Quitting When You're High

Active smokers underestimate rigors of withdrawal.

An alcoholic wraps his car around a tree in a drunken haze. He has "hit bottom" and vows never to drink again.

A meth tweaker gets so high he becomes unruly and disoriented and is arrested. In jail, cranked to the gills on speed, she pledges to go sober, starting right now.

A cigarette smoker stumbles to bed after a typical two-pack day, coughing, throat burning, reeking of tobacco, and swears that upon waking, his remaining cigarettes will go out with the trash and his life as a human ashtray is over.

Each of these addicts has started off on exactly the wrong foot, and will very likely fail quickly in their quitting attempts, according to recent research on smoking cessation from the University of Pittsburgh and Carnegie Mellon University. It is easy to say you're going to quit while you're high, sailing along on a comfortable level of nicotine in the bloodstream. Once that available nicotine is flushed out, you are going to have some serious second thoughts about the whole enterprise of abstinence. The smoker is likely to wake up the next morning, fumbling for a smokeable butt, muttering to himself: "What in the world was I thinking of last night? No way am I quitting today."

In a study to be published in the September issue of Psychological Science, researchers showed that cigarettes smokers who are not actively craving a cigarette when they vow to quit will likely not succeed, because they inevitably underestimate the rigors of the upcoming withdrawal, and the fierce intensity of their future desire to smoke.

According to lead investigator and professor of psychology Michael Sayette, "this lack of insight while not craving may lead them to make decisions--such as choosing to attend a party where there will be lots of smoking--that they may come to regret."

In the study, titled "Exploring the Cold-to-Hot Empathy Gap in Smokers," the researchers write: "In contrast to smokers in a hot (craving) state, those in a cold (noncraving) state underpredicted the value of smoking during a future session when they would be craving.... Failing to anticipate the motivational strength of cigarette craving, nonsmokers may not appreciate how easy it is to become addicted and how difficult it is to quit once addicted."

George Loewenstein, professor of economics and psychology at Carnegie Mellon and a co-author of the study, said that the research implications for non-smokers were crucial: "If smokers can't appreciate the intensity of their need to smoke when they aren't currently craving, what's the likelihood that people who have never smoked can do so?"

As further evidence of this psychological mismatch, the researchers cite earlier work performed by the University of Michigan’s Monitoring the Future longitudinal study of 1993, "which found that although only 15% of respondents who were occasional smokers (less than one cigarette per day) predicted that they might be smoking in 5 years, 43% of them were, in fact, smoking 5 years later."

All things considered, it's better to make the quitting decision when you're hurting, not when you're high.

Graphic Credit: Florida State University

2008 Marijuana Sourcebook

Feds back gateway theory, say no to medical marijuana.



Attention marijuana users: The President’s Office of National Drug Control Policy thinks it has a pretty good idea of where you live. Last month, the office released its 2008 Marijuana Sourcebook (PDF), which includes the map to the right. (Dark green equals low use, yellow equals moderate use, and red stands for high use.)

Prime marijuana territory, according to the estimates, includes Northern California, upstate New York and New England, Alaska, Northern Florida, Northern Arizona, and Western Montana. Areas showing little interest in pot include Texas, Oklahoma, Nebraska, Iowa, and Utah.

The Marijuana Sourcebook also features the controversial gateway hypothesis: “For younger users, the risk of marijuana abuse or dependency exceeds that for alcohol or tobacco. Recent research supports the ‘gateway’ dimension of marijuana — that its use creates greater risk of abuse or dependency on other drugs, such as heroin and cocaine.”

Many addiction researchers consider the gateway hypothesis to be outmoded at best. In a 2006 article in the America Journal of Psychiatry, researchers at the University of Pittsburgh Medical School could find no evidence that teenage marijuana use is predictive of drug and alcohol abuse in later life. According to Ralph E. Tarter, professor of pharmaceutical sciences at the University of Pittsburgh School of Pharmacy and lead author of the study, “the reverse pattern is just as accurate for predicting who might be at risk for developing a drug dependence disorder.”

The Sourcebook also concludes that “smoked marijuana is not medicine,” and reminds readers that the FDA has not approved the use of cannabis for anything, at any time. The Office of National Drug Control Policy has always held that the medical marijuana movement is nothing but a front for increased drug trafficking. The report puts the case in terms nobody is likely to misconstrue: “The FDA, along with the Drug Enforcement Administration and the Office of National Drug Control Policy, do not support the use of smoked marijuana for medical purposes.”

Even our friendly neighbors to the North come in for a bashing. “Canada is a consumer as well as a producer of marijuana,” the Sourcebook says, claiming that Canadian use has doubled since 1994.

In addition, under the heading, “Marijuana Growers Present Environmental Hazards,” the Sourcebook estimates that one marijuana garden can generate “up to 53 30-gallon garbage bags of trash.”

Nothing Beats Booze

Annual survey ranks alcohol as #1 problem.

Drugs may make headlines, but alcohol is the elephant sitting in the corner of the room, according to Community Anti-Drug Coalitions of America (CADCA), a non-profit organization that conducts an annual survey of community anti-drug service groups. CADCA, sponsored in part by the U.S. Department of Health and Human Services, found that 68 percent of community anti-drug coalitions ranked alcohol as “the number one problem facing their community.”

The group said that marijuana was in second place, listed by 60 percent of communities as one of the major problems in their areas. Tobacco was a close third.

“It’s no surprise that our members are seeing big problems with youth alcohol use in their communities,” said Arthur T. Dean, CADCA chairman and CEO. 700 community anti-drug coalitions took part in the 2007 survey. Community anti-drug coalitions rely on strategies including media outreach, advertisements, educational events and community forums.

Asked to name the major partners helping them tackle community drug problems, 88 percent of survey respondents listed “law enforcement.” That was slightly ahead of the number of respondents listing “parents” (86 percent).

While the results cannot be considered a surprise, it is disheartening to discover that an earlier CADCA survey found that the “alcohol stigma” is alive and well: 63 percent of Americans still believe alcoholism is a moral weakness. Only 34 percent of respondents labelled it a disease. The earlier survey also reported that two out of every five Americans reported that they have encouraged a loved one to seek help for an alcohol problem.

Moreover, a group of Britain’s most prominent drug researchers published a report in the Lancet last year calling for the U.K. to scrap its current drug classification scheme in favor of one that “more honestly reflects the harm caused by alcohol and tobacco,” according to an article in the U.K Guardian by science correspondent James Randerson.

The study team “asked 29 consultant psychiatrists who specialise in addiction to rate [20 drugs of abuse] in nine categories. Three of these related to physical harm, three to the likelihood of addiction and three to social harms such as healthcare costs,” writes Randerson. In the final rankings, heroin and cocaine were ranked as the most dangerous. Alcohol placed 5th, well ahead of marijuana (11th), LSD (14th), and Ecstasy (18th).

Predictably, howls of outrage and shock were heard from dozens of U.K. politicians and anti-drug crusaders after the report was published.

Photo Credit: LiveJournal

alcoholics anonymous

Clinical LSD

“Psychedelic psychotherapy” makes a comeback.



“Take a tab of Sunshine and call me in the morning.”

No, we haven’t reached that point yet. But there is a growing movement among research scientists to take another look at powerfully psychoactive drugs like LSD, psilocybin, MDMA and ibogaine as treatments for a variety of illnesses.

In June, the first clinical trial of LSD since the 1970s began in Switzerland, according to the U.K. Guardian. While LSD has sparked renewed interest as a potential treatment for everything from depression to cluster headaches to post-traumatic stress disorder, the Swiss trial will focus on administering LSD in varying doses to eight terminally ill subjects. “During the course of therapy,” the Guardian reported, “researchers will assess the patients’ anxiety levels, quality of life and pain levels.”

“The working hypothesis is that if psilocybin or LSD can occasion these experiences of great personal meaning and spiritual significance,” said Professor Roland Griffiths of the Johns Hopkins School of Medicine in Baltimore, “then it would allow [terminal patients] hopefully to face their own demise completely differently—to restructure some of the psychological angst that so often occurs concurrently with severe disease.”

Griffiths recently conducted a study of the effects of psilocybin on 36 health adult volunteers, the results of which were published in the British Journal of Psychopharmacology. “When administered under supportive conditions,” Griffiths concluded, “psilocybin occasioned experiences similar to spontaneously occurring mystical experiences that, at 14-month follow-up, were considered by volunteers to be among the most personally meaningful and spiritually significant of their lives.”

Griffiths told the Guardian that drugs classed as hallucinogenic had become thoroughly demonized after the excesses of the 1960s. “As a culture we just decided clinical research shouldn’t be done with this class of compounds,” he commented. “This was partly the federal regulatory authorities, it was partly the funding agencies and it was partly the academics themselves—Leary had so discredited a scientific approach to studying these compounds that anyone who expressed an interest in doing so was automatically discredited.”

The Journal of Psychopharmacology recently published a training manual for the use of investigators who are currently studying the effects of such drugs. According to the manual, psychedelic drugs are relatively safe when administered at the proper dose by a trained medical professional. The drugs are non-toxic, non-addictive, and, except in rare cases, do not cause long-lasting psychoses.

A paper in the same journal by B. Sessa of the Psychopharmacology Unit, Bristol University, concluded:

“There are similarities between the typical traits of creative people and the subjective psychological characteristics of the psychedelic (hallucinogenic) drug experience. This phenomenon was studied in a number of small trials and case studies in the 1960s. Results were inconclusive, and the quality of these studies – by modern research standards – was merely anecdotal. Nevertheless, with today’s current renaissance in psychedelic drug research and the growing interest in cognitive enhancing drugs, now may be the time to re-visit these studies with contemporary research methods.”

In the U.S., psychology professor Charles Grob of the Harbor-UCLA Medical Centre also recently completed a clinical trial using psilocybin to treat terminally ill cancer patients.

Graphics Credit: www.rsc.org

Why Don't They Just Say No?

Are addicts at fault for refusing to get well?

It often seems as if alcoholics and other drug addicts are at fault for perversely refusing to get well. Rarely do the treatment methods, or lack of them, come under question. The traditional view of the addict as an immature and irresponsible person, short on will power, low on self-esteem, and forever at the mercy of his or her “addictive personality,” works at cross-purposes with the goal of helping addicts recognize the need for treatment. Addicts have traditionally been taught to think of themselves the way Franz Kafka thought of himself in relation to his tuberculosis: “Secretly I don’t believe this illness to be tuberculosis, at least not primarily tuberculosis, but rather a sign of my general bankruptcy.”

Who is really at fault here—the patients, or the healers? Most of our current medical, legal, and psychiatric approaches to the prevention and treatment of drug addiction have failed—and are continuing to fail. As Susan Sontag has written: “Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.”

In Samuel Butler’s classic utopian satire, Erewhon, sick people are thrown in prison, under a statute that makes it a crime to be ill. Is that our current approach to addiction? Does the drug problem belong in the Attorney General’s office, as it now stands, or in the Surgeon General’s office, where a growing number of researchers say it belongs? In light of new medical findings about addictive disorders, what is enlightened public policy, and what is not?

Recent research in neurophysiology, cell biology, and molecular genetics, coupled with breakthroughs in the science of brain imaging, have made it possible, for the first time, to venture a solid assault on the basic mysteries of addiction. The past fifteen years have been exhilarating times for biomedical researchers in general; a time when basic breakthroughs in the biomedical sciences have changed the way science approaches a variety of human afflictions. We have been used to thinking of such conditions as alcoholism, drug addiction, depression, and suicide in terms of causes rooted firmly in the environment. What events in a person’s life, what outside social factors, led to the problem? However, the new medicine is telling us that we have been looking in all the wrong places for causality.

When I first began following the scientific research on addiction and alcoholism, the field was small, the insights tentative, and the overall enterprise woefully underfunded. Today, more than a decade later, an interlocking maze of biomedical and psychiatric sub-specialties make up the world of addiction science. I can only hope to impart a sense of the important work being done in addiction science. What I had originally viewed as a series of potential breakthroughs in addiction research very rapidly became the tip of an enormous iceberg: brain science, and the revolutionary new directions represented by modern biological psychiatry. The brave new sciences strongly suggest that, when it comes to addiction, the place to look is inside the brain itself.

Photo Credit: Conversations on the Fringe

Gates, Bloomberg Target Cigarettes

Billionaires pledge $500 million, but will it do any good?

If money were all it took, tobacco smoking would be on the run after Bill Gates and Michael Bloomberg jointly pledged last month to fight tobacco use worldwide, especially in low- and middle-income countries, through the Bill and Melinda Gates Foundation and Johns Hopkins University.

Mayor Bloomberg, who has been involved in anti-smoking campaigns for years, admitted at a joint news conference that "all the money in the world will never eradicate tobacco. But this partnership underscores how much the tide is turning against this deadly epidemic."

The program, put together by Bloomberg and Dr. Margaret Chan of the World Health Organization (WHO), is an ambitious, multi-faceted effort to be coordinated by the Bloomberg Initiative to Reduce Tobacco Use, the WHO, the World Lung Foundation, the Johns Hopkins Bloomberg School of Public Health, and the Centers for Disease Control and Prevention (CDC).

As Donald G. McNeil described the $500 million program, dubbed Mpower, in the July 24 New York Times: "It will urge governments to sharply raise tobacco taxes, prohibit smoking in publics places, outlaw advertising to children and cigarette giveaways, start antismoking advertising campaigns and offer people nicotine patches or other help quitting." The program also intends to bring "health officials, consumer advocates, journalists, tax officers and others from third world countries" to the U.S. for workshops and training.

It will not be the first such effort--far from it. Troubled by the rising tide of nicotine dependence among the common folk, Bavaria, Saxony, Zurich, and other European states outlawed tobacco at various times during the 17th Century. The Sultan Murad IV decreed the death penalty for smoking tobacco in Constantinople, and the first of the Romanoff czars decreed that the punishment for smoking was the slitting of the offender’s nostrils.

In America, the Prohibition years from 1920 to 1933 coincided with a short-lived effort to prohibit cigarettes. Leaving no stone unturned in the battle to eliminate drugs and alcohol from American life, Henry Ford and Thomas Edison joined forces to wage a public campaign against the “little white slavers.” Edison and Ford wanted to stamp out cigarette smoking in the office and the factory. Although that effort would have to wait another 75 years or so, New York City did manage to pass an ordinance prohibiting women from smoking in public. (See Siegel, Ronald K. Intoxication: Life in Pursuit of Artificial Paradise). Fourteen states eventually enacted various laws prohibiting or restricting cigarettes. By 1927, all such laws had been repealed.

Finally, Adolf Hitler himself took on the battle against cigarettes--and lost. In 1942, after letting loose a torrent of misbegotten screed about "the wrath of the Red Man against the White Man," Hitler, in one of the most aggressive anti-smoking campaigns in history, banned smoking in public places and slapped heavy taxes on tobacco. But by the mid-1950s, smoking in Germany exceeded prewar levels.

There is no evidence to suggest that any culture that has ever taken up the smoking of tobacco has ever wholly relinquished the practice voluntarily.

Photo Credit: National Health Service

Feeling a Need for Weed?

U.K. book on cannabis dependency.

For James Langton, author of "No Need for Weed: Understanding and Breaking Cannabis Dependency", it was no easy task to find information and support when he sought to rid himself of a 30-year marijuana relationship. Through his own efforts, and the early help of Marijuana Anonymous, Langton became abstinent. And in an effort to help others in the same boat, he published his own account, a combination of personal memoir, anecdotes from pot smokers drawn to his own Clearhead support website, and a thoughtful assessment of the nature of both active marijuana dependency and marijuana withdrawal.

Langton has written a valuable and insightful book, dedicated, he says, to those "who fell blindly in love with the drug, in all its forms, without a second thought. But this book is also for those who, just like me, found that ending this love affair was much more difficult than they could ever have imagined...."

The delights of pot are self-evident: "It didn't feel wrong, dangerous or difficult; I just enjoyed life more when my senses were heightened and when I allowed the reality of everyday life to become a little distorted. After a couple of tokes, I seemed to feel the disparate parts of my consciousness clicking into place."

So why quit at all? "For a start," writes Langton, "I wanted to be clearheaded again; to be able to remember things; to be aware of time passing at normal speed, not stretched or shrunk. I wanted more of a social life. I wanted to be more confident and not so self-obsessed. I wanted to be in control and less lazy." Finally, he felt ready to "turn away from a pleasure that had evolved into a routine, then into a habit, and finally into full-blown dependency."

Metabolically, Langton had reached a point of addiction: "I needed to smoke just to feel normal. My tolerance for dope had reached such a point that if the THC in my system fell below a certain level I would feel a deep lack, a terrible emptiness."

The author found that one aspect made quitting "harder and more demoralizing" than necessary --"the almost universal dismissal from the medical and drug treatment professions about the reality of cannabis withdrawal.... very little specialist help is available to anybody who has lost control over their dope smoking."

Langton's explanation of what had happened to him is simple and understandable: "Our dopamine levels aren't meant to be tuned to such a high pitch on an everyday basis. Maybe a few times a month or the occasional binge, but if you're smoking relentlessly day after day, particularly strong skunk, then is it any wonder you might find it hard to take pleasure in the ordinary things of life?"

Langton also offers vivid descriptions of common withdrawal effects, including "the feeling of being overwhelmed by even the simplest interactions with other people, or becoming frustrated by what you would normally consider straightforward tasks." He also noted that "night sweats are difficult because, combined with light sleeping, they can cause discomfort to your partner as well.... The sweating can last for anything up to 21 days, but usually you are over the worst after about 10." In addition, Langton suggests that if you are experiencing an extreme loss of appetite, "be reassured that this is a very common symptom. The important thing is to make sure you are taking some nutrients onboard, otherwise you will start to feel week, light-headed and slightly sick." He warns of vivid dreams, and episodes of outsized anger. (The author's salient advice on anger: You can take it back.) As for energy levels, the whole withdrawal experience can "feel like jet lag, and the best advice is to treat it as such; in other words, try not to go to bed as soon as you come home from work..."

How long does it take? "At Clearhead we have found that it takes, on average, around four to six weeks for most people to fully adjust to not using cannabis.... others will still hit upon lingering symptoms up to two months after smoking their last joint."

Overall, a good read, full of telling anecdotes, personal honesty, and practical advice.