Bees Benefit From Caffeine

Caffeinated plants provide an unforgettable experience.

Honeybees rewarded with caffeine remember the smell of specific flowers longer than bees given only sucrose, according to a study published in Science. “By using a drug to enhance memories of reward,” the study says, “plants secure pollinator fidelity and improve reproductive success.”

Many drugs used by humans come from plants. But what role do the drugs play for the plants themselves? Frequently, they play the role of toxic avenger, providing a chemical defense against attacks by herbivores. But in smaller doses, they often have pharmacological effects on mammals. The researchers looked at two genera of caffeine-producing plants—Coffea and Citrus. “If caffeine confers a selective advantage when these pants interact with pollinators,” the investigators reasoned, “we might expect it to be commonly encountered in nectar.” And it was. Caffeine at very low doses was measured in the nectar of several of the caffeine-producing plant species, including several Coffea species, as well as some citrus nectars—grapefruit, lemons, and oranges among them.

Next, the researchers wanted to find out if the caffeine-laced nectar could affect learning and memory in pollinating bees. They trained individual honeybees to associate various floral scents with sucrose containing various concentrations of caffeine. This pairing of odor and reward, with high-concentration sucrose as the control, demonstrated that low doses of caffeine had almost no effect on the rate of honeybee learning—but a profound effect on long-term memory. Three times as many caffeinated bees remembered the conditioned floral scent 24 hours later, “and responded as if it predicted reward.” Twice as many bees remembered the scent at the 72-hour mark.

What’s the trick? Caffeine’s ability to influence mammalian behavior is due to its action as an adenosine receptor antagonist. “In the hippocampal region,” the authors write, “inhibition of adenosine receptors by caffeine induces long-term potentiation, a key mechanism of memory formation." The Kenyon cells in mushroom bodies of the insect brain, which showed “increased excitability” under the influence of caffeine, are similar in function to hippocampal neurons, they write. “Remembering floral traits is difficult for bees to perform at a fast pace as they fly from flower to flower and we have found that caffeine helps the bee remember where the flowers are,” said Geraldine Wright of the UK’s Newcastle University, who was lead author on the study. “So, caffeine in nectar is likely to improve the bee’s foraging prowess while providing the plant with a more faithful pollinator.”

It is an interesting balancing act by nature: Too much caffeine makes the nectar toxic and repellent to honeybees. Too little, and there is no behavioral effect on bee memory. “This implies that pollinators drive selection toward concentrations of caffeine that are not repellent but still pharmacologically active,” says the report.  Humans have selected for a not-too-much, not-too-little dose of caffeine in the form of soda drinks and coffee. Is it possible that the humble coffee bean is pharmacologically manipulating us into taking good care of it? And do we drink it when we read or study because, for one thing, it enhances long-term memory? And speaking of memory, people often forget where they tucked the oregano, but they usually have little difficulty remembering where they stashed the coffee.

More pragmatically, honeybees on caffeine may lead researchers toward a better understanding of the foraging strategies of pollinator insects, and allow for improved management of crops and landscapes.

Wright G.A., Baker D.D., Palmer M.J., Stabler D., Mustard J.A., Power E.F., Borland A.M. & Stevenson P.C. (2013). Caffeine in Floral Nectar Enhances a Pollinator's Memory of Reward, Science, 339 (6124) 1202-1204. DOI: 10.1126/science.1228806

Photo credit: http://www.coorgblog.orangecounty.in

Addiction Machines: How Slots are Designed for Compulsive Play

Your player card, please.

The image of the compulsive gambler has traditionally been the male poker player, drink in hand, recklessly betting the night away. Slot machines? Those were for amateurs, the out-of-towners, the meek and the mild. But that irritating clang and buzz coming from over the card player’s shoulder is not just the sound of new money—it’s the sound of a new technology tuned to a ruthless edge.

Digital slots and poker machines have become the new games of choice for pathological gamblers. In 1999, Harvard addiction researcher Howard Shaffer predicted that, “as smoking crack cocaine changed the cocaine experience, I think electronics is going to change the way gambling is experienced.”

Modern gambling machines drive the casino gambling industry, and generate far more revenue than “table” gambling. Because of the manner in which they “facilitate the dissociative process,” as one psychologist puts it, excessive gambling is built into the design and structural characteristics of the technology itself. One physician has even suggested that machine gambling produces a trance state by closely matching human breathing patterns with its “basal slot play rate.” We don’t have to wait for the Singularity to observe the merging of man and machine.

By 2000, digital gambling machines were generating twice the revenues of “live” games. Today, the modern slot machine “drives the industry,” said the president of the American Gaming Association in Natasha Dow Schull’s book, Addiction by Design: Machine Gambling in Las Vegas. They are allowed, in one form or another, in at least 41 states. Journalist Marc Cooper, who covered Las Vegas in his book, The Last Honest Place in America, said in 2005: “The new generation of gambling machines has, predictably, produced a new generation of gambling addicts: not players who thrive on the adrenaline rush of a high-wager roll of the dice or turn of a card but, rather, zoned-out ‘escape’ players who yearn for the smooth numbness produced by the endlessly spinning reels.”

“A gaming machine is a very fast, money-eating device,” according to a spokesperson for Bally. “The play should take no longer than three and a half seconds per game.” Gambling engineers attempt to fine-tune the “capacitive logic of haptics,” by, for example, designing chairs that tingle and pulse in response to events in the game. The ideal is to achieve an “embodied relation,” in which a gambling machine becomes an extension of the gambler’s own cognitive capacities and spatial skills. Professor Schull of MIT’s Program in Science, Technology, and Society sees a digital gambling machine as “an interactive force that powerfully exerts its program for ‘player extinction’ and in so doing constrains the possible outcomes of play.”

At the simplest level, gambling machines function as Skinner boxes for human rats. Intermittent reinforcement, as psychologists showed long ago, is an effective way of shaping behavior. “If the number of responses required to receive a stimulus varies,” writes biologist Jason Goldman at his Scientific American blog, The Thoughtful Animal,“then you are using a variable ratio schedule. The best example for this is a slot machine, which has a fixed probability of delivering a reward over time, but a variable number of pulls between rewards. It is no wonder that variable ratio reinforcement schedules are the most effective for quickly establishing and maintaining a desired behavior.”

Casinos were early adopters of biometric surveillance methods, and now have the capability of offloading much of this work to distributed digital devices like player loyalty cards. Theoretically, machines could achieve and maintain an active feedback loop with each gambler. The machine could compile data on betting patterns, recent outcomes, time of day, and rhythm of play. The machine would have the ability to “automatically alter the volatility level for gaming events to match the general player preferences at specific times,” in the words of one patent application. The longer you play, the more the machine would understand your style, and offer more of what will keep your ass in the seat.

The advent of poker playing machines brought in more players aiming for time-on-device rather than supersized jackpots. Poker machines gave out some kind of reward on 45% of plays—the perfect intermittent reward, if you asked Pavlov. And there was a razor-thin component of skill to the gambling machines. But all of the trademark features of addictive play are present in Draw Poker machines as well.

Here’s what casinos currently depend on to keep compulsive gamblers at their machines:

—Faster play. The key introduction was the virtual reel, which allowed play to take place faster than mechanical reels could spin. The use of touch screens is on the upswing, to further increase play speed. And the “BET MAX” button is always nearby.

—Longer “time-on-device”. One industry expert said: “If the chase lights on the slot signs are running too fast, they make people nervous; if they run too slow, they put them to sleep. If the machine sound is too loud, it hurts the player’s ears; if it’s not loud enough, the energy level of the room suffers.”

—Upping the ante. So that players can spend their money more easily, designers have engineered bill acceptors, digital credit counters, loyalty program cards, and other ways to reduce the actual handling of coins and cash and eliminate physical payouts at the device site. But what about the continued popularity of the nickel slot? “A nickel game isn’t a nickel game,” said one game developer, “when you’re betting ninety nickels at a time."

—Disguising the odds. The wonders of the random number generator are perfectly disguised in digital machines. Virtual reel mapping, or “weighted reels,” is credited to mathematician Inge Telnaes. It describes a system in which there is no logical correlation between the actual number of choices seen by the player and the number of stops contained on the virtual reel. Blank reel spaces help increase the confusion, while a secondary mapping program translates the virtual stops selected by the RNG microchips into the actual stops visible to players onscreen.

Something has to give, since recent research seems to show that machine gambling pushes gamblers into an addictive relationship with gambling at a rate three times faster than gamblers who stick to live table games. Back in the skunk works, where the machines are designed and manufactured by companies like IGT, the nation’s leading maker of gambling machines, weakening the hold of the machines would mean limiting near-miss effects, coming clean about virtual reel mapping, and placing restrictions on building ATM access into upcoming models. But maybe none of that will matter. As a software designer who moved from slot machines to games for kids told Professor Schull, “it wasn’t that big of a leap, in fact it was very similar. That really struck me. I saw it as appealing to the same part of the mind, a really simplistic instinct for distraction. Similar types of customers—toddlers and gamblers.”

Photo credit: http://www.all-slot-machines.com/

Craving Relief

Why is it so hard for addicts to say “enough?”

One of the useful things that may yet come out of the much-derided DSM-5 manual of mental disorders is the addition of craving as a criterion for addiction. “Cravings,” writes Dr. Omar Manejwala, a psychiatrist and the former medical director of Hazelden, “are at the heart of all addictive and compulsive behaviors.” Unlike the previous two volumes in this monthful of addiction books, Manejwala’s book, Craving: Why We Can’t Seem To Get Enough,  focuses on a specific aspect common to all addiction syndromes, and looks at what people might do to lessen its grip.

Why do cravings matter? Because they are the engine of addiction, and can lead people to “throw away all the things that really matter to them in exchange for a short-term fix that is often over before it even starts.” When Dr. Manejwala asked a group of patients to explain what they were thinking when they relapsed, their answer was often the same: “I was so STUPID.” But the author had tested these people. “I knew their IQs.” And the best explanation these intelligent addicts could offer “was the one explanation that could not possibly be true.”

In my book, The Chemical Carousel, I quoted former National Institute on Alcohol Abuse and Alcoholism (NIAAA) director T.K. Li on the subject of craving: “We already have a perfect drug to make alcohol aversive—and that’s Antabuse. But people don’t take it. Why don’t they take it? Because they still crave. And so they stop taking it. You have to attack the other side, and hit the craving.” However, if you ask addicts about craving when they are high, or have ready access, they will often downplay its importance. It is drug access unexpectedly denied that sets up some of the fiercest cravings of all. Conversely, many addicts find that they crave less in a situation where they cannot possibly score drugs or alcohol—at a health retreat, or on vacation at a remote locale.

Why are cravings so hard to explain? One reason is that “people use the word to mean so many different things.” You don’t crave everything you want, as Manejwala points out. Cravings are not the same as wants, desires, urges, passions, or interests. They are “stickier.” The brain science behind craving starts with the downregulation of dopamine and other neurotransmitters. As the brain is artificially flooded with neurotransmitters triggered by drug use, the brain goes into conservation mode and cuts back on, say, the number of dopamine receptors in a given part of the brain. In the absence of the drug, the brain is suddenly “lopsided,” and time has to pass while neural plasticity copes with the new (old) state of affairs. In the interim, the unbalanced state of affairs is a prime ingredient in the experience of craving.

Cravings are “disturbingly intense” (Manejwala) and “incomprehensibly demoralizing” (AA). Alcohol researcher George Koob called craving a state of “spiraling distress.” Cravings are not necessarily about reward, but about anticipating relief. “The overwhelming biological process in addictive craving is really a complex set of desperate, survival-based drives to feel ‘normal,’” says Manejwala.

The late Alan Marlatt, a psychologist who studied cravings for years, proposed that apparently irrelevant decisions could trigger or prevent relapse, almost without the addict knowing it. Turning left at an intersection, toward the supermarket, or turning right, toward the liquor store, can feel arbitrary and dissociated from desire. We also know that environmental cues can trigger craving, such as the site of a crack house where an addict used to do his business. Manejwala points to research showing that “some relapses related to cues and context are mediated by a small subgroup of neurons in the medial prefrontal cortex,” and suggests that it may be possible in the future to target this area with drug therapy.

Manejwala is unabashedly pro-12 Step, and favors traditional group work as the standard therapy. For example, he points to a Cochrane analysis of 50 trials showing that group participation roughly doubles a smoker’s chance of quitting. One of the reasons AA works for some people is that AA attendance reduces “pro-drinking social ties.” Simply put, if you are sitting with your AA pals in a meeting, you’re not out with your drinking buddies at the tavern. The author admits, however that alternatives such as SMART recovery work for some people, and that “sadly, much energy has been wasted as members of these various organizations bicker with each other about which works best, and this leaves the newcomer perplexed…. Over 20 million American are in recovery from addiction to alcohol and drugs. I can tell you this much: they didn’t all do it the same way.”

And along the way, you can be sure that all of them became familiar with cravings. Manejwala offers several strategies for managing cravings, and I paraphrase a few of them here:

—Join something. Participate. Get out of your own head and become actively involved in some group, any group, doing something you are interested in.

—Hang around people who are good at recovery. Long-timers, with a solid base of sobriety. You will not only learn HOW to do it, but that it CAN be done.

—Write stuff down. This makes you pay attention to what you’re doing. Keep a cigarette log. Count calories. Know what you’re spending per month on alcohol. Educate yourself about your addiction.

—Tell someone. Tell somebody you trust, because if there is anything harder than dealing with cravings from drinking, smoking, or drugging, it’s doing it in secret.

—Be teachable. Watch out for confirmation bias. “When you think you have the answers, it’s hard to hear alternatives.”

—Empathy matters. The author notes that the Big Book insists that by gaining sobriety, “you will learn the full meaning of ‘Love thy neighbor as thyself.’” Altruism may have evolutionary, physiological, and psychological implications we haven’t worked out yet.

Addiction Rehab: Everything is Broken

Down the rabbit hole in search of effective treatment.

When I first began researching drugs and addiction years ago, a Seattle doctor told me something memorable. “It’s as if you had cancer,” she said, “and your doctor’s sole method of treatment consisted of putting you in a weekly self-help group.”

I’ve got nothing against weekly self-help groups, to be sure. But as Ivan Oransky, executive editor of Reuters Health and a blogger at Retraction Watch, told me as recently as least year, addiction treatment appeared to be “all selling and self-diagnosis. They’re selling you on the fact that you need to be treated.”

In his introduction to Inside Rehab by Anne M. Fletcher (pictured), treatment specialist and former deputy drug czar A. Thomas McLellan writes that the book is “filled with disturbing accounts of seriously addicted people getting very limited care at exhaustive costs and with uncertain results...”

A common notion about addiction treatment facilities, or rehabs, is they are commonly called, is that they are staffed by professional social workers, certified counselors, and family psychologists, as well as addiction specialists. However: “Of the twenty-one states that specify minimum educational requirements for program or clinical directors of rehabs, only eight require a master’s degree and just six require credentialing as an addiction counselor,” writes Fletcher. Neuroscience journalist Maia Szalavitz, who writes for Time Healthland and specializes in addiction and rehab, told Fletcher that “the addiction field has been about as effectively regulated as banking before the economic crisis in many states.” According to Tom McLellan, counselor and director turnover in addiction treatment programs is “higher than in fast-food restaurants.”

In the United States, where for-profit treatment is prevalent, money does not buy access to superior treatment. Fletcher, author of several self-help books on weight loss and alcoholism, doggedly documents what she learns from visiting treatment facilities and interviewing current and former staff and clients. One difficulty with a book of this kind, based primarily on first-hand accounts, is that the same treatment program can offer vastly contrasting experiences from one client to another. And Fletcher, no fan of the 12 Steps, wants AA and NA to account for themselves in a way those volunteer institutions were never designed to accomplish.

But let’s just say it: Addiction treatment in America is a disaster. Addicts get better despite the treatment industry as often as they get better because of it. How did it all go wrong? Part of the answer is that addiction, like depression, tuberculosis, and other chronic conditions, is a segregated illness, as McLellan explains in his introduction. Traditionally, chronic conditions like alcoholism “were not recognized as medical illnesses, and have only recently been taught in most medical schools and treated by physicians. They were seen as ‘lifestyle problems’ and care was typically provided by concerned, committed individuals or institutions not well connected to mainstream health care.”

For treatment of alcoholism and drug addiction, the work has historically fallen to addicts themselves, due to discrimination, segregation, and stigmatization. This prevailing condition is still seen today in many group treatment programs, which are often administered in large part by former addicts with little or no formal training, rather than medical or psychological professionals. Addiction, as the author’s husband wryly remarked, “is the only disease for which having it makes you an expert.”

Which brings up a central point: Where are all the M.D.s? Doctors aren’t helping, either, when they fail to screen for risky drinking or drug use, or when they automatically refer addicts rather than treating them.

If Christopher Kennedy Lawford’s new book, Recover to Live, is the pretty picture, then Fletcher’s Inside Rehab is the gritty picture, in which most addicts who recover don’t go to treatment, 28 days is not long enough to accomplish anything but detox, group counseling is not always the best way to treat addiction, the 12 Steps are not always essential to recovery, specialty drugs are often needed to treat drug addiction, and, perhaps the most troubling of all, most addiction programs do not offer state-of-the-art approaches to treatment that have been shown to be effective in scientific studies.

What clients get, for the most part, is “group, group, and more group,” Fletcher writes. And in many cases of residential or outpatient rehab, “the clients did most of the therapy.” The scientific evidence suggests that some addicts do better with an emphasis on individual counseling, rather than the constant reliance on group work that traditional rehabs have to offer. As one counselor put it: “If I made an appointment to see a therapist because I was depressed, would I be told I have to do a program with everyone else?”

Monthly residential treatment can easily cost $25,000 or more. But public, government funded rehab centers, which presumably have less incentive to treat clients like money, are frequently full. And since these programs run the bulk of prison-related treatment in this country, addicts often stand a better chance of getting into these less expensive programs if they commit a crime.

Even if you manage to get in, rehab rules all too often seem arbitrary and punitive: Recreational reading materials, musical instruments, cell phones, and computers are frequently not permitted. And there is a strong tendency to insist that use equals abuse in every circumstance. Rehab management—the business of what happens after formal treatment ends—is largely neglected in the treatment sphere.

Fletcher rails against the disease model, but mostly in response to how she believes this concept is presented by AA/NA. Like other critics, she dwells on the idea that the disease tag serves as a crutch and an excuse, rather than as an extremely empowering notion for many addicts. In fact, the disease model, as addiction scientists understand it, is seriously underrepresented in the treatment field. Too many mental health professionals continue to insist that “all you need to do is get to the bottom of the problem and the need to use substances to cope, will dissipate,” said an M.D. specializing in addiction. “However, there is absolutely no evidence that this approach works for people who are addicted to alcohol or drugs… The primary-secondary issue is moot and an artifact of the bifurcation of the treatment delivery system.”

A significant number of rehabs still oppose medication-assisted treatment, Fletcher makes clear. Hazelden made news recently for dropping its long-standing opposition to buprenorphrine as a maintenance drug for opiate addicts during treatment. Richard Saitz of Boston University’s School of Medicine says in the book that if addiction were viewed like other health problems, “patients addicted to opioids who are not offered the opportunity to be on maintenance medications would sue their providers and win.”

According to Dr. Mark Willenbring, former director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA): “No one wants to say, ‘Treatment as we’ve been doing it probably isn’t as effective as we thought, and we need more basic research to really come up with new tools. In the meantime let’s do what we can to help suffering people in the most cost effective way and strive to not harm them.’”

How to Kick Everything

Christopher Kennedy Lawford on recovery.

Christopher Kennedy Lawford’s ambitious, one-size-fits-all undertaking is titled Recover to Live: Kick Any Habit, Manage Any Addiction: Your Self-Treatment Guide to Alcohol, Drugs, Eating Disorders, Gambling, Hoarding, Smoking, Sex, and Porn. That pretty much covers the waterfront, and represents both the strengths and the weaknesses of the book.

There’s no doubting Lawford’s sincerity, or his experiential understanding of addiction, or the fact that the raw ingredients were present in his case: bad genes and a traumatic early environment. He is related to Ted Kennedy, two of his uncles were publically murdered, and he started using drugs at age 12. But this book doesn’t dwell on his personal narrative. Lawford is a tireless supporter of the addiction recovery community, and Recover to Live is meant to be a one-stop consumer handbook for dealing with, as the title makes clear, any addiction.

To his credit, Lawford starts out by accurately pegging the addiction basics: A chronic brain disorder with strong neurological underpinnings. He cites a lot of relevant studies, and some questionable ones as well, but ultimately lands on an appropriate spot: “You can’t control which genes you inherited or the circumstances of your life that contributed to your disease. But once you know that you have the disease of addiction, you are responsible for doing something about it. And if you don’t address your problem, you can’t blame society or anyone in your life for the consequences. Sorry. That’s the way it works.”

Once you know, you have to treat it. “It can turn the most loving and nurturing home into a prison of anger and fear,” Lawford writes, “because there is no easy fix for the problem, and that infuriates many people.”

 Lawford includes good interviews with the right people—Nora Volkow, Herb Kleber, and Charles O’Brien among them. And he makes a distinction frequently lost in drug debates: “Nondependent drug use is a preventable behavior, whereas addiction is a treatable disease of the brain.” Due to our penchant for jailing co-morbid addicts, “our prisons and jails are the largest mental health institution in the world.” He also knows that hidden alcoholism and multiple addictions mean “rates of remission from single substances may not accurately reflect remission when viewed broadly in terms of all substances used.”

One nice thing about Lawford’s approach is that he highlights comorbidity, the elephant in the room when it comes to addiction treatment. Addiction is so often intertwined with mental health issues of various kinds, and so frequently left out of the treatment equation. The author is correct to focus on “co-occurring disorders,” even though he prefers the term “toxic compulsions,” meaning the overlapping addictions that can often be found in the same person: the alcoholic, chain-smoking, compulsive gambler being the most obvious example.

The curious inclusion of hoarding in Lawford’s list of 7 toxic compulsions (the 7 Deadly Sins?) is best explained by viewing it as the flipside of compulsive shoplifting, a disorder which is likely to follow gambling into the list of behavioral dependencies similar to substance addictions. In sum, writes Lawford, “If we are smoking, overeating, gambling problematically, or spending inordinate amounts of time on porn, we will have a shallower recovery from our primary toxic compulsion.” Lawford sees the exorcising of childhood trauma as the essential element of recovery—a theory that has regained popularity in the wake of findings in the burgeoning field of epigenetics, where scientists have documented changes in genetic expression beyond the womb.

But in order to cover everything, using the widest possible net, Lawford is forced to conflate an overload of information about substance and behavioral dependencies, and sometimes it doesn’t work. He quotes approvingly from a doctor who tells him, “If you’re having five or more drinks—you have a problem with alcohol.” A good deal of evidence suggests that this may be true. But then the doctor continues: “If you use illicit drugs at all, you have a problem with drugs.” Well, no, not necessarily, unless by “problem” the doctor means legal troubles. There are recreational users of every addictive substance that exists—users with the right genes and developmental background to control their use of various drugs. And patients who avail themselves of medical marijuana for chronic illnesses might also beg to differ with the doctor’s opinion.

Lawford attempts to rank every addiction treatment under the sun in terms of effectiveness (“Let a thousand flowers bloom”), an operation fraught with pitfalls since no two people experience addictive drugs in exactly the same way. Is motivational enhancement better than Acamprosate for treatment of alcoholism, worse than cognitive therapy, or about as good as exercise? Lawford makes his picks, but it’s a horse race, so outcomes are uncertain. Moderation management, web-based personalized feedback, mindfulness meditation, acupuncture—it’s all here, the evidence-based and the not-so-evidence based. Whatever it is, Lawford seems to think, it can’t hurt to give it a try, and even the flimsiest treatment modalities might have a calming effect or elicit some sort of placebo response. So what could it hurt.

Lawford’s “Seven Self-Care Tools” with which to combat the Seven Toxic Compulsions vary widely in usefulness. The evidence is controversial for Tool 1, Cognitive Behavioral Therapy. Tool 2, 12-Step Programs, is controversial and not to everybody’s taste, but used as a free tool by many. Tool 3 is Mindfulness, which is basically another form of cognitive therapy, and Tool 4 is Meditation, which invokes a relaxation response and is generally recognized as safe. Tool 5, Nutrition and Exercise, is solid, but Tool 6, Body Work, is not. Treatments like acupuncture, Reichian therapy, and other forms of “body work” are not proven aids to addicts. Tool 7, Journaling, is up to you.

One of the more useful lists is NIDA director Nora Volkow’s “four biggest addiction myths."

First: “The notion that addiction is the result of a personal choice, a sign of a character flaw, or moral weakness.”

Second: “In order for treatment to be effective, a person must hit ‘rock bottom.’”

Third: “The fact that addicted individuals often and repeatedly fail in their efforts to remain abstinent for a significant period of time demonstrates that addiction treatment doesn’t work.”

Fourth: “The brain is a static, fully formed entity, at least in adults.”

Finally, Lawford puts a strong emphasis on an important but rarely emphasized treatment modality: brief intervention. Why? Because traditional, confrontational interventions don’t work. The associate director of a UCLA substance abuse program tells Lawford: “I haven’t had a drink now in 25 years, and this doctor did it without beating me over the head with a big book, without chastising me, or doing an intervention. What he did was a brief intervention. Health professionals who give clear information and feedback about risks and about possible benefits can make a huge difference. A brief intervention might not work the first time. It might take a couple of visits. But we need more doctors who know what the symptoms of alcohol dependence are and know what questions to ask.”

If your knowledge of addiction is limited, this is a reasonable, middle-of-the-road starting point for a general audience.

Khat: A Psychologist's Field Trip

Looking for a chew in London.
 
I ran across a great story by Vaughan Bell at Mind Hacks, about his stroll around London, looking for khat, the East African stimulant plant that is chewed much like coca leaves.

 Research psychologist Vaughan Bell is not your average armchair academician. Currently a Senior Research Fellow at the Institute of Psychiatry, King’s College, London, Bell is well known online for his contributions to the Mind Hacks blog, which covers unusual and intriguing findings in neuroscience and psychology. He recently taught clinical psychiatry at Hospital Universitario San Vicente de Paúl and the Universidad de Antioquia in Medellín, Colombia, where he remains an honorary professor. He has also worked for Médecins sans Frontières (Doctors Without Borders) as a mental health coordinator for Colombia. (See my interview with Bell last year).

Reprinted with permission:


Finding myself at a loose end yesterday I decided I’d try and track down one of London’s mafrishes – a type of cafe where people from the capital’s Ethiopian, Somali and Yemeni community chew the psychoactive plant khat.

I’d heard about a Somali cafe on Lewisham Way and thought that was as good a place as any to try. The cafe owner first looked a bit baffled when I walked in and asked about khat but he sat me down, gave me tea, and went out back to ask his associates.

“Sorry, there’s no khat in Lewishman. We have internet?” he suggested while gesturing towards the empty computers at the back. I kindly declined but in reply he suggested I go to Streatham. “There are lots of restaurants there,” he assured me.

Streatham is huge, so I arrived at one of the rail stations and just decided to walk south. Slowly I became aware that there were more Somali-looking faces around but there were no cafes to be seen.
Just through chance I noticed some Somali cafes off a side street and walked into the first one I saw. “There’s none here, but next door”, I was told. The people in the next cafe said the same, as did the next, and the next, until I came to an unmarked door.

“Just go in,” a cafe owner called to me from across the street, so I walked in.

The place was little dark but quite spacious. My fantasies of an East African cafe translocated to London quickly faded as my eyes adjusted to the trucker’s cafe decor. Inside, there were four guys watching the news on a wall-mounted TV.

The cafe owner greeted me as I entered. I asked my usual question about khat and he looked at me, a little puzzled.

“You know, khat, to chew?” I ventured. A furrowed brow. Thinking. “Oh, chat. Yes, we have bundles for three pounds and bundles for seven. Which do you want?”

“Give me one for seven” I said. “No problem” he replied cheerily. “Have a seat”.

This wasn’t the first time I had tried khat. Many years ago, when I was an undergraduate in the Midlands, I discovered khat in an alternative shop. It was sold as a natural curative soul lifting wonder plant from the fields of Africa.

I bought some, didn’t really know what to do with it, and just began to ‘gently chew’, as the leaflet advised, while walking through the streets of Nottingham.

So when my bundle of khat arrived, I just picked out some stems and began chomping on one end. “Wait, wait, stop!” they shouted in unison. “We’ll help you” said one and I was joined by the cafe owner and a friend. “Anyway, he said”, “you’re not allowed chew alone, it’s a social thing.”
I was given a bin to put beside my table, was shown how to strip off the stems and pick out the soft parts, and how to chew slowly. I was provided tea and water on the house and told to keep drinking fluids. Apparently, it can be a little strong on the stomach and the plant makes you go to the toilet a lot as, I was told, ‘it speeds up the body’.

I had the company of the cafe owner, a Somali Muslim, and his friend, an Ethiopian Christian.
Over the next two hours we chewed and talked. Ethiopian politics, football, living in another country, khat in Somalia, Haile Selassie, religion, languages, Mo Farah, stereotypes of Africa and family life in London.

People strolled in an out of the cafe. Some in jeans and t-shirt, others looking like they’d just walked in from the Somali desert. Everyone shook my hand. Some bought khat and left, others joined us, all the while chewing gently and drinking sweet tea. At one point I asked the Christian guy why he wore an Islamic cap. He whipped off his hat. “I’m bald” he said “and it’s the only cap you can wear inside” which sent me into fits of laughter.

Khat itself has a very tannin taste and it is exactly like you’d imagine how chewing on an indigestible bush would be. It’s bitty and it fills your mouth with green gunk. The sweet tea is there for a reason.
The effect of the khat came on gently but slowly intensified. It’s stimulating like coffee but is slightly more pleasurable. There’s no jitteriness.

It reminded me of the coca plant from South America both in its ‘mouth full of tree’ chewing experience and its persistent background stimulation. But while coca gave me caffeine-like focus that always turned into a feeling of anxiety, khat was gently euphoric.

My companions told me that it lifts the spirits and makes you talkative. They had a word, which for the life of me I can’t remember, which describes the point at which it ‘opens your mind’ to new ideas and debate.

The active ingredient in khat is cathinone which has become infamous as the basis of ‘bath salts’ legal highs which chemists have learnt to create synthetically and modify. But like coca, from which cocaine is made, the plant is not mental nitroglycerine. It has noticeable effects but they don’t dominate the psyche. It’s a lift rather than a launch.

The guys in the cafe were not unaware of its downsides though. “Don’t chew too often” they told me “it can become a habit for some”. I was also told it can have idiosyncratic effects on sexual performance. Some find it helps, others not so much.

Not everyone was there for khat. Some guys chewed regularly, some not at all, some had given up, some only on special occasions. Some just came to hang out, drink tea and watch the box.

Towards the end when I felt we had got to know each other a bit better I asked why the cafe was unmarked. The owner told me that while khat is legal they were aware of the scare stories and were worried about the backlash from less enlightened members of the community. ‘Immigrants sell foreign drug’ shifts more papers, it seems, than ‘guys chew leaves and watch football’.

Eventually, I said my goodbyes and decided I could use my buzz to go for a walk. I made London Bridge in a couple of hours. But I think my newfound energy came as much from the welcome as it did from the khat.


Bath Salts Mixed With Spice: Two Drugs In One

Researchers document latest recreational Frankenmolecule.

Researchers in Japan have run across what is believed to be the first example of a hybrid synthetic drug that is a combination of a methamphetamine-related cathinone (bath salts) and an entirely new synthetic cannabinoid.

In a paper now in press for Forensic Science International, investigators from the National Institute of Health Sciences in Tokyo conducted a new round of drug buying on the Internet, also netting and identifying 12 more synthetic cannabinoids, heretofore unseen in the market for non-THC marijuana substitutes. Japan, like the U.S. and Europe, has been attempting to outlaw these problem compounds. In the paper by Nahoko Uchiyama and others, a “completely new type of designer drug, URB-754,” was identified. It is a new synthetic cannabis compound, and the researchers found it packaged together with a cathinone derivative called 4-Me-MABP.

That, in itself, was odd enough. But mass spectrometry and a little mixing of their own revealed to the scientists that the two chemicals had also blended to create a third thing, a freak admixture, half fake marijuana, half designer amphetamine, and 100% new under the sun. This combination drug is so new it doesn’t have a short name yet. It’s called (N,5-dimethyl-N-(1-oxo-1-(p-tolyl)butan-2-yl)-2-(N′-(p-tolyl)ureido)benzamide). Check out additional coverage by Vaughan Bell at Mind Hacks, where the journal report was discussed earlier.

And that, at present, is all we know about the matter. It’s not even clear how this combination substance would be ingested for maximum effect. The authors of the paper express concern about the “reactive nature of both compounds” that comprise the new hybrid, but refrain from making any predictions about its effects. “There is little information about most of the newly detected compounds,” the authors write. “Furthermore, the recent trend seems to be to mix different types of designer drugs such as cathinones (stimulants) or tryptamines (hallucinogens) with synthetic cannabinoids in illegal products. Therefore, there is the potential for serious health risks associated with their use.”

Yes, that’s right, one additional product the Japanese researchers analyzed was found to contain a synthetic cannabinoid in combination with a tryptamine, a category of compounds that includes psychedelics such as LSD, DMT, psilocybin, and others. Swell. It’s now completely clear that without a sophisticated lab analysis of bath salt and spice products, there are no guarantees whatsoever about what is being smoked, snorted, or based.

Quite a haul: A new type of designer drug, 12 new cannabis-like drugs, and a crazy reaction product made up of synthetic cannabis and cathinone. The DEA charts above clearly show that something is causing an increase in drug-related toxic reactions lately.

Overall, the trend of scientific research on bath salts and spice drugs continues to be troubling. Whether any of this will resonate with people in their prime drug-using years, after all the years of “This is Your Brain on Drugs” disinformation campaigns, remains to be seen. It looks more and more like the best harm reduction advice available is to stick with marijuana and meth, if that’s what you’re using or abusing. Nothing coming down the pike as bath salts or spice cannabinoids is an obvious improvement, and the ability to know what you are actually taking has fallen to virtually zero in this category. Early identification and constant monitoring of new substances is now a vital task, however Sisyphean.


Uchiyama N., Kawamura M., Kikura-Hanajiri R. & Goda Y. (2012). URB-754: A new class of designer drug and 12 synthetic cannabinoids detected in illegal products, Forensic Science International,    DOI: 10.1016/j.forsciint.2012.08.047

Photo: Illinois Poison Control Center Blog