Drug Research and Recovery Act of 2009

What's in the budget for addiction scientists?

Scientists were among the likely beneficiaries of President Obama’s American Recovery and Reinvestment Act of 2009.

The National Institutes of Health (NIH) is slated to receive $10 billion for use over the next two years. A yet-to-be-determined portion of the grant will end up with the National Institute on Drug Abuse (NIDA).

Here is a sampling of NIDA’s wish, or “Challenge Topics” for which the agency is seeking grant proposals. The application due date is April 27, 2009.

--Dietary treatment of substance disorders.
“There is abundant preclinical and clinical evidence that suggest dietary therapies and behavioral interventions can promote neurogenesis, diminish susceptibility to metabolic and excitotoxic injury (e.g., diets rich in antioxidants), and/or counteract stress responses within the brain. Dietary regimens or supplements can be evaluated as individual treatments or as adjuncts to FDA-approved medications.”

--Drug genetics and informed consent.
“Address ethical issues related to access to broad sharing and use of new genetic information and technologies for addiction research to improve treatment and prevention options for addicts.”

--Addiction drugs combined in treatment.
“Network biological analysis predicts that modification of a single target by a drug is not nearly as likely to affect disease outcome as would rational combinations of drugs that target multiple, complementary mechanisms. Applications will focus on combination of medication strategies for the treatment of substance use disorders.”

--Neurobiology of opioid addiction.
“There is an urgent need for research that will more thoroughly delineate the neurobiological implications of long-term opioid use. This knowledge gap is of particular concern when it comes to the developing brain - and the urgency is underscored by the fact that increasing numbers of adolescents and young adults are using opioid medications, prescribed and otherwise.”

--Research on addiction drugs for pregnant women.
“Substance abuse during pregnancy often occurs in the context of complex environmental factors and poly-drug exposure, as well as medical conditions which are associated with adverse neonatal consequences. Much is known in regard to the negative effects of substances of abuse on the pregnant/post partum women and their substance exposed neonates but relatively little is known in regard to medication treatment strategies and research methodology.”

--Internet-based prevention and treatment in rural locations.
“Many persons living in remote or rural locations have limited opportunities to obtain drug abuse treatment services, due to a lack of available service settings, the barrier of traveling long distances, and/or the perceived lack of private and confidential treatment options. This program seeks to develop web-based drug abuse treatment interventions that do not necessitate frequent in-person visits to a central facility.”

--Finding new molecular targets for addiction treatment drugs.
“Projects may utilize techniques ranging from gene knockout technologies, behavioral evaluations, assay development, and targeted library synthesis and screening that could lead to the development of medications for drug addiction treatment. The focus may be on the identification of new molecular targets, and/or the discovery of small molecule selective ligands for previously identified targets, such as muscarinic M5 antagonists, neuropeptide Y antagonists, and neurotensin agonists.”

For general information on the National Institute on Drug Abuse implementation of NIH Challenge Grants, contact:

Christine Colvis, Ph.D.
NIDA Challenge Grant Program Coordinator
National Institute on Drug Abuse
National Institutes of Health
Phone 301-443-6480
Email ccolvis@nida.nih.gov
________
source: Addiction Inbox

One-Third of Americans Have an Addicted Relative

Nearly 1/3 of Americans have an immediate family member who has or have had an alcohol or drug abuse problem and almost half of those families have more than one member who had an addiction problem. For most of those families the most significant negative consequence of that addiction is the embarrassment or social stigma.

These finds were part of the "Attitudes Toward Addiction Survey" conducted by the Hazelden organization.

The telephone survey of 1,000 adults revealed some lingering stigma associated with alcoholism and drug addiction in spite of the fact 78% of those surveyed agreed that drug addiction is a chronic disease rather than a personal failing.

According to Hazelden, when survey participants were asked to describe people who have problems with drugs or alcohol included: "sinner," "irresponsible," "selfish, "stupid," "uncaring," "loser," "undisciplined," "pitiful," "pathetic," "weak," "criminal," "derelict," "washed up" and "crazy."

"What Hazelden's new survey brought home to me is that Americans understand addiction is a disease, yet much more work must be done to explain how effective treatment can be for addicts and to bring an end to the stigma that prevents addicts from pursuing treatment," said William Cope Moyers, executive director of Hazelden's Center for Public Advocacy in a news release.

The Prevalence of Addiction

Here are some of the survey findings about the prevalence of addiction:

* Nearly one-third of Americans reported past abuse of alcohol or drugs in their immediate family.

* Of those households with an immediate family member who had an addiction problem, 44% reported more than one family member with a drug problem.

* A third of the families which reported a drug problem in their immediate family say that a majority of their family members have problems with drugs.

* With one in six of the respondents dealing with substance abuse in their family, every member of the family has a problem with drugs or alcohol.

* When asked about extended family, virtually half of Americans surveyed reported three or more family members have experienced a problem with drugs during their lives.

Attitudes About Prevention, Treatment

The survey also revealed attitudes about prevention and treatment efforts:

* 79% percent feel the War on Drugs has not been successful.

* 83% agree that much more should be done to prevent addiction.

* 83% believe that first-time drug offenders should get chemical dependency treatment rather than prison time.

* 77 percent agree that many addicts who complete treatment go on to lead useful lives.

* 71% agree health insurance should cover addiction treatment, but most have no idea if their own insurance will pay.

As a result of the survey, Hazelden's Center for Public Advocacy will launch a public advocacy campaign in Washington, D.C. and across the United States this year.
__________
source: http://alcoholism.about.com

New Recovery

ALL ADDICTS ARE DIFFERENT — NOW THERE'S A TREATMENT THAT IS TOO

As a professional experienced with alcohol and drug addiction, you know those struggling with this debilitating disease face a long journey towards sobriety – one that requires a customized, leading-edge recovery program with a personalized approach. Unfortunately, there are few programs today that go above and beyond the standardized treatment formula to improve the odds for long-term sobriety. That's why Enterhealth, a premier alcohol and drug addiction recovery center, with its proven therapeutic approaches, neurology, technology, and leading anti-addiction medications, is earning a reputation as the better way to recover.

Here are just a few reasons why Enterhealth stands out from more traditional alcohol and drug addiction treatment programs. To learn more on how Enterhealth can help you and your clients, call 800.388.4601 or visit us at enterhealth.com.

Reason 1: Neuro therapy. In order to help clients overcome physical trauma to the brain caused by addiction, Enterhealth utilizes neurological therapy techniques. This integration of state-of-the-art diagnostics of the brain with clinical therapies involves an MRI to assess any damage caused to the brain by alcohol and/or drug use, an EEG to assess risk level of seizure, and a written neuro-psych test to check for cognitive brain function loss. The results of this evaluation support a personalized treatment plan.

Reason 2: Anti-addiction medications. Rather than rely on talk therapy alone, Enterhealth offers clients access to the latest, most effective anti-addiction medications such as Suboxone, Campral, and Vivitrol. This can help not only repair damage to the brain caused by alcohol and drug use, but also reduce cravings, providing them the opportunity to more fully participate and benefit from treatment.

Reason 3: Length of stay. In contrast to most residential treatment facilities that offer a typical length of stay of 28-30 days, Enterhealth recommends a customized length of stay based on the client's unique needs and recovery progress. This better ensures the client has the tools they need to continue sobriety post residential treatment.

Reason 4: Dual diagnosis. The Enterhealth facility is designed to diagnosis and treat both the addiction as well as other mental health disorders – which in most cases is what creates the desire for alcohol or drugs in the first place. By treating the mental disorder in tandem, typically with personalized, private therapy, the odds for relapse are greatly reduced.

Reason 5: Wellness emphasis. Enterhealth's personalized wellness program includes individual time with a trainer as well as a dietician to address physical and dietary patterns that are recommended for balance and healthy living.

Reason 6: Balance of group & private therapy. The Enterhealth facility is limited to 16 clients, offering an industry-low therapist-to-client ratio of 1:3. This intimate setting allows more focus to be placed on individualized, one-on-one therapy, while also supporting a menu of both small and large group therapies.

Reason 7: Post Residential Support. As your clients transitioned back to your care from the residential addiction treatment program, Enterhealth’s online Life Care program can assist them in continued recovery through access of Enterhealth's online recovery tools 24 hours a day from anywhere in the world.

We invite you to schedule a tour and meet our team. To learn more about what makes Enterhealth a better way to recovery and how it can help your clients, call 800.388.4601 or visit us at www.enterhealth.com

JOIN TOGETHER MERGES INTO CASA

NEW YORK, N.Y., January 15, 2009 – The National Center on Addiction and Substance Abuse (CASA) at Columbia University announced today that Join Togethertm will be merged into CASA and David L. Rosenbloom, Ph.D., will become the President and Chief Executive Officer of CASA on May 1, 2009, succeeding Joseph A. Califano, Jr., the former U.S. Secretary of Health, Education, and Welfare who founded CASA in 1992 and has been its Chairman and President since that time. Califano will continue to serve as CASA chairman.

“Naming David Rosenbloom CASA’s new president is the result of more than two years of work by the Board which involved an analysis of CASA’s first 16 years, discussions with 100 individuals and institutions about CASA achievements and potential, the needs of the substance abuse field, and an intensive search involving a number of qualified candidates. The Board and I are convinced that David Rosenbloom is the individual best suited to move CASA forward and increase its influence and activities,” said Califano. “Merging Join Together into CASA will greatly strengthen CASA’s ability to inform the American people of the economic and social costs of substance abuse and its impact on their lives, make CASA’s research findings and recommendations widely available to those working on the front lines to prevent and treat substance abuse and addiction, and significantly expand our nationwide advocacy capacity. The combination of CASA and Join Together will produce a total far greater than the sum of the parts.”

Rosenbloom, 64, has been Director of Join Togethertm since he founded it in 1991. He is a Professor of Public Health at the Boston University School of Public Health. For eight years, from 1973 to 1985, he was Commissioner of the Department Health and Hospitals for the city of Boston and CEO of Boston City Hospital. For several years after that he was president and CEO of Health Data Institute, a company that pioneered the clinical analysis of medical claims data and developed managed care techniques. He received his BA from Colgate University in 1965 and his Ph.D. from the Massachusetts Institute of Technology in 1970.

“Progress in addiction prevention and treatment is essential in order to reform America’s health care system and address most other critical social problems facing the nation. Combining the resources of CASA and Join Together creates the critical mass needed to focus the attention of our nation and its leaders on the need for effective prevention and treatment policies to achieve such progress. It blends the formidable research of CASA and the public and policy attention that CASA has attracted with the unique web based education and advocacy and tools of Join Together. I am excited by the opportunity to combine and lead these talented teams and work with Joe Califano,” said Rosenbloom.

Join Togethertm is the leading provider of news, information and continuing education on tobacco, alcohol and illegal, prescription and performance enhancing drugs to policy makers, community leaders, parents, and front line prevention and treatment practitioners; all free of charge to more than 50,000 subscribers and 7,000 daily users of its website http://www.jointogether.org/. Its advocacy campaigns promote adoption of prevention and treatment policies and practices that research has shown to be effective.

“CASA is the premier think/action tank in the field with the brightest group of professionals ever assembled under one roof to research and combat substance abuse and addiction. David has the right experience, talent and creativity to enhance this national asset. We are fortunate that he has accepted this challenge,” said Califano. “I look forward to working with him.”

CASA is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA and its staff of more than 50 professionals has issued 66 reports and white papers, published one book, conducted demonstration programs focused on children, families and schools at 224 sites in 87 cities and counties in 34 states plus Washington, DC and two Native American tribal reservations, held 17 conferences attended by professionals and others from 49 states, and has been evaluating the effectiveness of drug and alcohol treatment in a variety of programs and drug courts. CASA is the creator of the nationwide initiative Family Day—A Day to Eat Dinner With Your Childrentm –the fourth Monday in September—the 28th in 2009—that promotes parental engagement as a simple and effective way to reduce children’s risk of smoking, drinking and using illegal drugs. In May 2007, CASA’s Chairman Joseph A. Califano, Jr., called for a fundamental shift in the nation’s attitude about substance abuse and addiction with publication of his book, HIGH SOCIETY: How Substance Abuse Ravages America and What To Do About It. For more information visit http://www.casacolumbia.org/.
________________
source: http://www.casacolumbia.org

Marijuana Law Comes With Challenges

BOSTON — Last month, voters approved a statewide measure decriminalizing the possession of small amounts of marijuana. Now, wary authorities say, comes the hard part. They are scrambling to set up a new system of civil penalties before Jan. 2, when the change becomes law. From then on, anyone caught with an ounce or less of marijuana will owe a $100 civil fine instead of ending up with an arrest record and possibly facing jail time.

It sounds simple, but David Capeless, president of the Massachusetts District Attorneys Association, said the new policy presented a thicket of questions and complications.

One of the most basic, Mr. Capeless said, is who will collect the fines and enforce other provisions of the law. For example, violators under 18 will be required to attend a drug awareness class within a year, but it is unclear who will make sure that they do so. The fine increases to $1,000 for those who skip the class.

A complicating factor, said Mr. Capeless, the district attorney in Berkshire County, is that state law bans the police from demanding identification for civil infractions.

“Not only do you not have to identify yourself,” he said, “but it would appear from a strict reading that people can get a citation, walk away, never pay a fine and have no repercussion.”

Wayne Sampson, executive director of the Massachusetts Chiefs of Police Association, says he anticipates that many violators will lie about their identities.

“You can tell us that you’re Mickey Mouse of One Disneyland Way,” Mr. Sampson said, “and we have to assume that’s true.”

The authorities, he said, will also have to be sure that the substance they hand out citations for is marijuana, which will involve sending it to the State Police crime laboratory.

“You’re going to appeal it and go to the clerk’s hearing,” Mr. Sampson said, “and if we don’t have an analysis from the drug lab, the clerk is going to throw the case out.”

Mr. Sampson predicted that the law would result in de facto legalization of marijuana because it would prove too difficult to enforce.

“I would argue that the proponents knew these complications right from the beginning,” he said.

About 65 percent of state voters supported the decriminalization measure, which was promoted by a group that spent more than $1.5 million on the effort.

The group, the Committee for Sensible Marijuana Policy, said that in addition to ensuring that people caught with marijuana no longer have a criminal record, the change would save about $29.5 million a year that it estimates law enforcement currently spends to enforce existing drug laws.

A spokesman for the Marijuana Policy Project in Washington, which supports the drug’s legalization and created the Committee for Sensible Marijuana Policy to get the ballot question passed here, said that judging from the experience of other states with civil penalties for marijuana possession, Massachusetts officials were exaggerating the challenges.

“I can’t help but think that the real difficulty in implementing it,” said the spokesman, Dan Bernath, “is they don’t want to do it.”

Eleven states have decriminalized first-time possession of marijuana, though in most it is technically a misdemeanor instead of a civil offense.

In Nebraska, where possession of an ounce or less of marijuana is punishable by a $300 civil fine, the process has worked smoothly for three decades, said Michael Behm, executive director of the Nebraska Crime Commission.

In New York, possession of an ounce or less of marijuana is a noncriminal violation but is still processed through the criminal system, said Robert M. Carney, the district attorney in Schenectady County.

“They are brought down to the police station so their identity is established,” Mr. Carney said of violators, “but they are not fingerprinted because it’s not an arrest.”

In Massachusetts, the Executive Office of Public Safety is working with state and local law enforcement and court officials to determine how to apply the changes. Mr. Capeless said education officials were also in on the discussions because it was unclear whether public schools and universities could forbid marijuana possession under the new law.

A spokesman for the public safety office said its legal counsel was considering “a lot of questions” as the deadline drew near. But the spokesman, Terrel Harris, would not elaborate.

“We are just trying to make sure we have all the answers,” Mr. Harris said.

Mr. Capeless said that in particular the department needed to address a clause in the new law that said neither the state nor its “political subdivisions or their respective agencies” could impose “any form of penalty, sanction or disqualification” on anyone found with an ounce or less of marijuana.

“It appears to say that you get a $100 fine and they can’t do anything else to you,” he said. “Can a police officer caught with marijuana several times get to keep his job and not be disciplined in any fashion? Can public high schools punish kids for smoking cigarettes but not for having pot?”

Mr. Bernath agreed that the law was “not completely clear” on how to handle such situations, but predicted that they would be rare.

“I think the resistance has to do with dealing with something new,” he said. “We’re pretty confident that once this gets going and the newness of it wears off, a lot of the apprehension will go away.”
__________
source: New York Times

Florida Drug Rehab Center Now Offering Extended Stay Programs

Ambrosia Treatment Center, a holistic-based drug rehabilitation center located in Port St Lucie Florida, now offers extended stay addiction treatment programs specifically tailored to the needs of the patient.

When it comes to health problems, a quick and neat solution is preferred nowadays. We have pills and syrups to ease every possible symptom. Surgery procedures that can be performed the same day and leave minimal scarring. However, when it comes to drug and alcohol addiction there is no such thing as a 'quick and neat solution.' Recent scientific studies have shown that the longer the treatment, the better the recovery and the more permanent the sobriety.

Therefore, drug rehab centers nationwide have begun lengthening their programs and making recommendations to possible patients for longer treatment stays that are still cost effective. Ambrosia Treatment Center, a world-class holistic drug rehab facility located in Port St. Lucie Florida, has begun offering both 60-90 day programs and 6-12 month programs, in addition to their shorter programs, in order to provide specialized treatment for all of their clientele.



According to the National Institute on Drug Abuse, over forty to sixty percent of people 'will relapse after drug treatment.' Addiction experts are now proving that longer treatment where client's specific needs are taken into account will alleviate the massive weight of addicts relapsing and cycling between 30-day hospitalizations for years and years. Dr. David Lewis, director of Visions Rehabilitation Center in Malibu, says that 30-day treatment programs were originally established for the Air Force and were only scheduled in that manner for bureaucratic reasons--'men and women didn't need to be reassigned if they were away from duty for more than 30 days. Other treatment centers followed suit.'

However, there was at the time no direct scientific evidence that showed that 30 days was adequate time for treatment. Today, we know that there are no 'magic numbers' when it comes to drug and alcohol abuse treatment and those 30 days is not nearly enough. The Ambrosia Treatment Center, as a holistic-based drug rehab facility, follows this pattern by treating the 'whole' person in order to resolve the underlying issues that may be causing the addiction in the first place. Often times, treating the 'whole' person requires more than simply 30-days.

However, many people find that an extended stay beyond 30-days is too much for addiction treatment. People argue that they have jobs, school, families--the normal day-in-day out routine that needs attention. What they want from rehabilitation is a quick fix. Yet, as stated before, there is no quick fix for drug and alcohol addiction and abuse. Studies have shown that addiction is best analogized to a chronic disease, such as heart disease--addiction requires critical attention and perseverance in terms of treatment in order to remain healthy. The Ambrosia Treatment Center family provides strong and capable staff, each of which carry over 20 years experience treating substance abuse and addiction treatment clients from all walks of life. Their attention to detail enables them to provide each client with an individualized regiment of treatment and not necessarily 'cookie cutter' their therapy.

At the end of the day, this is what sets The Ambrosia Treatment Center different from other rehabilitation clinics--they care. They want to see your loved ones get well. They never give up on an addicted person. And, at the end of the day, they believe that you never fail unless you just quit trying.

For additional information on the AMBROSIA TREATMENT CENTER and drug abuse treatment please call 1-866-616-0069 or visit www.ambrosiatreatmentcenter.com.
__________
source: topix.net

Drug And Alcohol Abuse Double Risk Of ICU Admission

While the personal health and safety risks of drug and alcohol abuse are well-documented, a new study by researchers at LDS Hospital and Brigham Young University suggests substance dependence increases medical costs by way of the intensive care unit.

Analysis of intensive care unit admissions at LDS Hospital in Salt Lake City shows drug and alcohol abuse make a patient twice as likely to be admitted to intensive care, according to the new study, published in the December issue of Intensive Care Medicine.

"Since these patients are admitted to an intensive care unit, which is geared to treat patients with a much higher acuity, medical costs are higher than for those admitted to a general ward in the hospital," reported Mary Suchyta, M.D., lead author and a physician at Intermountain Medical Center and LDS Hospital.

The researchers reviewed records for 742 patients admitted to LDS Hospital's intensive care unit over a one-year period. Nineteen percent of those patients had a history of drug and alcohol dependence prior to becoming critically ill. That's twice the rate of the population served by LDS Hospital.

"It appears that that patients with drug or alcohol dependence are at higher risk for intensive care unit admission compared to the general population, which would increase overall medical costs," said Ramona Hopkins, a psychology professor at BYU and researcher at Intermountain Medical Center and LDS Hospital.

Patients with drug or alcohol dependence were on average six years younger than the rest of ICU patients.

"What's alarming is that substance dependence meant that these individuals were critically ill and admitted to the ICU at a much younger age than the general population," Hopkins said. "If these individuals do not completely recover and return to work, that represents large potential societal costs."

The new study earned praise from the editors of Intensive Care Medicine, who noted that there are significant gaps in this type of knowledge in most ICU settings and while this article did not answer many of the questions posed by these gaps, it should stimulate further research and collaboration.

Both Drs. Suchyta and Hopkins agree that the detection of substance dependence earlier would allow doctors to address those issues and this may improve recovery.

"Dr. Hopkins and myself have thought for many years that patients with drug and alcohol dependence were over represented in the ICU populations that we have studied over the last 10-15 years and this study suggests that we were correct," noted Dr. Suchyta.

BYU undergrad Callie Beck is also a co-author on the new study. It's her second time publishing an academic paper alongside Hopkins. In 2006 she co-authored a study on brain imaging, a field she would like to pursue in graduate school. Beck is applying to nine graduate schools, including UCLA, Vanderbilt and the University of Maryland.

"Callie is an amazing student," Hopkins said. "She was involved in many aspects of the research, including data analysis and writing. That level of experience will make her stand out as she applies to graduate school."
___________
source: MediLexicon

Heroin treatment also works on cocaine: study

Methadone, a drug used for many years to treat heroin addiction, appears to work well in cocaine addiction, too, a new Canadian study suggests.

Psychologist Francesco Leri of the University of Guelph has been making rats addicted to cocaine, and then treating them with methadone.

Most of the rats responded well, he says. They lost their powerful urge for cocaine, and in addition, their brains "re-set" themselves into the same pattern that existed before they first used cocaine.

"It can be done tomorrow with humans, and should be done tomorrow," he said.

That's because methadone -- unlike a new drug -- already exists as a tested drug, with clear prescription rules and clinical staff trained in giving it out.

"There is an entire system that is already in place for the employment of methadone," that could be used for cocaine addicts.

Mr. Leri said the U.S. National Institute for Drug Abuse is looking into the use of methadone -- or a similar drug such as buprenorphine -- in a clinical setting.

The idea came up because in real life, people mix drugs.

There's no such thing as a "pure heroin addict," he said. "The norm is people who are addicted to opiates, so heroin or prescription opiates, and they co-abuse cocaine at the same time."

Researchers have wondered what happens to their cocaine problem when they start taking methadone for the heroin addiction.

But it's hard to tease apart the two addictions in humans. In his Guelph lab, Mr. Leri worked on rats with a cocaine addiction, but no exposure to heroin.

The cocaine-addicted rats in his lab didn't get a cocaine high on methadone, he said. Instead, "the methadone may be able to curb the desire that they have for that drug (cocaine)."

In addition, methadone actually reversed changes in the rats' brains that are caused by cocaine, and are known to play a key role in addictive behaviour.

"What's interesting is that, among the rats given cocaine and then methadone, these regions of the brain looked similar to how they appeared in the rats that were never exposed to cocaine.

"We feel we may have the hope of re-setting the brains of some individuals to a type of normality," he said. "I think it should be tried and I guarantee you there will be some individuals -- not everybody -- who will do better on methadone, who will be stabilized on methadone."

The study means a person who is motivated to stop taking cocaine may benefit from methadone as one tool to help, the psychologist says.

"You cannot give methadone left and right and hope that it is going to work. You need to work with individuals who in addiction to social support, in addition to cognitive therapy, will need something to curb their desire" for cocaine.

His study is published in European Neuropsychopharmacology, a research journal.
______________
source: The Ottawa Citizen

Vodka makers may have to pay for addicts' treatment

Amid criticism from alcohol producers, a bill was introduced in the lower house of the Russian parliament (Duma) according to which
producers of vodka and other alcoholic beverages will have to pay for the treatment of chronic alcoholics.

Lawmaker Viktor Zvagelsky of the ruling United Russia party has introduced the bill which will bound the producers of alcoholic beverages to bear the 'moral and financial responsibility' and pay for the treatment of chronic alcoholics, according to a report.

Zvagelsky proposes to set a mandatory mechanism for compensation of damage to health of citizens caused by consuming alcoholic drinks

Earlier last month, Russian interior minister Rashid Nurgaliyev had recommended to restore the Soviet-era system of forced treatment of alcohol abusers.

According to the lawmaker, the alcohol producers will have to pay approximately four roubles for per litre of vodka produced by them into a self-regulated fund to finance the network of clinics and sanatoria involved in the treatment of alcoholics.
___________
source: Times of India

Kicking Depression: Recognize underlying disorders, tackle them, too

By Christine Stapleton

Palm Beach Post Staff Writer

Oh that we could have just one mental illness afflict us at a time.

Many of us diagnosed with one mental illness have another lurking - often undiagnosed or untreated. Doctors call it "co-morbidity." Others call it "dual-diagnosis." I call it "unfair."

Two weeks ago I started sliding. Hours of feeling OK, then hours of feeling down. The OK hours slowly shrunk to OK minutes. The down hours became a day, then another and another. On the second down day the switch between my brain and stomach flicked off.

Three days later, I had already lost 5 pounds. A trainer at the gym told me I was getting too thin. A couple of my girlfriends invited me to dinner. Another threatened an intervention. I ate a sweet potato and a little cup of chicken soup.

My therapist calls this anorexia. I call it lack of appetite. It's not like I'm a waif you could blow over with a hair dryer. I just don't want to eat, and I weigh myself twice a day and track the numbers in my weight journal. Did I mention I don't eat wheat and very little refined sugar? What's the big deal? Apparently that's called an "eating disorder." It's just one of a few other "disorders" I deal with, like hypomania - a type of bipolar.

My brain plays dominoes with these disorders. A bout of mania knocks over the depression domino, which knocks over the anorexia domino, which knocks over the exercise-drug-alcohol addiction domino, which goes on and on.

It took decades for me to figure this out. It took even longer to realize that the chain-reaction that effortlessly topples the dominoes does not work in reverse. They won't automatically pop up if I manage to right just one.

Each disorder has its own treatment. Successfully treating one will not necessarily cure the other. A bipolar drug addict who gets clean is still going to have eye-popping mood swings, bursts of energy and paralyzing depression if the bipolar is not treated, too.

A food addict who smokes and gets treatment for her eating disorder but keeps smoking is still addicted to nicotine. Same with the alcoholic who cuts herself. She is not necessarily going to stop cutting just because she gets sober.

Like I said, it's not fair. It is even worse because many doctors don't understand this. They treat one illness but fail to diagnose the companion disorder(s). Then we blame the antidepressants or therapy for not working and we quit. Life becomes hell, all over again.

My solution: Surrender. Recognize the other disorders and treat them, too. I don't think of it as being a loser. I just joined the winning side.
________
source: Palm Beach Post

Somewhat Better Outcomes With Longer-Term Treatment For Opioid-Addicted Youth

New research published in the November 5 issue of JAMA reveals that long-term therapy rather than short-term therapy for opioid-addicted adolescents yields better results. Those who received continuing treatment with the combination medication buprenorphine-naloxone were less likely to test positive for opioids and reported lower rates of opioid use compared to adolescents who participated in a short-term detoxification program with the same medication.

Adolescents tend to abuse opioids in the form of heroin or prescription pain-relief medications. Recent research suggests that more and more young people are abusing these types of drugs, and therefore treatment needs are rising as well. "The usual treatment for opioid-addicted youth is short-term detoxification and individual or group therapy in residential or outpatient settings over weeks or months. Clinicians report that relapse is high, yet many programs remain strongly committed to this approach and, except for treating withdrawal, do not use agonist medication [drugs that mimic the effect of opioids by altering the receptor]," write George Woody, M.D. (University of Pennsylvania, Philadelphia) and colleagues.

To compare outcomes of opioid-addicted adolescents who receive either short-term detoxification or long-term treatment using buprenorphine-naloxone, Dr. Woody and colleagues conducted a study with 152 patients, 15 to 21 years of age. The long-term treatment medication consists of an oral medication that relieves symptoms of opiate withdrawal (buprenorphine) and a drug that prevents or reverses the effects of injected opioids (naloxone). Patients who were randomized to receive the 12-week buprenorphine-naloxone treatment received up to 24 mg. per day for 9 weeks and smaller amounts through the twelfth week. The remaining participants (the detox group) received up to 14 mg. per day, with doses tapering off through day 14. Individual and group counseling was offered to all participants.

Wood and colleagues found that at weeks 4 and 8, the detox group had a higher percentage of opioid-positive urine test results. Specifically, after 4 weeks, 61% of participants in the detox group had opioid-positive urine test results compared to 26% of participants in the 12-week buprenorphine-naloxone group. The figures after 8 weeks were 54% positive in the detox group and 23% positive in the 12-week buprenorphine-naloxone group. By the twelfth week, the buprenorphine-naloxone group had been tapered off of their treatment and 43% tested positive for opioids compared to 51% of detox group patients.

About 21% of detox group patients and 70% of buprenorphine-naloxone patients remained in treatment by week 12. Patients in the 12-week buprenorphine-naloxone group reported, during weeks 1 through 12, less use of opioids, cocaine and marijuana, as well as less injecting and less need for additional addiction treatment. Both groups measured high levels of opioid use at follow-up.

The authors clarify that, "Taken together, these data show that stopping buprenorphine-naloxone had comparably negative effects in both groups, with effects occurring earlier and with somewhat greater severity in patients in the detox group."

"Because much opioid addiction treatment has shifted from inpatient to outpatient where buprenorphine-naloxone can be administered, having it available in primary care, family practice, and adolescent programs has the potential to expand the treatment options currently available to opioid-addicted youth and significantly improve outcomes," conclude Woody and colleagues." Other effective medications, or longer and more intensive psychosocial treatments, may have similarly positive results. Studies are needed to explore these possibilities and to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence."

David A. Fiellin, M.D. (Yale University School of Medicine, New Haven, Conn.) writes in an accompanying editorial that more evidence is necessary in order to claim any treatment is effective for opioid-addicted individuals.

He concludes that: "The results of this trial should prompt clinicians to use caution when tapering buprenorphine-naloxone in adolescent patients who receive this medication. Supportive counseling; close monitoring for relapse; and, in some cases, naltrexone should be offered following buprenorphine tapers. From a research perspective, additional efforts are needed to provide a stronger evidence base from which to make recommendations for adolescents who use opioids. There is limited research on prevention of opioid experimentation and effective strategies to identify experimentation and intercede to disrupt the transition from opioid use to abuse and dependence."
___________
source: MediLexicon News

Women and drug addiction

The most shocking thing about the modern drug user? That she could be someone like you.

Andrea Mackenzie 57, a divorced mother of three from Newquay, was first prescribed valium for back pain as a trainee teacher in 1969. She became addicted and continued to take it for almost 40 years.

When I think of the person I was before I took diazepam, or Valium as it was called back then, I don't get angry, I get upset. I was at college in London, training to teach dance and drama and I loved putting on shows. Most students around me looked forward to the holidays, but I looked forward to the start of each term.

I went to my GP because of muscle ache in my back. He prescribed some pills and in those days you didn't ask questions, you just took them. It helped with the pain and seemed to relax me. When I went for a repeat prescription no questions were asked. For year upon year the box was just ticked. They really were handed out like sweets.

Diazepam is probably one of the most addictive drugs there is and that doctor was prescribing me an illness. It gives you a numb feeling, blanks out your emotions so everything becomes sort of dull. If you've suffered a terrible bereavement it can calm you down, but if you take it all through life you sleepwalk; nothing touches you.

My overriding feeling was always, 'I can't be bothered.' I qualified as a teacher but didn't work as one because I met my husband, an engineer, young and started a family. I took those tablets three times a day, as prescribed, and my life revolved around them. I had to have 'my tablets' with me all the time just to feel safe and, if I forgot them, I'd start hysterically panicking and we'd have to go back.

It's funny – even though I built up a tolerance, I didn't ever up the dosage or abuse them because they were on prescription. My body was craving them so I had all sorts of symptoms and went through life feeling unwell with so many non-specific things. I'd feel strange and dizzy, I'd shake, sound would be magnified, lights were too bright. I basically thought I was a hypochondriac. My family used to laugh about it.

We had three children; I loved them, I lived for them, but I was removed from them. The best way to describe it is the way you feel when you have a hangover and you've kids to look after. I didn't crawl around on the floor playing dress-up or jump on a trampoline with them. I didn't participate at children's parties. They weren't neglected, though, and I don't feel guilty because it wasn't my fault. Thank goodness they're all happy, healthy adults. We've never sat down and talked about my addiction – though of course they must know.

No one ever really suggested I should stop taking Valium. After my mother died of a heart attack right in front of me, I became hysterical and the doctor just put me on a higher dose. It comforted me – but stopped me grieving. When my marriage broke down, I really wasn't that bothered. People would talk about the 'trauma of divorce', the 'stress of moving home'; I didn't feel it.

As the years passed, people became more aware of the dangers of diazepam. I read about it, realised what was happening to me – and by the time my last daughter went to university I knew it was time to come off it. It took me three years. By then I had a fantastic, supportive GP who helped me do it so, so gradually. It made me really ill – my speech was slurred, I was permanently exhausted. At one point I had to be tested for Parkinson's.

I've been totally clear for two and a half years now and I'm a different person – the person I would have been. I don't smoke or drink alcohol or caffeine and I exercise daily on my Air Walker. I'm motivated, full of energy. I spent last week with friends at Center Parcs. My daughter joined me for a day and we rode around on our bikes – something I'd never have done when she was younger.

The real difference, though, is emotional. I feel so much more. I'm affected by things. When my own children were born, yes, I was happy – but somehow nothing seemed to stick. When my first grandson was born seven months ago it was absolutely amazing. I couldn't believe how excited I was. I've so many activities planned for him. It's like my second chance.
__________
source: http://www.telegraph.co.uk

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

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 irishtimes.com

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

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?

Yes

*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

No

*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
_________
source: http://www.independent.co.uk

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.
_____
source: http://www.chron.com

Understanding Addictions

CAMDEN (Sep 22): “Understanding Addictions” will be the subject of a free evening program open to anyone in the Midcoast area and presented by the First Congregational Church, Camden, from 7 p.m. to 9 p.m. on Thursday, September 25.

“’Understanding Addictions” is intended both for people who may be suffering from an addiction and for individuals who would like to be more helpful to a family member or a friend who is struggling with addiction,” said program leader, Mary Ellen Ostherr who works as a substance abuse therapist for Mid-Coast Mental Health and also has a private practice. She has worked in the field helping individuals and families with substance abuse and recovery for 15 years.

“Part of the program will be about how to understand the signs of addiction and what you can do about it as a friend or family member. The program will also cover how to recognize enabling behaviors and what to do to help stop those behaviors that can contribute to someone’s addiction,” she said. “An important part of the program will cover how we can reach out and help others.”

Denial—how to recognize it and how to deal with it as a friend or family member will also be covered, Ostherr said.

Maine currently leads the nation in per capita addiction to opiates and the state is number two in alcohol addiction. Factors that make the problem worse for the people of Maine, she said, include the long winters, the ready availability of drugs and alcohol, and the high risk nature of some jobs in Maine.

It is easy to get hurt and take prescription drugs as part of the rehabilitation, she said. Good people can find that weeks later they may develop an addiction. Another factor is the Internet. There are now websites that make it all too easy to get prescription medications. Some of these websites have doctors standing by who will write the prescription.

“Understanding Addictions” is offered through the “Live and Learn” series of free seminars and workshops presented for residents of the Midcoast area by the First Congregational Church, Camden.

“Understanding Addictions” will be held in the Mayflower Room of the church at 55 Elm Street in Camden. Participants should park in the Church parking lot behind the Church and enter through the door on the parking lot side. The Church is handicapped accessible.
__________
source: http://waldo.villagesoup.com/

Drug addicts shun mobile needle exchange

Far fewer needles handed out and returned since fixed-site exchange was closed

Victoria's mobile needle exchange is handing out far fewer needles to addicts than its fixed-site predecessor, statistics released yesterday show.

The experiences of Peter, who has used both services, might explain why.

Before the Cormorant Street needle exchange closed on May 31, Peter picked up a supply of clean needles every day.

"I had my routine of going down there," the 32-year-old cocaine and heroin addict, who declined to give his last name, said last night as he sat on the grass outside the Our Place shelter on Pandora Avenue. "Now I have to chase the mobile exchange all over the streets in a 10-block radius and I miss them sometimes and I end up going without clean needles."

Needle exchanges are promoted as a service that reduces the spread of disease among addicts by providing them with clean syringes to inject their drugs. But critics have also suggested that exchanges encourage illicit drug use.

A report released yesterday shows the number of needles supplied by the mobile exchange is down 23 per cent, from about 35,000 a month at the fixed site to 27,000 in August from the mobile unit.

Needles returned amount to just 40 per cent of those going out, a sharp drop from the 70 per cent return rate at the Cormorant Street exchange.

The figures were released by the Vancouver Island Health Authority and AIDS Vancouver Island in a summary of the first three months of the mobile service.

The Cormorant Street needle exchange closed after neighbours complained about illegal drug activity. The mobile service is supposed to be a stop-gap measure until a new permanent site can be located.

A decrease in needles coming back could indicate a number of things, said Katrina Jensen, executive director for AIDS Vancouver Island. "There are a number of factors, one is that they're disposing of them in other ways, like putting them in the garbage," said Jensen. Another possibility is that clients are keeping them and haven't used them yet, she said.

"Some clients may be taking extra syringes to keep them going for several months, and that's why we're not seeing those ones come back. It could also be that clients are using their own syringes and refusing ours."

There haven't been reports of a spike in the number of syringes discarded on the streets, said Jensen.

Aside from the syringes, clients aren't taking part in counselling services to the extent they did at the permanent site. There is no privacy and those working on the mobile service don't have the time, said Jensen.

"Due to the public nature of the mobile service a lot of clients aren't comfortable engaging in long conversations with workers. They just want to get their stuff and be gone."

Concern is mounting over how the mobile service will fare when cooler weather sends illicit drug users indoors, Jensen said.

Victoria Coun. Charlayne Thornton-Joe is concerned by the decrease in the number of needles exchanged by the mobile service.

"It concerns me that a major city does not have a fixed site," Thornton-Joe said. "It's a loss. I've always been an advocate for a fixed site which offers support and services."

Thornton-Joe has discussed the issue at meetings with the Downtown Service Providers and the clean and safe committee of the Downtown Victoria Business Association.

Thornton-Joe would like to see statistics from other local groups who hand out or take back needles. Some groups take in needles, but don't give them out, she explained.

The councillor would also like to see statistics on addicts' increased use of crack pipes, instead of needles.

"I'm hearing from street nurses that people are re-using needles and health issues are going to increase because of that," said Thornton-Joe.

Back on the grass outside Our Place, Peter pulled up his pant leg to show an abscess on his leg that became infected two weeks ago after he injected drugs with a dirty needle. The abscess required surgery at Royal Jubilee Hospital. But because he only runs into the mobile exchange service about every three days, Peter said he continues to put his health at risk.

"An hour ago, I had to use a dirty needle to suck dope out of a spoon and transfer it into another dirty needle and put it in my arm," he said.

Then by chance, five minutes before speaking to the Times Colonist, Peter ran into the mobile needle exchange and took a handful of syringes.

"Here's a lost soul looking for one right now," he said, handing a syringe to a young girl who sat down beside him. "If I don't give her one, she'll find one in the sewers."
__________
source: © Times Colonist (Victoria) 2008

How to Decrease Your Chance of Becoming Addicted to Narcotic Painkillers

It's the patient's responsibility to find a doctor who knows how to screen for addiction.

The chance of becoming addicted to narcotic painkillers is around 1 in 500 when patients are properly screened before their doctors hand over a prescription, according to a 2008 meta-analysis that examined 2,500 chronic pain patients. With less careful screening, the risk can rise to 1 in 30.

The tricky part for pain patients, says David Fishbain, MD, a professor of psychiatry at the University of Miami, is finding a doctor who knows how to do the screening.

The patient's responsibility

Pain patients are often bounced from family doctors to specialists and back, with no one taking the time to monitor their ongoing use of the medication, or to “qualify” them for what the medical profession calls chronic opioid analgesic therapy (COAT)—the taking of narcotic painkillers for a long period of time.

That means it falls to patients to find health-care practitioners who are experienced in working with chronic pain patients, so that the physicians are comfortable deciding both when to prescribe narcotics and how their use can be safely monitored.

The top warning signs of addiction risk are, not surprisingly, a history of illicit drug use or alcohol abuse in the patient or his family. But smoking is also on Dr. Fishbain’s radar, because “any addiction is a potential risk factor for another addiction.” And there's a long list of factors that may be less predictive but still relevant, including depression and anxiety disorders, which means that doctors need to consider the patient's entire history and not just how he or she answers a few targeted questions.

More work for the doctor

Once a patient is on COAT, physicians have to watch for behavior that may presage or signal addiction, which includes the use of multiple doctors and pharmacies for prescriptions, as well as calling in early for refills. Doctors often ask patients to sign narcotics contracts; they also may issue only short-term prescriptions, and some docs even require urine tests.

So having a patient on narcotics is a lot of work for a careful doctor, and that, Dr. Fishbain says, explains why family doctors, also known as general practitioners (GPs), can feel caught in the middle.

“GPs are in the unfortunate position of having patients who have been put on COAT by specialists," he says. "But the specialists don’t have the time to [screen and monitor]; they want to do more invasive procedures [such as back surgery], so they send the patients back to the GPs. The GPs then have the patients but don’t know what to do.”

This all adds up to a lot of narcotic prescriptions being prescribed by poorly informed doctors, says Dr. Fishbain.

How to find the right care

“You should try to find a physician who has experience in pain management and who has experience in chronic opioid analgesic therapy," recommends Dr. Fishbain. "They need to be up on the literature and aware of the screening.”

In other words, the educated patient has to do his own screening to find the educated doctor. Referrals—to a pain clinic, for example—are reassuring, but there’s no substitute for asking questions up front and starting out with a GP who knows how to prescribe for chronic pain.
________
source: health.com