New Study Casts Doubt on Current "Despair" Models of Addiction

The recent Hari/Hart/Lewis hypothesis that addiction is not primarily metabolic or genetic, but rather the result of "despair" or "sociological conditions" or "flawed learning," takes a major hit in a new report appearing in The National Bureau of Economic Research. The study suggests that "changes in economic conditions account for less than one-tenth of the rise in drug and opioid-involved mortality rates." 

Jason Schwartz at Addiction & Recovery News does a deep dive into the flawed thinking behind the new (old?) sociological views of addiction here.

Alcohol and Cancer, Explained

"Alcohol and endogenous aldehydes damage chromosomes and mutate stem cells"

Juan I. Garaycoechea, Gerry P. Crossan, Frédéric Langevin, Lee Mulderrig, Sandra Louzada,  Fentang Yang, Guillaume Guilbaud, Naomi Park, Sophie Roerink, Serena Nik-Zainal, Michael R.
Stratton & Ketan J. Patel

    Nature doi:10.1038/nature25154

This pay-walled article, published in "Nature," presents fresh evidence that alcohol can damage chromosomes and cause mutations. If you don't have a zillion dollars to spare, The American Cancer Society has put together a layman's version of the subject here.

Here's an explainer from Britain's National Health Service. And here's an interview with one of the authors, published in "Genetic Engineering and Biotechnology News." Suffice to say that among the many health problems alcohol can cause, the one that all too often goes unmentioned, namely cancer, is not a trivial side effect.

Alcohol Should Be More Expensive

Without a doubt, the alcohol you're drinking this Holiday Season is too damn cheap.

By all means check out the new piece by German Lopez at Vox: "The case for setting a minimum price on alcohol."

Corey Booker's Statement on Marijuana Legalization

Sen. Booker's petition would remove marijuana from the list of controlled substances.

 "For decades, the failed War on Drugs has locked up millions of nonviolent drug offenders, especially for marijuana-related offenses. This has wasted human potential, torn apart families and communities, and squandered massive sums of taxpayer dollars.

"That's why I introduced the Marijuana Justice Act on Tuesday to call for the legalization of marijuana at the federal level. Will you sign my petition and call on your senators to join me in moving this critical legislation forward?

"If passed into law, this would have an immediate impact on our criminal justice system, on policing, on our communities, and even on the economy. This legislation would remove marijuana from the list of controlled substances, making it legal at the federal level.

"The bill would also incentivize states to change their marijuana laws if those laws are shown to disproportionately affect low-income individuals and/or people of color. The Marijuana Justice Act would be applied retroactively for those already serving time for marijuana-related offenses, providing for a judge's review of marijuana sentences. That means we could reduce our prison population, a goal that Democrats and Republicans alike have claimed to support.

"States have, so far, led the way in reforming our failed drug policy and in beginning to fix our criminal justice system. Unfortunately, the federal government isn't doing its share—and Attorney General Jeff Sessions, among his many offenses, is working actively to undermine the progress in this area. We can't let Sessions roll back our progress, criminalize more Americans, and terrorize our communities by doubling down on failed policy."

Marijuana, Sleep, and Dreams

The indica vs. sativa debate, continued. 

[First published July 13, 2015.]

Anyone who has smoked marijuana more than a couple of times knows that cannabis can alter how you sleep. The effect of cannabis on sleep is even part of the never-ending debate over Cannabis indica vs. Cannabis sativa, the two major species of the marijuana plant. Indica smokers typically report a marijuana high that is body-intensive and often soporific, sometimes leading to the condition aptly known as “couch lock.” Whereas sativa smokers, according to marijuana lore, experience a more cerebral, energetic “head high,” with fewer somatic effects. Not surprisingly, hybrid strains incorporating the alleged characteristics of both indica and sativa strains are popular in the medical marijuana community.

Although there is no official sanction for it in the medical community, marijuana is often dispensed medically for sleep problems. One piece of common wisdom holds that the higher the THC content of marijuana, the more helpful it will be in promoting sleep and improving poor sleep. The stronger the better, in other words. Similarly, indica strains are assumed to promote sleep more than sativa strains.

In an effort to clear the air, so to speak, a group of researchers, writing in Addictive Behaviors, sought to “document naturalistic choice of particular medical cannabis types among individuals who self-report using cannabis for the treatment of sleep problems…. Little research has documented species or cannabinoid concentration preferences among individuals who use medical cannabis for particular conditions…. We also evaluated the interaction between the type of cannabis used and diagnosis of cannabis use disorder among study participants.”

The researchers recruited participants from a medical cannabis dispensary in California under procedures approved by the VA and Stanford University review boards. 163 people with a mean age of 40, who used cannabis twice a day on average, provided self-reported information on their cannabis use for the study. 81 participants reported using cannabis for the management of insomnia, and another 14 reported using cannabis to reduce nightmares. (Frequent smokers insist they dream less. THC does appear to decrease the density of REM cycles, leading to more restful, dream-free sleep, according to some studies.)

So what did they find?

—“Individuals who reported using cannabis for nightmares, compared to those who did not, preferred sativa to indica.” (Small effect.)

Indica, considered the “heavier” high, might have seemed the likely choice here.

—"Individuals who self-report using cannabis to treat symptoms of insomnia and those with greater self-reported sleep latency reported using cannabis with significantly higher concentrations of CBD.” (Large effect.)

Again, a somewhat counterintuitive finding, since it is widely believed that CBD conduces toward a more wakeful state than THC alone.

—“Individuals who used sleep medication less than once/week used cannabis with higher THC concentrations than those who used sleep medication at least once a week.” (Large effect.) “There were no differences in THC concentration as a function of self-reported sleep quality, or use for insomnia or nightmares.”

Pretty straightforward finding: THC makes you sleepy. It is not clear, however, that above a certain threshold, more THC makes you even sleepier. In fact, some researchers would consider this finding unexpected, given that high THC concentrations have been shown to have a stimulating effect.

—“Older individuals were less likely to have cannabis use disorder compared to those younger….

No surprise about the older folks, since prior studies show a decrease in the prevalence of cannabis use disorders with age.

—“Individuals who preferred sativa or primary sativa hybrid strains were less likely to have cannabis use disorder compared to those who preferred indica or primary indica hybrid strains.” (Small effect.)

If replicated, this finding could have significant implications; both in strengthening programs to reduce marijuana smoking among the very young, and it warning consumers that some evidence suggests indica strains may be more addictive than sativa strains in plants with similar THC/CBD levels and ratios.

—“Neither concentration of THC nor CBD were associated with cannabis use disorder.”

Common sense, but useful to remember. In other addictive behaviors, such as heroin and alcohol abuse, the relative strength of the drug is not the primary determinant of its addictive potential.

Caveats and design limitations: The survey relied on retrospective reports of sleep quality and pot preferences. Also lacking is an examination of additional variables such as PTSD and co-occurring substance abuse.

Heroin in Vietnam: The True Story of the Robins Study

Editor's note: The famous Robins study 
on heroin use among Vietnam veterans
 has been so often—and so recently—misinterpreted 
that I felt motivated to reprint an older post on the subject.

[Originally posted 7/24/10]

In 1971, under the direction of Dr. Jerome Jaffe of the Special Action Office on Drug Abuse Prevention, Dr. Lee Robins of Washington University in St. Louis undertook an investigation of heroin use among young American servicemen in Vietnam. Nothing about addiction research would ever be quite the same after the Robins study. The results of the Robins investigation turned the official story of heroin completely upside down.

The dirty secret that Robins laid bare was that a staggering number of Vietnam veterans were returning to the U.S. addicted to heroin and morphine. Sources were already reporting a huge trade in opium throughout the U.S. military in Southeast Asia, but it was all mostly rumor until Dr. Robins surveyed a representative sample of enlisted Army men who had left Vietnam in September of 1971—the date at which the U.S. Army began a policy of urine screening. The Robins team interviewed veterans within a year after their return, and again two years later.

After she had worked up the interviews, Dr. Robins, who died in 2009, found that almost half—45 per cent—had used either opium or heroin at least once during their tour of duty. 11 per cent had tested positive for opiates on the way out of Vietnam. Overall, about 20 per cent reported that they had been addicted to heroin at some point during their term of service overseas.

To put it in the kindest possible light, military brass had vastly underestimated the problem. One out of every five soldiers in Vietnam had logged some time as a junky. As it turned out, soldiers under the age of 21 found it easier to score heroin than to hassle through the military’s alcohol restrictions. The “gateway drug hypothesis” didn’t seem to function overseas. In the United States, the typical progression was assumed to be from “soft” drugs (alcohol, cigarettes, and marijuana) to the “hard” category of cocaine, amphetamine, and heroin. In Vietnam, soldiers who drank heavily almost never used heroin, and the people who used heroin only rarely drank. The mystery of the gateway drug was revealed to be mostly a matter of choice and availability. One way or another, addicts found their way to the gate, and pushed on through.

“Perhaps our most remarkable finding,” Robins later noted, “was that only 5% of the men who became addicted in Vietnam relapsed within 10 months after return, and only 12% relapsed even briefly within three years.” What accounted for this surprisingly high recovery rate from heroin, thought to be the most addictive drug of all? As is turned out, treatment and/or institutional rehabilitation didn’t make the difference: Heroin addiction treatment was close to nonexistent in the 1970s, anyway. “Most Vietnam addicts were not even detoxified while in service, and only a tiny percentage were treated after return,” Robins reported. It wasn’t solely a matter of easier access, either, since roughly half of those addicted in Vietnam had tried smack at least once after returning home. But very few of them stayed permanently readdicted.

Any way you looked at it, too many soldiers had become addicted, many more than the military brass had predicted. But somehow, the bulk of addicted soldiers toughed their way through it, without formal intervention, after they got home. Most of them kicked the habit. Even the good news, then, took some getting used to. The Robins Study painted a picture of a majority of soldiers kicking it on their own, without formal intervention. For some of them, kicking wasn’t even an issue. They could “chip” the drug at will—they could take it or leave it. And when they came home, they decided to leave it.

However, there was that other cohort, that 5 to 12 per cent of the servicemen in the study, for whom it did not go that way at all. This group of former users could not seem to shake it, except with great difficulty. And when they did, they had a very strong tendency to relapse. Frequently, they could not shake it at all, and rarely could they shake it for good and forever. Readers old enough to remember Vietnam may have seen them at one time or another over the years, on the streets of American cities large and small. Until quite recently, only very seriously addicted people who happened to conflict with the law ended up in non-voluntary treatment programs.

The Robins Study sparked an aggressive public relations debate in the military. Almost half of America’s fighting men in Vietnam had evidently tried opium or heroin at least once, but if the Robins numbers were representative of the population at large, then relatively few people who tried opium or heroin faced any serious risk of long-term addiction. A relative small number of users were not so fortunate, as Robins noted. What was the difference? Was it a change in setting and circumstances that allowed most heroin users to quit? Or was it that the minority of soldiers who stubbornly became readdicted did so because, like Dr. Li’s rats, they were biochemically different from their friends who stayed clean?


Quotes from: Robins, Lee N. (1994). “Lessons from the Vietnam Heroin Experience.” Harvard Mental Health Letter. December.

The Manifesto for Children of Alcoholics

Parental heavy drinking affects everyone.

The British House of Commons recently issued a manifesto timed to coincide with International Children of Alcoholics Week. The manifesto was co-written by children of alcoholics, policy analysts, and representatives from charities, medical groups, and other interest groups. The ten-point plan makes the following demands:

        —Take responsibility for children of alcoholics.               
        —Create a national strategy for COAs
        —Properly fund local support for COAs
        —Increase availability of support for families battling addiction to alcohol
        —Boost education and awareness for children
        —Boost education and training for those with a responsibility for children
        —Develop a plan to change public attitudes
        —Revise the national strategy to tackle alcoholism to focus on price and availability
        —Curtail the promotion of alcohol – especially to children
        —Take responsibility for reducing rates of alcoholism

The complete manifesto can be downloaded here. You can visit the group's site, the National Association for Children of Alcoholics, by clicking here.