A High Old Time in Washington, D.C.

Feds release state-by-state drug use figures.

It’s that time of year again: the season for publishing the annual SAMHSA drug sweepstakes. SAMHSA, the Substance Abuse & Mental Health Services Administration, a unit of the Department of Health and Human Services, has released its latest national report, covering 2007.

The map to the right shows illicit drug use in the past month among persons aged 12 or older, by state--------------------->

Which states exhibited the most felonious behavior when it comes to illegal drugs?

This year, the big all-around champion—especially in the cocaine category—was the nation’s capital. Washington, D.C. outpaced the rest of the country in almost everything, ranking number one for cocaine, number one for alcohol, and number three for marijuana, according to the study.

The Washington area, writes Maria Schmitt in the Washington Examiner, “has had a troubling association with drugs and alcohol, from the overdose death of University of Maryland basketball star Len Bias to the undercover bust of then-Mayor Mario Barry to last year’s DUI arrest of Rep. Vito Fossella of New York.”

Meanwhile, Vermont stubbornly holds onto the title of pot-smoking capital of the country. Freedom and Unity, as the state motto would have it. Utah retains its title as the most unstoned state in the union. It also ranks dead last in alcohol abuse. Meanwhile, North Dakota leads the nation in underage drinking.

The Midwestern plains states, by and large, don’t seem to be showing any latent signs of picking up a serious illegal drug habit. For abstaining addicts looking for the least environmental drug cues, Iowa and Nebraska are probably the best bets. Although if you talk to residents of those two states, they will tell you about vastly underreported alcohol and methamphetamine problems.

What inevitably strikes the outside observer is the bewildering range of use from state to state. To use one example, Iowa, my home state, recorded half the illegal drug use of Rhode Island—yet Iowa’s alcohol abuse levels were pegged at 9.2 per cent, which places it among the nation’s major drinking states.

As states beg for various kinds of funding, SAMHSA’s figures have come under fire in the past, their accuracy and political neutrality questioned. So take them with a grain of salt. Nevertheless, the figures likely represent certain broad trends with relative fidelity. “This report shows that while every state faces its own unique pattern of public health problems,” said SAMHSA acting administrator Eric Broderick in a press release, “these problems confront every state.”

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A Drug for Kleptomania?

Naltrexone curbs shoplifting.

It seems like such an unlikely finding: In a University of Minnesota study of kleptomania—the compulsion to steal—a popular medicine used to treat both heroin addiction and alcoholism drastically reduced stealing among a group of 25 shoplifters. The drug, naltrexone, blocks brain receptors for opiates. It is one of the few drugs available for the treatment of alcoholism, and continues to gain momentum as a treatment for opiate addiction.

In an article for the April issue of Biological Psychiatry, Jon Grant and colleagues at the University of Minnesota School of Medicine record the results of their work with 25 kleptomaniacs, most of them women. All of the participants had been arrested for shoplifting at least once, and spent at least one hour per week stealing. The 8-week study is believed to be the first placebo-controlled trial of a drug for the treatment of shoplifting.

In the April 10 issue of Science, Grant said that “Two-thirds of those on naltrexone had complete remission of their symptoms.” According to Samuel Chamberlain, a psychiatrist at the University of Cambridge in the U.K., the study strongly suggests that “the brain circuits involved in compulsive stealing overlap with those involved in addictions more broadly.” The study, in short, strengthens the hypothesis that the shoplifting “high” may have much in common with the high produced by heroin or alcohol.

Researchers are also working with the drug memantine as a treatment for compulsive stealing.

The finding lends additional evidence to the theory that shoplifting is a dopamine- and serotonin-driven disorder under the same medical umbrella as drug addiction and alcoholism. Preliminary research has shown that naltrexone may also have an effect on gambling behavior.

If so-called “behavioral addictions” continue to display biochemical similarities with “chemical addictions,” the move to broaden the working definition of addiction will continue to intensify. And the same sorts of questions that plague addiction research will be replayed in the behavioral sphere: What level of shoplifting constitutes the disorder called kleptomania? Isn’t the medicalization of shoplifting just a way to excuse bad behavior? Is medical treatment more effective than jail time? From a legal point of view, what is the the difference between kleptomania and burglary?

In his book, America Anonymous, Benoit Denizet-Lewis quotes lead study author Jon Grant: “With all addictions, a person’s free will is greatly impaired, but the law doesn’t want to entertain that.... Why shouldn’t someone’s addiction be considered as a mitigating factor, especially in sentencing?”

Photo Credit: Napo Hampshire Branch

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Addiction: Gwyneth Puts the Question

Is "chemical dependency" too narrow a concept?

Ordinarily, a post on this blog would not begin: "Addiction: What does Gwyneth have to say about it?"

But today, it does.

Addiction: What does Gwyneth have to say about it?

Well, I'll tell you. That came up recently on Ms. Paltrow's new health web site, Goop.com. Specifically, Paltrow set before a group of "sages" the following questions:

"Have you ever loved somebody who drinks until their usually charming personality is usurped by a monster? Or discovered that someone you adore is throwing up after every meal? Or wondered if you are stuck in a feedback loop of tension and unrest because you need the adrenaline of stress to function? How do we become enslaved by addiction? What is addiction?"

Here are some excerpts from the responses, which were many and varied, but overall quite fascinating:

Episcopal Priest Cynthia Bourgeault:

“As recent neuroscience has demonstrated, every habit lays down its own neural pathway i.e., it carves its own rut track in the brain--and the inertia around these pathways is considerable. The disruption of ANY happy pathway brings with it considerable discomfort and resistance. So you’re quite right in lumping together habits and addictions; the difference between them is more one of degree than of kind. One can be addicted to coffee, alcohol, porridge for breakfast, endorphins, heroin, meditation, exercise, sex or God! The difference is only that the classic ‘chemical dependency addictions’ add to our already full plate of cognitive and emotional distress and at the interruption of a habit, physiological distress as well.”

Deepak Chopra:

“Human beings become addicted because we are complex. Addictions are like a jigsaw puzzle where all the pieces are on the table but no one quite knows what the whole picture should be. Here are the main pieces:

1. The addictive substance or behavior
2. Brain chemistry
3. Social pressure for and against addiction
4. A vulnerable psyche
5. The X factor

Drugs change the brain by affecting receptors in your brain cells that exist for pleasure and the cessation of pain. If you take any substance long enough, the brain adapts by altering its receptors, and then the trouble begins. The burned-out addict is actually a burned-out brain.... Addicts can be brought to healing and self-knowledge. They can be weaned off substances and their brains (slowly) returned to a more balanced chemical state. Yet there remains the X factor. Call it a predisposition, karma, the unconscious or a perverse urge to self-destruction. For some addicts, the journey of addiction is existential."

Kabbalist Michael Berg:

"There is a saying, 'if today I have one then tomorrow I want two, and if today I have 100, then tomorrow I will want 200.' The addiction battles many of us fight are here to push us toward finding a deeper fulfillment, which comes from connecting to the real things in life: love, compassion, sharing and revealing our true essence.”

Psychologist Karen Binder-Brynes:

“I tend to gravitate toward a multi-leveled, biopsychosocial model as a theorem for explaining addiction. Although historically addictions were usually regarded in terms of psychoactive substances, such as drugs, that when ingested caused chemical alterations in the brain, the current thinking has broadened to include other compulsive behaviors such as pathological gambling, shopping, eating, etc....Why some people become more prone to addictions than others is a matter of great debate. The arguments range from a strict “disease” model suggesting a biochemistry of addiction, perhaps with genetic basis, to a “choice” model (Szasz, 1973) suggesting that the addict is a person who chooses a taboo substance or behavior to a low-risk lifestyle.... Denial and shame are often deterrents to seeking assistance. Never lose hope that you or a loved one can get help and beat an addiction. People can make miraculous recoveries from the powerful grip of addiction. I have seen it!”

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If You’ve Seen One Drug Czar....

The language of drug politics.

In a May 29 post on his Salon blog, Drug WarRant, Peter Guither deftly deconstructs the language of drug czarism, and its corrosive effect on rational dialog over drug policy:

--So far, there has been little or no discussion of marijuana from the newest drug czar, Obama’s man Gil Kerlikowske, now director of the White House Office of National Drug Control Policy. “I've got to admit that it's a nice change from the reefer madness reign of Walters,” Guither writes. “Maybe Kerlikowske is following my mother's age-old advice... If you can't say something nice (and he can't by law), then don't say anything at all.”

--Prescription drugs are “the new crack.” To his credit, Guither worries about this new emphasis, and where it is likely to lead: “The prescription drug "epidemic" will be an excuse to further crack down on diversion, which will end up continuing the focus on pain doctors who prescribe large amounts of pain medication, with DEA agents deciding they know more than doctors. The result will be even more people suffering, unable to get the pain medication that actually makes life possible for thousands of people.”

--Drugs cause crime. As proof, Kerlikowske cites the statistic that half the men arrested in ten major U.S. cities tested positive for some sort of illegal drug, as reported by USA Today. From this data, Kerlikowske concludes that there is “a clear link between drugs and crime.” Guither notes that “There's a lot of reasons that people who have been arrested would tend to test positive for illicit drug use than the general population..... A very large percentage of arrests are for drug crimes, which naturally skews the population. Then there are socio-economic factors and a lot more.”

However, what the new drug czar is implying, writes Guither, is that drugs cause crime. “But implying that drugs cause crime is a lie. And that's what drug czars do.”

Kerlikowske has also come out in favor of greater use of drug courts as an alternative to prison sentences. Bill Piper, director of national affairs for the Drug Policy Alliance Network, told USA Today he agreed that drug use should be seen as a public health issue, but that “people shouldn't have to get arrested to get treatment."

Photo Credit: Lifehype Magazine

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Cocaine Treatment Drug Flunks the Test

Vigabatrin fails in clinical trials.

It wasn’t the Last Best Hope, or the Holy Grail, but it had stirred up great excitement as possibly the first effective treatment medication for cocaine addicts. So it was nobody’s idea of happy corporate news when Catalyst Pharmaceutical Partners of Coral Gables, Florida, announced last Friday that its drug Vigabatrin, known as CPP-109, had failed as a cocaine treatment in Phase II clinical trials.

Brian Bandell of the South Florida Business Journal reported that during the 12-week study, the drug did not help drug addicts stay cocaine-free, compared to a placebo group.

In a press release, CEO Patrick McEnany said “we are not ready to abandon our view that CPP-109 has the potential for use in treating cocaine addiction, which still represents a significant unmet medical need.” Vigabatrin is sold overseas as Sabril by a Belgian company, but is not approved for use in the United States. Earlier animal testing and two limited early-stage studies on human addicts in the 2003-2004 had convinced the company that Sabril diminishes cravings for stimulants. It may also blunt the euphoric effect of meth and cocaine.

Catalyst’s stock, traded on NASDAQ, fell 57 percent to 90 cents a share on the news. The company started operations in 2006. According to the Miami Herald, Catalyst raised $21 million in its initial public offering on a single drug “with huge potential.” McEnany told the Herald he was uncertain why the drug had failed, but added that “cocaine addicts are a very unpredictable group.” He said the company would be analyzing the data over the next few months. “The data is immense. We’re trying to get our arms around it.”

Ovation Pharmaceuticals (now Lundbeck, Inc.), which hopes to market the drug under the trade name Sabril in the U.S., had also promised to push forward with clinical trials.

Edward H. Nash of Merriman Curhan Ford, a San Francisco financial research firm, downgraded Catalyst’s stock on Friday. “Unfortunately, we do not believe Catalyst has the opportunity and the right technology in hand,” he said, adding that the firm “no longer represents a viable biotech investment.”

Vigabatrin attracted initial interest because of its ability to dampen neuronal responses to excess amounts of dopamine produced by chronic cocaine use. As noted earlier (FDA Puts Coke/Meth Treatment on Fast Track), the U.S. Food and Drug Administration (FDA) had given “Fast Track” designation to vigabatrin, an anticonvulsant, for evaluation as an anti-craving drug for cocaine and methamphetamine addiction.

However, potential side effects threatened to derail the trials almost before they started. The FDA was already on record with its concern about reports of retinal damage in patients overseas. (See “Drug For Cocaine Addicts Causes Weight Loss”).

Graphic Credit: Addiction Treatment Forum

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Study Probes Military’s “Culture of Binge and Underage Drinking”

Problems continue after active duty.

A University of Minnesota study found a level of underage binge drinking in the military that the study’s lead author called “dangerous to both the drinkers and those around them.” Mandy Stahre, the epidemiologist who headed up the study, said the results were disturbing, “given the equipment and dangerous environments commonly encountered by active duty military personnel.”

The article, “Binge Drinking Among U.S. Active-Duty Military Personnel,” appears in the March issue of The American Journal of Preventative Medicine. Researchers at the University of Minnesota and the Centers for Disease Control analyzed the results of an anonymous health survey of 16,000 military personnel conducted in 2005. (The group defined binge drinking as four or more drinks in one session for men, and three or more drinks for women.) In an interview with a University of Minnesota radio station, Stahre said that 43 percent of the active respondents reported binge drinking in the past month. Stahre said the figure represents “a total of 30 million episodes of binge drinking, or 32 episodes of binge drinking per person per year.” 5 million of those episodes, Stahre said, involved active duty personnel under the age of 21.

These figures are scarcely surprising, but the implications are no less nerve-wracking. Stahre said military binge drinkers were five times more likely to drive while drinking, compared to non-binge drinkers. Moreover, binge drinking is chronically under-reported in the military, Stahre said, cautioning that the conclusions in the study “may be conservative.” She called for an increase in alcohol excise taxes, stricter military enforcement of a minimum drinking age of 21, and “greater efforts at screening and counseling for alcohol misuse” in the military.

What can a study of this nature accomplish? Stahre said she hopes it will provide “further evidence that binge drinking is a major public health problem in the U.S. and in the military. And the military may be in a unique position to help reduce this problem in the general population, particularly given that nearly 13 percent of U.S. adults report current or past military service.”

Last summer, a study published in the August 13 issue of the Journal of the American Medical Association (JAMA) demonstrated that Reserve and National Guard combat personnel returning from the wars in Iraq and Afghanistan were at increased risk for “new-onset heavy drinking, binge drinking and other alcohol-related problems.” The article also found a strong association between posttraumatic stress disorder (PTSE) and substance abuse among returning veterans.

photo credit: http://navyformoms.ning.com/

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Marijuana Legalization Is Coming, Says Pollster

Nate Silver reads the numbers.

Last month, I missed this crucial article, penned by the inestimable Nate Silver. Silver, you may recall, is the numbers nerd who shamed all conventional pollsters during the run-up to the presidential election—and then proceeded to predict the Electoral College vote with perfect accuracy.

So when Nate Silver takes a hard look at statistics having to do with American sentiment about marijuana legalization, it behooves us to take his findings seriously. In an April 5 post called “Why Marijuana Legalization is Gaining Momentum,” on his FiveThirtyEight.com blog, Silver lays out the inevitable chronology.

“Back in February, we detailed how record numbers of Americans -- although certainly not yet a majority -- support the idea of legalizing marijuana,” Silver writes. “It turns out that there may be a simple explanation for this: an ever-increasing fraction of Americans have used pot at some point in their lifetimes.”

According to Silver’s number crunching, the peak pot year in anyone’s life is on or about age 20—duh—with most people reaching some sort of usage plateau between the ages of 30 and 50. The important point, Silver writes, has to do with the fraction of adults who have used. This is a dual-peaked distribution, “with one peak occurring among adults who are roughly age 50 now, and would have come of age in the 1970s, and another among adults in their early 20s. Generation X, meanwhile, in spite of its reputation for slackertude, were somewhat less eager consumers of pot than the generations either immediately preceding or proceeding them.”

Furthermore, reports of lifetime usage drop off precipitously after 55. “About half of 55-year-olds have used marijuana at some point in their lives, but only about 20 percent of 65-year-olds have.”

What does this tell us? While there is certainly not an exact correspondence between people who have smoked pot and people who support legalization, Silver ventures to guess that the link is fairly strong. What we have here, he argues, is a “fairly strong generation gap when it comes to pot legalization. As members of the Silent Generation are replaced in the electorate by younger voters, who are more likely to have either smoked marijuana themselves or been around those that have, support for legalization is likely to continue to gain momentum.”

Photo: Minnesotaindependent.com

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