More money more problems? Rich teens and drugs

Teens raised in affluent homes display the highest rates of depression, anxiety, and drug abuse according to a recent article in Monitor on Psychology, the APA‘s monthly magazine.

One of our recent posts dealt with some of the issues unique to teens and drugs. In addition to the issues we’d already mentioned, the article named a number of reasons for the high prevalence of mental-health issues among affluent teens. Among them were an increasingly narcissistic society, overbearing parents, and an common attitude of perfectionism.

Each of these reasons are likely contributors to the prevalence of mental health and drug abuse issues among upper-middle-class (and above) teens. Still, as far as I’m concerned, the main take home message of the article is this:

Money truly doesn’t buy happiness – Rich teens and drug use.

While drug abuse research often focuses on the lower socioeconomic strata these recent findings indicate that being financially stable offers little in the way of protection from some of the most common psychological difficulties.

Thankfully, the researchers cited in the article gave some simple advice to parents:

  • Give children clear responsibilities to help around the house.
  • Take part in community service (to unite the family and reduce narcissism).
  • Reduce TV watching (especially of reality TV shows that glorify celebrity and excess).
  • Monitor internet use.
  • Stop obsessing about perfect grades and focus instead on the joy of learning for its own sake.

I couldn’t agree more with these recommendations. Having taught a number of classes myself, I have witnessed the ridiculous inflation in students’ expectations of top grades. I think it’s time we turned attention back to the family and reintroduce some of the basic skills that many addicts find themselves learning much too late… Often in recovery.

Money or cocaine? It all depends on timing

People who are looking for treatment for their cocaine addiction still really like cocaine, but they’ll choose money as an immediate reward if they can only get their drug of choice later.

Cocaine or money? Depends on how long the wait is

Although it might be somewhat surprising, the above finding is the result of a recent study by a team of researchers spanning the U.S. and Australia that was recently published in the journal Psychophramacology.

We’ve talked about the concept of relatively high impulsivity among addicts on A3 before and the concept isn’t a new one — Addicts make drug-focused choices in the short term even if there are larger rewards far off in the horizon. In fact, this sort of delay-discounting (considering future rewards as being worth less) is a general human phenomenon that has simply been found to be exaggerated among addicts.

Think about it – Would you prefer $50 now or $1000 in 6 year? What about $100 now?

By asking a set of similar questions researchers can determine an individuals discounting rate or the amount of discounting people put on the delay in getting the later reward. Up to now, most of this sort of research has been conducted using the same “now” and “later” rewards. People were asked to decide between money now or later, cocaine now or later, cigarettes, meth… you get it.

This recent study made things more interesting by creating a few different conditions:

  1. Money now Versus Money later
  2. Cocaine now Versus Cocaine later
  3. Money now Versus Cocaine later
  4. Cocaine now Versus Money later

The goal was to see if people discount money and drugs equally. Since one of the hallmarks of addiction is that addicts seem to undervalue everything else while overvaluing drugs, figuring out whether bringing delay into the mix was at the least interesting but at best possibly useful in treatment.

The researcher used participants who were actively looking for cocaine treatment and ended up with a relatively small sample of 47 individuals who met criteria for cocaine addiction. As is usually the case with these sorts of studies, most of the participants were men, the average education equaled high-school and the average age was early 40s.

Participants were asked how many grams of cocaine a $1000 was worth and that unique number was used for each participant as the equal point between money and drug. Then they were presented with options such as the above (X number of dollars now or X number of dollars in six months).  As participants made selections, the immediate amount was changed by 50% to counter their choice (it was reduced if they chose immediate and increased if they chose delayed rewards) and the procedure repeated six times for each of seven different delay periods (1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years).

So, let’s say a participant was first asked if they wanted $500 now or 20 grams of cocaine. If they chose cocaine, their next choice would be $750 now or 20 grams of cocaine later; now if they chose money, the choices became $375 now or 20 grams of cocaine later… and on the experiment went.

Cocaine addicts choose cocaine if they can get it now, but not later

First of all, it’s important to note that the research showed that different participants had pretty stable discounting characteristics. That is, if a participant preferred to get things now rather than later, that was likely true across all conditions regardless of whether the reward was drugs or money. However, the different rewards also had a large influence on this equation.

The main finding from this study was that when faced with the option, cocaine addicts chose immediate money over later cocaine even if the immediate money amount was relatively low. That finding might seem surprising at first given what we think we know about addicts. Aren’t they supposed to always choose drugs regardless of what else we put in front of them?

Apparently, what matters is not only what we put in front of them but also when. Of course, anyone who actually knows an addict (or is one themselves) already understands that trying to simplify addiction to an ability to only choose drugs is silly. Addicts would die of starvation or a host of other issues pretty quickly if that was true. Addiction is much more nuanced than that, and as I mention at the end of this piece, this finding might not be as clear as one might think.

In fact, this finding has already been greatly supported by at least one addiction treatment tactic that we’ve discussed here on A3 – Contingency Management (CM). In CM, individuals in treatment are rewarded for staying clean and doing well in treatment. They’re not given cash but instead are rewarded with vouchers that let them buy food, clothes, etc. for providing drug-free urine tests and going to their assigned group meetings. This addiction treatment method follows the basic tenant of the psychology of learning – people do what they’re rewarded to do. This study offers a fresh perspective on the matter, suggesting that one of the reasons people do well and stay longer in treatment when given CM is that the immediate money reward is thought to be worth more than the possibility of getting drugs later. It might also explain why CM has only really been shown to work well while people are in treatment and not when they leave…

I mentioned earlier that I think these findings may be a little more complicated than they first seem. One of the major issues I have with this study stems from my life as a drug dealer. The users I know quickly equate money with drugs and so it is very possible that in their minds money now also equals cocaine now, although a smaller amount of it and they’ll take whatever drug they can get now instead of having to wait for it. Most regular users I’ve met would easily choose a single gram of meth now instead of 4 or 5 in 6 months. They simply don’t want to wait that long to get high. Money holds its value much better in the long run and this research supports that idea.

Citation:

Bickel, Landes, Christensen, Jackson, Jones, Kurth-Nelson, Redish (2011). Single- and cross-commodity discounting among cocaine addicts: the commodity and its temporal location determine discounting rate, Psychopharmacology

Two Million Dollars a piece – The cost of drug use and violence

The average cost to society of a lifelong criminal = About $2 million

I’ll get into more of this in later posts (I already talked about the cost of addiction prevention versus treatment versus enforcement), but if that cost of drug use and violence doesn’t cry out for a better application of money to prevention and addiction treatment, I don’t know what does.

At that cost, even if a treatment method costs $10k per client, it only needs to work for 1 out of 200 people to break even, and benefit society while doing so. In reality, our success rates are much higher than .5% (1/200) and closer to 15%-25%. When you take into account the fact that average cost of a month in addiction treatment (residential, outpatient treatment is much cheaper) is indeed about $7000-$10,000, it seems silly not to avoid the cost of crime by greatly reducing drug use, and hence criminal behavior.

NIDA, the government’s top agency for drug and alcohol abuse research recommends three months of treatment, but even then, success rates as low as 2% would leave us with a profit by providing treatment. Screw it, even a whole year of treatment would save us money if it succeeded but I can tell you that funding for that kind of addiction treatment length is almost non-existent, especially when compared to the actual need.

So with success rates about 20 to 30 times higher than our break-even point, we would literally benefit, and I’m talking financially, from helping people with treatment as expensive as $100,000 or more (as long as it worked). One of the things I’ve learned in all my work has been that while some individuals are actually interested in helping people, yes, even if they’ve been dirty drug addicts who have commited crimes, almost everyone cares about money. So forget for a second about all the social justice arguments to be made for helping addicts and think about the cost savings to our society… It makes sense.

True, true, not all drug users who would enter treatment would become lifelong offender, but if you’re still keeping tabs, even if only 1/20 or so do, we’re more than breaking even here. In fact, with our prison populations exploding as more and more drug users enter the system, I bet we’re in for some real savings.

Citation:

Dodge, K. A. (2008) Framing public policy and prevention of chronic violence in American youths. America Psychologist, 63, 573-590.

Demand & Money: Why Mexican drug cartels aren’t losing this war.

I’ve said it before, and I’ll probably say it again, but the Mexican drug war isn’t going to be won anytime soon, not while there’s black market demand for narcotics over here in the good old U.S. of A. The reasoning isn’t complicated and it shouldn’t take a RAND foundation study, or a man of Obama’s intelligence and charm to understand it… It’s the money. I’ve been there, take it from me.

Mexican Drug War, dealers, and Money

Since Calderon, Mexico’s President, declared an all out drug war on the cartels, Marijuana, Heroin, and crystal meth seizures at the U.S.-Mexico border have gone up by 30%-200% (crystal meth and heroin respectively) according to a recent L.A. Times article. As someone who’s actually been on both sides of the drug war, I can tell you that while Calderon’s people talk about the cartels trying to replace the state, the only thing drug dealers care about is money. Still, it’s true that having complete control over entire states in Mexico let’s these organizations operate more easily and control their business-interest more completely. At the end though, the drug war is all about the Benjamins, because there are a whole lot of those – like $40 Billion kind of a lot.

The reason I feel so confident in my position is this – I used to sell drugs in Los Angeles. I was not at the top of any cartel, but at some point I was selling tens-of-thousands of ecstasy pills a week along with a few pounds of crystal meth, cocaine stamped with those cartel logos (like scorpions, doves, and such), and any other drug my more than 400 clients, and 4-6 dealers, told me they would give me money for. The business brought me about $500,000 a year and though my success was short lived, having gotten arrested after my motorcycle accident, I got to learn quite a bit about the underworld in my five year immersion program.

While I stuck to drugs, others around me, each with their own little drug-empire, had no problem expanding into other profitable business like electronics, cellular phones, and credit card numbers complete with identity theft. If it made money, they wanted a part in it, and the drugs served as a great bonus since we were all high on a lot of them all the time. On many of our more extensive drug deals, involving those tinted-window car caravans you’ve seen in movies right along with secret meetings in the back of an abandoned gas station south of Orange County, we would use cell phones that my partners got from their underground operations, activated using a stolen identity so that they can’t be traced to us. A good deal of the stereo equipment in my old apartment was gotten through one of my friends’ little electronics-store operation – he gave me an entire stereo system, and I paid him with a few hundred ecstasy pills. I rocked and he made some money.

When cops sell drugs

One of my main connections, a stocky, short, Jewish guy we all simply called “D”, once took me along with him as he delivered a bag full of money and some boxes of armor-penetrating bullets to a Mexican Federale who would drive cocaine into the U.S. in the tires of his car. While he was supposed to be playing a different role in the Mexican drug war, he apparently really loved those bullets and would come back to his home country happy, with a trunk full of cash, while we drove away with spare tires full of those scorpion-stamped bricks of cocaine. And who could blame him given the huge sums of money flaunted in his face all the time as he was forced to live near poverty? At the time I certainly couldn’t.

The things is that morality aside, it doesn’t matter if anyone blames, or would arrest, this guy and the thousand others like him. We live in a world driven by money, and when the straight-and-narrow offers little compensation, the good life is only a few smuggling miles away. Of course on the money’s heels also comes intimidation, constant paranoia, and the almost certain feel of gun-metal either in your waist, or up against your temple. I’ve been there too.

Legalization? Probably not

All in all, it’s time for our government to realize that where there’s poverty there’s crime and where there’s crime drugs will soon follow. As the Mexican cartels send representatives to the U.S. they have taken over the distribution in many of our cities as well, increasing their profit margins, and their control, over this market. If you really want to deal them a blow, make all drugs legal and start regulating their manufacturing, though maybe then the difference between drug cartels and the Halliburtons of our world will become even less obvious.

Obviously, legalization isn’t going to happen, and I’m not sure that’s a bad thing. The most commonly abused drugs in this country are alcohol and nicotine, both legal, with marijuana, which is essentially decriminalized in most states, coming in a close third. Together, those three drugs account for more than 95% of drug abuse here, and for a substantial portion of health-problems and deaths. If we bring the rest of the drugs into the fold, we’ll no doubt see large increases in use for most of them, compounding the problems in terms of health and related mortality.

Still, that seems to be the question – Legalize and reduce black-market crime while hurting the health (physical and psychological) of your citizenship? Or try to reduce demand with prevention while continuing the drug war, stopping as much of the supply as you can but never getting enough of it and letting drug kingpins amass Bill-Gates-like fortunes?

Fortunately for me, I don’t have to answer that question…

Gambling it all away? The connection between gambling and drug addiction

Screaming in the last 10 seconds of a football game, the score is neck and neck, and your team has the ball on the 20 yard line. Needless to say your heart is beating like crazy in anticipation to see the outcome. Would it be beating any harder if you had money riding on the outcome? A recent study has shown that when it comes to gambling, the excitatory aspects are heightened when there is something to be won, no matter what game you’re playing, or the outcome (1).

Gambling’s more exciting when there’s money on the line

Recent work by researchers at SUNY Albany, discovered that in the last 30 seconds of a horse race and the following 30 seconds after the completion of a race, heart rate (HR) rises significantly more in individuals who think they will personally benefit from the race. The HR of those who lost money still rises after learning the outcome of the race—surprisingly just as much as those who won money. So whether you win or lose money in the race, your heart rate still goes up, which may provide a signal from the body that drives the continuation of gambling behavior.

Seems strange right? Win or lose, as long as you bet money on the game your body is going to become more excited about it. Still, when questioned afterwards, individual’s rated their experience as more exciting only if they won money. That, in fact, was the only difference between the men and women in the study. Women rated their subjective excitement higher even for lower winning rates (in this study $2, and $7), whereas men only said they were excited for the highest amount ($15).

How does gambling become addictive?

You become addicted to drugs because of chemicals that change your body and brain in specific ways that make you want more (see a past post here). Gambling doesn’t involve putting chemicals in your body, so how can you become addicted to it?
When you gamble, actual changes occur in your brain, just as they occur with drugs. Though gambling may not put chemicals in your body directly, it does affect the same class of chemicals that become altered by the intake of drugs. It all goes back to the reward pathway in the brain and neurotransmitters like dopamine, adrenaline, and noradrenaline. Whether a good experience or a bad one, the effect on the brain can apparently get some people to the point where they lose control over their betting, win or lose.

The question is: Why can’t you just play the same games without getting in debt?

Betting money creates a heightened excitement by the release of the reward-related neurotransmitters. That feeling of reward becomes associated with all the other surrounding stimuli (i.e. bright lights and sounds of casinos or screaming fans) and Bam! Here comes trouble (see my post about cravings here). As long as the gambling is sometimes paired with an actual win, the arousal from the situation as a whole (even while losing) will continue to create the desired effect. In fact, inconsistent rewarding, and especially the kind that can’t be predicted, produces the strongest, hardest to shake kind of learning. This is why casinos program slot machines (their biggest gambling money maker) to win one out of every five draws o average – it keeps people coming back for more. Every one of those unexpected wins pushes up dopamine levels in the brain making it more likely that you’ll go back for more…

Sound familiar?

Citation:

Wulfert, Franco, Williams, Roland, and Hatley Maxson (2008). The Role of Money in the Excitement of Gambling. Psychology of Addictive Behaviors, 22, 380-390.

Rx for reform: Spend on addiction treatment now, save later.

This was originally posted on takepart.com:

StatisticsThe debate about healthcare reform is raging with democrats and republicans seemingly entrenched in their positions on different sides. The overall question is simple: How do we reduce the cost of healthcare in this country without negatively affecting the quality of it?

US healthcare can be some of the most advanced and innovative in the world. Unfortunately, it can also leave nearly 46 million Americans with too little, or even no, coverage. With insurance companies caring more about the bottom line than about people’s health and well being (that is, along with safety, after all the stated job of the government, isn’t it?) individuals lose, or are not granted, coverage when they become unprofitable.

If you’ve seen Sicko, or a number of other productions dedicated to this problem, you know where this story leads: Bankruptcies, homelessness, and the destruction of families, due to cancers, genetically acquired maladies, and other chronic illnesses. This might be okay with some Americans, but it’s not okay with many of us.

Those who oppose reform are using the same scare tactics and generalities they normally resort too, warning us of the loss of our health coverage by this government takeover. If you’re told that regular checkups at the doctor will save you thousands in overall medical costs (and we all are), it would be silly to consider the co pay for the regular doctor visits an additional cost burden. In fact, those smaller payments are allowing you to avoid more expensive, and painful, procedures down the line.

The constant barrage of republican scare messages seems to ignore that simple fact. Spend more now to save money later has worked with thermostats, energy efficient appliances, consumer conveniences like AAA, and will work with a healthcare reform overhaul.

In the same way, treating drug addicts will reduce their burden on our healthcare system. Spending even tens of thousands of dollars on an individual that costs that much yearly in emergency room visits will reduce their total financial burden on society as long as it significantly reduces the number, and severity, of the healthcare visits they seek. And if we add to this and give coverage to the same group, many of whom are uninsured, and you’ve hit the jackpot.

Let’s clarify what costs we’re talking about:

  • With the average cost of an ER visit ranging from $200 to $2000, and an average of 13.3 ER visits per year for untreated addicts, we end up with costs ranging between $2600 and $26000 per year per addict in additional costs. Given the estimates of about 23 million addicts in the US, that takes us, even at the low end, to $60 billion more just for ER visits (the high end would leave us close to half a trillion).

Fortunately, addicts who enrolled in treatment had ER costs that were reduced by 20% and those who completed treatment reduced those costs by 50%!!!

All of this doesn’t take into account health costs associated with chronic illnesses and other indirect effects of addictions. Since these include heart disease (hypertension, stroke) cancers (lung cancer especially), and more (liver disease, kidneys, etc.) even the most conservative estimates would add additional billions of dollars in costs to our healthcare system annually.

As of right now, tax payers are left holding the tab for many of these services. California businesses and families alone shoulder a hidden health tax of roughly $1,400 per year on premiums as a direct result of subsidizing the costs of the uninsured**.  Similar numbers are available for other states, and our federal dollars subsidize even more of the overall healthcare system burden left behind by those who can’t pay for it.

Some suggest that we simply stop providing services to those who can’t afford them. The reality is that all we’ll end up with in that case are millions of people who will become hospitalized through our correctional system. If you need serious healthcare, you’ll do anything to get it. The US already holds the proud distinction of having more than 50% of the world’s prison population while only making up 5% of the overall population. I don’t know about you, but I’d rather lose that number 1 spot.

Addiction treatment may be expensive, but it’s far less expensive than the ER services I mentioned earlier. By allowing individuals to have coverage for those services, we’ll take away some of the burden those same individuals are currently placing on our system AND improve lives at the same time.

My last point has to do with the “pre-existing conditions” clause so many insurance companies love so much. As our understanding of many diseases, including addiction, improves, we’re finding genetic, environmental, and developmental effects on almost all conditions. If we don’t do something to eliminate such restrictions, we may all soon end up paying more that we could possibly be expected to afford because our genes show we have a slightly elevated risk for things like hypertension, arthritis, or yes, even addiction.

It’s time to change the conversation about this and take away the notion that any of us will lose anything in this reform effort. If you have money, you will always be able to get better treatment – this conversation isn’t about you. This entire debate should focus squarely on those who aren’t getting the medical services they deserve by their mere existence as human beings. Every other civilized society on earth recognizes this by now. It’s time for us to make our way out of the dark ages.

**Furnas, B., Harbage, P. (2009). “The Cost Shift from the Uninsured.” Center for American Progress.