Marijuana- a gateway drug?

An article in the New York Times this week talks about a couple of individual stories of people who are dependent on marijuana. One of the people interviewed, Joyce, had this to say about pot: Smoking pot, she said, “was a slow form of suicide.” The article touches on the stigma of marijuana addicts- mainly that people who were addicted to substances like heroin or crack cocaine looked down on people who had problems with marijuana. However, according to the National Institute on Drug Abuse reports that the marijuana of today is up to five times more potent than the marijuana of the 1970s.

“We need to be very mindful of what we are unleashing out of a Pandora’s Box here,” said Dr. Richard N. Rosenthal, chairman of psychiatry at St. Luke’s-Roosevelt Hospital in Manhattan and professor of clinical psychiatry at Columbia University. “The people who become chronic users don’t have the same lives and the same achievements as people who don’t use chronically.” However, you can say this about EVERY drug. I mean, if someone had the ability to drink one glass of wine a week as opposed to someone who drank a bottle of wine a night, the person who drank less would have less adverse consequences, right? And you can repeat that with ANY drug.

More adults are now admitted to treatment centers for primary marijuana and hashish addictions than for primary addictions to heroin, cocaine and methamphetamine, according to the latest government data, a 2007 report by the Substance Abuse and Mental Health Services Administration. However, those numbers are a little skewed, as 57 percent of those people were admitted due to court requirements- so they may not have been a complete addict.

So the question that defines this- are there consequences from marijuana use? Are lives made unmanageable as a result of smoking pot? The answer, of course, is yes- and with the genetic link for addiction a proven fact, then obviously any psychoactive substance can activate that addiction. So- marijuana, like any other substance, can be addictive when it's used by a person prone to addiction.

About legalization- my view is this: If alcohol and tobacco are legal and cause as many negative health consequences as they do, then we really need to review our policies on marijuana. If controlled and managed well (at least as regulated as alcohol and tobacco), then we'll see a safer, more controlled version of the drug that's out there now. But we'll see what happens.

Here's a great article by Freakonomics author Stephen J. Dubner from the New York Times about the economics of legalization.

Stephen Baldwin vs. Ron Paul on legalization:



And here's the trailer from "Reefer Madness," the overblown movie from 1936 against marijuana:



Here's something funny.

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Exercise and Substance Abuse Prevention

Don't know how I missed this in my previous post about exercise and recovery, but there have been some articles published about the effectiveness of exercise and sports as actual deterrents to substance abuse. About a year ago, the Associated Press posted an article about exercise as a prevention tool. The National Institute on Drug Abuse received a $4 million grant to explore this further. "Exercise has been shown to be beneficial in so many areas of physical and mental health," said Dr. Nora Volkow, NIDA Director. "This cross-disciplinary meeting is designed to get scientists thinking creatively about its potential role in substance abuse prevention."

There has been other research: Brown University took smokers to the gym three times a week and found adding the exercise to a smoking-cessation program doubled women's chances of successfully kicking the habit. The quitters who worked out got an extra benefit: They gained half as much weight as women who managed to quit without exercising, says lead researcher Dr. Bess Marcus.

''Exercise improves blood flow to the brain, it helps the body detoxify, it puts you on a better cycle of physical behavior, and it leads to decreased stress. It also improves thinking and mental function and decreases your tendency toward addiction,'' said Dr. Marc Siegel, an internist at New York University Medical Center and an associate professor of medicine at the NYU School of Medicine in New York City.

For example, ''there's evidence that exercise is maybe the best non-pharmacological antidepressant we have - studies have shown that it works better than some drugs. It's also a great anti-anxiety intervention,'' said James Maddux, a professor of psychology at George Mason University in Fairfax, Va., and an expert on the mind-body health connection.

I know when I was in treatment, I used exercise as a type of coping tool- gaining a "runner's high" and creating a challenge to complete. I still work out today as a way of keeping my cravings (especially around nicotine!) at bay. Not to mention the fact that working out creates chemical changes in our mind and body to make us feel better and happier. I know my mood has improved since I started working out more often. For now, let's list exercise as a tool in a toolkit for fighting addiction- it's not the end-all/be-all, but it's another way to encourage this next generation to avoid the pitfalls of addiction.

If you're looking for a great blog about exercise, staying in shape and diet advice, check out Move Ur Body- great content and advice here. Be sure to check out Phoenix Multisport, a group in Boulder, CO who uses exercise as a recovery tool. And Sober Living By The Sea, where I work, provides physical activity to their patients as an ongoing part of treatment.

Here's a great video about Todd Crandell of Racing For Recovery, an individual who used triathlons to help defeat his own addiction:



And Jaywalker Lodge, an extended care program for men who have been through multiple addiction treatments, does expeditions every year. Here's a video of their winter expedition:



As always, follow me on Twitter and connect with me on LinkedIn. Become a fan of the blog on Facebook. And see you later.

Pain Relievers- Too Dangerous?

A federal advisory panel finalized a close vote on Tuesday to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver. Since people who take these pain medications for long periods of time often need a stronger dose, the odds of liver damage increase drastically. Acetaminophen, a chief ingredient in these medications (and also in Tylenol and Excedrin), can cause liver damage when taken at high doses for a long period of time.

Vicodin (and its generic equivalent) is prescribed over 100 million times a year in the US alone- so this is a huge business decision. In a statement, Johnson & Johnson, Tylenol’s maker, said it “strongly disagrees” with the proposed restrictions on acetaminophen, adding that they would be likely to “lead to more serious adverse events as consumers shift to other over-the-counter products,” like Advil and aspirin.

However, without abuse or overmedicating, the odds of actual overdose or severe liver damage goes down. “If you keep track of what you’re taking, none of this is an issue for you,” Dr. Jan Engle, a panel member and head of the Department of Pharmacy Practice at the University of Illinois in Chicago, said in an interview after the meeting.

We need to be on the lookout for the long term affects of misusing pain management drugs. With the new recommendations on banning pain meds such as Vicodin and Percocet, people may be looking for something stronger, or at least something different. SAMHSA has publish some disturbing trends around prescription drug abuse:

* Over the past decade-and-a-half, the number of teen and young adult (ages 12 to 25) new abusers of prescription painkillers such as oxycodone (OxyContin) or hydrocodone (Vicodin) has grown five-fold (from 400,000 in the mid-eighties to 2 million in 2000).
* New misusers of tranquilizers such as diazepam (Valium) or alprazolam (Xanax, called "zanies" by youth)-medicine normally used to treat anxiety or tension-went up nearly 50 percent in one year (700,000 in 1999 to 1 million in 2000).
* More than 17 percent of adults over 60, wittingly or not, abuse prescription drugs.
* In 2000, more than 19 million prescriptions for ADHD drugs were filled, a 72 percent increase since 1995. An estimated 3 to 5 percent of school-age children have ADHD. A study of students in Wisconsin and Minnesota showed 34 percent of ADHD youth age 11 to 18 report being approached to sell or trade their medicines, such as Ritalin.
* Among 12- to 17-year-olds, girls are more likely than boys to use psychotherapeutic drugs nonmedically.

And the Office of National Drug Control Policy has some good facts on prescription abuse and awareness as well. Check that out here.

As we hear more and more about Michael Jackson and his prescription drug abuse, the need for awareness and prevention continues to rise. The medicine cabinet can be just as dangerous as the guy on the street corner. Doctors can be drug dealers too.


Here's video about the rise of prescription drug abuse:



And here's another one:



And here's something funny.

As always, connect with me on LinkedIn and follow me on Twitter. Become a fan of the blog on Facebook. And see you this week.

Michael Jackson's Tragic End

On June 25th, we lost one of the marvels of the entertainment world, a truly talented and tortured artist, Michael Jackson. With his meteoric rise to fame as the centerpiece of the Jackson 5 and then an amazing solo career, in total selling over 750 million records worldwide. However, this fame came at an amazing price.

Having been in the spotlight since the age of 5 or 6, Jackson seemed to struggle with his place in the world. Naming his home the "Neverland Ranch" lead us to believe he wanted to be a child who never grew up (which, of course, led to the infamous sleepovers on the Ranch and the molestation accusations). A documented addiction to painkillers, two failed marriages, and numerous lawsuits for pedophilia dominated Jackson's last 20 years, causing him to become a late-night joke mainstay and most of us to forget his talent.

The question remains- do we remember him for the art he produced? Has there ever been a more polarizing, successful individual? His death caused delays and nearly shut down numerous websites. He had become the centerpiece of a media storm- mostly negative in the last 20 years.

In 1993, Jackson abruptly canceled the remainder of his "Dangerous" tour after admitting on an audiotape that pain from a burn injury while filming a Pepsi commercial in 1984 as well as allegations of sexual abuse have caused him to become addicted to painkillers. As of yesterday, June 29th, various news and entertainment outlets were reporting that Jackson had received a Demerol injection the morning of his death- but we'll only find out for sure after the autopsy is published. Lisa Marie Presley, Jackson's wife for a few short years, posted a blog entry on her Myspace page talking about his drug use. She talks about how she and Jackson had conversations about how he would end up with the same fate as Elvis- and it's looking more and more like he did.

Either way, we've lost the most tortured and talented artist we've seen in a long time. There will never be another like him, good or bad. Here are some of the telling articles from a series of Vanity Fair interviews. It will be interesting to see what unfolds from the autopsy results- but it seems as though we've lost another soul to the disease of addiction. Would it have been possible for Jackson to get help? Had anyone offered treatment? Had he BEEN to treatment? Was there support for him to get well, or just to prop him up and keep him out in the public eye? We may never know, but these are questions we can answer as we move forward to help other artists in the future. He was not a commodity- he was a person. And it's hard to remember that sometimes.

Here's a tribute to Michael Jackson:





In health news, here's a great video by Lance Armstrong's organization, Livestrong:



Here's something funny.

As always, connect with me on LinkedIn and follow me on Twitter. Become a fan of the blog on Facebook. See you this week.

U.S. Drug Czar calls for end to "war on drugs"

As I talked about in an earlier post, I'm very excited to have Gil Kerlikowske as our new drug czar. On Wednesday, we finally got some good news in the so-called "War on Drugs." In a Wall Street Journal article, new head of the White House Office of National Drug Control Policy, Gil Kerlikowske, said that the "war on drugs" was a, "barrier to dealing with the nation's drug problem."

"Regardless of how you try to explain to people it's a 'war on drugs' or a 'war on a product,' people see a war as a war on them," he said. "We're not at war with people in this country."

FINALLY some progress and someone who sees the nation's drug problem as something that can't be fixed by putting more and more people in prison. The more people we funnel into treatment as opposed to prison, the better the solution is going to get. I also like how the Obama administration is going to change the policies surrounding the major criminal disparity between crack cocaine and powder cocaine, thus hopefully closing the racial barrier. The administration is also planning on changing the current federal rules that allow federal agents to raid state-run medical marijuana facilities based on federal law. This would allow states that legalize medical marijuana to operate freely as opposed to being under constant threat from the federal government. All of this is progress. As much as we can do to keep people out of prison for unnecessary reasons and put them into treatment when needed, the better we'll be off.

Here's a video about Barack Obama's stance on drug policy:



Here's a video from Ron Paul about ending the war on drugs:



And here's the famous episode of Different Strokes where Nancy Reagan talks about the war on drugs and just saying no:




Here's something funny.

As always, connect with me on LinkedIn and follow me on Twitter. Become a fan of the blog on Facebook. And please support my advertisers!

Also, if you're feeling generous, please donate a couple of dollars towards the Leukemia and Lymphoma Society- I'm riding 100 miles on August 15th in support of individuals suffering from these terrible diseases. Thanks so much, and see you tomorrow.

The Business of Addiction Treatment- A Manifesto

I was having a conversation with a friend of mine who doesn't work in the addiction treatment world this week, and she made the observation that it's strange to see people with no business training running successful treatment businesses. And, unlike the rest of the business world, this is definitely the majority of treatment centers as opposed to the other way around. The lack of business knowledge can be very detrimental to the treatment itself- when owners and executive directors are panicking about meeting the bottom line, the staff of clinicians and lower-level operations personnel can feel the panic. This isn't good for anyone, ESPECIALLY the patients, who can pick up on the tiniest weakness in their counselor and work to exploit it to their advantage. After all, addicts are the greatest manipulators. What we don't want is the option for addicts to basically be running their own treatment plan-- and when staff is in panic mode, they often can.

In these lean times, with unemployment rising and the economy not doing so hot (to say the least), more and more treatment centers are comprising their level of care, admitting clinically incorrect patients, and laying off staff in order to make the numbers work. What's sad is that even the most business-minded owners can't avoid this reality. Only a few of the treatment centers are running at capacity. And unlike the hey-day of the late 90s and early 2000s when people would take out home equity or other loans to pay for treatment, the credit has dried up and treatment centers are feeling the squeeze.

What we, as an industry, need to maintain is a sense of urgency. Every day we fight on the front lines of addiction. We help people change their lives, and see miracles happen every day. Some days, when the business doesn't make sense and it feels like we're not going to make it, we need to remember that we're doing some of the toughest work on the planet. We help dying people find a new light and a new LIFE. The more we help each other, as industry professionals, the better we all do, and we make sure everyone survives. So when someone calls in a panic, in need of referrals to keep the doors open, help. Because you never know when you'll be the person in need.

And as a follow up to my military post, the Joint Chiefs of Staff Chairman, Admiral Michael G. Mullen, said on Tuesday night that troops' mental health needs to be a priority. "I think we need to get to a point where everyone is screened by a competent mental health professional," he said. Check out the article on CNN here.


Here's a great video from Feliz Dennis, a former crack addict who now is one of the world's foremost publishers.





Here's something funny.

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Binge Drinking and the Military

In exploring the Blog Catalog, I stumbled across the Addiction Index blog which had a great article about binge drinking in the military. This is such a viable topic these days with the wars going on in the Middle East that I thought I'd grab some of the information and pass it along here.

"Binge drinking is so common in America's armed forces that startling numbers of those who serve on military bases report for work drunk, drive drunk and drink illegally while they are underage, according to a study released today by the University of Minnesota and the Centers for Disease Control and Prevention."- this is from the article in the Minnesota Post. The survey covered soldiers at home and overseas, and an astonishing 25% reported a history of drunk driving. Can we point to the fact that their lives are some dangerous that they seek risk even when off duty?

In an interview with a University of Minnesota radio station, Mandy Stahre, a researcher on the project said that 43 percent of the active respondents reported binge drinking in the past month. That broke down to 29.7 incidents of binge drinking per person per year. That's a huge and dangerous number. How do we better educate these service men and women?

An article in the Chicago Tribune touched on the increase in suicide of soldiers. "The Department of Veterans Affairs tracks the number of suicides among those who have left the military. It says there have been 144 suicides among the nearly 500,000 service members who left the military from 2002-2005 after fighting in at least one of the wars." The website wsws.org reported that in 2008, there were 128 confirmed suicides by serving army personnel and 41 by serving marines.

Now we've started to see progress, with the military providing classes on suicide prevention and alcohol abuse. But how do we truly improve this? It's not like we can take away the trauma that soldiers suffer while on active duty. Our Veterans Affairs offices are already swamped with cases and are underfunded. How do we fix this? The easiest solution- provide more funding to attract better researchers and addictional clinicians. However- that would increase taxes, something more than half the country is against, even though it goes towards making our soldiers safer. Some things to think about as we move forward.

Here's the suicide prevention video:



And here's one about the binge drinking in the military:




Here's my favorite new website.

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The Mechanism of Addiction

In an article posted in the Salt Lake Tribune, BYU researchers as well as Canadian neuroscientists, induced drug addiction in lab rats without using actual drugs. This is a huge breakthrough, basically proving that addiction is a brain disorder and not one of willpower.

Scott Stephenson, a lead researcher on the project, provided some good feedback. "We are wired for pleasure," said Steffensen, a professor in the department of psychology. "Drugs overwhelm this system that is under tight regulation. It's a sad spiralling disregulation that takes place." By isolating a protein in the brain (known as brain-derived neurotrophic factor or BDNF) that is enhanced in people struggling with addiction, they were then able to inject the protein into the rats and create the symptoms of opiate addiction.

This research opens many new directions for drug and alcohol treatment. Are we getting closer to a medical solution to addiction prevention? Maybe it's going to be possible in the future to establish blockers to these proteins that create the insatiable need for drugs and alcohol. Will it be possible to help a child with a family history of addiction to block the effects of drugs and alcohol with a simple medical treatment or prescription? I don't think that these are far off in the future.

I've been reading "The End of Overeating," by Dr. David Kessler (available here on Amazon), and in it he speaks about certain foods affecting our opiate receptors almost as much as drugs do directly. So we may also be on a path to developing further medical treatments for overeaters as well. Some doctors are already seeing progress in using naltrexone to stop the craving for carbohydrates. Dr. Richard Bernstein, in his book "Dr. Bernstein's Diabetes Solution" has published studies on the effectiveness of this method of treatment on chronic overeaters.

So it's possible that medical treatments may, in the future, be the true path to prevention and treatment. But we'll see.

Here's a video about some of the uses of naltrexone.



And here's a clip about the book, The End of Overeating:




And of course- here's something funny.




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