in Camrose, and one of the study's authors.

The focus was on adult users who were employed, ranging in age from 21 to 61, including 25 men and 16 women from Alberta, Quebec, Ontario and Newfoundland whose use of the drug ranged from daily to once or twice a year. They were predominantly middle class and worked in the retail and service industries, in communications, as white-collar employees, or as health-care and social workers. As well, 68 per cent of the users held post-secondary degrees, while another 11 survey participants had earned their high school diplomas.

The study also found that the participants considered themselves responsible users of the drug, defined by moderate use in an appropriate social setting and not allowing it to cause harm to others.

The findings should open the way for further scientific exploration into widespread use of marijuana, and government policies should move towards decriminalization and eventual legalization of the drug, the study recommends.

"The Canadian government has never provided a valid reason for the criminalization of marijuana," said Osborne. "This study indicates that people who use marijuana are no more a criminal threat to society than are alcohol and cigarette users. Legalization and government regulation of the drug would free up resources that could be devoted to tackling other crime, and could undermine organized crime networks that depend on marijuana, while generating taxes to fund drug education programs, which are more effective in reducing substance abuse," Osborne added.

The study was published recently in the journal Substance Use and Misuse.
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source: Science Daily

New Medication Shows Promise In Addiction Treatment

Prescription drug addiction continues to rage nationwide and across the region, despite state and federal intervention.

In 2006, nonmedical use of prescription painkillers drew the highest number of new users, or "initiates," than any other illicit drug, with 2.2 million users, according to the 2006 National Survey on Drug Use and Health.

And according to the U.S. Drug Enforcement Administration, there are nearly 7 million Americans abusing such drugs today – more than the number of those using cocaine, heroin, hallucinogens, ecstasy and inhalants combined.

Despite the alarming statistics, many insurance companies don’t cover substance-abuse treatment. In fact, Medicaid in Virginia didn’t cover the cost for anyone but pregnant women until last July.

Lisa Williams, director of the suboxone treatment program at Highlands Community Services in Abingdon, said one of the most difficult obstacles in combating prescription drug abuse is the availability of the drugs and the lack of viable treatment options.

Until 2005, methadone was the only treatment for opiate addicts, but it has a number of drawbacks. First, it can only be distributed at clinics, which in rural areas such as Southwest Virginia can be far away. Second, methadone gives its user a feeling of euphoria that mirrors the effect of an opiate, and the more methadone you take, the greater the high.

And perhaps the most telling drawback is the spike in methadone overdose deaths in the western district of Virginia. According to the state medical examiner’s office, there were 264 fatalities in 2006 from drug overdoses, 70 because of methadone. It’s the leading cause of fatal overdoses in the state.

Suboxone was introduced in the U.S. in 2005 as an alternative to methadone. Like methadone, the drug works to placate withdrawal symptoms and cravings in opiate addicts.

But, Williams said, the drug is superior in several ways. Because it does not give its user a feeling of euphoria, it has little potential for abuse. It simply satiates the cravings. It also has a "ceiling effect," which means exceeding the prescribed dose does not increase the patient’s relief.

Suboxone also can be prescribed by certified physicians across the country, which makes the treatment more convenient in rural communities.

But there are drawbacks. Strict criteria govern the treatment. In order to start on the drug, a patient must be in a specific phase of withdrawal and cannot be taking certain other drugs that interact poorly with suboxone. Also, only certified physicians can administer the drug, and they are limited in the number of patients they can treat.

Williams said those enrolled in her program have an astonishing 87 percent success rate at beating their addiction.

But some say the drug may not be all it’s cracked up to be. Suboxone is the most expensive drug per milligram on the black market today, said Richard Stallard, head of the Southwest Virginia Drug Task Force. An 8-milligram pill sells for $25 to $30 on the street, which means 80 milligrams – the average dosage of OxyContin – would cost more than $400, he said.

"There have been several suboxone arrests. I am not saying that it doesn’t work when used properly," he said. " ... But to say it has no potential for abuse is totally wrong. No one is going to spend $30 on a pill that don’t make you feel good when you use it."

Stallard said he started seeing the drug on the street about two years ago.

"Not many weeks go by in this area that there is not a suboxone purchased by undercovers [police]," he said. "I was here when oxy came in the mid-’90s. It started slow and then got big. Suboxone has some similarities."
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source: tricities.com

Men are more likely to crave alcohol when they feel negative emotions

Women and men tend to have different types of stress-related psychological disorders. Women have greater rates of depression and some types of anxiety disorders than men, while men have greater rates of alcohol-use disorders than women. A new study of emotional and alcohol-craving responses to stress has found that when men become upset, they are more likely than women to want alcohol.

Results will be published in the July issue of Alcoholism: Clinical & Experimental Research and are currently available at OnlineEarly.

“We know that women and men respond to stress differently,” said Tara M. Chaplin, associate research scientist at Yale University School of Medicine and first author of the study. “For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol-use disorders.”

As part of a larger study, the researchers exposed 54 healthy adult social drinkers (27 women, 27 men) to three types of imagery scripts – stressful, alcohol-related, and neutral/relaxing – in separate sessions, on separate days and in random order. Chaplin and her colleagues then assessed participants’ subjective emotions, behavioral/bodily responses, cardiovascular arousal as indicated by heart rate and blood pressure, and self-reported alcohol craving.

“After listening to the stressful story, women reported more sadness and anxiety than men,” said Chaplin, “as well as greater behavioral arousal. But, for the men … emotional arousal was linked to increases in alcohol craving. In other words, when men are upset, they are more likely to want alcohol.”

These findings – in addition to the fact that the men drank more than the women on average – meant that the men had more experience with alcohol, perhaps leading them to turn to alcohol as a way of coping with distress, added Chaplin. “Men’s tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain,” she said. “And this tendency may contribute to risk for alcohol-use disorders.”

There is a greater societal acceptance of “emotionality,” particularly sadness and anxiety, in women than in men, noted Chaplin.

“Women are more likely than men to focus on negative emotional aspects of stressful circumstances, for example, they tend to ‘ruminate’ or think over and over again about their negative emotional state,” she said. “Men, in contrast, are more likely to distract themselves from negative emotions, to try not to think about these emotions. Our finding that men had greater blood pressure response to stress, but did not report greater sadness and anxiety, may reflect that they are more likely to try to distract themselves from their physiological arousal, possibly through the use of alcohol.”
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source: Alcoholism: Clinical & Experimental Research

If Hazelden is healthy, why have almost all execs left?

A hard-charging outsider brought corporate sensibilities and a clash of cultures to the addiction center.

CENTER CITY, MINN. - Hazelden Foundation, the treatment mecca that made Minnesota a top destination for beating addiction, is in many ways enjoying some of its best years as a business.

The number of patients is growing. Donations are up. There's a new graduate school. A new women's center overlooks a lake on the bucolic campus.

So why, in just over a year, have nearly all of its top executives resigned?

Last month President and Chief Executive Ellen Breyer became the most recent of six executives to go, leaving a leadership vacuum just as a slew of initiatives launch.

The answer seems to rest in a clash of cultures -- between an iconic Minnesota institution steeped in tradition and a hard-charging manager who tried to haul it into the 21st century corporate world.

Admirers describe Breyer as a visionary who modernized the 59-year-old nonprofit institution, forging contracts with insurers and revamping its publishing business. Detractors bemoan a focus on money as a departure from Hazelden's mission of treating addicts, insured or not.

"Ellen was recognized for taking on an organization that I'm not sure wanted to be managed," said Ron Hunsicker, president of the National Association of Addiction Treatment Providers (NAATP). He credits Breyer with improving Hazelden's finances.

"The question is: Is it a happy organization? That's a delicate balance," he added.

Breyer was hired five years ago to reverse Hazelden's slide in an increasingly competitive national treatment market. Despite rosy financials, it hasn't regained its former stature. The choice of the next chief may determine whether Hazelden does that, or becomes just another little rehab on the prairie.

Glory days

Thirty years ago, Hazelden was the place a rock star like Eric Clapton would fly to from London for what was simply the best chance in the world to get sober.

Still highly regarded, it is no longer the go-to place it was in the 1970s and 1980s. Back then, as William Cope Moyers wrote in his 2006 memoir "Broken," to be treated at Hazelden was to be "part of a community of strangers who knew intimately why each of us was there, and so we all felt as one."

It started in 1949 in a farmhouse where men followed a recovery program based on the Twelve Steps of Alcoholics Anonymous. Teams of psychologists, chaplains and clinicians developed an approach that was copied worldwide.

But by the time Jerry Spicer became chief executive in 1992, managed-care companies had decided they didn't like what had become known as the Minnesota Model, with its costly, long-term inpatient approach. They preferred cheaper short stays and outpatient care. Hazelden felt the cost pressure. Hundreds of other centers closed or downsized.

An outsider moves in

A decade later, Spicer's successor, health care executive Nick Hilger, lasted one year. In 2002, Breyer was plucked from Hazelden's board and made president and chief executive.

She had been vice president for marketing at Ryan Companies, a commercial real estate developer. Breyer brought an outsider's corporate sensibilities to the insular treatment field.

Hazelden inked a contract with Blue Cross and Blue Shield of Minnesota, which now brings in about 30 percent of Hazelden's patient revenue.

That Blue Cross contract opened the floodgates to insured patients but squeezed out those at the high and low end. Therapists and alums used to referring patients couldn't always get their self-paying patients in the door. At the opposite end, charity care fell.

Still, it was hard to argue with the numbers: In 2007, Hazelden had operating revenues of $109.3 million and a record 10,754 patients. Donors gave a record $12 million.

Despite Hazelden's traditional devotion to abstinence-based treatment, Breyer approved use of new pharmaceuticals to treat addiction.

She won some fans. "People generally thought highly of Ellen," said Jill Wiedemann-West, Hazelden's senior vice president and chief operating officer of clinical and recovery services. "She brought a vision."

But to others, she represented a break from the Hazelden of old, where being in recovery was a credential as good as any fancy academic degree.

"The addiction field has been known for its warmth, its compassion, its affirmation," said Hunsicker. "Ellen brought with her a bit of an aloofness."

The treatment community felt the changes. "Hazelden used to be looked at as the mother ship, the mecca," said Dan Cain, president of the Twin Cities treatment agency RS Eden. "That level of awe, of deference, has diminished significantly."

Breyer sees Hazelden's role differently: "There's the recovery movement, and there's the AA movement. Then there are organizations, Hazelden being one of them, trying to provide services to people in these movements. We are not exactly the same. ... Sometimes people think we should match up."

The exodus begins

In 2006, Breyer brought in the Hay Group, New York consultants who grouped Hazelden's activities into three "strategic" businesses: treatment, publishing and the graduate school. Fundraising was a fourth important area.

"Trying to get your hands around that organization was like trying to sort stuff out of cotton candy," Hunsicker said. "Ellen, for good, better or worse, rolled up her sleeves and said I'm going to build some accountability."

That year, the National Association of Addiction Treatment Providers named Breyer Administrator of the Year.

By the next year, Hazelden executives began leaving.

General counsel Ivy Bernhardson became a Hennepin County judge. Carol Falkowski, director of research communications, is now director of chemical health at the Minnesota Department of Human Services. Both declined to be interviewed.

Chief Medical Officer Dr. Marvin Seppala left to head an in-home treatment program. Vying to return as Hazelden's chief executive, he declined to talk.

Mike Ranum, chief financial officer and chief administrative officer, joined an architectural firm in St. Paul. He did not return calls for comment. Nor did Tom Galligan, former market development chief.

All left, Breyer said, because of other opportunities. The departures "had very little, if anything, to do with me," she said.

Moyers, working on public policy, had become Hazelden's most recognizable public face. He also tried to leave last year but stayed after Hazelden funded a Center for Public Advocacy and put him in charge.

Moyers said he viewed the changes Breyer made as "necessary, challenging and inevitable" but added: "I knew it was going to be hard to get resources for things other than our bottom line."

The chairman of Hazelden's board of trustees, Norbert Conzemius, acknowledged that there was friction but said "every CEO that's trying to get a job done and manage change is going to meet resistance."

The last straw

Early this year, Breyer announced she was moving Hazelden's headquarters from near Center City to downtown Minneapolis. She wanted to raise Hazelden's Twin Cities profile.

Some employees and board members felt that location was all wrong. "There's nothing about it that reflects the spirit of Hazelden. It's entirely corporate," said a senior executive, who asked to remain anonymous. That move, the executive said, was the final straw.

On Feb. 1, Breyer told the Minneapolis St. Paul Business Journal her office would be at US Bancorp Center on the Nicollet Mall.

On Feb. 9, she suddenly backed out of a NAATP board meeting in Phoenix, explaining she had to attend a special Hazelden board meeting. Breyer said she resigned at that meeting because she had exceeded a self-imposed tenure of five years.

She leaves an organization scrambling to carry out initiatives she launched, including modernization of the Center City campus and a commitment for a $10 million expansion in Oregon.

Hazelden has begun rebuilding its leadership, although three positions -- chief executive, chief medical officer and chief financial officer -- remain open.

The next chief, said Hunsicker, needs to be "someone in recovery, someone well-known in this field. They can't bring in another outsider."
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source: Star Tribune

Promising Treatment Turns Into A Street Drug

He's a 35-year-old husband and father who grew up in a small suburb of Worcester. Prescription drugs led to heroin.

"I was doing dope every day."

She is a wife and mother, who got hooked on vicodin after surgery.

"I was just sick and tired of spending my money on drugs. I wanted to be clean," he told Team 5 Investigates.

But that changed when their doctors prescribed buprenorphine, also known as suboxone. "It got me clean for the first time in 10 years so they work, if you take them the correct way," he said.

"I was getting my life back," the mother said.

The little orange pill has been called a miracle drug by many medical experts. Suboxone is a safer way than methadone to treat heroin and painkiller addicts. Unlike methadone, a doctor prescribes suboxone.

"It prevents people from feeling withdrawal and it also gets rid of the craving," said Dr. Dan Alford, an opioid specialist with the Boston University Medical Center.

Suboxone is the only opioid for which doctors need special training and certification before they can prescribe it. Alford estimates that only 2 percent of physicians in the country, and in Massachusetts who are eligible to get the certification, actually do.

"Physicians aren't motivated to take this on, to embrace this," Alford said.

Patients prescribed suboxone sometimes get multiple refills, and often get little medical supervision. Only a small dose is needed, so some recovering addicts trade pills for heroin or OxyContin, or sell suboxone for between $5 and $15 per pill.

A recovering addict who declined to let Team 5 Investigates use his name said, "If you are getting a prescription of 120 and selling 90 of them, that's $900."

Team 5 investigates spent a day riding along with Tim O'Connor of the Worcester Police Vice Squad, and saw the problem firsthand.

"Those are his pills, he's just selling them," said O'Connor. He added that suboxone is starting to surface in nearly every drug bust.

A man who worked with police during a recent sting told Team 5 Investigates, "I walked to the first corner, looked around and asked for 'boxone. One guy had crack, one had dope, the other had suboxone."

Suboxone was never meant to be a street drug. In fact, it's the centerpiece of a multimillion-dollar government effort to shift the treatment of opiate addiction away from methadone clinics to private doctors' offices.

Even suboxone's manufacturer, Reckitt Benckiser Pharmaceuticals, uncovered disturbing trends in a report sent to the FDA earlier this year, including evidence of lax or inappropriate prescription by doctors. At a drug treatment center in Lynn, Mass., the report noted that a third of drug abusers said they used "bupe" to get high. More than a quarter of suboxone exposures involved children younger than 6 who found and ingested the drug in their homes. And, when mixed with other drugs, suboxone can be fatal. There have been 15 reported deaths since 2005.

Experts say the promise of suboxone treatment is tremendous when it's dispensed and supervised properly. But the great concern is, like the widely abused painkiller OxyContin, it is too often ending up in the wrong hands.

"I think similar to what happened with OxyContin, where there was a perception among the youth that it was safe, that it is a prescription medication, it's safe, so that is a concern," said Alford. "The solution is not clear to me."
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source: TheBostonChannel.com

Drug Addicts Can Learn How To Save Lives, Yale Researchers Find

Drug users can be taught to identify and quickly respond to overdoses of heroin or other opioids as effectively as medical experts, a Yale University study suggests.

The study supports efforts of some drug counselors, physicians and public health experts who have started community-based programs to train addicts and supply them with the opioid antagonist drug naxolone in order to respond to potentially fatal drug overdoses.

Naxolone, a medication lacking in abuse potential and routinely used by emergency medical personnel to treat heroin and other opioid overdoses, can be administered by a simple muscular injection. The drug temporarily combats effects of an overdose until medical help can arrive. Critics of such a harm-reduction strategy, however, have questioned whether drug users have the ability to recognize an overdose and can properly administer the drug. This study, recently published in the early online edition of the journal Addiction, suggests this concern is unwarranted.

"You have to keep people alive long enough to get access to drug treatment for their addiction,'' said Traci Craig Green, a doctoral candidate in the Yale School of Public Health and lead author of the research "You can't treat a dead person."

Ten individuals who were regular users of heroin or other opioid drugs such as oxycodone or hydromorphone were enrolled in the study at each of six sites across the United States. They were divided into two groups, one with members who had previously received training in overdose response and one with members who had not. Individuals were interviewed to determine if they could recognize signs of opioid overdose and when it was appropriate to administer naxolone. Their responses were then compared to those given by a group of medical experts.

The training, conducted well before the interviews were done, included recognizing differences between overdoses caused by opioids and those caused by other substances such as cocaine, for which use of the drug naxolone is not indicated.

"The study shows opioid users with training can spot an opioid overdose, are less likely to miss true opioid overdoses, and can determine whether naloxone should be administered and when it should not be administered,'' Green said.

The study was funded by the National Institute of Mental Health. Other authors included Robert Heimer and Lauretta E. Grau from the school of public health.
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source: Medilexicon

'Treatment works,' city-sponsored conference told

VANCOUVER - Treatment works for homeless, mentally ill drug addicts, despite many public myths that it doesn't, a senior public health authority said Tuesday.

It often seems that it fails because the treatment available in B.C. is sporadic, underfunded and a patchwork, Dr. Patrick Smith, a vice-president of the Provincial Health Services Authority of B.C., said at a conference on mental illness and addiction.

Smith said the evidence that treatment works for mental illness and drug addiction is stronger than the evidence for treatments for other diseases like cancer and diabetes.

"There are many things we don't understand about mental health and addiction, but there are many things we do understand," Smith told about 150 people at the conference. "Treatment works. I can't emphasize this enough. It's no longer okay for our leaders to believe there are not evidence-based approaches."

Afterwards, he said the reason people think treatment isn't effective is that the kind of treatment most mentally ill and addicted people get is so limited and erratic that it's bound to fail, the same way that giving someone a tenth of the dose of penicillin they need for an infection is also bound to fail.

"When you look at treatment that's applied with scarce resources, there's more failure," he said.

He pointed to the difference in the way cancer is treated in B.C., compared to addiction. The province has a comprehensive and aggressive system of care, which means people everywhere in the province have good access to the same standards of care.

As a result, B.C. has the best health outcomes in Canada for people with cancer.

The same could happen with addiction if the same resources and standards were applied, he suggested.

Smith and others emphasized that people have to stop seeing addiction, especially when it's combined with mental illness, as some kind of problem that can be cured with a magic-bullet, one-time-only miracle cure.

That's not realistic because it's an ongoing health problem, like diabetes, and needs to be treated that way.

"We are talking about chronic-disease management," said Soma Ganesan, the medical director of the psychiatric wards at the University of B.C. and Vancouver General Hospital. Ganesan said there needs to be a national strategy that comes with real money.

Others throughout the day agreed with Smith and Ganesan that the problem is not a lack of effective treatment, which they saw as including everything from early intervention and prevention to harm reduction to full-scale detoxification and recovery services.

But there are all kinds of gaps and dysfunctions in the system, particularly for the homeless mentally ill and addicted.

For years, mental illness and addiction treatments were run separately. That changed in 2003, but many speakers still talked about the fact that mental-health counsellors will often demand that clients get off drugs before getting help for their psychiatric problems.

As well, there are all kinds of barriers to communication. The drug-policy coordinator for Vancouver police, Insp. Scott Thompson, said his officers spend hours with mentally ill clients, picking them up and taking them to emergency rooms. Then they're told they can't have any follow-up information because it's a privacy violation.

The one-day conference was organized by the City of Vancouver as a way of focusing attention and building momentum to get system changes and more resources for people who have both psychiatric and addiction problems, a group that is a big part of the city's rising homelessness population.
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source: © The Vancouver Sun 2008

For Some Users, Cannabis Can Be Fiercely Addictive.

For a minority of marijuana users, commonly estimated at 10 per cent, the use of pot can become uncontrollable, as with any other addictive drug. Addiction to marijuana is frequently submerged in the welter of polyaddictions common to active addicts. The withdrawal rigors of, say, alcohol or heroin tend to drown out the subtler, more psychological manifestations of cannabis withdrawal.

What has emerged in the past ten years is a profile of marijuana withdrawal, where none existed before. The syndrome is marked by irritability, restlessness, generalized anxiety, hostility, depression, difficulty sleeping, excessive sweating, loose stools, loss of appetite, and a general “blah” feeling. Many patients complain of feeling like they have a low-grade flu, and they describe a psychological state of existential uncertainty—“inner unrest,” as one researcher calls it.

The most common marijuana withdrawal symptom is low-grade anxiety. Anxiety of this sort has a firm biochemical substrate, produced by withdrawal, craving, and detoxification from almost all drugs of abuse. It is not the kind of anxiety that can be deflected by forcibly thinking “happy thoughts,” or staying busy all the time.

A peptide known as corticotrophin-releasing factor (CRF) is linked to this kind of anxiety. Neurologists at the Scripps Research Institute in La Jolla, California, noting that anxiety is the universal keynote symptom of drug and alcohol withdrawal, started looking at the release of CRF in the amygdala. After documenting elevated CRF levels in rat brains during alcohol, heroin, and cocaine withdrawal, the researchers injected synthetic THC into 50 rats once a day for two weeks. (For better or worse, this is how many of the animal models simulate heavy, long-term pot use in humans). Then they gave the rats a THC agonist that bound to the THC receptors without activating them. The result: The rats exhibited withdrawal symptoms such as compulsive grooming and teeth chattering—the kinds of stress behaviors rats engage in when they are kicking the habit. In the end, when the scientists measured CRF levels in the amygdalas of the animals, they found three times as much CRF, compared to animal control groups.

While subtler and more drawn out, the process of kicking marijuana can now be demonstrated as a neurochemical fact. It appears that marijuana increases dopamine and serotonin levels through the intermediary activation of opiate and GABA receptors. Drugs like naloxone, which block heroin, might have a role to play in marijuana detoxification.

As Dr. DeChiara of the Italian research team suggested in Science, “this overlap in the effects of THC and opiates on the reward pathway may provide a biological basis for the controversial ‘gateway hypothesis,’ in which smoking marijuana is thought to cause some people to abuse harder drugs.” America's second favorite drug, De Chiara suggests, may prime the brain to seek substances like heroin. In rebuttal, marijuana experts Lester Grinspoon and James Bakalar of Harvard Medical school have protested this resumed interest in the gateway theory, pointing out that if substances that boost dopamine in the reward pathways are gateways to heroin use, than we had better add chocolate, sex, and alcohol to the list.

In the end, what surprised many observers was simply that the idea of treatment for marijuana dependence seemed to appeal to such a large number of people. The Addiction Research Foundation in Toronto has reported that even brief interventions, in the form of support group sessions, can be useful for addicted pot smokers.

In 2005, an article in the American Journal of Psychiatry concluded that, for patients recently out of rehab, “Postdischarge cannabis use substantially and significantly increased the hazard of first use of any substance and strongly reduced the likelihood of stable remission from use of any substance.”
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source: Addiction Inbox

Alcoholism: A Ride To Ruin

By BART O'CONNELL, Tribune correspondent
The Tampa Tribune
Published: April 29, 2008

Last Wednesday at Tampa Bay Downs produced one of those perfect racing afternoons - clear skies, a slight breeze, warm temperatures and a fast track.

Ronnie Allen Jr. grew up winning on days like that in the 1980s. Watching him romp to three wins on the card may have felt like a flashback to loyal followers of the track.

With unquestioned natural talent, many assumed Allen was just passing through back then, on his way to the top of the sport like another young rider who began a Hall of Fame career in Oldsmar - Julie Krone.

But Allen is just happy to be riding again, winning again.

Sober again.

Just as so many people in so many different worlds have come to know, alcoholism can destroy anyone's life. It came close to destroying Ronnie Allen Jr.'s.

"He's such a good kid. All he's ever done is hurt himself," said Ronnie's father, veteran trainer Ron Allen Sr. "It's tough when you know he should be a millionaire."

"I ruined my life. I almost ruined my career, I practically did. Disappointed my family so many times and disappointed myself," said Allen Jr., 44. "I could've been up there with the Jerry Baileys and the Mike Smiths, them guys, if I could have kept my head on straight."

Rise and Fall

Allen won his first of three Tampa Bay Downs rider titles in 1985, at 21. He would add two more in the next three years, becoming the first Downs' rider ever to win 100 races in a single meet in 1987. But it was then that Allen began to sink into the horrible habits that forced him to not only leave racing, but marriage, during a turbulent 20 years since.

"It had a lot to do with when I was younger, getting in the wrong crowd. That's what started me. Because in high school, I never drank," he said. "When I got to the racetrack and started to hang out with people that drank every day, I started drinking every day."

At his worst, Allen, weighing less than 120 pounds, would drink nearly a case of beer a day, opening his first at 6 a.m. after waking up. He also was arrested twice for driving under the influence in the 1980s, attending court-mandated rehabilitation programs each time. He resumed drinking about a month after each stint.

"He'd have a couple beers, and you'd try to tell him about it, and he'd say, 'Oh, I've got it under control,'" Allen Sr. recalls. "They all think they've got it under control, and then it's out of control again."

It was a spiral that extended through the 1990s, a decade punctuated by Allen's third DUI, a felony, in 1999. With his weight battles constant, and his mounts slowly drying up, he finally left racing in 2003, taking a job galloping horses at the Post It Stables in Jackson, Mich., owned by Jerry and Lisa Campbell, two of Allen, Sr.'s biggest clients.

"I really hit bottom, and the only way I was going to save my life was to quit drinking," he said.

Road To Recovery

Last August, a couple months after Allen Jr.'s mother, Betty, entered rehab for a similar alcohol addiction, he checked himself into the Family Recovery Center in Ohio. He spent 15 days there, undergoing detoxification and counseling. He emerged a changed man, attending daily Alcoholics Anonymous meetings and making Diet Coke and Propel Fitness Water his drinks of choice.

But because of his felony DUI, the state initially refused to grant him a license to return to racing. After stewards at Tampa Bay Downs vouched for Allen's soberness, he was granted a license and returned on Feb. 14, winning on his father's 7-year-old sprinter, Tricks of Glory. He has rapidly climbed up the jockey's standings since, and is now seventh overall with 40 victories.

"You couldn't pay him to take a drink, because he really woke up and wants to make something out of himself again," Allen Sr. said.

When the Tampa Bay Downs meet ends this weekend, the Allens will head to Presque Isle Downs in Pennsylvania. Allen Jr. will have the chance to visit his 16-year-old son, Christopher, who never knew his father sober until the past nine months.

"I hope he learns from my mistakes," Allen Jr. said.
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Bart O'Connell can be reached at boconnell@pop.tampatrib.com.

Substance and Substitution

Reviews
'Substance and Substitution is an extremely impressive work of scholarship and a genuine advance on existing studies of methadone maintenance treatment and of drug use more generally. It marries innovative theory with diverse empirical materials, and goes beyond a number of well-established binaries (e.g. resistance/conformity, social/material, body/mind, morality/medicine) in trying to understand the ‘co-production’ of substance, time, identities and gender.' - David Moore, Associate Professor, National Drug Research Institute, Australia.

Description
Located between three powerful phenomena, public health, the law and social stigma, methadone maintenance treatment attracts loyal advocates, vociferous critics and innumerable engaged onlookers. This book combines contemporary science studies theory with in-depth interviews, policy documents and media texts to examine this controversial approach to addiction, providing a unique approach to the understanding of illicit drugs. Arguing that methadone maintenance treatment depends for its rationale on two contradictory, yet equally powerful images - the disordered, compulsive heroin user and the responsible, choosing subject of contemporary health care - this book traces the ways the program both reproduces and disrupts conventional understandings of what it means to be human, a citizen, a woman or man, questioning, as it does so, the conditions under which treatment is delivered.

Contents
Introduction
1 Substitution, Metaphor and Authenticity
2 Governing Treatment
3 The Chronotope of the Queue
4 Treatment Identities
5 Repetition and Rupture: The Gender of Agency
Conclusion: Dependence, Contingency and the Productivity of Problems

Author Biographies
SUZANNE FRASER is Lecturer at the Centre for Women's Studies and Gender Research, Monash University, Australia. Her research interests include gender, science, the body and health. She is the author of Cosmetic Surgery, Gender and Culture.

KYLIE VALENTINE is a Research Fellow at the Social Policy Research Centre, University of New South Wales, Australia. She is the author of Psychoanalysis, Psychiatry and Modernist Literature.
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Publisher : Palgrave Macmillan