Government Kicks Off New Alcohol Web Site

Will NIAAA site help identify problem drinkers?

Alcohol use exists on a spectrum, from occasional sippers to full-blown alcoholics. If you have ever asked yourself where, exactly, on the drinking spectrum your own alcohol use falls, a new government web site aims to help you answer that question.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is making an effort to become more relevant and up-to-date by establishing a flashy new web site based on a revamped institutional philosophy. The idea, writes Melinda Beck of the Wall Street Journal , is to “help people recognize problems patterns earlier and catch themselves before they fall.”

Beck notes that the NIAAA web effort is a result of “a new understanding that there is a spectrum of alcohol-use disorders, which some experts hope will replace the current criteria for ‘abuse’ and ‘dependence.’”

The new site, called “Rethinking Drinking,” is a bit confusing to navigate at first. However, there is actually a wealth of information tucked away on the site. For example, people can compare their alcohol intake with the general population and with problem drinkers. There are “low-risk” drinking recommendations, an explanation of why women become intoxicated on less alcohol than men, and a list of medications that react negatively when combined with alcohol. Web surfers are also given a primer on “standard” drinks—some cocktails are equivalent to three standard drinks, and a bottle of wine counts as five glasses.

In the Wall Street Journal article, Mark Willenbring, NIAAA’s director of treatment and recovery research said that most people “don’t know what ‘drink responsibly’ means—they think it means not getting tanked. But there are levels of drinking that raise your risk for alcohol problems just like high cholesterol raises your risk for heart disease.” Low-risk drinking—no more than four drinks for men and 3 for women at a sitting, and no more than 14 drinkers a week for men and 7 drinks a week for women—can increase the risk of adverse events for people suffering from liver disease, heart arrhythmia, and bipolar disorder.

One little-known fact, according to the web site: Some 35 per cent of Americans don’t drink at all.

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Drug Research and the Recovery Act of 2009

What's in the budget for addiction scientists?

Scientists were among the likely beneficiaries of President Obama’s American Recovery and Reinvestment Act of 2009.

The National Institutes of Health (NIH) is slated to receive $10 billion for use over the next two years. A yet-to-be-determined portion of the grant will end up with the National Institute on Drug Abuse (NIDA).

Here is a sampling of NIDA’s wish, or “Challenge Topics” for which the agency is seeking grant proposals. The application due date is April 27, 2009.

--Dietary treatment of substance disorders.
“There is abundant preclinical and clinical evidence that suggest dietary therapies and behavioral interventions can promote neurogenesis, diminish susceptibility to metabolic and excitotoxic injury (e.g., diets rich in antioxidants), and/or counteract stress responses within the brain. Dietary regimens or supplements can be evaluated as individual treatments or as adjuncts to FDA-approved medications.”

--Drug genetics and informed consent.
“Address ethical issues related to access to broad sharing and use of new genetic information and technologies for addiction research to improve treatment and prevention options for addicts.”

--Addiction drugs combined in treatment.
“Network biological analysis predicts that modification of a single target by a drug is not nearly as likely to affect disease outcome as would rational combinations of drugs that target multiple, complementary mechanisms. Applications will focus on combination of medication strategies for the treatment of substance use disorders.”

--Neurobiology of opioid addiction.
“There is an urgent need for research that will more thoroughly delineate the neurobiological implications of long-term opioid use. This knowledge gap is of particular concern when it comes to the developing brain - and the urgency is underscored by the fact that increasing numbers of adolescents and young adults are using opioid medications, prescribed and otherwise.”

--Research on addiction drugs for pregnant women.
“Substance abuse during pregnancy often occurs in the context of complex environmental factors and poly-drug exposure, as well as medical conditions which are associated with adverse neonatal consequences. Much is known in regard to the negative effects of substances of abuse on the pregnant/post partum women and their substance exposed neonates but relatively little is known in regard to medication treatment strategies and research methodology.”

--Internet-based prevention and treatment in rural locations.
“Many persons living in remote or rural locations have limited opportunities to obtain drug abuse treatment services, due to a lack of available service settings, the barrier of traveling long distances, and/or the perceived lack of private and confidential treatment options. This program seeks to develop web-based drug abuse treatment interventions that do not necessitate frequent in-person visits to a central facility.”

--Finding new molecular targets for addiction treatment drugs.
“Projects may utilize techniques ranging from gene knockout technologies, behavioral evaluations, assay development, and targeted library synthesis and screening that could lead to the development of medications for drug addiction treatment. The focus may be on the identification of new molecular targets, and/or the discovery of small molecule selective ligands for previously identified targets, such as muscarinic M5 antagonists, neuropeptide Y antagonists, and neurotensin agonists.”

For general information on the National Institute on Drug Abuse implementation of NIH Challenge Grants, contact:

Christine Colvis, Ph.D.
NIDA Challenge Grant Program Coordinator
National Institute on Drug Abuse
National Institutes of Health
Phone 301-443-6480
Email ccolvis@nida.nih.gov


Photo Credit:www.ecampusnews.com

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Time for a Sales Tax on Sinsemilla?

Will states let marijuana revenue go up in smoke?

As California State Assembly member Tom Ammiano put it: “What if California could raise hundreds of millions of dollars in new revenue to preserve vital state services without any tax increase?”

That question is likely to hook any state legislature’s attention these days. When times are tough, you go with your strengths. In California, one of those strengths is the nation’s most robust homegrown marijuana industry—virtually all of it off the books at present.

Reeling from a $42 billion budget deficit, the California government has been slashing deeply into state spending. The marijuana industry, variously estimated at anywhere between $4 and $14 billion per year, is the state’s largest cash crop.

Is this any time to be turning down a couple of billion dollars a year in potential state revenue? The question of marijuana decriminalization may begin to be seen under a different light, as cash-strapped states look in every corner for ways to add revenue.

The Marijuana Control, Regulation and Education Act, introduced in the California legislature last week, would legalize the possession and sale of marijuana for people over 21—with a hefty sales tax similar to the taxes imposed on the sale of alcohol and cigarettes. The bill would prohibit open street sales or sales near schools. Marijuana wholesalers would be charged several thousand dollars up front to distribute the crop, and an individual sales fee of $50 per ounce at the retail level would be applied.

Proponents of the bill claimed it would generate more than $1 billion annually, according to a report by Stu Woo in the Wall Street Journal. The California chapter of NORML estimates that the take for the Golden State could be as high as $2.5 billion a year, when excise taxes, savings in law enforcement expenditures, and spinoff industries like coffee houses are taken into account.

Ammiano, the Democrat from San Francisco who introduced the bill, told Salon: “I do have support from a lot of colleagues, who say, ‘Oh my God, I think this is great, but I don’t think I can vote for it.’” In an opinion piece for the San Francisco Chronicle, Ammiano wrote that his reason for introducing the bill was to begin “a rational public policy discussion about how best to regulate the state’s largest cash crop, estimated to be worth roughly $14 billion annually. Placing marijuana under the same regulatory system that now applies to alcohol represents the natural evolution...” In addition, Ammiano suggests, “Regulation allows common-sense controls and takes the marijuana industry out of the hands of unregulated criminals.”

A lobbyist for California police groups told the Wall Street Journal that the bill was “based on a fallacious assumption that if we could only legalize marijuana, that we will have fiscal and social Shangri-La.”

Nonetheless, more than a dozen states have signaled a willingness to move toward more liberal marijuana enforcement policies recently. All of these efforts eventually collide with competing federal statutes, making the possession and sale of marijuana potentially a federal crime. As with the issue of gay marriage, it is possible that states will continue to push back, resisting federal efforts to nullify state changes in marijuana enforcement policy.

Photo Credit: Forest Service Drug Control Program

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Cancer and Women Who Drink: A Flawed Study?

Taking a second look at the numbers.

Last week’s front page Washington Post story on the increased risk of cancer among women who drink shed more heat than light on the underlying conundrum: Are a few drinks good for you, or aren’t they?

A British study involving almost one and a quarter million women—a huge survey by any standards—found that just one drink of alcohol per day increased the statistical risk of contracting cancer. According to the Post story by Rob Stein, as little as 10 grams of alcohol a day elevated women’s risk for cancer of the breast, liver, and rectum in particular. “Based on the findings, the researchers estimated that about 5 percent of all cancers diagnosed in women each year in the United States are the result of low to moderate alcohol consumption,” the Post reported. “Most are breast cancers, with drinking accounting for 11 percent of cases—about 20,000 extra cases each year—the researchers estimated.”

But wait a minute. Wasn’t it just yesterday that researchers were confirming and reconfirming that a couple of drinks a day was good for your heart? Presumably, this included women’s hearts as well. What’s going on?

For starters, the conclusions of the study itself, published in the Journal of the National Cancer Institute, have some problems. In an article entitled, “Women: How Bad is a Regular Nip?” Janet Raloff writes in the Web edition of Science News that female participants were queried only about weekly alcohol consumption. To arrive at figures for daily intake, the researchers divided by seven. “However,” writes Raloff, “if someone averages seven drinks a week, those beverages might have been downed on weekends only—leading to consumption of three or more drinks at a sitting. That would be bad even for the heart. Also, in the long haul, for anyone’s liver.” Unless we know about daily drinking, the study “only offers fodder for speculation.”

There are other problems. As it turns out, nondrinkers have an elevated risk for certain kinds of cancers. Study author Naomi Allen and coworkers at the University of Oxford write that alcohol apparently confers some sort of protective effect when it comes to cancers of the pharynx, esophagus, stomach, cervix, and other sites.

In addition, Raloff, points out, “There’s the impact of smoking.” Some of the alcohol-linked cases of cancer in women—esophagus, liver, and larynx, for example—increased only among those women in the study who also smoked.

Specifically, Raloff recommends that women with a genetic predisposition for breast cancer might decide that “no alcohol is the best policy.” And for people at low risk for heart disease, it’s difficult to justify drinking because it’s good for your heart. However, “study after study has offered quantitative evidence that middle-age and older adults who take a regular nip—like that proverbial glass of sherry after dinner or at bedtime—suffer less heart disease and diabetes than teetotalers or people who consume more than two drinks a day.”

And that, at present, is where the matter still stands. As Raloff sensibly concludes, “Let’s not scare people with incomplete data. There will be plenty of time to hammer home a call for temperance if and when stronger data emerge.”

Photo Credit: www.injuryboard.com

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Tobacco Industry Loses Crucial Court Case

Jury awards $8 million to widow of addicted smoker.

In a court decision that attorneys for Philip Morris called “profoundly flawed,” a Florida jury last week awarded $8 million to the widow of a man who died of lung cancer, ruling that nicotine addiction was the cause of his death.

Attorneys for Altria, the parent company of Philip Morris, argued in Hess v. Philip Morris USA that the deceased man had been fully aware of the dangers of smoking, and had been fully capable of quitting, had he chosen to do so.

Philip Morris will most certainly lodge an appeal, given that the closely-watched “Hess case” is the first of an estimated 8,000 similar cases filed in Florida in the wake of a class-action suit against cigarette makers in 1994. In 2006, the class-action suit was overturned by the Florida Supreme Court, which ruled that smokers had to prove in individual court cases that cigarettes were the immediate cause of their health problems.

Attorneys for the widow, Elaine Hess, argued that Philip Morris sold cigarettes that were “defective and unreasonably dangerous,” according to a Miami Herald report by Patrick Danner. Phillip Morris attorneys argued that smoking had simply been a “lifestyle choice” for Stuart Hess. Hess, the tobacco lawyers asserted, voluntarily chose not to follow the advice of family members and doctors, who told him to quit smoking.

According to the Miami Herald report, Hess “tried various means to quit smoking, including hypnosis, Nicorette gum and even going cold turkey. But all of his attempts failed.”

While technically the Hess case has no bearing on the individual court cases to come, attorneys said it was expected to serve “as a template for the other cases,” Danner wrote in the Herald article. Murray Garnick, a senior vice president and associate general counsel for parent company Atria, said in a press release that the verdict was the result of “an unconstitutional and profoundly flawed trial procedure. Fundamental fairness requires the plaintiff to establish basic liability before a jury can award damages.”

Photo Credit: http://snus-news.blogspot.com/2008_01_06_archive.html

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Raise the Bottom--Book Review

Recognizing alcoholism in the workplace.

In addition to all the other damage they do, alcoholics can literally cost businesses a fortune, says marketing consultant Arthur M. Jackson in his new book, Raise the Bottom. As a means of helping employers identify the problem, Jackson offers a checklist of early, middle and late-stage alcoholic behaviors, from drinking everyone under the table, to blame games, to personal financial problems.

The litany is at times simplistic, and the book is written in the Kenneth Blanchard “One-Minute-Manager” style of easily digestible business books, with a fictional senior consultant doling out data to his fictional protégé. Nonetheless, the author manages to impart some useful information, and draws attention to a problem most people choose to avoid or ignore—the toll active alcoholism takes on workplace efficiency and trust.

Physical early warning signs to watch for, Jackson writes, include a family history of alcoholism, “pre-drinking” before social functions, frequent lying, and cigarette smoking (a majority of alcoholics smoke cigarettes). These are all valid potential red flags, but often difficult to discern in a workplace setting.

Alcoholism is more likely to show itself in the middle stage, when “quotas go unmet, goals unachieved, and promises not kept.” At this stage, bosses and managers are likely to help the alcoholic with his excuses, agreeing that he or she is having an “off year,” or “problems at home.” Indeed, multiple divorces and increasing financial difficulties often accompany the progression of addictive disease.

The author leaves no doubt about where he stands on the disease debate: “We don’t punish someone for having a disease. We separate the alcoholic behavior from the alcoholic... The maladaptive and negative behaviors, and the poor business results following from them, must face direct consequences or they will continue.”

Two other maladaptive behaviors characteristic of the middle stage are “sexual exploitation” and “road rage,” writes Jackson. As odd as this may sound, I think the author is right here. Both behaviors—compulsive promiscuity and episodes of instinctual rage--can be seen as impulse control problems, which alcoholics often exhibit.

As the middle stage increasingly leads to poor job performance and declining results, “the downward slide of the progression begins to be noticeable to others, although the cause—alcoholism—is still well hidden most of the time.” The presence of the “pink elephant in the office” goes unaddressed—and things get worse.

Sensibly, the author notes that a single DUI or DWI does not prove the case for alcoholism. However, landing a second DUI, or continuing to regularly drink while driving, may be another matter entirely.

Jackson is a firm believer in early intervention on the part of friends, family, and coworkers. Moreover, “The job lever—the risk of losing his job because of alcoholism—can have a crucial effect.” Jackson’s two-word prescription: “Stop enabling.” By recognizing potential alcoholism and moving toward treatment rather than turning away, workers can break through the conspiracy of silence and help “raise the bottom” for alcoholics--saving their jobs, their relationships, and often their lives.

Photo Credit: http://www.freshknowledge.co.uk/

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Obama Set to Name New Drug Czar

Seattle police chief gets the nod.

Drug reformers, hoping for the appointment of a public health official, expressed initial dismay at the news that President Barack Obama will nominate Seattle Police Chief Gil Kerlikowske as the nation’s new “drug czar.”

As the president’s evident choice to head up the White House Office of National Drug Control Policy (ONDCP), Kerlikowske is not known for highlighting drug issues in national law enforcement circles, notes the Drug War Chronicle. “While we’re disappointed that President Obama seems poised to nominate a police chief instead of a major public heath advocate as drug czar,” said Drug Policy Alliance’s Ethan Nadelmann, “we’re cautiously optimistic that Seattle Police Chief Gil Kerlikowske will support Obama’s drug policy reform agenda.”

According to the Seattle Post-Intelligencer, “He’s likely to be the best drug czar we’ve seen, but that’s not saying much,” Nadelmann said. “At least we know that when talk about needle exchanges and decriminalizing marijuana arrests, it’s not going to be the first time he’s heard about them.”

For those worried about a radical change in the nation’s drug policy, Seattle City Councilman Nick Licata sought to assure citizens that Kerlikowske is “not on a platform arguing for decriminalization of drugs or radical drug reform measures.”

A spokesperson for the American Civil Liberties Union (ACLU) told the Post-Intelligencer: “I would imagine that being a chief law-enforcement officer makes it very difficult for someone to speak out in favor of more progressive drug laws and drug policies.” However, former Seattle Police Chief and drug reform advocate Norm Stamper insisted that Kerlikowske was more inclined to support “research-driven and evidence-based conclusions about public policy.”

In “Advice for the New Drug Czar,” an article for the online edition of The American Prospect, drug policy experts Mark Kleiman of UCLA and Harold Pollack of the University of Chicago laid out their recommendations for Kerlikowske. Here is an example of their thinking:

--“You’ll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don’t believe it. There is no coherent strategy. Enforcement, prevention and treatment are the names of three quarrelling constituency groups whose pressures you will sometimes need to resist....”

--“There are some real ‘drug wars’ raging: in Afghanistan, in Columbia, and in northern Mexico. Those wars matter terribly to the countries involved, but no outcome of those wars is likely to make the drug situation in the United States noticeably better or worse.”

--“Treatment needs to be more accessible and more accountable. Good news: even lousy treatment has benefits greater than its costs. Bad news: much of the treatment actually delivered is, in fact, pretty lousy. Demand to see results, and insist on rigorous evaluations. Focus resources on effective programs. It’s an outrage to have addicts dying of overdoses while on waiting lists for methadone treatment.”

--“Most primary care providers never perform highly cost-effective screening and brief intervention, because they’re neither trained for it nor paid for it. Many don’t think that dealing with drug abuse is in their job description; it needs to be.”

--“’Drug Czar’ is a silly title.”


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