Category Archives: Science

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, as his linked bio points out, is no cultural conservative;  that is, he’s no War on Drugs crusader who opposes legalization or decriminalization because of “Reefer Madness” type myths. So it’s significant that Kleiman, one of America’s top informed drug policy experts, 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. Again, though, like Kleiman, it’s presenting the information straight up, which should again indicate that it’s gotten serious consideration.

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.

This isn’t “just a political issue.” Rather, it’s spelling out likely public health impact of political action. Given that California, Lifering’s home state, has legalized medical marijuana, and Colorado, Lifering’s second-largest ground, has gone to full legalization, that’s part of why it’s important for Lifering to be aware of this, including Kleiman’s note about the number of people still in denial.

In fact, it’s arguably not just an American issue, as British Columbia, the home of Lifering Canada, allows medical marijuana, and across Canada, support for at least some form of decriminalization seems at least as high as in the US.

Can ‘using’ memories be erased?

IStock photo from Scientific American

For alcohol, and possibly even more, for illicit drugs, the memory of previous use can sometimes be a “trigger” to further use.

Well, what if such memories can be “deleted”?

It’s a small study, and obviously needs follow-up, but work on rats says, tentatively, that such a thing may indeed be possible, at least in the case of meth.

Stand by for more research in this area. We’ve had a few years of research on trying to lessen PTSD memories. The principle seems similar.

PTSD research does tell us that intervention needs to be immediate or near-immediate; once memories start to consolidate, it’s a different issue.

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.

Video: Alcohol and Your Brain

Here’s a seven minute video covering the basics of how alcohol affects the brain. It’s simple and straightforward, making up in clarity what it lacks in detail:

Yet another “false dichotomy” story

Just a couple of weeks after the New York Times, in a column by a person pushing a book, presents a false dichotomy between Alcoholics Anonymous and science-based moderation as the only alternatives on the table, Slate does the same thing. And, it’s story author is a Slate staffer who doesn’t even have the excuse of publishing a book. You can comment on the page or Tweet Brian Palmer here.

The story’s good otherwise; Palmer knows the history of AA’s semi-official opposition to medical assistance for addiction, counseling and more. But, there’s not a single word in there about secular sobriety organizations. Only by people like us contacting people like Palmer to get the full story out there, can we get the full story out there.

And, whether Palmer’s analysis of AA is close to correct or not is not the primary point of this blog post. (That said, I do think he is broadly correct.)