Been doing some publicity for my book, The Chemical Carousel. This radio interview with Diego Mulligan on KSFR in Santa Fe is from August 26th, and it turned out to be reasonably listenable.
In August 1979, I took my last drink. It was about four o'clock on a Saturday afternoon, the hot sun streaming through the windows of my little carriage house on Dickens. I put a glass of scotch and soda down on the living room table, went to bed, and pulled the blankets over my head. I couldn't take it any more. ---------- At about this time I was reading The Art of Eating, by M. F. K. Fisher, who wrote: "One martini is just right. Two martinis are too many. Three martinis are never enough." ---------- In my case, I haven't taken a drink for 30 years, and this is God's truth: Since the first A.A. meeting I attended, I have never wanted to. Since surgery in July of 2006 I have literally not been able to drink at all. Unless I go insane and start pouring booze into my g-tube, I believe I'm reasonably safe. So consider this blog entry what A.A. calls a "12th step," which means sharing the program with others. There's a chance somebody will read this and take the steps toward sobriety. ---------- I know from the comments on an earlier blog that there are some who have problems with Alcoholics Anonymous. They don't like the spiritual side, or they think it's a "cult," or they'll do fine on their own, thank you very much. The last thing I want to do is start an argument about A.A.. Don't go if you don't want to. It's there if you need it. In most cities, there's a meeting starting in an hour fairly close to you. It works for me. That's all I know. I don't want to argue with you about it. ---------- I've been to meetings in Cape Town, Venice, Paris, Cannes, Edinburgh, Honolulu and London, where an Oscar-winning actor told his story. In Ireland, where a woman remembered, "Often came the nights I would measure my length in the road." I heard many, many stories from "functioning alcoholics." I guess I was one myself. I worked every day while I was drinking, and my reviews weren't half bad. I've improved since then. ---------- The God word. The critics never quote the words "as we understood God." Nobody in A.A. cares how you understand him, and would never tell you how you should understand him. I went to a few meetings of "4A" ("Alcoholics and Agnostics in A.A."), but they spent too much time talking about God. The important thing is not how you define a Higher Power. The important thing is that you don't consider yourself to be your own Higher Power, because your own best thinking found your bottom for you.
A group of Canadian researchers has demonstrated the truth of a practice commonly used in European countries like The Netherlands and Switzerland: Heroin can be an effective treatment for chronic, relapsing heroin addicts. Published in the New England Journal of Medicine, the study is “the first rigorous test of the approach performed in North America,” according to a New York Times article by Benedict Carey.
In the study, 226 patients were randomly assigned to oral methadone therapy or injectable diacetylmorphine, the primary active ingredient in heroin, over a 12-month period. The “rate of retention in addiction treatment” was 88 percent for the diacetylmorphine group, compared to 54 percent for the methadone group. The “reduction in rates of illicit-drug use” was 67 percent for the heroin group and 48 percent for the methadone group.
Using doctor-prescribed heroin has two advantages, some researchers believe. It gets around the problem of addicts who don’t like the effect of methadone and therefore don’t take it as prescribed. Moreover, as European countries have demonstrated, it brings treatment-resistant opiate addicts into regular contact with physicians and medical treatment professionals, thereby keeping them away from drug dealers and out of jail.
The downside is equally obvious. It keeps addicts hooked on heroin, and may even exacerbate their addiction by providing a higher quality drug. Furthermore, it runs against the prevailing North American notion that heroin should be illegal, period. Certainly, doctors have no business prescribing it to active addicts, critics argue. Furthermore, the risk of overdose or seizure is always present.
According to senior author Martin Schechter of the University of British Columbia’s School of Population and Public Health, as quoted in the New York Times: “The main finding is that for this group that is generally written off, both methadone and prescription heroin can provide real benefits.”
In an editorial accompanying the journal article, Virginia Berridge of the London School of Hygiene and Tropical Medicine cautioned that “the rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”
At the end of the 19th Century in America, opium was widely prescribed as a cure for alcoholism. For opium addiction, the treatment was often alcohol.
They are not necessarily the poor, the desperate, or the weak-willed. A National Institute of Drug Abuse (NIDA) study by Dr. Michael Nader and coworkers at Wake Forest University demonstrates that they are likely to be people with innately low levels of dopamine receptor availability. This flaw, possibly genetic, renders them more sensitive to the rewarding effects of cocaine. Put simply: Individuals with less dopamine naturally available in the brain may have an inherited predisposition for cocaine addiction. [Brains Scans at right: Dopamine receptor availability in yellow falls markedly after 6 and 12 months of cocaine self-administration.]
Dopamine D2 receptors, a crucial part of the brain’s primary reward system, are normally occupied by dopamine molecules—although at any given moment, many of the receptors are empty and remain available until a stimulus like cocaine increases dopamine levels and the empty receptors help mop up the excess. Dr. Nader believes that lower D2 receptor availability could be a precursor of addiction to drugs like cocaine. “Perhaps an individual with low availability gets a greater kick from cocaine because the drug-induced dopamine release stimulates a greater percentage of their receptors,” Dr. Nader told staff writer Lori Whitten in a recent edition of NIDA Notes. “Another possibility is that the drug prompts some individuals’ brain cells to release dopamine in particularly high quantities that are sufficient to fill the great majority of vacant D2 receptors, and this augments the high.”
An obvious question hangs over studies of this kind: Are the D2 receptor differences innate, or do they represent changes induced by drug use? To answer this question, Dr. Nader’s team worked with rhesus monkeys in order to take D2 density measurements with PET scans before the animals had ever been exposed to cocaine. Sure enough, the monkeys with the lowest baseline level of D2 receptor availability went on to self-administer cocaine at much higher rates than their D2-normal compatriots. Offering food to the low-dopamine animals did not prove to be a substitute of cocaine, so the effect does not appear to increase all kinds of reward.
There is no doubt that the use of cocaine itself does lead to a rapid reduction of available dopamine receptors, as the brain seeks to achieve a new equilibrium in the face of regular dosings of dopamine-active chemicals. In five monkeys that self-administered cocaine for a year, three of the monkeys showed a strong recovery of receptor availability after only a month of abstinence. However, two of the monkeys showed slower recovery of previous D2 receptor levels. Dr. Cora Lee Wetherington, a neuroscience researcher at NIDA, said that the research thus posed the question of whether people whose dopamine receptor levels recover more slowly during abstinence might prove to be those most likely to relapse.
Medications that increase D2 receptor availability without themselves being highly rewarding represent another promising avenue for treatment. The drugs most likely to help, Dr. Nader thinks, are drugs that act indirectly on dopamine levels through alterations of serotonin and GABA levels in the brain. In addition, researchers are pursuing environmental enrichment experiments in animals and human subjects. Some studies have shown that enriching the environment results in greater D2 receptor levels, Dr. Nader says.
Let's face it: Despite all the folk remedies--ginseng, prickly pear extract, peanut butter, miso soup, and Vitamin B6, there really is no cure for a hangover except more alcohol.
However, there are things you can keep in mind when contemplating a night of serious drinking. What you do while you are drinking can mitigate or exacerbate the effects of the Day After. The following list was adapted from a post by the folks over at the Nursing Schools Network and Directory and used with their kind permission.
--If you're in it for the long haul, consider alternating an alcoholic beverage with a non-alcoholic drink. The reward for this is continual hydration, which helps offset the tendency of alcohol molecules to replace water molecules in the cells.
--Choose your liquor carefully. Red wine and cheap dark booze have more congeners, which are organic molecules that can contribute to a hangover. ML01, a genetically-modified yeast, is being touted as a way of cutting back on the headaches commonly associated with a night of red wine.
--Keep Count. When you lose count, it's time to stop. Know your measure.
--Skip the Sugar. Sweet drinks mess with your blood sugar level even more than regular drinks.
--Keep the smoking to a minimum. You'll need your oxygen come morning.
--Don't diss the bar and cocktail snacks. Foods high in fat well help absorb excess alcohol.
--Skip the Tylenol and Ibuprofen before going out. They probably won't help, and the combination with alcohol taxes the liver.
--Drink water. And keep drinking water. Morning-after dehydration causes many of a hangover's lingering effects.
--Stop drinking an hour before you go to bed. Better to nod off than to pass out, and you will have a better chance of sleeping through the night.
The alcoholic in A.A. and the cocaine addict on the street share a common appetite. This shared appetite, and the behaviors that come with it, are played out in a larger social context. For a practicing addict, the world is filled with risks, and some of these risks are invariably connected with the web of prohibitive laws and legislation governing the sale and use of addictive drugs. The movement for drug legalization, which began to coalesce about twenty years ago, is a collection of public voices spanning a variety of political and cultural points of view. Many prominent voices in the ranks of the legalization movement are public officials who have become disillusioned with the current state of affairs, and are now convinced that the present system is doing more harm than good.
The essential argument against legalization is that some drugs are not bad because they are illegal—they are illegal because they are bad. If alcohol and tobacco are legal, and we are only now beginning to come to terms with the health implications of that historical decision, it is insane to add heroin and marijuana and everything else to the list.
Harvard psychiatrist Robert Coles, a specialist in working with children, holds that legalization would be tantamount to a “moral surrender of far-reaching implications about the way we treat each other.” Such an act, Coles believes, would signal an acceptance of the pursuit of hedonism for its own sake.
However, the medicalization of addiction requires people to consider the possibility that drug abuse is less of a problem than drug crime--and that drug crime can be attacked differently. Very few of legalization’s adherents can be considered “pro-drug.”
Drug prohibition itself is a major part of the reason why the more potent and problematic refinements of plant drugs keep taking center stage. Since crack cocaine is more potent, more profitable, and more difficult to detect in transit, it replaces powdered cocaine, which, in its turn, replaced the chewing of cocoa leaves. Similarly, in the old days bootleggers switched from beer to hard liquor, just as modern international drug dealers switch from cannabis to cocaine whenever the U.S. enforcement engine lumbers off in the direction of marijuana interdiction and eradication. Is there anyone prepared to argue that the gruesome scenes along the Mexican border, as rival militias battle it out for control of the drug trade and the U.S. tries to interdict it, is somehow helping alcoholics and other drug addicts find their way to abstinence?
While the fact of addiction may be beyond the individual addict’s control, addicts nonetheless have a responsibility to do something about their disorder. What would we think of a diagnosed diabetic who told us there was no point in trying to treat his disease; it was all genetic and physical and therefore a waste of time to treat, and impossible to overcome? We would think they were nuts.
From a legal point of view, the biochemical model of addiction does not change the basic proposition that, with few exceptions, people must be held responsible for the crimes they commit in connection with drug or alcohol use. But simple possession should rarely be one of those crimes.
In time, it may be possible to separate out the criminals suffering from concrete biochemical abnormalities, so that they can receive medical treatment in addition to, or in lieu of, a prison sentence.
In a recent article for Scripps Howard News Service, Dr. Barton Goldsmith, a family therapist in California, listed "10 Reasons to Kick Addictions."
Nothing in the doctor’s list is shocking, or especially revelatory, or novel. But what caught my eye about his list was the simplicity with which Goldsmith states certain common facts about abstinence--facts that struggling alcoholics and other drug addicts often tend to deny or “forget.”
Here is a brief synopsis of some of Goldsmith’s observations:
--“Your friends and family will be happy to see and count on you again.”
In part, that’s because you will no longer being blaming them for your own problem.
--“You will like yourself better.”
Say goodbye to a whole lot of guilt and misdirected anger.
--“Your body and mind will feel awake and alive once again. One reason people continue to drink and use is because they physically experience the withdrawals of the substance and need to continue the addiction just to "feel normal.’”
The idea of a certain subset of people using drugs to “feel normal” is one of the crucial insights into modern research on addictive disorders.
--“You will make the world a tiny bit better. Just by being a little nicer, as well as extending a helping hand to others, (which will help you stay sober), you will make this world a better place.”
This may sound a bit twee, but it is a guiding principle in Alcoholics Anonymous and other non-profit self-help groups. Committing charitable acts for others is a classic way of seeking to go beyond the boundaries of the commanding self.
--“Others can once again trust you. An added benefit is that you can also trust yourself again, because you have gotten through one of the most frightening things in life.”
If you can do this one thing, you can do practically anything.
--“You will have more joy in experiencing a day rather than sleeping through it.”
You will also find that you have considerably more time available to you. In the early going, that can be a challenge, but it eventually becomes a wonderful thing.
Winner of the 2012 College on Problems of Drug Dependence/NIDA Media Award
"The most comprehensive single work on the topic for the lay reader.... The Chemical Carousel is an important look at the contemporary science of the addicted brain." --Jonathan Taylor, EROWID
"A savvy, big-hearted exploration of the latest investigations into addiction science."--Kirkus Discoveries
Notes, bibliography, index. 472 pages. ISBN 1439212996. Published by BookSurge. Available at Amazon. Available in Kindle format. For more, see TheChemical Carouselweb site.
addiction 
drugs
alcoholics anonymous
dopamine
smoking
