Obama and McCain on Addiction Treatment

Candidates differ on medical marijuana.

A drug and alcohol policy group has released a study of positions on drug policy by the presidential candidates, concluding that "neither John McCain or Barack Obama can really be considered a leader in the drug-policy area."

In an article published on the Join Together website, author Bob Curley notes that Obama has admitted to youthful marijuana and cocaine use, and McCain has admitted to youthful alcohol abuse. Both candidates are former cigarette smokers, Obama having quit only recently. Curley write that "both appear to have a broader and more nuanced understanding of addiction issues than their White House predecessor."

The article also quotes William Cope Moyers, vice president of external affairs at Hazelden treatment center, who says he has "never been more hopeful that addiction treatment will begin to get the attention it deserves, because we at least have two candidates who are aware of the issue." Obama's admission of drug use is already on the table as a potential campaign issue, while McCain purportedly had an alcoholic father, and his wife went through treatment for an addiction to painkillers in the 1990s.

Senator McCain has been active in efforts to regulate tobacco advertising, and advocates smoking cessation programs in the workplace. At other times, he has advocated tougher sentencing for drug crimes and capital punishment for international drug traffickers.

For his part, Senator Obama supported the Second Chance Act of 2007, which aimed at reintroducing veteran drug defenders to society. He has called for greater use of drug courts and rehabilitation programs in lieu of lengthy prison sentences. He is opposed to efforts to lower the drinking age to 18.

McCain is against marijuana legalization, and opposes the use of marijuana for medical purposes. He said he "would not support medical marijuana because I don't think that the preponderance of medical opinion in America agrees...."

Obama, according to the Join Together article, while not ready to let people grow their own, told a reporter in March that "my attitude is that if it's an issue of doctors prescribing medical marijuana as a treatment for glaucoma or as a cancer treatment, I think that should be appropriate because there really is no difference between that and a doctor prescribing morphine or anything else."

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Smoking Rates Fall 18% in Indiana

What's their secret?

Addiction is a tough disease, and smoking grabs hold of the addiction-prone with a speed and ferocity that remains impressive even in a world of crack cocaine and ice amphetamine. Zyban may help, and there is the ever-controversial Chantix, as well as a plethora of nicotine replacement products. They are valuable and frequently effective additions to the arsenal of medical approaches to nicotine addiction.

Yet there remains one universally effective--if equally controversial--method of lowering smoking rates in a given population. You can increase the price.

Last year, Indiana boosted state taxes on cigarettes by a whopping 44 cents per pack. The result? Cigarette sales fell in Indiana by almost 18 per cent in the nine months since the new tax was put into effect, according to a June 3 Associated Press report. That percentage represents a decrease in sales of roughly 80 million packs of cigarettes, according to state health experts.

"This is exactly what we predicted, " Dr. Judith Monroe, the state health commissioner, told AP. "We've got to remember that smoking is an addiction... not just a bad habit."

In an editorial, the Indianapolis Star put the matter straightforwardly: "In Indiana and nationally, the research in unequivocal: Taxes reduce smoking, especially among the young. So does serious spending on smoking prevention and cessation. The state used to do the latter, and has paid the price for slacking off."

Indiana currently ranks 6th highest in the nation for smoking prevalence. In 1999, under terms of the state-by-state settlement with the tobacco industry, Indiana used its money entirely for smoking reduction programs. After seeing significant declines in smoking, the state legislature nonetheless diverted the remaining settlement money to other programs in 2003. At which point, according to the Indianapolis Star, "smoking rose again, up to second-highest in the nation," making Indiana "one of the unhealthiest states."

"More than one million Hoosiers use tobacco," Karla Sneegas of Indiana Tobacco Prevention and Cessation told the Associated Press. "But we know from our data that approximately 90 percent of those people want to quit and 30 percent are ready to quit right now."


Photo Credit: SavingAdvice.Com

The Biology of Bulimia

The binge-and-purge addiction.

By 2000, the biological substrate unifying alcoholism, addiction, depression, and certain eating disorders had become irrefutable. Population surveys had shown that nearly half of alcoholic patients had a long history of coexisting depression and/or anxiety disorders. Overall, about a third of patients with depression or panic disorder have had lifelong problems with drug abuse. These are estimates, best clinical guesses, but associating depression and addiction is no longer a speculative venture.

As with more familiar forms of addiction, bulimia was coming to be seen as another serotonin/dopamine-mediated medical condition. As noted, serotonin is involved in both the binge and the purge. Once researchers began performing the necessary double blind, placebo-controlled studies, it became clear that serotonin-boosting drugs dramatically lessened bulimic behavior in general, and associated carbohydrate binging in particular, in a large number of diagnosed bulimics. (Anorexia nervosa, another eating disorder, does not show the same serotonin affinities in action.)

Bulimics often maintain a normal weight, but can suffer serious physical consequence—heart rhythm irregularities, electrolyte imbalances, low blood pressure, and damage to the esophagus. Once the binge-purge cycle has been established, some researchers believe, drug-like changes in serotonin 5HT receptor distributions help reinforce the pattern. It is not surprising to learn that Prozac and other serotonin reuptake inhibitors such as dexfenfluramine were prominent among the drugs being tested against bulimia in the 1990s. By 1995, a paper presented at the National Social Science Association Conference in San Diego stated: “The serotonin hypothesis of bulimia nervosa suggests that bulimia is the behavioral manifestation of functional underactivity of serotonin in the central nervous system.”

In 1997, Prozac became the first drug ever licensed by the Food and Drug Administration (FDA) for the treatment of bulimia nervosa, as this chronic disorder is officially known. The drug’s formal approval was based on three clinical studies showing median reductions in binging of as much as 67 per cent for Prozac, compared with 33 per cent for placebo. Vomiting was reduced by 56 per cent, compared to 5 per cent for female placebo users. (About 10 per cent of diagnosed bulimics are males.) There is often a family history of alcoholism and/or eating disorders. The locus of “serotonergic dysfunction” appears to be the hypothalamus. Low levels of serotonin and dopamine metabolites have been documented in the cerebrospinal fluid of bulimic patients. Evidence exists for the involvement of norepinephrine as well.

Bulimia, like alcoholism and other drug addictions, has its psychosocial side, but twins studies show that there is very probably a genetics of bulimia to be pursued. In one influential study, an identical twin stood a one-in-four chance of developing bulimia, if the other twin was diagnosed with the disorder. A combination of SSRI drugs and some form of structured cognitive therapy is the recommended approach.

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

Photo Credit: Graham Menzies Foundation

Epigenetics and Addiction

Turning off the genes for substance abuse.

If psychiatric disorders, including depression and addiction, are rooted in nature, but modified by nurture, some better way of viewing the interaction between genes and the environment is desperately needed.

Enter "epigenetics," defined as the study of how gene expression can be modified without making direct changes to the DNA. Writing in Science News, Tina Hesman Saey explains that "epigenetic mechanisms alter how cells use genes but don't change the DNA code in the genes themselves.... The ultimate effect is to finely tune to what degree a gene is turned on or off. Often the fine tuning is long-lasting, setting the level of a gene's activity for the lifetime of the cell."

A common form of epigenetic modification involves adding molecules to the DNA structure. Adding molecules from a methyl group or an acetyl group can change the manner in which genes interact with a cell's transcribing system. Cells can "mark" specific genes by attaching a methyl group consisting of three hydrogen atoms and one carbon atom to cytosine in the DNA base, effectively turning genes on or off without making major alterations to genetic structure. (Gene mutations or insertions, on the other hand, are capable of fundamentally altering the DNA protein structure.)

Scientists have learned that epigenetic changes can be caused by environmental impacts, but the details are not well understood. We have not yet reached the point of being able to link a specific experience of stress or infection or chemical exposure to specific epigenetic alterations.

What does any of this have to do with drug addiction or depression? One of the environmental impacts researchers have linked to epigenetic changes is drug addiction. The DNA double helix is packaged in proteins collectively called chromatin. One set of proteins, the histones, is a frequent site of epigenetic modification. In a study published in Neuron, Eric Nestler and co-workers in the Southwestern Medical Center at the University of Texas found that alterations in chromatin packaging were tied up with the dopamine release caused by cocaine addiction. The researchers concluded that chronic cocaine use was influenced by "chromatin remodeling." Specifically, modulating histone activity "alters locomotor and rewarding responses to cocaine."

How does this work? As Saey writes in Science News: "Another gene, known as delta-FosB, also switches on when a wave of dopamine washes over the nucleus accumbens.... Delta-FosB teams up with other transcription factors and recruits enzymes that acetylate histones and remodel control regions of some genes..... Such findings suggest that medicines that interrupt or reverse epigenetic changes caused by drugs of abuse could one day prevent or cure addiction."


Image Credit: Science in School

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Annals of Addiction: Richard Lewis

From The Harder They Fall

"It's hard to know exactly when I became an alcoholic. What I do know is that growing up I felt misunderstood, not appreciated, and needing validation. I didn't feel I was getting it from important people in my life. They had their problems, their own concerns. I felt sort of invisible....

"Drinking made me feel not as miserable. It was a great Band-Aid. It progressed, but it didn't stop me in my career. I've done well, and I was an alcoholic at the height of my career, when I really hit. When alcohol really got me by the throat, I quit stand-up comedy. Acting was easier. Easier to stay sober most of the time, do my work, and know I'm off for three days.....

"There were tip-offs, even way early. I remember getting some sort of sexually transmitted disease that was going to last for a week. I had to take certain antibiotics, and I remember the doctor very nonchalantly saying, 'Oh, by the way, you can't drink for five days.' I was going to New York to appear on the Letterman show, and all I thought about was, 'Oh my God, there I am in first class, five-and-a-half hours in an airplane, without booze. There I am in New York with my friends and no booze. I can't even have a couple of glasses of wine in my hotel room to relax before the show.' That's all I thought about. I wasn't thinking of my career. I wasn't thinking about anything but 'I can't believe I can't drink.' It was horrifying. And that was thirteen years before I bottomed.

"I was hallucinating. I was emaciated. Holed up doing coke for six nights.... I was ashamed to waste my life, given all the blessings I had. That I would throw away my life needlessly. To have a disease that I could stop giving myself, if I surrendered, finally.....

"One reason I love being sober is that I thought about this guy I saw who slipped last week, who I spoke to this morning.... I wouldn't have been able to do that if I was drinking. I couldn't have helped this guy.... If I'm going to leave any kind of legacy, making people laugh is fine, but to help somebody get the darkness from out of their eyes and to turn their life around, it's the most important aspect of my life."

Excerpted from:

The Harder They Fall, by Gary Stromberg and Jane Merrill. Center City, MN: Hazelden.


Photo Credit: Pearlies of Wisdom

Annals of Addiction: Grace Slick

From The Harder They Fall

"There's a whole bunch of alcoholics on both sides of my family, but they function in the sense that everybody kept their jobs. There were no divorces, except for my grandmother, but she's not an alcoholic. She was just a wild child like I was. Our alcoholics all kept their jobs and stayed married....

"The Airplane became famous as the original psychedelic band, but personally, I was more of a drinker. Anything that was around and easy I took--marijuana was very easy to score, but alcohol was my drug of choice. That's the genetic deal going on, where I'm an addict in the sense that anything I like I'm all over. Like flies on shit! And sometimes that works out fine. Right now I'm a painter. That's how I make my living and pay the mortgage....

"In 1970, when I became pregnant with China, I wasn't conscious of addiction. My life was all just sex, drugs and rock and roll. But I'm not a moron, so I knew that what you put into your face goes into your body, and part of your body is what's living in there--the child....

"Life is now fine. My daughter is sober. China came in a couple of weeks after me. Into the same rehab. My sponsor was amused. She had never seen a mother-daughter combination in the same rehab....

"I always felt very close to the story of Alice in Wonderland for a real good reason. If you remember what happened to her, she came from a very straight-laced Episcopalian Republican background, and at some point between twelve and twenty-four--mine at about eighteen or so--you go down the rabbit hole."

Excerpted from:
The Harder They Fall, by Gary Stromberg and Jane Merrill. Center City, MN: Hazelden.

Photo Credit: Donna E. Natale Planas/Miami Herald

Annals of Addiction: Malcolm McDowell

From The Harder They Fall

"My father was an alcoholic, so I never really drank much. I kept away from it, but I didn't realize that cocaine was really the same thing. Alcohol eventually started getting a little out of control, but in the form of 'fine wine.' That was my excuse....

"So I didn't consider wine a problem, but cocaine was a problem, and that got out of hand quite fast. It had a very bad effect on my marriage. The lies and deceit and everything that goes with addiction. I went from snorting it occasionally to now smoking it, doing freebase. Doing as much as I could. Finish a batch at four in the morning. Driving around the San Fernando Valley looking for some more of it. Driving while completely stoned, of course. How I was never in an accident, I just don't know....

"The using ended because I went down to the Betty Ford Center.... I didn't thank God at the time time, however. I felt I'd lost a great friend or mistress, that I'd lost the one thing that I could totally trust--all that bullshit! It wasn't until I started to work on myself at Betty Ford, which is a wonderful place as is any place that gets you sober....And, of course, it's hard work, recovery. Less and less hard as the years have gone by, but you know, the way we live our lives is all recovery in one sense or another. We go through a shattering experience like that, and everything we do in life from then on is in a way influenced by what we've been through."

Excerpted from:
The Harder They Fall, by Gary Stromberg and Jane Merrill. Center City, MN: Hazelden.

Photo Credit: MTV News