Drug Links, Various

It’s summer vacation. Did I turn off the stove?


Some recent posts I wrote before ending my run as editor of TheFix.com News Blog:

Drugging the Elderly
Why seniors take too many of the wrong medications at the wrong dose.

Never Heard of Kratom? You Will.
A plant from Thailand with opiate-like properties is the latest "designer drug" speeding its way through America.

How Binge Drinking Causes Fetal Damage
Studies in mice show that alcohol is toxic to DNA in the absence of two specialized enzymes.

Senators Blast Feds for Border Scandal
Botched gun-smuggling scheme put weapons in the hands of Mexican drug thugs, endangered informants, and may have gotten agents killed.

Testimonials to Betty Ford
In the wake of Mrs. Ford’s death, celebrities and politicians tell their personal stories about her work in raising awareness of addiction and recovery.

New Synthetic Marijuana Arrives to Replace Spice, K2
Designers are already busy with the second generation of cannabis-like drugs.

Crack and Coke Will Finally Receive the Same Legal Penalties
Civil rights leaders charged that the legal system's intense obsession with crack amped up minority arrests, but had no scientific basis. Turns out they were right.

Miracle-Gro Goes After the Medical Marijuana Market
It’s just quasi-legal cooperative organic gardening, right? All $1.7 billion of it.

(R.I.P. Amy Winehouse)

Why are Treatment Centers Afraid of Anti-Craving Medications?

Using What Works

Why do so many drug treatment centers continue to shun science by ignoring medications that ease the burden of withdrawal for many addicts? That’s the question posed in an article by Alison Knopf in the May-June issue of Addiction Professional, titled “The Medication Holdouts.”

“Nowhere else in medicine,” Knopf writes, “are the people who treat a condition so suspicious of the very medications designed to help the condition in which they specialize.”

Acamprosate, a drug used to treat alcoholism, is a good case in point. A dozen European studies examining thousands of alcohol test subjects found that the drug increased the number of days that most subjects were able to remain abstinent. But when a German drug maker decided to market the drug in the U.S., fierce advocates for drug-free addiction therapy came out in force, even though the drug was ultimately approved for use.

Disulfiram, naltrexone, acamprosate, methadone, buprenorphine—the evidence for all of them is solid. Knopf cites the case of buprenorphine:

“‘There are scores of peer-reviewed journal articles that evaluate the success of buprenorphine,’ says Nicholas Reuter, MPH, senior public health adviser in the Division of Pharmacologic Therapies at the federal Center for Substance Abuse Treatment (CSAT). ‘It's well established that the data and the evidence are there. Not treating patients with a medication consigns most of them to relapse, adds Reuter. While some opioid-addicted patients, as many as 20 percent, do respond to abstinence-based therapy, ‘That still leaves us with the 80 percent who don't,’ he says.”

Dr. Charles O'Brien, one the nation’s most respected addiction professionals and a Professor of Psychiatry at the University of Pennsylvania, is incensed that anti-craving medications are not more widely used. “It's unethical not to use medications,” he says. “This is a subject that I feel very strongly about.” O’Brien told Addiction Professional he no longer cares who he offends on the subject. “If you're discouraging people from taking medications, you are behaving in an unethical way; you are depriving your patients of a way to turn themselves around. Just because you don't like it doesn't mean you have to keep your patients away from it.”

And at the Association for Addiction Professionals, “the prevailing philosophy is pro-medication,” Knopf writes. Misti Storie, education and training consultant for the group, told Knopf that the “disconnect” at treatment centers is due to a “lack of education about the connection between biology and addiction.” Counselors working in centers that do not allow anti-craving medications are in a tough spot, Storie acknowledged.

It is continually astonishing that treatment centers--where the primary goal is supposed to be the prevention of relapse, even though the success rate remains abysmal--would spurn medications that often help to accomplish precisely that goal. Relapse rates hover around 80%, by an amalgam of estimates, so it’s not like rehabs are wildly successful at what they do. What’s really behind the resistance?

What stands between many addicts and the new forms of treatment is “pharmacological Calvinism.” I would love to claim this term as my own, but it was coined by Cornell University researcher Gerald Klerman. Pharmacological Calvinism may be defined as the belief that treating any psychological symptoms with a pill is tantamount to ethical surrender, or, at the very least, a serious failure of will. As Peter Kramer quoted Klerman in Listening to Prozac: If a drug makes you feel better, then by definition “somehow it is morally wrong and the user is likely to suffer retribution with either dependence, liver damage, or chromosomal change, or some other form of medical-theological damnation.”

Photo credit: www.life123.com

Falling Down and Getting Up: Nic Sheff’s New Addiction Book

 

Sheff jumps back on the carousel, lives to tell about it.

What would it be like to have written a drug memoir and an autobiography before you turned 30? Would it seem like the end or the beginning? Are there any worlds left to conquer?

The last decade has brought us fleshed-out young examples by Augusten Burroughs, age 37 (Dry); Joshua Lyons, 35 (Pill Head); and Benoit Denizet-Lewis, 33 (America Anonymous). This more or less fits the pattern established by the doyenne of the genre, Elizabeth Wurtzel, who, at age 35, wrote the addiction memoir More, Now, Again. And now along comes Nic Sheff to put them all to shame, making geezers out of every one of them.  Sheff wrote Tweak at 24, telling the world about addiction and how he’d conquered it. Well, as it turns out, not really. But for twenty-somethings, a week is like a year, so two years later, in actual time, comes We All Fall Down, in which we learn—if we didn’t learn it the first time—that the author is still learning about addiction, doesn’t have it figured, and isn’t really qualified to give out lessons to anybody just yet. Or perhaps I should wait for We All Stood Up Again two years from now before drawing any conclusions.

I know I am being a bit unfair to this well-intentioned young author. I blame it on the flood of weighty pronouncements found in the addiction memoirs that have flooded the market lately. God bless ‘em all, but Amazon, by listing Sheff’s book as “Young Adult,” probably gets it about right. You can’t go into these projects expecting great literature. Sheff’s text, perhaps in a deliberate appeal to younger readers, is peppered with whatevers, and clauses that begin with “like.” His favorite adjective, without question, is “super.” Too many one-sentence paragraphs give the book an irritatingly staccato effect at times.

But let’s get beyond that. There are good things here, and Sheff is certainly qualified to tell an addiction story: “We stayed locked in our apartment. I went into convulsions shooting cocaine. My arm swelled up with an abscess the size of a baseball. My body stopped producing stool, so I had to reach up inside with a gloved hand and….” And so forth.

There is a standard tension in addiction memoirs by young writers. The dictates of group therapy and 12-step treatment programs clash mightily with their innately sensitive bullshit detectors. It is hard—understandably—to buy into some of the more narrow-minded and coercive treatment programs they’ve been tossed into along the way. I was chilled to hear Sheff quoting substance abuse counselors threatening to commit him to lockdown psych wards, or blackmailing him into signing contracts about who he could or could not be friends with in the compound. For a free-spirited, open-minded young artist, the distinction between rehab and a Chinese re-education camp is pretty much lost entirely when personal freedoms are arbitrarily limited by lightly qualified drug counselors. One of the more compelling themes of the book is that rehab, as practiced in many treatment centers across the country, is something of a cuckoo’s nest joke.  It is a mutual con, where everybody fools everybody in order to turn a profit, on the one hand, and discharge legal or parental obligations, on the other. “Infallible institutions,” as Sheff derides them, “that know, absolutely, the difference between right and wrong.”

So Sheff plays along, he shucks, he jives, he lies, and it’s hard not to sympathize with him as he summarizes one counselor’s admonitions: “We don’t allow any non-twelve-step-related reading material, and you won’t be able to play that guitar you brought with you—so we’ll go ahead and keep that locked in the office.” Much like prisoners who leave prison chomping at the bit to commit new and more lucrative crimes, these kids are coming out of misguided drug rehab centers with nothing but an urgent desire to wipe away the bad memories of mandatory treatment by getting wasted as soon as possible.

And yet, and yet… “Once I had some knowledge about alcoholism and addiction, it was impossible to go back to using all carefree and fun,” Sheff writes. “The meetings and the things people told me had pierced the armor of my fantasy world. Somewhere inside I knew the truth.”

Maybe there won’t be a need for a third memoir. The book has a provisionally happy ending. Sheff found the right doctor, got on the right medications after a diagnosis of Bipolar Disorder (comorbidity, the elephant in the rehab room), and, when last seen, is clean and optimistic.

Sheff does have an appealing, Holden Caulfield-type persona, and this Catcher in the Rye mentality perhaps excuses the litany of things in this world that are phony, fucked up, and lame to this endlessly hip kid. All carpets are faded, all motel rooms are dingy. Even his airline boarding pass is “stupid.” But the style sometimes works for him: “Thinking, man, even that cat’s got enough sense not to jump on a hot grill twice, no matter how good whatever’s left cooking on there might look to her.” Or the time when he realizes that, like any old alkie, it was time to “start switching up liquor stores. That goddamn woman makes me feel as guilty as hell. And, I mean, who is she to judge? Christ.” And he’s got some nice truisms to deliver: “The most fucked-up detoxes I’ve ever seen are the people coming off alcohol. It’s worse than heroin, worse than benzos, worse than anything. Alcohol can pickle your brain—leaving you helpless, like a child—infantilized—shitting in your pants—ranting madness—disoriented—angry—terrified… You don’t go out like Nic Cage in Leaving Las Vegas, with a gorgeous woman riding you till your heart stops.”

Photo Credit: http://www.goodreads.com/

Addiction in the Courtroom [Guest Post]

Forensic psychology and the paradox of addiction.

Allison Gamble says she has been a curious student of psychology since high school. Though her studies ultimately led her to writing and editing, she keeps her understanding of the mind close at hand in the weird world of internet marketing.

The paradox of addiction presents a legal conundrum when it comes to determining the extent of a defendant’s guilt in criminal court. Although addiction is generally considered a mental health condition, it does not lie within the parameters that typically define mental illness in the courts. Though defense lawyers may present addiction as a mitigating factor--in some cases influencing the jury to vote for a lesser conviction--addiction does not excuse the defendant from being legally responsible for the crime.

Forensic psychology is a field that weaves together psychology and the criminal justice system. Oftentimes these insights prove useful for determining legal guilt or innocence. For example, if a defendant is found not guilty by reason of insanity, it is likely due to the work of a forensic psychologist. However, when it comes to crimes involving addictive behavior, forensic psychology is faced with paradoxical truths regarding addiction, and the relationship between addiction and responsibility for one’s actions.

A commonly held view of addiction is that it is a disease marked by lack of control. An alcoholic cannot stop himself from drinking. Likewise, a drug addict will do things no one in their right mind would ever do just to get the next high. All of these people may thoroughly regret their behavior when the high wears off, but that does not stop them from doing it again. Indeed, they often cannot stop without help.

Paradoxically, however, addiction is all about choice. A crucial part of treatment for addiction requires the addict to take full responsibility for his or her behavior. Addicts must recognize that their addictive behavior is, on some level, a choice, and that they can choose differently. It is not clear to what extent biology plays a role in starting an addiction. Social and emotional factors also play parts, both in forming an addiction and in continuing it.

This creates a huge gray area when an addict commits a crime related to his or her addiction. Did the person have control over their behavior? Is the addiction itself a choice, or something the addict can’t help any more than they could help catching the flu? Especially in cases where the addiction itself is a crime, such as compulsive shoplifting or narcotic use, these questions are crucial in determining the defendant’s responsibility for the crime and an appropriate sentence. Generally if these questions can be answered at all, the answer is often both yes and no, and the legal system often reflects this dichotomy: People convicted of addiction-related crimes may be ordered into treatment as part of their sentences. In some cases, especially for crimes not involving violence or repeat offenses, criminal charges are dropped if the defendant agrees to treatment. However, a defendant being treated for addiction may also be sentenced to jail time, probation, fines, community service, and/or restitution, especially if the crime involved violence or property damage. Since addiction is both under and outside of the addict’s control, someone who commits an addiction-related crime should be both held responsible and offered treatment.

Graphics Credit: http://diaryofasmartchick.com/

New Addiction/Recovery Web Site

Daily news blog is part of "The Fix."

I’m pleased to announce that I'll be writing and editing a new blog, “This Just In,” for the recently-launched addiction and recovery site, The Fix. Some top-notch writers are involved, like Susan Cheever and Walter Armstrong. Big take-down of Narconon in the current issue. I encourage you to take a look.

Addiction Inbox will continue to appear without change. Apologies in advance if the pace of posting tends to slow a bit in the immediate future.

Impulsivity and Addiction

The perils of a hypersensitive dopamine system.

The brooding, antisocial loner, the one with impulse control problems, a penchant for risk-taking, and a cigarette dangling from his lip, is a recognizable archetype in popular culture. From Marlon Brando to Bruce Lee, these flawed heroes are perhaps the ones with restless brain chemicals; the ones who never felt good and never knew why (“What are you rebelling against?” “What’ve you got?”).

A recent study at Vanderbilt University, published in Nature Neuroscience, used PET scans and fMRI imaging to suggest that impulsivity and other “antisocial” traits “predicted nucleus accumbens dopamine release and reward anticipation-related activity in response to pharmacological and monetary reinforcers, respectively.”

In other words, the Vanderbilt researchers maintained that so-called “psychopathic traits” like impulsivity and risk taking are linked to addiction and gambling by means of an overly active dopamine system. PET scans of dopamine responses to a low dose of amphetamine showed that “individuals who scored high on a personality assessment that teases out traits like egocentricity, manipulating others, and risk taking had a hypersensitive dopamine response system,” according to a press release from the National Institute on Drug Abuse (NIDA), which funded the study.

Putting a different spin on the matter, NIDA director Nora Volkow said: “By linking traits that suggest impulsivity and the potential for antisocial behavior to an overreactive dopamine system, this study helps explain why aggression may be as rewarding for some people as drugs are for others.”

Lead author Joshua Buckholtz of Vanderbilt said that “the amount of dopamine released was up to four times higher in people with high levels of these traits, compared to those who scored lower on the personality profile.  Buckholtz suggested that a pattern of exaggerated dopamine responses “could develop into psychopathic personality disorder.”

Dr. Robert Cloninger, a prominent addiction researcher, has asserted in the past that children who show a high propensity for risk-taking, along with impulsivity, or “novelty-seeking,” are more likely to develop alcoholism and other addictions later in life.

And, in interviews with the late psychologist Henri Begleiter for my book on addiction science, Begleiter insisted that addicts were stuck with a package of symptoms he called behavioral dysregulation. “Disinhibition, impulsivity, trouble fitting into society—you have certain behavioral disorders in kids who later develop into alcoholics and drug addicts,” he said. The behavior itself doesn’t cause the addiction. The dysregulated behavior is a symptom of the addiction.”

“When you talk to these people, as I have,” Begleiter said, “you see that the one thing they pretty much all report is that, under the influence of the drug, they feel much more normal. It normalizes their central nervous systems. Initially, what they have is a need to experience a normal life.”

So, it wasn’t ducktails, pool halls, tattoos, casual sex, or lack of parental involvement that caused addiction to alcohol and cigarettes and pot, and maybe cocaine and speed and heroin. It wasn’t just the “bad kids.” Irrational anger, impulsive decisions, certain compulsive behaviors like gambling—these behaviors were symptoms of the same group of related disorders that included drug and alcohol addiction, and which involved specific chemicals and areas of the brain related to reward, motivation, and memory.

The trait of impulsivity is a possible marker for addiction that may help explain why it is usually impossible to persuade addicts to give up their drugs by sheer force of logic—by arguing that the drugs will eventually ruin their health or kill them. “They tell me it’ll kill me,” sang Dave Van Ronk, “but they don’t say when.”

Consider the always-instructive case of cigarette smoking. In 1964, the Surgeon General’s Report on Smoking and Health laid out the case for the long-term ill effects of nicotine quite effectively—and millions of people quit smoking. A stubborn minority did not, and many of them still have not. Are they simply being hedonistic and irresponsible? Or are the long-term negative consequences, so dramatically clear to others, simply not capable of influencing their thinking to the same degree? Biochemical abnormalities similar to those predisposing certain people to addiction may also prevent them from comprehending the long-term results of their behavior.

Buckholtz, J., Treadway, M., Cowan, R., Woodward, N., Benning, S., Li, R., Ansari, M., Baldwin, R., Schwartzman, A., Shelby, E., Smith, C., Cole, D., Kessler, R., & Zald, D. (2010). Mesolimbic dopamine reward system hypersensitivity in individuals with psychopathic traits Nature Neuroscience, 13 (4), 419-421 DOI: 10.1038/nn.2510

Graphics Credit: http://www.nature.com/neuro/journal/

Should I Tell My Boss?

Health help in the workplace.

It’s no secret: Times are tough. The situation at work is uncertain at best, downright Machiavellian at worst. According to a recent survey by the American Psychological Association (APA), the primary source of stress for 80 % of Americans is—you guessed it—money.

Health Matters at Work, a program developed by Community Health Charities, is offering a four-part video podcast series on addiction, depression, and stress in the workplace. The goal of the Health Matters at Work program is to enhance the ability of “employers, employees, and their loved ones to connect to credible information and resources to improve their health and their lives.”

The podcast series focuses on work-related resources available through Mental Health America, the Depression and Bipolar Support Alliance, and the National Council on Alcoholism and Drug Dependence.

“The message we hope people hear,” said Robert Lindsey of the National Council on Alcoholism and Drug Dependence, “is that together we offer a broad network of support to people in communities across America, and we are all here for people that need our help.”

David Shern of Mental Health America said: “Mental Health is fundamental to health in every way. Increased levels of stress, depression, and anxiety all raise the risk of cardiovascular disease.”

Community Health Charities of America, located in Arlington, Virginia, is a consortium dedicated to assisting “people affected by a disability or chronic disease by uniting caring donors in the workplace with health issues and causes important to them and their families.”

A list of the group’s member charities can be found here.

Corporate partners include AARP, McDonalds, Exxon, HP, Siemens, and USA Today.


addiction drugs

Defining Alcoholism

How much is too much?

Alcohol consumption lies on a spectrum, from nondrinkers on one end to patients dying of alcohol-related liver disease on the other. Novelist Jim Harrison once claimed that his ambition was to be a “problem drinker,” rather than an alcoholic.

How do we make the distinction?

Professor George Vaillant of Harvard felt obliged to study that question, an inclination that resulted in his 1983 landmark work, The Natural History of Alcoholism, revised in 1995.

Dr. Vaillant was the motive force behind the Harvard Medical School’s Study of Adult Development, which began in 1940. The study was divided into three groups: the middle-class College sample, the so-called “Core City Longitudinal Study”, and a later group, the Clinic sample, comprised solely of people who had been admitted to a clinic for detoxification, and the only one of the three groups that included women.

So what did George Vaillant discover in the longest formal study of drinking behavior ever undertaken in the United States? One of the first observations Vaillant drove home was that the amount of alcohol consumed is NOT a reliable indicator of alcoholism. Not only is “amount of alcohol ingested” an unreliable predictor of alcoholic drinking—so is “frequency of intoxication.” Both attributes, Vaillant found, proved to be very poor “discriminators” when it came to distinguishing alcoholics from “problem” drinkers.

So, if how much you drink, and how often you drink, are not reliably predictive of alcoholism, what, IS a reasonable predictor? The key item on Vaillant’s questionnaires turned out to be: “Admits problem controlling alcohol use.”

Vaillant showed that “multiple alcohol-related problems result not from ingesting large amounts of alcohol but from being unable consistently to control when, where, and how much alcohol is consumed.” Alcoholism, Vaillant concluded, is “defined by the number, not by the specificity, of alcohol-related problems.”

This insight dovetailed neatly with the definition of alcoholism the National Council on Alcoholism had adopted way back in 1976: “The person with alcoholism cannot consistently predict on any drinking occasion the duration of the episode or the quantity that will be consumed.”

For George Vaillant and other pioneers of the disease model, the conceptual view had shifted long ago: “As with coronary heart disease, we must learn to regard alcoholism as both disease and behavior disorder.” Genetic loading, says Vaillant, “is an important predictor of whether an individual develops alcoholism,” while a difficult childhood environment “is an important predictor of when an individual loses control of alcohol.”

Based on his lifelong study, Vaillant discloses that chronic alcoholics are involved in at least half of all vehicle accident deaths, which comes as no surprise. Half of all emergency room patients with severe multiple fractures are alcoholics, and alcoholics are six times as costly to keep when hospitalized, says Vaillant. Alcoholics—22 million of them in the U.S. alone, by a recent federal estimate—commit suicide far more often than non-alcoholics do. 10 to 30 per cent of all suicides may be alcoholics, according to statistics cited by Vaillant. And this does not include suicides by people addicted to drugs other than alcohol.

“Progressive” alcoholics—those who never abstain or go through periods of stable social drinking—were twice as likely to smoke two packs of cigarettes a day, compared to other drinkers. Indeed, alcoholics almost never stop smoking. Vaillant believes that heavy drinking acidifies the urine in a way that increases the urinary excretion of nicotine. Hence, there is a need to smoke more while you are drinking more, lest blood nicotine levels fall below the comfort range.

And along with cigarettes, says Vaillant, comes depression: “Like smoking and alcohol abuse, depression is associated with premature mortality; and if alcoholics were three times as likely to be dead, they were also three times as likely to be depressed.” Depressed men and women, then, drink more, smoke more, and take more drugs than non-depressed people. It is never hard to anticipate the chorus of complaint that such reasoning elicits. Everybody has emotional vicissitudes, but not everybody resorts to abusing drugs. Everybody gets the blues, but not everybody drowns them in drink. With courage and discipline, people can resist the easy notion of a whiskey, neat, for every problem.

To combat that notion, Vaillant also documents the dismal stats concerning “treated” alcoholism: “For short periods, middle-class individuals respond well to treatment in the medical model, but that response may be short-lived and reflect premorbid variables rather than the efficacy of specific treatment.” It turns out that if you simply control for two “premorbid” variables—marriage and employment—you can account for most of the difference. Alcoholics who are solidly married and have jobs fare better in treatment. But even they don’t always do very good for very long.

(Image courtesy of Medline Plus-National Library of Medicine)

Shining New Light on Addiction

SAD phototherapy may help with alcoholism

It’s that time of the year again.

For many people, autumn is a bracing and enjoyable time of the year. But for an unlucky minority of people, the advent of seasonal affective disorder, or SAD, is only, and literally, a matter of time. Since the autumnal equinox at 9.51 a.m. GMT on September 23, when daytime lost its annual circadian struggle with nighttime, the amount of daily sunlight slowly but surely diminishes by as much as several minutes a day. And for a few months, it will only get worse. For dwellers in the northern latitudes, the long dark has begun.

To be precise, seasonal affective disorder is not typically considered to be a separate or unique disorder, but rather a symptom of unipolar or general depression, the “garden-variety” form of depression. Both general depression and its seasonal variant involve symptoms such as lethargy, weight gain, carbohydrate craving, oversleeping and joylessness.

The addition of strong light in certain frequencies—a form of phototherapy—helps some people combat this seasonal form of depression. The so-called SAD lights have become a fixture in homes, offices, and mail-order catalogs. The evidence for effectiveness is somewhat controversial, but generally accepted.

Recently, Science magazine has spotlighted work being done on other conditions that may respond to SAD phototherapy. Citing the work of Alfred Lewy and Thomas Wehr at the National Institute of Mental Health (NIMH), who showed that phototherapy worked by decreasing the production of melatonin through a complicated set of reactions leading to an increase in blood levels of serotonin, the article summarizes the evidence showing that many people suffering from either seasonal depression or general depression benefited from spending 30 minutes each morning sitting three feet away from bright white fluorescent lighting--light banks very much like the indoor “grow lights” people often purchase for their house plants.

However unorthodox it may sound, recent studies strongly suggest that phototherapy might also aid people suffering from bipolar disorder, commonly called “manic-depression.” This is a striking possibility, since bipolar depression is distinct from general depression, and rarely responds to the same therapies and medications used for that condition.

This development has led researchers to wonder whether other mental or behavioral disorders partially mediated by fluctuations in serotonin might also respond to light therapy. Last year, writing in the American Family Physician, Stephen J. Lurie and coworkers pointed out that “SAD is associated with serotonergic dysregulation and… may overlap with other diagnoses that share similar mechanisms.”

One diagnosis that shares similar mechanisms is alcoholism. The neurological connection between alcoholism and major depression is well documented by now, and involves serotonin, among other neurotransmitters and neurotransporters that ferry molecules around the brain and the rest of the central nervous system. Brain imaging studies of alcoholics do indeed show a marked reduction in serotonin transporter availability in cases of accompanying depression.

According to Lurie, a summary of recent research findings reveals that “some patients with alcoholism may be self-medicating an underlying depression with alcohol or manifesting a seasonal pattern to alcohol-induced depression.” Such patterns also show genetic underpinnings—SAD often runs in families with a strong history of alcoholism and general depression. All of this, the paper states, “may be related to serotonergic functioning.”

Dr. Leo Sher of the Department of Psychiatry at Columbia University believes that “Family and molecular genetic studies suggest that there may be a genetic link between seasonality and alcoholism.” In an article for the January 2004 issue of Comprehensive Psychiatry, Sher writes:

“The fact that SAD and alcoholism may be comorbid [occur together] shows the importance of a thorough diagnostic interview. Both mental health and drug and alcohol professionals should be provided with education to assist with appropriate identification, management and referral of patients presenting with comorbid alcoholism and SAD.”

For alcoholics who also suffer from seasonal affective disorder, a therapy regimen that includes exposure to bright lights in the morning could do more than boost their moods. It might also help them drink less. Much more research is needed, but the possibility that SAD phototherapy might help curb alcohol cravings or prevent relapse is a hypothesis worthy of further investigation.

Sources:

Bhattacharjee, Yudhijit, “Is Internal Timing Key to Mental Health?” Science, 317 14 September 2007. (Subscription).

“Alcohol and Seasonal Affective Disorder.” Comprehensive Psychiatry.

“Serotonergic dysfunction, negative mood states, and response to alcohol.” Alcoholism, Clinical and Experimental Research.

"Circadian Phase Variation in Bipolar I Disorder." Chronobiology International

"Influence of a functional polymorphism within the promoter of the serotonin transporter gene on the effects of total sleep deprivation in bipolar depression." Journal of Clinical Psychiatry.

“Seasonal Affective Disorder.” American Family Physician

“Shedding Some Light on Bipolar Disorder.” Living the Scientific Life (Scientist, Interrupted).

Bulimia as Food Addiction

Serotonin-mediated brain activity drives the binge-and-purge cycle

Bulimia, the binge-and-purge disorder that tends to afflict young women, seems especially linked to serotonin abnormalities. Bulimics gorge themselves and then induce vomiting--a debilitating cycle that often leads to severe health consequences.

Richard and Judith Wurtman, of the Massachusetts Institute of Technology (MIT) identified a subset of bulimics who binge severely and almost exclusively on high-carbohydrate foods. These bulimics tended to be mildly obese, severely depressed--and came from families with a strong history of alcohol abuse. Other researchers have reported that a significant number of bulimics are themselves abusers of alcohol and other drugs. What is being suggested is that carbohydrate-craving obesity and bulimia may turn out to be two additional forms of drug addiction. They may be variations on the addictive theme, and the underlying cause may be the same--irregularities in the reward system neurotransmitters.

For women whose bodies do not regulate the production of serotonin successfully, bulimia is one of the possible symptoms that can result from this condition. Unlike anorexia, its “partner” disorder, bulimia resembles addiction in several important ways. There is a definite “high,” which comes with the purging, and which has no analogue in anorexia. (Recall that serotonin is involved in smooth muscle functions, like vomiting and bowel movements.)

Bulimia’s impact on the brain’s reward center also seems to be quite direct, judging by the high relapse rates of bulimics. As further evidence, studies were performed by Walter Kaye and colleagues at the University of Pittsburgh Medical Center, where PET scans were taken of women who were former bulimics, and compared to a set of PET scans from healthy, age-matched women. The ex-bulimics showed a marked decrease in serotonin binding at the 5HT receptors, and studies by Kaye and others offer evidence that alterations in the brain’s serotonin pathways often persist after recovery from bulimia, and may represent permanent changes in brain chemistry.

The idea that serotonin disturbances are at the root of bulimia continues to make sense. Moreover, preliminary studies of female twins have bolstered the basic hypothesis, by showing evidence of a possible genetic predisposition toward bulimia.

Serotonin and Dopamine: A Primer

The Molecules of Reward

Serotonin and dopamine are part of a group of compounds called biogenic amines. In addition to serotonin and dopamine, the amines include noradrenaline, acetylcholine, and histamine. This class of chemical messengers is produced, in turn, from basic amino acids like tyrosine, tryptophan, and choline. The amines are of great interest, because both mood-altering drugs and addictive drugs show a very straightforward affinity for receptors sites designed for endogenous amines.

Addictive drugs have molecules that are the right shape for the amine receptors. Drugs like LSD and Ecstasy target serotonin systems. Serotonin systems control feeding and sleeping behaviors in living creatures from slugs to chimps. Serotonin, also known as 5-HT, occurs in nuts, fruit, and snake venom. It is found in the intestinal walls, large blood vessels, and the central nervous system of most vertebrates. The body normally synthesizes 5-hydroxytryptamine, as serotonin is formally known, from tryptophan in the diet.

Thus far, no other substance found the central nervous system has as many diverse receptor actions as 5-HT. The average adult has only about 10 milligrams of serotonin in his or her body. It is involved, to one degree or another, in appetite, sleep, mood, memory, learning, endocrine regulation, smooth muscle contractions, migraine headaches, motility of the GI tract, blood platelet homeostasis, so on. Serotonin also plays a large role in initiating and shaping certain kinds of behavior, especially behaviors of a sexual or hallucinatory nature. In animal models, lower serotonin levels correlate with higher levels of violence.

A receptor-selective agent like Sumatriptan, a popular migraine medication, works by binding selectively to a serotonin receptor subtype involved in arterial circulation and dilation. The difference between serotonin-active drugs like sumatriptan, and similarly serotonin-active drugs LSD or Ecstasy, is that the former locks exclusively into these “5-HT1” receptors, and nowhere else. The ergot alkaloids are all over the serotonin system, causing general surges of their own.

Psychedelic drugs like LSD and Ecstasy (chemically known as indoleamines) and mescaline (phenethylamines) make up the two major classes of hallucinatory drugs. They are both partial agonists at 5-HT receptors, boosting serotonin particularly in the cerebral cortex and the locus coeruleus. There is also some enhancement of glutamine activity as well. Other 5-HT agonists, like ondansetron (trade name Zofran), do not have that effect. Ondansetron helps block the nausea of chemotherapy by blocking serotonin activity in the GI tract. Vomiting is a serotonin-mediated reflex. In this case, it is the 5-HT3 receptor subtype that is of note. Ondansetron’s selective affinity for that subtype makes it a useful anti-emetic.

Dopamine, like serotonin appears to be strongly involved in mediating craving-- drug hunger, as well as real hunger. This yields a partial answer to one of addiction’s mysteries: Why would a drug addict, an alcoholic, continue to use when the adverse effects of continued use have long ago swamped whatever euphoric sense of well being, or even just plain normalcy, that once was obtained through the drug? One answer might be that dopamine causes human beings to pay attention to stimuli that are potentially rewarding. Even in the absence of any possibility of reward--on a desert island, in a rehab clinic--dopamine dysregulation could kindle episodes of fierce craving, because such episodes had led in the past to a renewed ingestion of the drug in question-- all the fiercer, these cravings, this drug hunger, whenever the addict was exposed to direct cues, like seeing the drug, or being in places where the addict had used before.

Scientists have managed to record a rise in dopamine levels in lab rats simply by cueing the rats to anticipate a pleasurable event--food, sex, sweet drinks. For example, you could condition the rats to a ringing bell before dinner, and soon the rats would be showing elevated dopamine levels at the sound of the bell only--with no reward at all. Anticipation of reward was all it took. Or you could give one of the male rats a good close look at a suitable female through a mesh panel, and the male rat’s dopamine levels would surge, presumably in anticipation of possible carnal pleasures, and dopamine levels would spike even higher, of course, once the divider was removed.

Serotonin/dopamine dysfunctions cause physical discomfort, anxiety, and panic--what a renowned neuropharmacologist has termed “spiraling distress”—which continues to occur even in the complete absence of the addictive drug. Take the drug away, and the brain begins its complex and minutely ordered repertoire of compensatory effects--unpleasant sensations as read out by the addict.

Finding a way to override serotonin- and dopamine-mediated mid-brain commands is one of the keys to recovery from addiction. One of the aims of a biological understanding of addiction is to tease out the mechanisms by which the reinforcing effects of addictive drugs become transformed into long-term adaptive changes in certain areas of the brain. “Why are we so surprised that when you take a poison a thousand times, it makes some changes in your head?” wondered James Halikas, who was co-director of the chemical dependency treatment program at the University of Minnesota during the crack heyday of the late 1980s and early 1990s. “It makes sense that poisons change things.”

addiction drugs

addiction drugs

Alcohol and HDL levels

Should Middle-aged Men Stop Drinking ?

Heavy drinking and age don't always mix very well, despite the alleged beneficial health effects of taking just a single drink per day. Now comes news that, for men in their 50s, even high levels of the protective HDL type of cholesterol will not shield them from the ravages of high blood pressure if they are heavy drinkers.

A recent Japanese study of more than 21,000 men suggests that even HDL cholesterol, the so-called “good” cholesterol, does not protect drinkers from high blood pressure once they reach their 50s.

High blood pressure is a known side effect of excessive drinking, but in 20-something drinkers, healthy levels of HDL, or high-density lipoprotein, help protect young men from developing high blood pressure due to excessive intake of alcohol. According to the paper, published in the September issue of Alcoholism: Clinical and Experimental Research, “The blood pressure of middle-aged men is elevated by alcohol drinking independently of blood HDL level and is more sensitive to drinking than is the blood pressure of young men.”

In other words, a man’s blood pressure become more sensitive to alcohol as he ages, regardless of his HDL levels. The research, undertaken at the Hyogo College of Medicine, demonstrated that men of any age cannot escape the likelihood of higher blood pressure if they are moderate to heavy drinkers. But for aging men, the problems are much greater. Even keeping their good cholesterol number high will not protect them from soaring blood pressure, if they continue to drink heavily in their 50s.

While men with the lowest HDL levels consistently showed the lowest blood pressure overall, the finding “fits well with the observation that the risk of stroke—which is more sensitive to blood pressure than heart attack—is not really substantially lower in moderate drinkers,” according to Dr. Kenneth Mukamal of the Harvard Medical School. 

Add to that the likelihood that moderate to heavy drinkers in their 50s are also likely to be cigarette smokers, and more likely to be overweight, and high blood pressure in 50-something men becomes all too easy to understand. The lifestyle changes required to do something about it are as obvious as they are profoundly challenging.

Graphics from: http://www.upei.ca/~stuserv/alcohol/effectsonbody.htm

Book Review (Part Three): Women Under the Influence

Rehab and the Working Mother

According to Columbia University’s National Center on Addiction and Substance Abuse, more than 2.5 million women abuse or are dependent on illegal drugs. Women are almost 50 per cent more likely to be prescribed a narcotic or sedative, and teenage girls are more likely than teenage boys to abuse prescription drugs, with dramatic increases among 12 to 17 year old girls.

Statistics cited in Women Under the Influence, produced by the Center, show that while women convicted of drug-related offenses represent the fastest growing subset of America’s prison population, their representation in the drug rehab community has not kept pace. Fully three-fourths of these incarcerated women are mothers, and that fact is at the heart of the difficulties women face when they seek treatment.

Put simply, millions of women who need treatment for addiction to alcohol and illegal drugs do not receive it. This has been true throughout American history. Women were not admitted to meetings during the formative years of Alcoholics Anonymous (AA), and there is evidence that the 19th Century practice of performing hysterectomies on alcoholic women as a last resort quietly persisted until the 1950s.

AA soon opened its doors to women, who now comprise roughly one third of its membership. But when it comes to rehab centers, the treatment gap has not closed: “For women with small children, lack of childcare is a serious obstacle to seeking treatment…. For some women, fear of losing their children to the child custody system upon admission that they have a problem makes them apprehensive about entering treatment.”

Moreover, there are no universal standards of training, practice or accountability among the nation’s treatment providers, and women face differing approaches to their needs for child care, pediatric services, transportation, and the like. While older women have treatment needs that differ from girls and pregnant women, very few treatment centers offer programs designed specifically for older females.

If treatment is to become noticeably more effective for addicted women, “it must be readily available, tailored to fit the needs of the individual patient, and part of a comprehensive program that addresses associated medical, psychological, social, and economic needs…. Appropriate, research-based, and effective prevention efforts tailored specifically to the unique needs of girls and women are in desperately short supply.”

Women Under the Influence--purchase info

The Myth of Controlled Drinking

Forward into the Past: White-Knuckle Alcoholics

For the past two decades, social psychologist Stanton Peele has questioned the necessity of abstinence for alcoholics, claiming, in The Meaning of Addiction and in Diseasing Of America: Addiction Treatment Out Of Control, that the “myth” of instant relapse is not well supported by statistical research.

Bulling his way past hundreds of published scientific studies about the neurobiology of addiction, Peele continues to insist that the disease concept of alcoholism has no basis in current science. Believing that people’s personal values determine whether or not they become addicts, Peele has also written that “no data of any sort support the idea that addiction is a characteristic of some mood-altering substances and not of others.”

“Those with better things to do,” Peele writes, “are protected from addiction.”

Andrew Weil, a well-known drug authority and author of The Natural Mind, has also objected to the “grossly materialistic conceptions of addiction” offered up by proponents of the biochemical view.

A biological view of addiction can be a way of giving intractable addicts hope, researchers say. Peele, however, draws exactly the opposite conclusion, arguing that the disease model is telling addicts that there is no hope, that they cannot do anything about their incurable “disease.”

Considering all the basic qualifiers about biochemical theories that the researchers themselves felt obliged to use in the first place, it was galling in the extreme to have critics like Peele deriding the effort in its entirety--and most amazingly of all, bringing back the old bugaboo about controlled drinking. Adherents of the controlled drinking theory hold that alcoholics can frequently return to social, responsible drinking, without having to maintain total abstinence.

If an alcoholic limits himself to two or three drinks a day, and does it successfully for a period of time, this behavior looks from the outside like controlled drinking. Many alcoholics and other drug addicts are able to accomplish this feat for varying lengths of time. Indeed, AA members are familiar with this counterfeit form of controlled drinking, and even have a name for it: White-knuckle sobriety. Controlled drinking-- also known as sobriety without abstinence--is certainly not unheard of among alcoholics

But is it a practical response to alcoholism?

Dr. Arnold Ludwig, professor of psychiatry at Kentucky University’s College of Medicine, disagrees. In his book, Understanding the Alcoholic’s Mind, Ludwig writes: “Those authors who argue that many can return to normal drinking fail to grasp an essential point: it is less frustrating for the preponderance of alcoholics to avoid drinking altogether than to settle for one normal-sized drink, such as a single martini, a glass of wine, or a beer.”

For most serious alcoholics, it is easier to abstain altogether, rather than to engage in controlled, responsible, non-intoxicated drinking.

The idea of controlled drinking (or controlled drug use) is the one hope almost every addict brings to his or her initial encounter with treatment. As one AA veteran put it: “If it were possible for a majority of alcoholics to revert to controlled drinking, every alcoholic in AA would have found out about it a long time ago.”

It sometimes seems as if critics like Stanton Peele are attempting to resurrect the moral view of the past, offering no new approaches while legitimizing the criminal penalties and social stigma that has been America’s response to addiction all along.

Sources:

Peele, Stanton. Diseasing of America. Jossey-Bass, 1999

Peele, Stanton. "A Moral Vision of Addiction: How People’s Values Determine Whether They Become and Remain Addicts,” Journal of Drug Issues, Vol. 17, Spring, 1987.

Ludwig, Arnold M., Understanding the Alcoholic's Mind. Oxford University Press, New York, 1988.




alcoholics anonymous

Book Review (Part Two): "Women Under the Influence"

The Rise of the Binge Grrls

“Women get drunk faster, become addicted more quickly, and develop alcohol-related diseases—such as hypertension and liver, brain and heart damage—more rapidly than men.” --The National Center on Addiction and Substance Abuse at Columbia University


Today, about one out of every four American girls has had one or more alcoholic drinks by the age of 13, according to “Women Under the Influence,” a book by Columbia’s National Center on Addiction and Substance Abuse. In the 1960s, only 7 percent of girls reported having consumed alcohol by that age.

80 per cent of college women living in sororities engage in regular bouts of binge drinking, compared to 35 per cent of non-sorority college women. While most women are moderate drinkers, the Center estimates that at least six million girls and women meet the DSM-IV criteria for alcohol abuse and dependence.

When it comes to alcohol, the study turned a few common assumptions upside down. For example, the more education a woman has had, the more likely she is to be a drinker. Surveys indicate that 36 per cent of women with less than a high school education drink alcohol, compared to 60 percent of women who attended college. White adult women are more likely to be drinkers than African-American, Hispanic, or Asian-American women. And while men traditionally drink more than women, women are fast closing that gender gap. Among high school seniors, the percentage gap between heavy-drinking boys and heavy-drinking girls was 23 percent in 1975. By 2003, the difference was only 12 percent, and among very young teenagers, girls have closed the gender gap completely. In addition, older women have higher rates of late-onset (over age 60) alcohol abuse than men.

Teenage girls whose mothers drank regularly during pregnancy are six times more likely to report alcohol use than girls whose mothers did not drink. Whatever the cause, or most likely causes, no such maternal relationship has been demonstrated for teenage boys of drinking mothers. And—bearing in mind that such estimates are fraught with peril—the Center concludes that genetic factors account for as much as 66 percent of the risk for alcohol dependence in women. As evidence, women who are alcoholics are somewhat more likely that male alcoholics to come from a family with a history of alcohol abuse.

Women metabolize alcohol differently than men do. With less water and more fatty tissue in their bodies, blood alcohol levels are higher for women than for men, given the same number of drinks. After two beers, women are more likely than men to exceed legal levels of alcohol in the bloodstream. Women get drunk faster and have heavier hangovers, and the reason may stem from differences in ADH enzyme activity in breaking down alcohol into its byproducts. (More research is needed.) Female alcoholics also develop liver diseases like cirrhosis more frequently than alcohol-abusing men, and at lower levels of alcohol intake.

From the sociocultural point of view, women are targeted heavily in alcohol advertising, primarily through promotion of the idea that alcohol will relax sexual inhibitions and improve communication with men. Alcohol advertising has increasingly zeroed in on selling beer to women—“beer’s lost drinkers,” as one brewery spokesman put it. Only about 20 per cent of women currently drink beer regularly. Ironically, the alcohol industry’s official code of ethics forbade the use of women in alcohol ads until 1958. And as recently as 2003, the Code of Responsible Practices of the Distilled Spirits Council of the United States specifically prohibited any ads or marketing materials that “degrade the image, form or status of women…”

All of the foregoing pales in comparison to the potential for damage among pregnant women who drink. The fact that alcohol is dangerous to fetal development is not a recent discovery. Aristotle pointed out that “Foolish drunken or harebrain women for the most part bring forth children like unto themselves.” While warning signs on alcohol containers and tavern doors have become a common sight, the study group estimates that about 10 percent of pregnant women still drink. (That number is quite likely higher, given the reluctance of patients to accurately report their alcohol intake). “Drinking during pregnancy,” according to the Center, “is the single greatest preventable cause of mental retardation” in America today. Indeed, the number of birth defects caused by alcohol in one year exceeds the total number of recorded thalidomide births.

Tragically, “As many as 60 percent of pregnant women who drink do not discover their condition until after the first trimester.” In addition to the well-known Fetal Alcohol Syndrome (FAS), there is also a range of other neurobehavioral deficits to the fetus associated with drinking during early pregnancy. Pregnant women who drink heavily suffer three times the normal risk of miscarriages and stillbirths. In fact, to this day, no safe level of alcohol intake during pregnancy has been established. The American Academy of Pediatrics continues to advise women who are pregnant or thinking of becoming pregnant to abstain for alcohol completely.

Part Two of Three

Women Under the Influence--purchase info

Book Review (Part 1): "Women Under the Influence"

Women and Cigarettes: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

“Compared to boys and men, girls and women become addicted to alcohol, nicotine, and illegal and prescription drugs at lower levels of use and in shorter periods of time, develop substance-related diseases like lung cancer more quickly, suffer more severe brain damage from alcohol and drugs like Ecstasy, and often pay the ultimate price sooner. Yet 92 per cent of women in need of treatment for alcohol and drug problems do not receive it. Stigma, shame, and ignorance hide the scope of the problem and the severity of the consequences.”

--Joseph A. Califano, Jr.

“Women Under the Influence,” with a Foreword by former Health, Education and Welfare Secretary Joseph Califano, appeared in print last year, but is well worth a second look. The result of studies undertaken at Columbia University’s National Center on Addiction and Substance Abuse, and collectively written by that group, “Women Under the Influence” gathers together a decade’s worth of research on the gender differences researchers have thus far been able to identify in the addict population.

The same genetic and biological mechanisms that predispose certain men toward alcoholism and other forms of drug addiction do the same in women. Young women with family histories of alcoholism will, like Pavlov’s dogs, salivate more intensely at the sight of alcohol than women from families without addiction histories. Studies of female twins also confirm the behavioral link between major depressive disorder and substance abuse. Women who have suffered from major depression are three to six times more likely to suffer from alcoholism than those who have not. Despite these and other commonalities, however, women and men often follow different arcs of addiction on a drug-by-drug basis.

We begin with cigarettes, since it is with nicotine that women have lately shown the ability to achieve a grisly parity, or in some cases even outdo men in the damage done by nicotine. About one American woman out of five smokes. While rates of lung cancer in men have been slowly declining since 1980, the number of women with lung cancer has increased 600 percent over the past 70 years. More women now die of lung cancer than the combined fatalities from breast cancer, ovarian cancer, and uterine cancer. As Antonia C. Novella, former U.S. Surgeon General, put it: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

80 per cent of female smokers began smoking before the age of 18, and women did not begin smoking in large numbers until the late 1940s, thus producing a delayed epidemic of lung cancer in women. To make matters worse, the Columbia group concluded that “At the same level of exposure to tobacco smoke, women have a greater risk of developing lung cancer than men.” Up to three times more likely, according to some studies. Moreover, women who smoke more than 20 cigarettes a day face an 80 per cent greater risk of developing breast cancer, compared to non-smoking women.

Women who smoke heavily have four times as many heart attacks as non-smoking women. Add in oral contraceptives, and the risk of heart attack increases by 1,000 percent.

Women who smoke have more respiratory disorders. Wheezing rates are consistently higher for women than for men, at all age levels. Women smokers develop more crow’s feet around the eyes than men who smoke. Female pack-a-day smokers suffer a steady accretion of bone density and a concomitant increase in rates of osteoporosis. And the fact that nicotine is an effective appetite suppressant is an open secret, as a couple of generations of chain-smoking supermodels have demonstrated.

Cigarette companies are increasingly placing their bets abroad, among a new generation of young women in countries like China, where authorities estimate that as many as 20 million Chinese women have taken up smoking over the past ten years. In “Lung cancer in U.S. women: A contemporary epidemic,” published in the Journal of the American Medical Association (JAMA 291(14):1767), J.D. Patel et. al. suggest that “Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today.”

The silver lining, if there is one, is that a majority of women still choose not to smoke.

Women Under the Influence--purchase info

End of Part One.

Media Suffers Attack of Cannabis Psychosis

Bad Science Makes for Bad Science Journalism

According to the London Daily Mail, smoking a single joint of marijuana increases your risk of developing schizophrenia by 41 per cent. The Mail quoted Professor Robin Murray of the Institute of Psychiatry in London, who dutifully warned that the risk was perhaps even higher than that, due to the increasing use of what the newspaper termed “powerful skunk cannabis.” The skunk effect, said Murray, meant that the study’s estimate that “14 per cent of cases of schizophrenia in the UK are due to cannabis is now probably an understatement.”

Marjorie Wallace of the mental health charity SANE told BBC News: “The headlines are not scaremongering, but reflect a daily, and preventable, tragedy.”

Wow. As Gertrude Stein once put it, “Interesting if true.”

But it’s not true at all, of course. Or, to put it more accurately: If it were true, there is no way in hell the meta study under question could be used to prove it.

Speaking as a science journalist, this is the sort of thing than can really ruin your day.

As always, it helps to start with the original published article, a meta-analysis published in the British medical journal Lancet under the title, “Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.” 2007 370: 319-28. Mark Hoofnagle, a MD/PhD Candidate in the Department of Molecular Physiology and Biological Physics at the University of Virginia, discussed the paper in depth on his Denialism Blog:

“First of all, the statement that ‘just one joint’ increases risk by 41% is absurd. The study here is of those who have tried marijuana once or more, not of people who have only tried it once. So already, the Daily Mail and every other news organization is way off. Second, I think we're ultimately seeing a post-hoc ergo propter hoc argument, and a dose-response that's more characteristic of the population studied than a real pharmacologic effect.”

Here’s why:

--People who suffer from a mental illness do more drugs than “normal” people. They are a high-risk population when it comes to addiction. There are people who have a propensity for addiction, and people who do not. Many of those who do will get hooked, but this does not mean that everything which follows is a result of the drugs.

--Latent schizophrenics often suffer their first break while under the influence of psychoactive drugs. Pot, along with LSD, physical trauma, the death of a loved one, and other intense emotional events can all trigger a schizophrenic break in late adolescence. So naturally there would be a correlation.

--The assumption that pot causes susceptibility to mental illness, rather than the other way around, can’t be proven. Hoofnagle uses the example of cigarette smoking. Anyone who has researched schizophrenia, or been around schizophrenics, knows that almost all schizophrenics smoke. (It helps quell hallucinations). Most of them began to smoke before the onset of their illness. Using the assumptions of the current study, we could say that cigarette smoking is almost certain to cause schizophrenia. Correlation, as Hoofnagle reminds us, is not causation.

--Daily pot smokers confound such a study. Are some of them exhibiting symptoms of schizophrenia, or are they exhibiting the symptoms of chronic marijuana intoxication? If they quit smoking so much, would they stop acting so crazy?

--Comorbidity is exceedingly common in drug addicts and users. There is a well-documented causal connection between depression and the use of psychoactive drugs. People suffering from depression often resort to cannabis and other drugs as a form of self-medication. Again, the mental condition leads to the drug use, and not the other way around.

--Finally, where is the epidemic of schizophrenia caused by millions of people smoking marijuana for years? What field evidence can be drawn upon to support this remarkable conclusion?

To be fair to the authors, bets are hedged. In their conclusion, Moore, et.al. state: “The possibility that this association results from confounding factors or bias cannot be ruled out, and these uncertainties are unlikely to be resolved in the near future.”

Nevertheless, the authors go on to conclude that “We believe that there is now enough evidence to inform people that using cannabis could increase their risk of developing a psychotic illness later in life.”

At www.badscience.net, Ben Goldacre wryly notes that “You know when cannabis hits the news you’re in for a bit of fun…” Of 175 studies identified as potentially relevant, Goldacre maintains that only 11 papers, describing 7 discrete data sets, actually turned to be relevant for purposes of the study. If every assumption in the paper is taken to be correct, and causality is accepted, Goldacre calculated, about 800 cases of schizophrenia per year could be attributed to marijuana in the U.K. “But what’s really important,” Goldacre writes, “is what you do with this data. Firstly you can misrepresent it….not least of all with the ridiculous ‘modern cannabis is 25 times stronger’ fabrication so beloved by the media and politicians.”

As it happens, all of this comes at a time in Britain when efforts to reclassify cannabis are being hotly debated in the government. As propaganda, the report is useful, but as a means of clarifying the debate, it will only produce confusion and demagoguery.

Sources:

--Moore, Theresa H.M., et. Al. “Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.” Lancet. 2007 370: 319-28 http://www.thelancet.com/

--MacCrae, Fiona and Andrews, Emily. “Smoking just one cannabis joint raises danger of mental illness by 40%.” London Daily Mail. 26/07/07

--“Cannabis ‘raises psychosis risk.’” BBC News. 2007/07/27 http://news.bbc.co.uk/2/hi/health/6917003.stm

--Cressey, Daniel. “Medical opinion comes full circle on cannabis dangers.” Nature. 27 July 2007.

--Hoofnagle, Mark. “Does Smoking Cannabis Cause Schizophrenia?” Denialism Blog. July 30, 2007. http://scienceblogs.com/denialism/2007/07/does_smoking_cannabis_cause_sc.php

medical marijuana

A View From the Other Side: What Disease?

A psychiatrist takes issue with the semantics of addictive disease in SLATE.

See "Medical Misnomer: Addiction isn't a brain disease, Congress."
By Sally Satel and Scott Lilienfeld

Food Addiction

Carbohydrates on the Brain, Food Rehab in the Future

Earlier this month, Yale University hosted the first-ever conference on Food and Addiction. Dr. Nora Volkow of the National Institute on Drug Abuse told the collection of experts on nutrition, obesity and drug addiction that “commonalities in the brain’s reward mechanisms” linked compulsive eating with addictive drug use. “Impaired function of the brain dopamine system could make some people more vulnerable to compulsive eating,” Volkow said.

Moreover, animal studies and brain imaging research in humans strongly support the notion of food addiction. In particular, research has pointed toward a form of food addiction known as “carbohydrate-craving obesity.” Dr. Mark Gold, chief of addiction studies at the McKnight Institute at the University of Florida, and a well-known authority on cocaine abuse, argued that “failed diets and attempts to control overeating, preoccupation with food and eating, shame, anger, and guilt look like traditional addictions.”

Conference organizer Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale, conceded that “it wasn’t obesity experts who got interested in addiction, it was the addiction scientists who got interested in food.” Brownell suggested that psychologists have been slower to grasp the import of food addiction “in part because of a bias that obesity is all about failure and personal responsibility, so why look at biology?”

As Dr. Gold summed it up, “It turns out that food and drugs compete for the same reward system in the brain.”

SOURCES:

--“Yale Hosts Historic Conference on Food and Addiction.” Yale University Office of Public Affairs. July 9, 2007. http://www.yale.edu/opa/newsr/07-07-09-01.all.html

--Hellmich, Nancy. “Does food ‘addiction’ explain explosion of obesity?” USA Today, July 9, 2007.

--“Yale Hosts Historic Conference on Food Addiction.” Medical News Today. 11 July 2007. www.medicalnewstoday.com

--Hathaway, William. “Experts Chew Over Eating as Addiction.” The Hartford Courant. July 11, 2007. http://www.courant.com/news/health

What's Wrong With This Picture?

A bit of cognitive dissonance, perhaps?

The situation could easily be reversed, but cigarette manufacturers mostly advertise in magazines, not newspapers. Otherwise, we might be reading about the dangers of consuming too much alcohol in casinos, while looking at an ad for a new brand of cigarettes.