My cortex sits atop my brain like my head sits atop my body like the whale rider sits atop the whale. When a destination is reached, the whale rider insists that it was his planned destination all along, and believes it to be so.
The pleasure centers of your brain don’t have to control you. Short term thinking does not have to guide your decisions. With motivation and a few simple tools you can take control of your life, honor your values and attain your long term goals.
Disclaimer: I am not a doctor nor am I licensed in the mental health field.
I am a trained SMART Recovery facilitator, and have been leading SMART Recovery meetings since 2010. I have been in recovery since August 16, 1989 and am interested in helping others overcome their addictions. This first page is devoted to current news in the area of addiction. More information is available on the following pages:
Reptile Brain? A brief explanation of why this site is called Reptile Dysfunction The Divided Mind How can brains be so stupid? They’re not. That’s the wrong question. Are You Addicted? How to tell if you or someone you care about is addicted. Why Them? An explanation of how smart people can continue making bad decisions. Now What? OK. I’m an addict. So, now what should I do about it? Site Administrator A little about myself and how I got here. Arrival I have broken the cycle of addiction, but how do I stay clean?
News From the Field of Addiction:
which had “Adapted with permission from the Harvard Mental Health Letter and Overcoming Addiction, a special health report published by Harvard Health Publications”
Understanding Addiction How Addiction Hijacks the Brain What Is Addiction? Key Points
- Addiction involves craving for something intensely, loss of control over its use, and continuing involvement with it despite adverse consequences.
- Addiction changes the brain, first by subverting the way it registers pleasure and then by corrupting other normal drives such as learning and motivation.
- Although breaking an addiction is tough, it can be done.
The word “addiction” is derived from a Latin term for “enslaved by” or “bound to.” Anyone who has struggled to overcome an addiction—or has tried to help someone else to do so—understands why.
Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing involvement with it despite adverse consequences.
For many years, experts believed that only alcohol and powerful drugs could cause addiction. Neuroimaging technologies and more recent research, however, have shown that certain pleasurable activities, such as gambling, shopping, and sex, can also co-opt the brain.
Although a standard U.S. diagnostic manual (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or DSM-IV) describes multiple addictions, each tied to a specific substance or activity, consensus is emerging that these may represent multiple expressions of a common underlying brain process.
New insights into a common problem
Nobody starts out intending to develop an addiction, but many people get caught in its snare. Consider the latest government statistics:
Nearly 23 million Americans—almost one in 10—are addicted to alcohol or other drugs.
More than two-thirds of people with addiction abuse alcohol.
The top three drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine.
In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit.
The scientific consensus has changed since then. Today we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.
The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex (see illustration). Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.
All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.
Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.
Brain’s Reward Center
Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine. The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli.
Scientists once believed that the experience of pleasure alone was enough to prompt people to continue seeking an addictive substance or activity. But more recent research suggests that the situation is more complicated. Dopamine not only contributes to the experience of pleasure, but also plays a role in learning and memory—two key elements in the transition from liking something to becoming addicted to it.
According to the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to take over the brain’s system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival (such as eating and sex) with pleasure and reward.
The reward circuit in the brain includes areas involved with motivation and memory as well as with pleasure. Addictive substances and behaviors stimulate the same circuit—and then overload it.
Repeated exposure to an addictive substance or behavior causes nerve cells in the nucleus accumbens and the prefrontal cortex (the area of the brain involved in planning and executing tasks) to communicate in a way that couples liking something with wanting it, in turn driving us to go after it. That is, this process motivates us to take action to seek out the source of pleasure.
Do you have an addiction?
Determining whether you have an addiction isn’t completely straightforward. And admitting it isn’t easy, largely because of the stigma and shame associated with addiction. But acknowledging the problem is the first step toward recovery.
A “yes” answer to any of the following three questions suggests you might have a problem with addiction and should—at the very least—consult a health care provider for further evaluation and guidance.
- Do you use more of the substance or engage in the behavior more often than in the past?
- Do you have withdrawal symptoms when you don’t have the substance or engage in the behavior?
- Have you ever lied to anyone about your use of the substance or extent of your behavior?
Development of tolerance
Over time, the brain adapts in a way that actually makes the sought-after substance or activity less pleasurable.
In nature, rewards usually come only with time and effort. Addictive drugs and behaviors provide a shortcut, flooding the brain with dopamine and other neurotransmitters. Our brains do not have an easy way to withstand the onslaught.
Addictive drugs, for example, can release two to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and more reliably. In a person who becomes addicted, brain receptors become overwhelmed. The brain responds by producing less dopamine or eliminating dopamine receptors—an adaptation similar to turning the volume down on a loudspeaker when noise becomes too loud.
As a result of these adaptations, dopamine has less impact on the brain’s reward center. People who develop an addiction typically find that, in time, the desired substance no longer gives them as much pleasure. They have to take more of it to obtain the same dopamine “high” because their brains have adapted—an effect known as tolerance.
Compulsion takes over
At this point, compulsion takes over. The pleasure associated with an addictive drug or behavior subsides—and yet the memory of the desired effect and the need to recreate it (the wanting) persists. It’s as though the normal machinery of motivation is no longer functioning.
The learning process mentioned earlier also comes into play. The hippocampus and the amygdala store information about environmental cues associated with the desired substance, so that it can be located again. These memories help create a conditioned response—intense craving—whenever the person encounters those environmental cues.
Cravings contribute not only to addiction but to relapse after a hard-won sobriety. A person addicted to heroin may be in danger of relapse when he sees a hypodermic needle, for example, while another person might start to drink again after seeing a bottle of whiskey. Conditioned learning helps explain why people who develop an addiction risk relapse even after years of abstinence.
Recovery is possible
It is not enough to “just say no”—as the 1980s slogan suggested. Instead, you can protect (and heal) yourself from addiction by saying “yes” to other things. Cultivate diverse interests that provide meaning to your life. Understand that your problems usually are transient, and perhaps most importantly, acknowledge that life is not always supposed to be pleasurable.
Adapted with permission from the Harvard Mental Health Letter and Overcoming Addiction, a special health report published by Harvard Health Publications. —– For more information about the pleasure centers of the brain, please see “The Compass of Pleasure” by David J. Linden —–
Crystallization Of Discontent
Three-quarters of us who have abused or were dependent upon a substance or activity have either self-remitted or moderated to non-abusive levels, either completely on our own, or with minimal help. That we have done so without formal treatment or self-help programs has been well-established by the scientific community in many detailed studies over several decades. In fact, at least 34 studies have indicated that the single most effective treatment method for dependence is a single brief intervention from a trusted health-care provider, such as a family doctor.
In 1999, I was sitting on a hospital bed, waiting to be released, merely five days after a major heart attack, wondering how to convince my wife to stop on the way home for a carton of cigarettes. Before my cardiologist signed the release, she looked me right in the eyes and told me that if I started smoking again, my chances of dying, and doing it quickly, were four times greater than if I didn’t. If that wasn’t enough, my wife told me on the way home that she would leave me, should I ever smoke again, because she couldn’t stay around to watch me die. I have never smoked again!
My doctor and my wife brought me to the point where the costs of continuing to engage in the activity of smoking no longer outweighed the benefits of using the substance. I was suddenly willing to do whatever it took to quit. Sure, I had cravings and urges, but I knew they wouldn’t last long, and I knew I could withstand them, as I was well-motivated.
Studies show that everyone who successfully overcomes a dependency problem does so after reaching the same cognitive decision that I did – the cost of engaging in the activity outweighs the benefits. The professionals call this decision, and it is a decision, the crystallization of discontent, and it provides the primary motivation for the self-change process that all remitters go through, whether they do it with or without help. Most who reach this decision on their own never show up in treatment centers or self-help groups, but there are those that do, and when they do, it’s most important that their decision be reinforced and augmented, as they are in either the Preparation or Action stages-of-change.
Others, who are still in the Pre-contemplative, or Contemplative stage, and have not as yet reached the crystallization of discontent, are in the greatest need of the tools SMART Recovery® offers. Referring back to studies again, the second most-effective treatment method is Motivational Enhancement, which includes tools such as an assessment of substance use, substance-related problems, level of dependence, level of motivation, and a complete cost vs. benefit evaluation. These are exactly the motivational tools we offer at SMART, and we use them not only to reinforce the decision already made by those who want to make a change, but also to help bring those who have not yet made the decision but are considering it, to the same point.
Reaching the point of crystallization of discontent with my alcohol use was a lengthier and more painful process, as it was the cumulative result of several incidents occurring over many months, culminating in a very emotional scene with my young daughter in the summer of 1990. Prior to that scene, I was very much in the Pre-contemplative stage. I didn’t question my own alcohol use because I truly believed the problems I was having, and the intense pain I was suffering as a result, were due to my job, my wife, my kids, anything not having to do with myself, or the alcohol I was drinking. The experience with my daughter opened me to the possibility that my drinking was the cause of my problems, and moved me into the Contemplative stage, which for me, lasted only a few hours, as my last drink was the next day. I was lucky, not everyone has the benefit of an intense emotional experience to help them make the decision to stop. Many linger, some undergoing additional years of suffering and pain.
If you are concerned that you may be experiencing dependence upon a substance or activity that is causing a problem in your life, I suggest you take advantage of the resources on the SMART Recovery® website, especially the Cost Benefit Analysis (CBA), (see here for an overview and instructions), and the confidential survey at Drinker’s Checkup, as they are tools that can help you reach the decision that the costs of whatever it is that’s causing the problem outweigh any benefits you may be receiving from it, especially in the long term. If you are honest with the CBA, you should see that there are simply NO long-term benefits of continuing the behavior, the benefits, if any are short-term only, and there are no long term costs for not continuing the behavior. That, my friend, constitutes the crystallization of discontent.
“The forgoing is an excerpt from the book “Powerless No Longer” by Pete Soderman, and is the property of the author.”
About The Author: Pete Soderman is a Smart Facilitator who co-founded the SMART meeting in Wilmington, NC with Mike Werner, and is currently facilitating a SMART meeting in Ajijic, Jalisco Mexico. He recently published a book about addiction and recovery titled: Powerless No Longer and publishes a blog with the same title.
FIGURE 1. Some of the brain structures affected by drugs of abuse. From the following article: Drug addiction: bad habits add up Trevor W. Robbins and Barry J. Everitt Nature 398, 567-570(15 April 1999) doi:10.1038/19208
The mesolimbic dopamine system originates in the ventral tegmental area (VTA) of the midbrain, and projects to the nucleus accumbens (NA). The amygdala (A), hippocampus (HC) and medial prefrontal cortex (PFC) send excitatory projections to the nucleus accumbens. C, caudate nucleus (striatum).
FIGURE 2. Neural systems of addiction. From the following article: Drug addiction: bad habits add up Trevor W. Robbins and Barry J. Everitt Nature 398, 567-570(15 April 1999) doi:10.1038/19208
A dopamine-releasing neuron from the ventral tegmental area (VTA) is shown innervating a medium spiny neuron dendritic spine in the nucleus accumbens (NA). The dopamine transporter (DAT) is a main site for cocaine and amphetamine action. These drugs inhibit the re-uptake of dopamine by the VTA neuron, where it is initially produced from the amino acid tyrosine. Dopamine is shown acting at the two main families of dopamine receptor (D1 and D2). These are coupled to guanine-nucleotide-binding proteins (Gsand Gi), components of the intracellular cyclic AMP system, which also includes adenylyl cyclase (AC) and cAMP-dependent protein kinase (PKA). Possible substrates for this kinase include ion channels and the nuclear transcription factors CREB, Fos and Jun. A, amygdala; HC, hippocampus; PFC, prefrontal cortex; EAAR, excitatory amino-acid receptor; Glu, glutamate. (Adapted from ref. 16.)
U.S. Attorney General and Republicans Join in Opposition to Stiff Drug Sentencing Laws
U.S. Attorney General Eric Holder is joining with libertarian Republicans, including Senator Rand Paul of Kentucky, in opposing mandatory minimum sentences for nonviolent drug offenders.
This political alliance may make it politically feasible to significantly liberalize sentencing laws, according to The New York Times. Libertarian-minded Republicans oppose long prison sentences because they see them as ineffective and expensive, the article notes. Rand is backing a sentencing overhaul bill in the Senate, and the House is considering similar legislation.
In August, Holder announced a Justice Department plan to change how some non-violent drug offenders are prosecuted. Low-level, nonviolent drug offenders who are not tied to large-scale drug organizations or gangs will not face mandatory minimum sentences.
Under the plan, severe penalties will be used only for serious, high-level or violent drug traffickers. Holder will give federal prosecutors instructions about writing their criminal complaints when they charge low-level drug offenders, in order to avoid triggering mandatory minimum sentences. Certain laws mandate minimum sentences regardless of the facts of the case.
In December, President Obama commuted the sentences of eight federal inmates who had been convicted of crack-cocaine offenses. Six of the inmates were sentenced to life in prison. The inmates likely would have received much shorter terms under current drug laws and sentencing rules.
While powder and crack cocaine are two forms of the same drug, until recently, a drug dealer who sold crack cocaine was subject to the same sentence as a dealer who sold 100 times as much powder cocaine.
The Fair Sentencing Act, enacted in 2010, reduced the disparity from 100 to 1 to 18 to 1, for people who committed their crimes after the law took effect. As a result, many defendants who are caught with small amounts of crack are no longer subject to mandatory prison sentences of five to 10 years. Those convicted of crack-cocaine crimes tend to be black, while those convicted of powder-cocaine offenses tend to be white.
Hmm. Lowers use. Reduces harm for those who are addicted. Cheaper for society. I know hardliners don’t like harm reduction but if it’s better for everyone concerned, it’s kind of hard to argue against it.
From Time .
A crack pipe vending machine for addicts sounds like the punch line of a bad joke—but the same kind of ridicule has been lobbed at many measures to fight drug addiction and related harm that have now proven to save lives. From needle exchange programs for HIV prevention to providing heroin to addicts, and from supervised injecting rooms to “wet houses” where homeless alcoholics are given free booze, approaches that seem to “enable” users are in fact effective in helping them to survive and recover.
Crack pipe vending machines were first introduced six months ago in Vancouver by a drug program, and a second one was added earlier this week. In this case, supporters believe that reducing the sharing of crack pipes will reduce the spread of diseases like Hepatitis C, though there is little published data on the question. “There’s no evidence one way or the other,” says Keith Humphreys, professor of psychiatry at Stanford and former Senior Policy Advisor for President Obama’s Office of National Drug Control Policy, better known as the “drug czar’s office.”
Harm reduction—the idea that drug problems can be addressed by reducing drug-related harms like overdose and disease even if users don’t become totally abstinent—became a major but controversial trend in drug policy at the height of the 1980s AIDS epidemic. Vehemently opposed by the Bush administration, which banned federal funds for such programs—and even by President Clinton, who later apologized for being wrong—harm reduction programs continued to spread because the data consistently showed reductions in infections without the feared increases in drug use.
Needle exchange, for example, which first began in the 1980s, has been found to be effective at fighting HIV by every public health organization that has investigated the method, including the World Health Organization [PDF], the Centers for Disease Control [PDF], and the Institute of Medicine. “Relative to other things we do in public health—like wearing seatbelts or fluoridation of water—this is a well-supported intervention and does reduce the prevalence of HIV in the population. That’s really valuable,” says Humphreys, adding that it is probably not as effective in preventing Hepatitis C because that virus can survive for much longer outside the body.
There is also significant evidence to support giving heroin to heroin addicts who have repeatedly been failed by other treatments like methadone maintenance and Twelve-Step programs. A 2012 Cochrane Review, considered to be among the highest levels of medical evidence, examined data from countries that have trialed or currently provide heroin maintenance treatment, including Great Britain, Canada, Switzerland, and Germany and comes down in its favor. The authors write that heroin provision “may help [addicted people] to remain in treatment, limit the use of street drugs, reduce illegal activities and possibly reduce mortality.”
And, though it sounds hard to believe, needle exchange can also be a pathway to abstinence or medication-assisted treatment. Far from making users more likely to continue to inject or increase their drug use, research shows that such programs actually increase the number of addicts who seek abstinence treatment or maintenance that will allow them to stop injecting.
There are two major theories about why this occurs. One is that taking action and using clean syringes to reduce drug-related harm increases drug users’ confidence that they can make other changes. The other is that by offering help without demanding anything in return, the staff of these programs (many of whom are recovering addicts themselves) inspire change. “The experience of being loved or cared about in a way that is something other than instrumental can be very powerful,” says Humphreys.
At Insite, North America’s only supervised injection center, addicts can get clean needles and shoot up under medical supervision. It also has a detox program. “In itself, harm reduction is valuable regardless of whether it leads to abstinence,” says Gabor Maté, a Canadian addiction doctor and author of In the Realm of Hungry Ghosts, about his experience working at Insite, “Had [my patients] not had contact with Insite and the experience of acceptance and nonjudgment, they would not have ended up in detox” Maté says.
There are more than two dozen peer-reviewed studies of injection rooms, Maté says, “all showing positive effects in terms of reducing disease, fewer medical costs, increased prosocial function—absolutely nothing negative.” Humphreys, however, finds the data here less convincing than for needle exchange alone or opioid maintenance because, he says, there are not as many good studies by objective researchers.
Providing free heroin leads to abstinence more often than one might expect. One Swiss study found that 40% of participants sought abstinence treatment as a way of completing the program, despite the fact that it wasn’t required. This may be because heroin addicts’ lives tend to be occupied and defined by the difficult quest for drugs and the hustling needed to get money for them. When the drugs are easy to get, their lives can seem empty and boring. But with support, this extra free time can pave the way for either abstinence or employment, or both. In fact, some of the heroin studies have shown that employment rates as much as double, although they remain low and the rise is not much greater than that seen with methadone treatment alone.
Though newer, alcohol harm reduction also appears to be promising. One study, published in the Journal of the American Medical Association, found that a Seattle “wet house” program offering both booze and housing to chronic alcoholics cut public spending on policing and medical care for them by 53%, saving the city an average of $2,449 per person per month. Not only that, but the participants actually reduced their drinking from an average of 16 drinks per day to 11.
“It removes anxiety, provides acceptance, and reduces isolation,” says Maté, “When they are less anxious and less isolated and feel more accepted, there is less need to use. [Excessive] use of substances is about trying to adapt to unbearable emotional and social situation.”
Humphreys cautions that it is not yet clear whether “wet houses” have negative effects on the street alcoholics who aren’t offered them. They are currently being considered in San Francisco to house the most chronic alcoholics who cause the biggest public nuisance, and he worries that this might provide an incentive for people to get worse so they can get housing. “I’d like an apartment in San Francisco. And free wine would be awesome,” he jokes.
While harm reduction may make politicians queasy, the data clearly supports the most commonly used measures like needle exchange, methadone, and Suboxone, and so far suggests possible benefit from more controversial measures like heroin provision, safe injecting rooms, and “wet houses.” It may be a while before you see a crack pipe vending machine side-by-side with a soda vending machine, and they still remain to be properly evaluated, but it’s probably too early to dismiss the notion outright.
November/December 2013 Issue Alternatives to 12-Step Addiction Recovery By Christina Reardon, MSW, LSW Social Work Today Vol. 13 No. 6 P. 12 Support is available for people seeking options beyond the 12 steps, and proponents believe recognition will grow with future generations’ exposure to different approaches. People trying to overcome addiction have a variety of experiences in treatment. They may receive outpatient, intensive outpatient, or residential treatment. They may access services in luxurious surroundings, community clinics, or prisons. They may encounter cognitive behavioral therapy, motivational interviewing, or family therapy. Despite these differences, there is something that many people in recovery will share as they progress through and out of treatment: They will be asked, if not required, to “work the steps.” Indeed, the process of recovery from addiction has been dominated in the United States by the 12-step method established with the founding of Alcoholics Anonymous (AA) in 1935. But AA and its various successors are not the only mutual-aid groups available to support people in recovery. For the past few decades, several other groups have tried to offer alternatives to those who want something other than a 12-step approach. These alternative groups historically have struggled to gain a significant following, but with the advent of new technologies and the rise of a new generation of people in treatment who want more control over their recovery, these groups believe the time has come for social workers and other behavioral health professionals to accept them as part of the mainstream continuum of recovery services. “A big part of what I believe in is choice,” says Robert Stump, executive director of LifeRing, a group based in Oakland, CA. “One shoe does not fit all people. Every day that goes by, there are more and more people who are demanding that choice. [Alternative groups] may not cater to a large section of the American public, but we do appeal to a subset of Americans, and professionals should be aware of that.” Different Roads to Recovery LifeRing is one of five organizations often cited as the largest national groups that provide an alternative approach to the 12 steps, according to the Substance Abuse and Mental Health Services Administration. The others are SMART Recovery, SOS (Secular Organizations for Sobriety/Save Our Selves), Women for Sobriety, and Moderation Management. Representatives of these organizations stress that it is not their goal to bash 12-step programs, and they acknowledge that such programs have helped countless people, including many who use the 12 steps to supplement their involvement with alternative organizations. However, there are several important differences that may make alternative groups attractive to people in recovery who do not want to use a 12-step approach. These differences generally fall into the following four categories: • Secularity: The 12 steps as originally outlined by AA are overtly spiritual, with references to “a power greater than ourselves,” God, and prayer. Other 12-step groups have retained the same or similar language. The alternative groups, on the other hand, promote themselves as secular in nature. A secular approach makes the groups more open and comfortable not only to atheists and agnostics but also to Buddhists, Muslims, and others who do not share a Western, Christian tradition, Stump says. The alternative groups are not antireligion, however, and many of their members belong to a religious denomination or identify as spiritual. • Emphasis on internal control: Twelve-step programs emphasize the recovering individual’s powerlessness over alcohol, other substances, or behaviors and the need to rely on a higher power for assistance in overcoming addiction. Alternative groups reject this view and instead see individuals as having adequate power within themselves to overcome addictions. This view is evident in the language of alternative organizations, which emphasize phrases such as “empowering our sober selves,” “saving our selves,” and “self-management and recovery.” • Evolving approaches: Although the number of 12-step groups has grown over the decades, the basic language and methods of the 12-step approach have not changed significantly since AA’s founding nearly 80 years ago. Alternative groups tend to be more open to changing their techniques in response to the development of evidence-based approaches to addressing addictions, such as cognitive behavioral therapy. The commitment to stay abreast of current research in the field of addictions is one of the main factors that attracted Brett Saarela, LCSW, to get involved in SMART Recovery. “It’s open to change. There’s no dogma about it,” says Saarela, vice president of SMART Recovery’s board of directors. “As new techniques are being produced, they’re evaluated and then incorporated. Nothing is frozen in time.” • Shedding of lifelong labels: AA and other 12-step groups portray the battle against addiction as a lifelong one that requires constant vigilance and at least periodic attendance at meetings, even for people who have been in recovery for years. Alternative groups take a shorter-term approach, presenting themselves as tools that people in recovery can use until they no longer see the need for them. Women for Sobriety, for example, refuses to give its participants lifelong labels based on past behavior and instead focuses on the present and the future, says Laura Makey, one of the organization’s facilitators and treasurer of its board of directors. “If I quit smoking, I wouldn’t say I was a smoker for the rest of my life,” she says. “We are not defined by our past. The idea of having to label yourself as an alcoholic or an addict for the rest of your life, that is disempowering, especially for women.” The alternative groups are not monolithic, however, and there are individual differences among the groups. For example, Moderation Management promotes a harm-reduction approach to alcohol use, while the other four groups are abstinence based. And the five groups mentioned above do not encompass every alternative to 12-step programs. For instance, many groups exist that provide services to people in recovery who want more religious-based support services than 12-step programs typically provide. These groups include The Calix Society, which is designed for Catholics in recovery, and Jewish Alcoholics, Chemically Dependent Persons, and Significant Others (JACS). A Struggle to Gain Visibility Although groups that provide alternatives to 12-step programs have been around in one form or another for decades, they still remain unknown among many, if not most, individuals in recovery. Jim Mergens, executive director of Moderation Management, acknowledges how difficult it is for alternative groups to gain the same visibility that AA and other 12-step groups enjoy: “AA is quite ingrained in American culture.” But why? In a consumer-driven society where people have countless choices with everything from what brand of yogurt they buy to what kind of car they drive, why does the 12-step approach remain dominant in recovery services? There’s no simple answer, and observers point to several theories to explain why alternative mutual-aid groups have not been able to catch on. One factor is history. AA was established more than 40 years before any of the major alternative groups. When AA was established, there were few treatment options available for alcoholics, so the organization filled a void, says Susan Foster, MSW, vice president and director of policy research and analysis for CASAColumbia, a New York-based research organization that assesses the impact of substance use on American systems and populations. “[AA] was the only resource available for people with addictions to alcohol, and it was life-saving and critical to many people,” she says. Another factor is how treatment services in the United States evolved after the formation of AA, according to Katherine van Wormer, PhD, MSSW, a professor in the University of Northern Iowa department of social work. Central to this evolution is the development of the “Minnesota Model” of treatment services, which focused on a 12-step approach, an insistence on abstinence, and emphasis on having trained recovering addicts joining professional staff as part of the treatment team (Anderson, McGovern, & DuPont, 1999). Eventually adopted by Hazelden, one of the best-known treatment providers in the country, the Minnesota Model became the one that was widely adopted across the United States. The incorporation of recovering addicts into treatment services further solidified the popularity of 12-step approaches because counselors who have been helped by such approaches become passionate about them and want others to have the same experience, Saarela says. “You come to believe that [the 12-step approach] is the model you have to follow; to think about other options is sacrilegious,” she says. “It’s about questioning your whole foundation, and that’s a scary thing.” In a recent article in the Journal of Groups in Addiction & Recovery, Kelly and White (2012) discuss other possible reasons for the dominance of 12-step groups, particularly AA. Among them is that AA’s lack of a highly centralized governing structure makes it relatively easy for anyone in recovery to start an AA meeting, whereas some of the alternative groups have a harder time establishing meetings because these organizations are stricter in their requirements regarding who can facilitate meetings. In addition, AA’s promotion of a spiritual approach to addiction recovery may be an especially good fit for the traditional view of the United States as a country built on religious values. Finally, the authors describe a catch-22 situation in which treatment professionals are more likely to refer clients to AA because its popularity means that more meetings are accessible and that there is more research on its effectiveness. These referrals further cement AA’s dominance and keep alternative groups on the margins. Changes Ahead? In today’s climate of technological change where information about various approaches to recovery is easily accessible, social workers and other treatment professionals have an ethical obligation to learn about alternative approaches to recovery, says Tom Horvath, PhD, ABPP, president of SMART Recovery’s board of directors. “People need to know that there’s a diversity of paths,” says Horvath, who also is president of Practical Recovery, a San Diego-based provider of non–12-step addiction treatment. “At this point, it is the responsibility of every addiction professional to find out what these groups are about.” There are signs that alternative mutual-aid groups are becoming more visible in the recovery community. One indication is that technology has given such groups new opportunities for outreach. Several of the alternative groups have an online presence through online chat rooms and message boards, Facebook pages, and Twitter feeds. Some groups even run online meetings. Online interaction not only engages recovering addicts who cannot make it to meetings because of geography but also those people in recovery who feel more comfortable interacting technologically than attending meetings in person, Saarela says. Alternative groups also have made renewed attempts to engage treatment service providers. For example, Women for Sobriety, SMART Recovery, SOS, and LifeRing worked together to create materials to educate providers of employee assistance program services, Makey says. Educating service providers is vital to increasing the reach of alternative groups because these clinicians are the ones who most likely will influence clients’ decisions regarding their paths to recovery, says Jonathan Egge, LCSW, an addictions therapist and SMART Recovery facilitator in Pennsylvania. Providers also have influence over other providers. “Providers have to communicate better within the provider community,” he says. “The provider community has to do more to interact with itself so these issues are kept in the forefront.” Saarela believes that as awareness of alternative groups increases, the hold that 12-step approaches have over recovery will loosen as people become exposed to other ideas. “Some years need to go by, and things will change,” she says. “The next generation will not be as die-hard, and it won’t seem as frightening to explore other options. They’ll see that people have been helped by different approaches.” — Christina Reardon, MSW, LSW, is a freelance writer based in Harrisburg, PA, and a contributing editor at Social Work Today. Alternative Mutual-Aid Groups for People in Recovery SMART Recovery Year established: 1994 Philosophy: SMART stands for Self-Management and Recovery Training (www.smartrecovery.org). It’s centered on a four-point program that emphasizes enhancing and maintaining motivation to abstain from addictive behavior; learning how to cope with urges and cravings; using rational ways to manage thoughts, feelings, and behaviors; and balancing short-term and long-term pleasures and satisfactions in life. The program’s tools are based on evidence-based interventions, including cognitive behavioral therapy and motivational interviewing. Reach: SMART Recovery has approximately 1,000 meetings worldwide. It reaches an expanded audience through technology, offering online meetings and activities and maintaining a presence on Twitter, Facebook, and YouTube. Moderation Management Year established: 1994 Philosophy: Moderation Management (www.moderation.org) is designed for people who believe their drinking has become problematic and want to moderate it before it gets harder to control. Participants are asked first to abstain from alcohol for 30 days, and during this time they are encouraged to think about how drinking has affected their lives and under which circumstances they had been drinking. After the 30 days of abstinence, participants are given guidelines about how to drink moderately. Participants who have trouble keeping their drinking moderate are encouraged to consider complete abstinence. Women for Sobriety Year established: 1976 Philosophy: Women for Sobriety (www.womenforsobriety.org) is designed to provide a safe, nurturing, and empowering environment for women in recovery. Its New Life Acceptance Program is centered on 13 principles emphasizing positive thinking, personal responsibility, and embracing the future instead of rehashing past mistakes. LifeRing Year established: 2001 Philosophy: LifeRing (www.lifering.org) has adopted a “3-S” philosophy focused on sobriety (abstinence from alcohol or drugs), secularity (recovery focused on human efforts vs. divine intervention), and self-help (personal motivation and effort as the key to recovery). Reach: LifeRing had 177 meetings worldwide as of September. Most of these meetings are in the United States, especially in the Bay Area of northern California. LifeRing also offers a variety of online resources, including chat rooms, e-mail groups, an Internet-based bulletin board, and a social networking site. SOS Year established: 1986 Philosophy: SOS’ programming (www.sossobriety.org) is based on its Suggested Guidelines for Sobriety, which emphasize sobriety as a member’s top priority in life. Participants must develop strategies to remain sober even when facing situations that make them want to go back to drinking or using drugs. References Anderson, D. J., McGovern, J. P., & DuPont, R. L. (1999). The origins of the Minnesota model of addiction treatment: A first person account. Journal of Addictive Diseases, 18(1), 107-114. Kelly, J. F., & White, W. L. (2012). Broadening the base of addiction mutual-help organizations.Journal of Groups in Addiction & Recovery, 7(2-4), 82-101. —–
Philip Seymour Hoffman, perhaps the most ambitious and widely admired American actor of his generation, who gave three-dimensional nuance to a wide range of sidekicks, villains and leading men on screen and embraced some of the theater’s most burdensome roles on Broadway, died on Sunday at an apartment in Greenwich Village he was renting as an office. He was 46.
The death, from an apparent drug overdose, was confirmed by the police. Mr. Hoffman was found in the apartment by a friend who had become concerned after being unable to reach him. Investigators found a syringe in his arm and, nearby, an envelope containing what appeared to be heroin.
Mr. Hoffman was long known to struggle with addiction. In 2006, he said in an interview with “60 Minutes” that he had given up drugs and alcohol many years earlier, when he was 22. Last year he checked into a rehabilitation program for about 10 days after a reliance on prescription pills resulted in his briefly turning again to heroin.
“I saw him last week, and he was clean and sober, his old self,” said David Bar Katz, a playwright, and the friend who found Mr. Hoffman and called 911. “I really thought this chapter was over.”
BY RADLEY BALKO
Recently, my Washington Post colleague Michael Gerson wrote a column urging conservatives to reject libertarianism. As a libertarian, I do agree with him on one point—the two are fundamentally opposing ideologies. In fact, I don’t even really consider libertarianism part of “the right,” as it is often portrayed. (I also wouldn’t conflate libertarianism with the Tea Party. Yes, there’s some overlap. There are also some sharp contrasts.)
But the part of Gerson’s column I want to take a closer look at is his discussion of the drug war and victimless crimes. Here’s the first relevant passage:
So conservatism is a governing vision that allows for a yellow light: careful, measured public interventions to encourage the health of civil society. There are no simple rules here. Some communities — disproportionately affected by family breakdown, community chaos or damaging economic trends — will need more active help. But government should, as the first resort, set the table for private action and private institutions — creating a context in which civil society can flourish.
This goal has moral and cultural implications. Government has a necessary (if limited) role in reinforcing the social norms and expectations that make the work of civic institutions both possible and easier. Some forms of liberty — say, the freedom to destroy oneself with hard drugs or to exploit other men and women in the sex trade — not only degrade human nature but also damage and undermine families and communities and ultimately deprive the nation of competent, self-governing citizens. (The principle applies, more mildly, to softer drugs. By what governing theory did the citizens of Colorado — surveying the challenges of global economic competition, educational mediocrity and unhealthy lifestyles — decide that the answer is the proliferation of stoners?)
To the extent that conservatives still defend the drug war (and there are fewer and fewer willing to do so), this is usually the way they go about it. Their argument is that drug use enslaves drug users with addiction, and that were drugs to be made legal, we’d all be robbed of the benefits of living in a populace of responsible citizens. Use and addiction would be common, thus shredding the moral fabric (or some other vague metaphor) that binds us all together. These arguments have been rehashed again since the legalization of marijuana in Colorado and Washington. (See also Davids Brooks andFrum.)
I think there’s good evidence that this is wrong on its face. Jacob Sullum’s book Saying Yes: In Defense of Drug Use, for example, presents compelling empirical evidence that the vast, vast majority of people who use drugs—even hard drugs—do so recreationally, don’t become addicts, and inflict little to no harm on those around them. But even if we accept the argument that legalization could lead to widespread use, significantly more addiction, and whatever itinerant harm comes with both, these arguments almost always fail to acknowledge the catastrophic harm inflicted by drug prohibition itself. If we’re truly concerned about policies that “degrade human nature,” “damage and undermine families,” and “deprive the nation of competent, self-governing citizens,” it seems like we should consider not only the effects of illicit drugs themselves, but also the effects of prohibiting them.
Depriving the nation of competent, self-governing citizens . . .
According to a new study published in the journal Crime & Delinquency, by the age of 23, “by age 23, 49 percent of black males, 44 percent of Hispanic males and 38 percent of white males have been arrested.” The study was based on surveys conducted between 1997 and 2008. A similar survey released last year found that overall, one in three Americans have been arrested by their 23rd birthday. According to the FBI’s Uniform Crime Reports, in 2012, more people were arrested for drug crimes than any other class of crimes. Moreover, 80 percent of drug arrests were for possession, not for distribution. In New York City alone, police arrested more than 40,000 people for marijuana possession in 2012. That number was actually down from previous years. Many of the hundreds of thousands of New York City pot smokers arrested over the last decade were not the result of smoking the drug in public, but because police tricked them into “displaying” the drug during a stop and frisk. Though possession of under 25 grams of pot isn’t a criminal offense in New York, “public display” of the drug is. And so pot possession remains the number one reason for arrest in New York City. And though blacks, whites, and Latinos use the drug at similar rates, 90 percent of those arrestedare black or Latino.
A mere arrest without resulting criminal charges may not seem like a big deal to you — if you haven’t been arrested. Here are researchers Alfred Blumstein and Kiminori Nakamura, writing in the New York Times:
The ubiquity of criminal-background checks and the efficiency of information technology in maintaining those records and making them widely available, have meant that millions of Americans — even those who served probation or parole but were never incarcerated — continue to pay a price long after the crime . . .
More than two-thirds of the states allow hiring and professional-licensing decisions to be made on the basis of an arrest alone . . .
Employers could apply their own judgments around those estimates, but the real problem is the state and local rules — often embedded in statutes — that restrict employment or licensing for the rest of the individual’s life. In New York, former offenders can be forever denied licenses for certain jobs, ranging from beer distributor to real estate broker.
An arrest—particularly a drug-related arrest—can also be used to deny citizenship to immigrants, even if the arrest never results in a criminal charge.
And those are just the consequences of an arrest. We should also look at the effects of a conviction and incarceration. Even a misdemeanor drug conviction can mean up to 2.5 years in jail, depending on the state. It means a bona-fide criminal record, which can limit eligibility for student aid. That of course has a disproportionate effect on the young and poor, who are most likely to need aid to attend college. And as noted, the poor are much more likely to be arrested for these crimes than people in higher income brackets. Blacks and Latinos are much more likely to be arrested and convicted than whites. In some states, a misdemeanor drug conviction can limit or even eliminate the possibility of attending a state college or university. It can get you evicted from public housing. (In fact, the mere accusation, without a conviction, that someone in your household possessed illicit drugs is enough to merit an eviction.) And it can prohibit you from ever owning a firearm.
Felony convictions are of course much worse. In addition to the consequences for a misdemeanor conviction, in many states a felony conviction comes with a ban on a variety of other forms of government assistance, including job training programs. Civic participation? As of 2010, about 6 million Americans couldn’t vote due to felony convictions. Many of those are of course convictions for violent crimes or major property crimes. But many are for relatively low-level drug convictions. In some states, possession of any amount of a drug like heroin or cocaine can bring a felony charge, even when there is no evidence of intent to distribute. Few places make possession of a small amount of marijuana a felony on the first offense, but there are states where a second offense can result in a felony, regardless of quantity.
In 2004, sociologists Bruce Western and Devah Pager sent volunteers out to apply for various jobs. The volunteers listed identical work histories and education backgrounds. But some noted on their applications that they had a prior criminal history. White applicants who admitted to prior incarceration got half as many call-backs as those who did not. Black applicants received only a third as many. Once they find work, former prisoners’ wages fall by 15 percent, annual earnings by 40 percent, and they’re far less likely to increase their annual income over time than those with comparable backgrounds who never went to prison.
It’s undoubtedly true that in some instances drug addiction by itself has “deprive[d] the nation of competent, self-governing citizens.” But there are legions of former drug users who have gone on to lead successful lives, including Nobel laureates, Olympic champions, our last three presidents, Supreme Court justices, and even a few prominent, anti-legalization opinion columnists. They were merely fortunate enough to be of a class, in a place, or of a time where such use didn’t result in arrests and criminal charges that prevented their later success. Those unlucky enough to have been caught—or even merely arrested—can face diminished education opportunities, employment discrimination, significant loss of lifetime earnings, loss of voting rights, and access to the social safety net.
All of which makes for a strong argument that the way we treat drug users is doing far more to rob us of competent, self-governing citizens than the drugs they’re using.
Degrading human nature . . .
Prohibition of a vice pushes that vice underground. Instead fighting for market share with better products, cheaper products, or better service—as people in developed, prosperous societies do—they win market share with violence. Instead of resolving disputes in the courts, they resolve them . . . with yet more violence. See this graph of homicides before, during, and after alcohol prohibition, for example. Or witness the spike in violent crime in the late 1980s and early 1990s as the introduction of crack created new turf wars. Or look south to the carnage in Mexico in the 2000s when the Mexican government, at the prodding of the U.S., disrupted the country’s drug markets by bringing in the military to fight the drug war in a far more literal manner.
The drug war also breeds corruption among public officials. Talk to the cops in groups like Law Enforcement Against Prohibition, and they’ll tell you how narcotics cops fight off temptations to corruption on a daily basis and how not all of them succeed.
Part of the problem is that with consensual crimes, there are no direct victims to report the crimes to police. In order to enforce the drug laws, law enforcement agents must often break them, either by going undercover, or by instructing confidential informants to break the laws for them. Cops don’t have to commit murders to catch murderers. They don’t commit burglaries to catch burglaries. But they do have to commit drug crimes to catch drug dealers. That can instill in some drug cops the idea that the rule of law is negotiable. Rules are subject to bargaining.
That’s true on an individual level, but it’s also true on an agency level and an institutional level. A few years ago, federal narcotics agents looked the other way while one of their informants participated in a series of gruesome murders in Juarez. Building a case against the cartel was more important than preventing murders. Just this month, El Universal reported on a deal between the DEA and the Sinaloa cartel that allowed the latter to import billions of dollars of illicit drugs into the United States. The Post’s Max Fischer has cast some doubt on the report, but federal officials looking the other way while informants continue to commit crimes is hardly unusual.
Asset forfeiture laws, in which police can seize property allegedly tied to drug activity, with the proceeds going back to the police department, provide more corrupting incentives. In a 1994 study reported in Justice Quarterly, criminologists J. Mitchell Miller and Lance H. Selva observed several police agencies that had identified drug stash houses, but delayed busting the houses until most of the drugs had been sold. A drug house stashed with cash is worth a lot to the police agencies who discover it. A drug house stashed with drugs isn’t. In Nashville, a local news station reported a few years ago that drug task forces were far more likely to pull over suspected drug couriers on their way out of the city — when their cars would be full of cash — than on their way in, when their cars would be filled with drugs. These laws can also induce police to snatch property when there’s no connection to criminal activity at all. This has provided incentives for narcotics cops to engage in what is basically legalized highway robbery.And this is a problem that, again, disproportionately affects the poor.
A generation of drug war rhetoric has also conditioned much of the country’s law enforcement personnel to think of themselves as soldiers and the communities they serve as the enemy. Numerous retired police officers I interviewed for my bookexpressed their dismay at the confrontational, combative approach with which too many modern cops today approach their jobs. Those communities, in turn, see law enforcement more as oppressive occupiers than protectors. The use of informants also contributes to this problem. Decades-long abuse of the informant system by narcotics officers has eroded trust between cops and the communities they serve. The rise of the“Stop Snitch’n” movement, abhorrent as it might be, is an indication of a profound phenomenon: There are communities in America where the citizens fear the people who are supposed to protect them more than they fear the criminals. That is a striking degradation of human nature.
Here again is Bruce Western, writing in Reason:
The third important effect of incarceration is cultural, shaping how the institutions of law and order are viewed in high-crime/high-incarceration neighborhoods. The prison population is drawn overwhelmingly from low-income inner-city areas whose residents come to associate police and the courts with the surrounding social problems of violence and poverty. Police are viewed as unhelpful, and often unaccountable, contributing to what the Harvard sociologist Robert Sampson calls “legal cynicism” in troubled, crime-ridden neighborhoods.
Part of the power of punishment as a deterrent to crime is the shame and stigma of a criminal record. Where incarceration has become commonplace, as it has in poor African-American communities, the righteousness of the police is no longer assumed and a prison record is not distinctive. The authority of the criminal justice system has been turned upside down, and the institutions charged with maintaining safety become objects of suspicion.
The negative effects of incarceration reduce the penal system’s capacity to control crime. Drug dealing and other illegal activities are more attractive to people with prison records, who have few legitimate prospects. Children of incarcerated parents, without a secure and predictable home life, are at risk of delinquency and school failure. And a community, soured on a capricious and unaccountable police force, is less likely to call for help or assist in investigations.
Our effort to prohibit drugs turns peaceful market competition into violent wars for turf. (When was the last time you read about a Michelob deal gone bad, or about two wineries fighting for market share with assault weapons?) It corrupts public servants, public agencies, and public institutions. And it has turned entire communities against not only the police, but the very idea of a state-administered justice system. I have no doubt that in some cases, drug abuse can “degrade human nature” on an individual level. But on a large scale, it’s hard to imagine how they could degrade peaceful human interaction, civic order, and civil society more than our efforts to prohibit them.
Damaging and undermining families . . .
According to data compiled by the Drug Policy Alliance, as of 2008 (see sources at the link), 59 percent of the men in state prison on drug offenses were fathers; 63 percent of women in state prisons for drug offenses were mothers. As of 2008, 11 percent of black children (1.2 million) had at least one parent in prison. The rate among Latino children was 3.5 percent. Among white children, 1.75 percent. The latter is up from 0.4 percent in 1980.
It’s interesting that later in his column, Gerson cites welfare reform as a policy conservatives successfully conceived of and implemented, and that has produced positive results. Conservatives have long cited the destructive effects of welfare policies that provided financial incentives for single-parent families, and then for the further propagation of fatherless children. Yet at the same time they’ve supported a policy in drug prohibition that produces comparatively well-paying, black market jobs for low-income teens and young men— and in communities with bleak schools that offer few prospects. Because of that same policy, many of those men are later arrested and incarcerated, leaving their children fatherless. (The same policy also leads to many of those men getting killed, which of course also creates fatherless children.) When they get out, as mentioned earlier, these men face long odds to find meaningful, legal work that offers a steady income. Once again, the drug trade is there to offer some quick money. If poorly structured incentives in the welfare system can affect behavior, surely the promise of quick income from the black markets created by drug prohibition can too.
Again to Western, this time writing with Becky Pettit in the journal Dædalus:
Partly because of the burdens of incarceration on women who are left to raise families in free society, incarceration is strongly associated with divorce and separation. In addition to the forced separation of incarceration, the post-release effects on economic opportunities leave formerly incarcerated parents less equipped to provide financially for their children. New research also shows that the children of incarcerated parents, particularly the boys, are at greater risk of developmental delays and behavioral problems.
But the drug war’s burden on families extends beyond the effects of incarceration. Under the “one strike and you’re out” federal housing policy I alluded to above, families can be evicted from public housing for mere allegations of drug use, even if the allegations concern a minor, or even a houseguest.
We also now have laws that allow prosecutors to charge pregnant women with feloniesfor using drugs during their pregnancies. These women also lose their children. While few would defend drug use during pregnancy, a more family-oriented policy would seek to get these women help, instead of tossing their newborns into the foster system. The policies have also resulted in mothers having their newborns quite literally taken from their arms after some of these tests have produced false positives. Likewise, parents who treat bona-fide medical conditions like multiple sclerosis, Gulf War syndrome, or the effects of chemotherapy with medical marijuana are also seeing their kids taken away from them. The D.A.R.E. program has long encouraged children to turn in their parents for drug use. This has resulted in incidents in which parents are arrested for smoking pot in front of the child who turned them in. Those children were then taken to relatives, or put into foster care. Still today, parents caught with recreational pot can face neglect charges and possible loss of custody, even if there’s no evidence they’ve smoked around their kids.
Pictured in the photo above, Carly Tangney-Decker and Jeff Decker are asking New York state to legalize medical marijuana. Their daughter has a condition that causes here to have debilitating seizures. Children with the disease can have 100 or more seizures per day, and the condition is often fatal. Marijuana has been shown to reduce both the frequency and severity of seizures. Yet parents of these kids can’t legally access the drug in most states. (See this father’s impassioned plea to New Jersey Gov. Chris Christie of New Jersey, and Christie’s rather callous response.) Here in Tennessee, some desperate parents have picked up their families and moved to Colorado to find relief for their kids, despite having no jobs, roots, or support systems there.
Few would argue against the proposition that drug abuse can disrupt and undermine families, but there are few events more destructive to a family than removing them from their home, taking children from their parents to put them in foster care, or incarcerating a parent. Here again, the effort to prohibit illicit drugs seem quite a bit more harmful than the drugs themselves.
Toward the end of his column, Gerson pines for the time when conservatives had more assertive public policy ideas. He writes, “In the 1990s, a cadre of conservative reformers achieved success against three seemingly intractable problems: welfare dependency, drug use and violent crime.”
I’m not qualified to address the efficacy of welfare reform. But for all the harm outlined above, I don’t know that we’ve really achieved “success” in curbing drug use. I used data from the National Household Survey on Drug Abuse to put together the chart below:
As you can see, there’s no real indication that illicit drug use dropped significantly after the early 1990s. (It’s worth noting that NHSDA changed its methodology in 1999, so it’s difficult to compare the years before then with the years after.) In fact, among teens it appears to have jumped. Among all ages, the line is pretty flat.
As for violence, Gerson is correct. The violent crime rate has plummeted since 1994. But it’s far from clear that conservative policies should get the credit. It’s true that you can find studies that appear to validate conservative ideas like broken windows policing, CompStat policing, or mass incarceration. There are also studies that claim to discredit those policies. There’s also some evidence that some of the more punitive law-and-order policies from the era, like “Three Strikes and You’re Out” law may have actuallyincreased violent crime. Other conservative rhetoric, such as dire warnings about the rise of juvenile “superpredators” or panics about satanists abusing children in bizarre sex rituals did irreparable harm.
The consensus among criminologists I’ve talked to over the years seems to be that we can credit mass incarceration for 10-15 percent of the drop in crime since the mid-1990s. There’s also increasing evidence that “hot spot” policing has helped in larger urban areas. Beyond that, there’s little agreement. Other theories for the crime drop include an aging population, improved standards of living, the dissolution of the crack epidemic, the regulation of lead out of gasoline and household products, and legalized abortion, among others.
The broader point to Gerson’s column is that conservatives should ignore libertarian influences and concentrate on finding government-affirmative solutions to problems like income mobility. He writes:
Economic mobility has stalled for many poorer Americans, resulting in persistent, intergenerational inequality. This problem is more complex than an income gap. It involves wide disparities in parental time and investment, in community involvement and in academic accomplishment. These are traceable to a number of factors that defy easy ideological categorization, including the collapse of working-class families and the flight of decent blue-collar jobs.
It’s particularly odd to see someone cite income immobility as a reason to continue the drug war. (David Frum has made the same argument.) In 2009, Harvard published the results of a 20-year longitudinal survey of a group of men who in 1986 were in the bottom quintile of earnings distribution. By 2006, 64 percent had moved into a higher quintile. Among men who had been incarcerated, the number dropped to just 25 percent. Of the five contributors to economic immobility Gerson lists in the paragraph above, the drug war is a factor in four.
In fact, as the New York Times’ John Tierney pointed out last year in a series on incarceration, researchers are finding that incarceration disrupts entire communities, even entire counties.
Epidemiologists have found that when the incarceration rate rises in a county, there tends to be a subsequent increase in the rates of sexually transmitted diseases and teenage pregnancy, possibly because women have less power to require their partners to practice protected sex or remain monogamous.
When researchers try to explain why AIDS is much more prevalent among blacks than whites, they point to the consequences of incarceration, which disrupts steady relationships and can lead to high-risk sexual behavior. When sociologists look for causes of child poverty and juvenile delinquency, they link these problems to the incarceration of parents and the resulting economic and emotional strains on families . . .
“Education, income, housing, health — incarceration affects everyone and everything in the nation’s low-income neighborhoods,” said Megan Comfort, a sociologist at the nonprofit research organization RTI International who has analyzed what she calls the“secondary prisonization” of women with partners serving time in San Quentin State Prison.
Before the era of mass incarceration, there was already evidence linking problems in poor neighborhoods to the high number of single-parent households and also to the high rate of mobility: the continual turnover on many blocks as transients moved in and out.
Now those trends have been amplified by the prison boom’s “coercive mobility,” as it is termed by Todd R. Clear, the dean of the School of Criminal Justice at Rutgers University. In some low-income neighborhoods, he notes, virtually everyone has at least one relative currently or recently behind bars, so families and communities are continually disrupted by people going in and out of prison .
In 2012, the economist David Henderson wrote a piece for the right-leaning Hoover Institution about the “bottom one percent.” By that, he was referring to the incarcerated, who of course have little to no annual income. There are currently well over a half million people in prison for non-violent drug offenses. There are about a million more on probation or parole. According to a study by Students for Sensible Drug Policy, about 200,000 young people have lost access to financial aid due to some sort of drug offense, although since that figure was from 2006, it’s probably much larger today. In 2012 alone, 1.5 million people were arrested for some sort of consensual drug crime. Of those, 1.2 million were arrested for possession, not distribution. On average, taxpayers pay $25,000 per year to house each prisoner. In some states, the figure can approach $50,000. As Henderson writes, we’re paying that money “so that the government can put poor people in prison and keep them poor,” and to “put non-poor people in prison and make them poor.”
If conservatives like Gerson and Frum are truly concerned about income inequality, income immobility, social disorder, erosion of the rule of law, disrespect for for public institutions, and the dissolution of the family, it seems they should at least address the drug war’s contribution to these problems. Instead, when contemplating solutions to these problems, reforming or ending the drug war is usually the first option they take off the table.
Personalized Feedback Can Help Reduce College Freshman Drinking
A program that provides college freshmen with personalized feedback on their drinking patterns can be effective in reducing their drinking, a new study suggests.
Researchers from Brown University reviewed studies of 62 programs designed to reducing drinking among college freshmen, which included more than 24,000 freshmen from around the country.
They concluded colleges should screen all freshmen within their first few weeks of school for alcohol risk, and offer interventions for those who said they drink, UPI reports. The program that provided the broadest benefits gave students a personalized feedback report, which included information such as how students’ own drinking compared with that of their peers, the costs of alcohol consumed, number of calories consumed, and blood alcohol levels. Students who had this information significantly reduced how much and how often they drank, the study found.
In addition to personalized feedback, other effective strategies include teaching students to alternate alcoholic beverages with non-alcoholic drinks, setting blood alcohol level limits, and identifying especially risky situations, such as fraternity house parties, the researchers found.
“Adoption of our recommended strategies would enable colleges to become more proactive – that is, targeting interventions to those students who have initiated alcohol use and may experience some alcohol-related problems but before their alcohol use meets criteria for alcohol dependence or abuse,” study lead author Lori Scott-Sheldon said in a news release.
The researchers cautioned that even the most effective programs do not completely stop freshmen from drinking. But even small changes in drinking patterns can have a large effect when implemented broadly, noted study co-author Kate Carey. “Small effect sizes mean that any given person may change just a little as a result of an intervention, but when we expand the effects to the whole freshman class we would expect prevention programs like those we reviewed to have a public health impact,” she said.
The study is published in the Journal of Consulting and Clinical Psychology. —–
Researchers Make Progress in Finding Medicines to Treat Addiction
Researchers are making progress in the search for medicines to treat addiction, according to The Wall Street Journal. They are learning more about how heavy drug and alcohol use affects the brain.
A study published recently in JAMA Internal Medicine found the drug gabapentin, used to treat epilepsy and some types of pain, can help people with alcoholism quit drinking.
The 12-week study of 150 alcohol-dependent participants found gabapentin decreased the number of days people drank heavily, and at least tripled the percentage of people who were able to stop drinking altogether, compared with those receiving a placebo. The drug also reduced alcohol craving and improved mood and sleep quality.
“There’s been a huge amount of progress understanding what drives alcoholism and makes it difficult to stop,” lead researcher Barbara Mason of the Scripps Research Institute in La Jolla, California, told the newspaper.
Researchers at the National Institute on Alcohol Abuse and Alcoholism are studying a chemical called corticotrophin-releasing factor (CRF), which plays a role in the brain’s stress response. It is triggered by drug or alcohol use. Years of heavy substance use makes the brain more sensitive to CRF, the article notes. Paul Kenny, who studies addiction at the Icahn School of Medicine at Mount Sinai in New York, says that in people who are addicted, the brain’s stress response becomes stuck in high gear.
NIAAA is conducting studies of two experimental drugs, to see if they can stop CRF from revving up the brain’s stress centers in alcoholics.
According to the National Survey on Drug Use and Health, 23.1 million people aged 12 or older needed treatment for illicit drug or alcohol use in 2012. Of these, only 2.5 million received treatment.
The following link was an HBO series on addiction and has some very good information: http://www.hbo.com/addiction —–
Joys of alcohol (my ex-wife is concerned the first part of this video, which initially appears to be an alcohol commercial, could cause people to relapse, so view with caution):
—– Exposure to Alcohol Before Birth Linked to Social Skills Problems in Childhood
Children whose mothers drank during pregnancy are more likely to have problems with social skills, compared with their peers whose mothers did not drink while pregnant, according to a new study.
A mother’s drinking during pregnancy was also found to be associated with significant emotional and behavioral issues in their children, according to HealthDay.
The study, published in Child Neuropsychology, included 153 children ages 6 to 12. Of these children, 97 had a fetal alcohol spectrum disorder. The researchers evaluated the children’s thinking, as well as their emotional, social and behavioral development. They found children whose mothers drank alcohol during pregnancy had more social problems, even after their IQ was taken into account. They were less able to connect past experience with present actions, or understand why people do what they do. They received lower scores on tests of planning and organizational skills, attention and working memory.
Parents of children with prenatal alcohol exposure said the children showed more inattentiveness, hyperactivity and impulsive behavior. These children were more likely to have symptoms of depression.
The researchers from the University of California, Los Angeles, said their findings indicate a great need for early detection and treatment of social problems in children that result from prenatal alcohol exposure. Intervening early is important, they said, because children’s developing brains have an ability to change and adapt as they learn.
From the New York Times
F.D.A. Shift on Painkillers Was Years in the Making
By BARRY MEIER and ERIC LIPTON
Published: October 27, 2013
When Heather Dougherty heard the news last week that the Food and Drug Administration had recommended tightening how doctors prescribed the most commonly used narcotic painkillers, she was overjoyed. Fourteen years earlier, her father, Dr. Ronald J. Dougherty, had filed a formal petition urging federal officials to crack down on the drugs.
Jonathan Ernst for The New York Times
Senator Joe Manchin III, Democrat of West Virginia, backed limits on prescription painkillers.
Since then, narcotic painkillers, or opioids, have become the most frequently prescribed drugs in the United States and have set off a wave of misuse, abuse and addiction. Experts estimate that more than 100,000 people have died in the last decade from overdoses involving the drugs. For his part, Dr. Dougherty, who foresaw the problem, retired in 2007 and is now 81 and living in a nursing home.
“Too many lives have been ruined,” his daughter said.
The story behind the F.D.A.’s turnaround on the pain pills, last Thursday, involved a rare victory by lawmakers from states hard hit by prescription drug abuse over well-financed lobbyists for business and patient groups, one that came during a continuing public health crisis.
For the full article from the New York Times, follow the link.
Half of Children Ages 6 to 19 Exposed to Secondhand Smoke: Study
An analysis of national data shows 53 percent of children ages 6 to 19 have been exposed to secondhand smoke. For children ages 6 to 11, even low levels of secondhand smoke were associated with more missed days of school, sleep disturbances, more wheezing and less physical activity.
“Adolescents may have more sporadic exposure (hanging with friends) compared to younger children who may be more chronically exposed at home,” study author Lara Akinbami of the National Center for Health Statistics in Hyattsville, Maryland, told Reuters. She noted other research has indicated that only smoking in one room of the house does not adequately protect children against secondhand smoke.
The findings are published in Academic Pediatrics.
A review of studies published last year found exposure to secondhand smoke increases the risk of wheezing and asthma in children and teens by at least 20 percent.
CMAJ October 15, 2013 First published October 15, 2013, doi:10.1503/cmaj.130295
- © 2013 Canadian Medical Association or its licensors
- All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
Crystal methamphetamine and initiation of injection drug use among street-involved youth in a Canadian setting
BC Centre for Excellence in HIV/AIDS (Werb, Kerr, Montaner, Wood); School of Population and Public Health (Werb, Buxton, Shoveller, Richardson) and Division of AIDS (Kerr, Montaner, Wood), University of British Columbia; British Columbia Centre for Disease Control (Buxton), Vancouver, BC.
- EvanWood, E-mail email@example.com
Background: Although injection drug use is known to result in a range of health-related harms, including transmission of HIV and fatal overdose, little is known about the possible role of synthetic drugs in injection initiation. We sought to determine the effect of crystal methamphetamine use on risk of injection initiation among street-involved youth in a Canadian setting.
Methods: We used Cox regression analyses to identify predictors of injection initiation among injection-naive street-involved youth enrolled in the At-Risk Youth Study, a prospective cohort study of street-involved youth in Vancouver, British Columbia. Data on circumstances of first injection were also obtained.
Results: Between October 2005 and November 2010, a total of 395 drug injection–naive, street-involved youth provided 1434 observations, with 64 (16.2%) participants initiating injection drug use during the follow-up period, for a cumulative incidence of 21.7 (95% confidence interval [CI] 1.7–41.7) per 100 person-years. In multivariable analysis, recent noninjection use of crystal methamphetamine was positively associated with subsequent injection initiation (adjusted hazard ratio 1.93, 95% CI 1.31–2.85). The drug of first injection was most commonly reported as crystal methamphetamine (14/31 [45%]).
Interpretation: Noninjection use of crystal methamphetamine predicted subsequent injection initiation, and crystal methamphetamine was the most commonly used drug at the time of first injection. Evidence-based strategies to prevent transition to injection drug use among crystal methamphetamine users are urgently needed.
Commentary: Quality Care for Adolescents, a Consumer Guide to Treatment
“As we recognize the significance of recovery this month and head toward implementation of the evolving Affordable Care Act and Parity legislation, we have more opportunities than ever to improve the adolescent substance abuse treatment system, and consequently, the lives of the next generation of Americans. Because treatment for adolescent substance use disorder is most effective when it is of high quality and when evidence-based treatments and practices (EBTs/EBPs) are delivered well, the Treatment Research Institute is contributing to promoting such practices by employing a consumer guide approach to measuring, reporting on (and ultimately improving) the quality of adolescent substance abuse treatment. Consumer Guides, as we know them, offer comparable information on features such as relevance, quality and value which can inform and direct a consumer’s purchase, but equally, and perhaps more importantly, can improve the service marketplace. This approach offers transparency for measurable quality indicators and reports on the availability of such within specific treatment programs. Consumers can make informed choices by selecting programs that offer elements a teenager needs. Programs can advocate for dollars to support EBPs they cannot offer due to budget constraints, and purchasers can see areas where funding limits should be reconsidered. In this way, more stakeholders can contribute to treatment improvements.
We have systematically identified 10 key elements with 67 corresponding components of effective adolescent substance abuse treatment programs. By conducting literature reviews and commissioning panels of scientific experts, practitioners and parents, we built the Consumer Guide1 to improve upon and advance the seminal work of Drug Strategies2.”
From SMART Recovery:
The Overcoming Addictions Webcourse is a confidential and interactive web-based course that can help you achieve and maintain abstinence from addictions using SMART’s 4-Point Program. The program has parallel but separate modules for addiction recovery from alcohol, marijuana, opioids, stimulants and compulsive gambling. Details and registration information for this newly released webcourse are available here.