Experimenting With Smoking
- posted by Jim Leitzel @ 10:52 PM

Mike is off to Russia for purely moral activity -- after all, it is International Women's Day -- so today's posting has fallen to moi.

The Guardian today features a collection of stories from some of their writers about their first experiences with such things as flying and high heels -- and smoking. Patrick Barkham had never smoked tobacco or marijuana, so at the age of 33 he went to Amsterdam to put his abstinent past behind him. His first smoke contained both tobacco and marijuana. Patrick's reluctance to inhale posed a barrier to achieving a high, but he eventually overcame that barrier, too. Some joints later, once the THC kicked in, Patrick became a slave to the drug, and he has not spent an unstoned moment since. Er, or maybe not:

I felt disappointed. Because I'd never done drugs, I had feared and expected everything - a spinning head, a creative mind, a hideous paranoia, a craven addiction and a desire to dance all night while dragons crossed the diamond sky with Lucy.

"It doesn't widen the doors of perception, it just slows you down enough to let you look in," I wrote [contemporaneously, in the notebook he had with him]. "This is what being stoned is about. I must get my bags from the hotel. Focus now. The end."

What an awful experience for Patrick. It is a good thing that the US arrests more than 700,000 folks per year for pot possession.

Labels: abstinence, arrests, Britain, marijuana

 
Understanding Abstinence
- posted by Jim Leitzel @ 11:24 PM

Yesterday's post drew upon the April 2007 edition of the UK-based journal Addiction, and obliquely noted that in the course of a year about 1/3 of American adults abstain completely from consuming alcoholic beverages. A slightly smaller percentage abstain from all forms of gambling, including the purchase of lottery tickets. Abstention is quite an important phenomenon in the vice world, and more so to Americans than to the British.

An editorial in that same April 2007 edition of Addiction suggests that vice researchers and commentators do not give abstinence its full due. To the non-abstinent, abstinence can seem to be simplistic and perhaps even misguided, especially when it moves from the private sphere into public policy. But that is no reason not to try to understand this long-term and recurrent approach to vice:

Whether abstinence is good, bad or indifferent we leave to the reader; but we are convinced that no purpose is served by dismissing the concept out of hand....Ideas that are merely disagreeable, that confer no benefit whatsoever, tend to have short histories and few followers. If abstinence were one of those ideas, if it were a pointless exercise in Grundyism, it would never have gained the ascendancy it has over the American imagination.

The authors -- Jessica Warner and Janine Riviere -- then suggest a few reasons for the appeal of abstinence, and why that appeal is stronger in the US than in the UK. (Part of the answer to the latter inquiry: British irony and wit.) While a simplistic approach to a problem sounds unsatisfying, an approach marked by simplicity has its attractions, as the authors note. Nobel Prize-winning economist Thomas Schelling has emphasised the "focal" effect of abstinence. If your rule is to have no more than two beers, well, what is so special about two? Why not one, or three? (And precisely what constitutes a single beer?) It would seem that someone who is concerned about drinking too much alcohol could adopt a "two beer" rule, or a rule to cut alcohol consumption by 50 percent. But these less-rigorous approaches, for many people, do not work as well as a "cold turkey" strategy, which makes the rule perfectly clear and any evasion immediately evident.

Incidentally, Jessica Warner is the author of an informative and entertaining book about the gin epidemic that surged through Britain early in the 18th Century.

Labels: abstinence, Britain

 
Nadelmann Talk at University of Chicago
- posted by Jim Leitzel @ 4:55 PM

Yesterday Ethan Nadelmann, the Executive Director of the Drug Policy Alliance, gave a talk at the University of Chicago, and Vice Squad was in attendance. The talk was chock-full of interesting tidbits, too many to do justice to in a blog post. I'll mention the overall framework, and maybe a couple of those tidbits. The usual disclaimer of blogging about a talk applies, namely, that though I took notes and tried to be careful, I am in danger of misrepresenting what was said.

Nadelmann believes that changes are necessary to two broad features of our (the US's) current war on drugs. The first feature is the central role played by the criminal justice system in the regulation of some drugs. (Nadelmann was pretty funny when he noted that it is "these" drugs for which we rely on the criminal justice system, and not "those" drugs. "Those" drugs -- caffeine, alcohol, nicotine, the pharmaceuticals -- can be handled by other means. Presumably he was suggesting that the distinction between "these" and "those" was fairly arbitrary.) Second, and a feature of the war on drugs that receives less attention from reformers, is the underlying notion that there is no permissible relationship between 'those' drugs and us except for abstinence. He thinks that this commitment to abstinence is a form of religious conviction: we shouldn't pollute our bodies, which are holy vessels, with "those" drugs, which are fundamentally evil. This mindset and rhetoric could simply be scoffed at, except that policy follows from these convictions, as when in 1988 Congress adopted a resolution that the US would be drug-free by 1995, and the UN in 1998 adopted the goal of a drug-free world. Much of the last part of Nadelmann's talk was given over to a strong endorsement of harm prevention policies, as exemplified by the Drug Policy Alliance-affiliated Safety First program. (Vice Squad has commented on harm reduction for teenagers and Safety First in the past.) Nadelmann gave a riveting performance.

The one minor area of disagreement that I had with the content of the talk concerned whether private employers should be allowed to discriminate against (read: fire) workers who smoke (or, presumably, use other drugs) off of the job. When the Michigan smoking case surfaced, I offered some reluctant support for the right of employers to discriminate in that fashion. Nadelmann believes that such forms of discrimination should not be countenanced, and the Drug Policy Alliance has a flash animation where you can register your own opinion. This same issue came up in my Regulation of Vice class on Thursday, and I was ambivalent then. Let's face it, I am even less sure about this than I am about the appropriateness of most vice policies.

Labels: abstinence, drugs, harm reduction, recreational drug use

 
Controlled Drinking for Recovering Alcoholics?
- posted by Jim Leitzel @ 7:15 PM

Someone close to you has a serious drinking problem. Should this person be counseled to cut back on alcohol consumption, or to become completely abstinent? Like certain other zero-tolerance v. harm reduction issues (e.g., abstinence-only sex education for high schoolers), this question is very controversial.

This month the journal Addiction contributes to the debate, first with an article by Dawson, et al., "Recovery from DSM-IV alcohol dependence: United States, 2001-2002," and then with four responses to the article and a rejoinder by Dawson, et al.

The main finding of Dawson et al. is that lots of folks who meet the standard markers for alcohol dependence eventually change their ways. While many of these folks become abstinent, a movement to low-risk drinking is also a common outcome. And these "recoveries" are generally accomplished without treatment for alcohol dependence. The authors themselves are quite measured in their interpretation of these findings, and the responses by and large are further calls for caution.

My own not-well-informed view is that for some (but by no means all) alcoholics, controlled drinking is essentially impossible. [Update: perhaps years after the current crisis or in a radically different environment even these individuals would be able to drink "socially".] A similar view (I think) is provided in Deborah Hasin's response:

A very important result of Dawson et al.'s paper is that full remission from the symptoms of DSM-IV alcohol dependence can occur among individuals who continue to drink. At one time, this finding would have been revolutionary. Fortunately, our field has matured enough so that is no longer the case. However, we remain without guidelines concerning who really must stop drinking in order to recover from DSM-IV alcohol dependence, and who can recover stably from dependence even while drinking moderately. While many guidelines exist on how to cut down or stop in terms of psychological (e.g. motivation, cognitive planning) and environmental changes (new peer groups, avoidance of cues for binging), however, these do not address the question of abstinence versus controlled drinking....

Labels: abstinence, addiction, alcohol, harm reduction, treatment, zero tolerance

 
New Year's Eve and Alcohol
- posted by Jim Leitzel @ 11:15 AM

New Year's Eve never fails to bring out our ambiguous relationship with alcohol. Imbibing is part of the stereotypical New Year's Eve celebration. Even excessive drinking receives a bit more of a pass on New Year's: newspapers tend to run stories about purported hangover preventions or cures at this time of year (examples here and here.) But the ambiguity is evidenced by the other sorts of alcohol stories in the news, particularly those involving drunk driving; here's an excerpt from one such story, from the LA Times: "New Year's Eve and New Year's Day are the most dangerous days of the year when it comes to alcohol-related collisions, according to a recent study by the Automobile Club of Southern California. Drivers and passengers on those days are 148% more likely to be killed or injured in a drunk driving crash than on other days."

Recently, some communities have been promoting alcohol-free celebrations, thanks largely to the efforts of First Night International. From their website: "First Night seeks to foster the public's appreciation of visual and performing arts through an innovative, diverse and high quality New Year's Eve program which provides a shared cultural experience, accessible and affordable to all." Here's the list of more than 130 municipalities that will host First Night celebrations today.

In general, I think that vice regulations should make it not too costly for someone to live in a "standard" way without being subjected at every turn to vices that he or she might prefer to avoid. In much of the US, it is hard for teetotalers or recovering alcoholics to shield themselves from alcohol in their day-to-day activities, and I can't go to my local deli without facing the importuning of the state of Illinois to sell me lottery tickets. At any rate, events like First Night celebrations are, I think, useful developments, by providing a "regular," but alcohol-free, New Year's celebration.

However you choose to celebrate, have a happy and safe New Year, and may 2005 smile upon you.

Labels: abstinence, alcohol, driving

 
More Confusing Alcohol and Health News
- posted by Jim Leitzel @ 11:03 AM

This time, the word is that people in their 40s and 50s should drink alcohol, but not more than once per month, if they want to reduce their chances of suffering from mild mental impairment later in life.

The researchers, writing in the British Medical Journal, found those who drank no alcohol and those who drank frequently – several times a month – in mid-life were both twice as likely to have mild mental impairment in old age than those who drank infrequently – less than once a month.

Labels: abstinence, alcohol

 
Optimal Advice to Teens About Alcohol: Just Tell Them No?
- posted by Jim Leitzel @ 6:23 PM

Primo research assistant Ryan Monarch brings this Washington Post column (registration required) to Vice Squad's attention. The column is entitled "Why You Shouldn't Teach Moderate Drinking," and it promotes the work of a group called "Community of Concern." Community of Concern publishes a pamphlet, "A Parent's Guide for the Prevention of Alcohol, Tobacco and Other Drug Use," that has been adopted by many school districts. Their website also offers an e-learning course for parents.

The Post article and the Community of Concern website both emphasize the science behind the policy prescription of keeping kids away from alcohol, tobacco, and other drugs. From the Post article: "[The booklet] says that kids should wait until their brains and bodies are both physically and emotionally mature enough to deal with the biochemical alterations of alcohol ingestion. The research indicates that people are not ready to drink until their early twenties. The law and science say the same thing independently -- don't drink until 21."

I am much less sure than the booklet's authors seem to be, however, that a policy of just telling kids not to use the stuff is so clearly the best approach and further, is dictated by science. Yes, adolescents and young adults do face specific physical and "economic" harms from drug use beyond those faced by adults, and irresponsible use by adolescents is particularly costly and troubling. But most kids in the US will try alcohol before they are 18, and a majority will even sample currently illicit drugs. Safe use messages, particularly for older teens, seem, then, to have a lot to recommend them. For this harm reduction approach in the case of drugs, see the website of Safety First. For a fuller discussion of this tricky issue, see this previous Vice Squad post.

Labels: abstinence, alcohol, harm reduction, teens