Another spate of Tropane related ER visits, and my experience with the Datura family

Edited and added to, after my initial writing in the middle of the night after driving six hundred miles. Updated - A friend who used to cultivate hallucinogenic plants emailed me after reading this post to tell me that Brugmansia was one of the plants he grew. He wasn't certain I had used it, but pointed out that I used pretty much all the plants he grew.

Abel Pharmboy has a post up, about a spate of ER visits due to Angel's Trumpet (Brugmansia). The Brugmansia genus is a close relative of the Datura (deadly nightshade) genus, both being part of the Solanaceae family. These plants contain atropine and scopolamine, which combined in these plants are sometimes commonly called daturine or Tropane. A commenter on Abel's post mentioned that there is a narrow window between a recreational dose and a fatal dose.

I have some fairly extensive experience with the Datura genus and people, especially young people + Tropane plants is very frightening. I have used Belladona, Jimson weed seeds, Henbane and Mandrake - the Belladonna most frequently, Henbane only once. To say the window between a recreational dose and a fatal dose is narrow, is putting it mildly.

The biggest problem is that a person's metabolism, weight and several general health factors are extremely important to both how much one needs to have the hallucinogenic experience that is expected and how much is a fatal dose - with some people having no separation between the two. People who have a slower metabolism are likely to need less and will have a lower threshold for a fatal dose. Someone who is overweight might not have a hallucinogenic experience at a lower dose and may not be able to handle a high enough dose. In most cases, people need to understand that even having a "successful" experience is likely to entail rather extreme discomfort and some serious health risks.

The last time I ended up drinking Jimson weed seed tea, for example, a person who took half what I did ended up hospitalized and (apparently) almost died. I almost died too, but that was a result of something I did as a result of the tea, not as a direct result - though I did drink nearly a gallon of gatorade, over about eleven hours after drinking the tea.*

Belladonna is even worse, because the baseline dose is so very small. Thankfully it is not easy to find in the U.S., as it isn't a native species. Though of course it is easy enough to cultivate and seeds aren't very difficult to come by - that would be why I was able to use it relatively frequently, over the course of a few years. It was rather nasty in retrospect, as it didn't cause an overt "high" and the effects lasted for weeks. Characteristic was having conversations with people who weren't actually there - they would appear, chat for a while and disappear. Both the appearance and disappearance would be abrupt, but seem perfectly normal - after a while I was cognizant of what was happening and simply believed that I was talking to "spirits." I never had serious complications with it, but was also very careful about companionship (read; babysitters) for the initial experience which would include experiencing hallucinations that were indistinguishable from reality. Without someone to keep track, I could easily have done very dangerous things - completely unaware of where I actually was.

This is really the most dangerous aspect of using tropane plants - the hallucinations are completely indistinguishable from reality. With some you get a definite "high" with the experience, but the actual hallucinations are exceptionally "real." They also usually encompass all of reality - everything you are experiencing, or most of it, may be a hallucination. You might be laying in or even restrained to a bed in reality, while what you are experiencing involves being somewhere completely different, in situations that seem entirely real. Even when they are patently absurd. An excellent example of that (beyond conversations with abruptly appearing and disappearing conversational partners) was "smoking" while on Jimson weed.

The last time I would roll my cigarette, smoke it - managing to smoke them down to the barest butt without burning my fingers, then having the butt completely disappear. I actually smoked more than normal that night, though not significantly more than I normally would under the influence of a moderately powerful, to powerful hallucinogen. When I was actually cognizant of reality again, I discovered that the pouch of tobacco I had bought the previous night remained unopened. Mind you, the whole smoking experience seemed entirely normal - I was mildly curious where the hell my butts were disappearing to, but not the least bit alarmed or surprised by their disappearance.

There was also the bonfire and the cops issue the initial night I drank the tea. We really did have a bonfire (which I was actually locked away from), but at some point I looked out the window and saw three police cars - lights flashing - driving into the bonfire, like they were trying to plow it under. Not realizing that I couldn't get outside if I wanted to, I got all panicked because I had lost my pants and someone needed to deal with the cops. I got downright pissed at my roommate, who also owned the farm, because he refused to go deal with the cops and was getting upset with me for yelling about them.

I later opened the door to the woodburning stove, with the catalytic converter closed. When my roomie woke up to the smoke and closed it, I was turning blue and barely breathing. He had already bungee strapped me to the bed - after that he used duct tape and large zip ties to strap me directly to the futon frame.

The only other time I used Jimson weed, it is mostly unknown what happened, as I accidentally slipped my sitters. I managed to escape through a second story window onto a porch roof, wandering west county St. Louis. I was completely naked when I left - I was wearing a strange sport jacket and shorts, when my friends picked me up about 38 hours later. I know what I thought was happening to me in that time - but no idea what actually happened. I was twenty seven miles away from the house I left, having likely gone through mostly rural, wooded terrain. I was severely dehydrated when my friends got me (I was taken in by a farmer, who allowed me to use his phone when I knocked on his door - I was mostly cognizant, but still seriously fucked up at that point) and suffered extremely nasty flu like symptoms soon after - likely from drinking water that wasn't particularly clean. I was also covered in cuts and bruises, two of the cuts being relatively nasty - though I hadn't lost a dangerous amount of blood.

In both cases, time dilation was also an issue. The first time I experienced roughly four days, in forty-seven hours. The last time, I experienced nearly a week in about eleven hours.

I had most of these experiences under controlled, safe conditions - at least as safe as taking shit that is that toxic can be. I was very aware of what I was doing and had a relatively reasonable idea what sorts of doses would be safe for me. Even with the best controls I or others could work out in place, I nearly died several times** when using plants in the Datura family. This is actually true of several other plants I used - some rather less safely than others. These plants and many other enthogens are, or can be very dangerous.

If you are considering fooling around with Tropane plants, please don't. These aren't something to do for fun and honestly, they aren't "fun" in the context of recreational drug use. If you are looking for fun and feel you must use hallucinogens, you might explore psilocybin mushrooms. Note that I am not encouraging anyone to use any hallucinogen. Having rather extensive experience with great many hallucinogens, I am very familiar with potential problems. Most of the problems with mushrooms or acid tend to occur infrequently. The problem is that some of those potential problems can be quite serious.

I am sure that if you're a U.S. American under the age of forty or so, you probably went through some sort of propagandizing about drugs - maybe you even went through DARE. They probably talked about the horrible things that will happen to you, if you use acid or mushrooms. What they probably didn't explain is that while going nuts isn't inevitable, it is entirely possible. While we don't understand the mechanisms behind a lot of neurological problems, such as schizophrenia or affective mood disorders such as bipolar, we can make some assumptions. One of those assumptions is that however a predisposition (susceptibility to) for such mental problems might occur (biological v. environment), something very likely has to occur to trigger that predisposition before a person actually becomes mentally ill. Hallucinogens are a very plausible trigger - even acid and psilocybin mushrooms.

The other problem, one that is common to all hallucinogens, are the things that can happen to you because you are on something that significantly reduces your control over, and even your perception of reality. It can become much easier for someone to take advantage of you. It is also possible to simply do really stupid, dangerous things. Some of the things that I have personally done on acid or mushrooms include: climbing trees and falling out, riding a bicycle and crashing into parked cars - also nearly getting hit by moving cars, trying to drive once, falling out of what was thankfully a first story window - the possibilities are pretty endless.

It is really easy to assume that it just can't happen to you. It is also generally desirable to think that it won't, because you only want to be special, or different in "good" ways. Unfortunately, there is no way to tell you have the predisposition for certain neurological disorders until you become symptomatic. Given our poor understanding of these problems, it is also possible that acid and mushrooms might cause psychosis in people who don't have a typical predisposition - it may be that there is something else going on in the brain that acid and psilocybin can affect.

A lot of us have a hard time with the nature of statistics and probability. We see something described as being less than ten percent and we want to assume that means it is rare. When we see things described as being less than one percent, we want to assume that means it is nearly impossible for it to happen to us. The problem with that thinking is that while those percentages may be small, it is entirely possible that you or me will be in that one tenth of one percent. After all, even at those odds, it is likely to have happened to someone you were in school with. There were more than three thousand students in my high school, so one tenth of one percent = at least three people I was in school with. One in a thousand means that more than 323 people in the greater Kalamazoo-Portage metro area, where I live, would be affected.

I am not going to pretend that if you use acid or mushrooms, it is extremely likely that something horrible will happen to you - I just want to make you aware of the risks - of the nature of those risks. I don't want you to use these drugs, because I really don't believe the risks involved are worth it. But if you are absolutely bent on using some sort of hallucinogen, I hope that you won't use anything except for acid, psilocyban mushrooms or possibly Salvia. Even then I would strongly recommend that you have someone sober around to help make sure that you are safe, while using hallucinogens. Preferably someone who isn't afraid to get you medical attention should you need it and who is capable of telling whether that is the appropriate response to a given situation.

I would also suggest that if you are going to use any enthogens, that you scroll down my sidebar and check out information about that drug on Erowid and the Lycaeum - MAPS is another good resource. Read about what others have experienced and about the pros and cons of a given substance. But also be very aware that what others experience may not be your experience. And also keep in mind that most of the people who write about their experience are the ones who had a positive experience - or relatively positive experience. People who had a particularly bad experience are far less likely to write about it.

Finally, please keep in mind that there is seriously important neurological development going on until you are somewhere in the range of 22, to 26 years old. The substances you use before that development is complete may have a significant and permanent effect on your brain. Even after that initial development period is over, our brains are still changing and shaping around our experiences and choices. The brain is harder to shape as we get older, but it is still changeable - even permanently so.

* A characteristic of Jimson weed use is extreme dehydration as well as a shut-down of the urinary tract - I got a kidney infection my first time.
** This would be indicative of the sort of behavior I am talking about when it comes to hallucinogens being a serious substance of abuse for me.

Talking to Kids about Substance Use and Abuse: Who and When

After mentioning some very disturbing statistics a couple posts ago, I would like to address ways that discussion might go and when it might be a good time to have it. Contrary to comments on that post, I am not suggesting you have it with the infants. But depending on various risk factors, I would suggest that it is hard to start too early. I have discussed this before and will probably do so again. The big difference between the last time I discussed this and now, is not the content of the discussion but that I now have evidence to support assertions I will make. I am only going to start this now, because I would like to post the paper I just wrote before I go into too much depth and I am waiting until I know it was graded to do that.

I think the first and most important issue to discuss, is that of what it is appropriate to talk about, with whom and when. I will start with who.

There are a remarkable number of parents out there who believe that they don't need to have this discussion with their child, because their child would never dream of using drugs. I am not engaging in hyperbole when I suggest that there are a lot of parents out there who have buried children they thought would never use drugs. While there are factors that elevate the risk that specific children are more likely to engage in substance use at a rather young age, that doesn't mean children who do not have those risk factors are immune. More importantly, there are risk factors you may not be aware your child has.

There are a lot of neurological issues that come up, that you may not be aware your child has. Your child may have friends who use drugs that you aren't aware of - your child might not even be aware of yet. A particular substance may be making the rounds at you child's school - this happens from time to time. A drug becomes particularly prevalent and is available at a very low price. It is there and because so many kids are using it, it becomes vogue to do so. It is also quite possible that your child is not nearly as open with you as you think s/he is. Your child may be something of a social outcast and you don't even know it - and that is a significant risk factor.

More importantly, as I mentioned in my last drug use post, there are substances that transcend normative risk factors. Pharmaceuticals are huge these days and kids don't necessarily have to raid the medicine cabinet at home. With a lot of children on psych meds (most commonly abused, more than a percentage point or two over pain killers) they can just quit taking their pills, save them up and trade some with another kid who has done the same and take some of both - or more, if they let another kids or so join the fun. I will grant that they usually get a little older before they add alcohol to the mix, but this is behavior that more than 5% of children age 12-13 have at least tried. At least 3% of kids in that age range are abusing pharmaceuticals. What the National Survey on Drug use and Health doesn't say, is that a significant percentage of 9-10 year olds are also trying this. By the time they are old enough that they are more likely to use alcohol, the percentage of kids playing with pharmaceuticals is above the 40% mark.

To be totally clear and rather harsh about it, it is critically important that you discuss pharmaceuticals with your kids. The wrong combination can cause serious problems, even death. Throw some alcohol into the mix and there is an even stronger likelihood that you will go to wake up your child, only to find them stiff and cold and very, very dead. I doubt the thought that this child was a very good kid is going to be much comfort at that point. And no, the fact that your child might well engage in really stupid drug use doesn't make them any less a good kid. It just might make them dead though...

The next question, now that I hope we are clear that all kids should have this conversation with their parents, is when. My own attitude is to start young and never stop. Latch onto opportunities as they present themselves. Don't be preachy and don't be too intense or regular with it. When they are very small, just use their own insatiable curiosity. If you are a drinker, tell them about what you are doing. See something on tee vee, use that as a starting point. As they get a little older, make a point of sitting down with them once in a while, specifically to talk about drugs and drug use. When they get towards 11, 12, 13 - ask them about it. Let them guide the conversation. Talk about it a little bit more often, but not too often.

Most importantly, make sure they know that they can ask you anything they want to know about. Make it clear to them that you would be happy to honestly and openly discuss topics that are important to them - sex, drugs, relationships. Encourage them to develop a habit of talking to you about things that are bothering them when they are young, because that will make it infinitely more likely that when they are confronted with choices like using drugs, they will be inclined to talk to you about it. Also keep in mind that the best time to talk about drugs initially, is before they ever start. Don't assume that they will wait to talk to you - make it clear that there are dangers and that they need to understand those dangers. Also, accept that they may come to you and tell you someone offered them something or another - you can ask, but don't push them for a name. Yes, it would be ideal to know - but they aren't going to tell you if they aren't going to tell you and pushing them will be a detriment to the development of that trust.

As they become teens, make sure you have laid the groundwork already. If you have done your part early on, trust them to come to you with questions. Make sure that you have discussed the specifics - the dangers of various substances and the like - I am going to write another post about how those discussions might sound. If they seem to be depressed, ask them how they are feeling - is there anything wrong that they might want to talk about. If not with you, then with someone else that you trust and they trust. It may well be that they aren't going to be as interested or comfortable talking to you at that point - let it go and encourage them to talk to someone who is trustworthy. About the best you can do is to make it clear you are available and open to them.

Whatever you do, do not lie - we will go into this more tomorrow, but this one is important. Never. Never ever lie to them. If they ask you something about your past that you aren't comfortable talking about (assuming it is age appropriate), my first suggestion would be to get over it and just tell them what they want to know. But shy of that, if you aren't willing to answer, then honestly tell them that. Don't tell them you never did something you did - just tell them that you aren't comfortable talking about that.

Unless of course you have or have had a substance use disorder. At that point all bets are off. Your child has a major risk factor and you absolutely have to make that clear to them. Forget about your pride and all that bullshit. Suck it up and spill it, because your child absolutely must know that you have a problem and that because of that, they are far more likely to have similar problems if they engage in drug use. The thing is, you have an almost magical power at your disposal, one that makes it exponentially less likely your child will have this problem. You tell them they have an elevated risk and you tell them why. Do that and it is exponentially less likely that your child will initiate drug use. This applies to most risk factors, but is considerably more poignant when it comes to owning up to your own issues with substance use.

I am not just pushing shit in your general direction, that I am afraid to do myself. I have had myriad substance abuse problems and will be dealing with them until the day I die. My oldest son has a lot of very significant risk factors besides the substance abuse issues of his dad. My youngest will probably not be too far off his brother's risk factors. We have talked about it before and we will continue to talk about it, my soon to be eight year old son and I.

No, it isn't easy. It is just critically necessary, because I love my boys.

Time for that chat with the kids about drugs...

Here are some statistics to scare the crap out of the parents out there. These are statistics for kids between the ages of 12 and 17. The figures come from the 2008 National Survey of Drug Use and Health. If you read nothing else of this post, please read the last couple of paragraphs. And please consider having a talk with your kids about drugs.

Seriously, this is critically important.

More than 60% have tried alcohol.
More than 47% have tries illicit drugs.
4.9% have experienced substance abuse problems with alcohol.
4.6% have experienced substance abuse problems with illicit drugs.
There is only a 1.9% crossover, so a full 7.6% of these kids have experienced substance abuse issues altogether.

In regards to the illicit drug use, there is a lot of crossover.
3.4% = Cannabis, 1.2% (est.) = other traditional illicit drugs.

The more frightening statistic is the abuse of pharmaceuticals, which is becoming one of the most serious youth drug problems today. An estimated 3% have abuse issues with pharmaceuticals. But that is just abuse, the estimates for kids in that age group to have tried/sometimes use pharmaceuticals are more than 40%. In context with other sources I have been reading, this is often in combination with alcohol and almost always includes mixing pharmaceuticals.

It doesn't matter if it is the first time a kid has tried this out. The right combination of pharmaceuticals, or mix of pharmaceuticals and alcohol = a dead kid.

I would also point out that initiation is getting younger and younger. We're talking 10 or 11 years old, sometimes younger. And the younger the child, the more likely it is that they will be trying pharmaceuticals. The other thing that is important about this pharmaceutical problem, is that there is far less correlation with traditional risk factors. Poverty, drug abusing parents and even an expressed distaste for illicit "street" drugs are not nearly as relevant with pharmaceuticals as they are with street drugs and alcohol.

A good time for that talk, would be when you next see your kids. Don't wait until they are preteens or teens - that could well be too late. If you are feeling a bit overwhelmed by the prospect, this is a great resource and I am going to post a longer discussion about this when I actually finish my paper.

The National Survey on Drug Use and Health: finally found it and damn it is scary

Linked in my top post now, in case you wanted to check it out...

I could really use some help from some of my addiction friends. I have tried search string after search string, trying to find the statistics for older children and adolescents (ages 12-17) who have tried illicit drugs, alcohol or tobacco, but who don't or didn't use them. I know that is part of the damned survey, but I cannot find figures anydamnedwhere.

I am not fond of asking for help - but I am not afraid to...Or to give something back for it.

Thanks to a very lovely commenter and dear friend, things are looking much better. If you really would like to help out, please call your local "sliding scale" clinic and ask about donating the funds for helping someone in your community get the prescriptions they need. Because I am far from alone with this problem and I can almost guarantee someone in your community could use the help...

We have run into a rather bad snag in my corner of the world. Overall things are rather sunshine and roses - at least as sunshine and rosy as they can be. But a somewhat nasty - scratch that - a very nasty problem has arisen. There is a need for medication, coupled with a very frightening lack of resources for meds for this month as possibly next. I think that next month is looking more promising and after that it is totally smooth sailing. But this month is most definitely fucked.

I really fucking hate asking for help, but I also dread the idea of school and honestly, life in general, moving backwards instead of forwards. I also want to be very clear that I absolutely do not want to impose on anyone who is in dire straights themselves. I am just hoping that some of you might have something to spare and would be willing to help out. It needn't be much, because I have come to gain a great many friends here on the intertubes and the need isn't that huge - though in relative terms, the cost of a months worth of wellbutrin - even the fucking generic, is rather high (for example, the combined cost of everything I take - sans my wellbutrin, is 1/5th the cost of my monthly scripts).

I also thought it would be fun to turn this into a something of a challenge - I will donate an hour of time, for every ten dollar increment towards the meds. I will grant that I was already intending to do some community volunteering, but I have simply been unable to form a solid plan for that. So if I actually get to my goal, I will commit to *52 hours over the next year, of **maintenance and repair to my local YWCA - who I understand can particularly use the help...

I am trying to figure out the whole fucking paypal thing and will probably leave the damned thing up, once I figure out how to actually get into my existing paypal account and how to post an icon. Until then, please email me if you can and want to help. And as an added bonus, I will be happy to hear what you might want me to write about and try to comply with requests as quickly as possible - which isn't to say it would necessarily happen quickly. I have a semester to finish up and boys coming hard on it's heels and......You get the picture...I am hopeful however, that the next semester will not be quite so brutal. It's a little heavier load, but in a regular, sixteen week semester, rather than this really short one I'm in now...

*above and beyond any other volunteering I am planning for - which admittedly is uncertain right now...

**Or whatever else they need done - as I understand that they also need donation pick-up help as well...

CAM, Anti-Vax loons and the Morons at Merck

I am more than a little pissed after reading this post, which I found through Greg Laden. I am pissed because I have become increasingly involved with fighting non-evidence based medicine, mostly with people around me. I don't really write about it much, though I have begun thinking that I should. I haven't really felt the need to, because there are a lot of great medical bloggers out there who do such a fantastic job of it - several of whom are linked in my sidebar. In particular, Orac, PalMD, Mark Hoofnagle and the great people at Science Based Medicine do one hell of a job tearing down the veneer of crap and exposing it for what it is.

Here's the issue I have. I'm a reasonably intelligent person, a bit above average even. Yet I am also what I like to call, pathologically credulous. I have fallen into remarkable amounts of magical thinking over the years and not because I'm dumb. In fact part of it is because I tend not to assume that something is true, just because everyone else says it is. And my relationship with non-evidence based "medicine" was largely grounded in the idea that evidence based medicine is largely profit based and therefore largely corrupt. What wasn't so apparent to me at the time, was that a lot of the bullshit that I was falling into was just as profit based and much of it was even more corrupt - though much of the corruption was a very different sort. I also fell into a lot of the bullshit because many of the claims were made by people who also made claims that were easily verifiable - they fostered my trust and I believed what they had to say about things that weren't so easily verifiable.

And that is the key to sucking people into so called alternative medicine. Efficacy by association. Throwing plant medicines that actually have some degree of efficacy (largely because many pharmaceuticals are derived from plant sources) into the mix, even though this can actually be quite dangerous in some cases (a whole post of its own sometime). Throwing legitimate medical treatments in, but using them for things they simply aren't called for - such as chelation therapy. It makes it easier to sell people on flat out bullshit. Things like osteopathy, homeopathy and energy medicine - things that are not only not supported by evidence, but which are flat out absurd on their face. Things that are based on nothing more than magical thinking.

It's bad enough that some of these "medicines" can be dangerous in and of themselves - either because the actual treatment is harmful, or more often, because the treatment is used in place of evidence based medicine. But it doesn't stop there. There is a very dark side to this, with insane and deadly notions like HIV/AIDS denialism, denial of the germ theory of disease, the anti-vaccine movement and anti-chemotherapy proponents. People actually die because of this complete and utter bullshit.

Another reason it is easy for some people to fall into magical thinking in regards to medicine, is because of the perception that evidence based medicine is mostly based on therapies developed by corrupt pharmaceutical companies. Most people don't start out believing that, but I think that most people do recognize that pharmaceutical companies and for that matter, medical science in general, is not immune to corruption. And I think that most people recognize that sometimes that corruption includes maliciously covering evidence that companies wish to avoid becoming public. This makes it rather easy for some people to buy the CAM line that critics of CAM and even fringe CAM ideas, are simply shills for Big Pharma - an evil bogyman that's out to addict people to their medicines and cast them aside when they've been poisoned by them. From there it isn't much of a trek to believing that all evidence based medicine is evile and that doctors are merely merchants of death, the death manufactured by Big Pharma.

This is why I am so very angry at Merck and the doctors that contributed to their advertising rag, disguised as a legitimate science journal*. The doctor involved should should face sanctions. And Merck should be fined heavily by the FDA. Things that would happen, if we lived in a reasonable world, in a reasonable country with reasonable oversight. There is something very wrong with a system where this can happen and the people involved don't even understand that they did something wrong. This is absolutely and categorically disgusting and unconscionable.

But the idea that this somehow validates the proponents of woo, the peddlers of magical thinking in the guise of medicine, is a logical fallacy and a rather obvious one - if not also one that is easy to accept. Just because another pharmaceutical company and some doctors were really damned stupid and highly unethical, does not mean that all of science based medicine is. And there are several doctors and scientists out there who would like to make sure you know that this is not the mainstream of science based medicine. Some of them have even written about this....


Respectful Insolence

Adventures in Ethics and Science


Dr. Isis

Stranger Fruit

Greg Laden

*I would also note that I am more disappointed in Elsevier for publishing this bullshit, than I am with Merck and the people involved from their end. That they would choose to put out this kind of garbage reflects poorly on them and while it may be a while yet before I am publishing papers, this will certainly reflect on my decisions about where to publish.

Wherein DuWayne Rants About the #$@&ing Drug Laws

Before I start, I would really like to recommend that you take a listen to Gabriela Montero. I recently discovered her whilst listening to one of my Pandora stations and her playing made me weep for the beauty and the passion with which she throws herself into her variations and compositions. Gabriela is a wholly remarkable pianist, a child prodigy who has matured into brilliant and nuanced composer. And she is also great stress relief...

I have had a not so grand day today. It started well enough, though not as productively as I might have wished. And I had a fantastic visit with the doctor, where we discussed my meds and how the new regimen has been working out. We decided to double my dose of Wellbutrin, from 100mg in the morning to 100mg in the morning and another at lunch (something I was going to do a couple weeks ago, but chose to wait because he wanted to see me to add the extra dose). I was actually feeling pretty damned good when I left the doctor's office - almost three and I had only smoked two cigarettes all day.

How quickly things can change. Today I discovered just how fragile a thing, this thing that is my calm and collect self.

More...

The fucking war on drugs put me on the verge of a nervous fucking breakdown today. Though I was heading that way when I went to get my scripts filled in the first place.

My fucking Wellbutrin costs eighty-six fucking dollars as a fucking generic. Eighty-six dollars!!! And the version I am taking is not available much cheaper anywhere - including mail order. I very nearly started crying in the fucking store when they told me that. I'm working on getting help with my scripts through the state, but the wheels turn slowly. My folks are helping out some, but that just stresses me out more, because I don't want to be a fucking burden on them at thirty-two years old. I was frustrated and angry and decided to hold off on that one to see if I could find to cheaper elsewhere, or if there might be another option for finding Bupropion for less, but in the same dose as I've been taking.

No such luck, this time around.

So I decide to get it filled and owe my parents even more. Fucking yeah for me!!! I headed back to Wal-Mart and handed the women at the window the script, having completely forgotten that I had been told earlier (when I dropped off the others) that they were out of that one anyways. The women at the window punched it all into the computer and told me it would be about twenty minutes, so I sat down to wait. After about half an hour, the women who had originally taken my scripts came out to remind me that they were out of that particular dosage of Wellbutrin. Mind you, the women who had taken the script had seen me sitting there several times, while helping other fucking customers - never once occurred to her to let me know that I couldn't get my fucking drug. Nor did they consider just fucking calling me to tell me - if they hadn't noticed (they are usually really good about calling for stuff like that and they weren't very busy).

What the fuck does this have to do with the war in drugs, you ask?

I had a check with me, written for the total cost of all three of my scripts. And even though another Wal-Mart has the Welbutrin, I couldn't pay for it at the one I was in. So I had to transfer the other two to the other fucking pharmacy as well. The only problem being that Clonidine and Ritalin are controlled fucking substances and they can't be called in. They can't be faxed over and apparently, they can't even get them ready in anticipation of the fucking paper script being brought in. Nor can they be refilled - every month, my doctor has to write another script for me.

Of course I had wasted nearly half an hour sitting in fucking Wal-Mart before I became aware that I would have to go to another store - about half an hour across town. And not only would I have to run over there to get them, I would have to fucking wait there while they filled my other two scripts - because we have the most ridiculous fucking drug laws ever. Mind you, it was close to dinner time and a friend of mine was joining us. I was about fifteen minutes late when it was all over with. (Though I did get a text from the most beautiful and brilliant women in the world, who just seems to know when a text from her is going to take the edge off of stressful situations - thanks Juniper)

My problems today and with getting more than thirty days worth of my meds at a time, are far from the only egregious intrusion that our draconian drug laws have thrust into medicine. Because of course, there is also the war on pain management to be considered. You know, the war in which not only patients who doctor shop and fraudulently acquire multiple scripts for the same pain killers (often times to sell them) got to jail, but even doctors who appear to be over prescribing and patients who are engaged in a good faith pain management regimen with their (only) prescribing doctor.

I am so fucking tired of this paternalistic fucking bullshit! This has gotten beyond fucking ridiculous - went beyond that point fucking years ago. The war on drugs interferes with the ability of doctors to care for patients, therapists to freely help drug addicts and substance abusers and patients to have reasonably simple and rather less costly access to their medications.

Fuck You drug warriors - Every MotherFucking One of You!!!

I got my E-Cigarette!!! - Calling For Smokers Ex and those who want to be be Ex...

Addendum - I am looking for contributors - I am setting up a quitters blog, see below. No longer considering it - doing it. Email me or leave a comment.

And it's up over here - please leave a comment there or email me if you are interested in contributing...

Just came in this afternoon, while I was at school and it rocks. It will take some getting used to, but I think this is definitely going to make a huge difference in my run to quit smoking.

And while I'm on the topic, a visit from one of my favorite commenters at Dispatches, Abby Normal, got me thinking. Abby posted a really kick-ass comment, describing his experience with quitting smoking. Would there be any interest from my ex-smoking readers, as well as those who are trying to or who are planning on quitting, in a blog project for you (and me) to post about our experience? I would love to throw up another blog around here and allow you all to post - with team posting privileges for those who want them.

I would also be really happy to add medical, sciencey types and addiction counselors to the mix, should they wish to contribute posts as well.

I think that this could be of immense benefit to all of us, especially those of us who are still smoking. If there is interest and it works out, I would love to add blogs for other addiction issues - or possibly a forum. Though if the latter was developed, it would require volunteers to moderate. And keep in mind that I really can't devote much time to making this go, which is partly why I would just prefer to give those who want it, team posting privileges. This would not be something to abuse and there would have to be some rules - number one being to keep it topical. But I think this could be pretty rocking big fun, as well as built in support for us quitters.

Please let me know what you think.

And actually, I should also note that though I've gotten out of the habit since I resurrected this blog, I am all about having guest posters. I will be somewhat selective about what I post and will admit that my reasons may be pretty arbitrary, but I am all about hearing from you, if you want to post. I do recommend that you ask me before you write the post, so you don't end up writing something that I don't really want - but I really do like the idea of getting some other voices up around here and outside of comments. Finally, please don't assume that because you disagree with me on something, that I won't be willing to post your views - there are some things that I just won't, but that is not a common restriction for me.

Addiction, Neurological Issues, Satan and the Framing Wars

I am keeping this top posted for the moment, as I have a couple of comments out that refer to it - please check out more recent posts below.

A couple of quick additions. First, I want to let those who care know that the new meds seem to be coming together for me. It's still a little early to tell, but switching off the Seroquel was definitely a positive and I do feel better overall. Second, a friend who is familiar with the coffee shop and it's denizens - as well as me, thought it likely that the scowls I got from those around us, were probably as much because of the slam on Bill. She also mentioned that they were probably already scowling at me, I just didn't notice. There are usually a few AA folks there and I do tend to discuss addiction quite a bit. So a lot of the regulars know that while I'm not as harsh as some folks on AA, I am highly critical.

I would just like to provide an example of why I have, the position I have, on a discussion over at Greg Laden's blog and on what amounts to a three year discussion about framing science and it's intersection with religion. This is something that keeps flaring up and always perks my interest, because one, I've been involved for about three years (give or take several months) and two, my position on it has changed considerably for several reasons.

Taxing my google skills to their max and beyond (learned a couple things doing this), I have managed to find one of the earliest posts on this discussion, by none other than my own brother Ed, over at Dispatches. If you're a glutton for punishment, you can wade through some of the comments and check out my contribution, which is a far different position than I express today. And one of the contributors to the evolution of my stance and shedding of my Faith, has been this very discussion. It was my intent to actually dig through and find a couple of my comments, but after the time and effort it took just finding these posts, I haven't the will. Please keep in mind that this isn't actually the first post, nor was this the only one at the time. There were at least a couple dozen other bloggers who weighed in on that particular flame war, several with more than one post.

On and off, this discussion has continued over the last couple of years, most often fomented by a Matt Nisbett who blogs at the Seed sciblog collective. I'll link to one of his more recent examples of foolishness, though to be honest, I dislike Matt enough and suspect his motivations to the point that I am hesitant to actually link him. Back around thanksgiving last, he posted this bullshit, wherein he explains to us ignorant gits, that calling people who deny certain fundamentals, such as evolution, the importance of vaccines, or, in the context of this very post, basic neuropsychology denialists, is a bad, bad thing. Several of my favorite bloggers had a lot to say about that. Matt has also given out several other fuckyouverymuch's, like this gem. And I don't know why it didn't occur to me before, but Bora, the sciblogger aggregator has this passel of links from days gone by. (Bora totally rocks, btw...)

Hell of a build-up, to a rather short example - but this is why I am not going to shut up and play nice. (also note that this was my first day off Seroquel and on the new drugs)
More...
I was in the coffee shop the other day, when I chanced into a conversation with an absolute Uber-Faithful nutter. A bible and Big Book thumping True Believer. I was discussing addiction and harm reduction, with a casual coffeehouse friend, when TB decided to jump into the conversation. I had just finished explaining my own experience with addiction, (yes, I actually talk some about the things discussed in the last link on occasion, though honestly I don't remember whether I did in this conversation) when TB busted in with; "You're going to school to study Addiction! You think you're managing your addictions?! You're either nuts or stupid!!!" He wasn't actually that loud, but he was nearly hysterical by the time he got to the last bit, at which point he decided to sit down at our table - to his credit, he does know Casual Friend.

The money quote, my response to which sent him away horribly offended, ranting under his breath:

You are never going to actually deal with your addictions or get to the root of your supposed "neurological issues" until you accept Jesus back into you heart and accept the truth. Mental illness is bullshit. It's nothing more than Satan convincing you that instead of drinking and getting high, you can take these other drugs. Man is not going to help you get through your problems, therapy isn't going to solve anything, unless it's Christ centered therapy. Satan has control of you man and you need to fight him - drugs aren't going to fight Satan! Only Christ and the power of prayer can get you through this!!

Then he put his hand on my shoulder and actually asked me if he could pray with me. Seriously.

"Get your fucking hand off me, you fucking nutter! Take your Faith in Christ and your Faith in Bill and your Faith in Satan and shove it up your ass, you denialist fucking loon! Fairytales have nothing to do with what's going on in my head jackass, it's fucking neurochemistry - the way my fucking brain works!"

"You're addicted to drugs and addicted to Satan!"

"I'm a fucking atheist you fucking moron!!!"

And yes, I was more or less fucking hysterical by this point - seriously fucking pissed. Pissed enough that I shouted rather loudly, in the middle of a coffee shop in the midwest, that I'm an atheist. And I'm really only an atheist in the broadest sense of the word, deist is far more accurate a label. But I was pretty sure he wouldn't have a clue what that meant, and as I said, I was borderline hysterical - which side of said border, it's hard to say. My rather loud admission garnered me a few scowls. On the other hand, when next I went for a refill, my friendly barista mentioned that a gent over yonder had covered my next cup - when I looked over, he smiled at me and shortly after wandered over to our table.

Now I need to explain that there was about half an hour, forty-five minutes of discussion before TB and I got into our shouting match. It had mostly been a reasonable discussion, with TB mostly just listening. When he started into the above long quote (not quite a perfect reproduction, but very close - the last one was his exact words), it was like he just couldn't take it anymore and had to respond to a lot that had been said. I avoided saying anything at all about AA while he was sitting there, but I did talk about harm reduction and started touching on linguistics - he really took exception to the idea that anyone can be considered successful in treating their addiction, if they aren't entirely abstinent from all psychoactive substances - including psychiatric drugs.

After he had left, Casual Friend explained that TB regularly relapses, carries a great deal of guilt and seems to be increasingly unhinged about it all. Mind you TB's relapses aren't multi-week, or even multi-day binges in which he gets totally hammered and blacks out. Every several months, he apparently breaks down and has a couple of beers before he can stop himself.

I also want to explain that I grew up with TB's same sort of bullshit, though not quite as extreme. My mom firmly believed that my "problems" growing up, were the result of demonic activity - probably passed down from my biological father. While she has come to accept some of the ideas of neuropsychology, she still believes that many of my problems are influenced by demons - at least she accepts that the drugs are probably a very good idea (Yes CPP, I will get to discussing my cognitive therapy soon). By default, I also believed that sort of bullshit and it was nothing but trouble for me, until I got over it and accepted who I am and how my brain functions.

The thing is, while TB is an extremist, fringe fucking loon, my mom isn't. Her beliefs aren't really outside the fundamentalist mainstream on this - indeed she's rather comparatively tame these days. I am not trying to claim that all, or even most Christians attribute mental illness to demonic possession or activity, but a great many fundamentalists do. They'll accept the occasional need for medication, grudgingly, but many of them have serious issues with members of the flock seeing secular therapists instead of Christ focused counseling and prayer. And I have been to talk with several pastors in that context - it's truly insane what these folks are legally allowed to get away with in the name of religion.

Just in this, my small corner of the conflict between Faith and reason, the stakes are high and the battle is tough. Those fundamentalist positions, watered down to the moderate baseline are still quite often an uphill battle. Instead of the extreme, anti-science - blame it on Satan approach, it is merely a distrust of science that conflicts with dogma. And no matter how much you water it down, there is still conflict between science and dogma. Because unless that dogma makes absolutely no claims about it's god's influence on the natural world, there is either conflict or a god that does virtually nothing at all.

I am not militant. I'm not even really much of an atheist, I rather tend to think it likely that there is some sort of physical/spiritual duality to living beings. I no longer Believe it, but I certainly wouldn't be surprised if someday we discover that this is indeed the case. When people decide that they want their god to bless me, I just smile and nod. When they ask me if it's ok to pray for me, I politely tell them that I don't think it makes a lick of difference, but it doesn't bother me. But when people want to make claims about Faith, that conflict with reality, I am not just going to smile and nod - I will respond to it. And if they are going to insist on fucking idiot notions like those of TB, I may well get fucking rude about it. If they are going to insult me with their presumptions about the nature of my shedding my Faith, I am probably going to get pissed if they insist on keeping up with it, after I've made my position clear. (Though as a general rule, I don't tend to get hysterical - that was more the headspace I was in already, than anything TB said)

And if you want to tell me that my doing this is a bad thing, that I need to change my language or shut up and let others talk about it, you can go fuck yourself.

Seriously.

Reading What isn't there - Figuratively and Literally

I should mention that I actually got the material I was looking for, thanks Becca.....

Before I go very far, I am hoping for some help. I really need an article out of a journal that is not part of the databases I have access to. Because I am uncertain I will actually want to use it, I don't want to buy it. So if you have access to the journal Psychology of Men and Masculinity I would really appreciate it if you would email me. If I actually end up using the article I am looking for, I don't mind buying it. But if I'm not, I'd rather not spend the money.

So I stuck foot in mouth a bit yesterday. Being in a strange state of focus lately, I rather read an awful lot into some comments at Greg Laden's blog. What annoys me about this is not the embarrassment of having to admit to my mistake and apologize. Being rather egotistical, I appreciate having the opportunity to be humbled. I am annoyed, because I just don't do this - reading in things that are not actually there. I get really irritated when people do it to me, being one who tends to mean very specifically what I actually say.

I much prefer to have to admit I was wrong about something, because someone else convinces me that my reasoning was flawed or my evidence is wrong. I really hate admitting I was wrong, because I jumped to conclusions by inference. The fact that most of the time the conclusions are correct, does not make it any less obnoxious or sloppy.

Having been somewhat focused on this line of thinking, I realized that I have been guilty of this a lot lately. While this is the first time it's really come to bite me, I am doing a lot of reflecting on how I have developed this habit. Stress is at least a part of it, but I tend to think that there is something more going on that I need to delve into. This is not the only "not DuWayne" issue that has arisen in the last few months.

The problem with this is there are so many factors involved, that it's really hard to differentiate and sort through it all. And it is really important that I sort through a lot of it, because I am finally trying to really deal with the negative aspects of my neurological make-up. It is critically important to me that I maintain the best balance possible between functionality and retaining who I am. But at the same time it has become increasingly apparent that my neurochemistry needs more help than Ritalin and the occasional Xanax are providing now.

Going much beyond the minimal constrictions of my current regimen really scares me. It hurts like hell to be me, quite a lot of the time. It's hard sometimes to sort through the constant barrage of ideas, words and music that inundate my mind. It's frustrating to get sent on tangents that distract from what I am trying to accomplish at a given moment. But it's me. It's who I am, what I am. I don't know how to be not me.

But I also don't know how to be me and succeed in the ways that I must.

Kerlikowske: Is Heading the Director of Drug Control Policy Position Appropriate?

While Gil's not without his faults, I have to say that overall I've come to rather like Kerlikowske, the more I read about him. We'll start with some of the bad, to get it out of the way, then we'll get into the good. But ultimately, I have to conclude that Drug Czar isn't the right position for him.

In 2001 Kerlikowske made some errors in judgment that led to one death and several injuries, some critical during a Mardi Gras celebration. He did not take decisive action and allowed his second to order officers to pull back when the celebration started getting violent. However, Kerlikowske also accepted full responsibility for what happened and admitted that mistakes were made. Small comfort for those injured and the family of the young man who died, but at the same time decisions made in the heat of the moment are not always the right ones.

Kerlikowske also has a record for supporting fairly extreme gun control measures, something that I tend to have mixed feelings about. While I certainly see some gun control laws as critically important to public safety, I also believe very strongly in the right to own and in many cases carry firearms. Some of the discussion surrounding Kerlikowske's position on gun control has made me a bit uncomfortable. This is especially ironic, given that in 2004 he left his own weapon under the seat of his car while shopping with his wife - which ended up being stolen from the car.

There are a lot of other tidbits that do paint Gil in an unfavorable light, but ultimately I don't think you're going to find an effective chief of police anywhere that doesn't create a fair amount of controversy. And to counter the negatives, Kerlikowske has some very positive marks.

Gil Kerlikowske has a solid record for effectively supporting harm reducing public health measures. He changed the policy of having police officers watching needle exchange sites, a practice that previous to his administration was a matter of policy. He also instituted a policy of making misdemeanor cannabis arrests a low priority, even before I-75 passed in Seattle, a ballot measure reflecting the voting public's support for that policy. Seattle journalist Dominic Holden lays it out clearly (link above):

The bigger issue—and safer issue, politically—is replacing enforcement with public services. On that issue Kerlkowske has incubated a revolution. Seattle implemented two programs that get drug users off the street before they get arrested. Most notably, the Get Off The Streets (GOTS) program hatched in the Central District when Lieutenant John Hayes (now a captain) set up a table as an arrest-free area that people with criminal warrants could visit for health and human services.

“That was, at that time, a very edgy approach, and the chief was willing to let one of his people staff the program,” says City Council Member Nick Licata, who soon seized on the idea, passing legislation to fund the project permanently. “It was a stage where Gil could have stopped it from [getting funding], but he allowed it go forward,” he says.

I also really like Kerlikoswke because I am a very strong advocate for community policing, which he is as well. Under the Clinton administration he was director of the Office of Community Oriented Policing Services of the DOJ. During this time he developed a strong working relationship with then Deputy AG Eric Holder, now Obama's AG. He has fostered solid, positive community policing strategies in every police department he's worked in.

That pretty well defines my support for Kerlikowske. While he certainly doesn't support legalization, no one who does is going to get this slot. But Kerlikowske is a strong advocate for harm reductionist drug policies and seems to have a record for listening to the science and basing his decisions on evidence. But there are two very good reasons why I think Gil's the wrong choice for Director of Drug Control Policy.

First, he's a cop, not a public health expert. While I think his respect from law enforcement leadership across the U.S. is a major advantage, I still believe that having a public health expert in the field of illicit drugs would be a much better direction to go. Doing so would show a firm commitment on Obama's part that his desire to shift the focus of drug policy to public health is absolute. Appointing a police officer to the position, even one with a solid record on public health sends a very mixed message.

But most importantly, I think that Kerlikowske would be far more valuable in a law enforcement position that is in desperate need of new leadership. The DEA is in dire need of leadership that will reflect the priorities of the Obama administration. And there are several reasons why Kerlikowske would be a excellent choice for the role, not the least being - he has an interest in the position.

The respect he commands from the law enforcement community would be just as useful in the head slot at DEA, as it would as DDCP. This is an agency that often works in cooperation with local law enforcement, having a leader who is well respected by cops across the country would go a long way towards smoothing the often rocky relationships between federal and local law enforcement officers.

Kerlikoswke has a solid relationship with AG Holder. I have no doubt that he would also develop a fine relationship with the public health expert who should get the DDCP position, which in turn would help develop reasonable priorities for the DEA. But most importantly, Gil Kerlikowske has a solid record as a law enforcement leader. While he has listened closely to the communities he's worked in and public health experts, he is not a policy maker. He's a policy enforcer and top notch leader.

I suspect that Kerlikowske will make a fine DDCP. I definitely think his appointment signals a serious commitment on Obama's part to the shift of focus in drug policy. But I feel very strongly that Kerlikowske's skills would be far more valuable, focused on enforcement instead of policy.

Addiction: A New Paradigm

This is my first addiction paper. Unfortunately I got too distracted in the middle of writing it and had a rather awkward change of focus. While it will work for the assignment, I am less than pleased with the results. I will try to amend it when time and opportunity allow. Here is a link to the annotated bibliography.

I should mention that any comments and criticisms are quite welcome, especially those that are constructive in nature. I know that some of the folks who come by are quite well versed in psychology and addiction. Please don't hesitate to point out errors, either factual or implied. And of course I welcome criticism of the writing itself.

Substance abuse and addictions cost American taxpayers more than $500 billion a year (NIDA). And more than sixty-five percent of Americans are affected by substance abuse issues, either directly as an addict, or because they are close to someone with substance abuse issues (Riskind). Yet twelve step programs, the dominant method for treating addictions in the U.S. has proven itself woefully inadequate at reducing the harms associated with addictions. Only a very small percentage of addicts and substance abusers who utilize twelve step therapies manage to get control over their addictions, and the percentages associated with cognitive-behavioral approaches are equally dismal. Society is in desperate need for a new addiction paradigm, a paradigm that addresses not only treatment, but our very perception of addiction and successful addiction management.

According to the American Psychology Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), addiction is defined as "impaired control over drug use” (APA). The NIH's MedlinePlus medical dictionary defines addiction as "...compulsive physiological need for and use of a habit-forming substance..."(Merriam-Webster), while the MedlinePlus encyclopedia claims that "A physical dependence on a substance (needing the drug to function) is not always part of the definition of addiction”(NIH & USNLM) Stedman's Medical Dictionary defines addiction thus; "Habitual psychological and physiological dependence on a substance or practice beyond one's voluntary control”(Houghton Mifflin).

While the aforementioned definitions may seem to be quite similar, there are important differences. The distinction between overt chemical dependence and the underlying psychological dependence is particularly critical. It's also a major point of contention for those involved in addiction science. Another critical point of contention is whether or not non-substance addictions are addictions at all. Language largely defines reality and in regards to addiction it fails us in the most fundamental context: addiction science. It's no wonder that many of the people who work with addicts and substance abusers tend to eschew the word “addiction.” Lacking a coherent, cohesive clinical definition, addiction has become a very loaded term, even in the realm of hard science.

In Over the Influence Dr. Denning et al. express concern that “addiction” is often used too loosely “and does not speak to the user's relationship with a drug” (Denning 141). Instead the authors prefer to restrict “addiction” to the very top of a definitive spectrum that describes specific characteristics of the different relationships that people have with drugs. Moreover, the authors prefer to use the word “chaos” to define that point on the spectrum (Denning 28-30). While their desire to eschew the using the word addiction and it's related connotations is understandable, doing so ignores the broader social perception of what “addiction” means. And there is nothing to prevent describing the important distinctions between the different sorts of relationships people have with drugs, within a broader contextual framework of “addiction.”

The generalized social perception of what “addiction” means is in parts more simplistic and more complex than the confusion surrounding it in the clinically-oriented definitions presented above. Outside the hard science and clinical frameworks, context becomes even more important when discussing “addiction.” From the myriad pop songs that describe a romantic relationship as “addiction” to describing a homeless drunk who exists in a perpetual stupor, the connotations of “addiction” range from something warm and loving to something very dark and ugly. While on it's face it might appear that the use of “addiction” in the context of a romantic relationship or other ambivalent/benevolent contexts is irrelevant to the discussion at hand, it cannot be ignored. Again, language largely defines reality. More clearly our use of language largely defines reality. So like it or not, in the broader social context, ambivalent/benevolent behaviors are an important aspect of the discussion of “addiction.”

When Denning et al. shy away from the negative implications of “addiction,” they are also shying away from the positive connotations. While those connotations aren't part of any clinical framework of “addiction,” they are an important part of the broader social connotations. There is no reason not to take advantage of these implications in a clinical setting and many ways it could be used to effectively help people who are significantly hampered by substance abuse or other negative “addictive” behaviors. Words, with their implications, hidden meanings and quiet connotations are incredibly powerful tools. We should never be afraid to explore the possibilities that these tools have to offer. Especially when we are working with the intricacies of the human mind. There is no reason, when discussing addictions in a clinical setting, to ignore the less negative connotations of addiction. When someone comes forward with concerns about their substance use issues or other negative addictive behaviors, “addiction” is in the room, whether the therapist wants it to be or not. Instead of trying to change their language, it would be much easier to work on the association they have with the language they're thinking in.

In The Heart of Addiction, Lance Dodes, MD doesn't shy away from it. He takes a very broad approach that strikes to the core:

Addictions have been segregated as though they are different from other human problems, as though they required a unique approach (as in Alcoholics Anonymous), and as though they could not be understood as emotional issues by either the people treating them or the people suffering with them. But if addictions and compulsions are basically the same, psychologically, there can be no reason to think of or treat them differently. Like compulsions, addictions are...in the mainstream of the human condition (Dodes 185).

And this is why it is so very important to embrace the use of the term “addiction.” Not so addicts can cower in fear, in the hopelessness of their ability to ever manage their addictions, as the dominant approach to addiction treatment would have them do. Nor so they can exist apart from society, as some are wont to do. We should embrace the term “addiction” because we are human and addictions are very much a part of the human condition. Not just the negatives either, by embracing the language of “addiction” we are embracing it in all of it's glory, the good, the bad and everything in between. By embracing the language of “addiction” we are embracing the humanity of the addict and facing head on the problems of the addict's addictions. By embracing the language of addiction, addiction becomes less scary – less insurmountable, because we come to understand that addictions, like every other aspect of the human condition, aren't inherently good or bad, it's the expression that defines its positives/negatives.

Unfortunately, many of the expressions of addiction are quite negative and destructive. Substance abuse alone really is a mainstream human condition, all in itself. As NIDA tells us, it costs more than five-hundred billion dollars a year (NIDA). And as the survey posted by Faces and Voices for Recovery points out, addictions affect more than sixty-three percent of Americans (Riskind). Addressing the definitions of addiction only gets us so far, while definition is important, we also need to address the approaches of addiction treatment. There are three basic approaches to addiction treatment, which I will discuss in the order of their prevalence in practice. But it is important to understand that when dealing with addictions, there is no “one size fits all” approach. While I am going to be rather critical of the most prevalent, twelve step programs, it's important to keep in mind that for some addicts, the twelve steps not only work, but are critical – in many cases a lifesaving approach. The problem is not with the twelve step programs, it's with the broad assumptions that go with them.

The twelve steps to recovery are based on the disease model of addiction. The disease model of addiction is rather controversial, with notables in the field, such as Dr. Stanton Peele and the authors of Over the Influence, Denning et al., disputing its validity altogether. But a lot of research suggests a fairly definite link between alcoholism and genetics and there is a growing body if evidence to suggest a link between dopamine deficits and substance abuse. At the same time it's pretty clear that not all addictions are founded in that disease model and even those that are, don't necessarily fit into a single treatment approach. The Narcotics Anonymous: Basic Text typifies the basic assumptions that dominate the social and political addiction paradigm.

We realize that we are never cured, and that we carry the disease within us for the rest of our lives. We have a disease, but we do recover. Each day we are given another chance. We are convinced that there is only one way for us to live, and that is the NA way.(NA International 8)

Over time some addicts lost contact with other recovering addicts and eventually returned to active addiction. They forgot that it is really the first drug that starts the deadly cycle all over again. They tried to control it, to use in moderation, or to use just certain drugs. None of these

control methods work for addicts. (NA Inernational 78)

The problem with this, is that it presupposes that any addict who doesn't follow the NA or some other twelve step program, is doomed to a life of addictions. It also presupposes that it doesn't matter if someone alters their drug use to be less harmful. Any use is considered failure and any other method of treatment for addictions cannot possibly succeed. This is patently false and the repercussions of this position resonate throughout our society to the detriment of the vast majority of addicts.

This position has a huge influence on public policy in the U.S., including the sentencing guidelines for a variety of civil and criminal offenses. From drunk driving, to simple possession of an illicit drug, hundreds of people are sentenced to twelve step drug treatment programs every day in the U.S. Many of these people aren't addicts at all. Others are simply not going to successfully respond to twelve step treatment plans. In spite of several studies, including studies in which AA and NA were involved with (AA 12), showing that coercion into twelve step programs is ineffective and possibly counterintuitive, the principle that only the twelve steps can successfully treat addictions provides the momentum to keep such policies alive.

This position also has a detrimental effect on the perception of society as a whole. First off, it provides many addicts with an excuse not to try anything. They believe that because the twelve steps failed them, they should just give up – or that because they know they can't quit everything they won't bother trying to quit using the substances that are causing them the most harm. Second, it creates a perception in our society, that more people have addiction problems than really do. It convinces parents and friends, that because an individual has had substance abuse issues in the past, that any use on their part is a “relapse,” which can lead to alienation. And finally, this view segregates addicts from the rest of society. It says that addicts are somehow different from everyone else, that we're somehow damaged, weak or otherwise unfit.

With those criticisms in mind, it is also important to remember that AA, NA and other twelve step programs do seem to work for some people. Just because they don't work for everyone, there is no reason to assume they don't work at all. There are a great many people alive today, who attribute their survival to the twelve step approach to addiction recovery. And for some addicts total abstinence from all psychoactive substances is an absolute necessity. While the assumption made by many proponents of the twelve step philosophy, that the only treatment for addictions are the twelve steps is absolutely wrong, it is equally erroneous to assume that this makes the twelve steps a categorical failure. Indeed, quite often the twelve step approach is combined with the second most prevalent approach to addiction treatment, cognitive-behavioral therapy.

The most common cognitive-behavioral (C-B) approach is really quite simple. The premise is to change the way that an addict thinks of their addictions. The goal is to empower the addict, help them think in terms of strength and success. To move them away from hopeless, defeatist thought processes (Kadden et al). It is rarely, if ever a stand-alone therapy. It is a part of almost all in-patient addiction treatment programs. Indeed, it is rarely engaged outside the context of in-patient or aggressive out-patient treatment programs. While engaged in C-B therapy, the addict will usually meet with their therapist several times a week, sometimes daily for the initial few weeks of treatment. As treatment progresses, the patient will meet with the therapist less often. Usually they will be down to one session a week with their therapist after ten to fifteen weeks. Sometimes they will stop meeting with their therapist altogether at this point (Barry ch4).

A less common form of C-B is meeting with a therapist in a more traditional psychotherapy setting. Dr. Dodes. author of The Heart of Addiction, engages is therapy in a similar manner. The idea is to redirect the thinking and actions of the addict (Dodes). Really, this form of therapy has existed for as long as we've had psychotherapy, though the individual tactics have changed considerably over the years. One of the advantages to this method is that therapy is tailored to the addict and the addict has the advantage of a trained therapist who can help him or her make decisions about treatment beyond the C-B therapy sessions. Quite often, this form of therapy forms the core of harm reduction approaches to treating addictions.

The harm reduction approach to addiction treatment is firmly entrenched in the idea that there is no and never will be a “one size fits all” approach. As Patt Denning, Phd puts it in Over the Influence, “The harm reduction way of understanding drug use and abuse takes into account the complexity of each person's relationship with drugs” (Denning 8). That's right, everyone who uses drugs has a “relationship” with the drug or drugs they use. Moreover, people who engage in any addictive behavior have a specific relationship with that behavior that is central to their addiction. This recognition that there is a relationship involved and that said relationship is unique to the person experiencing it, is the key advantage that harm reduction therapy has over other, singular methods of addiction treatment.

By understanding that everyone has their own relationship with drugs, harm reduction can help addicts find approaches that will work for them. The harm reduction approach recognizes that not everyone will be abstinent from all psychoactive substances or even the substance that is the object of their addiction. Harm reduction doesn't gauge success by arbitrary standards. Success is gaged by reducing the harm of the addictive behaviors. The harm reduction approach recognizes that success may be an ongoing process of gradual reduction of harm. But most importantly, the harm reduction approach recognizes that success is entirely relative to the addicts relationship to their drugs or other addictive behavior.

Another powerful advantage to recognizing that people have relationships with drugs and their addictive behaviors, is possibly the most powerful. “Relationships change” (Denning 28). Our relationships are always changing, always evolving – no matter the relationship being discussed. As they grow and change, my relationship with my children changes. I'm confident that it will continue to do so well into their adulthood, because my relationship with my own parents has been ever changing. Change is very much the nature of relationships.

But while the harm reduction approach sounds and ultimately is pretty remarkable, many practitioners of the harm reduction approach have a very singular view just the same. As was shown in our exploration of the definitions of addiction, many harm reduction practitioners are uncomfortable using the word addiction. In part, because they are uncomfortable with the disease model of addictions as a whole. And this is ultimately to the detriment of the addicts who come along, who would be best served by a twelve step program. Just like the dominating twelve step approach that claims that nothing else can work, many harm reduction practitioners would exclude ideas outside their purview. And even Dr. Dodes, who seems very open to many different approaches isn't immune to the language of exclusion. While he really does have a rather revolutionary approach to viewing addiction and avoids couching his terms in outright absolutes, it's clear that he has a very strong preference for his analytical approach.

It is time for us to chart a new course for dealing with addictions in our society and at the very top of the list is a driving need to get over our petty turf wars. You saw the figures in the introduction to this paper. We aren't running out of addicts any time soon, there are more than enough to go around. Unfortunately all too few of them are getting any help at all. While this is largely due to the exclusivity of the dominant paradigm, it is also due to the claims by various elements that they have the method to help the addict with their addictions. What the message to addicts should be, is that one way or another, there is a way to help them reduce the harm caused by and ultimately overcome their addiction. That if one approach doesn't work, there are other options available.

Beyond that, we need to fundamentally change our perception of addictions. Addiction is a mainstream, even a fundamental aspect of the human condition. Humans are creatures of habits and compulsions. When taken out of the context of negative, harmful behaviors, “addiction” takes on a great many connotations that range from benign to outright positive. While searching for a coherent clinical definition for addiction, it was hard not to notice that there are probably hundreds of pop songs with addiction in the title or as the title. People talk about their addictions to books, walks in the park, hiking, spending time with their kids, community service – the list is endless. And there isn't a single thing in that list that couldn't be taken to a unhealthy, negative extreme. There are few, if any humans who can truly claim to have never manifested some sort of addictive behavior that was taken to an unhealthy extreme.

Yet as a society, we feel justified in segregating the “addicts” into a special group. And “addicts” are just as guilty of anyone else in perpetuating this tendency. Because people want to believe that there are addicts and there are “addicts.” It's easier that way. Segregative labeling is also, quite unfortunately in the mainstream of the human condition.

There are a great many things that would make a major difference in helping people reduce the harm of their addictions. Policy changes, such as legalizing, regulating and taxing currently illicit drugs, for example, would make it much easier for people with serious addictions to get help, while removing a lot of people who don't have addiction issues with those drugs out of the treatment system. Making sure that people who commit crimes such as driving under the influence of intoxicating substances both pay for their crime and get treatment that will help them get control of their addictions, instead of just pawning them off on AA or NA. Providing kids with a realistic view of drugs and drug use, that doesn't make claims they're going to know are false but ensures that they understand the very real dangers involved with drug use and other risky behaviors.

But most important, is fundamentally altering our view of addictions as a society. Language largely defines reality. Before humans developed language, we were little different than any other omnivore out there. It could be and in fact has been argued that language is what makes humans human. We need to be using our language to move us forward with regards to addictions. Because right now we are failing and failing badly. Considerably more than half of the people in our society are dealing with the effects of harmful substance addictions. We are spending more than $500 billion every year in the U.S. alone, just dealing with substance addictions. And according to the median of several statistics I saw, from sources at the NA website, to the harm reduction sites and substance abuse help clearinghouse sites, we are failing more than seventy percent of the people who actually go looking for help. No way of knowing what percentage of actual addicts we fail, because most of them never look for help.