Calling bullshit on addiction treatment bullies

About three years ago, I was attending a national conference on public health (American Public Health Association) and presenting my posters on the relationship between drug use and violence, and sexually transmitted infections and injecting drugs. As I walked the aisles I ran into a woman who runs a Florida addiction “treatment” facility. We talked for a bit about my work, her facility, and then we shared some of our personal stories. Mine included meth addiction, jail, recovery, and now graduate school studying addictions. Everything was great until I mentioned that I now drink alcohol socially… “We’ll save a seat for you” she told me as she handed me her business card. Idiot.

Recovery bullies and addiction treatment

Dr. Adi Jaffe Lecturing in Los AngelesAs soon as my version of recovery from addiction didn’t match her expectations, it was an immediate failure. Forget the 6 years I’d spent free from crystal meth use, the excellent graduate school career that was producing real results I was there to present. Forget the fact that my family, my bosses, and my girlfriend at the time thought I was doing amazingly well – As far as this woman was concerned it was her way, or her way. Well I call bullshit on that thinking once and for all.

Unfortunately for her, the research evidence, as well as the actual human evidence that I’ve seen, shows that recovery from addiction comes in many colors and flavors, like pretty much everything else in life. We’ve covered research on all about addiction before showing that the best evidence to date actually calls into question the idea that relapse is the necessary disaster so many paint it as. The fact that the majority of those who meet criteria for drug dependence at some point in their life actually recover on their won is also there, and although this does nothing to reduce the impact of addiction on all those who have an incredibly difficult time quitting, it’s there and can’t be ignored. Drug dependence is almost certainly not a one size problem and the solution is probably far from a one-size-fits-all, no matter how much you like your own solution.

So there’s cognitive behavioral therapy, peer support solutions (like SMART Recovery, Rational Recovery, Life Ring, 12 Step groups like Alcoholics Anonymous, and more), medication-supported recovery (like Suboxone, Methadone, Vivitrol and more), Motivational interviewing and other Motivational Enhancement techniques, as well as a whole host of psychotheraputic approaches that are more eclectic. No research we have to date indicates that any of these approaches is necessarily more effective than others, which means that they are all essentially equally effective. We’ve already talked about some combinations that work very well together, like PHP programs for physicians, but there is absolutely nothing to indicate that the 12-steps (for examples) are somehow superior to CBT, or Rational Recovery, when it comes to treating addiction.

If you get better, you’re a success in my book

When it comes down to it, whether this Florida 12-stepper likes it or not, I am still a social drinker and I still don’t believe that this nullifies any of my other achievements or my successful recovery. More importantly, it doesn’t nullify the success of millions of others, no matter how poorly it fits with some people’s notions. When a life gets overrun by drug use or another addiction, a successful outcome to me means recapturing a functional life that is no longer dictated by the pursuit of that addictive behavior. Anything more or less is a personal preference sort of thing. The problem with these idiots who will absolutely ignore success because it doesn’t conform to their expectations is that they drive people out of treatment and away from success and that is not okay. I’ll continue to call them out for their narrow mindedness and hopefully eventually, their voice will be far from the dominant one.

Should all drugs be decriminalized? A UK debate

Christopher Russell

In a recent UK parliamentary debate, Bob Ainsworth MP, a former Home Office minister in charge of drugs policy, called for the decriminalization of all drugs. Ainsworth, the most senior UK politician to publicly endorse a system of decriminalization, joins respected figures from the medical and research communities in recent months in suggesting that the decriminalization of drugs would significantly improve public health and reduce crime further than is being achieved under the current system of criminalization. Ainsworth argues that that the past 50 years of the War on Drugs has been counter-productive to its intended goals of reducing the availability of drugs and improving public health. Furthermore, he claims that billions of pounds had been spent without preventing the wide availability of drugs, reducing the wide use of drugs, or weakening the illicit drug market. Consequently, Ainsworth proposes that the drug market be taken out of the hands of organized criminals and be placed into the hands of medical professionals and licensed vendors. Such a change in policy would mark a return to UK drug policy prior to the mid-1960’s in which drug use was treated as a health issue, not a criminal issue.

“It is time to replace our failed war on drugs with a strict system of legal regulation, to make the world a safer, healthier place, especially for our children. This (policy of criminalization) has been going on for 50 years now and it isn’t getting better. The drugs trade is as big, as powerful as it ever was across the world. Prohibition isn’t the answer to this problem” he said.

It is important to understand that Ainsworth is not arguing that drugs like heroin and cocaine should be freely available to buy in the same way that adults can buy alcoholic drinks and tobacco products. Rather, he argues that drugs be decriminalized, which is different from legalized. Decriminalizing would likely mean the government would control all aspects of the manufacture, quality, purity, distribution, and trade of drugs, including who will be licensed to provide drugs. Legalization would mean drugs could be traded in the free market, a position which Ainsworth is explicitly against. “I’m not proposing the liberalization and the legalization of heroin so we can all get zonked out on the street corner” Ainsworth said in an interview with BBC’s Radio 4.

Why decriminalize drugs?

The argument for decriminalization is based on the hypothesis that the legal regulated supply of drugs will draw trade away from the illicit market and so reduce crime related to the illicit sale and purchase of drugs; improve the health of users by providing quality-controlled drugs under the guidance and supervision of licensed individuals; increase the uptake of addiction treatment; allow treatment providers to reconnect with a group of drug users who do not typically seek or know about treatment options or have distanced themselves from treatment providers for fear of criminal prosecution; and improve drug education for current and would-be drug users.

If decriminalizing does shift the drug market toward legal vendors, a major benefit could be the medical and addiction research communities’ sudden widespread access to a population of drug users who are notoriously difficult to reach. This access would allow medical professionals and researchers obtain rich first-hand information as to why these people started using drugs and why they use drugs today, to provide drug education, to provide assistance with any problems relating to employment, housing, relationships or physical and mental health. Decriminalizing drugs may therefore better place treatment providers to support those who want help and to minimise harm in those who continue to use. Paradoxically then, while many people believe decriminalization will send a message to the youth that drug use is acceptable as well as maintaining use in current users, proponents of decriminalization argue that, by reconnecting drug users to the health community, legal regulation of drugs will actually increase in the number of people quitting drugs and provide earlier opportunities to deliver educational interventions to ‘would-be’ drug users.

What might decriminalization look like?

While Ainsworth did not describe in detail how drugs should be regulated, Steve Rolles, Head of Research for the Transform Drug Policy Foundation, which campaigns for the decriminalization of drugs, released a ‘blueprint for regulation’ in December, 2009 which described how models of regulation for different types of drug would improve health and decrease crime. The report proposes that cannabis and opium could be sold and consumed on membership-based “coffee shop-style” licensed premises and would likely be subjected to similar trade laws as those currently applied to tobacco products; cocaine, ecstasy and amphetamines could be sold by licensed pharmacists or named purchasers; and psychedelic drugs, including hallucinogens such as LSD or Salvia could be used only under supervision in licensed “drug clubs” or similar venues. Rolles said: “Drugs are here to stay, so we have a choice – either criminals control them, or governments do. By the cautious implementation of a legally regulated regime, we can control products, prices, vendors, outlets, availability and using environments through a range of regulatory models, depending on the nature of the drug, and evidence of what works”.

Rolles also echoed Ainsworth’s sentiments about the futility and counter-productiveness of prohibition in a recent BBC radio interview: “It hasn’t reduced drug use, it hasn’t prevented the availability of drugs, but it has created a whole raft of secondary problems associated with the illegal market, including making drugs more dangerous than they already are and undermining public health and fuelling crime”.

Rolles called on the UK government to consider evidence about the effectiveness of the prohibition policy both in the UK and other countries and health and crime projections under a decriminalized system. Craig McClure, foreword author on the Transform Drug Policy Foundation report and former executive director of the International Aids Society states that several Latin American governments have already realised how their war on drugs have undermined public health goals and fueled crime and have already moved, or are moving, towards decriminalization and a public health model targeting the prevention and treatment of drug misuse.

What next for the decriminalization deabte?

Knowing that drug decriminalization is a sensitive, emotion-laden, divisive idea, and therefore public support from fellow MPs will initially be largely absent, Ainsworth has called for an impact assessment to be conducted on the Misuse of Drugs Act, 1971 – the legislation which introduced drug classification in the UK – rather than calling for drugs to be decriminalized outright.

“I call on those on all sides of the debate to support an independent, evidence-based review, exploring all policy options, including: further resourcing the war on drugs, decriminalizing the possession of drugs, and legally regulating their production and supply” he said. As influential political, medical and scientific forces join to pressure a review of the efficacy of current drug policy, there is a sense in the UK that drug decriminalization is slowly moving from an ideological conviction to an evidence-based alternative to a failing system of prohibition.

Please write your comments about the prospect of drug decriminalization in the box below.

References:

Bob Ainsworth BBC 1 television interview, 16th December, 2010. Accessible at http://www.bbc.co.uk/news/uk-12005824

Bob Ainsworth BBC Radio 4 interview, 16th December, 2010. Accessible at http://www.bbc.co.uk/news/uk-12005824

Transform Drug Policy Foundation (2009). After the war on drugs: Blueprint for regulation. Accessible at http://www.tdpf.org.uk/Transform_Drugs_Blueprint.pdf

Medical and political support for the Transform Drug Policy Foundation’s ‘blueprint for regulation’ (2009) report. Accessible at http://www.tdpf.org.uk/blueprint%20download.htm

Proposition 19 – Marijuana legalization or nothing? The business of weed

On November 2nd, California voters will be asked to determine whether they’d like to change the legal status of marijuana, and for the first time ever, advocates of legalization may actually accomplish their goals. There are a number of reasons why a well-intentioned voter would choose legalization, from the potential billions of dollars in tax revenue to the reduced burden of non-violent drug cases on a mired legal system. Unfortunately, without the opportunity to vote for decriminalization rather than full legalization, these voters are being presented with a false choice between a senseless century-old prohibition policy and a new option designed not to maximize the safety of California’s citizens, but rather to greatly enrich a chosen few.

Proposition 19 – Marijuana legalization and taxation

Proponents of Proposition 19 have many valid arguments working in their favor. Foremost among them is the simple but wide-reaching argument that marijuana users, like users of most other drugs, should not be jailed for their personal use. Study after study shows that the vast majority of those who experiment with drugs do not develop dependence or addiction problems, and that those who do develop such problems benefit far more from addiction treatment than from incarceration. In fact, supporters of legalization often cite Portugal as an example of a country that has reaped great social benefit from treating drug abuse and possession as a public health, rather than criminal, issue. Portugal, however, has never legalized any drug; their possession, rather, has been decriminalized, while the drug trade itself remains illegal. The crucial benefit of this approach speaks to the strength of market forces: by keeping drugs illegal, we keep them expensive enough to provide a disincentive to serious and widespread abuse. If fully legalized, the extreme reduction in cost, along with the clever and predatory marketing of marijuana in less stigmatized formats- cookies, lollipops, teas – could drive use up far closer to the levels currently seen for alcohol abuse, and with 15 million American dependent on alcohol, we all know how that fight is going. Given the high public cost of treatment and the correlated increase in depression, schizophrenia, and other related disorders, the perceived financial windfall of legalization may be nothing more than a cloud of smoke. The increase in use however is almost certain.

Driving while high – Polydrug use and marijuana

There is also the question of road safety. While proponents of marijuana are quick to point to a handful of studies that proclaim low to no risk when operating a motor vehicle, they are often too eager to ignore numerous other studies including simulation studies and research from countries such as Australia and Canada, which keep national databases on accident statistics. In Australia, one such study found a 300% to 600% increase in fatal car accidents when drivers were positive for THC (depending on concentration), and Canadian studies have shown that the combination of marijuana and alcohol can be more dangerous for drivers than the combination of alcohol and benzodiazapines. Given that nearly half of individuals admitted to drug addiction treatment include marijuana among their polydrug use pattern, the notion that newly legal marijuana users would not combine their pot use with alcohol or other drugs seems highly dubious. It certainly won’t help that drivers might suddenly be able to buy their weed brownies in the same place as their Bud Light.

Legalization versus decriminalization – Who really benefits from prop 19?

There is no doubt, however, about the one California group that stands to unequivocally gain from the legalization, not decriminalization, of marijuana- the entrepreneurs that have staked their claim to what they see as potentially a very big business. Decriminalization, by diverting marijuana users from the legal system and focusing our efforts on getting compulsive users into treatment, will both save taxpayer money and do far more for public health than legalization or the status-quo. What it will not do is make men like Richard Lee, Oakland’s major marijuana-sales benefactor and one of Prop 19’s biggest financial supporters, any richer. As California voters cast their ballot in a few short weeks, they should by all means carefully consider making a statement about our nation’s failed drug policies and misplaced law enforcement priorities. They should also carefully consider the solution that isn’t being presented as an option- and why.

Know before you speak – Why etiquette is important

You know, I try to write this blog from a completely objective point of you, but guess what – I’m a person, so things take on a personal tone once in a while.

There’s nothing I hate more than readers who come to this site, read a single post, and then decide they know who I am, or what I’m about. It’s taken me more than 13 years to get to this point in terms of my knowledge, experience, and viewpoint on drugs, addiction, and policy issues. It all started with 8 years of some personal “experimentation” with the behaviors I’m talking about. I’d love to say I was doing it for science, but the last three years were far from enjoyable for many around me. Since then I’ve studied statistics, neuroscience, public-health, and psychology. And I’m not done. Staying in the academic world, I keep educating myself on issues related to addiction from every field I have access to.

So please, if you have opinions, share them, but if you want to insult me, make sure you know what you’re talking about, because I’ll tell you if you don’t. Personal attacks are easy to make through an internet connection, but being stupid will leave an obvious stain and will cause me to either remove your comment or just reveal how ridiculous it is. I don’t like making personal attacks on people – not in posts, not in comments, and not in real life. Don’t tell me how you do, or don’t, want me to die because I probably don’t care how you go and I certainly don’t want the experience to be bad.

I know blogs are a little loose, but let’s keep this at least somewhat professional, okay?