The Alcoholic Rats of Dr. Li.

Excerpt from chapter 1 of The Chemical Carousel.

In the early 1990s, it was safe to say that Dr. Ting-Kai Li was in possession of the largest and most famous collection of alcoholic rats in the world.

Housed in a laboratory near Dr. Li’s office at Indiana University, the “P-line” of rodents were freely self-administering the body-weight equivalent of one bottle of whiskey a day for a 155-pound man; a blood alcohol concentration that would have gotten them arrested on any highway in America. The P-line rats were seriously addicted to ethanol, the purified form of booze known outside the laboratory as grain alcohol, or white lightning.

“It’s actually the only line that’s been well developed in the world,” Dr. Li told me at the time, with justifiable pride. “And it has been developed through genetic selection for alcohol preference.” In other words, Dr. Li did not teach these animals to drink. He didn’t have to.

Dr. Li, who was until recently the Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the alcoholism wing of the National Institutes of Health (NIH), made it sound easy: “You take a stock with some genetic heterogeneity in it, and then you test it for drinking behavior, and there will be, say, two or three out of a hundred that like to drink, so you take those, and you breed them. And the ones that don’t like to drink, you breed those, and within ten generations you start to have a very good separation between drinking scores.”

Why would a rat drink alcohol, and why would anybody care? When I first spoke with Ting-Kai Li, the lack of suitable animal models of alcoholism and addiction was all too apparent. Without suitable strains of test animals, most genetic and neurobiological research would take centuries, and would involve ethical questions about human testing far stickier than the questions raised by the animal rights movement. Animal models are one of the primary pathways of discovery available to neurobiologists and other researchers.

The precisely spoken, self-effacing Dr. Li, along with neurobiology professor Dr. William McBride and their co-workers at Indiana University, were never really in the business of teaching rats to drink. They were in the business of discovering ways to make them stop.

To be like human alcoholics, the rats must also demonstrate both an increased tolerance to the effects of the drug, and the onset of physical dependence as manifested by withdrawal symptoms. And they do. The P-line rats develop tolerance, and they show acute withdrawal symptoms when researchers cut off their supply. The rats suffer tremors, seizures, and a rodent version of delirium tremens. They fall down a lot. They are also quick to avail themselves of a little “hair of the dog.” After a period of abstinence, they take alcohol again to relieve the withdrawal symptoms.

The P-line rats met every definition of alcoholism anyone could imagine, and the cause of their alcohol addiction appears to be strictly genetic. What was happening with the P-line rats was not explainable by resorting to arguments about simple learned behavior.

“How do you explain this difference?” said Dr. Li, all those years ago. “My explanation is that there are genetic differences among different individuals. You’re making the assumption that you expose them to the same environment, the same environmental influences, and yet they behave differently in terms of addiction.”

Today, we can safely say that Dr. Li’s hypothesis has proven to be true.

© Copyright 2008

Photo Credit: smh.com.au

addiction drugs

Are You Okay?

A variety of drinking tests: the good, the bad, and the silly.

Here’s a short, no-nonsense questionnaire that uses your weekly drinking habits to produce an at-a-glance comparison of how your intake stacks up against others your age and sex. For example, your result might say: “Only 4% of the adult male population drinks more than you say you drink.” Which is food for thought, at least. Join Together (sponsored by The Partnership at DrugFree.org and Boston University School of Public Health) provides this service.

Here is the Mayo Clinic alcohol use self-assessment test, which says with refreshing frankness: “This assessment can’t diagnose you with an alcohol use or abuse problem, but it can help you evaluate your drinking and understand whether you may benefit from seeking help.” Tends to be a bit stern on the drinks-per-day end of things, but otherwise it’s quite straightforward.

Then there is the venerable Michigan MAST Test, first offered in 1971, and revised regularly every since. It’s showing its age a bit as a clinical tool, but here is a link to the 22-question self-administered version: TEST

Iondesign’s Drink-O-Meter is a whimsical test that makes a sober point: “Why not take our test to calculate the state of your kidneys, wallet, and quantity of alcohol you have consumed over the years?” Why not? Well, maybe because you can’t HANDLE the truth: Test results give an estimate of the total number of drinks you have consumed, an estimate of how much money you’ve spent—and an estimate of the number of Ferraris you could have bought instead.

And finally, we have the amazing and ever-popular CAGE Test, so called for the system of naming and memorizing the questions. The CAGE test takes less than a minute, requires only paper and pencil, and can be graded by test takers themselves. It goes like this:

1. Have you ever felt the need to (C)ut down on your drinking?

2. Have you ever felt (A)nnoyed by someone criticizing your drinking?

3. Have you ever felt (G)uilty about your drinking?

4. Have you ever felt the need for a drink at the beginning of the day—an “(E)ye opener?

People who answer “yes” to two or more of these questions should seriously consider whether they are drinking in an alcoholic or abusive manner. Unfortunately, the CAGE test is considered to be an accurate diagnostic tool primarily in the case of adult white males.

Photo Credit: http://tokyotek.com

Take the Alcohol Test

CAGE questionnaire still a useful tool

Despite the time, labor, and expense that have gone into the search for a better way to diagnose alcoholism, researchers have yet to outdo what may be the simplest, most accurate test for alcoholism yet devised. A set of four simple, relatively non-controversial questions, first devised in 1970 by Dr. John A. Ewing, still serve as a useful predictive tool for alcoholism.

Neurobiology has taught us that addictive drugs cause long-lasting neural changes in the brain. The problems start when sustained, heavy drinking forces the brain to accept the altered levels of neurotransmission as the normal state of affairs. As the brain struggles to adapt to the artificial surges, it becomes more sensitized to these substances. It may grow more receptors at one site, less at another. It may cut back on the natural production of these neurotransmitters altogether, in an effort to make the best of an abnormal situation. In effect, the brain is forced to treat alcoholic drinking as normal, because that is what the drinking has become.

The likelihood that many alcoholics and other drug addicts have inherited a defect in the production and distribution of serotonin and other neurotransmitters is a far-reaching finding. While it is difficult to measure neurotransmitter levels directly in brains, there are indirect ways of doing so. One such method is to measure serotonin’s principle metabolic breakdown product, a substance called 5-HIAA, in cerebrospinal fluid. From these measurements, scientists can make extrapolations about serotonin levels in the central nervous system as a whole.

However, testing for serotonin levels is imprecise and impractical in the real world of the doctor's office and the health clinic. Despite all the promising research on neurotransmission, what can physicians and health professionals do today to identify alcoholics and attempt to help them? For starters, physicians could look beyond liver damage to the many observable “tells” that are characteristic patterns of chronic alcoholism—such manifestations as constant abdominal pain, frequent nausea and vomiting, numbness or tingling in the legs, cigarette burns between the index and middle finger, jerky eye movements, and a chronically flushed or puffy face. Such signs of acute alcoholism are not always present, of course. Many practicing alcoholics are successful in their work, physically healthy, don’t smoke, and came from happy homes.

The CAGE test takes less than a minute, requires only paper and pencil, and can be graded by test takers themselves. It goes like this:

1. Have you ever felt the need to (C)ut down on your drinking?

2. Have you ever felt (A)nnoyed by someone criticizing your drinking?

3. Have you ever felt (G)uilty about your drinking?

4. Have you ever felt the need for a drink at the beginning of the day—an “(E)ye opener?

People who answer “yes” to two or more of these questions should seriously consider whether they are drinking in an alcoholic or abusive manner.

--Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.

Thursday is National Alcohol Screening Day

Assess your drinking risk with this easy test.

The more you drink, the less likely you are to accurately perceive the risks of heavy drinking, according to a survey by Screening for Mental Health (SMH), a Boston-area non-profit group.  The phone survey of 1,000 adults in the U.S. indicated that 7 out of 10 respondents would consult a health care provider if they “thought they might have a problem with alcohol,” but that only 50% of responders with the highest number of at-risk drinking episodes per year said they would seek medical help.

Phone surveys can be notoriously unreliable when it comes to questions about the personal use of drugs and alcohol. However, the point being made here is clear: There are ways to screen high-risk drinkers, who aren’t always the best judge of their own behavior. For National Alcohol Screening Day on Thursday, April 11, SMH offers www.HowDoYouScore.org, where you can take a quick quiz to see how you measure up. More than a thousand community organizations, colleges, and military bases will be taking part. The screening, which is geared toward younger drinkers, is free, anonymous, and online—just the way college students like it. The event, held in April in conjunction with Alcohol Awareness Month, netted more than 40,000 online anonymous screenings last year.

In another finding from the survey, 20% of respondents said that drinking heavily is a “phase many kids go through,” which is certainly true and a suspiciously rare choice in this survey. It’s unlikely that people are eager to approve of young people drinking heavily, even as a “phase.” Nonetheless, we know that kids who begin drinking before age 15 are far more likely to drink alcoholically as adults. And at-risk drinking correlates strongly with age: Most of the mayhem is committed by men under age 35. No surprise there.

“Despite public opinion, at-risk drinking increases your chances of developing alcohol use disorders—such as alcoholism—as well as other physical and mental health problems," said Douglas G. Jacobs, M.D., associate clinical professor of psychiatry at Harvard Medical School and medical director of SMH, in a prepared statement. “In the U.S., about 18 million people have an alcohol use disorder. The screenings allow individuals to assess their drinking habits and have an opportunity to connect with local support resources.”

And while we are on the subject of, and in the month of, alcohol awareness, here are some earlier posts on ethyl alcohol and you:

7 Myths the Alcohol Industry Wants You to Believe

The Truth About Weight Loss Surgery and Alcohol

Mixing up the Medicine: What Alcohol Doesn’t Go With

Alcoholic Deception

Dude, where’s my metaconsciousness?

Update on Synthetic Drug Surprises

Spicier than ever.

Four drug deaths last month in Britain have been blamed on so-called “Superman” pills being sold as Ecstasy, but actually containing PMMA, a synthetic stimulant drug with some MDMA-like effects that has been implicated in a number of deaths and hospitalizations in Europe and the U.S. The “fake Ecstasy” was also under suspicion in the September deaths of six people in Florida and another three in Chicago. An additional six deaths in Ireland have also been linked to the drug. (See Drugs.ie for more details.)

PMMA, or paramethoxymethamphetamine, causes dangerous increases in body temperature and blood pressure, is toxic at lower doses than Ecstasy, and requires up to two hours in order to take effect.

In other words, very nearly the perfect overdose drug.

Whether you call them “emerging drugs of misuse,” or “new psychoactive substances,” these synthetic highs have not gone away, and aren’t likely to. As Italian researchers have noted, “The web plays a major role in shaping this unregulated market, with users being attracted by these substances due to both their intense psychoactive effects and likely lack of detection in routine drug screenings.” Even more troubling is the fact that many of the novel compounds turning up as recreational drugs have been abandoned by legitimate chemists because of toxicity or addiction issues.

The Spice products—synthetic cannabinoids—are still the most common of the novel synthetic drugs. Hundreds of variants are now on the market. Science magazine recently reported on a UK study in which researchers discovered more than a dozen previously unknown psychoactive substances by conducting urine samples on portable toilets in Greater London. Call the mixture Spice, K2, Incense, Yucatan Fire, Black Mamba, or any other catchy, edgy name, and chances are, some kids will take it, both for the reported kick, and for the undetectability. According to NIDA, one out of nine U.S. 12th graders had used a synthetic cannabinoid product during the prior year.

“Laws just push forward the list of compounds,” Dr. Duccio Papanti, a psychiatrist at the University of Trieste who studies the new drugs, said in an interview for this article. “The market is very chaotic, bulk purchasing of pure compounds are cheaply available from China, India, Hong-Kong, but small labs are rising in Western Countries, too. Some authors point out that newer compounds are more related to harms (intoxications and deaths) than the older ones. You can clearly see from formulas that newer compounds are different from the first ones: new constituents are added, and there are structural changes, so although we have some clues about the metabolism of older, better studied compounds, we don't know anything about the newer (and currently used) ones."

The problems with synthetic cannabinoids often begin with headaches, vomiting, and hallucinations. At the Department of Medical, Surgical, and Health Sciences at the University of Trieste, researchers Samuele Naviglio, Duccio Papanti, Valentina Moressa, and Alessandro Ventura characterized the typical ER patient on synthetic cannabinoids, in a BMJ article: “On arrival at the emergency department he was conscious but drowsy and slow in answering simple questions. He reported frontal headache (8/10 on a visual analogue scale) and photophobia, and he was unable to stand unassisted. He was afebrile, his heart rate was 170 beats/min, and his blood pressure was 132/80 mm Hg.”

According to the BMJ paper, the most commonly reported adverse symptoms include: "Confusion, agitation, irritability, drowsiness, tachycardia, hypertension, diaphoresis [sweating], mydriasis [excessive pupil dilation], and hallucinations. Other neurological and psychiatric effects include seizures, suicidal ideation, aggressive behavior, and psychosis. Ischemic stroke has also been reported. Gastrointestinal toxicity may cause xerostomia [dry mouth], nausea, and vomiting. Severe cardiotoxic effects have been described, including myocardial infarction…”

In a recent article (PDF) for World Psychiatry, Papanti and a group of other associates revealed additional features of synthetic cannabimemetics (SC), as they are officially known: “For example, inhibition of γ-aminobutyric acid receptors may cause anxiety, agitation, and seizures, whereas the activation of serotonin receptors and the inhibition of monoamine oxidases may be responsible for hallucinations and the occurrence of serotonin syndrome-like signs and symptoms.”

Papanti says researchers are also seeing more fluorinated drugs. “Fluorination is the incorporation of fluorine into a drug,” he says, one effect of which is “modulating the metabolism and increasing the lipophilicity, and enhancing absorption into biological membranes, including the blood-brain barrier, so that a drug is available at higher concentrations. An increasing number of fluorinated synthetic cannabinoids are available, and fluorinated cathinones are available, too.”

A primary problem is that physicians are still largely unacquainted with these chemicals, several years after their current popularity began. This is entirely understandable. In addition to the synthetic cathinones, several new mind-altering substances based on compounds discovered decades ago have also surfaced lately. Papanti provided a partial list of additional compounds that have led to official concern in the EU:

—Synthetic opioids (the best known are AH-7921, MT-45)

—Synthetic stimulants (the best known are MDPV, 4,4'-DMAR)

—New synthetic psychedelics (the NBOMe series)

—New dissociatives (Methoxetamine, Methoxphenidine, Diphenidine)

—New performance enhancing drugs (Melanotan, DNP)

—Gaba agonists (Phenibut, new benzodiazepines)

Most of the new and next-generation synthetics are not readily detected by standard drug screen processes. Spice drugs will not usually show up on anything but the most advanced test screening, using gas chromatography or liquid chromatography-tandem mass spectrometry—high tech tools which are rarely available for anything but serious (and costly) forensic investigations.

“Testing is a big problem,” Papanti declares. “From a clinical point of view, do you need the test to make a diagnosis of intoxication, for following up an addiction treatment, or for forensic purposes? With the new drugs, maybe taken together, with different pharmacology, we are not very sure about this yet. If I want to have confirmation of a diagnosis of SC intoxication, I need two weeks as an average, in order to obtain the result. Your patient has been discharged by that time, or in the worse case, he is dead.”

 Another major problem, according to Papanti, “is that the machines need sample libraries in order to recognize the compound, and samples mean money. Plus, they need to be continuously updated.”

In summary, there is no antidote to these drugs, but intoxication is general less than 24 hours, and the indicated medical management is primarily supportive. If you plan to take a drug marketed as Ecstasy, or indeed any of the spice or bath salt compounds, Drugs.ie notes that there are some basic rules of conduct that will help maximize the odds of a safe trip:

—If you don’t “come up” as quickly as anticipated, don’t assume you need another pill. PMMA can take two hours or more to take effect. Do not “double drop.”

—If you don’t feel like you expected to feel, and are noticing a “pins-and-needles” feeling or numbness in the limbs, consider the possibility that another drug is involved.

—Don’t mix reputed Ecstasy with other drugs, especially alcohol, as PMMA reacts very dangerously with excessive alcohol.

—Remember to hydrate, but don’t overhydrate. If you go dancing, figure on about a pint per hour.

Marijuana Fact and Fiction

Why cannabis research is a good idea.

There is little doubt among responsible researchers that marijuana--although it is addictive for some people--is sometimes a clinically useful drug. However, there is little incentive for commercial pharmaceutical houses to pursue research on the cannabis plant itself, since they cannot patent it.

The use of marijuana in the treatment of glaucoma is well established. As for the relief of nausea caused by chemotherapy, the precise “antiemetic” mechanism has not yet been identified, but several studies show that marijuana works at least as well as the popular remedy Compazine for controlling nausea. Cancer patients have used marijuana successfully to increase appetite and combat severe weight loss.

Yet another intriguing possibility centers on Huntington’s chorea, the single-gene disease researchers spent years chasing down. Early data from the National Institutes of Health (NIH), reported in Science News, showed a loss of THC receptors in the brains of Huntington’s sufferers.

Queen Elizabeth believed that marijuana tamed her menstrual cramps back in the 16th Century, but there is no clinical and little anecdotal evidence to support this notion. Perhaps the anti-anxiety and mood elevating effects associated with marijuana are useful for menstrual irritation and mood swings, just as they are sometimes perceived to be useful by those suffering from depression.

The typical joint rolled in paper contains roughly 0.5 grams of plant matter, of which anywhere from 1 to 15 per cent is THC. THC content varies widely because some genetic strains of cannabis are more potent than others. This fact has led to intense debate in the United Kingdom over the issue of so-called “Skunk” marijuana. Skunk is not a new, lethally potent form of pot, but rather a shorthand term for describing one of several strains of strong, aromatic female marijuana plants. Most of the potent forms of marijuana for sale are hybrids resulting from cross-pollination of various strains. Of itself, “Skunk” marijuana is no more or less dangerous than other potent and popular varietals, such as “White Widow” or "Hawaiian Haze."

The half-life of marijuana is fairly short—about 50 hours for inexperienced users, and about half that for experienced users. However, THC and its metabolites are fat soluble, and are therefore easily stored in fatty tissue. Other drugs clear the system much more efficiently. The marijuana high may be history, but the metabolites live on--for up to 30 days. Blood tests can confirm THC in the body, but cannot reliably determine how recently the marijuana was smoked. There is no marijuana analysis kit comparable to the Breathalyzer test for alcohol. Drivers under the influence of cannabis may suffer some perceptual impairment. They tend to drive more slowly and take fewer risks, compared to drivers under the influence of alcohol. Possibly, cannabis smokers are hyperaware of the modest motor impairments they exhibit under the influence. Heavy drinkers are often unaware that there is anything wrong with their driving at all, as their sometimes-vociferous arguments with police officers and state troopers can attest.

As with cigarettes, chronic pot smoking can lead to chronic bronchitis. We don’t know for certain whether heavy marijuana use causes lung cancer, but it seems safe to assume that smoking vegetable matter in any form is not compatible with the long-term health of lung tissue. Patients with risk factors for cardiovascular disease are well advised not to smoke anything. Marijuana smoking can raise the resting heart rate as much as 30 per cent in a matter of minutes, and while there is no present evidence of harmful effects from this, we will have to monitor the situation more closely as pot-smoking and former pot-smoking Baby Boomers enter their cardiovascular disease years.

Other patients for whom marijuana is definitely not indicated include those suffering from respiratory disorders--asthma, emphysema, or bronchitis. In addition, schizophrenics or anyone at genetic risk for schizophrenia should shun pot, as it has been known to exacerbate or precipitate schizophrenic episodes—though it does not, as is commonly rumored, cause schizophrenia.

The evidence for significant impairment of cognitive function is equivocal—heavy marijuana use does not, like alcohol, result in gross structural brain damage. Numerous studies have addressed the possibility of subtler impairments in memory, attention, and the retention of new information. The extent to which such alterations are transient as opposed to long term is still under scientific debate.

Cannabis augments the effects of morphine in animal studies, thus allowing for a lower dose of opiates. Pain relief may be a primary attribute of anandamide—the brain’s own THC. Rats given the drug were less sensitive to pain than their non-drugged counterparts, as detailed in the Proceedings of the National Academy of Sciences. Drug companies may have closed the book on marijuana spin-offs too early. It would not be surprising if pills to selectively increase the amount of anandamide in the brain will one day augment or offer an alternative to existing anti-anxiety medications or pain relievers. On the other hand, a substance that blocks anandamide might find use as an agent to help combat memory loss.

Graphic: http://www.seedsman.com/en/health

For more, see: The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.

Related Posts: Anandamide: The Brain's Own Marijuana

medical marijuana

Popular “Bath Salt” Hooks Lab Rats

Mephedrone shows addictive properties in animal models.

Cathinones, like methedrine and other stimulants, are primarily dopamine-active drugs. Though they are now illegal in the U.S., they were formerly of primary interest only to pharmaceutical researchers. The best-known cathinone sold in the form of bath salts and plant food—mephedrone—has both dopamine and serotonin effects. It broke big in the UK a few years ago as a “legal” party drug alternative to MDMA. The idea was to get high without testing dirty, as the saying goes.

Behavioral clues about mephedrone have been teased out of rat studies. The Taffe Laboratory at Scripps Research Institute has been focusing on the cognitive, thermoregulatory, and potentially addictive effects of the cathinones, and mephedrone in particular. Scripps researchers have carried the investigation forward with a recent study in the journal Drug and Alcohol Dependence.

Now comes additional evidence, also from the Taffe Lab at Scripps, that mephedrone, or 4-MMC, looks like an addictive drug. In a paper accepted for publication by Addiction Biology, which Addiction Inbox was allowed to review in advance, Dr. Michael Taffe, along with lead author S.M. Aarde and coworkers, demonstrated in an animal study that lab rats will intravenously self-administer mephedrone under normal lab conditions—roughly analogous to shooting speed.

Without suitable strains of test animals, most genetic and neurobiological research would take centuries, and would involve ethical questions about human testing far stickier than the questions raised by work with animals. Animal models are one of the primary pathways of discovery available to neurobiologists and other researchers.

But it’s tricky. Establishing traditional rodent laboratory conditions is a Goldilocks endeavor: The environment must be not too hot, but not too cold, because this can effect rodent behavior. And the drug must be given at rates that are not too frequent and not too rare.

The curious thing about mephedrone is that it appears to combine the effects of prototypical stimulants like cocaine and methamphetamine, with the trippy, “entactogen” effects of MDMA, aka Ecstasy, in the bargain. The drug rapidly crosses the blood-brain barrier, reaching peak levels two minutes after injection, and full effects last about an hour. In one study, 76% of people who had snorted both cocaine and mephedrone reported that the quality of the mephedrone high was “similar to or better than” cocaine. But the paper also states that “human recreational users report 4-MMC to be subjectively similar to MDMA.”

The investigators ran a series of tests with various groups of rats, and found that 80-100% of the rats would happily reward-press a lever for an infusion of mephedrone. “Under these conditions,” writes Taffe, “methamphetamine and 4-MMC have about equal effect on rat self-administration although the 4-MMC is considerably less potent, requiring about 10 times the per-infusion dose for effect.” Although it wasn’t demonstrated directly in this paper, Ecstasy “is at best unevenly self-administered by rats,” and “despite an MDMA-like serotonin/dopamine neuropharmacological effect, mephedrone has a liability for repetitive intake more similar to the classical amphetamine-type stimulants such as methamphetamine.”

It’s a weaker type of stimulant, mephedrone, but it does the trick. It is highly reinforcing. Mephedrone chemically resembles speed, but also has Ecstasy-like effects. "Furthermore, neurochemical data suggest MDMA-like patterns of relatively greater serotonin versus dopamine accumulation in nucleus accumbens.” Even with its added Ecstasy-like effects, the scientists conclude that “the potential for compulsive use of mephedrone in humans is likely quite high, particularly in comparison with MDMA.”

Photo Credit: Creative Commons

Heroin for Heroin Addiction

Getting your fix at the doctor’s office.

A group of Canadian researchers has demonstrated the truth of a practice commonly used in European countries like The Netherlands and Switzerland: Heroin can be an effective treatment for chronic, relapsing heroin addicts. Published in the New England Journal of Medicine, the study is “the first rigorous test of the approach performed in North America,” according to a New York Times article by Benedict Carey.

In the study, 226 patients were randomly assigned to oral methadone therapy or injectable diacetylmorphine, the primary active ingredient in heroin, over a 12-month period. The “rate of retention in addiction treatment” was 88 percent for the diacetylmorphine group, compared to 54 percent for the methadone group. The “reduction in rates of illicit-drug use” was 67 percent for the heroin group and 48 percent for the methadone group.

Using doctor-prescribed heroin has two advantages, some researchers believe. It gets around the problem of addicts who don’t like the effect of methadone and therefore don’t take it as prescribed. Moreover, as European countries have demonstrated, it brings treatment-resistant opiate addicts into regular contact with physicians and medical treatment professionals, thereby keeping them away from drug dealers and out of jail.

The downside is equally obvious. It keeps addicts hooked on heroin, and may even exacerbate their addiction by providing a higher quality drug. Furthermore, it runs against the prevailing North American notion that heroin should be illegal, period. Certainly, doctors have no business prescribing it to active addicts, critics argue. Furthermore, the risk of overdose or seizure is always present.

According to senior author Martin Schechter of the University of British Columbia’s School of Population and Public Health, as quoted in the New York Times: “The main finding is that for this group that is generally written off, both methadone and prescription heroin can provide real benefits.”

In an editorial accompanying the journal article, Virginia Berridge of the London School of Hygiene and Tropical Medicine cautioned that “the rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”

At the end of the 19th Century in America, opium was widely prescribed as a cure for alcoholism. For opium addiction, the treatment was often alcohol.

Photo Credit: www.steps2rehab.com

addiction drugs

Bill Manville’s Booze Book

A “professional bar fly” who flirted with death and Helen Gurley Brown.

"From the drinking man's classic, Saloon Society, back in the Sixties, to his sadder but wiser Cool, Hip and Sober, Bill Manville has consistently provided an honest, insightful first-person account of where alcoholism begins--and where it ends.”  So said the respected Keith Humphreys of Stanford University’s School of Medicine, when Manville’s account of beating booze was published some years ago. What makes his book unique in the annals of addiction books, so far as I know, is the additional blurb on Cool, Hip and Sober from none other than Cosmopolitan Magazine founder and Sex and the Single Girl author Helen Gurley Brown, who wrote: “I never read anything like this and am thrilled to recommend the book to anybody with the problem himself or with a suffering family member.”

That represents a pretty wide spectrum of opinion makers, so I took a look—and had fun with it. Written in a breezy, question-and-answer style based on his call-in radio show in Sonora, California, Manville represents an older generation of addicts whose distilled experience is as timely now as ever. Novelist, newspaper journalist, radio host, and a self-confessed “professional bar fly” on the New York City circuit who has been sober now for more than twenty years, Manville has been in the game long enough as a professional writer and practicing alcoholic to have seen a thing or two. “Those were the days when I was living on the Five-Martini Diet—writing for Helen Gurley Brown at Cosmopolitan Magazine by day, and passing out before dinner more nights than I like to remember,” Manville wrote in a recent piece for TheFix.com.

“Addictions and Answers,” the widely-read column he currently co-authors for the New York Daily News, takes personal questions and gives out useful, straightforward, evidence-based advice. So does his book. Some excerpts follow:
----------

--“Take an alcoholic or drug addict without a penny in his pocket. Deposit him, friendless and alone, in a bluenose town. Dump him there at 6AM Sunday morning, broke and hungover, the bars and liquor stores closed.  He’ll find a way to get high before noon. That’s will power.”

--"In vino veritas?  No. ‘In vino bullshit,’ says John A. Mac Dougall, D. Min., a United Methodist Minister who is also Manager of Spiritual Guidance for Hazelden in Center City, Minnesota.”

-- “‘Each time your addiction brings you smack up against trouble or grief,’ says Brian Halstead, a Program Director at the Caron Foundation, ‘you are being presented with a choice. Do you want this to be your bottom, or do you want to be hit harder?’”

--“Sobriety makes you a more competent player; it does not guarantee you will be a winner. You’re still a dress size too large, and your husband is going bald. Your wife doesn’t understand you, and you’re in a dead end job. You’ll be able to address these problems with a cool, sober brain, yes… with a bit of detachment, yes… but they are still there. You’ve discovered that even glorious sobriety has realistic limits. The pink cloud begins to float down, closer to earth. Very dangerous time.”

--“The essence of addiction is: it SPEEDS up. That’s why it’s called progressive.

--"The phrase I like is that the genetic type of alcoholic was born two drinks behind."

--“Says Scott Munson, Executive Director, Sundown M Ranch, one of the top rehabs in the country, ‘I think it is important for psychologists and psychiatrists to understand the mistrust of those professions by many people in AA. Chemical dependency is a primary illness, not the result of another disorder.’" 

 --“There are pharmaceuticals, like insulin, that correct a deficiency in the body's mechanism. When the patient takes them, he does not get high… any diabetes sufferer will tell you that is a small price. And if taking a daily pill will end your enthrallment to addiction, that's not a high price either."

--Let me end with this, a kind of self-test I heard during a lecture when I was a facilitator at Scripps McDonald: Do you remember your first drink?  How did it make you feel? If you reply, ‘For the first time in my life it made me feel normal, like other people’--take it as a warning bell. In the UC Berkeley "Alcohol & Drug Abuse Studies" catalog, it estimates "that more than one half of clients in alcohol and drug treatment have coexisting psychiatric disorders."

Photo Credit: http://www.sabredesign.net