Category Archives: Media

Pot legalization has its dark side, too

Mark Kleiman/Wikipedia

Lifering takes no official policy on drug decriminalization or legalization, of course. Nonetheless, with legalized medical marijuana in California, and fuller legalization in Colorado and Washington State, and that wrapped around questions of addictiveness, it’s an unavoidable issue, how legalization or decriminalization will affect access, the number of people becoming addicted, quality of marijuana affecting possible addictiveness and more.

And, here’s a great discussion of related issues. Mark Kleiman, no cultural conservative or even close, does NOT favor full, “broad” legalization, in part because he thinks something similar to Big Pot might, like Big Tobacco, want to get people hooked.

Why? Well, marijuana is addictive. And, that’s Lifering’s starting point.

Kleiman talks more about its addictiveness, abuse potential and related issues that some ardent legalizers often try to avoid:

A lot of people on the pro-legalization side are still in denial about the cannabis abuse problem.  The numbers are about 33 million people will say in a survey that they’ve used cannabis in the last year.  About half of those, about 16 million, say they’ve used it in the last month.  Of those, about a quarter say they use 25 days or more per month.  In a different survey that folks over at Rand did the people who smoke many days per month also use a lot more per day.  That very heavy user group accounts for 85 or 95 percent of the total cannabis consumed.

About half the people who are daily or near daily users just from their own self-reporting in the surveys meet clinical criteria for abuse or dependence.  Cannabis is interfering with their lives and they’ve tried to cut down and they can’t.  It’s not as bad as an addiction to cocaine or methamphetamine or the opiates or alcohol. But it’s plenty bad enough if it happens to you or your brother or your kid or your parent.

Note that Rand is one of the nation’s top libertarian-oriented think tanks. If anybody had incentive to soft-pedal this issue, it would be a group like Rand.

Kleiman draws parallels to “responsible drinking” PR of the alcohol industry or manipulation of tobacco by Big Tobacco.

Anybody who tells you, you can legalize cannabis and not have more drug abuse is fooling himself. Of course we’re going to have more. The question is how much more? My belief is if you can keep the prices close to the current illicit prices you won’t get a big upsurge in heavy use. It’s the heavy users and the kids who care most about price.

He also expects pot e-cigs to be the wave of the future. And, if anything like full legalization happens in other states, wants them to be.

New book hits hard at fundamentals of 12-step based sobriety support

In a book that’s getting plenty of discussion around the Internet, including multiple reviews, “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry,” is one of the hardest-hitting and most direct critiques yet of the 12-step ideas, structure and model for sobriety support. Per the subtitle, it’s about more than just Alcoholics Anonymous and Narcotics Anonymous. Authors Lance Dodes and Zachary Dodes, the former with  35 years of psychiatric experience, tackle how the 12-step model has become accepted by the rehab industry, and also the courts, including noting, of additional importance to LifeRing, legal rulings that 12-step programs are a religion in terms of First Amendment views. and therefore mandatory  orders to AA or NA meetings are not allowed.

From the review on Amazon:

In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success.

But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Dr. Dodes explores the entire story of AA’s rise, from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media.

The Sober Truth includes true stories from Dr. Dodes’s thirty-five years of clinical practice, as well as firsthand accounts submitted by addicts through an open invitation on the Psychology Today website. These stories vividly reveal the experience of walking the steps and attending some of the nation’s most famous rehabilitation centers.

The Sober Truth builds a powerful response to the monopoly of the 12-step program and explodes the myth that these programs offer an acceptable or universal solution to the deeply personal problem of addiction. This book offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem.

To many LifeRingers who came to LifeRing from 12-step programs, these critiques may already be known. But, as Dr. Dodes notes, they’re still not well known in either the court system or his own profession.

Some, based on the first major media review of the book, in Salon, an excerpt from the book by the authors, may fear this book engages in “AA bashing.” However, Dodes does note that the 12-step methodology does work for some people. Rather, to me, the book seems to be what flows from his observations of “medical best practice” based on his 35 years as a psychiatrist.

In one earlier book, per a review on Amazon, he labels as “myth”:

  • Addictions are fundamentally a physical problem.
  • People with addictions are different from other people.
  • You have to hit bottom before you can get well.
  • You are wasting your time if you ask “why” you have an addiction.

In other words, he seems to discuss issues of addiction from a variety of medically and psychologically informed angles. In that book, these issues seem to be related to what he presents in his current book, namely that addiction is a psychological issue as much as anything, and that while addictive substances affect brain chemicals, that’s not the most productive way, or the right level of approach, to address this situation. I do know that neuroscientist Carl Hart, in his new book, “High Price,” is more explicit about ideas about how addiction boils down to dopamine problems are more and more panning out as not true. (I’ll have a review of that book in a couple of days.)

Per the informational angle, this book is gaining “traction” nationally, and aside from any possible concerns about “tone” on Dodes’ discussion of 12-step methodology, raises important issues from a medical stance. Besides Salon, it’s now also been reviewed in The Atlantic and at NPR, as part of an author interview.

There is one thing that is a bit eyebrow-raising, that I noticed most at his NPR interview. He talks about “managing” addiction. I don’t know if “moderation” is under his “management” ideas or not.

You can learn more about Dodes, including a blog he maintains on addiction issues, at his website.

Note: This post h as been lightly edited since its original posting to drop most references to other Liferingers’ opinions and to add a reference to another new book about addiction, that of Hart.

100 Americans Die Every Day from Drug Overdose

hoffmanPhillip Seymour Hoffman, the widely admired and award winning actor, died recently from a drug overdose. That got a lot of publicity and millions of people asked themselves how such a thing could happen to someone like that. Meanwhile, on that same day if it was average, 99 other people died in the same way without the public taking notice, or seeming to care. Overdose is the largest single cause of accidental death in America — beating out car crashes for that “honor.”

Here is an article from the Washington Post, a lengthy interview with a prominent psychiatrist and leading researcher in the field of addiction. There is much of interest in the article. An example, when the interviewer asks about private detox facilities, the response is scathing:

It’s such a horrible promise to hold out to desperate people and their families. By the way, those programs are usually cash-pay only. They promise to take away your addiction in two weeks but what they really take is your money….Some [very wealthy people] are checking into rehabs that don’t seem much different than luxury hotels. I suspect, actually, that you might get better care being a working class veteran, or someone who happens to live near a primary care doctor who has trained him or herself using buprenorphine than you would being a rich and famous person in that luxury tier of care.

The article is filled with much information and insight. See it Here.

 

AA Agnostica Features LifeRing

we agnosticsAn AA-related website is featuring an article from LifeRing Board of Directors member (and deputy Executive Director) Mahala Kephart. The article features a introductory quote from Martin Nicolaus’s book How Was Your Week. Here’s a brief excerpt from the article:

In LifeRing, we believe individuals can and must learn to stop ingesting addictive substances before worrying what to call themselves or wrestling with their religious or spiritual beliefs. In LifeRing we are united by the practice of a behavior — abstinence.  That we lived long enough to begin the recovery journey at all should probably be accorded more awe and respect than is our societal norm.

The website, at http://aaagnostica.org/ is from We Agnostics, a group of atheists and agnostics within AA.

At the same site, a recent article from the New York Times is featured, and it’s worth a read as well. The article examines the place of non-religious people in AA:

This meeting, as the parting phrase suggests [the article talks of a meeting ending with the phrase "Live and let live" rather than the Lord's Prayer], is one of a growing number within A.A. that appeal to nonreligious people in recovery, who might variously describe themselves as agnostics, atheists, humanists or freethinkers. While such groups were rare even a decade ago, now they number about 150 nationally. A first-ever convention will be held in November in Santa Monica, Calif.

See Mahala’s piece Here, and the New York Times piece, “Alcoholics Anonymous, Without the Religion” Here.

LifeRing, of course, is not anti-religion, it is simply non-religious, seeing addiction as a physical and psychological condition, not a spriitual one.

Be sure to look at the Comments under the LifeRing piece — they demonstrate a positive attitude towards LifeRing, at least in some of the comments, that we often don’t see in AA.

– Craig Whalley

 

Philip Seymour Hoffman: A caution, about triggers

Philip Seymour Hoffman, via Slate

Science writer Seth Mnookin has a very good piece about Hoffman’s death.

First, there’s the scary part. Now, in recovery, we want to grow to the point where fear isn’t our primary motivator, but, we should still have a healthy fear for addiction. That’s why this scary part is of the “healthy fear” type:

I cried when I heard about Philip Seymour Hoffman. The news scared me: He got sober when he was 22 and didn’t drink or use drugs for the next 23 years. During that time, he won an Academy Award, was nominated for three more, and was widely cited as the most talented actor of his generation. He also became a father to three children. Then, one day in 2012, he began popping prescription pain pills. And now he’s dead.

Why he started back, we don’t yet know, and maybe never will. But, he did.

And, contra some recent columns that tout how much “moderation” may be able to help people, it usually doesn’t. Hoffman’s addiction progressed until he died with a heroin needle in his arm, and heroin dangerously “cut” with the narcotic fentanyl. (Updated, Feb. 13 — Although fentanyl from new “cuts” of heroin was under suspicion at the time this was written, none was found in Hoffman’s case.)

Mnookin goes on, to reveal his own background:

My first attempt at recovery came in 1991, when I was 19 years old. Almost exactly two years later, I decided to have a drink. Two years after that, I was addicted to heroin. There’s a lot we don’t know about alcoholism and drug addiction, but one thing is clear: Regardless of how much time clean you have, relapsing is always as easy as moving your hand to your mouth.

He got and stayed sober after that, but later got “reminders” himself. What we might call “triggers”:

Being back in Boston was a visceral reminder that there’s an important part of my past that isn’t on the bio page of my website: From 1995 to 1997, the last time I’d lived in the area, I’d been an IV drug addict. Living here again made me acknowledge that past every day: The drive to my son’s preschool took me within blocks of the apartment that I’d lived in during those years; my route from his school to my office went past the free acupuncture clinic where I’d sought relief from withdrawal pangs. One afternoon, I looked up and realized I was in front of the emergency room I’d been taken to after overdosing on a batch of dope laced with PCP. I did a double take and looked to my wife, but, of course, that wasn’t a memory we shared. We met in 2004, when I’d been sober for more than six years.

One truism of addiction science is that long-term abuse rewires your brain and changes its chemistry, which is why triggers (or “associated stimuli,” in scientific parlance) are major risk factors for relapse. But these changes can be reversed over time. Walking past the apartment where my dealer used to live didn’t make me want to score; it made me feel as if I was in a phantasmagoria of two crosshatched worlds—but I was the only person who could see both realities.

Give the whole thing a read. It’s worth it.

And, although Lifering has no formal “program” of recovery, talk like Mnookin’s is why many in Lifering talk about the issue of “triggers.”