Monday, October 27, 2008

Third of routine drinkers get potentially fatal liver damage

One third of routine drinkers sustain enough liver damage to put themselves at risk of an early death, researchers have found.

A study at University College London found an unexpectedly high level of liver abnormalities among "normal working people" who consume more alcohol than average but would not regard themselves as alcoholics.

Professor Rajiv Jalan, head of the liver failure group at University College London hospitals and one of the authors of the study, said: "These are people working in offices who we routinely encounter.

"They are representative of working people in our society and they are at risk."

The study looked at results from more than 1,000 men and women, mostly aged 36 to 55, who used home testing kits to measure liver damage.

The kits measure specific enzymes in the blood, high levels of which indicate liver abnormalities.

More than 70 per cent of those involved in the study said they regularly drank more than the government's recommended limit of 14 units of alcohol a week for women and 21 units for men, and 41 per cent of them said they drank every day.

The results showed at least 30 per cent of the people tested had liver abnormalities.

The worrying findings will be published this week in the medical journal Hepatology and come as the government considers the introduction of national screening to counter rising levels of liver disease.

Up to two million people in Britain have chronic liver disease and many are unaware of their illness.

Deaths from the disease have increased by eight times in men aged 35 to 44 and by seven times in women over the past 30 years.

Doctors warn that symptoms of liver disease are not felt until too late and by that time patients have up to a 50 per cent chance of dying early.

A Medical Research Council study found that intelligent people can be at greater risk of alcohol problems as they seek to cope with stressful jobs.

Saturday, October 25, 2008

Struggling With Alcohol? Better Quit Smoking, Too

Overcoming alcoholism is tough enough. That's one reason many alcoholics who smoke continue to light up even while they're in recovery from alcohol dependency.

But new research suggests that tackling both addictions simultaneously may offer the best chance of success.

Recovering alcoholics often admit they're using nicotine as a drug, said Dr. Michael M. Miller, president of the American Society of Addiction Medicine.

"They can tell you, 'I don't want to quit [smoking], because it changes the way I feel. I use it to deal with stress,' " added Miller, who's also director of NewStart, a chemical dependency rehabilitation program at Meriter Hospital in Madison, Wis.

A study of alcoholics in treatment for their alcohol problems used brain scans to examine how performance on cognitive tests changes with abstinence from alcohol. Twenty-five alcoholics stopped drinking for six to nine months, but the 12 who smoked continued to smoke.

"We found that the smoking alcoholics over six to nine months of abstinence did not recover certain types of brain function as the non-smoking alcoholics did," said study author Dieter J. Meyerhoff, a professor of radiology at the University of California, San Francisco. Decision-making skills, thinking speed, 3-D visualization and short-term memory were affected, calling into question the prospects of long-term sobriety, he noted.

And while smoking and non-smoking alcoholics improved on several other cognitive tests, such as learning and remembering words, smokers' brain function, in general, took longer to recover.

The findings were published in the journal Alcoholism: Clinical and Experimental Research.

Studies indicate that 60 percent to 75 percent of people in alcohol-treatment programs smoke cigarettes, and 40 percent to 50 percent are "heavy" smokers, consuming more than a pack a day.

Yet treatment for tobacco dependence is not routinely included in alcohol treatment programs, Boston University researchers reported recently in the journal Alcohol Research & Health, published by the U.S. National Institute on Alcohol Abuse and Alcoholism.

"I would say that over half of chemical dependency treatment agencies now talk about nicotine, encourage patients to stop [smoking] and provide them assistance to stop, such as with nicotine-replacement therapy or prescriptions for Zyban or Champix," Miller said. "So that's a tremendous advance."

Oftentimes, though, smoking is excused. "What you don't see," Miller said, "is building nicotine into the treatment plan and considering tobacco use to be a relapse of addiction."

The concern had been that addressing both dependencies concurrently would pose "too great a difficulty for the patient" and impede recovery from alcoholism, the Boston researchers noted. But studies now suggest that quitting smoking does not derail alcohol treatment -- and may even improve the likelihood of longer-term sobriety, they said.

In fact, Miller said studies show that people in recovery for other addictions who delay smoking cessation can later relapse to their chemical dependency because of the stress of quitting smoking six to 18 months later.

"So stopping everything at once -- getting all the psychological stress out of the way at once -- is the best way to go, and also getting all the physical withdrawal syndromes out of the way at once is the best way to go," he concluded.

Meyerhoff agreed that tackling smoking as part of an alcohol treatment program is a smart tactic.

"The alcoholics have shown that they are willing to change one behavior, namely excessive drinking," he said. "If they are in that mindset, it is a great opportunity for treatment specialists to also convince them of the negative effects of continued chronic smoking."
source: U.S.News & World Report

Friday, October 24, 2008

Survey: Alcohol abuse remains problem at UConn

STORRS, Conn. --One of every four University of Connecticut students say they have blacked out from heavy drinking during Spring Weekend festivities, according to a new survey.

The review, conducted by UConn's Center for Survey Research and Analysis, also says two of every five students surveyed say they got "severely drunk" during the annual party.

Some UConn officials said they were shocked by the findings, especially since the university has stepped up enforcement and offers many alcohol-free recreation events. However, national experts and some students say they were less surprised.

The survey mirrors national trends, said Brandon Busteed, founder and chief executive officer of Outside the Classroom, a company that works with colleges to fight high-risk drinking.

"That is a very frightening statistic, but I don't think it's too far out from national statistics, which is kind of depressing," Busteed said of the 25 percent blackout figure.

The university's Department of Wellness and Alcohol and Other Drug Prevention Services commissioned the survey to gauge what students want out of Spring Weekend, and how UConn can make it safer and more memorable for them.

The festivities, which occur just before final exams, draw up to 20,000 students and their guests each spring.

Unsanctioned off-campus parties at nearby apartment complexes frequently generate dozens of arrests, assaults and ambulance trips for inebriated and injured party guests.

UConn Spring Weekend events gained national attention in 1998, when a party in an off-campus parking lot led to rioting. This year, the student newspaper's editor said she was sexually accosted at one of the parties and wrote about it on the paper's front page.

A committee examining Spring Weekend has been holding informal hearings for the past two weeks to get suggestions from police, doctors, student, apartment complex owners, Mansfield town employees and others.

The survey results come from an online questionnaire sent in March to all of the approximately 15,000 UConn undergraduates ages 18 or older on the Storrs campus.

The survey did not include the most recent Spring Weekend in April, since it was distributed about a month earlier.

A total of 2,571 students responded, with 1,709 answering the question about whether they had blacked out due to substance use during a Spring Weekend.

The survey defined "blacking out" as being conscious, but having no recollection due to substance use. It distinguished blacking out from "passing out," which was described as being unresponsive due to substance use.

Twelve percent of students reported passing out at a Spring Weekend.

"I agree that it's a shocking number," said Julie Elkins, assistant to the vice president for student affairs at UConn. "In some ways, it reminds me of folks who usually drink responsibly, and then New Year's Eve hits and they make choices they normally don't. I think Spring Weekend is their New Year's Eve."

Given the level of drinking, Student Body President Ryan McHardy said, the number of blackouts reported was right on the mark.

"Am I surprised? No, and it's unfortunate. That's the behavior I've seen in Spring Weekend," McHardy said.

"There's an expectation that's going to happen," McHardy said. "That, to me, seems to be the No. 1 issue that needs to be addressed."

Thursday, October 23, 2008

Gene mutation in worms could further understanding of alcoholism in humans

Scientists at the University of Liverpool have found that a genetic mutation in worms could further understanding of alcoholism in humans.

The work follows a study carried out by Oregon Health and Science University, which suggested a link between a gene mutation in mice and tolerance to alcohol. Researchers at Liverpool have investigated this in worms, looking specifically at the role the gene plays in communication between cells in the nervous system.

This gene specifies the ways in which amino acids arrange themselves into a protein called UNC-18 - or Munc18-1 in humans, an essential component of the nervous system. Researchers found that a naturally occurring change in this gene can result in a change in the nature of one of the amino acids, which then alters communication between cells in the nervous system. As a result of these changes the nervous system becomes less sensitive to the effects of alcohol, allowing the body to consume more.

Professor Bob Burgoyne, Head of the University's School of Biomedical Sciences, explains: "Alcohol consumption can affect the nervous system in a number of ways. Low concentrations of alcohol can make the body more alert, but high concentrations can also reduce its activity, resulting in motor dysfunction and a lack of coordination. Some people, however, are more susceptible to these effects than others, but it has never been fully understood why this is.

"We used the nematode worm as a model to look at the role genes play in alcohol tolerance because all of the worm's genome has been characterised and we can therefore identify its genes easily. The gene we looked at corresponds to a gene in humans that performs the same function in the nervous system. Mutations in genes can occur naturally without any known cause and will persist if they are not particularly harmful."

Dr Jeff Barclay, co-author of the research, added: "We investigated alterations in amino acids in two genetically identical worms. One carried a mutation that was exactly the same as the genetic change our American colleagues found in mice and the other carried a different change within the same gene. Both these mutations altered the way communicate occurs between cells in the nervous system. The mutations reduce the negative behavioural effects of alcohol and so more can be consumed before the body starts to react badly to it.

"Now that we have shown the link between the gene and alcohol tolerance in worms, it is possible to search the human gene to see if there are any spontaneous changes that could help identify individuals with a predisposition to alcoholism."

The research is published in Molecular Biology of the Cell.

Tuesday, October 21, 2008

Cocaine usage continues to rise, report finds

One in 20 Irish people and almost one in 10 young people has taken cocaine, a major all-Ireland study of the use of the drug has established.

Men are twice as likely to use cocaine as women and regular and even daily use of the drug is increasing, according to the drug prevalence study carried out for the National Advisory Committee on Drugs (NACD).

North Dublin, where almost 16 per cent of young people reported use of the drug, emerges as the country’s cocaine blackspot, but prevalence rates are rising steeply throughout the country.

Use of the drug by 15-34-year-olds has risen five-fold in the north-eastern counties over the past five years, and more than three-fold in the midlands and the west.

The vast majority of cocaine users start taking their drug in their early twenties and the most popular means of obtaining it is from friends and family, the study finds.

One in four people said they knew someone who took cocaine, compared to 14 per cent in the last all-Ireland survey carried out in 2002/03.

The study reveals that cocaine users are taking the drug more often, with one-in-four users snorting the drug once a week and 7 per cent reporting daily use. No-one reported daily use in the earlier survey.

Overall lifetime use now stands at 5.3 per cent, up from 3 per cent in the last survey. Some 1.7 per cent of respondents reported using the drug in the previous year, up from 1.1 per cent, and 0.5 per cent said they had taken cocaine in the previous month, up from 0.3 per cent.

“While these figures are of concern, we should not lose sight of the fact that they are reasonably low and that any perception that ‘everyone is at it’ is far from the true situation,” commented Minister of State with responsibility for drugs strategy, John Curran.

The survey also shows that cocaine use varies greatly between different regions, with the highest rates recorded in the more densely populated areas in the east of the country, roughly from Louth to Cork. “The challenge is to ensure that the lower rates are kept at such levels while the problem is tackled comprehensively in the areas of higher use.

Mr Curran said the risks attached to cocaine use were often ignored or underestimated by users. “Cocaine use is linked to heart conditions, strokes and to various other physical complaints that vary depending on the route of administration of the drug. Frequent (or long-term) use of cocaine can also have a powerful effect on the user’s mental health, through depression, anxiety, agitation, compulsive behaviour and paranoia.”

He defended the efforts being made to tackle drug misuse, pointing out that the over €61 million was allocated to the area in last week’s Estimates. The Government is spending over €200 million on measures aimed directly at problem drug use, he said.

Almost 7,000 people were surveyed north and south for the study, which was carried out between October 2006 and May 2007.
source: © 2008

Monday, October 20, 2008

12-stepping Alcoholics into the 21st century

After 73 years, program continues to help addicts and loved ones

God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.

Editor’s note: Anonymity is the spiritual foundation of all of the traditions of Alcoholics Anonymous, according to the organization’s literature. For that reason, we have chosen to identify by first name only the AA members quoted in this story.

On May 16, 2004, Bob awoke at 2 a.m. in the driver’s seat of his car with a bottle of vodka in his lap. He was in the parking lot of a convenience store, but he had no idea where the store was.

“I had developed a tendency to get angry and drink and drive and be gone for a couple of days,” Bob says. “This was one of those crazy excursions. I could have been in Arkansas or Minnesota. I figured it would seem stupid to stagger into the store and ask where I was, so I drove around until I figured it out.”

He shakes his head. “Great logic.”

Luckily, he was in Conyers.

“When I got home, my heart was pounding, I was sweating and the room was spinning, like a thousand times before. But I’d scared myself so much that the fear of continuing to live like that overcame my fear and reluctance of turning my life and will over to God.”

Bob was willing to admit that he was powerless over alcohol and prayed to God to take the burden from him.

“It sounds stupid, but I felt the presence of something in the room,” he says. “I could feel it, and then it felt like an elephant had been sitting on my chest, and it got up and walked away. Something big and good had happened.”

Bob hasn’t had a drink since, and attributes his abstinence to the five Alcoholics Anonymous (AA) meetings he attends every week.

“Every time I go, I’m reminded that I’m an alcoholic and I have a problem,” he says. “But it can be overcome, and I am overcoming.”

It’s been 73 years since AA began, and the 12-step concept it fathered is more popular than ever. Twelve-step programs now treat millions around the world for everything from drug addiction, gambling and overeating to clutter, sexual compulsion and workaholism.

“Twelve-step programs are very helpful for a lot of people, especially when it comes to substance abuse issues,” says Dr. Tommie Richardson, a staff member of the Ridgeview Institute. “They are the most successful modality we know of right now. The fact that they’ve been around so long and continue to thrive tells you that.”

“It’s a brilliant program,” says Tere Tyner Canzoneri, a minister and pastoral counselor at The Emmanuel Center for Pastoral Counseling in Atlanta. “There’s not a person on the planet who couldn’t benefit from working the steps.” Robby Carroll, a minister at Shallowford Presbyterian Church and a marriage and family therapist, regularly refers clients to 12-step programs because “they’re the only programs that understand the challenge of addiction.”

Addiction has resisted the best efforts of science, medicine, psychiatry, social workers and social pressure before and since the providential meeting in 1935 of Bill Wilson, a New York stockbroker, and Dr. Bob Smith, an Akron, Ohio, surgeon.

Both were alcoholics, but Wilson used spiritual principles and the insight that alcoholism was a disease to get sober. After he persuaded Smith to follow suit, they began working with other alcoholics and started the first AA group that same year.

Favorable publicity and the publication in 1939 of Wilson’s book “Alcoholics Anonymous” anchored the program’s status and popularity.

Today AA is the largest of the 12-step programs (followed by Narcotics Anonymous and Al-Anon) with an estimated worldwide membership of 2 million. Experts, citing the difficulty of estimating anonymous fellowships, believe the numbers are much higher.

There are more than 400 groups and 1,100 AA meetings a week in the Atlanta area alone. Dr. Steven Lee, medical director of Summit Ridge Hospital and director of Addiction Services in Gwinnett County, estimates addictions affect 15 to 20 percent of the population in Gwinnett alone.

“We’re just touching the tip of the iceberg that needs treatment,” he says.

The 12 steps are a rigorous program of spirituality, self-examination and self-renewal that Smith, affectionately remembered as “Dr. Bob” by 12-steppers, summarized as “Trust God, clean house and help others.”

Trusting God doesn’t come easily, however. Many participants either don’t believe in God or blame Him for their difficulties, which is why the steps refer to “a Power greater than ourselves” and “God as we understood him.” Mention of religion during meetings is forbidden, and rigorously enforced.

Nevertheless, therapists say that some find spirituality of any stripe objectionable and don’t return. Nor do 12-step programs always work with those in the early stages of addiction.

“I see folks who have gotten into treatment after a DUI or who think it’s an aberration,” says Bob Fredrick, a clinical social worker and therapist in Atlanta. “They say ‘I just don’t connect there’ or ‘I’m not as bad as them.’ There’s a lot of denial with addiction.”

Lee says there is an organization for physicians that relies on conventional therapy and medication rather than meetings. “I disagree,” he says, “but they’re not the core of the recovery community. It’s hard for them to admit they’re powerless.”

There are other recovery groups, says Scott Maddox, an addiction counselor and executive director of Alpha Recovery in Atlanta and Brunswick, “but all the evidence shows that the 12-step approach is the most successful.”

And while individual therapy gets to core issues faster, he says, 12-step programs are superior because, “You have people who have common problems and experience with solutions to those problems. They provide a support network for ongoing recovery that therapy doesn’t provide.”

“They’re one of the few places that folks really feel understood,” AA member Frederick says. “Folks ready to deal with addictions find kindred spirits who understand that they’re dealing with a disease, and it’s not a willpower or moral issue.”

Bob says he thinks the steps are pure genius.

“When they started to take hold,” he says, “I realized it wasn’t about stopping drinking, it was really about living sober.”

The program, he says, offers a systematic formula for living life.

“It’s a toolbox,” he says, “to get me through life. Before, I had one tool, and that was a bottle opener.”

Al-Anon Helps Spouse Deal With Disease

Peggy knows how long she’s been in Al-Anon by calculating how long her husband’s been sober: 25 years.

“I’ve been in 27 years,” she says. “In the beginning I didn’t really want it, but I needed it. Then I realized I really wanted it, that it was good for me. I knew what was going on. He couldn’t con me anymore. I went to a lot of AA and Al-Anon meetings, so I was very aware of the disease.

“The alcoholic is drinking, and we’re hugging the alcoholic. We’re perfectionists, sensitive, fun and caring. It’s almost the same disease, except we’re not allergic to alcohol.”

She attends two or three Al-Anon meetings a week, and accompanies her husband to AA meetings a couple of times a month.

“It’s a miracle,” she says. “I’ve learned so much, but I don’t know it all, so I keep going. I think it’s for all people, not just those with alcohol problems. It just makes for a better life.”

‘Your Part Is The Only Thing You Have Control Over’

Karen, a single mother with a 9 1/2-year-old daughter, is a recovering alcoholic who’s been sober and attending AA meetings for 22 years. Two years ago, she began going to Al-Anon as well.

“I was dating a crack addict,” she said. “It was the most insane thing I could do. I knew I loved alcoholics; that’s the gist of it. They’re fabulous people, exciting. In Al-Anon, you learn to focus on yourself because your part is the only thing you have control over.”

Karen’s daughter attends a weekly meeting of Alateen (for children and teens affected by alcoholism in a family member) and “loves it. She’s never known me to drink, but she gets a lot of help with what she’s going through with her father.”

Karen says the meetings “taught me to apply spirituality in a way I didn’t learn in church. I have freedom to do anything I want to do, to be anything I want to be… .”


1. We admitted we were powerless over alcohol —- that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Note: Other 12-step groups have adapted AA’s steps, sometimes changing the wording to accommodate the needs of their constituents. Al-Anon, for example, changed one word, replacing “alcoholics” in Step 12 with “others.”
source: Atlanta Journal-Constitution

Friday, October 17, 2008

Alcohol admissions triple at central London hospital

Adult alcohol-related admissions to an inner London hospital have tripled in the last four years, according to new research.

Trends in admissions were studied at the emergency departments and in medical admissions at two inner London hospitals – University College Hospital and the Whittington Hospital from 2004-8.

The total number of adult in-patient admissions at the two hospitals rose from 998 in 2004-05, to 2,690 in 2007-08. Adult attendances linked to alcohol in the emergency departments rose too - from 2,560 in 2004-05 to 3,434 in 2007-08.

Dr Andrew Smith, lead researcher, and colleagues found the figures for University College Hospital demonstrated a clear trend. This was not the case with the Whittington data.

University College Hospital is located in an area with a high concentration of pubs and nightclubs whilst the Whittington is not, which might be the reason for the increase in alcohol-related attendances at this hospital, they suggested.

Separately, they examined trends in teenage alcohol-related presentations. No increase in hospital admissions was observed, although the number of A&E attendances for under-18s rose from 98 in 2004/05 to 165 to 2007/08.

‘This increase coincides approximately with the change in the licensing laws. While under-18s might not generally be expected to be drinking in licensed premises, the law changes also affected off-licenses which may be of relevance,’ said Dr Smith.

The Licensing Act 2003 came into effect in November 2005. This change appears to have been paralleled by an increase in the presentation of alcohol-related illnesses in these two hospitals, conclude the authors.

‘A three-fold increase in the total number of adult admissions is noted at one hospital which if repeated at other centres, would have significant ramifications on NHS resources if this trend continues,’ they added.

The data were presented at the Royal College of Psychiatrists’ Faculty of General and Community Psychiatry Annual Meeting in Manchester today.

It follows last week’s calls for strong public policy measures to counter the alcohol problem in society. Dr Nick Sheron and colleagues said changes to price and availability of alcohol would work better than clinical treatments or Government initiatives to cut alcohol-related harm.

Writing in Gut, they say evidence from the WHO, the Academy of Medical Sciences and the EU, show that the best way of reducing consumption and alcohol-related harm is to tackle price.
source: On Medica

Wednesday, October 15, 2008

A tough-on-crime approach to justice that actually works

Instead of jailing repeat petty criminals, we should send them to mandatory addiction treatment

In a season of tough talk on crime, I propose a challenge to our political leaders. In Canada, one group of criminals commits a disproportionate number of crimes that we could easily reduce with more coercive sentencing. However, our usual form of coercion -- imprisonment -- doesn't work for them. They need a different kind of sentence. But to make that happen -- and to significantly reduce the number of crimes they commit -- would require will and wisdom that our legislators can't seem to muster.

The legal system refers to these men -- they are almost all men -- as chronic offenders. What everyone knows, but the justice system doesn't acknowledge, is that they are also drug addicts, hooked on heroin or crack cocaine. They steal not for gain but to support their addiction, to pay for their next fix.

This has nothing to do with getting high. For an addict, the point is to avoid the effects of withdrawal, which in the case of heroin can include cramps and muscle spasms, fever, cold sweats and goose bumps (hence the phase "cold turkey"), insomnia, vomiting, diarrhea and a condition called "itchy blood," which can cause compulsive scratching so severe that it leads to open sores. For addicts, drug use is not a lifestyle choice that's easy to change.

Many have been addicted for their entire adult lives, and as a result have spent half their lives behind bars, serving dozens of sentences for minor crimes. These are the "revolving door" criminals -- arrested, tried, sentenced to a few weeks or months, then dumped back out on the street, only to be arrested, tried and convicted again a few weeks later.

Canada has hundreds of criminals like that, mainly in the larger cities. Vancouver alone recently identified 379. According to a report by the Vancouver Police Department, the vast majority were addicted to drugs or alcohol. Many also suffer from a mental disorder, generally untreated. Between 2001 and 2006, Vancouver's few hundred chronic offenders, as a group, were responsible for 26,755 police contacts -- more than 5,000 contacts per year, 14 a day. The costs are staggering. Arrests, prosecutions and incarcerations end up costing some $20,000 per criminal per month -- per month! There has to be a better way.

Punishment alone is not it, though, for a couple of reasons. For one, the idea of punishing criminals is based at least partly on the concept of specific deterrence. You steal, we lock you up. Applied most strongly to property crimes -- which is what these offenders mainly commit -- specific deterrence assumes that the criminal is a rational actor who will consider: Is it worth it? And in fact, specific deterrence often works; many offenders really do stop committing crimes after fairly short jail sentences.

But not addicts.

The problem is the presumption of a rational actor. That is exactly what we do not have with drug addicts, who do not -- usually cannot -- stop to consider the likely punishment for a crime they are about to commit. They see only the escape from the more immediate and dire punishments of drug deprivation. By comparison, the threat of being caught and thrown in jail is nothing.

As well, because chronic offenders tend to commit minor crimes and draw short sentences -- say, 30 to 90 days for theft -- their lives shift constantly between jail and the streets.

We could use longer sentences to "warehouse" chronic offenders -- the American "three strikes and you're out" approach. But long-term imprisonment would be a very high-cost way to deal with what is really a public health issue.

And there's the crux of the problem.

The criminal justice system is not designed to treat addicts. While prisons do provide some drug treatment, it is almost always short-term and underfunded.

Clearly, Canadians need more protection from chronic offenders than we are now getting.

With chronic offenders, we have an issue of both criminal law and public health. Addicted offenders must be required to undergo serious, long-term drug treatment.

Since 1996, Alberta law has required minors with an apparent alcohol or drug addiction to participate, with or without their consent, in an assessment and treatment program. Saskatchewan and Manitoba have similar legislation and even allow parents of drug-addicted children to ask a court to require treatment, whether or not the child is in trouble with the law.

Although the research is scant, mandatory treatment does appear to have about the same success rate as voluntary treatment. A 1970s American study looked at the effectiveness of methadone maintenance treatment for those who entered the program under high, moderate or no coercion and found no significant difference in outcomes for the three groups.

Given the costs of incarceration -- not counting the costs to future victims -- paying for mandatory drug treatment for them hardly seems an issue, even if it only works some of the time. As for whether mandatory treatment is somehow inhumane, how humane is it to sentence these addicts to punishments we know don't work and then dump them back on the street no better than before?

Politics aside, Canadians deserve evidence-based criminal justice policies that actually reduce crime. Our challenge is to make the tough choices that move beyond "tough on crime" rhetoric and produce real change.
source: James C. Morton and The Ottawa Citizen

Tuesday, October 14, 2008

The Big Question: Why is opium production rising in Afghanistan, and can it be stopped?

Why are we asking this now?

Nato and the US are ramping up the war on drugs in Afghanistan. American ground forces are set to help guard poppy eradication teams for the first time later this year, while Nato's defence ministers agreed to let their 50,000-strong force target heroin laboratories and smuggling networks.

Until now, going after drug lords and their labs was down to a small and secretive band of Afghan commandos, known as Taskforce 333, and their mentors from Britain's Special Boat Service. Eradicating poppy fields was the job of specially trained, but poorly resourced, police left to protect themselves from angry farmers. All that is set to change.

How big is the problem?

Afghanistan is by far and away the world's leading producer of opium. Opium is made from poppies, and it is used to make heroin. Heroin from Afghanistan is smuggled through Pakistan, Russia, iran and Turkey until it ends up on Europe's streets.

In 2008, in Afghanistan, 157,000 hectares (610 square miles) were given over to growing poppies and they produced 7,700 tonnes of opium. Production has soared to such an extent in recent years that supply is outstripping demand. Global demand is only about 4,000 tonnes of opium per year, which has meant the price of opium has dropped. In Helmand alone, where most of Britain's 8,000 troops are based, 103,000 hectares were devoted to poppy crops. If the province was a country, it would be the world's biggest opium producer.

In 2007, the UN calculated that Afghan opium farmers made about $1bn from their poppy harvests. The total export value was $4bn – or 53 per cent of Afghanistan's GDP.

Is it getting better or worse?

There was a 19 per cent drop in cultivation from 2007 to 2008, but bumper yields meant opium production only fell by 6 per cent. Crucially, the drop was down to farmers deciding not to plant poppies, and that was largely a result of a successful pre-planting campaign, led by strong provincial governors, in parts of the country that are relatively safe.

Only 3.5 per cent of the country's poppy fields were eradicated in 2008. High wheat prices and low opium prices are also a factor in persuading some farmers to switch to licit crops.

In Helmand, one of the most volatile parts of Afghanistan, production rose by 1 per cent as farmers invested opium profits in reclaiming tracts of desert with expensive irrigation schemes. Opium production was actually at its lowest in 2001. The Taliban launched a highly effective counter-narcotics campaign during their last year in power. They used a policy of summary execution to scare farmers into not planting opium. Many analysts attribute their loss of popular support in the south, which contributed to their defeat by US-led forces in late 2001, to this policy.

How are the drugs linked to the insurgency?

The Taliban control huge swaths of Afghanistan's countryside, where most of the poppies are grown. They tax the farmers 10 per cent of the farm gate value of their crops. Antonio Maria Costa, head of the UN Office on Drugs and Crime, said the Taliban made about £50m from opium in 2007.

They also extort protection money from the drugs smugglers, for guarding convoys and laboratories where opium is processed into heroin. The UN and Nato believe the insurgents get roughly 60 per cent of their annual income from drugs. The Taliban and the drug smugglers also share a vested interest in undermining President Hamid Karzai's government, and fighting the international forces, which have both vowed to try and wipe out the opium trade.

What about corruption?

The vast sums of drugs money sloshing around Afghanistan's economy mean it is all too easy for the opium barons to buy off corrupt officials.

Most policemen earn about £80 a month. A heroin mule can earn £100 a day carrying drugs out of Afghanistan. Most Afghans suspect the corruption reaches the highest levels of government. President Karzai is reported to have called eradication teams to halt operations at the last minute for no apparent reason.

When an Afghan counter-narcotics chief found nine tonnes of opium in a former Helmand governor's compound, he was told not burn it by Kabul – but he claims he ignored the order.

President Karzai's brother, Ahmed Wali Karzai, is widely rumoured to be involved in the drugs trade – an allegation he denies. The New York Times claimed US investigators found evidence that he had ordered a local security official to release an "enormous cache of heroin" discovered in a tractor trailer in 2004. Privately, Western security officials admit they suspect that a number of government ministers are drug dealers.

Where does that leave the international community?

Right across Afghanistan, the government is corrupt and Afghans are fed up. The police organise kidnappings. Justice is for sale. Violence is spreading and people don't feel safe. The progress promised in 2001 hasn't been delivered.

Education is a rare success. There are now more than six million children at school, including two million girls, compared with less than a million under the Taliban.

But the roads which link the country's main cities aren't safe. Taliban roadblocks are increasingly normal. UN convoys are getting hijacked.

A report published by 100 charities at the end of July warned violence has hit record highs, fighting is spreading into parts of the country once thought safe, and there have been an unprecedented number of civilian casualties this year.

General David McKiernan, the US commander of almost all the international forces in Afghanistan, insited to journalists at a press conference on Sunday that Nato isn't losing. The fact he had to say it suggest public perception is otherwise. He also said that everywhere he goes, everyone he speaks to is "uniformly positive" about the future. Those people must be cherry-picked.

Crime in the capital, Kabul, is rising. The Taliban broke 400 insurgents out of Kandahar jail this summer, and they attacked the provincial capital in Helmand last weekend. People are frustrated at the international community's failures and scared that the Taliban are coming back.

What does that mean for the future?

President Karzai has touted peace talks with the Taliban through Saudi intermediaries. The international community maintains it will support the Afghan government in any negotiations, but privately diplomats admit that if they opened talks tomorrow they would not start from a "perceived position of strength".

General David Petraeus is about to take command at CentCom, which includes Afghanistan, and he is expected to focus on churning out more Afghan soldiers and engaging tribes against the insurgents.

Meanwhile, in Pakistan, it remains to be seen whether Asif Ali Zardari will rein in his intelligence service and crack down on the Taliban safe havens in the Pakistani tribal areas, which they rely on to launch attacks in Afghanistan.

There are also elections on the horizon. The international community is determined that they must go ahead, despite the obvious security challenges, and anything the Afghan candidates do should be seen in the context of securing people who can deliver votes.

Does the war on drugs undermine the war on terror?


*Working to eradicate poppies will remove farmers' best source of income and turn them against Nato

*Using resources to fight against the entrenched poppy trade diverts them from the war with the Taliban

*Corruption in government means that battling opium turns the mechanism of the state against our forces


*In the end, an Afghanistan without opium production will be much less prone to the influence of the Taliban

*Money from the international drugs trade may find its way to terrorists outside of Afghanistan

*Removing the source of corruption will strengthen the country's institutions in the long term

Monday, October 13, 2008

Alcohol-related arrests up at IU Southeast

The Indiana University Southeast Campus Police Department is now dealing with a problem many campuses have had for years — alcohol offenses.

For the first time, IUS offers on-campus housing for students this year. With residents comes more students trying to test the limits.

Less than two months since the residence halls opened, campus police have already made nine alcohol-related arrests. Several others have been cited or given referrals. By comparison, IUS reported only two on-campus alcohol violations and six referrals from 2004 until 2006. The 2007 crime reports will be released next month.

“This is something we’ve never really had to deal with before,” said Dennis Simon, campus chief of police. “We’ve had very few arrests in the past.”

In fact, the police department is in the process of changing its crime reporting system so that an arrest log will be available in the campus police office. In the past, there were so few arrests they never had to worry about that.

So far, two arrests were made and three citation issued for minor consumption. There have been four operating while intoxicated arrests, two disorderly conduct arrests and one possession of marijuana arrest.

Simon believes the number of alcohol violations will continue to drop as students realize campus police and school administrators will not tolerate alcohol on campus.

“Problems have decreased significantly after the first two weeks,” he said. “We indicated to people that you can’t get away with breaking the rules.”

Most of the problems have involved non-students visiting students on campus, Simon said. Six out of nine people arrested were not students.

The university prohibits alcohol, tobacco and weapons on campus. The only exception is when alcohol is allowed at certain events approved by the chancellor.

Simon met with Floyd County Prosecutor Keith Henderson earlier this year, and both agreed to let the school handle minor offenses like alcohol consumption. In those situations, campus police will issue referrals and Student Affairs decides the discipline. The range of penalties include probation and suspension or even removal from campus housing for repeat offenders.

“We want students to have a good college experience,” Simon said.

Simon also thanked the Community Advisors, students who are selected to monitor residence halls, saying they had been “vigilant.”
source: News and Tribune

Saturday, October 11, 2008

Don’t wait for cops to detect alcohol abuse

Rightful outrage over dangerous drunken drivers has fueled new demands for tougher laws and penalties.

And who can argue?

But with Wisconsin on top of most lists for binge drinking or drunken driving, you know there are many more folks out there who are risks but have yet to become a statistic or headline.

So let’s not overlook another, better way to get at the nub of the problem.

A pilot prevention program, if broadened as many respected medical associations say it should be, would screen many more people for problem drinking or drug use before it’s too late. It would intervene with information and, where needed, treatment, before these problem drinkers end up in highway carnage or handcuffs.

It would start at the doctor's office.

One of my doctors requires me to complete an annual survey that asks, among other things, about alcohol or drug consumption. The trouble is, most doctors don't have time to talk about it. They can barely deal with your high blood pressure or arthritis or other painful ailment as it is.

Waukesha's Family Practice Center is one of 20 clinics participating in the promising prevention effort through the Wisconsin Initiative to Promote Healthy Lifestyles, financed with a $12 million, five-year federal grant. (See www.wiphl.comfor information.)

Betzaida Silva-Rydz is the specially trained health educator at the Waukesha clinic. She describes a woman who came to the clinic for medical issues and, like others, completed four screening questions - like when was the last time she had four drinks in one sitting.

After she was provided information, without judgment, the woman recognized that both she and her husband had a problem in ways they hadn't considered, affecting their health, their family, their finances.

Through a few more sessions, the couple saw their way to changes that put more effort into family and less into social drinking.

It's the kind of story repeated last week at a meeting of health care professionals where early screening and intervention were hailed by the likes of Milwaukee Commissioner of Health Bevan Baker and Milwaukee County District Attorney John Chisholm.

Baker, quoting his wife, said it's not just taking the bull by the horns - which can leave you gored - it's removing the horns.

The National Institute on Alcohol Abuse and Alcoholism says one in four Wisconsinites is a problem drinker or drug user, but only 10% to 20% of them get help. The state estimates the consequences cost $5 billion a year in health care, social services and criminal justice. One brief screening and intervention saves $1,000, a state study reports.

The National Commission on Prevention Priorities, which tries to identify the biggest bang for the buck in public health spending, has an eye-opening ranking of how to best make us healthier:

First, men older than 40 and women older than 50 should take a daily aspirin for cardiovascular health. Second, children should be immunized. Third, help people quit smoking.

And fourth? Have routine alcohol screening and intervention. It's ahead of cholesterol screening, blood pressure screening. even cancer screenings.

It's that important. So more clinics should get involved. More insurance plans should cover it. And more people desperate to do something about drunken drivers should demand it.
source: Milwaukee Journal Sentinel

Tuesday, October 7, 2008

Doctors can't treat your drinking problem

The rise in alcohol abuse should be a matter for social policy not the GP's surgery

‘Your GP is the first place to turn if you are concerned about your drinking.’ This was the concluding advice of a recent eight-page Guardian supplement devoted to ‘Britain’s harmful relationship with alcohol’. Once regarded as a manifestation of moral turpitude, excessive drinking is now defined as a medical condition. GPs have taken the place of evangelical ministers at the head of the modern temperance crusade. The fact that these same doctors come second only to publicans in terms of death from alcohol-induced cirrhosis of the liver has not diminished medical authority in this area.

The rise of GPs in dealing with alcohol problems is based on claims for the effectiveness of ‘brief interventions’. This means doctors giving patients a quick, but empathetic, lecture on the adverse health consequences of alcohol before advising them to stop. But close scrutiny of these studies reveals that their high success rates are achieved at a cost. They exclude patients who are alcohol dependent (including only those deemed to have ‘hazardous’ levels of drinking). They follow up for a short period (usually less than 12 months). And they define success in terms of a reduction in total consumption or episodes of binge drinking (rather than achieving abstinence).

If doctors suggest to patients drinking over the odds that they should consider cutting back, they do, for a while, before resuming their old habits. A desperate resort to old-fashioned medical paternalism? – yes. A solution to ‘Britain's harmful relationship with alcohol’? – no.

Prominent doctors and medical organisations instinctively recognise the ineffectiveness of medical intervention – and indeed of medical treatment. They have campaigned for prohibitionist measures to deal with excessive drinking. No newspaper or television feature on alcohol is now complete without a leading liver specialist, psychiatrist or GP demanding more regulations on the sale of alcohol. They call for banning advertising, raising prices and for tougher policing of licensing laws. But if doctors cannot treat alcoholism in their surgeries, why should anybody accept their proposals in the sphere of social policy? After all, they have no expertise there whatsoever.

The notion that doctors can treat the nation’s alcohol problem is a delusion that is convenient for the medical profession and for politicians eager to respond to the latest moral panic. But it marks an evasion of the real issues. Self-destructive patterns of alcohol consumption express personal and social demoralisation. This is not susceptible to medical – or political – quick-fixes.
source: The Times

Monday, October 6, 2008

Stress of Ike recovery also strains recovery of addicts

Houstonians are still confronting the lingering effects of Hurricane Ike: damaged homes, piles of debris, lost work and ends that won't meet. But for recovering alcoholics and addicts, coping with post-Ike realities may also mean reaching out to sobriety buddies instead of the bottle or drugs.

Stress is the greatest threat to people fighting addictions, Houston experts say, and Ike's toll could trigger relapses.

"What underlies addiction and substance abuse is fear, anxiety and stress. People drink and use because it medicates their anxiety," said Dr. Scott Basinger, a neuroscientist and associate dean at Baylor College of Medicine. "Don't get too hungry, too angry, too lonely or too tired, because being hungry, angry, lonely or tired are well-known risk factors for relapse."

The risk is heightened during a disaster, when loss of power, phone service and transportation cuts contact with counselors. Afterward, assessments of the damage, joblessness and other factors could create a perfect storm for recovering addicts to slip.

"A lot of times, these things have a delayed effect," said Joy Schmitz, a psychologist at the University of Texas Health Science Center at Houston who studies behavior and substance abuse. "It could be a challenging time for patients who are trying to maintain abstinence, especially if they recently quit."

Many people did reach out for help in Ike's aftermath.

Calls flooded area treatment centers, and some support groups held meetings by candlelight just hours after Ike passed. The Sunday after the storm, for instance, people showed up for substance abuse meetings at Memorial Hermann's Prevention and Recovery Center.

"I think people seek out the fellowship, they seek out each other to have someone to lean on, to talk to and to support," said center CEO Matt Feehery. "People who have a solid recovery network will do just fine. Isolation is an enemy if you've lost something — property, power, a loved one."

Heather, who agreed to speak on the condition that her last name not be used, admitted that Ike tested her newfound sobriety. She had voluntarily gone to treatment, she said, to overcome alcohol and cocaine abuse.

But on the evening that Ike made landfall, she found herself with an unopened beer in her hand at a hurricane party. She reached in her pocket to feel for her silver coin — a recovery reminder handed out at Alcoholics Anonymous meetings.

"I surprised myself by not drinking," the former bartender said.

"I thought underneath those stressful situations I would relapse, but I didn't," said Heather, who resumed treatment at a Houston center after the storm.

Because of the chance of relapse under stressful post-storm conditions, the Texas Department of State Health Services has required state-funded substance abuse treatment services to track clients impacted by hurricanes Katrina, Rita, Gustav and Ike.

"This information can help service providers offer better screening, assessment and referral services as they will have an idea of what environmental factors, such as being a disaster survivor, may have contributed to the change in behavior," agency spokeswoman Emily Palmer wrote in an e-mail.

Substance abuse counselors are concerned that Ike will continue to spin off stress, leading people deeper into addictions.

"They go through something like this, and they start to self-medicate, and the problem starts to escalate," said Dr. Jason Powers, chief medical officer at The Right Step, a Houston treatment center.