A (Belated) Review of "The Los Angeles Diaries"

A powerful—and true—memoir of addiction.

I’ll admit it: I don’t like drug memoirs. I didn’t like drug memoirs even before James Frey blew up the whole genre by telling a heartfelt story about addiction that turned out to be a tissue of lies.

But The Los Angeles Diaries by James Brown transcends all that. I’ve never read a better true story about addiction. It’s also one of the best modern autobiographies I have ever read, addiction notwithstanding. In addition to having been an alcoholic and a meth head, James Brown is a very talented writer, the author of four novels, and it shows.

First published in 2003, The Los Angeles Diaries is a spare, utterly harrowing account of the author’s experience in a family marked by a history of virulent alcoholism. Brown’s unvarnished truth-telling about addiction is evident early on: “I know there’s no excuse for getting drunk when you’re supposed to be home with your family and I wish knowing this would stop me from doing it. I wish that’s all it took. That I could will it to happen. But it doesn’t work that way, it never has, and in my state of mind, at this particular moment, I can’t imagine living without it.”

While offering up memorable sketches of his boyhood in Los Angeles, Brown paints a devastating picture of the “denial and rage” that characterize full-blown addiction. He deals with the suicide of family members, divorce, the neglect of his children—all of it caused by addiction—without a shred of self-justification. It is, he writes, “a constant quest for more when there can never be enough.”

Interspersed throughout are the author’s mordantly funny adventures in the screen trade, as book after book is optioned for the movies, taken apart and ultimately scrapped before reaching the screen. However, we are never far from the author’s chilling revelation: “Never underestimate the power of denial.”

I can’t improve on the review that appeared in Washington Post Book World: “It’s the balance of agony and grace, of course, that makes life so ferociously interesting. Brown has perfectly captured that balance in his unpretentious, very profound book.”

Inspiring, witty, and bleak, all at the same time, James Brown’s book will appeal to anyone with an interest in addiction—and anyone who enjoys tough, spare prose.

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E-Cigarettes: Another Look

FDA remains conflicted over safety concerns.

The Food and Drug Administration (FDA) issued a controversial Safety Alert over electronic cigarettes, known as “e-cigarettes,” then held a press conference to explain itself. The agency’s muddled response to the issue has prompted increased advertising and online sales for Asian e-cigarette manufacturers, as well as a countering burst of criticism about the newest nicotine delivery system under the sun.

The FDA conducted a small-scale lab analysis of two different brands of e-cigarettes, and found “carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.” The FDA’s Division of Pharmaceutical Analysis also found evidence of small amounts of cancer-causing nitrosamines. “These products do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes,” the agency bulletin said. Therefore, the agency “has no way of knowing, except for the limited testing it has performed, the levels of nicotine or the amounts or kinds of other chemicals that the various brands of these products deliver to the user.”

The agency did not seek to ban e-cigarettes, as Canada did in March. However, in a written statement to CNN in March, the FDA admitted it had been detaining or refusing importations of electronic cigarettes for more than a year.

Debate has raged recently over the safety of e-cigarettes, which are battery-operated cigarette substitutes that technically dodge no-smoking bans, since no actual smoke is emitted. When a smoker inhales on the e-cigarette, the battery warms liquid nicotine stored in a plastic filter, producing a smokeless but inhalable form of synthetic nicotine. Upon exhalation, there is a small puff of vapor that quickly evaporates (See my earlier post, "E-Cigarettes and Health").

Michael Levy, director of compliance for the FDA’s division of drug evaluation and research, said he believes the products are illegal. However, “There is pending litigation on the issue of FDA’s jurisdiction over e-cigarettes,” he said.

Proponents of the e-cigarette claim that the devices are self-evidently safer than smoking cigarettes, and can help people stop using tobacco products. Critics respond that the safety of synthetic nicotine drug-delivery devices has not been established. Moreover, the range of fruit and candy flavors offered by e-cigarette manufacturers suggests to Jonathan Inickoff of the American Academy of Pediatrics Tobacco Consortium that the devices seem “tailor-made to appeal to kids,” while addicting them to nicotine and turning them into future cigarette smokers.

With half a million Americans dying prematurely each year from smoking, according to figures from the Centers for Disease Control (CDC), some doctors and tobacco researchers have pointed out that nitrosamines are also found in everything from nicotine patches to bacon. According to one researcher, “FDA should be encouraging, not maligning the manufacture and sale of electronic cigarettes, and working with manufacturers to assure the highest possible quality control.”

For a robust discussion of the e-cigarette question, see www.e-cigarette-forum.com


Photo Credit: www.politech.wordpress.com

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Treating Addicts Like Human Beings

Addiction stigma is alive and well.

Over at ScienceBlogs, Abel Pharmboy of Terra Sigillata blogged about astronaut Buzz Aldrin’s long struggle with depression and alcoholism. He also noted how he “hadn't really thought about our relative lack of discussion of substance abuse and chemical dependence in the context of scientific training and academia.”

In response, a student left this comment:
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“Thank you so much for this post. I am a recovering drug addict and am in the process of applying to graduate programs. I have a stellar GPA, have assisted as an undergraduate TA, and have been engaged in research for over a year. I also have felony and was homeless for 3 years. I don't hide my recovery from people once I know them, but I sometimes, especially at school, am privy to what people think of addicts when they don't know one is sitting next to them. It scares me to think of how to discuss my past if asked at an admissions interview. Or whether it will keep me from someday working at a university. I've seen a fair amount of posts on ScienceBlogs concerning mental health issues and academia, but this is the first I've seen concerning humanizing addiction and reminding us that addiction strikes a certain amount of the population regardless of status, family background or intelligence. I really appreciate this post. Thank you.”
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Two quick points: This is how bloggers in the field of health and medicine get their reward. Secondly--and obviously--the addiction stigma lives on-- (See my post, “Would you live next door to a drug addict? ). It is hard to imagine these anxieties stemming from someone with diabetes or sickle cell anemia. These days, we can also add unipolar depression and bipolar illness to the list of disorders that have recently emerged from the closet, so to speak.

If only the same reasoned compassion could be brought to bear on addiction one day.

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The Cybernetics of Alcoholics Anonymous

Is there a secular Higher Power?

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

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

A.A.’s contention that there is a power greater than the self can be seen in cybernetic terms—that is to say, in strictly secular terms. As systems theorist Gregory Bateson concluded long ago after an examination of A.A principles in Steps to an Ecology of Mind:

“The ‘self’ as ordinarily understood is only a small part of a much larger trial-and-error system which does the thinking, acting and deciding... The ‘self’ is a false reification of an improperly delimited part of this much larger field of interlocking processes. Cybernetics also recognizes that two or more persons--any group of persons--may together form such a thinking-and-acting system.”

Therefore, it isn’t necessary to take a strictly spiritual view in order to recognize the existence of some kind of power higher than the self. The higher power referred to in A.A. may simply turn out to be the complex dynamics of directed group interaction, i.e., the group as a whole. It is a recognition of holistic processes beyond a single individual—the power of the many over and against the power of one. Sometimes that form of submission can be healthy. Many addicts seem to benefit from being in a room with people who understand what they have been through, and the changes they are now facing. It is useful to know that they are not alone in this. “The unit of survival—either in ethics or in evolution—is not the organism or the species,” wrote Bateson, “but the largest system or ‘power’ within which the creature lives.” In behavioral terms, A.A. enshrines this sophisticated understanding as a first principle.

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

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The Drug Myth That Will Not Die

Brits still pushing marijuana/schizophrenia connection.

If at first you don’t succeed....

The UK Telegraph reports that scientists at the Institute of Psychiatry in King's College London injected (yes, injected) 22 healthy men with high potency THC (not marijuana), and recorded the results. According to the leader of the study team, Dr. Paul Morrison, "These findings confirm that THC can induce a transient acute psychological reaction in psychiatrically well individuals."

The Telegraph article said the researchers found that the "extent of psychotic reaction" was not related to "the degree of anxiety or cognitive impairment" in the men.

Mary Brett, vice president of Europe Against Drugs, said: "This shows that anyone who is healthy can become psychotic by smoking cannabis. They don't already have to have a mental illness. Healthy people can become psychotic."

Well, no. Observant readers will no doubt find all of this familiar: More than a year ago, a national hysteria over “skunk” cannabis was sparked in Great Britain when the University College of London produced a study purporting to show that strong pot was literally driving people crazy. The lunacy peaked with Prime Minister Brown’s description of new strains of cannabis as 'lethal.' At the time, the London Guardian reported that "Whitehall's own panel of experts has concluded that increased marijuana use has not been matched by a corresponding rise in mental illness."

Against the advice of her own drug advisers, then-Home Secretary Jacqui Smith restored cannabis from class C to the “harder” class B status because of mental health concerns. British health authorities maintained that "skunk" cannabis was linked to the onset of schizophrenia. Since no one knows what, exactly, causes schizophrenia, and since recent findings continue to point toward genetic causes, this was a triply astonishing claim.

Colin Blakemore, a prominent professor of neuroscience at the Universities of Oxford and Warwick, tackled the issue of “pot so strong it can make you psychotic” in an article for the Guardian:

“And what of the alarming stories of horrifying powerful "skunk"? Some newspapers have told us that the level of THC, the active ingredient, in street cannabis today is 20 or 30 times higher than 10 years ago. That would be rather surprising, given that THC content was 7 per cent on average in 1995. In reality, two studies, due to be published later this year, concluded that the average THC content has doubled.”

With the latest report, King’s College has once again proven that if you inject someone with massive doses of THC, he or she will find the experience dramatically unpleasant. So do monkeys. Years ago, when researchers injected test monkeys with synthetic THC approximately one hundred times more powerful than the naturally occurring substance, the monkeys fell down and didn’t move. This was dramatic proof of... nothing in particular. But it was sensational and it made headlines.

Meanwhile, the solid fact that a minority of marijuana users experience strong withdrawal symptoms when they abstain—an important and verifiable scientific finding—remains largely unknown to the general public.


Photo Credit: http: www.healthjockey.com

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The History of Prozac

How a pill for alcoholism became a blockbuster antidepressant.

Back in the 1970s, while doing research on antidepressants at Eli Lilly and Co., several organic chemists had been working on identifying new compounds that showed activity at serotonin receptor sites. The Lilly researchers came across Compound 82816, which very cleanly and very selectively blocked the reuptake of serotonin, and it did so without effecting any other neurotransmitter system at all. Clinical trials of compound 82816, chemically known as fluoxetine, continued into the early 1980s. At the same time, compounds with profiles similar to fluoxetine were being tested at various universities and drug firms.

The new drugs—with names like citalopram, zimelidine, fluoxetine, and fluvoxamine—were extensively investigated in animal models, and along the way, investigators made some unexpected discoveries. European investigators had shown that one serotonin uptake blocker in particular—zimelidine—seemed to reduce the self-administration of morphine and alcohol in addicted rats. A good part of the research began to center on three serotonin-enhancing compounds—zimelidine, citalopram, and fluoxetine.

Since rats decreased their administration of both alcohol and morphine when given zimelidine, and since low serotonin is a strong potential marker for human alcoholics and other addicts, Dr. Claudio Naranjo and Dr. Ed Sellers, along with their colleagues at Toronto’s Addiction Research Foundation, began testing zimelidine on heavy drinkers. Characterized as “early stage problem drinkers,” the test subjects showed a slight but noticeable decrease in the number of drinks consumed per day when they took zimelidine. There was also a consistent increase in the number of days the drinkers were completely abstinent. (Zimelidine was later withdrawn from use worldwide because of immune system side effects.)

As research continued, it became consistently evident that drugs capable of increasing concentrations of brain serotonin tended to cause large numbers of animals and human test subjects to drink less alcohol. But it wasn’t simply an aversive reaction at work, as in the case of Antabuse. People in the clinical trials still drank, but in many cases, the urge to drink seemed to diminish, and while the decrease was modest, it was measurable.

Moreover, rats given serotonin-enhancing drugs selectively cut back on carbohydrates, and lost weight. Ultimately, Lilly’s investment centered on flouxetine. In late 1987, Fortune magazine’s article on fluoxetine reported that “the prospect of making people both happy and thin has helped Lilly stock rise 28 per cent this year.”

The prospect of making alcoholics drink less, or stop drinking altogether, was a less publicized but equally attractive notion. Lilly already had a trade name picked out for fluoxetine. They were calling it Prozac.

A year after its introduction as an antidepressant, Prozac was a runaway success. Prozac quickly proved the existence of a huge potential market for serotonin reuptake inhibitors. Research continued on the diminished craving response that the serotonin uptake blockers seemed to produce in certain drinkers. The drug’s allure as an anti-craving medication for alcoholism and other possible addictions remained an open secret among researchers. Lilly wasn’t saying much in public about it, and with sales booming for fluoxetine as an antidepressant, the company could afford to concentrate on that indication. In the end, Lilly chose not to pursue further investigation of Prozac’s ability to reduce drinking and initiate weight loss.

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

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The Changing Face of Addiction Counseling

Most addiction workers are no longer addicts themselves.

For years, addiction therapists and counselors tended to be people who had been addicts themselves. These days, not so much. Drug and alcohol counselors who have experienced addiction firsthand represent a dwindling slice of the addiction therapy community.

But does it matter? A recent study by William L. White for the Great Lakes Addiction Technology Transfer Center and the Philadelphia Department of Behavioral Health and Mental Retardation Services suggests strongly that it does not. The study, “Peer-based Addiction Recovery Support” (PDF), concluded that “Studies of addiction counselors in the United States have not found that addiction counselors in recovery are more or less effective than addiction counselors who are not in recovery....”

This is a good thing, if true, since the report also documents that the percentage of counselors in personal recovery within the “addiction workforce” has fallen from a high of almost 70 % in the early 1970s to about 30% as of 2008. It is unclear what is behind this trend, given that “studies of the personalities of recovering men and women working as addiction counselors reveal few differences from counselors without addiction recovery backgrounds.” White suggests that as the “educational levels of people in recovery have increased,” the perceived differences between counselors in recovery and those not in recovery “diminish or disappear completely.”

The bottom line for counselors: “The key determinants of effectiveness do not include recovery status.”

Nonetheless, White argues, attitudes toward workers in addiction treatment continued to be “plagued by misconceptions and stereotypes that are contradicted by most scientific studies. The prevailing view is that the majority of addiction counselors are in recovery; that most recovering counselors do not have college or advanced degrees; and that recovering counselors differ in their attitudes beliefs, knowledge, skills, and effectiveness” from counselors who have never experienced addiction.

Nowadays, as it turns out, none of these views is correct.

White’s paper also reiterated the sad fact that recovering addicts who work in addiction treatment “are paid less than people not in recovery for comparable work, even when their educational credentials are equal.”


Photo Credit: US No Drugs

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