Are You Okay?

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

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

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

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

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

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

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

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

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

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

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

Photo Credit: http://tokyotek.com

The Empty Seat at the Holiday Table

Mothers and the War on Drugs.

Guest post by Gretchen Burns Bergman

Gretchen Burns Bergman is Co-Founder and Executive Director of A New PATH (Parents for Addiction Treatment and Healing) and lead organizer of Moms United to End the War on Drugs.

The Holiday season is upon us. At this time, when the weather turns chilly and we move indoors to enjoy the warmth and safety of our homes and the closeness of family and friends, I am acutely aware of those not so fortunate: people who are out in the elements, either because of dire financial situations or mental and addictive illness.

The Holidays are particularly difficult for those who must navigate the mighty and destructive waves of addiction. It is a painful time for families who are separated because of a loved one’s incarceration, whose young person is lost on the streets due to drug problems, whose children are in danger because of the violence of the drug cartels, or those who have lost a loved one to overdose. Often a family member is missing from the festivities because of stigma and shame.

I don’t remember when I started dreading Thanksgiving. It wasn’t after my father or my nephew died, because they were remembered and celebrated at the table, or even after the breakup of my first marriage. It was all of the times that my older son was absent because he was locked behind bars in that cold, concrete jungle, and I couldn’t figure out where I belonged – with him to somehow nurture and sustain him, or in the bosom of the rest of my family. It is the memories of holidays when one of my sons wasn’t included because he was lost in the maze of his addiction, and his name wasn’t even mentioned because of pain, discomfort, and even judgment. Those omissions widened the hole in my heart.

I weep for the countless families who have been torn apart by discriminatory and destructive drug policies that lock up fathers and remove children from their mothers in the name of the war on drugs, which is really a war waged against families and communities.

This season, mothers are banding together and speaking out with human stories of injustice and devastation, to encourage other mothers to join our voices for change. Moms United to End the War on Drugs is a national movement to end the violence, mass incarceration and accidental overdose deaths that are result of these blundering punitive policies. At a time when 2.3 million people are incarcerated in the United States and overdose is a leading cause of accidental death, mothers must lead the way in demanding harm reduction strategies, health-oriented solutions, and restorative justice.

The following are stories written by mothers who have experienced the ravages of the war on drugs, and who honor that empty seat at the holiday table:

The missing seat at the prison visiting table.

It was Thanksgiving and my family and I drove 4 hrs to visit my young son in his California prison for the holiday. He was serving time for drug possession, celled with a murderer, in one of the state’s highest security prisons, so “processing time” including prison official dysfunction, near total disrobing, endless questioning, metal detectors, sally-ports, and guard escorts, took about 4 hours to complete before we got to the highly secure visiting room. Because of this time consuming process, there was only 45 minutes left to visit. On the other side, my inmate son was being strip searched and waiting in a line moving at glacial speed to enter the visiting area. I cried to the guard that, as time ticked by, I was being left with five minutes to see my son for Thanksgiving…but I wanted those five minutes. He waited in his sally-port on the other side, while we all waited at our assigned table for that precious few minutes with my son. That seat remained empty. Alerts sounded that visiting was over.

--Julia Negron, A New PATH Los Angeles, California

Until this war ends, an extra place at my table.

During the holidays, we reflect as we prepare meals, set our tables, and decorate our homes. As I begin planning, with my daughter and husband’s help, I think back to the time when I was addicted to heroin, and missing from my family’s holiday table. Though it was more than 20 years ago, my family experienced extreme grief over my addiction. My father tells me that he is so grateful that I am alive. He didn’t know, in the midst of my homelessness, whether I’d ever be able to attend, let alone host, a Thanksgiving with my own family. I think how lucky I am, because I had the opportunity to get treatment that worked for me. I know someone waited and despaired over me. Now, I wait for those with substance use disorders to be served by our health care system rather than languishing in prison. Until that wait is over, there will always be an extra place setting at my holiday table for those who are locked up, thrown away or left out. The person in prison for a drug crime might not be able to eat with me this year, but perhaps next year, they will.

--Kathie Kane-Willis, Illinois Consortium on Drug Policy, Roosevelt University

Emptiness is everywhere.

Since our son was born, we always picked out the Christmas tree together. It became a tradition and one of the fun parts of the holiday rush. Dad would put the lights on the tree and make clam chowder, while Jeff and I did the ornaments. As years passed, it was sometimes difficult for us all to be together for this tradition, but we were. Our son had addictive illness, and through the many rehabs, the short county incarcerations, the times where he’d isolate because he was using, we somehow were able to keep that tradition. Christmas Eve was spent with our entire family either in our home or my sister’s. The first year without Jeff – just 3 months after he died of an accidental overdose and 2 days after release from 4 months in county jail, was unreal. Jeff had been so much a part of Christmas, sharing Santa duties and passing out gifts to the little ones with the biggest smile on his face. The emptiness was EVERYWHERE. He should have been there. We haven’t had a Christmas tree or decorations in our home since 2007. I don’t think we ever will again. The Holidays bring nothing but pain.

--Denise Cullen, Broken No More, Orange County, California

Photo Credit: http://sisterjohnpaul.blogspot.com/

Book Review of "Drunken Angel"

A hipster gets his shit straight—sort of.

Addiction memoirs remain one of the most popular forms of autobiography on the shelves. But now, when considering a new addition to the genre, it’s impossible not to wonder whether the claims being made by the author are genuine. Since serious drunks often end up visiting the lower circles of hell during the course of their disease, hair-raising and improbable scenes are lamentably common—that is part of the genre’s charm, if that is the right word for it. But how are we to react now? The answer is, you can’t know, and you never really could, that bastard James Frey notwithstanding.

But read them we do. Alan Kaufman, the author of the lively but exasperating autobiography of alcoholism, Drunken Angel, sweetens the pot considerably. He drops so many names, and finds himself involved in so many improbably episodes of transnational mayhem and kinky sex, that the escapades could almost fill a Bond novel. But to be fair, there’s nothing debonair going on here; not from a man who describes himself at one stage as “filthy, nauseous, hungover, astonished at my gargantuan appetite for the abyss.” And a willing suspension of disbelief, an attitude of innocent until proven guilty, must hold sway in the end, else why read them at all?

Alan Kaufman is more Jack Kerouac than James Bond: One of the founding members of California’s Spoken Word scene, editor of The Outlaw Bible of American Poetry, Kaufman bounced through the beat/hippie/downtown scenes in New York, and San Francisco and Israel, writing for Jewish publications, treating his wives shabbily, and blacking out all over whatever town he happened to be in. It’s not pretty, and it’s not meant to be. The deep layer of poverty and grunge that settles over the author’s existence between bouts of the literary high life caused Kirkus Reviews to complain that “Drunken Angels” was marred by the author’s tendency to whip schizophrenically “between manic moments of literary self-aggrandizing and deeply depressive moments of shocking wreckage.” That’s true—but Kaufman is also a classic case of dual diagnosis, an alcoholic who also suffers from delusions, hallucinations, and Post Traumatic Stress Disorder after his time spent in the Israeli Army. (It’s complicated.) Also known as co-morbidity, this combination often makes for complicated, even potentially fatal difficulties, as on a bus ride with his wife one night, when he “realized that certain passengers were Satanists who had singled out Anna and me for human sacrifice.” Not good.

Down and almost out, he is scooped from the gutter by an acceptance letter from the Columbia University Master of Fine Arts program, where he hobnobs with Tama Janowitz and Steve Jobs’ sister, the writer Mona Simpson. But always, there are “the nightmares, the operatives, the unfolding skein of sinister designs” that Kaufman must negotiate as his mental health deteriorated. And the drinking never really stopped.

Finally, in order to both prove he’s sick and to signal his distress, Kaufman slit his wrists, then “staggered to the bathroom, wrapped white towels around the bloody wounds, and with a sense of exhilaration, called 911.” Perhaps the reader may be forgiven for not sharing in the exhilaration at this stage of the narrative, after reading about the author being ejected from crash pads by acid dealers for bad debts, dodging alimony and child support, neglecting a daughter on another continent, veering into sadomasochistic sex (in considerable detail), sleeping in filthy gutters, on warm street grates, on park benches. Kaufman made a habit of sitting down at restaurant tables to finish off the leftovers. “Ate donuts from garbage cans, pizza crusts from sidewalks, half-rotten fruit found in doorways. I kept my cash for booze…” In one excruciating scene, he tracks down an ex-girlfriend in her class at Columbia, calls her a whore in front of the class, and hits her in the face. A roomful of witnesses to that one, presumably. “In all this,” he tells us,” I never once lost my grip on the scotch bottle. Not a drop lost.”

So, that was it for Columbia. “All my life,” Kaufman writes, “ I had been going, fleeing. Leaving. Home, friends, jobs. Cities, countries, armies. Marriages, families—everything…. Anything but this, anyone but you, anywhere but here.” That was also about it for common sense from our anti-hero. We are pretty safe, it seems to me, in assuming that only a blackout alcoholic with severe mental problems is likely to wake up with a cruel hangover, married to the total stranger he finds lying in bed next to him. And then proceed to try and make the marriage work.

But in time, the story arc swings toward redemption, and Kaufmann falls in with AA and the Twelve Steppers.  “You’re allergic to alcohol and obsessed with it at the same time," an AA companion tells him. “The combination is fatal and unstoppable. Once booze hits your system, the jig’s up: you must drink.” And, to his immense credit, at long last, Kaufman gets straight, and eventually stays that way, even if the sordid circumstances of his life do not instantly change for the better. One of the most valuable lessons Kaufman takes away from AA (one of the most valuable lessons many people learn there) is a hoary old maxim called HALT: Don’t get too Hungry, Angry, Lonely, or Tired. All serious trigger conditions for relapse in freshly abstinent alcoholics and other drug addicts.

His book is a reminder that all of an addict’s life problems do not blessedly vanish the instant he or she stops drinking or using, any more than a regular schedule of insulin injections ends all problems for diabetics—the more so in cases where addiction is mixed with diagnosable mental illness. Getting clean and sober does not eliminate Kaufman’s sexual aggression, his tendency to lie to his wives, or bring back his ability to write steadily for a living.

In the end, Kaufman met a lot of famous people, managed to get published in some very hip venues, helped spark a poetry movement in San Francisco—and has now been clean and sober for more than 20 years. So what does he have to say about the prime mover of this amped-up narrative, alcoholism itself? It happened in the usual way—a formative alcohol experience at a young age. In early high school, a football player, Kaufman went out with some school buddies and without much thought began passing around those big gallon jugs of cheap Gallo wine. “I felt the universe swim into view. I stumble, drunk, to the grass and lay with arms and legs akimbo, like an altar sacrifice smiling at the blazing stars. For the first time in my life, I felt connected, happy, sure that life belonged to me and I to it. And I drank myself unconscious.”

Travelling alone in Germany, late in the book, after a nightmarish tableaux of temptation arranged for him by a cadre of Russian soldiers ready to pour vodka down his gullet in the spirit of macho brotherhood, Kaufman breaks away and finds a quiet spot in a deserted train car, and holds his own AA meeting in his head. “My name is Alan, I’m an alcoholic,” he says silently to himself. And then he says the Serenity Prayer, “then the 12 steps, and, appointing myself as guest speaker, shared about the experience I’d just had with Russian soldiers and endless vodka.” The phantom faces of his AA friends “kept me company right until I reached Berlin. And they are always with me, to this day, the meeting that I carry in my soul.”

Photo credit: http://www.booksmith.com/

7 Myths the Alcohol Industry Wants You to Believe

Staying on message in the liquor biz. 

“Our national drug is alcohol,” wrote William S. Burroughs. “We tend to regard the use of any other drug with special horror.” This emotional loophole in the psyche has been skillfully manipulated by the alcohol and tobacco industries ever since modern advertising was invented.

 Recently, the European Alcohol Policy Alliance, known as EuroCare, put together a brochure addressing the common messages the liquor industry attempts to drive home through its heavy spending on advertising. The messages are not just designed to sell product, but also to influence alcohol policy at the political level as well. (Eurocare is a network of more than 50 voluntary non-governmental organizations working on the prevention and reduction of alcohol-related harm in 20 European countries.) According to the group, the “industry”—the alcohol and tobacco companies—“has traditionally worked closely together, sharing information and concerns about regulation. They have used similar arguments to defend their products in order to prevent or delay restrictions being placed on them (Bond, et al. 2010).”

EuroCare offers this introduction: “The intention of this brochure is to inform professionals about the attempts made by the alcohol industry to influence alcohol policy globally and to subsequently arm them against the industry’s methods to prevent effective policies from being made…. For politicians and health experts it is important that they reveal to the public the subversive messaging of the alcohol industry and do not fall prey to the industry’s half-truths—or worse—outright lies.”

Message 1: Consuming alcohol is normal, common, healthy, and very responsible.

Explanation: To bring this message home, alcohol advertisements nearly always associate alcohol consumption with health, sportsmanship, physical beauty, romanticism, having friends and leisure activities.

I note here that it’s left to the social service agencies and non-profits to attempt to convey the opposite side of the coin: a dramatically heightened risk for health problems, traffic fatalities, domestic violence, loss of job, loss of marriage, suicide—you name it.

Message 2: The damage done by alcohol is caused by a small group of deviants who cannot handle alcohol.

Explanation: Indeed, the message of the industry is that ordinary citizens drink responsibly and that ‘bad’ citizens drink irresponsibly and are the cause of any and all problems associated with high alcohol consumption.

This one is insidious and unscientific. There is no evidence that alcoholics are “bad people,” or simply unwilling to stop engaging in bad behavior. For the industry, irresponsible drinkers are a major revenue source—the dream customer— even though alcohol manufacturers continue to insist that their advertising is primarily about driving home the message of responsible alcohol consumption and brand choice.

Message 3: Normal adult non-drinkers do not, in fact, exist.

Explanation: Only children under 16 years of age, pregnant women and motorists are recognized by the industry as non-drinkers.

My personal favorite, this one. The existence of non-drinkers is seen by the industry as a threat. Accordingly, they have subtly reinforced the message that moderate drinking is not only normal, but also good for you. Never mind that the real profits come from excessive drinking and pricing strategies that encourage it. Estimates vary, but recent studies  at UCLA show that “the top 5% of drinkers account for 42%of the nation’s total alcohol consumption.” If 5% of all drinkers account for nearly half of total alcohol sales, it would be folly for the alcohol industry to get serious about encouraging moderation. It’s not too far off the mark to say that the alcohol industry’s quarterly statements hinge on the success they have in encouraging alcoholics to believe that everything’s okay, everybody drinks that way. The message becomes clearer: Drinking is mandatory—unless you’re a deviant.

Message 4: Ignore the fact that alcohol is a harmful and addictive chemical substance (ethanol) for the body.

Explanation: The industry does not draw attention to the fact that alcohol (ethanol) is a detrimental, toxic, carcinogenic and addictive substance that is foreign to the body.

Naturally, pointing out the neuroscientific parallels between alcoholism and heroin addiction is not part of the message. Alcohol is a hard drug—ask any addiction expert. Alcoholism can kill you quick. But so far, the labeling mania that struck opponents of Big Tobacco has not played out in a major way in the battle against deceptive alcohol advertising.

Message 5: Alcohol problems can only be solved when all parties work together.

Explanation: Good, effective policies to combat alcohol consumption would require a higher excise-duty, no marketing or sponsoring, an increase in the drinking age to 18, a prohibition of the illegitimate sale of alcohol, and an increase, through a campaign, in the public’s awareness of the damages that alcohol can cause (Babor et al, 2010; WHO, 2009).

Obviously, these bullet points are not high on the alcohol industry’s agenda.

Message 6: "Alcohol marketing is not harmful. It is simply intended to assist the consumer in selecting a certain product or brand."

Explanation: Meanwhile, research has indisputably demonstrated that alcohol advertisements are both attractive to young people and stimulate their drinking behavior (Anderson et al., 2009: Science Group of the Alcohol and Health Forum; 2009). Yet the industry continues to flatly and publicly deny that advertising stimulates alcohol consumption (Bond et al; 2009).

Stuffed with attractive young people meeting and mating over alcohol, it seems fair to suggest that alcohol ads had better stimulate increased drinking, i.e., a boost in quarterly sales, or else the industry is wasting a lot of money fighting over pieces of a pie that isn’t getting any bigger. These days, slow growth is no growth.


Message 7: “Education about responsible use is the best method to protect society from alcohol problems.”

Explanation: Effective measures such as a higher alcohol excise-duty, establishing minimum prices, higher age limits and advertisement restrictions can reduce alcohol related harm and will therefore decrease the profits of the industry (Babor, 2003; Babor, 2010). The industry therefore does its best to persuade governments, politicians, and policy makers that the above mentioned measures would have no effect, are only symbolic in nature or are illegitimate.

A truly great dodge, because the strategy being advertised sounds so imminently sensible. Who could be against the promotion of responsible alcohol use? Irresponsible zealots and deviants, that’s who. Why should all of us happy drinkers be made to suffer for the sins of a few rotten apples?

Indeed, all of the messages, overtly or covertly, send the same signal: You should drink more. It’s good for you.

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

Alcoholic Deception

Big Alcohol Wants a Piece of the Health Market

For a long time now, snack food companies have been spending billions to convince shoppers that their fattening food offerings are fit and healthy nutrition alternatives. Big Alcohol, which has played around the edges of all this with “lifestyle” beer commercials, has been pushing into the health business more steadily of late, as opportunities for advertising shrink. The Marin Institute, which has got to be Big Alcohol’s least favorite advocacy group in the world, just released its new study: “Questionable Health Claims by Alcohol Companies: From Protein Vodka to Weight-Loss Beer.” The group documents the many ways in which alcoholic beverage makers are seeking to emulate food corporations in staking a misleading claim to words like “natural” and “organic.”

“The wine industry has been exaggerating wine’s health benefits for years. Now Big Alcohol is taking such messages to a whole new level,” said Marin Institute’s Research and Policy Director Michele Simon, one of the report’s authors. “Major alcohol companies are exploiting ineffective or non-existent regulatory oversight,” she added.

The Marin Institute breaks down Big Alcohol’s advertising assault into three areas of concern: adding nutrients, using the term “natural,” and using alcoholic beverages in fitness-themed promotional campaigns. It’s a free country, more or less, and there’s no point being a prude about these things. But a deeper look at alcohol advertising strategy can be enlightening. As the Marin Institute admits, alcohol’s advertising strategies “may seem relatively harmless.” but when it comes to promoting sales, the consequences are “potentially dangerous.” And overlapping regulatory agencies don’t make it any easier. Technically, the U.S. Alcohol and Tobacco Tax and Trade Bureau (TTB) is in charge of regulating alcoholic beverages, but the U.S. Federal Trade Commission has control over alcohol advertising, and determines whether it is unfair, false, or deceptive.

Here is a portion of the Marin Institute’s list of unsupported health claims:

--Fortified vodkas. Fortified foods have been around forever, but it wasn’t until 2007 that the first fortified vodka hit the market. Lotus White, infused with added B vitamins, “could actually be good for you,” said the company’s CEO. The Federal Trade Commission (FTC) prohibited Lotus from advertising the B vitamins on its packaging, so CEO Bob Bailey told the press that Lotus White provided drinkers with 100% of their daily recommended intake of B vitamins. “Alcohol is bad for you,” he told the press, according to the Marin Institute report. “Ours is just slightly less bad.” The report says that retailers in Los Angeles advertise Lotus as a “Vitamin B Enhanced Super Premium Vodka.” However, since alcohol is known to inhibit the absorption of nutrients like Vitamin B1 and B12, and folic acid, Dr. R. Curtis Ellison at the Boston University Medical School says that putting B12 in alcohol is “like putting vitamins in cigarettes.” Nonetheless, sales of Lotus vodka shot up 50% in 2009, says the Marin Institute, before the company went out of business last year. In November of 2009, along came Devotion, billed as the world first “protein-infused ultra premium” vodka. Sounds more like shampoo than a shot of vodka, but adding “protein” is now another marketing angle. The problem is that these approaches appear to fail the basic health rules of the regulatory agencies, to wit, that such claims must be “substantiated by medical research.” Try this one: Fragoli, introduced three years ago, a red liquid with a little red strawberry at the top of the bottle. “Forbidden Fruit,” has been one of the company taglines. And a company press release put it this way: “In a recent scientific study, researchers found that the addition of ethanol—the type of alcohol found in most spirits—boosts the antioxidant nutrients in strawberries and blackberries.” As the Marin Institute pointed out: “While the study they referenced did find that ethanol increased antioxidant levels in berries Fragoli implies that drinking cocktails is one way for people to get those antioxidants, which the study does not conclude.”

--All-natural spirits. Flavored vodkas have been with us for decades. But the competition is brutal. By 2008, there were at least 120 flavored vodka products on the market. The Marin Institute found that in that year, “three of the five top-selling vodka companies in the U.S. had ad campaigns with fruit and positioned their products as fresh or all-natural: Absolute (2nd), Skyy (4th), and Stoli (5th). Skyy was advising drinkers to “Go Natural,” with “100% real fruit and premium Skyy vodka,” as well as its line of “all-natural infusions.” Notably, the words “infusion” and “all-natural” remain undefined by the TTB. Similarly, Blue Ice vodka was among the 84 “organic” alcohol products that came on the market between January, 2008 and October, 2009. My particular favorite is Blue Ice Organic Wheat—certified organic by the U.S. Department of Agriculture (USDA), in a classic case of federal agencies in conflict. 

--Fitness campaigns. Miller Lite, the “healthy” beer that started it all, launched in 1973, and ever since, commercial viewers have been subject to an endless collage of young people running, dancing, and diving into crystal streams. But it was not until the diet-conscious new century that sales of light beer exploded along with low carb diets. In 2004, Great Britain went after Michelob Ultra for its “lose the carbs, not the taste,” advertising, on the grounds that the campaign implied that beer drinking was part of a healthy lifestyle. No matter; Michelob went on to sponsor the UK Olympic teams in 2006 and 2008. By 2009, Michelob Ultra had no qualms about advertising itself as “a smart choice for adult consumers living an active lifestyle.” The Marin Institute has always been particularly rankled by the mainstay of beer advertising—sponsored sporting events. When Michelob signed a three-year deal with Lance Armstrong, the Marin Institute howled, because “the advertising campaign mixed images of Armstrong exercising and consuming beer while in the context of this activity,” another violation of the advertising rules concerning alcohol consumption and health. “Probably the most blatantly illegal advertisement came in early 2009,” says the Institute’s report, “when a new beer called MGD 64 (boasting just 64 calories) sponsored an online fitness program in association with Shape and Men’s Fitness magazines.” Again, the authors argue that if FTC and TTB standards don’t apply to alcohol-sponsored weight loss programs, then what DO they cover?

If you put it all together, “such marketing represents a significant failure in the regulatory oversight of alcohol advertising.” Small wonder, since regulatory oversight is split across two or three federal agencies, 50 state beverage control agencies, and state attorneys general. Plenty of regulating to go around, if it was more sensibly deployed. But if it were, protein vodka would probably not be on the market. The Marin Institute’s modest proposal is to transfer jurisdiction over the regulation of alcohol advertising practices to the Food and Drug Administration (FDA), to which Congress recently granted greater powers of regulation for cigarette products. Once again, the institutional confusion and inertia caused by the artificial distinction between “legal” and “illegal” drugs is hampering efforts to effectively regulate the sale of this addictive drug.

Graphics Credit: http://www.marininstitute.org/site/

Bill Manville’s Booze Book

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gimme a Drink--But Hold the Acetaldehyde

Another look at alcohol and cancer.

If beverage alcohol were a new drug, it would face an uphill battle to make it through the Food and Drug Administration (FDA) pipeline. Why? Because the amount of acetaldehyde in alcoholic drinks—combined with acetaldehyde from other sources—might be too carcinogenic to pass muster under existing regulations.

When drinkers drink, the first thing that happens is that enzymes convert the alcohol into acetaldehyde. Previous research has shown that this common organic chemical is implicated in certain cancers, particularly cancers of the digestive tract. Studies at the National Institutes of Health (NIH) showed that the concentration of acetaldehyde measured in human saliva during drinking episodes was sufficient to produce the kind of damage to DNA that can result in cancer.

In a study published recently in the journal Addiction, researchers from Canada and Germany showed that heavy drinkers ingest enough acetaldehyde to raise their lifetime cancer risk to as high as 1 in 1,000. The study concludes: “The life-time cancer risks from acetaldehyde from alcoholic beverages greatly exceed the usual limits for cancer risks from the environment.”

The real problem comes when alcohol is used in combination with acetaldehyde from other sources, such as tobacco, food flavorings, pesticides, and perfume. Heavy drinkers “face a magnitude of risk requiring intervention.” According to Dr. Jurgen Rehm at Canada’s Centre for Addiction and Mental Health (CAMH), quoted in Science Daily: “Most risk assessments to date were based on one source of exposure only. This has led to a negligence of the overall risk.”

According to the Science Daily article, “Alone, the risks associated with surpassing limits of acetaldehyde from the air may not yet be alarming, but for heavy drinkers and smokers, it adds to the acetaldehyde levels already received from these sources. This overall risk then surpasses established safety limits.” To make matters worse, acetaldehyde is a common substance in tobacco smoke—and alcoholics are often heavy cigarette smokers.

A Finnish drug company is currently conducting clinical trials of a time-release capsule of the amino acid cysteine, which can bind with acetaldehyde and render it inactive.

In a related development, a study in PLoS Medicine appeared to demonstrate that people who suffer from the so-called alcohol flush reaction—primarily Japanese, Chinese, and Koreans—are at increased risk for throat cancer. The culprit? An excess of acetaldehyde.

Photo Credit: National Institute of Standards and Technology

addiction drugs

Alcopops: California Cracks Down on Kid-Friendly Alcohol

“Training Beers” and “Girlie Drinks” Come Under Fire

In June, the California State Assembly passed the “Alcopops Warning Label Bill,” requiring a warning label on the bubbly, sweetened, premixed alcohol drinks sold in mini-marts and gas stations and often indistinguishable from soda and juice drinks.

Critics say that the beverages, which contain 5 to 8 % alcohol and are currently taxed as beer in California, are designed and labeled specifically to attract underage drinkers. The State Senate is currently considering the bill. Several states have already reclassified the drinks.

In “The Cost of Alcopops to Youth and California,” the Marin Institute, a California-based alcohol industry watchdog, claims that fruit-flavored alcopops “fuel the underage drinking epidemic by serving as a transition or bridge from soft drinks to alcohol, especially for youth. The alcohol flavor is masked by sweeteners and young people report drinking alcopops because they are easier to conceal and ‘go down easy.’” According to a high school student quoted in the New York Times, Smirnoff Ice “tasted like a Sprite with a splash of 7-Up.” Other products in the alcopop line include Bacardi Silver, and Mike’s Hard Lemonade.

The primary argument is that the beverages contain distilled spirits, yet are sold, advertised, and taxed as beer. The Marin Institute, the prime mover in the attempt to reclassify the beverages as hard liquor for tax purposes, scoffs at the liquor industry’s insistence that such products are “flavored malt beverages.” According to the Institute, “How else could these corporations explain why in the U.K. and elsewhere, alcopop products such as Smirnoff Ice are marketed as containing vodka, while the exact same brands in the U.S. are instead called “malt beverages?”

Reclassifying the beverages would cost the liquor industry dearly. Currently in California, beer is subject to a state tax of 20 cents per gallon. In contrast, distilled spirits are hit with a tax of $3.30 per gallon. At least five European countries—Germany, the U.K., Switzerland, Denmark and France—have boosted taxes on alcopop products. In Germany, for example, taxes on alcopop products are 16 times higher than in most American states. (The U.S. has the second-lowest alcohol prices in the world, after Luxembourg, says the Marin Institute.) After the U.K. raised taxes on the products in 2002, consumption fell by more than 40%. Germany saw an even more dramatic decline as alcopops became expensive, with no accompanying increase in sales of other alcohol products.

The original alcopop was the wine cooler of the 1970s and 1980s. In the 1990s, the emphasis switched from wine to beer bases with alcohol-containing flavorings, producing the so-called “hard” lemonades and teas now available.

The Department of Health and Human Services estimates than more than 10 million Americans under the age of 21 drink alcohol.

Sources:

--Rosen, Simon and Simon, Michele. “The Cost of Alcopops to Youth and California. The Marin Institute. July 2007. http://www.marininstitute.org/alcopops/index.htm

--Marshall, Carolyn. “Drinks With Youth Appeal Draw Growing Opposition.” New York Times. April 13, 2007.”

--“Alcopop market showing FAB-ulous growth.” Food&DrinkEurope.com. 02/04/2003.

http://www.foodanddrinkeurope.com/news/ng.asp?id=17291

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.

Does AA Work?

Bill W., co-founder of AA








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


Despite recent progress in the medical understanding of addictive disease, the amateur self-help group known as Alcoholics Anonymous, and its affiliate, Narcotics Anonymous, are still regarded by many as the most effective mode of treatment for the ex-addict who is serious about keeping his or her disease in remission. A.A. and N.A. now accept anyone who is chemically dependent on any addictive drug—those battles are history. In today’s A.A. and N.A., an addict is an addict. A pragmatic recognition of pan-addiction makes a hash of strict categories, anyway.

Nonetheless, under the biochemical paradigm of addiction, we have to ask whether the common A.A.-style of group rehabilitation, and its broader expression in the institutionalized form of the Minnesota Model, are nothing more than brainwashing combined with a covert pitch for some of that old-time religion. As Dr. Arnold Ludwig has phrased it, “Why should alcoholism, unlike any other ‘disease,’ be regarded as relatively immune to medical or psychiatric intervention and require, as AA principles insist, a personal relationship with a Higher Power as an essential element for recovery?”

The notion is reminiscent of earlier moralistic approaches to the problem, often couched in strictly religious terms. It conjures up the approach sometimes taken by fundamentalist Christians, in which a conversion experience in the name of Jesus is considered the only possible route to rehabilitation. But if all this is so, why do so many of the hardest of hard scientists in the field continue to recommend A.A. meetings as part of treatment? Desperation? Even researchers and therapists who don’t particularly like anything about the A.A. program often reluctantly recommend it, in the absence of any cheap alternatives.

In 1939, Bill Wilson and the fellowship of non-drinkers that had coalesced around him published the basic textbook of the movement, Alcoholics Anonymous. The book retailed for $3.50, a bit steep for the times, so Bill W. compensated by having it printed on the thickest paper available—hence its nickname, the “Big Book.” The foreword to the first printing stated: “We are not an organization in the conventional sense of the word. There are no fees or dues whatsoever. The only requirement for membership is an honest desire to stop drinking. We are not allied with any particular faith, sect or denomination, nor do we oppose anyone. We simply wish to be helpful to those who are afflicted.”

In short, it sounded like a recipe for complete disaster: naive, hopeful, objective, beyond politics, burdened with an anarchical structure, no official record
keeping, and a membership composed of anonymous, first-name-only alcoholics.
......................
Amid dozens of case histories of alcoholics, the Big Book contained the original Twelve Steps toward physical and spiritual recovery. There are also Twelve Traditions, the fourth one being, “Each group should be autonomous except in matters affecting other groups or A.A. as a whole.” As elaborated upon in Twelve Steps and Twelve Traditions, “There would be real danger should we commence to call some groups ‘wet’ or ‘dry,’ still others ‘Republican’ or ‘Communist’…. Sobriety had to be its sole objective. In all other respects there was perfect freedom of will and action. Every group had the right to be wrong. The unofficial Rule #62 was: “Don’t take yourself too damn seriously!”

As a well-known celebrity in A.A. put it: “In Bill W.’s last talk, he was asked what the most important aspect of the program was, and he said it was the principle of anonymity. It’s the spiritual foundation.” Co-founder Dr. Bob, for his part, believed the essence of the Twelve Steps could be distilled into two words—“love” and “service.” This clearly links the central thrust of A.A. to religious and mystical practices, although it is easily viewed in strictly secular terms, too.

Alcoholics Anonymous recounts a conversation “our friend” had with Dr. C.G. Jung. Once in a while, Jung wrote, “…alcoholics have had what are called vital spiritual experiences…. They appear to be in the nature of huge emotional displacements and rearrangements.” As stated in Twelve Steps and Twelve Traditions, “Nearly every serious emotional problem can be seen as a case of misdirected instinct. When that happens, our great natural assets, the instincts, have turned into physical and mental liabilities.”

Alcoholics Anonymous asserts that there are times when the addict “has no effective mental defense” against that first drink.

Bill Wilson wrote:
"Some strongly object to the A.A. position that alcoholism is an illness. This concept, they feel, removes moral responsibility from alcoholics. As any A.A. knows, this is far from true. We do not use the concept of sickness to absolve our members from responsibility. On the contrary, we use the fact of fatal illness to clamp the heaviest kind of moral obligation onto the sufferer, the obligation to use A.A.’s Twelve Steps to get well."

This excruciating state of moral and physical sickness—this “incomprehensible demoralization”—is known in A.A. as hitting bottom. “Why is it,” asks Dr. Arnold Ludwig, “that reasonably intelligent men and women remain relatively immune to reason and good advice and only choose to quit drinking when they absolutely must, after so much damage has been wrought? What is there about alcoholism, unlike any other ‘disease’ in medicine except certain drug addictions, that makes being in extremis represent a potentially favorable sign for cure?”

Hitting bottom may come in the form of a wrecked car, a wrecked marriage, a jail term, or simple the inexorable buildup of the solo burden of drug-seeking behavior. While the intrinsically spiritual component of the A.A. program would seem to be inconsistent with the emerging biochemical models of addiction, recall that A.A.’s basic premise has always been that alcoholism and drug addiction are diseases of the body and obsessions of the mind.

When the shocking moment arrives, and the addict hits bottom, he or she enters a “sweetly reasonable” and “softened up” state of mind, as A.A. founder Bill Wilson expressed it. Arnold Ludwig calls this the state of “therapeutic surrender.” It is crucial to everything that follows. It is the stage in their lives when addicts are prepared to consider, if only as a highly disturbing hypothesis, that they have become powerless over their use of addictive drugs. In that sense, their lives have become unmanageable. They have lost control.

A.A.’s contention that there is a power greater than the self can be seen in cybernetic terms—that is to stay, in strictly secular terms. The higher power referred to in A.A. may simply turn out to be the complex dynamics of directed group interaction, i.e., the group as a whole. It is a recognition of holistic processes beyond a single individual—the power of the many over and against the power of one.

“The unit of survival—either in ethics or in evolution—is not the organism or the species,” wrote anthropologist Gregory Bateson, “but the largest system or ‘power’ within which the creature lives.” In behavioral terms, A.A. enshrines this sophisticated understanding as a first principle.

alcoholics anonymous

Drug Rehab in China

After two years of a nationwide “people’s war” against drug addiction in China, government authorities are claiming major accomplishments—but treatment, which is mostly compulsory, remains limited and largely ineffective, Chinese doctors say.

The Chinese surge against drugs was credited with numerous successes almost before it had begun. Zhou Yongkang, Minister of Public Security, told the official news agency Xinhua that officials had seized more than two tons of methamphetamine, and three million “head-shaking pills”--otherwise known as Ecstasy tablets.

Two years later, in June of 2007, Minister Yongang, claimed that the number of drug abusers in China had been cut from 1.16 million to 720,400 due to compulsory rehabilitation measures. “The effort has yielded remarkable results,” Yongang told the China Daily. (Other drug experts estimate the number of Chinese drug addicts to be 3 million or more.)

However, a recent paper co-authored by several Chinese physicians, published in the Journal of Substance Abuse Treatment, suggests that things are not so rosy. The report, titled, “Attitudes, Knowledge, and Perceptions of Chinese Doctors Towards Drug Abuse,” paints a dismal picture: Less than half the Chinese doctors working in drug abuse had any formal training in the treatment of drug addicts, the report found. Moreover, less than half of the treatment physicians believed that addiction was a disorder of the brain. (One cannot help wondering whether the percentage for American doctors would be any higher.)

The study could find no coherent doctrine or set of principles for drug rehabilitation being employed in China, beyond mandatory detox facilities. In the Chinese government’s White Paper on “Narcotics Control in China,” the practice of “reeducation-through-labor” is considered to be the most effective form of treatment. Another name for this form of treatment would be: prison.

There are perhaps as many as 200 voluntary drug treatment centers as well. These centers emphasize treating withdrawal symptoms, and feature more American-style group interaction and education, but observers say such centers are often used by people evading police or running from their parents.

In addition, the lack of formal support from the Chinese government has led to the closing of several such facilities after only a few months. The American origins of such treatment modalities have not helped sell such programs to government officials. Pharmaceutical treatments for craving remain unavailable in China.

SOURCES:

--Fan, Maureen. “U.S.-Style Rehabs Take Root in China as Addiction Grows.” Washington Post Foreign Service, A14, January 19, 2007.

--Yi-Lang Tang, et. al. “Attitudes, Knowledge, and Perceptions of Chinese Doctors Towards Drug Abuse.” Journal of Substance Abuse Treatment. vol. 29 no. 3. 215-220.

--“Anti-Drug Campaign Yields Result.” China Daily. June 16, 2007. http://www.china.org.cn.

--“With Prohibition Failing, China Calls for ‘People’s War’ on Drugs.” Drug War Chronicle. vol. 381. 4/8/05 http://stopthedrugwar.org

Neurobiology of Addiction

Book Review




By George F. Koob and Michel Le Moal.
Academic Press
(Elsevier), London, 2006.

Over the past twenty-five years, the neurobiology of addiction has become established as an important arena of scientific study. In particular, the molecular adaptations the brain makes in response to addictive drugs has placed addiction squarely in the forefront of modern brain science.

Dr. George F. Koob, a respected American alcoholism researcher of long standing, has put together an academic treatise beyond the expertise and the pocketbooks of most laypersons, but the book is of crucial importance in the burgeoning
field of addiction science.

In Neurobiology of Addiction, Koob and co-worker Michel Le Moal review the neural and molecular mechanisms responsible for the effects of individual addictive drugs in five categories--psychostimulants, opium, alcohol, nicotine,and cannabis.

Particularly well documented is the “anti-reward” system, by which the abuse of addictive drugs leads to a net decrease in dopamine and serotonin in the nucleus accumbens,the brain structure associated with withdrawal and craving. Thus, the
pursuit of artificial pleasure becomes, through the process of addiction, a state of chronic depletion of the brain neurotransmitters associated with states of joy, happiness and well-being.

The authors also do a good job of putting forth their theory of “allostasis,” defined as a “state of chronic deviation of the regulatory system from its normal (homeostatic) operating level.” The addicted brain is constantly attempting to normalize through counteradaptions at the neural level, as well as by switching on the body’s stress responses. Craving and anxiety are among the behavioral results.

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

Sources:

--Koob, George, and Le Moal, Michel. “Drug Abuse: Hedonic Homeostatic
Dysregulation.” Science. October 3, 1997. 278: 55.

--Everitt, Barry J. “From the Dark Side to the Bright Side of Drug Addiction.”
Science 314 p. 59, 6 October 2006.

Pass Me a Cold One

It’s a common phenemonon: A cold beer on a hot day gives you more of a buzz than a cold beer on a chilly day. Uncounted numbers of northern tourists have learn this lesson at their peril after a few tequilas in Cozumel. Fruit flies get drunk faster in hot weather, too. Their drink of choice is the decaying flesh of fruit, and fly populations in higher, cooler latitudes can really hold their rotten fruit, compared to their tropical cousins.

Higher temperature alters the detoxification pathways for alcohol and decreases the rigidity of cell membranes. Increased temperature also slows the activity of alcohol dehydrogenase, a primary enzyme involved in breaking down booze in the body. Alcohol is an amphiphilic molecule, meaning that cells treat it like water. So in hot weather, alcohol travels faster and lingers longer in the bodies of both humans and fruit flies.

Geneticist Kristi Montooth and colleagues at Brown University used fruit flies from an Australian site averaging 80 degrees F, and compared their intake of ethanol in solution with the intake of their more alcohol-tolerant cousins from a Tasmanian climate, where the temperature was 59 degrees F. The researchers traced the difference to regulatory proteins that help the flies cope better with alcohol in low temperatures; specifically, the expression of genes controlling fatty acid synthesis. The study was published in the Journal of Experimental Biology.

Sources:

--Montooth, K.L., et. al. “Membrane lipid physiology and toxin catabolism underlie ethanol and acetic acid tolerance in Drosophila melanogaster. Journal of Experimental Biology. 209 3837-3850. 2006.

--Blackburn, Laura. “Hot Flies, Good Times.” ScienceNOW Daily News. September 15, 2006. http://sciencenow.sciencemag.org/

--Phillips, Kathryn.“Ethanol Tolerance in Temperate Drosophila.”Inside JEB.September 19 2006. http://jeb.biologists.org/cgi/content/full/209/19/iii

Smokers Drink More

It’s no secret that smoking and drinking go together like salt and pepper. No comes further evidence that smoking helps drinkers hold more liquor. Put simply, “Cigarette smoking appears to promote the consumption of alcohol,” says Wei-Jeun Chen of the Texas A&M Health Science Center.

Nicotine seems to slow the movement of alcohol through the intestines, leaving more alcohol molecules backed up and metabolised before reaching the bloodstream by means of intestinal absorption. In animal studies, in which rats were given stomache injections of alcohol and nicotine, clinicians found that “smoking” rats exhibited lower blood-alcohol levels than rats given the same amount of alcohol without the addiction of nicotine.

Dr. David Ball of the Institute of Psychiatry in London, told BBC news: This is a really interesting study. I’m surprised nobody has done it before.”

Chen, an associate professor of neuroscience and experimental therapeutics at Texas A&M College of Medicine, stressed that the results of such “cross tolerance” between alcohol and nicotine could be to “encourage drinkers to drink more to achieve the pleasurable or expected effect.”*

Susan Maier, a spokesperson for the National Institutes of Health (NIH), which sponsored the research, pointed to the potential for harm among young binge drinkers who choose to smoke, and who could “develop chronic alcohol-related diseases earlier in life because of it.”

Conceivably, other drugs might interact with alcohol in a similar fashion. Scientists are beginning to take a look at popular gastric upset products like Pepcid and Tagamet. “Individuals who abuse alcohol are likely to use other drugs,” Chen said. “The potential interactive effects of alcohol and other drugs needs to be considered. For example, the co-use of alcohol and cocaine will result in the formation of cocaethylene, which is highly toxic and has led to a higher mortality rate in animal studies.”

*Coffee and cigarettes go very naturally together as well. This is probably true for as many different reasons as there are coffee drinkers and cigarette smokers, but as we previously noted in the case of alcohol and tobacco, there is a metabolic synergism at work. The two drugs really do seem to have been made for each other. Rats on caffeine will self-administer nicotine faster and more steadily than decaffeinated control rats. This is because nicotine causes caffeine to clear the body at twice the normal rate, thereby allowing coffee or tea drinkers to imbibe larger amounts than usual, whether consciously aware of it or not. In turn, caffeine has an equivalent reinforcing effect on nicotine. The more you smoke, the more coffee you can drink, and vice versa. At the chemical level, smokers may be drinking caffeine in order to more finely balance the mood-altering effects of nicotine. A moment’s reflection brings us to the coffee house, an ancient establishment wherein tobacco and coffee are combined to maximum effect. Coffee and cigarettes, to be sure, are the least psychoactive of the psychoactive drugs—more proof that the sheer intensity of the drug high is not the primary determinant of addiction.

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

Sources:

--Scott E Parnell, James R West, Wei-Jung A Chen. “Nicotine Decreases Blood Alcohol Concentrations in Adult Rats: A Phenomenon Potentially Related to Gastric Function” Alcoholism: Clinical and Experimental Research 30 (8), 2006 1408–1413.

--”Smoking ‘reduces alcohol effect.’” BBC News, July 24, 2006. http://news.bbc.co.uk/go/pr/fr/-/2/hi/5209990.stm.