A Night of Serious Drinking: The Results

"A systematic review of the next‐day effects of heavy alcohol consumption on cognitive performance"

The latest scientific rundown on the ramifications of hangovers, in the journal Addiction, can be found HERE.

 

The Myth of Healthy Drinking

Another meta-study demolishes decades of wishful thinking.

Vox notes that "an impressive new meta-study involving 600,000 participants, published recently in The Lancet, suggests that levels of alcohol previously thought to be relatively harmless are linked with an earlier death. What’s more, drinking small amounts of alcohol may not carry all the long-touted protective effects on the cardiovascular system."

Readers of Addiction Inbox will not be surprised by this finding. Back in 2014, I wrote a blog post entitled "Alcohol and Your Heart: Health benefits of moderate drinking come under fire." The post referenced studies suggesting that recent findings were bringing “the hypothesized cardioprotective effect of alcohol into question.”

Also in 2014, I published a report with the headline "Single Bout of Binge Drinking Linked to Immune System Effects."

It's not at all surprising that research touting alcohol's health benefits has been heavily pushed by the alcohol industry. See my post, "Alcoholic Deception: Big Alcohol Wants a Piece of the Health Market".

In the end, the myth about the health effects of moderate drinking made its way into the public consciousness for one obvious reason: People very much wanted it to be true.

Alcohol and Cancer, Explained

"Alcohol and endogenous aldehydes damage chromosomes and mutate stem cells"

Juan I. Garaycoechea, Gerry P. Crossan, Frédéric Langevin, Lee Mulderrig, Sandra Louzada,  Fentang Yang, Guillaume Guilbaud, Naomi Park, Sophie Roerink, Serena Nik-Zainal, Michael R.
Stratton & Ketan J. Patel

    Nature doi:10.1038/nature25154

This pay-walled article, published in "Nature," presents fresh evidence that alcohol can damage chromosomes and cause mutations. If you don't have a zillion dollars to spare, The American Cancer Society has put together a layman's version of the subject here.

Here's an explainer from Britain's National Health Service. And here's an interview with one of the authors, published in "Genetic Engineering and Biotechnology News." Suffice to say that among the many health problems alcohol can cause, the one that all too often goes unmentioned, namely cancer, is not a trivial side effect.

Alcohol Should Be More Expensive

Without a doubt, the alcohol you're drinking this Holiday Season is too damn cheap.

By all means check out the new piece by German Lopez at Vox: "The case for setting a minimum price on alcohol."

Cancer: Alcohol’s Dirty Little Secret?

What Doctors Don’t Tell You

It is, in fact, no secret at all that alcohol causes cancer.  Rather than conferring any demonstrable metabolic benefit, alcohol is more likely to damage your health in a variety of ways. The body converts alcohol (ethanol) into acetaldehyde as part of the metabolic process, and acetaldehyde is carcinogenic in sufficient quantities. Drinkers are particularly susceptible to cancers of the head and neck, as well as the liver, breast, and bowel.

However, you wouldn’t know this if you only talked to doctors. In a commentary written for the journal Addiction, Terry Slevin and Tanya Chikritzhs of Curtin University in Perth, Australia, suggest that health professionals may be consciously or unconsciously in denial.

A 2015 survey taken in the UK demonstrated that only about 13% of the population was aware of a link between alcohol and cancer. Moreover, surveys of physicians show that “significant proportions are not aware of or resist the notion that alcohol causes cancer and do not advise their patients of the relationship. This is compounded by the fact that many physicians are reluctant to ask about patient alcohol use, particularly when drinking does not appear to have a direct impact upon their health.” (98% of medical students in a survey from Saudi Arabia, where drinking is rare, said that alcohol causes cancer.)

The authors raise the following question: Could individual alcohol use among doctors be part of the problem? Some studies have shown that physicians drink more than average, other studies conclude that they drink about the same as everybody else. As for attitudes about drinking, the authors reference a U.S. study showing that 24% of doctors admitted to having imbibed alcohol while on call. 64% reported witnessing colleagues who appeared to be under the influence of alcohol while on call.

Given that most doctors probably drink socially at about the levels one would expect of the general population, the authors point up the possibility that a form of cognitive dissonance might be behind an apparent, perhaps unconscious reluctance to discuss the alcohol/cancer link. If true, “an important source of health information for members of the public may not be communicating the alcohol-causes-cancer message consistently or effectively.”

The alcohol industry itself has always viewed the alcohol/cancer question primarily as a threat to sales. These powerful companies exhibit “a vested interest in maintaining the status quo of relative ignorance, uncertainty and denial among the general population and their trusted health advisors. In the face of this, it is time that health professionals set aside any leanings that might stem from their own drinking—good or bad—and convey unreservedly to their patients and the communities they serve that alcohol causes cancer.”

Graphics: http://www.alcoholandcancer.eu/risks/

From Failure to Enthusiasm

Guest Post

By Andy

"Success is walking from failure to failure with no loss of enthusiasm." —Winston Churchill

One of the reasons I love this quote, is because for many of us, being able to keep our enthusiasm up in the midst of trying times can be very difficult to achieve. But once you figure out how to never lose it, no matter how hard life can get, it will mark the difference between giving up and succeeding. I love this quote and remind myself every time that sobriety success is shaped by my attitude. In this post I’m going to take you through my personal sobriety journey.

The Addict/Alcoholic

When I was 4 years old my parents made the life changing decision of moving from Colombia to California. It was 1986 and the situation in my country was scary and very violent. Upon arrival in California my parents took on many jobs to be able to provide for me and my siblings; they worked really hard to make sure we would have a life full of opportunities.

The great thing about latinos is that culturally not only are we very hard working people, but we are also very happy people who love to party. And of course, no Colombian party is ever complete without that anise-flavored drink called Aguardiente. Not that all Colombian’s are drunks, it’s just simply something they enjoy once in awhile, when there’s a good excuse to celebrate.
The first time I got drunk was at a family friend’s house party when I was nine years old. I was always a pretty mischievous kid, therefore at the party my cousin and I played a game to see who could steal more shots of aguardiente without getting caught.

After a few shots I was feeling very different inside. I felt comfortable, more secure, I danced salsa with my sister and all my cousins, I felt great. From that night on I drank every time I had the chance.
At 15 a friend introduced me to marijuana. Although today teen drug use is declining, back when I was a teenager the statistic was increasing and at 19 I attended a party and some guys introduced me to meth and so began the downward spiral. At 23 I found myself incarcerated in Idaho on drug related charges for two years.

You might be wondering why I left so many parts of the story untold. Well, I’m not writing this to reminisce on war stories, being eight years sober now I believe myself to be a bit wiser and truth be told, a little tired of recounting my crazy times. Jail in Idaho was the starting point of my recovery, and that is the part of THIS story I really want share.

AA and NA

When you are in prison, any activity that can take you out of your cell is welcomed with open arms. So when I was told that I could attend the Alcoholics Anonymous meetings I did not hesitate. At the time I was not interested in recovery, in fact, I thought I didn't have a drinking problem or substance abuse problem. I just needed to do something else than read in bed. So I attended meetings without participating. It took three months of going to these meetings to realize that I might have a slight drinking and drug problem.

One day, a fellow inmate told the story of how he hit rock bottom. He was a high level accountant abusing drugs in order to deal with the insane amount of work and stress at his job, until one day, having suicidal thoughts, he got drunk and drove his car into a local store. He lost his job, his wife filed for divorce, his family had lost hope (this wasn’t his first run in with the law). He shared that apart from coming to terms with his drug and alcohol problems he had also realized that he also had an anger management problem, he concluded that “rage spawns from anger, anger spawns from hurt, hurt spawns from getting your feelings hurt.”

Like I said before, I thought I didn't have a problem. I was convinced that I was fine, that I wasn’t hurting anyone. But thanks to that inmate sharing his story and his realization my eyes were opened: I had hurt the only person I had to live with for the rest of my life and the damage I had done to myself needed to be repaired. I had a drinking problem, a drug problem, a personality problem...a life problem.

The Workaholic

Prison was everything but easy, but attending the AA and NA meetings and the friendships I built helped me get through it. Once I was released I had a new sense of responsibility, I knew I needed to find a job, and be able to provide for myself. But it wasn't easy. Having a criminal record made it a challenge to find a good job, so I struggled for months. And when I finally found one, I was unmotivated and feeling trapped in a routine. Despite attending my AA and NA meetings on a regular basis, I relapsed. I lost my job and life seemed unbearable, hence my voluntary check in to a rehab center in Idaho.

After 3 months in rehab I moved back to California where I landed a job selling knock-off cologne. Being closer to my family helped me immensely, therefore my motivation was higher than ever. I would wake up at 5:00 am to pick-up my co-workers and go to gas stations, shopping center parking lots, flea markets, etc. to sell perfume out of the trunk of my car. After a few months I had become very good at selling. I had learned how to approach strangers, how to pitch my product, make people feel comfortable and how to overcome rejection. The job was purely commission based, thus if I didn’t sell, I didn’t make money. There is a great feeling about making cash on a sale that I cannot really describe. It is a feeling of accomplishment, it is a feeling that I wanted to replicate time and time again. I was determined to keep working harder and harder.

Months went by and next thing I knew I was training more than 10 people to sell perfumes and other beauty products on the street. I had my own office, had ads running in the paper, had a secretary taking calls, etc. In that year I had lost ten pounds, I had zero friends, and I barely saw my family.

After a long conversation with a friend he presented me with a book by Jeffery Combs called Psychologically Unemployable (Jeffery is also a recovering addict). One of the most important things said is that you should never confuse obsession with passion. After reading it and studying it for a few weeks, I understood that I had simply traded drugs and alcohol for work. It was an addiction and it wasn't any better. I was getting physically sick and emotionally unstable from the pressure I was putting on myself.

The Entrepreneur

I sold my perfume business and moved into my parents house. It was really important in my road to recovery to have their support. After a month I got a job at Target, so I could help my parents pay the bills and have some sort of income. I had no passion for that job whatsoever, and I was completely unmotivated in that point of my life. I couldn't find balance between success and a healthy, happy life. Being afraid of relapsing I started attending weekly AA/NA meetings. I acquired a really good sponsor that I am very grateful for. He gave me the task of taking a class at the local community college.

At the time I was not very happy to do the task. I felt old and I thought there was no point in taking a measly course. I just wanted to go to work, do my job and pay my bills, that was it. Nevertheless, I forced myself to take a class. The class I took was called Introduction to Website Development (HTML). I liked computers and websites, so I thought, why not give it a shot?

You should have seen my bedroom after three months in the class. I had stacks of books and papers about HTML and website design. I found myself at the computer for hours, coding, creating, learning. Finally, one day I thought to myself that it would be great if I could make a business out of my new acquired skill.

Nine years later I co-own a successful digital marketing agency. I have a great team that I feel are like my family, in fact, my brother is part of it. We are based in Medellin, Colombia, which means my life has taken a 180 degree turn. 30 years ago my parents left Colombia to give my siblings and I a better life, now I am back with that better life.

I still go to meeting and try to keep in touch with some of the good friends I made on my way to recovery. We always give each other support during rough times. Being sober has become a part of my life now. My attitude defines me and I do not let anything take control of my emotions, it only gets easier with time. I have learned to attend dinner parties and skip the wine; to dance with my colombian friends and kindly decline those beers and still enjoy myself. In regards to my business, I didn't let myself get lost while pursuing success. I have learned that balance is what makes you successful. Being able to work hard for months enjoying what you do, but also taking a weekend off to recharge has proven to be a critical part of my work-life balance. I feel very fortunate because I went out and found something I was passionate about, put my skills and knowledge to work and built a business. Sobriety, just like building a business, does not happen overnight, one has to commit to it and work hard.

It’s Not All About You

When you are in the process of recovering, every single thing you do to maintain your sobriety seems to be about you. Every one of the 12 steps you complete, every single task or piece of homework your sponsor gives you, every book or article you read is all about you and your recovery. But after a while you realize, there's a bigger picture. And going back to that Winston Churchill quote, "Success is walking from failure to failure with no loss of enthusiasm," learning that failing is just a part of the process. Behind the most successful people are years of failure, even if it's on their way to sobriety or on their way to being a successful entrepreneur. The issue is not failing, since we all will go through it, it's to never lose enthusiasm. Good luck and thank you for reading my story.

Graphics: https://pocketperspectives.com

Alcohol and Refugee Populations

How displaced peoples are harmed and helped by alcohol.

Although it is impossible to know with certainty, 50 million is the current U.N. estimate of the number of human beings around the world categorized as refugees or displaced persons due to war and other violence. These "conflict-affected populations" suffer in a thousand different ways, but widely overlooked is the frightening prevalence of alcohol and other drug use disorders in these groups. The humanitarian health sector’s understandable focus on “immediate life-saving activities” means that longer-term chronic and behavioral issues remain unexamined.

What are the risks of ignoring alcohol use disorders in these populations? Bayard Roberts and Nadine Ezard, in an editorial for the journal Addiction, suggest that they are formidable. For conflict-affected groups, the “risk environment” includes loss of home and livelihood, exposure to war trauma, PTSD, anxiety, violence, and depression. In such environments, alcohol and other drugs are capable of producing a familiar and depressing litany of results are enumerated in setting after setting: Disruptions to household economies, alcohol-related suicides, violence against women, increased HIV and other blood-born viruses, unsafe sex practices, and increased mental health problems.


Nadine Ezard, co-author of the editorial in Addiction, was also lead author of a 2011 paper, “Six rapid assessments of alcohol and other substance use in populations displaced by conflict,” published in the journal Conflict and Health. Ezard and colleagues conducted extensive interviews on substance use and abuse in a range of populations displaced by conflict in Kenya, Liberia, Uganda, Iran, Pakistan, and Thailand. The work resulted in the development of a field guide for rapid assessment of alcohol and other substance use used by the United Nations High Commissioner for Refugees and the World Health Organization (WHO).

The aim of the study was to describe current substance use patterns in the study populations, and to identify possible interventions. As Ezard et al. write, “A number of effective interventions exist for problem substance use, but little attempt has been made to adapt these interventions to populations displaced by conflict.”

The six assessments took place between 2006 and 2008. Populations included refugees both in and out of camps, residents of nearby communities, returning populations, in both urban and rural settings.

Kenya

The main study group was located in Kakuma Refugee Camp and nearby Kakuma town, each with about 100,000 people. The camp was established in 1992 to house Sudanese refugees, but at the time of assessment there were refugees in the camp from nine countries. Alcohol production and use was common, while cocaine and heroin were relatively rare. Food rations provided a workable source for fermentation products. Local women produced a cereal-based brew, busaa, and a stronger distilled version, changa’a. These were important sources of income in the area. The distilled product was illegal and associated with family disruption, violence, and gender abuse. One woman told researchers: “I brew because I want my children to survive. When my customers buy my brew and buy my body, even if I die, my children will inherit my brewing business.”

Liberia

In 2003, a 14-year civil war ended after 250,000 casualties and near-total destruction of infrastructure. Nearly a million refugees and displaced persons, supported largely by non-government organization, have been there ever since. Alcohol and marijuana were cheap, easily available, and widely consumed. Distilled cane juice liquor and palm wine were popular. “Beer is drunk like water,” said one respondent, “assuming that people can afford it.” Cannabis is popular with young people, who use it, according to one youthful observer, “to stop the bad dreams.” Benzodiazepines were also in play, with sex workers reporting that diazepam was frequently used in the bars as a date rape drug.  Cocaine was also available, particularly when smoked with marijuana in a mix called a “dugee.” No respondents indicated any drug injection. There were no specific alcohol or drug treatment services available in the region.

Uganda

At the time of the assessment, more than 2 million people, displaced due to protracted civil conflicts, were scattered across an archipelago of more than 100 displaced persons camps. Alcohol was readily available, acknowledged to be a serious problem, and health care was limited. The usual results of alcohol abuse were in evidence in the disruption of community cohesion that “left families short of food and children hungry.” Both male and female respondents “drew causal links between dispossession and alcohol use. Dispossession promoted alienation, idleness and loss of traditional gender roles among men…. As a result, cultural norms were changing, as one woman explained: ‘now there are no rules for drinking alcohol.’” As one youth said, “how can I respect these older men when I see them becoming drunk and falling down in the dirt.” Yet once again, alcohol brewing was a crucial source of income for many women in poverty.

Iran

For the past 20 years, Iran has been host to Afghan refuges, an undocumented million of which live outside the camps. The prevailing drug problem in this population is widespread opiate use, rather than alcohol. According to the study, “Refugees are permitted access to basic education and health care on the same basis as Iranian citizens. Service utilization by Afghans is thought to be low due to a combination of barriers such as poverty, lack of awareness, and perceived discrimination,” as well as fear of the authorities. “Newer opiates were becoming more popular, such as heroin, Iranian ‘crack’ and crystal (highly concentrated forms of heroin), and there was some transition to injection. Nevertheless, respondents perceived opiate as less prevalent among the Afghan refugee population than the host population.” Respondents also reported a number of benefits to opiate use: “pain relief, pleasure and socialization.”

Pakistan

In 2007, Pakistan contained an estimated 3 million Afghans, half of them living in so-called “refugee villages” along the border. In this region, the main substance use classes included opium, plus hashish for men, and benzodiazepines, commonly, for women.  There were not specialist drug abuse services available in the villages. “Although each refugee village context was distinct, substance use patterns were characterized as a continuation or exaggeration of pre-displacement use modified under the influence of patterns of availability and village livelihood options…. For example, in urban, but not rural areas substances were sometimes injected, reflecting the substance use patterns of the host population.” Alcohol use was uncommon and confined to home-brew made from sugarcane or grapes and predominantly used by young people. In fact, “one third of the women interviewed said that they knew someone who had a serious problem with hashish and gave accounts of domestic violence associated with its use. Respondents believed that limited skills, education and employment opportunities promoted substance use.”

Thailand

Refugees from civil war in Myanmar have been in Thailand now for decades. Out of the millions of undocumented migrants, the study group concentrated on 150,000 refugees living in nine camps along the border.  Access to health care was considered good, and in this case there were residential substance abuse treatment programs available in the camps. Alcohol was the primary public health concern. Home-brewed distilled rice liquor was the primary source. Less prominent drugs included meth and caffeine were available, as were diazepam, cough syrup, opiates, and marijuana.  The results were predictable: “dependence, high risk sexual behavior, family disruption, and gender-based violence.” Young people had three choices, according to one young man: “They can leave the camp and look for work, they can lead a traditional life which means they will have lots of babies, or they can drink alcohol.”


Despite all this, the authors sensibly urge that public health workers should not ignore “the perception in some communities that substance use may have important social functions…. The combined effect of substance use problems may inhibit community capacity to recover from conflict, yet some types of substance use may be important for social cohesion in some settings.”

The authors believe that conflict-affect populations require, as a minimum, “screening and brief intervention for high risk alcohol use” as well as “identification and treatment of severe mental illness (as both a cause and consequence of substance use).” In addition, “primary health services should be capable of managing withdrawal and other acute problems.”

What else needs to be done?

—Brief community-based interventions, which have proven cost-effective in higher income settings.

—Gender-sensitive interventions.

—More epidemiological research on alcohol risks and comorbidity with mental health disorders including depression and anxiety.

—Evaluation of feasibility and cost-effectiveness of interventions, including the use of experimental designs.

“This requires a public health approach,” Ezard and Roberts write, “for example, ensuring that work on non-communicable diseases addresses underlying risk factors as well as treatment; exploring community-based responses; supporting better coordination between different sectors such as health and protection or mental health and psychosocial support with communicable disease control activities…. And ensuring that the needs of conflict-affected civilians are recognized in global alcohol control activities.”

There is, however, one clear-cut approach to drug abuse problems in such communities that the authors most definitely do not recommend, and it is the most time-honored modality of all: “Despite their popularity among many service providers and community groups, general public information campaigns and school-based education for primary prevention programs have been shown to be ineffective to reduce alcohol-related harm.”

What would be the benefits of tackling alcohol disorders in these beleaguered, violence-prone communities? Roberts and Ezard argue for several:

—Improved mental and physical health.

—Reduced risk of disease, injuries, and accidents.

—Reduced harm and violence to others.

—Improved family relations and social networks.

—Improved economic productivity.

—Reduced health care costs.

The editorial concludes that “without greater engagement, alcohol use disorder and its consequences among conflict-affected civilians will remain neglected and the multiple benefits of tackling it will continue to be ignored.”

Tripling the Tax on Alcohol

Would it do any good?

A recent article in Slate by Reihan Salam, a sort of modest proposal on behalf of a big boost in alcohol excise taxes, caught considerable flack from free market advocates and conservative bloggers last week.

Salam says Americans agree on the fact that marijuana is not as dangerous a drug as alcohol, and that this agreement offers us an opportunity to “regulate alcohol more stringently than we regulate marijuana.” In fact, Salam argues, why not push the envelope: “Raise the alcohol tax to a point just shy of where large numbers of people will start making moonshine in their bathtubs.”

Salam tries to head off some of the usual criticisms by noting that Prohibition was an unmitigated disaster, but that “what most of us forget is that the movement for Prohibition arose because alcohol abuse actually was destroying American society in the first decades of the 20th Century," and that companies like Anheuser Busch and MillerCoors are plotting with national retail chains as you read this, scheming to make alcohol as cheap and easy to buy as humanly possible.

Salam further justifies a tripling of alcohol taxes by viewing it as a tactical offset to the efforts of liquor companies to focus on their best customers: “the small minority of people who drink the most.” Salam says that right now, it costs about two bucks per inebriated hour to get your drink on. Can we really argue that this price level is just too unsustainably high? Drug expert Mark Kleiman, Professor of Public Policy at UCLA, agrees.  In his book Marijuana Legalization: What Everyone Needs to Know, Kleiman and co-authors argue that “tripling the tax would raise the price of a drink by 20 percent and reduce the volume of drinking in about the same proportion. Most of the reduced drinking would come from heavy drinkers, both because they dominate the market in volume terms and because their consumption is more price-sensitive…."

Minnesota legislators recently passed a bill that opponents say would increase state excise taxes on alcoholic beverages to six times the current levels. Supporters of the alcohol tax say it means an extra $200 million per year to the state, at a cost to drinkers of about seven cents per drink. Or, in Salam's example: “Charging two-drink-per-day drinkers an extra $12 per month seems like a laughably small price to pay to deter binge drinking…. If you’re going to tax tanning beds and sugary soft drinks, why on earth wouldn’t you raise alcohol taxes too?”

Why wouldn’t you? Because it doesn’t accomplish what you want to accomplish, writes Michelle Minton at openmarket.org, the blog of the Competitive Enterprise Institute.  After a bit of throat clearing about the Nanny State, Minton writes that “fortunately, a society’s relationship with alcohol isn’t based solely on the price of alcohol…. Research shows that alcohol price is not an effective means of achieving lower total consumption or reducing binge drinking.” As evidence, Minton points to studies showing that Luxembourg and the Czech Republic “have both the highest priced alcohol and the highest rates of consumption in Europe.”

As for a comparison favored by Salam—New York’s anti-smoking campaign—Minton admits that the new higher cost of cigarettes cut the adult smoking rate dramatically, but points out that “New York is now the number-one market for smuggled cigarettes—which account for more than half of all cigarettes smoked in the state.” This is a powerful argument. If we triple the taxes on alcohol, do we risk a black market of dangerous home-brew bootlegger booze?

In my view, such threats are real, but they are theoretical. The current costs of alcohol in socioeconomic terms are enormous and undeniable. Tripling the alcohol tax might be asking for trouble, but we could get there in stages if Americans saw it as a desirable goal. Arguments against tax increases tend to ignore the fact that alcohol is a different kind of product, capable of addicting a significant minority of users, in addition to killing a certain percentage of drinkers outright through alcohol poisoning and traffic accidents. If we ignore the issue of drug dependence, and the health and legal costs of assorted alcohol-related mayhem, and simply lean on the fact that most people who drink use alcohol responsibly, then it gets easier to argue against increases in alcohol and cigarette taxes. Alcohol is not like other household products, and needn't be regulated like them.

Fruit Fly Larvae Go Cold Turkey and Forget the Car Keys

Not a pretty sight.

Let’s start with the fruit fly, your basic Drosophila. A fruit fly, like a human, can become addicted to alcohol even at a very young age. The larval age. In other words, even as a maggot. And, just like humans, alcohol degrades a fruit fly maggot’s ability to learn. But adaption is an amazing thing, and drunken larvae eventually learn as well as their teetotaling cousins. That is, until the alcohol is taken away, in which case, the maggots become impaired learners once again. The larval nervous system goes haywire, and hyperexcitablity sets in. They can’t concentrate on their work. But one hour of “ethanol reinstatement” restores larval learning to normal levels.

It looks and sounds like withdrawal. Such effects in human alcoholics are often chalked up to state-dependent memory, but neurobiologists at the Waggoner Center for Alcohol and Addiction Research at the University of Texas, whose maggots these are, believe that state-dependent memory is not at work in the case of invertebrate ethanol dependence.

Brooks G. Robinson and associates fed the larvae a 5% ethanol supplement to their daily food. The maggots, incredibly enough, can reach blood-alcohol concentrations as high as 0.08, or roughly the legal limit for humans. If you blew a 0.08, the official chart says you would be suffering from impaired reasoning, disinhibition, and visual disturbances. For the maggots, no different. Larvae that fed on “ethanol food” for one hour learned poorly compared to straight maggots. The learning test, done before introducing alcohol into the picture, used a heat pulse to condition larvae away from an otherwise attractive odor. The reduced attraction to the odor is a form of associative learning.  Figuratively speaking, the drunken maggots kept burning themselves on the stove as they reached for the soup. They failed the field sobriety test.

But was it truly a case of impaired learning? Perhaps the drunken larvae had an impaired sense of smell. But the researchers could not document a reduced sense of odor based on responses with untrained animals. And both groups of maggots sensed heat equally, so the reduction in learning was not due to simple alcoholic anesthesia. Could the withdrawal response be due to the fact that alcohol is a calorie-rich food? To test that possibility, the researchers ran the experiment with sucrose instead of alcohol, and didn’t record any learning impairment in that case. As for state-dependent memory, the researchers assert in Current Biology that withdrawal effects “cannot be attributed to state-dependent learning, because the less than 20 minute training and testing assay for all treatment groups occurs on nonethanol plates.”

And finally, the investigators write, “the fact that both the withdrawal-induced learning deficit and the neuronal hyperexcitability responses are reversed by ethanol reinstatement suggests that they have related origins, and that withdrawal learning may suffer because the nervous system is overly excitable.”

So what have we learned? Well, alcohol dependence in humans is clearly associated with learning and memory deficits that can last for a year or more after quitting. Now that the researchers have demonstrated cognitive alcohol dependence in invertebrates—for the first time ever, they say—it may open the door to more sophisticated genetic analyses of alcoholism in Drosophila, for all the reasons that have drawn other biologists to the study of fruit flies over the years.

And there is more research to be done relative to the finding that neuronal hyper-excitability is linked in some way to the learning deficits caused by alcohol. A brief article by Stefan Pulver in the Journal of Experimental Biology  notes that the work of Robinson and colleagues “reinforces how eerily conserved ethanol’s physiological effects are across animal taxa. Alcohol addiction is truly the great leveller. It doesn’t matter whether you are man, mouse or maggot—over-consumption of alcohol will trigger very similar cellular and behavioral responses, with devastating consequences.” 

Robinson B., Khurana S., Kuperman A. & Atkinson N. (2012). Neural Adaptation Leads to Cognitive Ethanol Dependence, Current Biology, 22 (24) 2338-2341. DOI: 10.1016/j.cub.2012.10.038

Twelve Months of Addiction Box

(Inspired by Twelve Months of Drug Monkey)

Drug Monkey writes:

The rules for this blog meme are quite simple.
-Post the link and first sentence from the first blog entry for each month of the past year.
I originally did this meme, after seeing similar posted by Janet Stemwedel and John Lynch.

Okay, here we go:

January:

Say what you will about glutamate-gated chloride channels in the parasitic nematode Haemonchus contortus—but the one thing you probably wouldn’t say about the cellular channels in parasitic worms is that a drug capable of activating them may prove useful in the treatment of alcoholism and other addictions.

February:

Here’s a book I’m delighted to promote unabashedly.

March:

Mo Costandi at the UK Guardian expanded on his Nature article about the mechanisms that result in memory impairment when people smoke marijuana.

April:

Our latest participant in the “Five Question Interview” series is Dr. Keith Laws, professor of cognitive neuropsychology and head of research in the School of Psychology at the University of Hertfordshire, UK.

May:

I'm not a huge fan of infographics, mostly because they tend to overpromise and are often marred by factual errors.

June:

Reporting the results of published studies concerned with genetic risk factors has always been a tricky proposition.

July:

Dr. Tom McLellan, chief executive officer of the Treatment Research Institute, who served on President Obama’s healthcare reform task force, called the recent U. S. Supreme Court Decision on the Affordable Care Act “the beginning of a new era in prevention, early intervention, and office based care for patients who are not addicted—but whose drinking, smoking, and use of other substances is harming their health and compromising the effectiveness of the care they are receiving for other illnesses and conditions.

August:

Medical marijuana advocates will finally have their day in federal court, after the United States Court of Appeals for D.C. ended ten years of rebuffs by agreeing to hear oral arguments on the government’s classification of marijuana as a dangerous drug.

September:

Voters in The Netherlands may have lost their final chance to block the nationwide imposition of the wietpas, or so-called "weed pass," as the law of the land in The Netherlands next year.

October:

People who say they are addicted to marijuana tend to exhibit a characteristic withdrawal profile.

November:

Children with heavy alcohol exposure show decreased brain plasticity, according to recent research on fetal alcohol spectrum disorders (FAS) using magnetic resonance imaging (MRI) scans.

December:

When a stroke happens to anyone under the age of 55, a major suspect is drugs, specifically the stimulants—methamphetamine and cocaine.


Photo Credit: lotteryuniverse.com

Have a Smart Christmas and a Harm-Reduced New Year

Thoughts on addiction and the holidays.

Addiction During the Holidays: Recovered or Not, It’s Important to be Prepared 
[Adi Jaffe, Psychology Today]

“The holidays are a stressful time for everyone. Between gift-giving, travel, and keeping up with all parts of the ever-complicated modern family unit, nearly anyone can find themselves driven towards the nearest coping mechanism, whatever that may be….”

The Season to be Jolly Careful 
[Paula Goodyer, Sydney Morning Herald]

“More parties, more time with family and less time at work help make Christmas special, but these ingredients can also make it harder for anyone trying to rein in their eating, drinking or drug use….”

Families and Addiction: Surviving the Season of Stress
[Christina Reardon, Social Work Today]

“The holidays usually evoke images of family bliss: —Uncle Joe carving up a big turkey for a traditional family dinner, Aunt Mary bestowing her wonderful gifts, Grandmom sharing cherished stories with the children. The reality is that this dreamy scene usually is nothing more than that—a dream. For many families, the holidays can be a time of great anguish, strife, and overindulgent behavior that is later regretted….”

Addiction and the Holidays
[Danielle B. Grossman, PsychCentral]

“Ah, the holidays: Candy canes, cozy slippers, festive lights, family peace, marital joy, and grateful children. Or not. The holidays are stressful. There are the challenges of too much family, not enough family, not enough money, continual exposure to food and alcohol, and perhaps worst of all, the gap between our actual life and our fantasy life….”

Rehab for the Holidays
[Nic Sheff, The Fix]

“It’s no big revelation to say that the holidays can fucking suck—and that being around family can be stressful as hell….”

Tips for Preventing the Holiday Blues, Staying Sober
[Hazelden]

“Most people know the holidays can be a period of emotional highs and lows. Loneliness, anxiety, happiness and sadness are common feelings, sometimes experienced in startling succession. The bad news is the holiday blues can trigger relapse for people recovering from alcoholism and other drug addiction. The good news is the blues can be remedied by planning ahead….”

Addiction and Christmas Chaos 
[Candace Plattor, Vancouver Observer]

“Even before Halloween came and went, I noticed that several of my clients were already becoming quite antsy about the upcoming holiday season—for a variety of reasons. People who struggle with addictive behaviors—anything from drugs and alcohol to eating disorders, gambling, sex addiction, or relationship addiction—wondered if they would be able to maintain their sobriety when they began to actually feel the loneliness, fear, and isolation that they had used these behaviors and substances to avoid experiencing….”
 
The Holidays and “Food Addiction”
[Vicky Hallett, Washington Post]

“If Santa really does stuff his face with every cookie he encounters after shimmying down those chimneys, that explains the big belly. But health and fitness expert Pam Peeke might say Saint Nick's behavior also could be a sign of something commonly found south of the North Pole: food addiction….”

Holiday Season Can Trigger Substance Abuse
[WIBW, Topeka]

“The holiday season is a busy and stressful time. All the festivities - and preparing for them - also can bring a spike in substance abuse. Stormont-Vail West chemical dependency counselor Fiana Martin says alcohol is commonly served at celebrations this time of year. But she says people recovering from addiction don't have to miss out on the fun if they arrive with what she calls a safety plan….”


Graphics Credit: pareeerica, Creative Commons.

How Many Calories in Your Daily Alcohol?

Booze as food.

Everywhere we turn, the news is packed with stories about the nation’s obesity epidemic. But one little-discussed fact about our daily calorie count is that Americans consume an average of 100 calories each day from alcohol, according to new numbers from the U.S. National Center for Health Statistics (NCHS).

The center, which is part of the Centers for Disease Control and Prevention, said that on a daily basis, about 33 % of men and 18% of women consume alcohol calories daily. Men, who drink more than women, account for 150 daily calories, on average. Women consume a little over 50 calories in the form of alcohol, or roughly half a glass of wine. Predictably, the hardest-drinking cohort was men aged 20-39, who accounted for about 175 calories on daily average.

That may not sound like much—and it is generally within the normal moderation guidelines of one drink per day for women and two drinks for men. However, among members of the study group, about one in five men, and 6% of the women, consumed more than 300 alcohol calories daily—three drinks or more. Considering that the average daily per capita calorie consumption was about 2,500 calories in 2008, according to USDA estimates, this category of drinker can easily end up downing 15% or more of the daily caloric intake in the form of alcohol. The report notes that government dietary guidelines for “solid fats and added sugars”—the  broad category into which alcohol falls—should represent “no more than 5%-15% of calories,” no matter what the overall level of calorie intake.

“A lot of people don’t think about the calories in the alcoholic beverages,” Cynthia Ogden, one of the researchers, told USA Today. “It’s not a diet soda.” Even a shooter of hard liquor, hold the mixer, will run 50-90 calories.  A 12-oz Coke and a 12-oz beer both contain about 150 calories. “We’ve been focusing on sugar-sweetened beverages. This is something new,” said Ogden in an AP article, prompting the unnamed AP writer to ask: “Should New York officials now start cracking down on tall-boy beers and monster margaritas?”

But the Distilled Spirits Council, the lobbying group for hard liquor, saw the silver lining in the research: “The overwhelming majority of adults drink moderately.”

Nonetheless, nutrition policy director Margo Wootan of the Center for Science in the Public Interest told AP she was disappointed that the Obama administration plans to exempt alcoholic drinks from upcoming federal rules mandating calorie labeling on restaurant menus. Customers will be able to see the number of calories in a flavored ice tea drink, but not the calorie count for a Long Island Iced Tea, with easily four times as many calories.

The NCHS Data Brief also found that “no significant differences were observed in average calories per day from alcoholic beverages consumed by non-Hispanic white, non-Hispanic black, and Hispanic persons.” In addition, those in the highest income category drank more than those whose income was at or below the poverty line. Men preferred beer, and women preferred wine.

The study was based on data from the National Health and Nutrition Examination Survey for 2007-2010. Researchers collected data through in-home interviews and at a mobile examination center. The researchers oversampled population subgroups to obtain reliable estimates of nutritional measures in those cohorts.

Graphics Credit: http://www.mslimalicious.com/

NIH Director Calls Off NIDA-NIAAA Merger

Nation’s addiction research institutes to remain separate but unequal.

Two years ago, the National Institutes of Health’s Scientific Management Review Board (SMRB) issued a report recommending that NIH move to establish a new institute focused on substance use, abuse, and addiction-related research to optimize NIH research in these areas. The idea was to combine the two existing addiction research agencies: the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Skeptics like myself wondered if it would ever happen.And now we have our answer—no, it’s not going to happen. (NIH'S Collins)-->

Score one for the alcohol researchers, who mostly opposed the merger from the start, viewing it as more of a hostile takeover. NIAAA has always been the weaker sister in the addiction research family. With only half of NIDA’s billion-dollar budget, NIAAA deals strictly with alcohol research, even if the NIAAA has at times seemed unsure of what constitutes its main area of study—alcohol the addictive drug, or alcohol the healthy beverage. The merger would have represented a recognition that alcohol is just another drug, albeit a legal one.

It was an obvious thing to do. Former NIH director Harold Varmus had complained that the sprawl was hobbling NIH’s ability to “respond to new science.”

However, in a Science (sub req) interview that year,  Francis Collins, the current director of the NIH, said: “I guess most people would have said, ‘Well yeah, of course.’ But when you look at the details…. and you consider that alcohol is after all a legal substance and 90% of us at some point in our lives are comfortable with taking it in while the drug abuse institute is largely focused on drugs that are not legal. So there's a personality of the institute issue here that people thought might be important to preserve, others thought would be good not to preserve.”

It did not take long for the fraternity of alcohol researchers to view the potential move with alarm. Acting NIAAA director Dr. Kenneth Warren offered up what has come to be seen as the basic counter-argument: “The best way forward is a structure that increases collaboration all across NIH… nothing is gained by structural merger.” Warren said he favored “a separate, but equal” pair of agencies. “Alcoholism is a much broader issue than simply addiction.” 

Here is where it starts to get tricky. The assertion that alcoholism is not simply an addiction distills the disagreement down to its essence, which can be found not so much within the arena of science as within the arenas of morality, ethics, and the law.

On Friday, the traditional time for troubling news announcements in the media world, the NIH released its statement  from Director Collins: “After rigorous review and extensive consultation with stakeholders, I have concluded that it is more appropriate for NIH to pursue functional integration, rather than major structural reorganization, to advance substance use, abuse, and addiction-related research.”

Collins added: “The time, energy, and resources required for a major structural reorganization are not warranted, especially given that functional integration promises to achieve equivalent scientific and public health objectives.”

 But the smooth and cost-effective advance of addiction science may have met a stumbling block in the director’s refusal to do the obvious, and streamline the crucial research on drugs and addiction performed by the nation’s premier medical research agency, the NIH. As one observer commented,  there are rumors that “the alcohol beverage industry is lobbying Kentucky politicians, including U.S. Rep. Hal Rogers, chairman of the House Appropriations Committee, to keep the institutes separate because it doesn’t want alcohol to be associated with cocaine.”

Short Subjects

Brief news on drugs and addiction.

The editorial staff at Addiction Inbox (see photo), occasionally finds itself overwhelmed with news and opinion worth broadcasting. Hence, this bullet list of drug/alcohol related news from recent weeks:

•    Children with heavy alcohol exposure show decreased brain plasticity, according to recent research on fetal alcohol spectrum disorders (FAS) using magnetic resonance imaging (MRI) scans. The research, supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), included 70 children heavily exposed to alcohol in utero. According to NIAAA, the children showed “lost cortical volume,” described in the study as a pattern of static growth “most evident in the rear portions of the brain—particularly the parietal cortex, which is thought to be involved in selective attention and producing planned movement.”

•    Combining medications for a better outcome is a staple of medical practice. So it’s not surprising to see the same thing being investigated in addiction treatment. Scientists evaluating medications for alcoholism have found that in some cases, mixing the medicine gives better outcomes. In two separate trials, naltrexone proved to be a more effective treatment for alcoholism when combined with either acamprosate (reported in Addiction), or baclofen (as detailed by Dr Mark Gold at the recent meeting of the Society for Neuroscience). In the Addiction study, the authors concluded that “acamprosate has been found to be slightly more efficacious in promoting abstinence and naltrexone slightly more efficacious in reducing heavy drinking and craving,” which suggests the possibility of using different drugs at different stages of recovery for maximum benefit. In preliminary work on baclofen, some researchers now claim that combining it with naltrexone often leads to better outcomes.

•    Every year at about this time, the rumors start flying: Did you hear that Amsterdam is closing its marijuana coffee shops? This breathless annual announcement is never true, and this year, despite all the fuss over “weed passes” and border skirmishes over drug traffic in the south of the Netherlands, Amsterdam’s mayor recently announced that he has no attention of closing the roughly 200 cannabis shops in his city by year’s end, as originally mandated by the now-defunct conservative government. In addition, rumors are flying that the incoming cabinet of Prime Minister Mark Rutte is already backing away from the previous government’s position on banning foreigners from the shops, according to a New York Times report. “Changes to the new policy have not been finalized,” according to a spokesperson for the Dutch Justice Ministry, quoted in the Times. Rutte himself has hinted that the ban may remain intact, but that local councils may be allowed to override that decision—an outcome not untypical of Dutch politics. “I’m guessing that behind the curtains, it’s already been arranged,” said Michael Veling of the Dutch Cannabis Retailers Association.

•    Here’s a finding you can easily test for yourself. Conduct a conversation with a heavily intoxicated chronic drinker. Introduce ironic, “wink-wink” comments into the exchange. Really lay on the irony. And then sit back and watch most of it sail right by your drunk and maddeningly literal companion. And now science is attempting to confirm it: A modest recent study in Alcoholism: Clinical and Experimental Research says that “drinking too much alcohol can interfere with men’s feelings of empathy and understanding of irony.” 22 men in an alcoholic treatment program read a series of stories ending with either an ironic comment or a straightforward one. Chronic heavy drinkers identified ironic sentences 63 % of the time, compared to a group of non-alcoholics, who identified 90 % of the ironic comments. Lead researcher Simona Amenta said in a press release that the results may mean that alcoholics “tend to underestimate negative emotions; it also suggests that the same situation might be read in a totally different way by an alcoholic individual and another person.” Ya think?

Photo Credit: http://www.globaljournalist.org/

Dude, where’s my metaconsciousness?

“Lost in the sauce.”

I have to admit I was taken with the opening sentence of this 2009 study published in Psychological Sciences: “Alcohol consumption alters consciousness in ways that make drinking both alluring and hazardous.”

Indeed it does. There’s no improving on that direct statement about the basic paradox presented by booze: Like so many pleasures, it is both seductive and dangerous. I was further intrigued by the prospects held out by the abstract, which promised “a rigorous examination of the effects of alcohol on experiential consciousness and metaconsciousness.” After all, we have come a long ways from the 50s, when alcohol was seen in Freudian terms, as a way of releasing tension, steam-engine style.

The study, by Michael A. Sayette and Erik D. Reichle of the University of Pittsburgh in Santa Barbara, along with Jonathan Schooler of the University of California at Santa Barbara, walks us through the salient recent theories, including the alcohol-myopia theory that gained a foothold in the 90s. In this theory, alcohol “reduces processing capacity so that a great proportion of this capacity has to be devoted to the demands of immediate, ongoing activity.” Like remaining upright, or inserting a key in the lock of a door. It also means that alcohol consciousness is precarious. The pissed-off office worker who comes home to drink may relieve his worries “if he is distracted by television, but he may ‘cry in his beer’ if no such distraction is available.”

One of the alluring and hazardous affects of alcohol is its tendency to cause what the study authors meticulously refer to scientifically as: zoning out. That is to say, episodes of mind wandering.

Enjoy drinking while you read? Listen to this: “Participants who drank alcohol were mind-wandering without awareness of doing so about 25% of the time that they were engaged in the reading task. This frequency was more than double that for participants in the placebo condition.”

The study—“Lost in the Sauce: The Effects of Alcohol on Mind Wandering?”—investigated “the effect of alcohol on both the occurrence of mind wandering and the capacity to notice that one’s mind has wandered.” The psychologists gathered 50 men between 21 and 35, put them in a lab, and then split them into a control group and test group. The participants entered the “drink-mixing room where a research was waiting with a tray containing a chilled vodka bottle, a bottle of chilled cranberry-juice cocktail (Ocean Spray), a glass, a graduate cylinder, and a beaker.”

Participants are never in short supply for this kind of clinical study. For half the group, the bottle contained 100-proof Smirnoff. The placebo group got flattened tonic water in a glass pre-slimed with vodka, and were later given fake blood-alcohol test results to further the illusion that they’d had a little alcohol. The drinking participants achieved a mean blood alcohol level of 0.067. Participants in the placebo group received a bogus reading of 0.045, which is the “highest credible reading for deceived participants.”

How did the researchers know if the drinkers were zoning out? They asked. But first, they set them to work reading the first five chapters of War and Peace on a computer. The experimenters asked each participant if they had read War and Peace, in whole or in part, before the experiment, and “all indicated that they had not.” (Men aged 21 to 35, recall.) Their task was to read the first 34 pages of the book, or read for 30 minutes, whichever came first. Before starting, the researchers drilled them on the technical description of zoning out: “At some point during reading, you realize that you have no idea what you just read.”

That’s it in a nutshell, and as we all know, you don’t have to be drunk to experience that effect—but it helps. We have all been witness to the drunk who “loses the thread” of his or her monologue and heads off in another linguistic direction altogether, without apparently noticing the shift. The researchers asked participants to hit a special key, helpfully marked “ZO,” when they noticed during reading that they had zoned out. And they used an additional probe measure, interrupting the readers with a tone and asking them if their mind was wandering or concentrated on the text at that moment. At the end of the session, both groups took a 20-question true/false test on what they had read.

So, what were the differences? Both the placebo group and the drinking group spend about the same amount of time reading, and scored roughly the same on the reading comprehension test. No significant differences in reading rates or immediate retention. And when the researchers compared the first, self-reported measure of mind wandering, the two groups were also “similar in the frequency with which they caught themselves zoning out.”

The big difference showed up when researchers compared the frequency of mind wandering as measured by the arbitrary prompts. In that case, the drinkers zoned out twice as often, but were less likely to catch themselves at it. What the drinkers appeared to be sacrificing was a significant degree of meta-awareness, the act of “thinking about thinking.”

So, when they got probed, what were the drinkers thinking about instead of War and Peace? According to the authors, “alcohol seemed to particularly increase distraction related to sensory states, such as hunger, thirst, and other consummatory motives.” One might be tempted to call them “mammalian motives,” in the sense that alcohol intoxication sometimes reduces drinkers to back-brain, lower-order, fight-or-flight responses not highly compatible with meta-cognition.

This is not exactly a groundbreaking study, it’s fair to say. But it does point up the fact that only a few ounces of alcohol can induce episodes of mind wandering which are not detected by the drinker—mini-blackouts, in a manner of speaking.

Although a reduction in working memory capacity is part of the answer, it is not the whole story. What else fuels this “alcohol myopia” is unclear, but the authors suggest that their findings represent the first practical demonstration that “alcohol disrupts individuals’ meta-awareness of the current contents of thought.” Or, as a heavy drinker might be prone to put it, “Now where was I?”

Graphics Credit: http://www.pnas.org/

LSD and Alcohol: The History

Back when acid was legal.

After last week’s blitz of coverage concerning studies done in the 60s on the use of LSD for the treatment of alcoholism, I thought it would be useful to provide a bit of background; some pertinent psychedelic history to help put this information in perspective:

It may come as a surprise to many people that throughout the 60s, there were LSD clinics operating in England and Europe. European LSD therapists tended to use very low doses as an adjunct to traditional psychoanalytic techniques. But North American researchers took a different, bolder approach. When “psychedelic” therapy began to catch on in Canada and the United States, therapists typically gave patients only one or two sessions at very high doses. These early efforts were aimed at producing spontaneous breakthroughs or recoveries in alcoholics through some manner of religious epiphany or inner conversion experience. The only other quasi-medical approach of the day, the Schick Treatment Center’s brand of “aversion therapy,” was not seen to produce very compelling long-term recovery rates, and subsequently fell out of favor. In this light, the early successes with LSD therapy, sometimes claimed to be in the 50-75 per cent range, looked noteworthy indeed. However, the design and criteria of the LSD/alcoholism studies varied so widely that it has never been possible to draw definitive conclusions about the work that was done, except to say that LSD therapy seemed to be strikingly effective for certain alcoholics. Some patients were claiming that two or three trips on LSD were worth years of conventional psychotherapy—a claim not heard again until the advent of Prozac thirty years later.

 “I’ve taken lysergic acid several times, and have collected considerable information about it,” Bill Wilson, the co-founder of Alcoholics Anonymous, disclosed in a private letter written in 1958. “At the moment, it can only be used for research purposes. It would certainly be a huge misfortune if it ever got loose in the general public without a careful preparation as to what the drug is and what the meaning of its effects may be.”  Like many others, Wilson was excited by LSD’s potential as a treatment for chronic alcoholism. Even Hollywood was hip to the new therapy. Cary Grant, among others, took LSD under psychiatric supervision and pronounced it immensely helpful as a tool for psychological insight. Andre Previn, Jack Nicholson, and James Coburn agreed. (It could be argued that the human potential movement began here).

No drug this powerful and strange, if American history was any guide, could remain legal for long. Unlike their colleagues in the intelligence agencies, politicians and law enforcement officers didn’t know about Mongolian shamans and their fly agaric mushrooms; about European witches and their use of psychoactive plant drugs like nightshade and henbane; about Persian sheiks with their cannabis water pipes; Latin American brujos with their magic vines.

But for the CIA, the big fish was always LSD.

What interested the Central Intelligence Agency about LSD was its apparent ability to produce the symptoms of acute psychosis. Operation ARTICHOKE was designed to ferret out LSD’s usefulness as an instrument of psychological torture, and as a possible means of destabilizing enemy forces by means of aerosol sprays or contaminated water supplies. (The drug’s overwhelming potency made such parts-per-billion fantasies a possibility.)

The agency knew where to turn for a secure American source of supply. Eli Lilly and Co., the giant drug manufacturer, was already involved in LSD research on behalf of the U.S. government. The trouble was that LSD was expensive, and all roads led to Sandoz Laboratories in Switzerland. Organic LSD had to be painstakingly extracted from ergot, a fungus that grows in kernels of rye. Eventually, Sandoz and Eli Lilly successfully synthesized LSD in their own laboratories. With the advent of a reliable domestic supplier of synthetic LSD, the CIA under Allen Dulles was assured of a steady source for experimental purposes.

When LSD did not pan out as a reliable agent of interrogation, CIA investigators turned their attention to its purported ability to mimic acute psychosis—its “psychomimetic” aspect—which researchers were praising as a new avenue toward a biological understanding of schizophrenia. The CIA funneled grant money for LSD research into the academic and commercial R&D world through a host of conduits. Various experiments with non-consenting subjects—typically military or prison personnel—showed that LSD could sometimes break down established patterns of thought, creating a “twilight zone” during which the mind was more susceptible to various forms of psychological coercion and control. Perhaps, under the influence of LSD, prisoners could be transformed into counter-espionage agents. It also occurred to the CIA that the same drug could be used on their own agents for the same purposes. Numerous CIA agents took LSD trips in order to familiarize them with acid’s Alice-in-Wonderland terrain. Some of these unusual experiments were captured on film for use in military training videos.

One place where ARTICHOKE research took place was the Addiction Research Centre at the Public Health Service Hospital in Lexington, Kentucky—the same hospital that specialized in the treatment of hardcore heroin addicts. Lexington was part hospital and part penitentiary, which made it perfect for human experimentation. The addict/inmates of Lexington were sometimes given LSD without their consent, a practice also conducted at the federal prison in Atlanta, and at the Bordentown Reformatory in New Jersey. 

In 1953, then-CIA director Allen Dulles authorized Operation MK-ULTRA, which superseded earlier clandestine drug investigations. Under the direction of Dr. Sidney Gottlieb, a chemist, the government began slipping LSD and other psychoactive drugs to unwitting military personnel. During a work retreat in Maryland that year, technicians from both the Army and the CIA were dosed without their knowledge, and were later told that they had ingested a mind-altering drug. Dr. Frank Olson, a civilian biochemist involved in research on biological warfare, wandered away from the gathering in a confused state, and committed suicide a few days later by leaping to his death from an upper floor of the Statler Hilton in New York City. The truth about Olson’s death was kept secret from his family, and from the rest of the nation, for more than twenty years. In 1966, LSD was added to the federal schedule of controlled substances, in the same category as heroin and amphetamine. Simple possession became a felony. The Feds had turned off the spigot, and the research came to a halt. Federal drug enforcement agents began showing up at the homes and offices of well-known West Coast therapists, demanding the surrender of all stockpiles of LSD-25. The original acid elite was being hounded, harassed, and threatened in a rancid atmosphere of pharmaceutical McCarthyism. Aldous Huxley, Humphrey Osmond, even father figure Albert Hoffman, all viewed these American developments with dismay. The carefully refined parameters and preparations, the attention to set and setting, the concerns over dosage, had gone out the window, replaced by a massive, uncontrolled experiment in the streets. Small wonder, then, that the circus atmosphere of the Haight-Ashbury “Summer of Love” in 1967 seemed so badly timed. Countercultural figures were extolling the virtues of LSD for the masses—not just for research, not just for therapy, not as part of some ancient religious ritual—but also just for the freewheeling American hell of it. What could be more democratic than the act of liberating the most powerful mind-altering drug known to man?

It is at least conceivable that researchers and clinicians eventually would have backed away from LSD anyway, on the grounds that the drug’s effects were simply too weird and unpredictable to conform to the rigorous dictates of clinical studies. Nonetheless, researchers had been given a glimpse down a long, strange tunnel, before federal authorities put an end to the research.

—Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction

Graphics Credit: http://news.sky.com

Harm Reduction Advocate Takes on the Abstinence Question

A guest editorial on “clean and sober” vs “drinking less.”

One of the most divisive issues in the harm reduction movement is the question of abstinence versus controlled drinking. This rift has come to symbolize differences over the AA philosophy, the disease model, the role of will power, and other issues related to addiction. Those who find the disease model unconvincing at best, and some sort of fraud at worst, are more likely to bristle at the notion that total abstinence is the only course available to the addict in treatment. But disease model proponents point out that, for most alcoholics, not drinking at all turns about to be easier than drinking a little. Still, for heavy drinkers who are not addicted to alcohol, cutting down often makes the most sense.

Kenneth Anderson of the harm reduction group HAMS has written an article on the abstinence question which is as straightforward and free of special pleading as any I’ve seen from the harm reduction movement. Bear in mind that I don’t agree with all of the opinions expressed in this guest post, and remain convinced that for most people who abuse alcohol regularly, sustained abstinence is the best policy. But I definitely believe it’s worth a read.


Drinking Again
By Kenneth Anderson

If you have successfully resolved your problems with alcohol via long term (6 months or more) abstinence from alcohol then HAMS urges you to use great caution before you consider drinking again. Studies (NIAAA 2009) show that about half of persons with Alcohol Dependence resolve the problem by quitting completely. HAMS is always supportive of total abstinence as a recovery goal; since the “A” in HAMS stands for Abstinence we like to say that “Quitting drinking is our middle name.” Harm reduction strategies are aimed at those who are unwilling, unable, or not yet ready to abstain from alcohol. This includes people who have attempted abstinence and ultimately not succeeded at it but instead have gone on major benders after short abstinence periods. It also includes those who have never attempted abstinence or who currently have no interest in abstinence. Increased trauma produces increased drinking (Denning & Little 2011). The more resources people have intact, the better their odds of achieving recovery–whether abstinent or non-abstinent recovery. Harm reduction helps keep people’s resources intact enabling them to recover more quickly and easily than if they lost all.

If you are succeeding at abstinence and your alcohol related problems have disappeared or are disappearing then we strongly urge you to continue with what you find to be working–i.e. abstinence. However, if you have already decided that you are going to dink again then HAMS is a safe place to experiment with controlled drinking and you will be far safer here than if you attempt this on your own with no support at all.

If you are wavering and have not yet decided whether or not you wish to drink again then we strongly suggest that you do a Cost Benefit Analysis (aka a Decisional Balance Sheet) which compares the pros and cons of continuing to abstain with the pros and cons of drinking again. We also suggest that you write out a list of alcohol related losses and problems and a list of what you have gained as a result of abstinence from alcohol.

Some people are more likely to succeed in drinking again than others:

People whose drug of choice was not alcohol. If you went to rehab for heroin or some other drug which was not alcohol you were probably told that you were cross addicted to all mood altering drugs and that you must never drink again or you would relapse. The simple fact is that this is not true. You may well have noticed your rehab counselors using mood altering drugs like caffeine and nicotine all the time and not calling this a relapse. The fact is that if you try to use alcohol as a direct substitute for heroin and get as drunk as possible all the time instead of shooting heroin then you will certainly have alcohol problems. However, if you get your life together and become a whole new person with a whole new life there is no chemical reason in your brain why you should not have an adult beverage at times. Opioids are directly cross-tolerant with each other; they are only slightly cross-tolerant with alcohol. Other drugs like speed are not cross tolerant with alcohol at all.

We do, however, very strongly recommend that if you are an ex drug user who is choosing to drink in moderation that you track your drinks by charting. Keeping a drinking chart will help you keep your drink numbers under control and let you know if you are starting to slip out of bounds. If you find your drinking is showing a tendency to “creep” up more and more you might wish to opt to return to abstinence from alcohol. We also strongly suggest that you do your experimenting within the safety net of a HAMS group and that you write out a Cost Benefit Analysis.

Another group who may tend to succeed with drinking again are those who were sowing a lot of wild oats in high school or college and wound up in rehab or an abstinence program in their teens or early twenties. If you are now in your forties you might have matured a great deal and no longer be interested in being the wild man. If you now find that moderate drinking is appealing to you but the thought of being a drunk teenager throwing up on your date’s shoes at a party is repulsive to you then you may well find success at becoming a moderate drinking. Again we suggest that you do your experimenting within the safety of a HAMS group and that you chart and do a Cost Benefit Analysis.

If you had a long drinking career and a long history of alcohol related problems then the odds of returning to controlled drinking are greatly reduced. The longer the drinking career and the more problems the lower the chances of successful controlled drinking.

If you think that you have a shot at becoming a successful controlled drinker, then write down what it is that has changed in your situation that you believe will make you a successful controlled drinker this time around. If nothing has changed then it may well be excruciatingly difficult to try to use the HAMS harm reduction and moderate drinking tools to become a controlled drinker. Not only may you find that your odds of success are low, but you may also find that staying within the moderate drinking limits you have set for yourself is a form of torture and that abstinence is far simpler and more pleasant.

HAMS harm reduction strategies are not a magic bullet which can turn everyone into a successful controlled drinker. For many, many people abstinence remains the best choice. Abstinence is simple and clear cut and avoids the problem of shades of gray

And whether you opt to continue to abstain or you choose to drink again, always remember that you and no one but you are responsible for your choices.


REFERENCES:

Denning P, Little J. (2011). Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions. The Guilford Press.

NIAAA (2009). Alcoholism Isn’t What It Used To Be. NIAAA Spectrum. Vol 1, Number 1, p 1-3. (PDF)


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