Urban myths exposed

1242257784-vaillantPoints blog is back with a great interview with George Vaillant.

Here’s one of the questions and his response:

2. What do you think a bunch of alcohol and drug historians might find particularly interesting about your book?

The value of the Grant study to the history of alcoholism is the number of urban myths that it exposes, and for this reason it received the biennial Jellinek prize for the best research in alcoholism in the world.

The first urban myth exposed is that depression causes alcoholism. Our prospective study shows beyond a doubt that alcoholism causes depression.

Second, alcoholics have unhappy childhoods due to their parents’ alcoholism; unhappy childhoods without a history of alcoholism do not lead to alcoholism. Therefore, the relationship between childhood and alcoholism appears to be genetic.

The third urban myth exposed is that AA is only for a few alcoholics and drugs are more useful. There are no two-year or longer studies of Naltrexone, Antabuse, or Acamprosate that have been shown to be effective, nor has long-term follow-up of cognitive behavioral therapy proved to be effective. On the other hand, when we followed, over 60 years, our sample of roughly 150 alcoholics, the men who made complete recovery—that’s an average of 19 years of abstinence—as contrasted to those men who remained chronically alcoholic until they died, the men who “recovered” went to 30 times more AA meetings than the men who remained chronically ill. Like outgrowing adolescence, it takes a long time to learn to put up with AA, but when you do, it works.

Filed under: Controversies, Mutual Aid, Research Tagged: acamprosate, antabuse, Depression, George Vaillant, naltrexone

New to Drug Testing: We’re There

Image of PhilosophyWeek #51

During my educational journey this past year, I had the opportunity to meet many colleagues across several departments of our business. Throughout these months of learning, I noticed that each of these people had a story to tell of a time when they were able to help a client in need. Whether it was a customer service representative who took a phone call after hours, or a laboratory technician who worked a longer shift to process an extra specimen, each of my colleagues had an example of a time when they were there for our clients.

As the world’s leading provider of diagnostic testing, information and services, we perform more than eight million drug tests every year. We also provide a comprehensive range of laboratory-based and on-site drug testing products designed to deliver fast, accurate, reliable results. But our dedication to excellence does not stop there. We believe it’s not enough to simply deliver results, but instead we strive to be there for our clients through every step of the drug testing process – from the specimen collection to results reporting.

We pride ourselves on the fact that at every possible opportunity, we’re there when you need us. When you look around our business, this philosophy is manifested on every team. You don’t have to take my word for it. Watch a video of a Quest Diagnostics drug testing employee as they share their unique story about a time when they went above and beyond to exceed a client’s expectations.

As a new employee at Quest Diagnostics, there’s hardly a day that goes by that I don’t learn something new about the world of drug testing. Like some of you, I have a lot to learn about the industry. During my first year of employment, I’m going to write this weekly column highlighting drug testing procedures, products and processes as I discover them. To learn more about my journey, you can read my introductory post.

A Second Company Asks FDA to Reconsider Denial of NCE Exclusivity for Approved FDC . . . and to Stay Application of the Agency’s New Interpretation

By Kurt R. Karst

The battle over New Chemical Entity (“NCE”) exclusivity for Fixed-Dose Combination (“FDC”) drugs continues to heat up.  In a recent Petition for Reconsideration and Petition for Stay (Docket No. FDA-2013-P-0119), Ferring Pharmaceuticals, Inc. (“Ferring”) requestes that FDA reconsider its denial of NCE exclusivity for PREPOPIK (sodium picosulfate, magnesium oxide and citric acid) for Oral Solution.  Ferring also requests that FDA stay application of a new interpretation of the FDC Act to award NCE exclusivity to certain newly approved FDCs until the issues Ferring raises are resolved.

As we previously reported, on February 21, 2014, FDA denied three Citizen Petitions requesting that the Agency award NCE exclusivity to three previously approved FDCs containing an NCE and a previously approved drug.  Those petitions concern STRIBILD (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate) Tablets (Docket No. FDA-2013-P-0058), PREPOPIK (Docket No. FDA-2013-P-0119), and NATAZIA (estradiol valerate and estradiol valerate/dienogest) Tablets (Docket No. FDA-2013-P-0471).  On the same day FDA issued its petition response, the Agency announced that upon finalization of a draft guidance document, the Agency would reinterpret the NCE exclusivity provisions of the FDC Act to award NCE exclusivity for a newly approved FDC containing an NCE and a previously approved drug.  FDA refused to apply its new interpretation to previously approved drugs, such as PREPOPIK.  The 60-day comment period on FDA’s draft guidance document expires on April 25th, but it is unclear how quickly FDA will act to finalize the draft guidance. . . . and whether or not there will be a legal challenge to FDA’s reinterpretation of the statute.

Ferring is the second company to request that FDA reconsider its denial of NCE exclusivity.  As we recently reported, Gilead Sciences, Inc. (“Gilead”) submitted a Petition for Reconsideration asking FDA to rethink its position with respect to STRIBILD, and to refuse to accept any ANDA or 505(b)(2) application for a drug product containing either of the two NCEs in STRIBILD – elvitegravir and cobicistat – under the rules governing NCE exclusivity.  According to Gilead, none of the reasons FDA cites in its petition response, such as recognizing NCE exclusivity would burden sponsors with pending applications, fit the circumstances surrounding STRIBILD.

Ferring raises some of the same points in response to FDA’s petition denial as Gilead does in its reconsideration request.  According to Ferring:

  • The Commissioner’s statutory interpretation of the five-year exclusivity provisions for fixed-combinations with at least one novel drug substance is the only correct interpretation, and must be applied to all relevant applications.  No change in the Agency's regulations is required legally or technically.
  • The Commissioner failed to adequately consider all points raised in the original Citizen Petitions, including wildly inconsistent exclusivity results under its umbrella policy and the support in the legislative history for five-year exclusivity for fixed-combinations with novel ingredients.
  • Due Process and fairness require that five-year exclusivity be recognized for all applicable drug applications with remaining exclusivity, particularly Ferring’s Prepopik.
  • The Commissioner should adopt Petitioners’ statutory interpretation immediately.  The Commissioner’s decision to implement the interpretation prospectively at some indefinite future date (i.e., through final guidance) is arbitrary and capricious action that cannot be considered reasonable when all relevant factors are considered.

Among other things, Ferring highlights an alleged “irrational and arbitrary nature” of FDA’s application of the Agency’s “old rules” concerning NCE exclusivity for FDCs containing a new and a previously approved drug, and cites FDA’s recent approval of NDAs for alogliptin as a prime example.  As we previously reported, in the case of alogliptin, FDA approved three NDAs on the same day – one NDA for single-entity alogliptin (NDA No. 022271), and two NDAs for FDCs containing alogliptin and a previously approved drug (NDA Nos. 022426 and 203414).  FDA was careful to note that single-entity alogliptin (NDA No. 022271) was approved first in the day, thereby preserving NCE exclusivity for NDA No. 022271, and allowing that NCE exclusivity to apply under the Agency’s “umbrella exclusivity policy” to the other two approved NDAs.  According to Ferring:

This concocted process [] clearly shows the arbitrary nature of FDA’s current interpretation of the [statute’s] exclusivity provisions.  Based on FDA’s current (i.e., pre-Citizen Petition) policy on exclusivity, if either of the combination products had been deemed to have been approved first, none of the products would have been able to obtain five years of exclusivity, regardless of the fact that the same amount of effort would have been involved in the drug development process.  These conclusions produce precisely the type of result that courts have feared, whereby exclusivity periods are based on the order of NDA approval rather than any scientific, technical, economic, or other rationale.  Interpretation of the statute in a manner that permits such outcomes, when there is an alternate valid interpretation (one which FDA acknowledges in its decision), is arbitrary and capricious in violation of the Administrative Procedures Act (“APA”).  FDA’s approach here highlights the fears raised by the courts about the Agency juggling or manipulating the timing of approvals to accomplish a preconceived goal that affects intellectual property (here, market exclusivity) rights.  In fact, it raises those fears by orders of magnitude.

Ferring also objects to FDA’s decision to announce a new interpretation of the FDC Act’s NCE exclusivity provisions in guidance.  According to Ferring, that decision was legally incorrect and creates significant regulatory uncertainty:

This decision to issue draft guidance for public comment was legally incorrect because draft guidance is not binding, does not create or confer rights, is intended to help industry carry out its obligations, and may be deviated from in appropriate circumstances.  FDA’s change in statutory interpretation here is in fact binding, does create rights, is meant to help FDA (not industry) carry out an obligation, and cannot be departed from lest individual FDA reviewers decide to award exclusivity however they see fit.  Guidance is therefore not the appropriate legal means to implement FDA’s change in statutory interpretation with respect to NCE exclusivity for fixed-combination drug products. [(Emphasis in original)]

Instead, says Ferring, FDA should have regulated directly from the statute and immediately implemented its new interpretation of the NCE exclusivity provisions. 

Clearly, the battle over NCE exclusivity for FDCs is far from over.  To date, there has been verly little comment on FDA’s proposed reinterpretation of the FDC Act’s NCE exclusivity provisions.  Docket watchers will be looking closely at the docket this week as the 60-day comment period draws to a close.  And speculation on the timing of a final guidance will likely begin to grow.      

Does it matter whether it’s viewed as a disease?

We are all one by JohnnyRokkit

The maker on The Anonymous People recently wrote:

“Is addiction a disorder, a matter of human frailty or something else?”

This debate about whether addiction is a disease or a matter of choice continues to garner headlines and direct our collective discussion away from the only thing that really matters: “How do people enter recovery from addiction and stay well?”

He points to the fact that addicts are dying and there are “23.5 million people in recovery.”

About that number, I’ve written about it before. Now, Young People in Recovery throw a little cold water on it:

“There are 23 million people in long-term recovery in the United States.” This widely cited statistic, sourced from a 2012 survey conducted by the Partnership at Drugfree.org and the New York Office on Alcoholism and Substance Abuse Services (OASAS), is often used to justify the need for increased recovery support services in the United States. However, in fact, what this survey actually asked to adults (ages 18 and over) was, “Did you once have a problem with drugs or alcohol, and no longer do?” Each respondent who answered “Yes” to this survey question has subsequently been labeled by the recovery community as a person in “long term recovery.” This begs the question: if a person has struggled with drugs or alcohol at one point in their life, is he or she automatically “in recovery”?

I think it does matter that it’s a disease and I think it matters that we distinguish between those with the chronic, impairing illness of addiction. I tend to believe that failing to distinguish will actually add to stigma. It will perpetuate the conversations that sound something like, “Greg, when your Uncle Tom was in the Navy, he drank too much and got into some trouble. Then he had kids and knocked it off. Why can’t you just do the same?” The reason they can’t do the same was that Uncle Tom was a problem drinker and Greg is an alcoholic.

Non-alcoholics using the drinking experience of non-alcoholics (themselves or others) to understand the experience of alcoholics only increases stigma.

It’s not a different degree of the same thing. It’s a different kind of thing.

In my experience, it’s only when people understand that it’s a different kind of thing—that the experience of the alcoholic cannot be understood by reflecting on your own experience of drinking too much in college—that stigma can be challenged.

So, to me, it’s a political fiction and reasonable people can disagree on whether it’s a useful political fiction. It reminded me of this old post.

Recovering community as political fiction

Ta-Nehisi Coates explores the challenges and political fiction of political movements by unpacking this passage from a feminist:

“She, who is so different from myself, is really like me in fundamental ways, because we are both”: This is the feminist habit of universalizing extravagantly–making wild, improbable leaps across chasms of class and race, poverty and affluence, leisured lives and lives of toil to draw basic similarities that stem from the shared condition of sex…

Inevitably, the imagined Woman fell short of the actualities of the actual woman it was supposed to describe, and inevitably, the identification between the feminist who spoke and the woman she spoke for turned out to be wishful, once those other women spoke up…

But although the Woman at the heart of feminism has been a fiction like any political fiction (“workers of the world,” “we the people”), it has been a useful fiction, and sometimes a splendid one. Extravagant universalizing created an imaginative space into which otherwise powerless women could project themselves onto an unresponsive political culture….

I’ve sometimes struggled with the recovery advocacy movement suffering from the same thing. I think you could substitute “woman”, “feminist”, etc with recovering people and it would be pretty accurate.

We often struggle with how inclusive to make definitions of recovery, who we include in the “community”, etc.

This push to universalize recovery has, I think, been helpful. It’s pushed many people in the recovering community to think of themselves as something larger than their small group and how more people might be helped. (It’s worth noting that Bill Wilson has been described as obsessed with how to reach and bring more people into recovery.) But, it has its limits and, at some point, I suspect it could be harmful. The same walls that inhibit inclusiveness also serve as a container for shared identities, concerns, sentiments, etc. So, I think some caution is probably a good thing.

Ta-Nehisi offers this thought:

But what I like about her analysis is that it doesn’t stop at noting the very obvious point, that political fictions don’t live up to realities.Instead she pushes on to assert that people create political fictions for actual reasons, and often those fictions have actual positive results.

Filed under: Uncategorized

Religious Belief Linked to Brain Cortex Thickness

In a previous post, I reviewed a longitudinal study of religious belief and major depression.

This study by Lisa Miller and colleagues found a reduced risk of depression in subjects who rated religious belief or spirituality as an important factor in their lives.

Reduction in depression risk with religiosity/spirituality was largest (90% smaller risk) in those with a family history of depression.

This correlation may not be causal and may be explained by some common third factor between religion and depression.

A recent study explored further a potential mechanism for a protective effect of religious belief/spirituality on depression risk.

Miller further studied the cohort using brain magnetic resonance imaging (MRI) to estimate cortical structure volumes. 

Brain structure measures were compared in three groups of subjects:

  • High stable: subjects reporting religion or spirituality as being of high importance on two separate ratings five years apart
  • Low stable: subjects reporting religion or spirituality as being of low importance on two separate ratings five years apart
  • Unstable: subjects with inconsistent ratings of the importance of religion or spirituality

The key findings from this brain imaging study were:

  • Subjects in the high stable group showed statistically thicker brain cortex measures in the left and right parietal lobes, left cuneus and precuneus regions and in the mesial frontal lobe of the right hemisphere
  • High risk subjects (family history of depression) showed stronger effects of high religiosity/spirituality on cortical thickness and this was noted to be evident in the mesial frontal lobe regions
  • Subject ratings of depression severity at the time of imaging correlated inversely with temporal lobe brain cortex thickness 

The authors note the parietal cortex and cuneaus brain regions are involved in spatial processing, sensory processing, sense of self and reflective self-awareness.

They summarize their study and implications with the following:
"The importance of religion or spirituality therefore likely reinforces persons who are at greater familial and neuoranatomical risk for developing depression against actually becoming ill by providing reserve in the regions within the (depression) endophenotype.."
This is an important study that is likely to lead to further structural and functional brain imaging research in risk and resilience to major depression. 

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link in the citation below.

Image of brain parietal lobe and cuneus regions is a screen shot from the iPad 3D Brain. 3D Brain is produced by the Cold Spring Harbor Laboratory DNA Learning Center with funding from the Dana Foundation and the William and Flora Hewlett Foundation.

Follow the author on Twitter at WRY999

Miller L, Bansal R, Wickramaratne P, Hao X, Tenke CE, Weissman MM, & Peterson BS (2014). Neuroanatomical correlates of religiosity and spirituality: a study in adults at high and low familial risk for depression. JAMA psychiatry, 71 (2), 128-35 PMID: 24369341

Ask the Expert: Do our fears for our son get in the way of him truly seeking recovery?

Question: My 22-year old son has been in and out of various treatment programs for depression and polysubstance use for the last 5 years. He also has a serious medical condition that will eventually require an organ transplant. He was recently denied a return to his extended care program because they deemed him not stable enough. We feel stuck in that we’re not sure he’s committed to getting better but agrees to go to programs because he prefers that to homelessness. We wonder if he is really getting anything more out of treatment other than keeping him safe. Our biggest fear is that if we don’t pay for treatment he is likely to die by overdose or suicide. What recommendations do you have?

Jon DailyAnswer from Expert Jon Daily:  I have had clients whose parents who have spent over $150,000 on treatment programs. The first couple of go-rounds in the great treatment programs are deserved. However, after that, the trick is assessing their motivation for a third go-round.

You have to determine is if spending money on treatment again is actually enabling the problem. It is enabling if the person is now only going to treatment because it is simply better than being on the streets. 

In contrast, when someone has been on the streets and has been going to meetings and showing though behavioral change that they really want recovery, then I say get them into a program, perhaps one that isn’t as sophisticated as the previous ones if you are paying out of pocket ,as the client already knows a lot going in.

The fear of death or more consequences in their life in the absence of wellness is real and sadly, you can’t control people to wellness.  He needs to truly want it for himself in order to change.

Photo of Ricki TownsendAnswer from Expert Ricki Townsend:  It sounds like your son’s fear of facing his addiction illness, and possible homelessness could be overwhelming.  So he is continuing to run from the real issues, using drugs and alcohol to find peace.

You seem to have been a huge support for him, offering him treatment and extended care, but if he has not made up his own mind as how to use this support for good, then you could be just giving him a place to just settle in.  So, it boils down to just this:   each one of us is is responsible for ourselves.  You are responsible for your continued growth in the understanding of the disease of addiction and its impact on the family (via Al-Anon or an addiction therapist).  Your son is responsible for taking care of himself.

The reality is that you could watch your son 24/7, and he could somehow still slip away and overdose.  We cannot keep our loved ones from dying from their addiction, any more than we can keep them from dying from cancer or diabetes that they choose not to manage.

Perhaps he will choose the streets for a while, and that will help him realize he really wants treatment and support. I have worked for several years with the homeless addicts, and they do live, survive and even thrive.  And many of them ultimately seek a life of recovery after a stint on the streets.  I encourage you to let go with love and respect, take care of your own pain, and let your son see what he is capable of doing. You are welcome to contact me for further ideas.

Reflections from a SMART Volunteer

“I’m From” by Questor7, SMART Recovery Online Volunteer
Listen to the audio version


    I’m from the 60s, from my old lady and my old man, from flower children, groovy, and “far out, man;”

    I’m from “you dig”, “coming down”, “I’m hip”, and meanwhile back at the ranch I’m from uppers and downers, and tripping and booze. I’m from free love, pedal pushers, pig out and right-on;

    I’m from James Taylor, Bob Dylan, Joni Mitchell and Sting, I’m from we all live in a yellow submarine;

    I’m from staying up too late, getting up too late, running away, and screwing and getting stoned;

    I’m from hating my job, fear of flying, crazy landlords and cheating and lies;

    I’m from who cares, why does it matter, hope I die, can’t stand it, and can’t do it;

    I’m from it should not, must not be this way and it’s just not fair;

    I’m from I’m afraid of getting too close and I’m afraid of being alone;

    I’m from silk stockings, sculptured nails, permed hair, red wine and married men;

    I’m from who gives a flying f, why do I have to do it, why does bad stuff always happen to me, I’m from it’s awful, it’s terrible, and the world must do what I want or else I’m gonna get seriously pissed off;

    I’m from too much LFT, and too much LSD, I’m from getting triggered, and woe is me;

    I’m from broken promises, broken hearts and broken legs;

    I’m from numbed out, pushed down, blissed out, dismissed and fired;

    I’m from fear of the future, regret about the past and never being here in the present;

    I’m from dark days and sleepless nights and panic attacks and endless depression and way too many therapists;

    I’m from Buddhist retreats, I’m from being twice a widow, I’m from blacking out, falling down, I’m from endless hangovers, I’m from too much caffeine, I’m from pills and potions and desperate pleas for help, I’m from fed up, wiped out, and pretending to turn my life over to a higher power;

    I’m from falling down the 12 steps and then looking for a different way to quit using and boozing;

    I’m from choosing to be clean and sober;

    I’m from saving my life with health foods, mantras, Hakomi therapy, 5 Rhythms dancing, and SMART Recovery tools;

    I’m from going to meetings, and I’m from volunteering;

    I’m from playing the tape to the end of the story;

    I’m from ABCs and CBAs, VACI’s and USA and UOA and ULA and UBA, and I’m from ANTS, and I’m from PIG and I’m from PB&J;

    I’m from grieving over too many deaths in too short of a time, I’m from fleeing from fires in Australia, I’m from a major car crash that came close to killing me, I’m from watching my husband die from a brain hemorrhage, I’m from wishing we had a chance to say goodbye;

    I’m from meditating and sitting with my feelings;

    I’m from learning how to live alone and I’m from getting on with a new life after over four years of grieving;

    I’m from laughing for no reason at all, I’m from DISARMing my urges, I’m from being clean and sober no matter what it takes;

    I’m from an HOV that lovingly places ‘clean and sober’ at the top of my list, and because of what they call ‘the hundred year flood’, I’m from a dilapidated motel room in Boulder Colorado with no idea where I’m going next, and I’m from I’m ok with being in a dilapidated motel room in Boulder Colorado with no idea where I’m going next;

    I’m from accepting that I’m still a little crazy, pedantic, insecure, silly, temperamental and pushy, I’m from not being a bad person, just behaving badly sometimes, I’m from a kind heart, I’m from compassion and joy, I’m from effervescence, and intuition and a wisdom that just keeps growing;

    I’m from trust, I’m from letting go, I’m from love, I’m from knowing that I can’t change the past, I’m from gratitude, I’m from forgiving but not forgetting when it’s important to remember;

    I’m from this place I like to think of as my home away from home,

    I’m from SMART Recovery.

About the author: Questor7 has been a SMART Recovery Online Participant since 2005 and she is currently a Volunteer. She enjoys writing, playing guitar, teaching drama and blogging.

Questor7 is one of the many volunteers that make it possible for SMART Recovery to assist individuals seeking abstinence from addictive behaviors. The approach used by SMART is science-based using non-confrontational, motivational, behavioral and cognitive methods. To find out how you can get involved, log-on to our message board for more information about Volunteering, including our Volunteer Q&A Drop-In, Sunday 4/27/14 (4pm EDT). http://goo.gl/78vMMX

Help us to bring SMART Recovery to even more people. Thank you for your support!

How to let go of the chains of co-dependency and move forward

chainsIt seems that no matter how much time I spend on relieving myself from the chains of co-dependency, I still struggle with worry.  And maybe, the biggest gift of all of this self-discovery is the raw awareness of each and every thought and action that I do.   Sometimes ‘denial’ does seem like a viable option, yet I know that my life is much better when I consciously deal with issues that arise.    Today’s dilemma is that I recognize that I am beginning to worry about future events, also known as ‘future tripping’.  For such a fun sounding phrase, it sure does lead to angst.

When my daughter decided to move back to town it was a joyful situation for so many reasons.  She was close to 2 years clean and sober, hard-working, and being a responsible young woman.  Yet in the back of my mind I struggled with all the ‘what ifs’ that could take place.  I am a strong believer of ‘what you think about comes about’.  So I consciously had to stay positive and not obsess on all the future possibilities.  I have developed techniques to ward off those obtrusive thoughts by engaging new thoughts like a song that I find inspirational or quote or prayer.  I also discuss my worries and fears with my daughter.  Also, boundaries need to be respected and discussed so that we are on the same page.  I also try to remember that things change and I need to look forward.  So many blessings and joys have transpired, and I choose to celebrate those along the journey.

Cannabis Sense

culture-warA study finding brain changes in casual users of marijuana got a lot of press last week.

There were people seizing upon it as proof of marijuana’s danger and other attacking or debunking the study. Those who attacked the study seemed to react to the inferences people were drawing from the study’s findings, rather than dealing with the actual findings.

I held back because there seemed to be much more heat than light.

Now, finally, we hear from a dispassionate voice of reason that examines the actual findings. The U.K. National Health Service provided this analysis of the findings:

This study found differences between young recreational cannabis users and non-users in the volume and structure of the nucleus accumbens and amygdala, which have a role in the brain’s reward system, pleasure response, emotion and decision making.

However, as this was only a cross sectional study taking one-off brain scans of cannabis users and non-users, it cannot prove that cannabis use was the cause of any of the differences seen. It is not known whether cannabis use could have caused these changes in regular users.

Or conversely whether the cannabis users in this study had this brain structure to start with, and that this may have made them more likely to become regular users of cannabis.

Also, this is a small study comparing the brain structure of only 20 users and 20 non-users. With such a small sample of people, it is possible that any differences in brain structure could have been due to chance. These changes may not have been evident had a larger number of people been examined.

Examination of different samples of people, and in different age groups, may have given different results.

Similarly, examining the extent of brain structural change was related to factors such as age at first use, and frequency or duration of use, are less reliable when based on such a small sample of people.

Confirmation of these tentative findings through study of other groups of cannabis users is now needed.

It would also be of value to see whether the structural differences observed actually correlated with any demonstrable differences in thought processes and decision making behaviour.

It’s a shame that this has, somehow, turned into a front in the culture wars.

Mark Kleiman  questions the motives criticized the unjustified implications* (but not the data) of the researchers:

Overall then, if you were that neuroscientist, you’d write a paper saying “We studied cannabis users and non-users and found the following brain differences. Here’s the next study we plan to do, addressing the questions of causation and possible impact.”

That’s assuming that your goal was informing your readers about the content of your findings. If instead you wanted to score points in the culture wars, push your political agenda, and perhaps please your sponsors at the National Institute on Drug Abuse and the Office of National Drug Control policy, you’d behave differently.

He also challenges the users be framed as “casual users”:

Pretending that the findings to “casual” cannabis user would require that you gloss over how extreme your sample was: an average age of onset of just over 15 (very young exposure is known to be correlated with higher risks) and cannabis use of a minimum of a joint a week and an average of 11 joints a week. (The median cannabis user consumes once a month; once a week – the minimum in this study – puts someone in the top quartile, while 11 joints a week would put someone in the top 15%.) Instead, you’d describe your findings as applying to “recreational” or “light-to-moderate” cannabis use.

The then ends with a point that will disappoint some people who’d been cheering him on:

It’s entirely possible, though not yet demonstrated, that chronic heavy cannabis use causes undesirable changes in brain structure and function. Even if it doesn’t, spending a good chunk of your waking hours zonked seems to me like a bad idea no matter what the zonking agent is, and that’s true in spades for adolescents, who may be unable to make up missed opportunities for both formal and social learning.

[* updated to reflect Kleiman's comment below]

Filed under: Uncategorized

Recovery Management extends therapeutic reach

Lambert's PieYesterday’s post on addiction counseling as community organization got me thinking about something I’d heard from a Scott Miller presentation.

Miller argued that treatment outcomes are sue to the following factors in the following proportions:

  • 40%: client and extratherapeutic factors (such as ego strength, social support, etc.)
  • 30%: therapeutic relationship (such as empathy, warmth, and encouragement of risk-taking)
  • 15%: expectancy and placebo effects
  • 15%: techniques unique to specific therapies

Part of his argument was that we can’t control that 40% related to client and external factors, and we spend tons of time and capital arguing about the 15% related to specific therapies. He argues that we should spend much more time on the 45% we have more control over, hope and the alliance.

Here’s what I was thinking—that recovery management attends to that 45% plus the 40% Miller says is out of our hands. Bill White calls on us to shape those external factors. The attention to family, community, social, vocational, educational and other factors extends our reach.

Its worth noting that Physician Health Programs do this too, by creating social peer support (caduceus groups) and support within the workplace.


Filed under: Uncategorized Tagged: addiction counseling, community organization, external factors, Scott Miller, Therapeutic relationship