Tuesday, July 31, 2007

Court makes it easier for patients to enter rehab

HARRISBURG — Pennsylvanians battling drug and alcohol addiction will not need a second opinion from their HMO before entering treatment programs, a state appeals court ruled.

In a unanimous decision released Thursday, Commonwealth Court ruled that group insurance companies and HMOs must cover drug and alcohol treatment costs for policy holders referred to detoxification, rehabilitation and outpatient programs by a doctor or psychologist.

The ruling will help about 15,000 state residents with private insurance who seek substance abuse treatment each year, said Deborah Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania.

"It’s a really important decision that I think gives power back to doctors and psychologists," said Beck, whose Harrisburg-based organization represents licensed treatment centers and school-run counseling programs. "Somebody at the end of an 800 number in another state … should never be making these decisions."

The case centered on a 1989 state law that required insurance companies to cover drug and alcohol treatment services.

Aetna, Independence Blue Cross, the Insurance Federation of Pennsylvania and other managed-care groups sued the state Insurance Department, arguing that insurers should be allowed to review drug and alcohol treatment referrals to keep down costs and make sure treatment is appropriate.

But the court sided with the Insurance Department’s interpretation that treatment would be covered as long as a doctor or psychologist prescribed the treatment.

Samuel R. Marshall, Insurance Federation of Pennsylvania Inc. president and chief executive officer, said he was unsure if the ruling would be appealed to the state Supreme Court.

Marshall said state law allows insurers to review treatment in other health care areas before paying for care and believed it was reasonable that drug and alcohol services be included.

The reviews would be conducted by physicians or psychologists, Marshall said.

"I think utilization review can help get better treatment," Marshall said. "Excess utilization and high utilization patterns drive up the cost of health care and, therefore, the cost of health insurance. The experience across the country is that when you don’t have scrutiny over treatment patterns, you do get increased cost."

But Beck said limiting obstacles to treatment is important when dealing with addicts.

"If you make [getting treatment] complicated, the addict will disappear and die," Beck said. "This is a life-saving law upheld by the court."

source: Bucks County Courier Times

author: Kori Walter

Saturday, July 28, 2007

Why the scourge of alcoholism defies a cure

Headlines out of Hollywood tell tales of addiction, but for millions in the U.S., the stories hit close to home

The titillating gossip this week might be all about the latest Hollywood celebrity to fall off the wagon and get arrested for alleged drunken driving just weeks after completing a stint in rehab.

But for millions of ordinary Americans struggling to free themselves from alcohol addiction, the story of star Lindsay Lohan inspires not self-satisfied tut-tutting but rather a grimly familiar dread.

Despite decades of research and dozens of treatments, alcoholism, America's most common addiction, remains notoriously difficult to overcome.

More than 30 percent of U.S. adults have abused alcohol or suffered from alcoholism at some point in their lives, according to a study released this month by the National Institute on Alcohol Abuse and Alcoholism, a branch of the National Institutes of Health.

Yet only a quarter of those afflicted received any treatment. And other studies show that, at best, only a quarter of those who seek treatment manage to abstain from alcohol for a year.

"Alcohol problems are not just something that affects Hollywood stars," said Dr. Robert Swift, a psychiatrist at Brown University who specializes in alcoholism. "We're talking about a chronic, relapsing condition. And we still have a long way to go in treatment. It's like treatment of cancer -- some people can be helped but others just cannot."

There are traditional "12-step" treatments for alcoholism, such as the program pioneered by Alcoholics Anonymous, that rely largely on peer support to encourage abstinence. There are a variety of behavioral and cognitive therapies employed by psychologists and psychiatrists to help patients avoid the triggers and thought-patterns that impel them to drink. There is a new generation of drugs to help curb an alcoholic's craving to drink.

And there are posh, inpatient rehabilitation centers -- the retreats of choice for infamous celebrities, disgraced politicians and other well-heeled alcohol abusers -- that sometimes sound more like spa resorts than rigorous treatment clinics.

But despite all that variety, experts say there is no unambiguous, foolproof treatment for alcoholism that ensures success.

That's because researchers are learning that alcoholism, like addiction to narcotics, causes permanent changes to the brain that can at best be ameliorated but never permanently undone. Moreover, scientists have discovered that some people are genetically more susceptible to develop alcoholism if they start drinking, just as some people are more likely to develop diabetes if they eat poorly and don't exercise.

"Once you become an alcoholic or a drug addict, you can't go back," said Swift. "It's something that becomes a chronic illness. So the idea that you go through rehab and you're cured is really kind of a ridiculous idea. You wouldn't expect that with diabetes, so why do people expect it with alcoholism?"

The scientific findings have begun to change the popular perception of alcoholism as a mere failure of will on the part of the drinker to stop drinking.

"The first drink may be volitional, but after one becomes addicted, it becomes a compulsion," said Ann Bradley, spokeswoman for the National Institute on Alcohol Abuse and Alcoholism. "Although we're always to be held responsible for our actions and their outcome, it's pretty fair to say that the most addictive drinking is well outside the control of the drinker."

For more than 70 years, since Alcoholics Anonymous was founded in 1935, complete abstinence from alcohol has been regarded as the only antidote to the disease of alcoholism -- and even then, alcoholics never regard themselves as "cured," but rather in a state of ongoing recovery or remission.

Just one drink, the theory went, and an alcoholic was destined to descend into a debilitating spiral of relapse.

But experts say that AA is successful for only about 1 in 5 alcoholics. And relapses are so characteristic of the disease that no other combination of drugs or therapy offers much better results, if the measurement is total abstinence maintained for at least a year.

So rather than discourage alcoholics by insisting on a goal many cannot reach, some addiction experts have begun changing the definition of success.

A 2005 study by the federal government's alcoholism institute determined that nearly 36 percent of U.S. adults suffering from alcoholism could be considered to be in "full recovery" after a year, if the definition of recovery was expanded to include not only complete abstainers (18.2 percent) but also "low-risk" drinkers (17.7 percent) who had managed to cut back, but not completely curtail, their alcohol consumption.

"There's a shift in the treatment approach toward being a little more flexible and being respectful of the patient's goals," said Dr. Edward Nunes, a psychiatry professor at Columbia University in New York and an addiction expert. "There are many patients for whom abstinence is still the best outcome and the one you should shoot for, but it's clear from clinical experience that there are some patients who can move from problem drinking back to a level of moderated drinking that's not problematic any more."

If that sounds to skeptics like moving the goal posts to make alcoholism treatment statistics look better, Nunes says that's not the intention of clinicians.

"When we're working with an individual patient, we're not worried about making the numbers look better," he said. "To me it's a question of how best to engage a patient. If a patient doesn't want to deal with [complete abstinence] right off the bat, it may be better to go with them a certain distance in order to build a relationship."

source: The Tribune via Alcoholics Anonymous Reviews.

Friday, July 27, 2007

Celebrities giving rehab a bad name

Celebrities like actress Lindsay Lohan and pop star Britney Spears are making a mockery of rehabilitation programs by appearing not to take treatment seriously, U.S. addiction experts warned.

Lohan was arrested Tuesday on a second drunken-driving charge just days after leaving her second stint in rehab flaunting an alcohol-monitoring ankle bracelet at nightclubs.

Spears twice spent less than a day in rehab before entering a third time for a month after behaving erratically.

"It is making a mockery of rehabs," said Harris Stratyner, a psychologist with Caron, a non-profit addiction treatment organization.

"In some ways it's starting to make rehabs look like a joke and that's very sad because hundreds of thousands of people a year are saved."

Lohan, 21, spent a month in rehab in January. But after crashing her car May 26, she checked in for another six weeks of treatment at another centre. She was charged last week with drunken driving in relation to that accident.

Hours after Tuesday's arrest, Lohan's lawyer said she had suffered a relapse and was "presently receiving medical care."

In February, Spears checked into rehab -- for the third time in a week -- where she spent the minimum 30 days after a spree of high-profile partying and unusual behavior such as shaving off her hair.

Upon finishing treatment, the 25-year-old singer completed her divorce from dancer and aspiring rapper Kevin Federline.

To avoid relapsing, rehab patients are advised to stay away from "high-risk" situations, including people who could put direct or subtle pressure on them and places where it is easy to obtain drugs or alcohol. They are also told to reduce the stress in their lives and engage in healthy activities.

Most treatment centres also recommend they attend a 12-step recovery program meeting every day for the first month after leaving rehab and then go regularly to such meetings.

Jon Morgenstern, of the National Center on Addiction and Substance Abuse at Columbia University, said it was not uncommon for people to need several rounds of treatment but that those "waltzing" in and out of rehab for short periods could be perceived as not taking their problem seriously.

source: Michelle Nichols, Reuters

Wednesday, July 25, 2007

Missing Person Alert

Edit: She Has Been Found!

A fellowship friend has passed this on to me:
Hello: We are trying to get this info to as many of our fellowship as possible. I hope you feel inclined to help if so please get this info posted to as many recovery blogs as possible. Thank you.

Dear Fellow AA Members:

Please forward this email to as many members of AA as possible nationwide. We need your help.

Steve Tate is a fellow member of AA. His wife Francine has been reported missing. Details can be viewed at http://www.channel3000.com/news/13726948/detail.html

Or www.francinetate.com .

Prior to her disappearance, Steve and his wife had taken a member of AA into their home. He had been traveling the country, using the local general service offices to find meetings and contact AA members. He would frequently stay at AA member’s homes. This person is currently considered a Person of Interest for questioning only. The local officials feel he may have important information regarding this case.

His description is as follows:

  • Name-Randy
  • White Male
  • 35 to 40 years old
  • 5’-6” tall
  • Thin build, approximately 135 lbs
  • Brown shoulder-length hair, usually pulled back in a ponytail
  • Crooked teeth
  • Sun-weathered skin
An important detail is that Randy was traveling with a 7-month old puppy, possibly a black lab mix. He kept the dog on a red leash and appeared to have a great deal of affection for the dog.

If anyone has seen this individual, please contact the State of Wisconsin Dane County Sheriff’s office at the following number. Dispatch @ 608-255-2345, callers can remain anonymous and there is no caller ID on this phone.

Please remember that he is only a PERSON OF INTEREST and should not be detained.

Thank you for you help and support.


Telephone counseling may help problem drinkers

A few phone conversations with a counselor might help patients who abuse or who are dependent on alcohol cut back on their drinking, at least in the short term, a new study suggests.

Researchers found that after just six telephone sessions with a counselor, men and women with alcohol problems were able to reduce their drinking.

All of the study participants had their drinking problems identified through screening during a routine visit to the doctor's office. None had been seeking treatment for alcohol abuse.

The findings, say the study authors, suggest that screening and phone-based counseling might help people who otherwise wouldn't have their problem drinking addressed.

"The study shows that we shouldn't just give up on those alcohol-dependent patients who cannot or choose not to get treatment," lead study author Dr. Richard L. Brown said in a statement.

"If we can identify these folks in primary care waiting rooms and provide telephone counseling ... we can start to help many of these patients," he said.

Brown and his colleagues at the University of Wisconsin in Madison report the findings in the journal Alcoholism: Clinical & Experimental Research.

The study involved nearly 900 adults with an alcohol disorder who were randomly assigned to one of two groups. The treatment group had telephone sessions with a counselor to talk about ways to cut back on alcohol; each call was followed by a letter from the counselor that summarized the conversation.

The comparison group received only a pamphlet on maintaining a healthy lifestyle, which included information on alcohol.

After three months, patients in the counseling group were drinking less, the study found. The men had a statistically significant reduction in total alcohol consumption (17 percent) and in the number of "risky" drinking days (31 percent).

Women also reduced their drinking, but the changes were not statistically different from the reductions seen in the women in the comparison group. It's possible, according to Brown's team, that simply being screened for problem drinking spurred many women in the comparison group to cut back.

Experts have called for primary care doctors to routinely screen patients for alcohol abuse. These findings, according to Brown's team, suggest that when drinking problems are spotted, many patients might benefit from phone counseling.

"Getting patients to participate in the counseling sessions was actually much easier than we thought it would be," Brown said. "Once they had established rapport with that counselor over the phone, many patients really looked forward to their sessions."

The researchers are now studying whether the drinking improvements last for up to a year.

source: Alcoholism: Clinical & Experimental Research, August 2007.

Tuesday, July 24, 2007

How chance encounter saved him

Today, Bob Tracey runs Tracey Real Estate on Avenue S in Marine Park, one of the top five real estate offices in Brooklyn. His company handles mega-millions in annual sales, and Tracey has a loving family, a fine Marine Park home, a summer house in Breezy Point and two other real estate offices, specializing in getting affordable Brooklyn homes and mortgages for cops and firefighters and other civil servants.

He also owns the Brooklyn Proud apparel label and sits on the local community board and the Marine Park Civic Association.

Tracey leads a very successful, privileged life but also gives back - heavily sponsoring the Hurricanes football team, all the local Little Leagues, the local cadets and countless local charities.

It almost didn't happen.

Back on the night of Feb. 10, 1978, Tracey was a 28-year-old raging alcoholic stumbling into the Sheepshead Bay Road subway station.

"I was 240 pounds, hugging a six-pack of Rheingold," he says. "I grew up in the Sheepshead/Nostrand Projects, where I ran the street hard. My father worked sales for the phone company. Most of the guys I went to Resurrection grammar school with were doing great. I hit bottom."

Tracey drank alone in a tiny furnished room on Avenue P and Nostrand where his father paid for a phone that worked only for incoming calls.

"I walked the streets smoking clippies from the gutter," Tracey says. "I almost died when I was beaten with a crowbar. I drank rotgut wine. I wanted to die more than I wanted to live."

Tracey says that on that winter night at the subway station, he saw the Manhattan train light blinking and planned on jumping the turnstile.

"But for some reason the token booth clerk just waved me in," Tracey says. "It was like passing through the gates to salvation. Because when I got onto the platform God sent me a messenger. He was an old guy. He had a beard. He wore a hat. He sat on a bench. His name was Irving."

Tracey sat in the vacant seat next to Irving. Frightened, the old man rose and hurried down the platform.

Tracey followed.

The train roared into the station in a gust of icy wind.

Wary, Irving climbed aboard the train.

"I looked menacing, ravaged," Tracey says. "The doors were closing; I looked Irving in the eyes. The fear went out of his face. He held the doors for me. And my life forever changed."

In the three stops to Kings Highway, where Tracey got off, Irving told Tracey that he was in Alcoholics Anonymous and that Tracey should come to a meeting.

"I gave Irving my phone number," Tracey says. "I went home to my room, littered with beer and wine bottles, stinking of urine, and I drank. But Irving started to call me. He called me for nine consecutive Monday nights asking me to come with him to an AA meeting. I used to pretend I was my brother. Then on April 25, 1978, Irving called and said, 'Tracey, I'm coming to get you.'"

Irving came and took Tracey to his first AA meeting, where an alcoholic named Ray was celebrating his 25th anniversary of sobriety, telling his own inspiring story.

"I've been sober since," Tracey says. "I always told Irving that God sent him to me. But Irving was agnostic and he said it was just a twist of fate. We agreed to disagree."

On his hard road back from the darkness of active alcoholism, Tracey took a job at Fillmore Realty.

"I did okay," he says. "But I kept asking my father, who was an usher at Resurrection Church, involved in the Cub Scouts, Marine Park Civic and well-liked in the community, to open a real estate office with me.

"He told me that if I could find a storefront on Avenue S between E. 36th and E. 37th Sts., he'd do it with me. I think it was his way of saying I wasn't ready."

But Tracey soon found a storefront for $300 a month. They built an office. All of his father's goodwill in the community paid off as locals gave Tracey Real Estate their listings.

"When we started to get successful, my father said to me, 'You know how you give back? You don't do it to get anything. You do it because someone did it for you.' He was so right.

"This community has been very good to me. I could go on all day about how grateful I am for the success I have. But nothing is as important or valuable to me as my sobriety because if I didn't have that first I wouldn't have a great family, a nice home, a successful business. So, I will never forget Irving, who died last Aug. 30. If Irving had not held the subway doors for me on Feb. 10, 1978, I wouldn't even be here."

source: New York Daily News
author: Denis Hamill

Sunday, July 22, 2007

The Effect Of Alcohol On Aggression

The link between alcohol and aggression is well known. What's not so clear is just why drunks get belligerent. What is it about the brain-on-alcohol that makes fighting seem like a good idea "and do all intoxicated people get more aggressive" or "does it depend on the circumstances"?

University of Kentucky psychologist Peter Giancola and his student Michelle Corman decided to explore these questions in the laboratory. One theory about alcohol and aggression is that drinking impairs the part of the brain involved in allocating our limited mental resources -- specifically attention and working memory. When we can only focus on a fraction of what's going on around us, the theory holds, drunks narrow their social vision, concentrating myopically on provocative cues and ignoring things that might have a calming or inhibiting effect.

The scientists tested this idea on a group of young Kentucky men. Some of the men drank three to four screwdrivers before the experiment, while others stayed sober. Then they had them all compete against another person in a somewhat stressful game that required very quick responses. Every time they lost a round, they received a shock varying in intensity. Likewise, when they won a round they gave their opponent a shock. The idea was to see how alcohol affected the men's belligerence, as measured by the kinds of shocks they chose to hand out.

But there was more to it. Giancola and Corman also deliberately manipulated some of the volunteers' cognitive powers. They required them -- some drinkers, some not -- to simultaneously perform a difficult memory task. The idea was to see if they could distract those who were "under the influence" from their "hostile" situation. If they could tax their limited powers of concentration, perhaps they wouldn't process the fact that someone was zapping them with electricity.

And that's exactly what happened. As reported in the July issue of Psychological Science, the drunks who had nothing to distract them were predictably mean, exhibiting aggression towards their adversaries. However, the drunks whose attention was focused elsewhere were actually less aggressive than the sober non-drinkers. This seems counterintuitive at first, but it's really not: the sober men were cognitively intact, so they would naturally attend to both provocations and distractions in the room, resulting in some low level of aggression.

It appears that alcohol has the potential to both increase and decrease aggression, depending on where's one's attention is focused. The psychologists speculate that working memory is crucial not only to barroom behavior, but to all social behavior, because it provides the capacity for self-reflection and strategic planning. Activating working memory with salient, non-hostile, and health-promoting thoughts, in effect reduces the "cognitive space" available for inclinations towards violence.

source: Medical News Today

Wednesday, July 18, 2007

On the long road to recovery

The last time former Surrey city councillor Gary Robinson was in the public eye, he was addicted to crack cocaine and recovering in hospital from second- and third-degree burns on 25 per cent of his body after he was doused in rubbing alcohol and lit on fire in an apparent drug-related attack.

It was a devastating low for a man who spent 12 years on municipal council with ambitions of becoming mayor, only to fade off the radar in 1999 shortly after going public with his cocaine and alcohol abuse problems.

Now he's clawing his way out of seven years lost to drugs, and is trying to bring others along with him.

Robinson, 51, has been in recovery for over a year, and earlier this month officially opened Trilogy House, a Newton recovery home for men.

The centre, which has been running since February and now houses 10 men, is the result of Robinson's frustration with a lack of treatment facilities in Surrey.

"There are a lot of people in positions of making decisions that don't understand the problem, because people do want help," Robinson said in a cellphone interview from a U-Haul truck packed with furniture and blankets donated to Trilogy House.

"It's just amazing the number of people who want to get help but can't," Robinson said, adding he's turning away two or three people a day from the centre.

Trilogy House is funded through a combination of private donations and the provincial assistance that clients receive.

Robinson -- who said the worst part of addiction was "not being with my kids and not being with my family and not seeing any way out" -- tried treatment three times before he finally stayed clean.

He is using his experience to shape the recovery program, which he says is unusual because it doesn't force residents to follow a schedule.

When men first come off the street, all but the most serious cases undergo an initial detox at Trilogy House. After that, Robinson said, they are encouraged to just hang out at the centre for "TV and DVD recovery," before they move on to counselling to address the underlying problems behind their substance abuse. The process can last from three months to a year, Robinson said.

The Fraser Health Authority, which stretches from Burnaby to Hope, has 40 detox beds with an average occupancy of 95 per cent.

"Certainly we need more," said Lois Dixon, executive director for mental health and addiction with the health authority, adding that longer-term housing and support is also "hugely missing, because it's often one of the factors that leads people to relapse."

Trilogy House was founded with the help of Robinson's wife, Susan Sanderson, president of the local NDP riding association.

Robinson is currently rebuilding relationships with his family, including his sons, Derek, 19, and Trevor, 17.

"It's wonderful," said Sanderson, saying that Gary took Trevor to the recent Roger Waters concert and helped Derek fix his car.

Although he says he's still recovering, Robinson is already thinking of running for council in the next election.

Coun. Marvin Hunt, who once served with Robinson, said he'd be open to working with him again, saying when his former colleague slid into drug addiction it was a tragedy for the city of Surrey.

Hunt said ultimately it will be up to voters to decide whether Robinson is ready for the job again, adding he thinks his current work might be more important that politics. "I think his greatest story will be his recovery," Hunt said.

source: The Vancouver Sun
author: Catherine Rolfsen,

Tuesday, July 17, 2007

Getting high: Quebecers push Canada to top of list

Were it not for prodigious pot use in Quebec, Canada would not have placed first in a United Nations drug study of marijuana use in the industrialized world.

In fact, were Quebec a sovereign nation, it would have finished first ahead of Canada, according to a breakdown of data supplied by Canada for the study.

The biggest difference between Quebec and the rest of Canada is seen in the youngest age groups. According to the Health Canada 2002 Youth Smoking Survey, which looked at marijuana as well as tobacco, 32 per cent of students in Grades 7 to 9 in Quebec have smoked marijuana at least once.

This compares with 18 per cent in British Columbia, which ranked second in Canada, and 11 per cent in Ontario, which ranked lowest among provinces and territories.

The 2007 World Drug Report of the UN Commission on Narcotic Drugs made headlines last week when it said Canada topped the list of industrialized nations for marijuana use.

Spain topped the world for cocaine, Iran for heroin, Australia for ecstasy and the Philippines for amphetamines.

In the Montreal area, police say, marijuana consumption has become a particular problem in the booming suburbs north of Montreal and Laval.

Of the 10 high schools in metropolitan Montreal that saw the greatest number of police interventions related to drug use in 2005, nine were in the northern suburbs, according to an analysis of police records in February by the Journal de MontrEal.

Schools in Terrebonne and Mascouche had the worst drug problems, according to the Journal study, which involved 83 access-to-information requests from 163 high schools in 41 Montreal-area municipalities, including the city of Montreal.

No English-language schools were in the top 25 list.

Overall, marijuana use in Quebec is running 12 per cent higher than the national average, according to the most recent inter-provincial comparison, the 2004 Canadian Addiction Survey, co-ordinated by Health Canada. That was the main study used by the UN to determine Canadian consumption.

In Quebec, addiction experts say, marijuana has surpassed alcohol as the drug for which young people are most likely to seek treatment in publicly funded rehabilitation centres.

"It's really cannabis (i.e., marijuana) that is the substance that is the most problematic among youths that come to treatment centres today - more than for alcohol, certainly," said Michel Landry, director of research for the Centre Dollard Cormier.

The centre co-ordinates publicly funded drug rehabilitation services in the Montreal region for Quebec's Health Department.

Alcohol still causes more societal problems in terms of risky sexual behaviour, property damage and person-on-person violence, Landry said. And overall, marijuana is still considered among the "least addictive of all psycho-active substances," said Jurgen Rehm, a senior scientist with the Toronto-based Centre for Addiction and Mental Health.

But marijuana, for whatever reason, is becoming more of a worry to those who actually use it, or at least those who believe they are dependent on it.

Whether increased demand among Quebec youth for marijuana-related rehab services reflects the escalating potency of the illegal crop, or the prevalence of grow operations in southwestern Quebec, are not questions that are easily answered, Landry said.

The 2007 World Drug Report found 16.8 per cent of Canadians age 15 to 64 used marijuana in 2004; only four countries, all non-industrialized, had higher rates - Papua New Guinea, the Federated States of Micronesia, Ghana and Zambia.

The 16.8 per cent figure was arrived at after making adjustments to the data sent to the UN by Canada. The data, which consisted mainly of the Canadian Addiction Survey findings, found 14.1 per cent of Canadians admitted to using marijuana at least once in 2004. The figure for Quebec was 15.8 per cent, so Quebec consumption was found to be running 12 per cent higher than national consumption overall.

In Quebec, the Institut de la statistique du QuEbec tracked 5,000 high school students in grades 7 to 11 from 2000 through 2004 and found consumption rates had dropped to 35 per cent from 40 per cent in that period.

Landry and Rehm said policy-makers shouldn't get too concerned by data over lifetime or past-year consumption rates, by which a certain percentage of people are said to have tried marijuana at least once in their lives, or at least once in the past year.

The key figure for addiction experts is chronic consumption. And as far as marijuana is concerned, Landry and Rehm said, all the data suggest only five to 15 per cent of Canadian marijuana users are "problem" users - a proportion that is more or less the same for users of alcohol and other drugs.

source: The Montreal Gazette

Monday, July 16, 2007

Survey: 1 in 12 U.S. workers using drugs

One in 12 full-time workers in the United States acknowledges having used illegal drugs in the past month, the government reports.

Most of those who report using illicit drugs are employed full-time, with the highest rates among restaurant workers, 17.4 percent, and construction workers, 15.1 percent, according to a federal study being released Monday. About 4 percent of teachers and social service workers reported using illegal drugs in the past month, which was among the lowest rates.

Federal officials said the newest survey is a snapshot and was not designed to show whether illicit drug usage in the workplace is a growing problem or a lessening one. The current usage rate is 8.2 percent. Two previous government surveys reflected a usage rate of 7.6 percent in 1994 and 7.7 percent in 1997, but those studies involved a much smaller sample of interviews.

The latest study comes from the Substance Abuse and Mental Health Administration, an agency within the Health and Human Services Department. The data is drawn from the agency's annual surveys in 2002, 2003 and 2004 of the civilian, non-institutionalized population. Each survey included interviews with more than 40,000 people, who were each paid $30 to participate.

Joe Gfroerer, an agency official, said most of the illicit drug use involved marijuana.

Anne Skinstad, a researcher and clinical psychologist, called the survey's results "very worrisome" because there are fewer treatment programs than there used to be to assist employees and employers with a dependence on drugs.

However, testing programs for drug use are fairly prevalent, with 48.8 percent of full-time workers telling the government that their employers conducted testing for drug use.

"I used to train supervisors to detect chronic use and intervene as early as possible, and that is a very good, constructive way rather than firing people," said Skinstad, an associate professor and director of the Prairielands Addiction Technology Transfer Center at the University of Iowa. "Some employers want drug testing. I'm not sure that's the way I would like to go. What I think I would like to focus on is employee performance."

The study also showed that the prevalence of illegal drug use reported by full-time workers in the past month was highest among younger workers.

Nineteen percent of workers age 18 to 25 said they used illegal drugs during the past month, compared with 10.3 percent among those age 26 to 34; 7 percent among those age 35 to 49; and 2.6 percent among those age 50 to 64.

Men accounted for about two-thirds of the workers - 6.4 million - who reported using illegal drugs in the past month, the government said. Men were also more likely than women to report illegal drug use in the past month - 9.7 percent for men, versus 6.2 percent for women.

The study also looked at alcohol use by workers. About 10.1 million full-time workers, or 8.8 percent, reported heavy alcohol use. Heavy alcohol use was defined as drinking five or more drinks on one occasion at least five times in the past 30 days.

source: The Associated Press

Friday, July 13, 2007

Alcohol and Drug Treatment Programs Uncovered!

It appears that there's an increasing amount of people who suffer from alcohol and drug related addictions. I’m not sure if the problem is actually worse than it used to be or whether folks are just more honest about it these days, but it’s a major crisis nonetheless. Hi everyone, my name is Bob and I'm an Alcoholic and pharmaceutical drug addict in recovery. I never found my way to the doors of the alcohol and drug treatment programs, but I wished to god I had, and the reasons are obvious.

Those who face up to their problems and admit complete defeat have overcome the biggest hurdle of recovery, which is admitting they are powerless over their drug of choice and that their life has become somewhat unmanageable as a consequence. Heaven knows we addicts have tried long enough and hard enough to kick our habits, but will-power alone and a fierce determination to stop did little to help. Drug alcohol addiction, or any serious addiction come to that, often means those who suffer could do with a bit of a kick start onto that road of recovery, and this is where the alcohol and drug treatment programs really come into their own.

Do I Need Alcohol and Drug Treatment Programs?

Only you are able to answer that. If you're reading this introduction, then there's a chance that either you or someone you know, is having problems with drugs or alcohol. If you're not sure whether that person is an addict of not, you might want to read our short piece entitled, 'What is Drug Addiction', for which there is a link above this page (Addictions). By the way, just in case you were wondering, alcohol classes as a drug too.

For me personally, even when I’d admitted defeat to myself, it still took a while to finally put a plug in the jug and a lid on the pills. I found the fellowship of Alcoholics Anonymous a great help and I can't say enough good about those guys and their 12 step program of action. But for me those rooms had a revolving door and I was in and out a fair bit before I finally got the message. That message was that there was nothing in my life today that a drink of drug could possibly make better. On the contrary, the longer I stayed out there the worse it got. If I hadn't been so stubborn, and checked myself into one of the fine alcohol and drug treatment programs, I could have saved myself and those closest to me, years of countless turmoil.

But it takes what it takes, and all I'm saying here is that there are so many free alcohol rehab programs around for drug alcohol addiction, (and many more paid options for those who can afford to be selective), that it's just crazy not to check in and get a head start in recovery. It really is a tragedy to see addicts suffering unnecessarily, while at the same time destroying their lives and the lives of those around them. If this is you and you've hit your rock bottom, or you're just sick and tired of being sick and tired, then why not check out the free drug rehab centers or alcohol support centers in you're neighborhood.

This is the twenty first century, and no one, and I mean no one, need to go through the physical and emotional ringer for any longer than they choose to. There is so much help and support for recovering alcoholics and drug addicts, that it's just impossible not to find some kind of drug and alcohol rehabilitation program near your home.

What if I don't Qualify for Alcohol and Drug Treatment Programs!

If you say you're an alcoholic and or drug addict, then you are. These kinds of addictions are the only form of illness where we diagnose ourselves. But if for some reason you don't feel you belong in the alcohol and drug treatment programs, or perhaps you feel them to be a little extreme in your case, then simply go along to any AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) meeting and see if you connect.

The only requirement for membership at these anonymous meetings is a genuine desire to stop drinking or drugging. You will be welcomed with opened arms and nurtured back to health by those in the group if you want their help. There are no dues of fees for these memberships as they are self supporting through their own contributions. There's usually an endless pot of coffee and plates full of cookies too, which all add to the informal, friendly, and relaxeed atmosphere to what is otherwise a serious program.

So you see, the alcohol drug treatment centers are not a necessity for getting clean and sober, they are simply there to support those that have tried all other measures to quit but failed. Alcohol rehab programs, and the anonymous fellowships are by no means the only way people have gotten themselves cleaned up and back into a free and sober lifestyle, but they are the only ones I have any experience and authority to write about, evaluate, and respect.

If I kick drug alcohol addiction, what will become of me?

This is a real classic and a question asked by many newcomers into sobriety! So many active drunks and addicts have convinced themselves that their recurring compulsion to indulge in more of the same has at least given them some escape, or comfort in day to day living. Look folks, most of us take mind altering substances because we want to change the way we feel. We don't cope too well with sobriety so we opt for comfortably numb or just plain out of it!

We have a tendency to magnify any negative thoughts and minimize positive ones. Drugs and alcohol, for most of us, has silenced that storm from raging in our heads. We think that the moment we stop drinking of drugging, we shall become the hole in the donut, a life full of nothingness being lived by a nobody! Well, I literally know 100's of recovered aditcts and drunks and nothing could be further from the truth. Sure it's the end of your life. It's the end of your old life and the start of a new one. A life that you never dreamed possible if you just give yourself a break!

Sobriety is great and I'm grateful for it, but it only comes to those who really want it. If you're ready to get into action and take that first step in whatever drug or alcohol treatments you decide upon, this moment right here and now, could be the turning point you've yearned for, for so long.

source: http://www.treatmentsgalore.com/

Tuesday, July 10, 2007

Mother's ruin: how my mother's drinking sent me down that same dark road

The truth is, I was born drunk. I lay screaming on the delivery table, blowing out alcohol fumes as if my life depended on the stuff, the smell so strong a theatre sister asked who'd been drinking - so my mother told me, years later.

She had tippled gin the night before to calm her nerves and my father, a consultant anaesthetist, told me she'd been drunk again on the way home from hospital a few days later.

He'd smelled her breath, stopped the car and dragged her out onto the road. "You useless bloody woman," he bellowed, shaking her shoulders. "Can't stay sober long enough to have a bloody baby."

"I know what I'm doing," she shouted back. "I'm a doctor, too, you know." That was how they went on all the time. She was terrified of him and drank because of his shouting, and he shouted because of her drinking.

By the time I was 12, my mother was a chronic alcoholic. I watched her drink from the bottle until, one day, the tables turned and the bottle began to drink her; all of her. In a matter of months, she turned from being a strikingly beautiful woman into a pickled old prune, her youth sucked utterly dry.

As for drinking, I started really young myself, heading exactly the same way as my mother; drinking simply because there were so many things I couldn't face.

By 17, I couldn't even dry my hair without a glass of something in my hand. I had watched for years as booze stripped my mother of her face, friends, figure and life - yet I let it set about destroying me as well.

It was almost impossible to believe how privileged my mother's own childhood had been; her family's beautiful homes in Guernsey and London, the servants, a first- class education at a top girls' school, Roedean.

Her mother, Lady Edith De Saumarez Craig, had been a debutante presented to the Queen. Her father, Sir Maurice Craig, was a prominent psychiatrist famous for treating the Royal Family. But my mother had swallowed the silver spoon she'd been born with and had nothing left over.

My mother, Monica, met my French father, Claude, as medical students at Edinburgh University. Conventional and ambitious, he fell for her ebullience and passion.

My parents moved to a terrace of three-storey Georgian houses in Murrayfield, Edinburgh, in 1949, and in their early days they both drank a lot and liked a good time. But it wasn't long before my father's beautiful wife became an embarrassment.

By the time I was eight, they were restricting their social life to the odd cocktail party, until she started sneaking into the pantry for drinks - and was seen, standing in a smart party frock, tippling straight from a bottle.

She invariably ended up in an armchair, dress pulled up to reveal her underwear, legs apart, brain elsewhere.

My father - scolding, disapproving and unhappy - kept everybody at arm's length, including his children. My brothers Michael, Peter and Richard, who were just a few years my senior, were dispatched to Ampleforth College in Yorkshire, and when they came home, they either stayed in their rooms or went out.

Because the neighbours were polite, nobody ever said anything when Mummy staggered out in the mornings, her black leather shopping bag full of rattling empties. Eventually, her drinking made her reluctant to leave the house. By the time I was ten, she was sending me out to collect stashes of vodka from a friend.

One day, I arrived back with the booze to find Mummy shaking. "Hurry up, you stupid bitch," she shouted. "You should be at school by now. You're always late."

She snatched the bag from me and took the bottles up to her bedroom. Minutes later, she was back out on the landing, begging me to go to buy some cheese and a loaf of bread - her favourite snack.

I loved Mummy more than anything, but just wanted her to be normal like other kids' mothers, to bake scones, make us meals and look after us.

If I found one of Mummy's bottles of vodka after she'd had too much, I'd chuck half the contents away then refill the bottle with water. Usually, she was too drunk to notice. If she did realise, she beat me on the bare bottom with a belt.

The scariest times were when she came into my bedroom in the middle of the night, drunk, stumbling about in the dark. On one of these nights, she fell on top of me and lay there, refusing to move, a ton weight. I felt all the air being squeezed out of my chest as she crushed me into the mattress.

Often, drunk and full of sleeping pills, she would perch on a chamberpot in her room at night and fall asleep sitting like a Buddha until, eventually, something would startle her and she'd jump, sending the pot and its contents flying over the carpet.

She spilled medicine and booze onto that carpet every single day of her life.

I was ten when I arrived home from school and found I couldn't get into the house. The door was blocked by something large. I realised to my horror it was Mother motionless - possibly dead.

Dad was on one of his frequent climbing trips, so I ran to a phone box and dialled 999. The police smashed their way in and I could see she was lying on her back in a torn nightdress, her face tear- stained and bruised from the fall.

I put my arms around her and hugged her for the first time in years, amazed at the sense of relief I felt.

"I thought you were dead," I said. "Poor Mummy."

They took mother to hospital, where she became more and more agitated. She pointed at me, screeching: "That girl there, she's trying to poison me."

She lurched towards me, raising one hand as if to slap my face. A male nurse grabbed her arm.

Back at home, life carried on as normal. My father grew more and more remote, staying away from my mother as much as possible.

At 13, I went to board at a convent in Littlehampton, Sussex. There, in the middle of a lesson, my mother stormed in. She had come all the way from Edinburgh.

Seeing her standing in my classroom - her hair dishevelled, wild eyes darting, made my heart thump. The room went quiet, then my mother turned to me and screeched: "Nic, I've come to get my skirt . . . that one you're wearing. I need it to go away on holiday. Take it off immediately."

She came closer, until I could see the pinks of her eyes. I wondered whether she had slept recently. She must have stopped drinking for a few days and developed delirium tremens, the DTs. I knew the highpitched voice and ridiculous, illogical requests from past experience.

"All I want is a short holiday but I can't go if Nicola doesn't give me that skirt," my mother complained. The headmistress approached with the school doctor, and gently led mother away. She was admitted to a local nursing home, where she remained for several days before she went home.

By now, I had watched for years as booze stripped my mother of her life - yet I was about to let it set about destroying me as well. My first taste of alcohol came just before my French oral exam. I was 16 and I asked another girl to buy me a bottle of vodka.

I'd seen my mother drown her terror with gin. I would do the same with vodka. I drank enough to make me feel very confident for an hour or two and I got full marks for the exam.

After A levels, I spent a year teaching English in France. I started buying vodka from the local shop and drinking alone in my room.

By the time I returned to Edinburgh a year later I was drinking a lot, usually in secret, just like my mother. I rented a flat, doing odd jobs to fill in time before university.

One morning I set out to see my mother - I tried to visit her once a week to check she was OK.

Letting myself into the house, I found my mother lying face down in the kitchen, totally still. I dabbed her forehead with water until she opened her eyes.

"What the hell have you been drinking?" I asked, glaring at her. "No, wait at minute," she retorted very slowly. "What the hell have you been drinking?"

My mother, now in her late 50s and despite her years of drinking, managed to look elegant occasionally. She had neat, greyish-black hair swept back off her face and large brown eyes, somewhat redrimmed of late.

Her chin was beginning to slacken and lipstick, always applied in the morning, had smeared around her mouth by lunchtime. Her breasts and stomach sagged, her shoulders seemed to cave in.

Sitting in her bed the next day, she had a rare moment of clarity. "There must have been so many times you've come into the house and found me in that state and been disappointed, angry . . . hated me even," she said sadly.

"A kid coming home, wanting her tea, and all she finds to greet her is a drunk mother."

A statement or a question, I wasn't sure which. "I know you won't believe me, darling, but I have tried to stop. I used to think I could stop any time I wanted. Now I'm not so sure . . ."

My father had been particularly cold towards me recently, the result of two drink-driving episodes in the same week. I was 19 and borrowed his car to drive to a party in Edinburgh. The first time the police stopped me I'd had 20 vodkas. I was stopped again, well over the limit, just a week later.

In 1970, I met a gentle marine biologist called Colin at university in St Andrews. I was 20 and he was my first serious boyfriend.

Mum begged me to invite him for dinner and finally I gave way. She was in her room when we arrived, knocked out by tranquilisers and drink. Colin and I ate together, and eventually the door handle rattled and Colin prepared himself to greet a possible mother-in-law.

Then Mummy chose to stumble into the room, totally naked, intent on finding something to eat. Colin sat frozen. My mother's face was streaked with make-up, her thighs covered in bruises from bumping into furniture. Her backside wobbled along behind her.

"Hi," she said, her voice thick with alcohol, "I'm Nicola's mother. How are you?" Then she wobbled out.

I drank more during the time I was with Colin than ever, yet we stayed together for five years. At times I felt I was turning into the one thing I dreaded: my mother. Like her, whenever I was called upon to make an impression, I needed drink.

One night, Colin took me to a restaurant to meet his friends. I drank a whole bottle of wine beforehand for courage, downed a vodka and tonic when I arrived and then needed the loo.

An Italian waiter was watching me beneath hooded eyes. I winked at him and he jumped to hold open the toilet door. In the dark corridor that ran past the Ladies, the waiter drew me towards him. He was kissing me, and I didn't object.

This was something I did when drunk - went along with a person's wishes because I couldn't be bothered fighting.

Unsurprisingly, Colin and I finished. I graduated and flew to Japan to teach English. In 1976, a diving accident left me with a broken neck. I returned home - still drinking a bottle of vodka a day. Even an attack of alcohol-induced pancreatitis which nearly killed me didn't stop me.

Finally, on Saturday, September 16, 1978, I called around to see my mother, to check she was OK while my father was away. I didn't need a key to get into the house - which was unusual because Mummy always locked the outside door.

I opened her bedroom door as quietly as I could and stuck my head inside. The first thing I noticed was her bedside lamp lying on the floor, its bulb dead, having burned a hole in the carpet.

Next to it, in a disorganised heap, was my mother. Her head looked awkward, as if it had been screwed onto her body back to front. She lay on her right side, facing the door. Her old blue dressing gown, gaped down the middle.

Her arms were outstretched, mouth wide open; saliva running down her chin and down the front of her dressing gown. I wanted to go to Mummy, but my legs wouldn't move. I could see empty bottles of vodka and pills scattered around her. She was dead.

The moment I had been dreading so long was here and I didn't want to know. "Mummy, I did love you," the words blocked my throat even as a voice inside my head asked: "Did you really love her that much?"

I stumbled into the garden and sat for an age, sobbing, before finally phoning my father. I had always promised I would take her to be buried alongside her parents.

So, a few days after her cremation I drove her ashes to an old Sussex village, close to where she had lived as a child. There, I met my brother Peter and a vicar. As we stood in that churchyard, I vowed that I was not going to waste my life in the way she had wasted hers.

No matter how hard it proved, I would not allow myself to sink into drink and drugs. I was going to live my life to the full. It was the greatest tribute I could pay to a woman I felt I had not loved enough.

I turned to Alcoholics Anonymous for help and I never went back to drinking - not even after the death of my father or my beloved brother Richard in climbing accidents.

Occasionally, I start a glass of wine, but I rarely finish it. Drink represented a battle my mother had fought, lost, then passed on to me.

I miss my mother and wish I could see her now, to bring her up to date with my life as a writer, happy wife to be and stepmother. She is still managing to exert a powerful influence over my life.

During the good times and the bad, she lives on like a faint but persisting echo.

source: Daily Mail

author: Nicola Barry

ADAPTED from Mother's Ruin by Nicola Barry, published by Headline on July 12 at £12.99. °Nicola Barry 2007.

Monday, July 9, 2007

Teen drinking still a serious problem

Each day, 5,400 American citizens under the age of 16 take their first drink of alcohol. Some might say that this is one of the primary substance abuse problems in the United States.

In connection with teen drinking is the alarming fact that teens who have had their license for a comparatively short period of time are drinking and driving. Teen drinking doesn't just affect people who come from slums or broken families. It affects the family who lives two houses down from you. It affects your local officials' children, senators and even our own beloved president and his daughters.

A study done by the U.S. Department of Health and Human Services reported that roughly 2.6 million teenagers are unaware that a person can die from an alcohol overdose. Oblivious to this startling fact, teens will drink until they can no longer see, unconscious of their body's decay. These devastating occurrences happen most frequently on the premises of college campuses.

Alcohol depresses nerves that manage involuntary actions such as breathing, the heartbeat and gag reflexes that thwart suffocation. A fatal dose of alcohol will eventually hinder these functions. After the victim stops drinking, the heart continues to beat, and the alcohol in the stomach still enters the bloodstream and circulates through the system.

Various credible surveys released by the Department of Health and Human Services have reported that white male youths have the highest likeliness to drink. White females fall second. Although minorities are often scapegoated as lawbreakers, youths of African-American and Asian descent tend to drink the least, even though there is still quite a high portion that do choose to.

The adolescents of the United States have benefited greatly from the raise in the drinking age. European youths suffer deeply with their ability to drink at an earlier age, and the statistics from a survey done by the European School Survey on Alcohol and Drugs illustrate that the general percentage of binge drinkers is overwhelming. Eighteen may not be a ripe enough age for teens to muster up the gumption to fight off their demons and refrain from drinking in excess.

Approximately three adolescents are killed each day in the United States due to accidents caused by driver under the influence of alcohol.

You may ask yourself how these teens are acquiring their alcohol. I can say from experience that it's quite easy to find a loop in restrictions. Often times teens are able to find an older acquaintance to purchase alcohol for them for a small fee. Inadequate enforcement allows unscrupulous retailers to sell to people who are underage. Increased penalties for alcohol merchants may make them tighten their morals.

Now, I could go on for days about the current teen binge drinking epidemic, but what's really needed is a solution. Some might say that there is no straight shot in this case, and I'm in agreement with them. While I'm not one of those nuts who believe that all of children's wrongdoings derive from poor parenting, I do believe that a parent's concern may halt kids from drowning themselves in liquor.

I also believe that more youth programs such as Big Brothers Big Sisters type of organizations would provide much-needed assistance, and maybe allow youngsters to cease peer-pressuring one another to involve themselves in a potentially life threatening activity.

Some states have already taken the initiative to ban outdoor alcohol advertising. Maryland is one of these states. They have banned billboards advertising alcohol. Advertising for alcohol is seemingly everywhere, and it doesn't help youths keep their minds from wandering into that direction when everywhere they look is a public notice influencing them to use alcohol. I believe that if Massachusetts followed in their footsteps, it may make great headway.

An idea that might squash urges for some teens to drink is to ban advertisements for alcohol on certain channels that teens frequent. This could prove to be difficult though, for many of these channels are said not to be produced for this age group. If the cable executives could put some sort of restrictions on when they air alcohol commercials, we might be able to salvage some livers.


source: South Coast Today

Sunday, July 8, 2007

Ending illegal opium production in Afghanistan: Why there are no silver bullets

There is broad agreement among countries whose soldiers are fighting and dying in Afghanistan that peace and stability will never be achieved unless something is done to curtail the country’s soaring opium production.

Afghanistan is now a narco-state. It produced 92 per cent of the world’s opium last year, according to the latest UN World Drug Report. The illegal trade involves everyone from poor farmers, to warlords, to senior government officials. Drug money buys weapons that are used to continue the conflict. It fuels the rampant corruption undermining the fragile institutions of the Afghan state. And it defeats attempts, some of them funded by Canadian taxpayers, to build a viable economy and national system of law and order.

But while the problems caused by illegal opium production are all too clear, what to do about it is not. How do you wipe out an industry that employs an estimated 2.9 million people and accounts for somewhere between one-quarter and one-third of the economy without destroying an already devastated country?

In such a situation, simple solutions — so-called silver bullets — have an understandable allure. At least three are being debated: eradication, where chemicals or bulldozers are used to destroy poppy crops; alternative livelihoods, where farmers are given support to grow other crops or pursue other businesses; and legalization, where opium is purchased from producers and used to make legal painkillers.

A sobering predicament

Would that they were as simple as they sound. They are not. Two experts with long experience in Afghanistan outlined the drawbacks of each approach at a recent conference in Ottawa organized by the International Development Research Centre and the Aga Khan Foundation Canada. David Mansfield, a drugs and development specialist, has spent 10 years in the country doing research in rural areas. William Byrd is a World Bank economist specializing in South Asia. Their analysis was sobering.

Eradication is favoured by the United States, which has used crop spraying in its so-called war on drugs in South America and wants to do the same thing in Afghanistan. The problem is that the two crops are not the same. Coca leaves that are used to make cocaine grow on bushes that take time to mature, and destroying them can set producers back years. Poppies are an annual crop. Wipe them out one year and they can be replanted the next, sometimes in the same area, sometimes in a different part of the country. The opium industry is "footloose and flexible," Mr. Byrd said. Eradication also hits the poorest farmers the hardest. It deprives farm families of funds from the current crop, but also plunges them further into debt because many of them have borrowed money against anticipated earnings from the harvest. They face stark choices: plant more poppies next year to make up for the shortfall, sell some of their meagre assets, or even arrange marriages for their young daughters.

Those with money can bribe government officials to overlook their fields. But this results in an uneven application of eradication, which only increases discontent with the government among the poor.

Canada favours alternative livelihoods

Encouraging alternative livelihoods sounds wonderful. And if Afghanistan is to survive as a country, all those involved in the illegal drug trade will have to find some other way to make money. This is also the policy prescription that Canada favours. (Canadian troops are not involved in the eradication campaign.)

But while the goal is clear, how to make the transition is not.

As Mansfield points out, no other crop offers the same attractions as opium. It is easily transportable, does not perish en route to market, and garners much higher returns than most agricultural products. The UN report said the farm-gate price of opium was $125 US per kilogram last year. (The farmer would not keep all of that, as he would have costs, such as labour and bribes.) The average yield is 37 kilograms per hectare. Poppy cultivation is more labour intensive than other crops. Switching to wheat or vegetables, where soil conditions make such crops possible, automatically means higher unemployment.

Still, in areas where land is fertile, transport reliable, and there are markets nearby, wheat and vegetables represent viable alternatives. They fetch a lower price, but the risks of having the crop confiscated by a warlord or wiped out in an eradication program are low. However, much of Afghanistan has poor soil and bad roads. Farmers in these areas have fewer choices.

Development workers can sometimes worsen the situation with well-meaning but poorly thought out interventions, says Mansfield. For example, building a new irrigation system to give farmers access to more water might actually encourage them to grow more poppies if they do not have access to a market for other crops. Each area is different, so programs have to be tailored to local circumstances, which are changing all the time.

Legalization requires a functioning government

Legalization of the illegal industry, which is being promoted by the Senlis Council (and was recommended at least as a pilot project in a recent report of the House of Commons National Defence committee), also has its drawbacks. It has been done successfully in Turkey. Other countries, such as India and France, have legal opium industries. But as these two experts point out, a legal industry requires government infrastructure to impose and enforce regulations, something that Afghanistan lacks. The majority of the opium in Afghanistan is produced in the unstable provinces of the south and southeast, where Western troops, including those of Canada, are still fighting.

Without strict government oversight, illegal production could flourish alongside the legal industry. Only three per cent of farmland is currently used for poppy cultivation, leaving lots of room for expansion. They also believe there is no shortage of legal opium globally, so producer countries will have to cut production to make room for Afghan production. This last point is disputed by the Senlis Council. Finally, it is not just the Afghanistan government’s ability that is lacking, it is also its willingness to end an illegal trade that involves some senior government officials. So what is the answer? Attractive as the idea seems, there is no silver bullet. Instead, a mix of well-designed and well-integrated policies is needed to tackle illegal opium production in Afghanistan. And even then, success will take decades, not years.

Of course, there is another approach that governments outside of Afghanistan could take. The market for opium and its derivatives, such as heroin, operates like any other on the principles of supply and demand. All of the solutions proposed above tackle the supply end. But what about demand? If that were wiped out, there would be no market for illegal opium and the suppliers would have to find other ways to make a living.

This is a problem best tackled from both ends, and not just on the ground in Afghanistan.

author: Madelaine Drohan
source: Canadian Broadcasting Corporation

Saturday, July 7, 2007

Bill ignores addiction

Good news if you live in North Carolina, you have insurance and you suffer from depression, obsessive-compulsive disorder, schizophrenia, post-traumatic stress disorder, anorexia, bulimia or are bipolar.

Bad news if you live in North Carolina, you have insurance and you suffer from depression, obsessive-compulsive disorder, schizophrenia, post-traumatic stress disorder, anorexia, bulimia or are bipolar and you are an addict and/or alcoholic.

This month, the North Carolina senate approved a sort of insurance parity bill that would require private insurers to provide mental health coverage comparable to coverage for physical illnesses. But North Carolina lawmakers excluded coverage requirements for one of the most devastating mental illnesses - addiction/alcoholism.

While North Carolina's parity bill makes for good headlines, it leaves about 30 percent of the mentally ill in serious trouble - even though they have insurance.

That's because research has shown that about 30 percent of people with mental illnesses, such as depression, bipolar and schizophrenia, are also addicts or alcoholics. Conversely, the National Mental Health Association estimates that about one-third of the alcoholics and over half of addicts suffer a companion mental illness.

Under North Carolina's proposed law, insurance will cover treatment for one of their mental illnesses, but not the other. That's kind of like telling a guy with high blood pressure and high cholesterol that you will pay to treat his high blood pressure but he's on his own when it comes to treating his high cholesterol.

The concern was that providing insurance coverage for substance abuse would costs businesses too much money.

What lawmakers and employers must understand is that when an addict/alcoholic has another mental illness, you must treat both illnesses because these illnesses are diabolically conjoined - the depression tells the alcoholism that another drink will solve everything. The alcohol - itself a depressant - tells the depression, "Thanks for giving me a reason to drink."

If you only treat a depressed alcoholic's depression and not her alcoholism, you're still going to have an alcoholic on your hands - just a happier one. And alcoholism alone costs employers about $100 billion every year.

Will someone explain to me how this kind of parity is going to save money?

author: Christine Stapleton
source: Palm Beach Post

Friday, July 6, 2007

How We Get Addicted

Addiction is so harmful, evolution should have weeded it out by now. If it's hard to drive under the influence, imagine running from a tiger.

I was driving up the Massachusetts Turnpike one evening last February when I knocked over a bottle of water. I grabbed for it, swerved inadvertently--and a few seconds later found myself blinking into the flashlight beam of a state trooper. "How much have you had to drink tonight, sir?" he demanded. Before I could help myself, I blurted out an answer that was surely a new one to him. "I haven't had a drink," I said indignantly, "since 1981."

It was both perfectly true and very pertinent to the trip I was making. By the time I reached my late 20s, I'd poured down as much alcohol as normal people consume in a lifetime and plenty of drugs--mostly pot--as well. I was, by any reasonable measure, an active alcoholic. Fortunately, with a lot of help, I was able to stop. And now I was on my way to McLean Hospital in Belmont, Mass., to have my brain scanned in a functional magnetic-resonance imager (fMRI). The idea was to see what the inside of my head looked like after more than a quarter-century on the wagon.

Back when I stopped drinking, such an experiment would have been unimaginable. At the time, the medical establishment had come to accept the idea that alcoholism was a disease rather than a moral failing; the American Medical Association (AMA) had said so in 1950. But while it had all the hallmarks of other diseases, including specific symptoms and a predictable course, leading to disability or even death, alcoholism was different. Its physical basis was a complete mystery--and since nobody forced alcoholics to drink, it was still seen, no matter what the AMA said, as somehow voluntary. Treatment consisted mostly of talk therapy, maybe some vitamins and usually a strong recommendation to join Alcoholics Anonymous. Although it's a totally nonprofessional organization, founded in 1935 by an ex-drunk and an active drinker, AA has managed to get millions of people off the bottle, using group support and a program of accumulated folk wisdom.

While AA is astonishingly effective for some people, it doesn't work for everyone; studies suggest it succeeds about 20% of the time, and other forms of treatment, including various types of behavioral therapy, do no better. The rate is much the same with drug addiction, which experts see as the same disorder triggered by a different chemical. "The sad part is that if you look at where addiction treatment was 10 years ago, it hasn't gotten much better," says Dr. Martin Paulus, a professor of psychiatry at the University of California at San Diego. "You have a better chance to do well after many types of cancer than you have of recovering from methamphetamine dependence."

That could all be about to change. During those same 10 years, researchers have made extraordinary progress in understanding the physical basis of addiction. They know now, for example, that the 20% success rate can shoot up to 40% if treatment is ongoing (very much the AA model, which is most effective when members continue to attend meetings long after their last drink). Armed with an array of increasingly sophisticated technology, including fMRIs and PET scans, investigators have begun to figure out exactly what goes wrong in the brain of an addict--which neurotransmitting chemicals are out of balance and what regions of the brain are affected. They are developing a more detailed understanding of how deeply and completely addiction can affect the brain, by hijacking memory-making processes and by exploiting emotions. Using that knowledge, they've begun to design new drugs that are showing promise in cutting off the craving that drives an addict irresistibly toward relapse--the greatest risk facing even the most dedicated abstainer.

"Addictions," says Joseph Frascella, director of the division of clinical neuroscience at the National Institute on Drug Abuse (NIDA), "are repetitive behaviors in the face of negative consequences, the desire to continue something you know is bad for you."

Addiction is such a harmful behavior, in fact, that evolution should have long ago weeded it out of the population: if it's hard to drive safely under the influence, imagine trying to run from a saber-toothed tiger or catch a squirrel for lunch. And yet, says Dr. Nora Volkow, director of NIDA and a pioneer in the use of imaging to understand addiction, "the use of drugs has been recorded since the beginning of civilization. Humans in my view will always want to experiment with things to make them feel good."

That's because drugs of abuse co-opt the very brain functions that allowed our distant ancestors to survive in a hostile world. Our minds are programmed to pay extra attention to what neurologists call salience--that is, special relevance. Threats, for example, are highly salient, which is why we instinctively try to get away from them. But so are food and sex because they help the individual and the species survive. Drugs of abuse capitalize on this ready-made programming. When exposed to drugs, our memory systems, reward circuits, decision-making skills and conditioning kick in--salience in overdrive--to create an all consuming pattern of uncontrollable craving. "Some people have a genetic predisposition to addiction," says Volkow. "But because it involves these basic brain functions, everyone will become an addict if sufficiently exposed to drugs or alcohol."

That can go for nonchemical addictions as well. Behaviors, from gambling to shopping to sex, may start out as habits but slide into addictions. Sometimes there might be a behavior-specific root of the problem. Volkow's research group, for example, has shown that pathologically obese people who are compulsive eaters exhibit hyperactivity in the areas of the brain that process food stimuli--including the mouth, lips and tongue. For them, activating these regions is like opening the floodgates to the pleasure center. Almost anything deeply enjoyable can turn into an addiction, though.

Of course, not everyone becomes an addict. That's because we have other, more analytical regions that can evaluate consequences and override mere pleasure seeking. Brain imaging is showing exactly how that happens. Paulus, for example, looked at methamphetamine addicts enrolled in a VA hospital's intensive four-week rehabilitation program. Those who were more likely to relapse in the first year after completing the program were also less able to complete tasks involving cognitive skills and less able to adjust to new rules quickly. This suggested that those patients might also be less adept at using analytical areas of the brain while performing decision-making tasks. Sure enough, brain scans showed that there were reduced levels of activation in the prefrontal cortex, where rational thought can override impulsive behavior. It's impossible to say if the drugs might have damaged these abilities in the relapsers--an effect rather than a cause of the chemical abuse--but the fact that the cognitive deficit existed in only some of the meth users suggests that there was something innate that was unique to them. To his surprise, Paulus found that 80% to 90% of the time, he could accurately predict who would relapse within a year simply by examining the scans.

Another area of focus for researchers involves the brain's reward system, powered largely by the neurotransmitter dopamine. Investigators are looking specifically at the family of dopamine receptors that populate nerve cells and bind to the compound. The hope is that if you can dampen the effect of the brain chemical that carries the pleasurable signal, you can loosen the drug's hold.

One particular group of dopamine receptors, for example, called D3, seems to multiply in the presence of cocaine, methamphetamine and nicotine, making it possible for more of the drug to enter and activate nerve cells. "Receptor density is thought to be an amplifier," says Frank Vocci, director of pharmacotherapies at NIDA. "[Chemically] blocking D3 interrupts an awful lot of the drugs' effects. It is probably the hottest target in modulating the reward system."

But just as there are two ways to stop a speeding car--by easing off the gas or hitting the brake pedal--there are two different possibilities for muting addiction. If dopamine receptors are the gas, the brain's own inhibitory systems act as the brakes. In addicts, this natural damping circuit, called GABA (gamma-aminobutyric acid), appears to be faulty. Without a proper chemical check on excitatory messages set off by drugs, the brain never appreciates that it's been satiated.

As it turns out, vigabatrin, an antiepilepsy treatment that is marketed in 60 countries (but not yet in the U.S.), is an effective GABA booster. In epileptics, vigabatrin suppresses overactivated motor neurons that cause muscles to contract and go into spasm. Hoping that enhancing GABA in the brains of addicts could help them control their drug cravings, two biotech companies in the U.S., Ovation Pharmaceuticals and Catalyst Pharmaceuticals, are studying the drug's effect on methamphetamine and cocaine use. So far, in animals, vigabatrin prevents the breakdown of GABA so that more of the inhibitory compound can be stored in whole form in nerve cells. That way, more of it could be released when those cells are activated by a hit from a drug. Says Vocci, optimistically: "If it works, it will probably work on all addictions."

Another fundamental target for addiction treatments is the stress network. Animal studies have long shown that stress can increase the desire for drugs. In rats trained to self-administer a substance, stressors such as a new environment, an unfamiliar cage mate or a change in daily routine push the animals to depend on the substance even more.

Among higher creatures like us, stress can also alter the way the brain thinks, particularly the way it contemplates the consequences of actions. Recall the last time you found yourself in a stressful situation--when you were scared, nervous or threatened. Your brain tuned out everything besides whatever it was that was frightening you--the familiar fight-or-flight mode. "The part of the prefrontal cortex that is involved in deliberative cognition is shut down by stress," says Vocci. "It's supposed to be, but it's even more inhibited in substance abusers." A less responsive prefrontal cortex sets up addicts to be more impulsive as well.

Hormones--of the male-female kind--may play a role in how people become addicted as well. Studies have shown, for instance, that women may be more vulnerable to cravings for nicotine during the latter part of the menstrual cycle, when the egg emerges from the follicle and the hormones progesterone and estrogen are released. "The reward systems of the brain have different sensitivities at different points in the cycle," notes Volkow. "There is way greater craving during the later phase."

That led researchers to wonder about other biological differences in the way men and women become addicted and, significantly, respond to treatments. Alcohol dependence is one very promising area. For years, researchers had documented the way female alcoholics tend to progress more rapidly to alcoholism than men. This telescoping effect, they now know, has a lot to do with the way women metabolize alcohol. Females are endowed with less alcohol dehydrogenase--the first enzyme in the stomach lining that starts to break down the ethanol in liquor--and less total body water than men. Together with estrogen, these factors have a net concentrating effect on the alcohol in the blood, giving women a more intense hit with each drink. The pleasure from that extreme high may be enough for some women to feel satisfied and therefore drink less. For others, the intense intoxication is so enjoyable that they try to duplicate the experience over and over.

But it's the brain, not the gut, that continues to get most of the attention, and one of the biggest reasons is technology. It was in 1985 that Volkow first began using PET scans to record trademark characteristics in the brains and nerve cells of chronic drug abusers, including blood flow, dopamine levels and glucose metabolism--a measure of how much energy is being used and where (and therefore a stand-in for figuring out which cells are at work). After the subjects had been abstinent a year, Volkow rescanned their brains and found that they had begun to return to their predrug state. Good news, certainly, but only as far as it goes.

"The changes induced by addiction do not just involve one system," says Volkow. "There are some areas in which the changes persist even after two years." One area of delayed rebound involves learning. Somehow in methamphetamine abusers, the ability to learn some new things remained affected after 14 months of abstinence. "Does treatment push the brain back to normal," asks NIDA's Frascella, "or does it push it back in different ways?"

If the kind of damage that lingers in an addict's learning abilities also hangs on in behavioral areas, this could explain why rehabilitation programs that rely on cognitive therapy--teaching new ways to think about the need for a substance and the consequences of using it--may not always be effective, especially in the first weeks and months after getting clean. "Therapy is a learning process," notes Vocci. "We are trying to get [addicts] to change cognition and behavior at a time when they are least able to do so."

One important discovery: evidence is building to support the 90-day rehabilitation model, which was stumbled upon by AA (new members are advised to attend a meeting a day for the first 90 days) and is the duration of a typical stint in a drug-treatment program. It turns out that this is just about how long it takes for the brain to reset itself and shake off the immediate influence of a drug. Researchers at Yale University have documented what they call the sleeper effect--a gradual re-engaging of proper decision making and analytical functions in the brain's prefrontal cortex--after an addict has abstained for at least 90 days.

This work has led to research on cognitive enhancers, or compounds that may amplify connections in the prefrontal cortex to speed up the natural reversal. Such enhancement would give the higher regions of the brain a fighting chance against the amygdala, a more basal region that plays a role in priming the dopamine-reward system when certain cues suggest imminent pleasure--anything from the sight of white powder that looks like cocaine to spending time with friends you used to drink with. It's that conditioned reflex--identical to the one that caused Ivan Pavlov's famed dog to salivate at the ringing of a bell after it learned to associate the sound with food--that unleashes a craving. And it's that phenomenon that was the purpose of my brain scans at McLean, one of the world's premier centers for addiction research.

In my heyday, I would often drink even when I knew it was a terrible idea--and the urge was hardest to resist when I was with my drinking buddies, hearing the clink of glasses and bottles, seeing others imbibe and smelling the aroma of wine or beer. The researchers at McLean have invented a machine that wafts such odors directly into the nostrils of a subject undergoing an fMRI scan in order to see how the brain reacts. The reward circuitry in the brain of a newly recovering alcoholic should light up like a Christmas tree when stimulated by one of these alluring smells.

I chose dark beer, my absolute favorite, from their impressive stock. But I haven't gotten high for more than a quarter-century; it was an open question whether I would react that way. So after an interview with a staff psychiatrist to make sure I would be able to handle it if I experienced a craving, I was fitted with a tube that carried beer aroma from a vaporizer into my nose. I was then slid into the machine to inhale that still familiar odor while the fMRI did its work.

Even if the smells triggered a strong desire to drink, I had long since learned ways to talk myself out of it--or find someone to help me do so. Like the 90-day drying-out period that turns out to parallel the brain's recovery cycle, such a strategy is in line with other new theories of addiction. Scientists say extinguishing urges is not a matter of getting the feelings to fade but of helping the addict learn a new form of conditioning, one that allows the brain's cognitive power to shout down the amygdala and other lower regions. "What has to happen for that cue to extinguish is not for the amygdala to become weaker but for the frontal cortex to become stronger," says Vocci.

While such relearning has not been studied formally in humans, Vocci believes it will work, on the basis of studies involving, of all things, phobias. It turns out that phobias and drugs exploit the same struggle between high and low circuits in the brain. People placed in a virtual-reality glass elevator and treated with the antibiotic D-cycloserine were better able to overcome their fear of heights than those without benefit of the drug. Says Vocci: "I never thought we would have drugs that affect cognition in such a specific way."

Such surprises have even allowed experts to speculate whether addiction can ever be cured. That notion goes firmly against current beliefs. A rehabilitated addict is always in recovery because cured suggests that resuming drinking or smoking or shooting up is a safe possibility--whose downside could be devastating. But there are hints that a cure might not in principle be impossible. A recent study showed that tobacco smokers who suffered a stroke that damaged the insula (a region of the brain involved in emotional, gut-instinct perceptions) no longer felt a desire for nicotine.

That's exciting, but because the insula is so critical to other brain functions--perceiving danger, anticipating threats--damaging this area isn't something you would ever want to do intentionally. With so many of the brain's systems entangled with one another, it could prove impossible to adjust just one without throwing the others into imbalance.

Nevertheless, says Volkow, "addiction is a medical condition. We have to recognize that medications can reverse the pathology of the disease. We have to force ourselves to think about a cure because if we don't, it will never happen." Still, she is quick to admit that just contemplating new ideas doesn't make them so. The brain functions that addiction commandeers may simply be so complex that sufferers, as 12-step recovery programs have emphasized for decades, never lose their vulnerability to their drug of choice, no matter how healthy their brains might eventually look.

I'm probably a case in point. My brain barely lit up in response to the smell of beer inside the fMRI at McLean. "This is actually valuable information for you as an individual," said Scott Lukas, director of the hospital's behavioral psychopharmacology research laboratory and a professor at Harvard Medical School who ran the tests. "It means that your brain's sensitivity to beer cues has long passed."

That's in keeping with my real-world experience; if someone has a beer at dinner, I don't feel a compulsion to leap across the table and grab it or even to order one for myself. Does that mean I'm cured? Maybe. But it may also mean simply that it would take a much stronger trigger for me to fall prey to addiction again--like, for example, downing a glass of beer. But the last thing I intend to do is put it to the test. I've seen too many others try it--with horrifying results.

source: Time Magazine