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

What Does Harm Reduction Mean?

A rift in the addiction treatment community over abstinence.

What is harm reduction? How does it differ from the approaches traditionally associated with drug recovery and rehab?

Originally, I became interested in harm reduction because its advocates were highlighting the folly of prison terms over treatment for drug addicts—a sentiment with which I wholeheartedly agree. Also, the various harm reduction organizations worldwide were fastened tenaciously to the issue of clean needle exchanges as a means of reducing HIV transmission—another approach I heartily support. And at its core, harm reduction has always been about reducing the number of deaths by drug overdose. At its essence, harm reduction is sensible and necessary, given the failures of the drug war, and the inability to make a significant dent in addiction statistics by traditional socioeconomic approaches.

Harm reduction, as formally defined by Harm Reduction International, concerns itself with “policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families, and the community.” It’s a hopeful mission statement. But reducing harm without necessarily reducing drug consumption? What does that mean, exactly?

Lately, activists in the harm reduction movement have been leaning hard on the notion that abstinence is just so much humbug; an archaic admonition that need not be automatically imposed on addicts. Who said addicts have to become abstinent for the rest of their lives? Are we forever hostage to the religious zealotry of the Cambridge Group and it’s successor, Alcoholics Anonymous? If an alcoholic drinks one drink less today than yesterday, or a junkie shoots up a bit less junk today than yesterday, that is harm reduction in action.

But now that harm reduction has become intimately associated with the abstinence debate, egged on by activists like Stanton Peele and Jack Trimpey, the ground underneath the movement has shifted. Many harm reductionists are becoming wary, and sometimes completely hostile, to the notion of addiction as a disease syndrome with a distinct, lifelong, and incurable timeline beyond the reach of notions like “Rational” or “Smart” recovery. “Your best thinking got you here,” AA likes to say, reminding alcoholics that “being smart” or feeling full of “will power” often have less to do with recovery than one might suppose.

But in order to free themselves of the need for abstinence, extreme harm reductionists often deny that addiction is in any meaningful way a medical disorder. This has created a rift in the treatment community, and complicated the mission of recovery programs based on abstinence. Kenneth Anderson, a harm reduction advocate and the author of How to Change Your Drinking, framed it this way for me in an email exchange: “The more alcohol related problems you have, the more you need to practice harm reduction by planning safe drinking strategies, until you resolve your alcohol related problems by quitting or developing a non-problematic drinking pattern.” Like many harm reductionists, Anderson is no fan of Alcoholics Anonymous. One of the book’s sections is headed: “Everything You Always Wanted to Know About Alcohol—But you got told to go to AA and not ask.”

Anderson said that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) “tells us that about half of people who overcome alcohol dependence do so by quitting, the other half overcome it by cutting back.” If even the nation’s premier scientific agency for researching alcoholism doesn’t seem so sure about whether alcoholics need to strive for abstinence, why should abstinence be a stated goal at the outset of treatment at all? Said Anderson: "When abstinence is forced on people against their will, it often backfires and leads to more drug or alcohol use."
 
A few weeks ago, on Denise Krochta’s excellent podcast, Addicted to Addicts, I suggested that part of the argument over abstinence vs. controlled drinking stemmed from a confused bundling of “problem drinkers” and “alcoholics”—a move that the National Institute on Alcohol Abuse and Alcoholism, whose very name is a testimony to the institute’s fundamental ambivalence, has been championing lately. This has helped harm reductionists center the battle precisely where the definitions are fuzziest: at the point on the spectrum where “problem drinking” becomes “alcoholism.” Nonetheless, by focusing on this imprecise edge, harm reductionists make a legitimate point: Culture and environment are major influences on the course of heavy drinking.

“I do not use the word alcoholism [in the book], because it has no scientific definition in the current day and is not found in the DSM IV” Anderson told me. “Although there is some heritability of alcohol dependence, it is a great error to overlook the importance of environmental factors. Alcohol dependence is not located on a single gene--currently there are dozens of genes implicated in alcohol dependence.” And he’s right. These are legitimate caveats that apply to many of the disease models of addiction now at play in the scientific community.

The counter-argument here is that genuine alcoholics do not have, and cannot develop, a “non-problematic drinking pattern,” any more than a serious diabetic is likely to develop a non-problematic sugar doughnut strategy. What alcoholic hasn’t tried controlled drinking? Again and again? And failed? Where are the legions of former drunk-tank alcoholics who have rationally transformed themselves into social drinkers?

These are some of the terms of the current debate in the addiction recovery community. But we do a disservice by concentrating solely on points of departure. The harm reduction movement, at street level, has some very sound contributions to make regarding addiction and public policy. Anderson, in his book, drives home the overlooked but essential point that there is no one-size-fits-all treatment for destructive drinking:

• “Harm reduction never forces people to change in ways which they do not choose for themselves.”
• “Harm reduction recognizes that each of us is a unique human being different from all others.”
• “Harm reduction recognizes the need for ‘different strokes for different folks.’”
• “Harm reduction supports every positive change.”

I fervently hope that 12-Step Groups and Harm Reduction Groups can work their way toward a rapprochement. And so does Kenneth Anderson. But what stands in the way of this is, I fear, is the disease model of addiction—and medical addiction researchers aren’t likely to turn their backs on that premise any time soon. Still, we cannot say what future research will reveal. And I agree with harm reductionists that the best attitude we can bring to the subject of addiction and recovery is open-mindedness, and a willingness to treat each case as unique, in order to forestall “metabolic chauvinism.”

Graphics Credit: http://hamsnetwork.org 

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 

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

 

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

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

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

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

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

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

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

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

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

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

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

Drinking on Television

  

Does alcohol on TV make you bend the elbow?

I have a guest post at All About Addiction covering a journal article in Alcohol and Alcoholism with the unambiguous title: “Alcohol Portrayal on Television Affects Actual Drinking Behaviour.”

It is an easy and familiar accusation. Over time, it has been levied at violent video games, drug use in the movies and alcohol advertising of every stripe. But what is the actual evidence for it? Leave it to a group of Dutch scientists to design a practical experiment to test the proposition when it comes to drinking.... More.

Photo credit: http://josh-wyxl.itmblog.com/page/14/

“They’ll Drink Bucket Loads”

The subtle subterfuge of alcohol advertising.

“To own all routes to sociability; football, music, and everything else that brings the lads together, is to dominate the beer market.”

--Ad agency Mobious in Carling strategy document, 2006.

“Carling Commandments: Thou shalt never abandon your mates in favour of a girl… though shall never desert thy mates in drunken distress, thou shalt always welcome a mate’s mate.”

--Slide presentation by Hill & Knowlton advertising agency, pitching Coors for sports advertising, 2006.

“Shot used to crank up the evening, accelerate the process of getting drunk with less volume of liquid. Sense of danger. For a pleasure ride or to get blasted.”

--Slide presentation by ad agency Cheethambell JWT, 2003.

When the U.K.’s House of Commons Health Select Committee ordered up a report on alcohol last year, the resulting paper once again put the alcohol industry in the spotlight, after researchers at the University of Stirling gained access to a treasure trove of documents from four alcohol companies and their ad agencies. 

The title of the report—“They’ll Drink Bucket Loads of the Stuff”—comes from a “creative brief” prepared by the Cheethambell JWT ad agency in 2005 for the makers of Lambrini, a sparkling pear drink with a kick (7.5 % alcohol by volume) that is popular with young women:

Drinking starts early! Early afternoon at the weekend or straight after work Monday to Friday meeting your girly mates and getting on it is the only way forward…. A light, easy to drink, affordable ‘wannabe’ wine that gets their nights out or in off to a good start. They’ll drink bucket loads of the stuff and still manage to last the duration.

As in the U.S., the U.K. government has a love-hate relationship with the alcohol industry. The flashpoint for disagreement, in many cases, is advertising. Druglink (PDF), a magazine for drug treatment professionals and the criminal justice community, published its analysis of the report in the January/February 2011 issue. Editor Max Daly argues that the alcohol industry in the U.K. is adopting “a similar strategy to that used amid mounting regulation of cigarette advertising 30 years ago.”  Under increasing regulatory pressure, cigarette ads “became more and more elliptical and imaginative as the codes on content were tightened.” The supposedly restrictive advertising codes imposed on cigarette manufacturers simply “honed the advertiser’s skills—either in camouflage or creativity.”

Daly also points to a report on the use of social networking sites to promote alcohol use, prepared by Scottish Health Action on Alcohol Problems, an independent medical advocacy group. Facebook and other sites, the report warned, are being colonized by alcohol promoters “due to the youth appeal of these sites, the difficulties associated with enforcing age restrictions, the relative lack of regulation and the sheer volume of promotional messages. The extensive use of new media to market alcohol represents a proliferation of alcohol branded messages directed at consumers.” 

 In the U.S., Bacardi-branded Mojito Party apps were installed by more than 100,000 Facebook users in 2008. Brewing giant Anheuser-Busch hosts a “VIP micro-site” on Facebook as well. 

A few months earlier, the British Medical Association called for a thoroughgoing ban on alcohol advertising more in line with restrictions on tobacco advertising.

 The Health Select Committee’s report was met with a “furious response” by the alcohol industry, according to Daly. Simon Litherland, managing director of alcohol maker Diageo GB, claimed that “inappropriate consumer views and early proposals” were part of early marketing consultations and were subsequently rejected.

Perhaps because there were no outright examples of law breaking, or perhaps due to a change in U.K. government four months after the report was made public, “They’ll Drink Bucket Loads of the Stuff” has evidently disappeared, leaving few tracks for others to follow. As Daly concludes in the Druglink feature, “whichever political party is at Number 10, there will not be the stomach for a fight with such a powerful adversary as the British drinks industry.”

Photo Credit: http://weblogs.jomc.unc.edu

Personalizing Addiction Medicine

Gene variants make anti-craving drugs a hit-or-miss affair.

Rather than taking on another broad hunt for the genes controlling the expression of alcoholism, noted addiction researcher Dr. Bankole Johnson and co-workers at the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia took a different tack. The researchers focused, instead, on investigating whether genetic variations among alcoholics might affect their responses to a specific anti-craving medication.

The result, according to Kenneth Warren, acting director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), is a study that represents “an important milestone in the search for personalized treatments for alcohol dependence.”

For any addiction, once it has been active for a sustained period, the first-line treatment of the future is likely to be biological. New addiction treatments will come—and in many cases already do come—in the form of drugs to treat drug addiction. Every day, addicts are quitting drugs and alcohol by availing themselves of drug treatments that did not exist fifteen years ago. As more of the biological substrate is teased out, the search for effective approaches narrows along avenues that are more fruitful. This is the most promising, and, without doubt, the most controversial development in the history of addiction treatment.

The researchers were interested in variations in the gene controlling the expression of a serotonin transporter protein. Dr. Johnson’s earlier work had centered on teasing out the influence the serotonin 5-HTT transporter exerts on the development of alcoholism. Previous research had focused attention on the so-called LL and TT variants of this transporter gene. After performing genetic analyses to determine which test subjects were carrying which versions of the gene in question, Dr. Johnson and his colleagues conducted a controlled trial of ondansetron on a randomized group of 283 alcoholics.
The findings were published in the American Journal of Psychiatry.

Ondansetron is an anti-emetic medication that has shown promise in treating addictions, particularly alcoholism. Ondansetron (trade name Zofran), helps block the nausea of chemotherapy by altering serotonin activity in the GI tract. (Vomiting is a serotonin-mediated reflex.) The scientists found that “individuals with the LL geno-type who received ondansetron had a lower mean number of drinks per day (-1.62) and a higher percentage of days abstinent (11.27%) than those who received placebo.”  This put the ondansetron drinkers under five drinks a day. All of the placebo drinkers continued to exceed the five drinks per day mark.

But the strongest difference was found in the group of alcoholics who possessed both the LL and TT genetic variants. The LL/TT alcoholics taking ondansetron “had a lower number of drinks per drinking day (-2.63) and a higher percentage of days abstinent (16.99%) than all other geno-type and treatment groups combined.” 

The goal here is straightforward. In an email exchange, Dr. Johnson told me: “I agree that it would be great if we could use a pharmacogenetic approach to study other anti-craving drugs. The idea of providing the right drug to the right person is definitely important for optimizing therapeutic effects and minimizing side-effects.” Here is a video of Dr. Johnson discussing the research, courtesy of the University of Virginia:

It won’t be easy. Such genetic testing is still in its infancy, and complications abound. For example, in an earlier study in the Journal of the American Medical Association, Dr. Johnson found that diagnosed patients who received ondansetron over an 11-week period increased their days of abstinence compared to alcoholics on placebo. However, in that study, “The researchers found no differences between ondansetron patients with late-onset alcoholism and those who received placebo.” This suggests that, along with genetic variations, ondansetron’s effectiveness with alcoholics may also depend on the type of alcoholism under consideration: early onset or late onset.

We have a long way to go, but individualized pharmaceutical assistance in the early stages of addiction recovery remains the Holy Grail for many addiction researchers. And hopes are running high.

Johnson, B., Ait-Daoud, N., Seneviratne, C., Roache, J., Javors, M., Wang, X., Liu, L., Penberthy, J., DiClemente, C., & Li, M. (2011). Pharmacogenetic Approach at the Serotonin Transporter Gene as a Method of Reducing the Severity of Alcohol Drinking American Journal of Psychiatry DOI: 10.1176/appi.ajp.2010.10050755

Graphics credit: Sergey Ivanov at http://pn.psychiatryonline.org/content/

Who Controls Addiction Research?

The ongoing merger wars at the NIH.

As researchers await the National Institute of Health director’s decision on the matter of merging the nation’s two major addiction research agencies, interested parties to the dispute continued to wonder whether the alcoholic beverage industry will weigh in on the matter—with cash.

The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) exist within the large institutional framework of the National Institutes of Health (NIH), and operate under mandates that overlap enough to make them prime candidates for a cost-saving consolidation. Advocates of the merger, most of them advocates for NIDA, also suggest that the research itself will improve as a result of a decrease in “overlapping missions.” (See my earlier post.)

Recently, Nature News suggested the possibility of efforts against the merger from another interested party: “Although the alcohol industry is unlikely to relish its legal product being lumped in for study with street drugs such as cocaine and heroin, it has so far remained silent. US Trade groups including the Beer Institute, the Wine Institute, the American Beverage Institute and the Distilled Spirits Council of the United States all declined to comment for this article.”

DrugMonkey, an anonymous NIH-funded researcher, has noted on his blog: “I’m still betting [the beverage industry’s] entire strategy (if they actually care about this, which I suspect they do) is going to be by trying to get a pet Congress Critter or two to oppose the plan. Spirited opposition can probably block the whole plan.”

 DrugMonkey even notes that by one common yardstick—recent success rates for grant applicants—NIAAA has actually put up better numbers than its larger cousin, NIDA, “something that NIAAA people have been quietly bragging about for the past several years.”

There have been other rumblings. Behind the scenes, some NIAAA proponents have criticized NIDA’s Nora Volkow for what they see as a heavy-handed attempt on her part to steamroll any opposition to the merger.  The battle lines were clearly drawn earlier this year when Volkow testified before the Scientific Management Review Board. Quoted in the NIH Record, a National Institutes of Health publication, Volkow said that “all psychiatric disorders have similar roots involving combinations of genes and environment…. it is a serious problem, a devastating problem, whether you are talking about alcohol or drugs.”  The NIDA director also said she was “impatient” with progress on the matter, arguing that the separation of resources had already resulted in missed research opportunities. “Why put roadblocks in the way of treatment and prevention?”

At the same meeting, 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. NIH Director Francis Collins told Science (sub. required): “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.”

As Maia Szalavitz wrote at TIME Healthland:

There's another, somewhat moralistic argument for keeping the institutes separate. As Dr. Deborah Hasin argued at a February national advisory meeting on the question, “[There is] a need for a public health message more nuanced for alcohol than for drugs, including nicotine. In contrast with drugs, light drinking is not “bad.'’ It was a curious statement from a scientist who is supposedly charged with studying the effects of psychoactive substances objectively.

Does the NIAAA really have any solid, science-based arguments against the creation of a combined research agency?

Just ask them. Officially, the NIAAA has a very long list of reasons why they are just saying no to the merger—which looks, from the NIAAA point of view, more like an acquisition, anyway. Here are some of acting director Warren’s arguments, taken from an appendix to the minutes of the February 3-4 meeting of the National Advisory Council to the NIAAA, over which Warren presided:

--Alcohol use disorders are different than drug addiction. "The genetics of alcoholism differs from the genetics of drug addiction. Prospective studies have shown that the sons of alcoholics are at greater risk for alcoholism than for drug dependence.”

--The existence of certain commonalities in the brain pathways that mediate the rewarding effects of alcohol and other drugs of abuse does not justify the merger of NIAAA and NIDA. "The fact that dopamine is an important neurotransmitter in signaling reward associated with motivational stimuli does not provide a strong rationale for merging institutes.”

 --Most people with AUDs (alcohol use disorders) do not abuse other drugs.  “The large size of the population with AUDs who don’t abuse other drugs and the enormous public health burden of their illness justify NIAAA’s focused approach to research on AUDs, separate from drug dependence.”

--Alcohol differs from other drugs of abuse in the degree to which heavy use damages the brain and other organs. "Alcohol damages multiple organ systems through common mechanisms of toxicity, including oxidative stress, the disruption of critical cell signaling systems, and the generation of toxic metabolites, cytokines, and chemokines. The coordinated study of these multiple organ toxicities is best suited to a single alcohol Institute.”

--The systems approach is essential to the study of alcohol beneficial and adverse effects. "The merger of NIAAA with NIDA to form a new Institute focused on addiction would orphan and dissociate critical programs focused on alcohol and cardiovascular health, liver disease, pancreatitis, fetal alcohol spectrum disorders, immune disorders, myopathy, neuropathy, and brain disorders.”

Almost all of these contentions are open to debate. I believe some of them are just plain wrong. Nonetheless, the notion that a merger of two or more sprawling federal agencies will automatically streamline and strengthen government operations is equally open to question (See Department of Homeland Security). 

But the greater weight of logic, it seems, continues to tip the argument in the direction of a merger. Legal or illegal should have very little to do with it. David Rosenbloom, director of Join Together, said in an excellent article by Bob Curley that a single NIH addiction institute could “yield important science and public health benefits.”

Rosenbloom added that “many individuals with addiction use alcohol and tobacco and drugs at the same time. A broad addiction institute may be better able to design and sponsor clinical, basic, and health services research that matches this real-world reality instead of focusing on just one substance at a time.”

Dr. Benjamin Rush and “Diseases of the Mind”

Founding Father also fathered concept of alcoholism.

The “Good Creature of God,” as the Puritans referred to alcohol, was the social centerpiece in taverns throughout the colonies. The phenomenon of the village drunkard was easily understood:  He was simply the person in town of the lowest moral fiber.

One of the first physicians to argue that habitual drunkards were “addicted” was Dr. Benjamin Rush, a signer of the Declaration of Independence, America’s first professor of chemistry, a fervent believer in copious blood-letting, and the author of the 1812 treatise, Medical Inquiries and Observations upon the Diseases of the Mind, for which he is considered by some to be the father of American psychiatry. Rush was another controversial figure, touted by many as a heroic innovator and by others as something of a quack. Rush strenuously emphasized “depletive” remedies—anything that made the patient bleed, sweat, retch, or blister.

As for alcoholism, Dr. Rush considered it a “disease of the will” resulting in loss of control over drinking behavior, and curable only through abstinence. He recommended the creation of “sober houses” where drunkards could acquire the habit of abstinence. John B. Gough, a well-known presence on the temperance lecture circuit, called alcoholism a sin, “but I consider it also a disease. It is a physical as well as moral evil.” The drunkard’s confession was a popular literary motif in the mid-19th Century. A novel written by Walt Whitman was called Franklin Evans, or The Inebriate. If Carrie Nation became the strident public face of the American Temperance Movement, Benjamin Rush was its patron saint. 

Nonetheless, the temperance movement remained largely committed to the notion that habitual drunks could quit if they wanted to. All they really needed was a good dose of Emersonian self-reliance. The temperance movement soon switched to an obsession with nationwide prohibition, and treating alcohol addiction gave way to activist politics and battles with the “liquor trust.” Addiction, as a concept, again transmogrified into a condition brought on exclusively by opium products. The idea of alcoholism and all other substance addictions as recognizable disease states did not significantly reemerge until the founding of Alcoholics Anonymous in the late 1930s.

Graphics Credit: http://thebsreport.wordpress.com/

Choline for Fetal Alcohol Spectrum Disorders?

Common supplement may reduce cell death in pregnancies.

A common dietary supplement markedly decreases defects in the skull and brain formation of  lab mice born to mothers exposed to alcohol, say researchers at the Medical College of Georgia.

Among the grisly list of potential effects caused by alcohol consumption during pregnancy, one involves a relatively obscure lipid called ceramide. Ceramide can markedly increase the rate of programmed cell death—a process known as apoptosis—and may be involved in the characteristic cranial defects seen in fetal alcohol syndrome.

In the study, 25 % of the mouse embryos exposed to alcohol showed characteristic defects in skull development, including diminished growth in the multi-layered membrane—the meninges--covering the brain.  Biochemists Erhard Bieberich and Guanghu Wang, in an article published in Cell Death and Disease, found that the supplement CDP-choline decreased cell death and protected the fetal cranium from damage due to maternal drinking episodes. According to Dr. Bierberich in a press release from the Medical College of Georgia, the result of alcohol on pregnancy is “a snowball effect. The neural crest is damaged, the meninges doesn’t develop properly and tissue like bone and brain that are regulated by the meninges don’t develop properly either.”

Choline is a precursor to the neurotransmitter acetylcholine. In addition, it has been known for decades that alcohol increases choline requirements. Choline is already added to some baby formulas and prenatal vitamins. Choline’s effects on stroke and traumatic brain injury are also being investigated.

A similar discovery twenty years ago concerning folic acid led the U.S. Public Health Service (USPHS) to recommend that all women thinking of becoming pregnant should consume supplemental folic acid daily in order to reduce their risk of having a pregnancy affected by spina bifida or other neural tube defects. The rate of occurrence of this kind of birth defect has been dropping ever since.

The researchers believe that “there is just a little window” four weeks after conception—while neural cells are forming numerous organs--when the alcohol-related cranial damage is likely to occur. Unfortunately, this window of disaster opens before many women have discovered that they are pregnant. 

Since warnings about the dangers of drinking during pregnancy are either not known or are ignored in many cases, researchers are always on the lookout for medications that could be given after exposure to alcohol--or even after birth of a baby to an alcoholic mother.  As early as 2005, researchers at Tripler Army Medical Center in Honolulu demonstrated that adding choline to the pre-natal diet of pregnant alcoholic rats suppressed physiological symptoms of fetal alcohol syndrome in the offspring. In a press release from the American Physiological Society, lead researcher John Claybaugh asserted that the results “are consistent with the hypothesis that supplemental dietary choline fed to the pregnant dam can prevent the alcohol-induced partial diabetes insipidus seen in the young adult offspring.”

The American Psychological Association, in the wake of a 2007 study published in Behavioral Neuroscience, announced that “giving choline to infants who were exposed in the womb to alcohol may mitigate some of the resulting problems” related to learning, attention, and motor skills. The researchers gave choline to rat pups exposed to alcohol during the third trimester. Alcohol-related hyperactivity and learning deficits decreased, the researchers say. “The data suggest that early dietary interventions may reduce the severity of some fetal alcohol effects, even when administered after birth."

 Despite such optimism, the issue is whether a choline supplement would be capable of rescuing cells after alcohol exposure, or whether choline would need to be taken ahead of time as a supplement.

What is not at issue is that pregnant women should not drink, and should be aware that fetal damage can occur very early in a pregnancy.

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

Wang, G., & Bieberich, E. (2010). Prenatal alcohol exposure triggers ceramide-induced apoptosis in neural crest-derived tissues concurrent with defective cranial development Cell Death and Disease, 1 (5) DOI: 10.1038/cddis.2010.22

Feel Lucky, Drunk?

Sobering stats on alcohol-impaired driving.

Somewhere just before the stages veteran drinkers sometimes refer to as “bulletproof” and “invisible” comes a stage known as, “Can I drive home drunk, and avoid arrest?”

In the small town where I live, the college kids have it lucky: They can park their cars at the afterparty, and walk, or rather weave, to their respective domiciles, leaving a trail of frustrated cops parked in squad cars, waiting for fresh meat to slide drunkenly behind the wheel.  Not much point in breathalyzing pedestrians. 

Summer is approaching, and with it, new opportunities for drunk driving. Your chances of safely driving home drunk, without arrest, are 49 out of 50, according to figures from the AAA Foundation for Public Safety. Roughly 1 in 50 drunk drivers gets arrested while driving. However, considering the stiff penalties associated with DUI and DWI-type offenses, are those odds really good enough to take the risk?

Consider a few additional numbers from the Centers for Disease Control and Prevention (CDC): The annual cost of drunk-driving crashes is somewhere in the neighborhood of $51 billion. Every day, 32 people in the United States die in crashes that involve an alcohol-impaired driver.  This results in a truly appalling number: 1 in 45, or 1 death due to drunk driving every 45 minutes--all day, every day.  Almost one-third of all traffic-related deaths in the U.S. each year. That is the true cost, the daily dice throws, caused by being drunk behind the wheel.

But there is another set of equally appalling numbers, relating to that 1 in 50 figure we started with. In 2008, over 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics--less than one percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year. The CDC estimates that 2.5 million parents drive under the influence of alcohol each year. Drunk drivers involved in fatal crashes were eight times more likely to have a prior conviction for DWI than were drivers with no alcohol.

Oh yes, and here is another number you should remember: 0.08 per cent.  That is the blood-alcohol content limit in all 50 states, at this writing.  According to the CDC, fatal alcohol-related crashes have dropped by 7 per cent since the adoption of the 0.08 standard.

Photo Credit: http://letsfightalcoholism.wordpress.com/

Origins of the Disease Model of Addiction

Roger Williams and “deranged cellular metabolism.”

                                                  (with Linus Pauling, 1974-------------->)

The idea of addiction as a disease first began to gain a tentative foothold in scientific and government circles in the early 1960s, after the publication of E.M. Jellinek’s The Disease Concept of Alcoholism. Jellinek may not have invented the “alcohol science movement,” as he called it, and he may not have been much of a scientist himself (the evidence suggests that he faked his doctorate), but he was the first to describe the “disease syndrome” of alcoholism—chronic relapse leading to death by liver failure. A salesman by nature, Jellinek ardently presented the disease model of alcoholism to the world of the social sciences just as zealously as he had previously done banana research in Honduras for United Fruit, and biostatistics work for Worcester State Hospital in Massachusetts. The trouble was that the “science” part of alcohol science was murky at best. No real progress was made in loosening the grip that traditional psychology exerted upon the prevailing public view of addiction.

A few years earlier, in 1959, a colorfully maverick dissenter named Roger J. Williams, professor of chemistry at the University of Texas, had proposed a specific disease model of his own; one that went all but unnoticed at the time. The late Roger Williams was best known as the biochemist who discovered vitamin B-5, commonly known as pantothenic acid, one of the so-called “anti-stress” vitamins. This discovery produced a nice revenue stream for Williams’ home university through the patents he took out on various processes for synthesizing B-5.

 One of the problems with traditional theories of alcoholism, Williams believed, was that it was very difficult to identify the specific psychosocial pathologies psychiatrists insisted were behind alcoholism—such things as infantile regression and oral fixation. Those few researchers who did pay attention to alcoholism, he asserted, “have been so diverted by the rather vague and ill-defined personality disorders that alcoholics allegedly have that they have failed to concentrate upon the one thing that all alcoholics have—whether they are rich or poor... introverts or extroverts, dominant or submissive, repulsive or charming—namely, an excessive appetite for alcohol.”  The idea of appetite was, for Williams, the essential semantic shift. As Williams insisted in his book, Alcoholism: The Nutritional Approach:

“Alcohol is a physiological agent and the urge which the initial drink produces, in my opinion, arises because of deranged cellular metabolism. Except for the fact that derangement is involved, the urge is fundamentally similar to the urge we have for water when our tissues become dehydrated, for salt when our tissues become salt-hungry... or the unfortunate craving some diabetics have for sugar....”

Dr. Williams was saying that after a certain point, the burning urge for alcohol, or the insatiable craving for heroin became, for “addiction-prone” people, indistinguishable from the primal drives of food, thirst, or sex. “This is something that it is impossible to understand unless we take into account the tremendous biochemical individuality that exists.” If alcohol and addictive drugs didn’t effect you that way, well then, they just didn’t, and you thanked your lucky stars for it, the way you would be thankful for not having allergies or diabetes. Blood composition, enzyme levels, endocrine activities, excretion patterns, and nutritional needs all vary from person to person, argued Williams, and the effect of any given addictive drug was going to vary widely from person to person. This neglect of biochemical individuality, Williams was convinced, was the reason physicians had no medical treatment to offer. They had the wrong paradigm—they were focusing on the drugs themselves, and not on the bodies and brains of the users.

There were, Williams insisted, periodic references in the literature to what he called the “X” factor—some particular defect, or excess, or absence, that was present in alcoholics, but absent in moderate drinkers and abstainers. The hunt for the X Factor, for Substance H, was fast becoming the Holy Grail of addiction research.

Williams thought the X factor was genetic.

Photo Credit: http://bioinst.cm.utexas.edu

Moonshine Makes a Comeback

But it’s still illegal.

The question has always been straightforward. Distilled to its essence, if you’ll pardon the pun: Why is it legal to brew up to 300 gallons of beer, or produce your own wine, while it is illegal to make your own “hard liquor?”

After all, distillation of spirits is the logical next step. “If you are making beer,” says Max Watman, author of Chasing the White Dog, a book about moonshine, “it’s just a matter of time that you are going to be staring at the beer and going, ‘There’s whiskey inside of that.’” The newest category of illegal distillers, Watman told the Fort Worth Star-Telegram, were “foodie folks,” the same people who “drove the home brewing craze.”

The big catch is that the distilling, sale and consumption of unlicensed liquor is still a felony or Class A misdemeanor--just as it was during the Prohibition Era--carrying a sentence of one to five, and a fine of up to $10,000.  Earlier this year, investigators in two Texas counties seized stills and small amounts of moonshine in two separate raids, according to the Star-Telegram article by Steve Campbell.  Recently, a Kentucky man was arrested in possession of 100 gallons of moonshine.

And, in perhaps the ultimate sign of the times, Willie Nelson’s bus was searched and crewmembers were arrested for pot, of course—but also for the possession of untaxed alcohol in the state of North Carolina. The Star-News Online reported that  “agents entered the bus after smelling marijuana. Inside they found a quart jar, three quarters full of untaxed alcohol, or moonshine, as well as marijuana.” Matthew Rowley, author of Moonshine!, said in the article that there “aren’t any figures about it. What I know, see with my own eyes, taste with my own mouth, it really is everywhere.”

Judging by the Internet, stills and distillery supplies do seem to be ubiquitous. However, there is another, more serious class of moonshiners, consisting of criminals who produce cheap liquor for sale to illegal booze joints in larger cities. In an article in the Norfolk Virginian-Pilot, Watman said he had sampled some of the criminal booze available at a “nip joint” in Virginia, and reported that it tasted like “some sort of experimental kerosene-powered mouthwash.” In its more lethal forms, “white lightning” can lead to fatalities from lead and alcohol poisoning. (In Russia, home brew vodka has been responsible for numerous deaths.)

Home distillers would like to see hobby distilling treated as something less than a criminal enterprise, since in most if not all cases, no sales are taking place. But it may get harder and harder to avoid the “revenooers” in the future, due to the development of portable infrared spectroscopy equipment for identifying and tracking the content of alcoholic spirits emerging from illicit home stills.

An article in Chemistry Central Journal estimates that as much as 25% of all alcohol sold and consumed worldwide is unrecorded and unregulated.

Photo Credit: http://www.blog.thesietch.org/2007/03/07/diy-ethanol/

Alcoholism: The Genetic Puzzle

Fathers and Sons.

The hunt for genetic influences on alcoholism derives largely from the work of Dr. Donald W. Goodwin, chair of the Department of Psychiatry at the University of Kansas Medical Center. Starting in the early 1970s, Dr. Goodwin and co-workers, using computer technology and a detailed database of Scandinavian health records, scrutinized the results of 5,000 adoption cases in Copenhagen. The results of the initial study stunned alcoholism experts around the world. The sons of alcoholics were more likely to become alcoholics themselves, as many had expected. But the relationship held true even when the children of alcoholics were separated from their natural parents shortly after birth, and subsequently raised by foster parents.

In Phase 2 of the Danish studies, Goodwin selected only alcoholic families in which one son had been raised by his biological parents, while the other son had been adopted away early in life. Raised in separate environments, twins of this sort are highly prized for genetic research. Goodwin compared the sons who had been raised by their alcoholic birth parents to their adopted-away brothers. It didn’t seem to make any difference: Rates of alcoholism were roughly the same. Environmental factors alone did not seem to account for it.

“By their late twenties or earlier,” Goodwin wrote, “the offspring of alcoholics had nearly twice the number of alcohol problems and four times the rate of alcoholism as the children whose parents had no record of hospitalization for alcoholism.” It did not look like family environment was the primary determinant.

Perhaps some of the children simply ended up with less effective foster parents, detractors pointed out. Alternatively, some unknown trauma might have been inflicted in the womb. Maybe the pregnant mother drank. Environmental factors can never be ruled out. Nonetheless, the basic implications of Goodwin’s work could not be shaken off. The Danish adoption studies were the first major scientific papers to establish a firm link between heredity and alcoholism.

Beginning in the 1980s, Dr. C. Robert Cloninger, professor of psychiatry and genetics at Washington University in St. Louis, and Michael Bohman, a Swedish pediatrician, began a broader series of adoption studies. The Stockholm Adoption Study scrutinized the records of more than 3,000 adopted individuals, and confirmed the Danish studies: The children of alcoholics, when compared with the children of non-alcoholic parents, were far more likely to become alcoholics themselves—even if they were adopted away. 

Moreover, “Alcohol abuse in the adoptive parents was not associated with an increased risk of abuse in the children they reared,” Cloninger later reported in the journal Science, “so there was no evidence that alcoholism is familial because children imitate their [non-biological] parents.”  

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

Graphics Credit: http://www.3dscience.com/

Risky Drinking

 

The one-question questionnaire.

Answer: Once or twice.

Question: “How many times in the past year have you had 5 or more drinks (for men), or 4 or more drinks (for women) in a single day?"

A recent study published in the Journal of Internal Medicine strongly suggests that this simple question identifies those drinkers at risk for alcohol use disorders roughly 75 % of the time.  While the one-question screening test has been endorsed by both the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for several years, little clinical evidence existed for assuming that it worked. 

It seems weirdly unrealistic as a standard measure, leaving out, as it does, so many other telling features of active alcoholism. Nonetheless, the group at the Boston University School of Medicine that conducted the research concluded that “the single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in the sample of primary care patients.”

It seems safe to assume that the majority of people who occasionally overdrink are not alcoholics. Is the occasional binge or bender by recreational drinkers really that rare? In a research summary comment on the results, Dr. Peter D. Friedmann opens up the possibility of using the one-question screen to “facilitate more discussion of heavy episodic (binge) drinking, a major source of adverse consequences among nondependent drinkers.”

Five or more drinks, on a single occasion in the past year? Is that really sufficient data? Is a response of  >1 really a genuine cause for concern?

But it gets even stranger. In 2006, the Journal of Studies on Alcohol published a primary care validation study which showed that narrowing the criteria to one incident in three months did not significantly change the results. When the choices available were “within 3 months,” “within 12 months,” “ever,” or “never,” the 3 month and 12 month positive answers were predictive of risky consumption levels about 75% of the time in a study of 625 patients.

One conclusion to be considered is that “normal,” non-alcoholic drinking males rarely—if ever—consume more than 5 drinks in one evening (4 for women). For heavier drinkers, this seems an impossibly Puritan standard, and useless as a diagnostic tool.  As usual, more studies are needed. But the authors of the 2006 paper were confident enough to conclude: “A single question about the last episode of heavy drinking is a sensitive, time-efficient screening instrument that shows promise for increasing alcohol screening in primary care practices.”

Photo Credit: http://talesblog.com/2008/07/19/highlights-of-tales-so-far/

Moderate Drinking: The Debate Continues

New study says it’s the lifestyle, not the alcohol.

Ever since the first studies showed modest statistical health benefits for people who drank a light to moderate amount of alcohol, the debate has bounced back and forth among researchers. Now an Italian study of more than 3,000 older adults, published in the Journal of the American Geriatrics Society, claims that it is the moderate lifestyle of drinkers, and not the alcohol itself, which helps prevent functional decline as we age.

After controlling for body weight, level of physical activity, education, and income, Cinzia Maraldi and coworkers in the Department of Clinical and Experimental Internal Medicine at the University of Ferrara pointed the finger at lifestyle characteristics—primarily weight control and exercise.

The researchers did not dispute the finding that moderate levels of alcohol intake can lower the risk of cardiovascular disease--but lead author Maraldi said in a press release that “the benefit of alcohol intake on other health-related outcomes is less convincing.”

Maraldi said the positive effects of moderate alcohol on physical aging and cognitive impairment in the elderly may be only apparent, “because life-style related characteristics seem to be the real determinant of the reported association.”

The research follows earlier U.S. studies suggesting much the same thing. A finding that had become common folk wisdom—with perhaps a little nudge from the alcoholic beverage industry--is now openly disputed by scientists.

“The moderate drinkers tend to do everything right,” said sociologist Kaye Middleton Fillmore, in a New York Times article by Roni Caryn Rabin. “They exercise, they don’t smoke, they eat right and they drink moderately.” In the same article, an Oakland cardiologist said: “It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative.”

In the New York Times article, Dr. Tim Naimi of the Centers for Disease Control and Prevention said: “The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study—the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country.”

Photo Credit: Rhodes University


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