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.

The New Asylums: Complete System Failure

I have been meaning to write about this issue for a very long while, but have left it on the burner for so long I forgot about it. Then today in psych class I had it thrust into the forefront rather brutally. Before I go on, I want to share this episode of Frontline from 2005, one that I hadn't actually seen before. I should expect that it won't take long to get the gist of a truly magnificent breakdown of how we manage mental illness in the U.S.



It didn't take very long to provide you with a pretty good idea as to just how truly screwed up this is. Keep in mind Frontline filmed that episode in a prison that is still considered a model for psychiatric care in the prison setting. This is no way to treat people with mental illness, even people who really do need to be locked away from society.

What really makes me angry about our new model for dealing with serious mental illness, is that all the excuses made for closing state institutions are exacerbated by this method of dealing with the seriously mentally disturbed. It is far more expensive to deal with the mentally ill either in prison, or on the streets coasting in and out of jail. The biggest reasoning was expense - but the expense has dramatically increased. It is a huge expense for local communities and ultimately still costs the state more.

On top of this, it is extremely hard for the seriously mentally ill to actually get the help they need and even qualify for. There are "homeless" mentally ill persons who aren't actually homeless. They have a place in a group home and access to care. But then they wander off from home and end up living on the streets - off their meds, hungry and exposed. And there are truly homeless mentally ill persons who aren't getting any help - not because they don't qualify, but because they are not together enough to go out seeking it. And even if they try, the system is not set up to be managed by a paranoid schizophrenic who believes there are people trying to kill her, or someone with bipolar who walked nearly a hundred miles from people who knew him while in a manic phase. That is not the "freedom" that wellmeaning, but ultimately ignorant lobbyists/policy makers were trying to provide with the idea of mainstreaming.

And the local communities - the communities in which people who know and love a particular mentally ill individual lives, are not set up to deal with them. We have had forty plus years to get it together and help these folks and still we are flailing about, failing too many. Even here in MI, where the quality of care provided by county Community Mental Health (CMH) services is generally quite exceptional, we are allowing too many to slip through the cracks. In many places, there is virtually no organization to provide services to the mentally ill. In others, southern California in particular, the services provided are truly abysmal.

And again, the states are still fitting a huge portion of the bill - in many cases a much larger bill than the state hospital system cost.

Michigan is particularly hard hit right now, as we have closed some of our mental health facil...Excuse me, prisons at the same time we have also eviscerated the budgets of the county CMHs. We are dumping these folks onto their local communities and pulling the funding that might have provided services for them. The clinics that manage paroles and people on probation are getting overwhelmed - in many cases with clients who should not be outside of a lockdown facility. Meanwhile, people with less serious mental problems, but who do not have insurance and do not qualify for medicaid are screwed.

Myself for example. I finished with my last therapist about a year ago. I was told that I would see another intern therapist last summer - then that was bumped to the fall...I haven't bothered trying to call again - I know what is happening and know that I am not going to get help. At least I am on meds and not left completely screwed. For more people are worse off than I am. No therapy, no psychiatric services - they won't get help until their mental illness becomes acute and they either commit a crime and end up in prison, or at least get picked up by the cops and pushed through the medicaid requirements.

Please don't think that things are much better elsewhere. For the past several years MI has managed to provide mental health services on a shoestring, that far outstrip the quality of care offered in many other states that have substantially larger budgets per public mental health consumer. It is not like those services have improved as budgets get hit across the U.S. Indeed the quality of care here has not actually suffered that much, we just can't provide that care to the people who desperately need it.

I have some hope that the new healthcare plan is going to help with some of this. The APA has managed to push for some provisions that should improve access to mental health services and they went through. But it is only going to help with people in temporary crisis. People who are dealing with situational mental problems or who exhibit mild symptoms. It is not going to do a damned thing to change our prison and "homeless we can ignore" based system of care for the seriously mentally ill.

Just so we are perfectly clear about this, those scenes where they showed these yellow cages in a half circle - their "group therapy" session - that is not a reasonable way to provide group therapy. Not an effective means for any sort of functional therapy. Punishing inmates for breaking rules they don't understand is not effective therapy. Pretending that there is anything valid about an admission of guilt for rules violation, coming from a guy who is incapable of understanding what he is pleading guilty to is a fucking atrocity.

And remember, the system we got a glimpse of in that video - that is a model system for prison based mental health care. That is worlds apart from what one gets in county lockup or most prisons in the U.S. It gets far, far worse than what we see in that episode of Frontline.

Give That Moderate Theist A MotherFucking Cookie

Addendum - My lovely partner (and Thomas himself) has pointed out that Thomas isn't particularly liberal. So we can add that he is also one of those delusional fucks who pretends that anyone who can't afford healthcare doesn't deserve it. What would you feel, if you suddenly lost the coverage you have. Seriously, if you did, would you just stoically accept that it is all your fault and that you simply don't deserve it? Because shit happens motherfucker, shit that you just can't plan for. What you have today could be gone tomorrow - through no fault of your own. So tell me, if you lost it all and needed help, can we assume you would be good enough to stand by your convictions? How about if you get desperately ill and your insurance company finds a way to squirrel out of covering it? Hmm?

Exhaustion has prevented me from getting nearly as much done with all this as I was planning, but there you have it. Eleven hours in the car yesterday, with a seven year old and a twenty month old, then another hour and a half after we dropped them off was rough. Getting on the road this morning by eight was also rough. But here I am...

Some moderate theists have been on the defensive, as of late. Philip H. was rather resentful of some characterizations of moderate theists. And a certain Thomas Joseph rather resents being lumped with extremist, fundamentalist loons. He whines that he's different - better. He's a liberal and all around decent fellow. And, and - he accepts evolution... Well YAY!!! Thomas, how about a motherfucking cookie? Because you deserve a cookie for being such an upstanding fellow who is apparently only mildly delusional. And dammit man, I am so sorry if my criticism of religion was in any way offensive - after all, it's your personal thing and your god forbid, I should criticize you're personal beliefs as though they have any impact on the society and the world in which I have to live and raise my family.

Except that they do.

But no, sputter the Thomases and Philips - we're decent people and don't believe monstrous things. We support gay rights and a woman's right to choose - we're decent liberal folks, who just want to be left alone to our faith. Don't alienate US!!! RESPECT!!! RESPECT!!!

I will most certainly not, fuck you very much. More to the point, I will happily respect you. I will respect your political stances when I agree and argue them when I don't. I will not, however, have the least respect for your religion. The fact that it is moderate, even liberal, just makes it more insidious and less worthy of my respect. To be clear, little more than a year or so ago, I was one of you. I spent the vast majority of my life wallowing in destructive ignorance and bullshit, not a whole lot different than your own. Moreover, I was a fundamentalist way back yonder, when I was quite young. I worshiped, with all of my heart and mind, the same genocidal maniac that you worship.

Eventually I got better and started recovering.

It is not the orthodox, fundamentalists and other assorted extreme theists who perpetuate the very worse that faith has to offer our society. It is the moderates who foster this mentality that says we should allow parents not to vaccinate their children, because some imaginary being told them not to. It is moderates who foster the notion that kids should be allowed to be "educated" at home, with little or no real monitoring from the state and allowed to wallow in ignorance, because that is what their religion demands. It is moderates who foster the attitudes that we should allow them to opt their children out of vital aspects of education - some of them lifesaving, because their gods don't want them to learn about science or avoiding STIs. It is the moderates who foster the belief, that I am a very nasty man indeed, for daring to criticize ignorant fucking bullshit, or for simply not believing in magical beings.

It is fucking moderates who foster the social phenom that makes the fringe fucking loons and their egregious behaviors acceptable.

And to make this whole conversation more delicious, Thomas is a bloody Catholic. So Mr. Nice Liberal Fellow, supports an organization that bears the brunt of the blame for the scope of the AIDS pandemic that is decimating massive swaths of sub-Saharan Africa. He supports an organization that hates most of my friends, simply because they prefer to have relations with members of their same sex. He supports an organization that believes women should not have the right to choose whether or not to terminate a pregnancy. He supports an organization that believes that birth control is fucking evil. He supports an organization that has repeatedly shown blatant disregard for the welfare of children, by not only allowing pedophiles in the clergy to have continued access to children, but also by actively fighting against those sick fucks being prosecuted or their victims receiving reparations.

While I am certain there are areas in which Thomas and I agree, in which he is even worthy of my respect, he has given up all credibility when it comes to discussing criticism of theism. In that, he gets nothing but my utter disdain.

Help Vaccinate a Child...

Times are really tough - I know that about as well as one can. Though there are those who have been suffering worse financial woes than I have, having lost my family's home in Portland, I know all too well how bad things are. But there are those here in the U.S., who could really use your help - and if it helps to shame anyone into donating, I made a donation myself, even though I am a student without income.

I was shocked this afternoon, when I read over at Respectful Insolence, that Nevada has abysmal vaccination rates. Not because of the anti-vax loon brigade, but because the economy is bad there and apparently the state doesn't have enough funding to ensure that all kids get vaccines. The state recently managed to put together the funding for the actual vaccines, but not enough that they don't have to charge for the actual administration of the shots. They must charge $16 for a single vaccine or $25 for more than one.

I have been where a lot of those families are. While $25 may not seem like a hell of a lot to most people, when you are to the point where you have to ration your eating to five or six meals a week, to ensure your children get enough to eat, that works out to being a lot of meals you will miss that month. And I can also attest, trying to functionally work when you're only eating one meal, ever day or so is not easy and certainly not healthy. These are folks who cannot afford to lose a single damned dime. And so there are a lot of kids not getting the vaccines that will not only keep them safe - they keep their communities safe too.

And so as bad as things are right now, I managed to throw down $25 dollars and will sleep somewhat more soundly tonight, knowing that I just ensured that a child in Nevada who wouldn't have been vaccinated will be now. And dammit, if I can manage that, what can you manage?

Here is a link to the page where one can register for a James Randi Education Foundation event. If you scroll down the page, you will see a line that allows you to donate $16 or $25 to help vaccinate a child. I would ask you to ignore that $16 bullshit and help a child get the whole shebang. Further, I would ask that you give until it fucking hurts, because this is not just for them, it's for all of us. Here is a direct link to the $25 donation slot. Please vaccinate as many kids as you can....

On Strip-searches in Schools: What About Boys? And other questions...

I think a great many of us are aware that SCOTUS ruled the other day, on a case involving the strip search of an eighth grade girl, by school faculty.  As Ed put it, it is indeed a partial victory for sanity, given that the majority opinion explicitly stated that such a search might have been reasonable had the faculty suspected that she had illicit drugs on her person, rather than the Advil they were looking for.  Several people have weighed in on the ruling, including Greg Laden, who's blog is so very often a starting point for very interesting conversations.  So I don't feel all that compelled to throw much into the legal discussion, except to say that I strongly feel faculty should not be performing strip searches - ever.  If there is a reasonable assumption that a child has contraband secreted in their underwear, the school should call the police in to deal with it - period.  If the police don't believe there is adequate reason to search, then the search should not happen.

But I do want to weigh in on a discussion that got started over on Greg's thread - namely the question of how outraged we might be if it were a boy who was strip searched instead.  I am not at all fond of the commenter who got that ball rolling - he and I have butted heads way to harshly for that.  But he raises a very important question and one that is indicative of far more than just the implications of strip searches. 

I am going to go into a great deal more detail on this, when I don't have three tests between now and Tuesday that I really need to study for.  However, I would like to refer you to my paper on masculine social gender constructs and help-seeking in men.  And I would also pose the question to you:

How would you feel about this situation if it had been a boy who was strip searched, instead of a girl?  Would you feel any different about it?  If so, why?  And please try to be objective in your thinking and honest with yourself.  Moreover, if you are comfortable doing so, drop your answers in comments or an email.  And on this post only, I am willing to accept completely anonymous comments, because I want to know what you really think.  I figure that some people might not want to be associated with their real feelings on this and I will respect that.

And while I am asking questions, I would also be interested to hear from some skeptics who were raised without religion. Stemming from an earlier discussion about cannabis, I am inclined to think that there is some tendency amongst those who never went in for particularly pervasive forms of magical thinking, to discount their skeptical nature when it comes to certain topics they hold dear - or dare I say, sacred. The lovely Juniper and I were discussing this the other night and it occurred to me that it might be a very good topic to write about. So if you were raised a free-thinker, or at least without Faith, these are for you.

Do you believe that you are pretty much immune to magical thinking - that you have some innate ability to think rationally about anything and everything? (discounting inherently arational notions, like love) Do you feel that you don't really have to be careful about how you approach topics that you may have strong personal feelings about? Do you ever find yourself questioning the evidence for something, not because you have seen more compelling evidence to the contrary, but because you don't like the conclusions implied by the evidence you discount?

Again, please be as objective and honest as possible. And again, feel free to email me answers or leave them anon. Any emails I receive about this will remain confidential.

Silence Is The Enemy

I've never been raped, never been sexually assaulted, never been inappropriately touched even. In all honesty, I have never been nervous walking to my car at night, in a deserted parking lot or on an empty street. I've never been concerned about a man or women staring at me in a restaurant or the coffee shop - honestly, I'm pretty oblivious to that sort of thing.

I have however, been the object of wary, nervous glances from women who happened to be walking on the same deserted street I was. I have been an object of fear, because I am a guy and in certain circumstances women should be assuming that I am a potential attacker. Actually they shouldn't, because reality shouldn't require it - but it does and as long as it does they should. I hate being thought of that way - being the type of person that I am, that is the last thing that any women should fear from me. But that's the reality in which we live.

Rape happens here in this corner of the western world. It happens all too often and while we as a society don't approve and indeed consider rape repugnant and vile, women still need to be wary of strangers on the street. Because whether the assault was instigated by a stranger or, more often, by someone the victim knows or is related to, I doubt anyone reading this doesn't know a women who was sexually assaulted - most of us probably know men who have been as well. Even in our western society, with western mores, there are a lot of sick fucking people who do sick fucked up things to other people.

But at least in our society, this behavior is considered vile and repugnant, the perpetrators pathological.

In many other cultures, in other parts of the world this is not the case. Nicholas Kristof of the New York Times writes of post-civil war Liberia, where rape has fallen off from 75% of Liberian women being raped during the war. Now the figure is around 12% of "women" seventeen years old and younger being raped - with 33% of those being inflicted on children twelve years old and younger. And this story is echoed all over the globe, in cultures that just accept it as a matter of course.

From Congo, to Darfur, all the way into Latin America, there are places where one can assume that any women you meet over the age of twenty has probably been raped - violently. Those who have not are the exception. And unlike the U.S., the UK, Germany or any other western nation, these women don't have the support of counselors, law enforcement or anyone else outside of their own families and sometimes not even there. It's life and that's that.

Sheril Kirshenbaum and Dr. Isis have teamed up with Scicurious, Tara Smith and Jessica Palmer, in donating their blog income for the next month to Doctors Without Borders. Sheril Writes:

The goal is two-fold: Raising funds and–arguably more importantly–awareness. Since blogging revenue increases with traffic, we hope to get people to keep coming back for more information about what’s going on and thinking about how to make a difference. Do not feel obligated to donate, but it’s one idea. There are many ways to contribute: Write and email Members of Congress (Congressional Directory here), speak at community meetings, encourage others to get involved, or donate to our chosen charity (Doctors Without Borders). Help us maximize our donations by visiting Isis, Jessica, Tara, Neurotopia, and returning here often because every click will help raise money. Spread the word. We want to make sure elected officials at multiple levels realize this is a global issue that matters to a large voting constituency!

There is always something we can do, even those of us who haven't money to help with. If you have a blog, write about this. Whether you do or not, write to the people on your email list - send them to Sheril's blog post, or that of anyone else who's written about this. Hell, copy and paste this whole entry and send it to them. Write your local and federal politicos and pretend they're actually good for something. Talk to the student affairs office, or it's equivalent at your local educational institutions and see about having someone in to speak about it - or even do some research and ask if you can speak. Public libraries are also a good place to try to have a speaking engagement of this sort. Be creative - if you have other ideas, leave them in comments or email me with them.

And if you do choose to write about this at your own blog, email Sheril at srkirshenbaum@yahoo.com and let her know. For that matter, let me know too and I will do my best to put up links as well.

I discovered Sheril's post via Greg Laden's post on this - well worth reading.
And here is a list of bloggers stepping up...Soon to be in Sheril's sidebar.

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.

My first Research Paper

I was a bit nervous about it, because I found out that we do have some restrictions on the paper. Mainly that the first one has to be a MLA format paper. Given that my topics tend towards being rather science oriented, I wasn't sure I could get them to fly. But my instructor told me today that writing about addiction was going to be fine. I made it clear that there would be a fair amount of science involved, but as I can focus it on our social and political addiction paradigm, she let it slide. I think it helped that I have an interesting take on it.

So now I am going to work on my topic proposal and start throwing myself into more formal research. So the posting may get a little more sporadic and will probably tend towards a definite theme, as my reading material gets more focused.

The major upshot of it is, this is going to be a theme throughout my education. While I am sure that as an undergrad, I will be required to right a lot of class specific papers, this will be the early and short version of writing that will be revisited several times over the next several years. It will be especially relevant when I get my undergrad and move upward from here. I think it will be interesting to compare this paper to the versions that will come out towards the final stretch of my education. I suspect that in the middle, it will get far heavier on the science. I also suspect that (unless I drastically change gears somewhere) that my final dissertation will come full circle to a much longer version of the paper I am about to write, tempered by the next several years of intensive, formal education.

More on the Conversation that Never Ends

The last post garnered rather a lot of response, so I wanted to clarify a few things. Also, quite a few responses came via email. Please, comment publicly. There were several good points made, that I think could add a lot of value to the discussion. For those who are uncomfortable talking about this openly, I do allow anonymous comments - i.e. I don't get any information about you. I only ask that you sign off with some identifier, besides simply anonymous. I don't care what you choose to use as a screen name, just give me something to refer to. Unidentified comments will be deleted.

I would also take this opportunity to point out that another sciblogger has weighed in on this. Dr Free-Ride, at Adventures in Ethics and Science, makes some very similar points to my own.

First, Abel actually was referring to legal wrangling, when he talked about going over the line. And this is a very important factor in discussion of issues such as sex and drugs with our children.

This is a very real concern, for a lot of parents. The only real answer for it, is to be active and try to affect change in our communities. In many places it is possible to have one's children taken away or be otherwise oppressed for making very reasonable and sound parenting choices. And it's a catch twenty two. On the one hand, the only way to effect change is to talk about why these are perfectly reasonable choices. On the other hand, if one talks about it, it could be cause for serious legal problems. This is a tough enough issue that even living someplace as reasonable about these things as Portland is, it still makes me a bit nervous, talking about it.

I do know that this is a pretty big problem, one that is all the more difficult, having been raised to believe that the freedom of expression is akin to being a sacred ideal. Especially true when it comes to raising one's children and doing what we believe is right, to raise as functional, ethical and safe children as we can. There are no easy answers. Many contributors to the problem are rather obvious, but actually changing them, is as complex a problem as trying to break the deathgrip the republicrats have on American electoral politics. One advantage, is that this is very much a localized issue and we can all get very directly involved with local politics. It is still an uphill fight, but I think it is one worth fighting.

Drugmonkey also weighed in, with a very important point about risk assessment. This being that even a seemingly small chance, such as one percent, is not as small as it seems. To illustrate, take a group of five hundred kids, not far off the mark for a lot of graduating classes at high schools all over the country. If anything, it's probably a little small. But it works for illustrating the numbers easily.

Something that affects one percent of a teen population, is going to affect five kids in that group. But that leaves four hundred, ninety five kids who it doesn't affect, right? Of course it does, but I want you to consider exactly what this means. I want you to consider the odds of one of those five kids being someone you and your child knows. At the least, it is exceedingly likely that at least one of the five will be known to someone you/your child knows. Less likely, but still plausible, one of those five will be your child. So lets look at some numbers, kindly provided by Drugmonkey;

In this we are supported by the data in the sense that 50% of 12th graders have tried an illicit drug, 73% have tried alcohol and 56% report having "been drunk".

So lets look at how this translates into our group of five hundred kids. We have a full two hundred, fifty kids who will try an illicit drug. Two hundred, eighty of them will get drunk. And three hundred, sixty five will try alcohol. To be clear, it is virtually impossible that you/your child will not know several kids who will fall into one or more of those categories.

I would also like to take a look at the numbers for inhalant use among teens, from this context. Mainly, because this is the one that frightens me the most. According to a 2006 report by the American Academy of Pediatrics (Warning, PDF link), 11.1% of twelfth graders have used inhalants, holding steady since 2002. Finding statistics on the percentage of kids who use inhalants, who die of it is proving rather difficult, but according to this same report, of those who die, 22% are first time users. So of our group of five hundred kids, fifty-five or fifty-six of them will use inhalants. Here is a listing of likely side effects of inhalant abuse, from the National Institute on Drug Abuse. Note the stats are a little different for the frequency of use. Keep in mind that until this page, we have been looking at statistics for use before high school graduation. NIDA's figures are for lifetime use, not just use among youth.

So while it is easy to point at figures like one percent, and assume that this means something is safe, the reality is that one percent isn't that far away from us, at any given point.

Finally, I wanted to clarify what I am trying to encourage parents to do. I am not suggesting that parents tell their children that if they really need to use drugs, do such and such, because it's safer than other options. While for some kids, that might well become a reasonable method of harm reduction, most kids really don't need that. What I am advocating, is nothing more than providing our kids with enough information, to make an informed decision, should they choose not to abstain. Make sure that you aren't going to find them cold and dead in their bedroom, with an aerosol can in their mouth. Make sure they aren't going to drive intoxicated, or ride with an intoxicated driver.

Drugs and Children, the Conversation that Never Ends

Abel Pharmboy has a great post up, about the dangers of prescription and even some over the counter medications, that kids use to get high.

Related to the DrugMonkey post, PharmGirl just tipped me off to this Benadryl nightmare at the Sweet Hill (OR) High School. Students have turned up in local emergency rooms after having taken 20 to 30 of the tablets, each containing 25 mg of diphenhydramine.

At high doses, diphenhydramine's central antimuscarinic effects become apparent as hallucinations but this is a terribly risky approach. Suppression of parasympathetic drive to the heart can cause tachycardia and lead to fatal cardiac arrhythmias. The story is deeply concerning...

He then goes on to describe the problems with a couple other commonly abused medications, well worth reading the entire post and comments. Towards the end of the post, he poses a very important question;

But it's stepping over the line to tell them if they're going to choose any illicit behavior, there are far safer alternatives.

How do other parents ethically approach this conundrum?

First I would like to comment on the very notion that it's stepping over the line, to tell children there are far safer alternatives.

One of our very important responsibilities as a parent, is to do everything that we can, to ensure they survive childhood. The point that we decide that something this important is off the table, is the point where we really start to gamble with the lives of our children. Kids are all individual, different beasts. They each have unique needs, what works for one child, won't work for another. Thus it is important to recognize that one needs to tailor this discussion, to the needs of their child – also realizing that the approach you take with one of your kids, may not work for the next one that comes along.

This is much akin to the discussion of sex. It's a hotbutton issue, with no easy answer. But just as we gamble with the life and well being of our children, if we refuse to teach them about making sex safer, we also gamble with their lives, if we just say no. It is not telling your child it's ok, to make them aware of ways to keep themselves safer. But we owe it to our children, to give them information that can and probably will, keep them alive and safe.

While every kid is different, there are some very standard, near universal steps one should take, when making their child aware of the dangers of drugs. Most of this also applies to every single hotbutton issue we should discuss with our kids.

Honesty – Always

This cannot be emphasized enough. There is nothing more important, than always being honest, when talking to our kids about sex, drugs, dangerous activities or any hotbutton issue. Never, ever lie about anything. Never even exaggerate anything with them. Always be honest with your child. If they ask a question your not comfortable answering, at the very least tell them your not comfortable talking about that. The best policy is to be open with them, occasionally telling them you will be happy to discuss it when they are a little older, if it really isn't age appropriate. But if you just can't bring yourself to respond, then have the courage to tell them that.

The point that we start to lie or overstate the case for something, is the point that we lose all credibility about that issue. Do it enough and we lose credibility all together. For a good many kids, the credibility we are talking about, is a lot easier to lose, than it is to ever regain it, should it be lost. If the goal is to have a child that is confident and comfortable with bringing up any and every topic they wish, then this credibility is essential. We throw that away at our own peril. More importantly, we throw that away at our child's peril.

Get Your Facts Straight

Do not approach the topic of drugs, without doing your homework. If, like me, you have personal experience to draw from, by all means use it. Even if your experience is limited to only small aspects of the discussion, they are far more valuable than anything else you will bring to the table. First, this is establishing credibility. They know you're being honest, when you discuss your own failings, or even less dire experiences, with licit or illicit drugs. Too, they place a lot more value on your actual experiences in life, than they usually let on.

For those with less experience, or even those with a lot of them, read and question people who've been there. Don't depend on sites the government provides. Read a wide range of information, from different perspectives. Call organizations such as narcotics anonymous and even alcoholics anon. Tell them you are interested in finding someone who can talk to you and your kids about substance abuse. I can virtually guarantee that they can and will be very keen on helping you. The perspectives of people who have lived the worse of drug use, are extremely valuable.

But the most important aspect of this, is to never overplay the very worse of consequences. Talk to your kids realistically. Taking alcohol as an example; Focus the majority of your attention, on the potential consequences to their bodies development, especially the brain. Make it clear that in their early to mid twenties, the consequences of having a drink, are far less dire. The brain is pretty well developed, having a drink or smoking a little pot, is going to do far less damage. While the brain is still developing, THC or alcohol (not to mention a whole lot of different drugs) will inhibit proper neurological development. It may not translate to significant loss, but there is no getting around it, they will impair neurological development.

Use Realistic Risk Assessments

Yes, you are right in sensing a theme here. But it is critical that we make sure we use the best possible information. Risk assessment, is where a lot of drug campaigns really falter. They want to scare kids out of using drugs, so the focus is on the very worse potential consequences, consequences that are the least likely to be observed by the child. Meanwhile, the milder, but far more common consequences are virtually ignored.

The thing is, most kids, unless they are sheltered to an extremely unhealthy degree, are going to observe the milder, more common consequences of various sorts of drug use. The more dire consequences are less likely to ever be observed. Focusing more on the realistic, provides another source for the credibility that is so important.

To take an honest risk assessment approach, means that you will be telling your children that there are safer, albeit still dangerous alternatives out there. Such as, you will be telling them that smoking pot isn't nearly so dangerous as huffing canned air or gasoline. You will be telling them that freebasing cocaine (crack) is more addictive and dangerous than snorting a line of cocaine. You will be saying that it is far safer to only drink where it is safe and stay there, if they decide to drink, instead of following their parent's advice. Because always, above all else, we have to focus on safety first.

Do Not be Afraid to Tell Kids How to be Safe

We can be clear that something is a bad idea, while maintaining that there are things that can make certain activities far more dangerous than they inherently are. To tell a kid to use a condom if they are going to have sex, does not have to mean we condone them having sex. Likewise, telling a child the difference between smoking crack and smoking a joint, is not telling them they should go smoke pot. What we are doing, is refusing to gamble with our children's lives.

The consequences of having unsafe sex, can be as bad as death, or at least a horrible, ravaging disease. The consequences of using various substances to get high, can also be as bad as death. There are all sorts of potentially dire consequences, to all sorts of activities. There are also ways of reducing the potential for the very worse consequences, for any number of activities. Some people, in the name of ideological or dogmatic purity, feel the need to take an abstinence only approach to all of these topics. They want to make it as simply black and white. Then they trust that there kids will just do as they are told and abstain.

This is nothing less than gambling with your child's life. You are doing nothing less than throwing your child to the wolves, without the least bit of protection. You make them vulnerable to perfectly natural impulses they may be unable to control. If they are going to break down and have the sex, they're going to do it. Statistically, it is far more likely they're going to than they're not – no matter what try to teach them. Likewise, it is entirely likely that they are going to use some sort of inebriant, some time in their youth. The only question becomes; What sort of risk assessment are they going to use? Because if one's just as “bad” as the rest, one of the easiest ways to get high, is using highly toxic, very dangerous inhalants. They are bar none, the easiest to get their hands on.

Build Confidence

The more confident the kids, the less likely they will fall prey to peer pressure. Peer pressure is a huge part of using various substances. Most dangerous, it takes the control out of the hands of our kids, and gives it to their compatriots. By themselves, our kids are probably in pretty good shape for staying safe and listening to us parents. It's when they feel it's more important to fit in, than to be safe (or safer), that they really can get into the worse trouble.

Start Early

It is never too early to talk about the hard stuff. Make it a habit from the git go. We first discussed drugs with our son, when he was three. He saw a friend of ours rather drunk and the conversation began. A few months later, we saw someone smoking crack in the streets. When he was five, he actually had quite the q&a with a guy he saw hitting a crack pipe. He has also talked with a friend of mine, who has been dealing with some serious substance abuse issues for much of his life. We started with very general, very basic ideas and haven't progressed far beyond them. But we have begun the habit of talking about drugs and inebriation. Likewise, we have done the same with topics such as sex, bigotry, hatred, environmental issues, social issues. It doesn't take much, but with even the tiniest foundation, you pave the way for talking about it when these issues become very relevant to your child.

Showing them you have the courage to talk about difficult issues, also makes it more likely they will want to involve you in their decision making process. As much as I would love to see my children retain their virginity until they are secure, mature adults, I would settle for them being comfortable asking my advice, when they decide they are going to do it anyways. Likewise, I would love to see my boys forgo smoking pot or drinking, until they are much older, if ever. But I will settle for them talking to me about it, before they decide to do those sorts of activities. Remember, if they don't feel they can trust you, they aren't going to talk about it. They will however, likely make decisions you aren't going to like anyways – you just won't know what it is.

This means biting your tongue. It also means standing your ground and making it clear what the consequences are likely to be. It means knowing your child well enough to know when they are likely to do something dangerous and when you just have to bite it and do what you can to keep them safe while they do it. Because it may be the difference that prevents them from transmitting HIV, or means they have a beer instead of dying with a can of air freshener in their mouth. Most importantly, it means making sure that they never have to question your love for them, no matter what they choose to do. Let them know when you are disappointed, but never let them question your love. Like your credibility, if they question the love, you've lost important and hard to restore ground.

There is plenty more involved with this topic. I would love to go on about it far more than I have here and may well do so, but these are what I consider the most important keys to keeping one's children safe. For certain, they are pretty universal.

I am also going to just have to admit that it is unlikely I will get to a lot of things any time soon. We just have a lot on our plates and things aren't slowing down anytime soon. I will keep up posting as much as I can, but please bare with me, it will be slow.