Moonshine Makes a Comeback

But it’s still illegal.

The question has always been straightforward. Distilled to its essence, if you’ll pardon the pun: Why is it legal to brew up to 300 gallons of beer, or produce your own wine, while it is illegal to make your own “hard liquor?”

After all, distillation of spirits is the logical next step. “If you are making beer,” says Max Watman, author of Chasing the White Dog, a book about moonshine, “it’s just a matter of time that you are going to be staring at the beer and going, ‘There’s whiskey inside of that.’” The newest category of illegal distillers, Watman told the Fort Worth Star-Telegram, were “foodie folks,” the same people who “drove the home brewing craze.”

The big catch is that the distilling, sale and consumption of unlicensed liquor is still a felony or Class A misdemeanor--just as it was during the Prohibition Era--carrying a sentence of one to five, and a fine of up to $10,000.  Earlier this year, investigators in two Texas counties seized stills and small amounts of moonshine in two separate raids, according to the Star-Telegram article by Steve Campbell.  Recently, a Kentucky man was arrested in possession of 100 gallons of moonshine.

And, in perhaps the ultimate sign of the times, Willie Nelson’s bus was searched and crewmembers were arrested for pot, of course—but also for the possession of untaxed alcohol in the state of North Carolina. The Star-News Online reported that  “agents entered the bus after smelling marijuana. Inside they found a quart jar, three quarters full of untaxed alcohol, or moonshine, as well as marijuana.” Matthew Rowley, author of Moonshine!, said in the article that there “aren’t any figures about it. What I know, see with my own eyes, taste with my own mouth, it really is everywhere.”

Judging by the Internet, stills and distillery supplies do seem to be ubiquitous. However, there is another, more serious class of moonshiners, consisting of criminals who produce cheap liquor for sale to illegal booze joints in larger cities. In an article in the Norfolk Virginian-Pilot, Watman said he had sampled some of the criminal booze available at a “nip joint” in Virginia, and reported that it tasted like “some sort of experimental kerosene-powered mouthwash.” In its more lethal forms, “white lightning” can lead to fatalities from lead and alcohol poisoning. (In Russia, home brew vodka has been responsible for numerous deaths.)

Home distillers would like to see hobby distilling treated as something less than a criminal enterprise, since in most if not all cases, no sales are taking place. But it may get harder and harder to avoid the “revenooers” in the future, due to the development of portable infrared spectroscopy equipment for identifying and tracking the content of alcoholic spirits emerging from illicit home stills.

An article in Chemistry Central Journal estimates that as much as 25% of all alcohol sold and consumed worldwide is unrecorded and unregulated.

Photo Credit: http://www.blog.thesietch.org/2007/03/07/diy-ethanol/

Impulsivity and Addiction

The perils of a hypersensitive dopamine system.

The brooding, antisocial loner, the one with impulse control problems, a penchant for risk-taking, and a cigarette dangling from his lip, is a recognizable archetype in popular culture. From Marlon Brando to Bruce Lee, these flawed heroes are perhaps the ones with restless brain chemicals; the ones who never felt good and never knew why (“What are you rebelling against?” “What’ve you got?”).

A recent study at Vanderbilt University, published in Nature Neuroscience, used PET scans and fMRI imaging to suggest that impulsivity and other “antisocial” traits “predicted nucleus accumbens dopamine release and reward anticipation-related activity in response to pharmacological and monetary reinforcers, respectively.”

In other words, the Vanderbilt researchers maintained that so-called “psychopathic traits” like impulsivity and risk taking are linked to addiction and gambling by means of an overly active dopamine system. PET scans of dopamine responses to a low dose of amphetamine showed that “individuals who scored high on a personality assessment that teases out traits like egocentricity, manipulating others, and risk taking had a hypersensitive dopamine response system,” according to a press release from the National Institute on Drug Abuse (NIDA), which funded the study.

Putting a different spin on the matter, NIDA director Nora Volkow said: “By linking traits that suggest impulsivity and the potential for antisocial behavior to an overreactive dopamine system, this study helps explain why aggression may be as rewarding for some people as drugs are for others.”

Lead author Joshua Buckholtz of Vanderbilt said that “the amount of dopamine released was up to four times higher in people with high levels of these traits, compared to those who scored lower on the personality profile.  Buckholtz suggested that a pattern of exaggerated dopamine responses “could develop into psychopathic personality disorder.”

Dr. Robert Cloninger, a prominent addiction researcher, has asserted in the past that children who show a high propensity for risk-taking, along with impulsivity, or “novelty-seeking,” are more likely to develop alcoholism and other addictions later in life.

And, in interviews with the late psychologist Henri Begleiter for my book on addiction science, Begleiter insisted that addicts were stuck with a package of symptoms he called behavioral dysregulation. “Disinhibition, impulsivity, trouble fitting into society—you have certain behavioral disorders in kids who later develop into alcoholics and drug addicts,” he said. The behavior itself doesn’t cause the addiction. The dysregulated behavior is a symptom of the addiction.”

“When you talk to these people, as I have,” Begleiter said, “you see that the one thing they pretty much all report is that, under the influence of the drug, they feel much more normal. It normalizes their central nervous systems. Initially, what they have is a need to experience a normal life.”

So, it wasn’t ducktails, pool halls, tattoos, casual sex, or lack of parental involvement that caused addiction to alcohol and cigarettes and pot, and maybe cocaine and speed and heroin. It wasn’t just the “bad kids.” Irrational anger, impulsive decisions, certain compulsive behaviors like gambling—these behaviors were symptoms of the same group of related disorders that included drug and alcohol addiction, and which involved specific chemicals and areas of the brain related to reward, motivation, and memory.

The trait of impulsivity is a possible marker for addiction that may help explain why it is usually impossible to persuade addicts to give up their drugs by sheer force of logic—by arguing that the drugs will eventually ruin their health or kill them. “They tell me it’ll kill me,” sang Dave Van Ronk, “but they don’t say when.”

Consider the always-instructive case of cigarette smoking. In 1964, the Surgeon General’s Report on Smoking and Health laid out the case for the long-term ill effects of nicotine quite effectively—and millions of people quit smoking. A stubborn minority did not, and many of them still have not. Are they simply being hedonistic and irresponsible? Or are the long-term negative consequences, so dramatically clear to others, simply not capable of influencing their thinking to the same degree? Biochemical abnormalities similar to those predisposing certain people to addiction may also prevent them from comprehending the long-term results of their behavior.

Buckholtz, J., Treadway, M., Cowan, R., Woodward, N., Benning, S., Li, R., Ansari, M., Baldwin, R., Schwartzman, A., Shelby, E., Smith, C., Cole, D., Kessler, R., & Zald, D. (2010). Mesolimbic dopamine reward system hypersensitivity in individuals with psychopathic traits Nature Neuroscience, 13 (4), 419-421 DOI: 10.1038/nn.2510

Graphics Credit: http://www.nature.com/neuro/journal/

No Urine Test for Addiction

Drug wars never work.

The recognition that drug wars create crime is long overdue. More than fifteen years ago, a study of the economics of street drug dealing by the Rand Corporation confirmed that most drug dealers make more money illegally than they could possibly make through any form of legitimate employment. That equation has not changed.  For minors, drug dealing is without a doubt the best-paying job available to them. 

The effort to combat drugs has poisoned our relationships with other countries. Farmers in Latin America, Southeast Asia, and Afghanistan are not the source of the drug problem. The danger of concentrating on the interdiction of foreign shipments is that it breeds the fantasy solution—a belief that the nation’s drug problem can be solved offshore, if the barriers and borders of the United States are vigorously defended.

Drug wars weaken the force of law at home. Minor drug laws are flouted with impunity, while basic civil rights are under attack in the name of national security. Drug wars ask a lot from citizens:  weakened rules of evidence, the erosion of the doctrine of probable cause, and an end to the presumption of innocence, for starters.

A different strategy would obviate the need for these enhanced powers of repression and control. Drug wars foster a form of social hypocrisy. Many of the country’s finest doctors, scientists, judges, and legislators have routinely used illegal drugs in their past. Yet their lives were not irreparably damaged, their futures thrown on the trash heap. Millions of productive citizens now in their 40s and 50s know that youthful drug use need not be permanently deleterious. They dare not speak up, of course. The people who have the most experience with these drugs have been systematically excluded from the public debate. The emerging models of addictive disease call into question almost every aspect of drug wars as they have been historically waged.

For many Americans, the use of alcohol, cocaine, or any other addictive drug is a matter of personal recreational choice. None of the strategies employed in the drug wars of the past four decades has been able to override the fact that prohibition can only be effective with the cooperation of the citizenry. Without voluntary compliance, the only recourse is federal coercion; some Orwellian nightmare of detection, control, forced detoxification, and detention.

Only a fraction of the nation’s corporations had drug-testing programs in place in 1990, but the number has climbed dramatically ever since. Inaccuracies and false positives have bedeviled drug-testing programs from the outset. Ibuprofen, available over the counter as Advil or Motrin, registers on some tests as positive for marijuana. Cold remedies such as Nyquil, Allerest, Contac, Dimetapp, and Triaminicin all contain a substance, phenylpropanolamine, which sometimes shows up as positive for amphetamine. The list of potential false positives is a long one.

Many drug testing programs do not test for alcohol, and even if such constitutionally dubious testing programs were unerringly accurate in what they do test for, there would still be valid reasons not to adopt them. Few people would insist that the presence of alcohol metabolites in the bloodstream is incontrovertible proof of incompetence on the job. But we frequently make this assumption in the case of illegal drugs, in part because the drug tests themselves are not refined enough to reliably distinguish between casual use and consistent abuse. There is no urine test for addiction. 

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

Deputy Drug Czar Goes His Own Way

Doctors are part of the problem, says McLellan.

In a March 15 cover story titled “The American Way,” Drink and Drugs News  of the UK ran an insightful interview with America’s “deputy” Drug Czar, Thomas McLellan. Professor McLellan, deputy director of the Office of National Drug Control Policy, is not a cop, like his boss Gil Kerlikowske, or a retired Army general, like former Drug Czar Barry McCaffrey. McLellan is a rare breed, a treatment specialist, and brings an entirely different viewpoint to an office that has traditionally been strongly oriented toward law enforcement.

“In the US we’ve been thinking about addiction as just a lot of drug use,” McLellan told a group of addiction specialists and policy professionals at the Institute of Psychiatry in London. “And as a result we’ve been purchasing [treatment] stupidly. We can’t decide if addiction is a crime or a disease so we’ve compromised and given them treatments that aren’t any good.”

McLellan singled out doctors for special attention: “Most physicians are not trained in how to treat substance abuse. They don’t see it as a disease and don’t see why they should look for it.”

Treating addiction like any other medical condition is still a goal rather than a reality. “You may know that the relapse rates for diabetes, hypertension and asthma are almost identical to the relapse rates for any addictive disorder…. And no one puts their hands on their hips when a diabetic comes back and says, ‘I ate half a bucket of fried chicken and I forgot to take my insulin, and now I’m back here.’ They just treat them.”

If there are doctors who don’t believe in the disease model of addiction, we can’t be surprised if members of the general public—and addicts themselves--often feel the same way.  McLellan said that less than 3 % of all referrals for addiction treatment and specialty care originate with doctors. Moreover, roughly half of 12,000 smaller treatment programs in the U.S. have no doctor, nurse, or psychologist on staff. And counselors, who make up the majority of treatment staff, suffer from a 50 % turnover rate.

In addition, McLellan took on the traditional British aversion to methadone treatment for heroin addicts: “That this has been a battle, that you are either on methadone or you are on the path of truth, beauty and light, is artificial and unfortunate…. I’m now officially wagging my finger and saying not just to Britain, but to the whole damn field; get past this, this is an artificial contrivance. People ought to have the opportunity to get the medications and other services they need.”

McLellan also had choice words for politicians and policy makers who see incarceration as the only acceptable response to drugs and drug-related crime.  He referenced studies that “suggest very clearly that in a prison situation, when you release somebody with a drug problem, they are back and you’re going to do it all over again. It’s a bad business deal.”

Ongoing care—after prison, or after treatment—is essential to success. “I think residential care is important and necessary, but not sufficient,” McLellan maintained. “It is like having a very good junior high school education.”

Photo Credit: http://www.csam-asam.org/

Can I Smoke in Here?

New tobacco map highlights state differences.

An interactive online map set, showing state-by-state variations in smoke-free laws, cigarette tax rates, and rates of tobacco control spending, has been put together by the Robert Wood Johnson Foundation, and is now available for viewing at the foundation’s Public Health site HERE.

“Users will be able to see whether a state is ahead or behind the curve in protecting and promoting health,” says Michelle Larkin, the leader of the Robert Wood Johnson Foundation Public Health Team. “We know from the research that the two most effective policies to pursue are raising tobacco taxes and putting smoke-free air laws into place,” says Larkin, adding that “these two policies help to prevent youth from ever starting to smoke and they also help smokers quit.”

To that end, the interactive maps that comprise the project can be used to track changes from state to state in smoke-free legislation and taxation rates over time. A third map can be used to track the extent to which states are complying with CDC recommendations for tobacco control expenditures. (Answer: most of them aren’t.)

The hope is that the interactive tobacco map will provide policymakers with a nationwide picture of tobacco policy, using the state-by-state breakdowns to predict trends and to demonstrate how the tobacco control landscape has evolved and changed over the years.

The RWJF Tobacco Map uses data from the Campaign for Tobacco-Free Kids and Americans for Non-Smokers’ Rights.

Meth Babies—Fact or Fiction?

Research team finds brain abnormalities.

When it came to babies born to crack-addicted mothers, the media went overboard, creating a crisis in the form of an epidemic that never quite was. By contrast, when it came to babies born to alcoholic mothers, Fetal Alcohol Syndrome went unrecognized in the science and medical community until 1968.

Now comes a study on prenatal methamphetamine exposure in The Journal of Neuroscience, headed up by Elizabeth Sowell of the University of California, Los Angeles, with support from both the National Institute on Drug Abuse (NIDA) and the National Institute of Alcoholism and Alcohol Abuse (NIAAA.) The report garnered considerable media attention. “We know that alcohol exposure is toxic to the developing fetus and can result in lifelong brain, cognitive and behavioral problems,” Sowell said in a press release. “In this study, we show that the effects of prenatal meth exposure, or the combination of meth and alcohol exposure, may actually be worse.”

It makes sense that meth might effect the health of unborn children.  There is a modest body of research to support the notion. The Sowell study points a finger at the caudate nucleus, a brain region involved with learning and memory.  The study showed that the caudate nucleus of the meth-using group was reduced in size. “Identifying vulnerable brain structures may help predict particular learning and behavioral problems in meth-exposed children,” the press release optimistically states. And the potential problem is real enough: More than 16 million Americans have used meth, according to government numbers. An estimated 19,000 of these users are pregnant women.

But is this particular study a definitive one? The icing on the cake? To begin with, the press release from The Journal of Neuroscience admits to a major problem right up front: “About half of women who say they used meth during pregnancy also used alcohol, so isolating the effects of meth on the developing brain is difficult.”  Even in cases of meth exposure only, there are a host of negative behavioral factors that often accompany meth addiction (bad nutrition, minimal health care, poor health) that can significantly effect fetal development.

The study team compared the MRI brain scans of 61 children: “21 with prenatal MA (methamphetamine) exposure, 18 with concomitant prenatal alcohol exposure (the MAA group), 13 with heavy prenatal alcohol but not MA exposure (ALC group), and 27 unexposed controls. While finding “striatal volume reductions,” as well as increases in the size of certain limbic structures in both groups with meth and/or alcohol exposure, the researchers conclude that striatal and limbic structures “may be more vulnerable to prenatal MA exposure than alcohol exposure.” However, that conclusion was apparently reached despite the fact that only 3 of the 61 children under study were born to mothers who did meth, and meth only, during pregnancy.

Furthermore, there is significant controversy over brain scan studies that measure gross anatomical changes in the size of specific brain regions, rather than brain region activity based on blood flow.

Is there other evidence for the danger of meth use during pregnancy? There is, but as is frequently the case, some of the best evidence comes from animal studies. A 2008 guinea pig study by Sanika Chirwa showed neural damage to the hippocampus, another region involved in memory, in newborn animals with prenatal meth exposure. Furthermore, the newborn animals showed an impaired ability to distinguish novel objects from familiar ones.

In 2006, a study at Brown Medical School, published in Pediatrics , found that newborns exposed to meth during pregnancy were born “small for gestational age,” meaning they were born full-term, but smaller than babies not exposed to meth in utero.  According to study author Barry Lester, “Children who are born underweight tend to have behavior problems, such as hyperactivity or short attention span, as well as learning difficulties.”

However, Lester added an important caveat in a Brown University press release : “I hope that the ‘crack baby’ hysteria does not get repeated. While these children may have some serious health and developmental challenges, there is no automatic need to label them as damaged and remove them from their biological mothers.”

Similar caution was urged by the authors of a 2009 report in the Journal of Developmental and Behavioral Pediatrics: “Efforts to understand specific effects of prenatal methamphetamine exposure on cognitive processing are hampered by high rates of concomitant alcohol use during pregnancy.”

In 2005, an open letter from the Center for Substance Abuse Research at the University of Maryland warned about the dangers of hyperbole, calling upon the media and public officials to “stop perpetuating ‘meth baby’ myths.” The Center argued that “The terms ‘ice babies’ and ‘meth babies’ lack medical and scientific validity and should not be used,” and requested that “policies addressing prenatal exposure to methamphetamines and media coverage of this issue be based on science, not presumption or prejudice.”

Sowell, E., Leow, A., Bookheimer, S., Smith, L., O'Connor, M., Kan, E., Rosso, C., Houston, S., Dinov, I., & Thompson, P. (2010). Differentiating Prenatal Exposure to Methamphetamine and Alcohol versus Alcohol and Not Methamphetamine using Tensor-Based Brain Morphometry and Discriminant Analysis Journal of Neuroscience, 30 (11), 3876-3885 DOI: 10.1523/JNEUROSCI.4967-09.2010

Smith, L., LaGasse, L., Derauf, C., Grant, P., Shah, R., Arria, A., Huestis, M., Haning, W., Strauss, A., Grotta, S., Liu, J., & Lester, B. (2006). The Infant Development, Environment, and Lifestyle Study: Effects of Prenatal Methamphetamine Exposure, Polydrug Exposure, and Poverty on Intrauterine Growth PEDIATRICS, 118 (3), 1149-1156 DOI: 10.1542/peds.2005-2564

Photo credit: http://www.psychiatry.emory.edu

Germs in Tobacco

Bacteria found in major cigarette brands.

It’s not enough that smoking causes all manner of cardiopulmonary complications, or that more than 3,000 chemicals and heavy metals have been identified as additives. Now comes evidence that tobacco particles extracted from cigarettes contain markers for hundreds of known bacteria. Lung infections in some smokers may be caused by germs on shredded tobacco, rather than the act of smoking itself.

According to a report by Janet Raloff in Science News, Amy Sapkota and a team of researchers at the University of Maryland screened tobacco flakes from cigarettes for bacterial DNA using known markers. In an online paper for Environmental Health Perspectives, the scientists explored the bacterial metagenomics of cigarettes using standard cloning and sequencing processes. The team provided evidence for the presence of Campylobacter (a cause of food poisoning), E. coli, several Staphylococcus varieties, as well as a number of bacteria, such as Clostridium, which is directly associated with pneumonia and other infections. Fifteen different classes of bacteria in all, with no significant variation from one cigarette brand to another. 

The time has come, Sapkota and coworkers conclude, “ to further our understanding of the bacterial diversity of cigarettes,” given the more than 1 billion smokers worldwide.  Smoking is now recognized as a risk factor for a basketful of respiratory illnesses, including influenza, asthma, bacterial pneumonia, and interstitial lung disease. In light of this, the authors have advanced their study as solid evidence that “cigarettes themselves could be the direct source of exposure to a wide array of potentially pathogenic microbes among smokers and other people exposed to secondhand smoke.”

In 2008, researcher John Pauly and coworkers at the Roswell Park Cancer Institute in Buffalo, New York, helped provide early evidence by conducting a tobacco flake assay and publishing the results in the journal Tobacco Control. The scientists opened a package of cigarettes “within the sterile environment of a laminar flow hood. A single flake of tobacco was collected randomly and aseptically from the middle of the cigarette column and placed onto the surface of a blood agar plate. The test cigarettes included eight different popular brands, and these were from three different tobacco companies.”

And the results? “After 24 hours of incubation at 37 degrees C, the plates showed bacterial growth for tobacco from all brands of cigarettes. Further, more than 90% of the individual tobacco flakes of a given brand grew bacteria.” Pauly believes that “the results of these studies predict that diverse microbes and microbial toxins are carried by tobacco microparticulates that are released from the cigarette during smoking, and carried into mainstream smoke that is sucked deep into the lung.”

In a recent study published in Immunological Research , Pauly and others expanded on their findings, writing that “Cured tobacco in diverse types of cigarettes is known to harbor a plethora of bacteria (Gram-positive and Gram-negative), fungi (mold, yeast), spores, and is rich in endotoxin (lipopolysaccharide).” This time out, the researchers conclude that “lung inflammation of long-term smokers may be attributed in part to tobacco-associated bacterial and fungal components that have been identified in tobacco and tobacco smoke.”

Cigarette manufacturers already use antibacterial washes during the curing process in order to reduce infection by fungi and bacteria.

If the findings are sound, they could place the argument over secondhand smoke in a vastly different light—cigarettes smoke may be taking the rap for respiratory infections cause by extant bacteria. With smoking rates in the U.S. holding at a steady 21 percent of the population, the issue is not trivial.

Graphics Credit: http://commons.wikimedia.org/

Sapkota, A., Berger, S., & Vogel, T. (2009). Human Pathogens Abundant in the Bacterial Metagenome of Cigarettes Environmental Health Perspectives, 118 (3), 351-356 DOI: 10.1289/ehp.0901201

Pauly, J., Smith, L., Rickert, M., Hutson, A., & Paszkiewicz, G. (2009). Review: Is lung inflammation associated with microbes and microbial toxins in cigarette tobacco smoke? Immunologic Research, 46 (1-3), 127-136 DOI: 10.1007/s12026-009-8117-6