From "Rethinking Substance Abuse." In the closing chapter of their 2006 book, "Rethinking Substance Abuse,” editors William R. Miller and Kathleen M. Carroll attempt to sum up what has been learned about the science of addiction. Their useful contribution, entitled Drawing the Science Together, offers "Ten Principles" that are designed to synthesize the welter of recent scientific research on addiction and help make sense of what we know. In vastly truncated form, they are as follows: 1. Drug Use is Chosen BehaviorAt least in the beginning, people choose to take drugs, as one of the behavioral options available to them.   2. Drug Problems Emerge Gradually "Dependence emerges over time, as the person's life becomes increasingly centered on drug use," the authors write. "The diagnostic criteria for classifying people with 'drug abuse' and 'drug dependence' represent arbitrary cut points along a gradual continuum" (p.296). 3. Once Well Established, Drug Problems Tend to Become Self-Perpetuating Once regular drug use has caused dysregulation of limbic reward systems, addictive behaviors "take on a life of their own," and become "surprisingly resistant to ordinary forces of persuasion, religion, punishment, and self-control. It can be challenging to destabilize such a self-organizing system" (p.296). 4. Motivation is Central to Prevention and Intervention Miller and Carroll write: "Taking action also predicts change. Better outcomes follow from attending more sessions or staying longer in treatment, going to more 12-step meetings, adhering to treatment advice, or faithfully taking one's medication. It appears that actively doing something toward change may be more important than the particular actions that are taken" (p.297). 5. Drug Use Responds to Reinforcement "Drug use tends to be associated with a foreshortening of time perspective, so that longer term delayed rewards are discounted in value.... People who more steeply discount delayed rewards are at higher risk for drug use and problems; moreover, drug use exacerbates discounting. Some effective medications reduce the reward value of drug use, which can enhance the appeal of alternative reinforcers" (p. 298). 6. Drug Problems Do Not Occur in Isolation, but as Part of Behavior Clusters In young people, drug abuse often co-exists with mood disorders, behavioral problems at school or the job, and anti-social behaviors. As Miller and Carroll remind us, the same is true of adults. Family violence, health problems, unemployment, and child neglect are frequently associated with cases of active addiction. 7. There Are Identifiable and Modifiable Risk and Protective Factors for Problem Drug Use "It is clear that heredity contributes to risk for alcohol problems, and evidence is mounting for genetic predispositions for or against other drug use" (p.299). 8. Drug Problems Occur within a Family Context In addition to the evidence pointing to a direct genetic mode of transmission, parental drug use is also a risk factor. Anything that delays an addiction-prone young person from first use of alcohol or other drugs decreases the risk of long-term addiction. 9. Drug Problems Are Affected by a Larger Social Context "Social isolation is both a promoter and a consequence of the progression of drug dependence, and social bonding with nonusers can be an antidote" (p.301). 10. Relationship Matters In formal treatment settings, effectively matching counselor to client is crucial. Confrontational counselor styles are generally "countertherapeutic." Graphics Credit: University of Utah, Genetic Science Learning Center

Quest Diagnostics releases 2007 figures. Quest Diagnostics, the nation’s leading provider of employee drug testing services, reported a 22 percent drop in the number of U.S. workers and job applicants testing positive for methamphetamine last year. The percentage of positive tests for cocaine fell 19 percent in the same period—the largest single-year decline since 1997, the company reported. Overall, drug test positives were at an all-time low (see chart). The company said 3.8 percent of employees had tested positive for drug use in 2007, compared to a high of 13.6 in 1988. Quest Diagnostics based its conclusions on a summary of results from more than 8 million workplace drug tests the company conducted in 2007. The data include pre-employment, random, and for-cause testing. The primary test population included federally mandated testing of “safety-sensitive” workers such as pilots, truck drivers, and employees at nuclear power plants It is not immediately clear what conclusions can be drawn from the Quest Drug Testing Index. Do the results indicate a falloff of stimulant use, or are they a reflection of scarcities of supply?The DEA was quick to jump in and claim the latter: “The fact that America’s workers are using cocaine and methamphetamine at some of the lowest levels in years is further evidence of the tremendous success that law enforcement is having at impacting the nation’s illicit drug supply,” Drug Enforcement Administration (DEA) Acting Administrator Michele Leonhard said in a press release.   In the same press release, Dr. Barry Sample of Quest Diagnostics, citing figures that show a 5 percent increase in the use of all forms of amphetamines last year, said: “Although some may conclude that there is a reduced availability for methamphetamine, the fact that our data show an increase in amphetamines suggests that some workers might be replacing one stimulant drug for another in the larger drug class of amphetamines.” It is also unclear whether or not the lower numbers reflect greater employee awareness of drug testing, and greater knowledge of methods for finessing the testing system, such as a crash course of abstinence when testing is considered likely. Moreover, drug testing remains a controversial practice. Critics maintain that the costs of drug testing far exceed the benefits of identifying a very small percentage of workers with testing procedures that are not always and inevitably reliable. In a review of a report on drug testing by the National Academy of Sciences in 1999, the American Civil Liberties Union (ACLU) concluded: “There is as yet no conclusive evidence from properly controlled studies that employment drug testing programs widely discourage drug use or encourage rehabilitation.” According to the ACLU, the federal government spends more than $77,000 dollars for each positive drug test, when overall costs of the federal government’s drug testing program are taken into consideration. Graphics Credit: Market Wire

1 out of 100 Americans now in jail. For the first time in American history, according to a study released by the Pew Center on the States, more than one in every 99.1 adult men and women are now in prison or in jail. States spent a total of $49 billion on prisons in 2007, compared to $11 billion 20 years ago. The United States incarcerates a larger percentage of its population than any other country. China ranks second. “For all the money spent on corrections today, there hasn’t been a clear and convincing return for public safety,” according to Adam Gelb, director of the Pew Center’s Public Safety Performance Project. The report says that higher incarcerations rates have not been caused by increased crime or a corresponding surge in population numbers. Rather, stricter sentencing policies, such as “three-strikes” laws, as well as longer sentences, are behind the surge. A PDF version of the full report is available here. A Newsweek article by Claudia Kalb notes that the number of drug offenders in the federal prison system leaped by 26 per cent between 2000 and 2006. In addition, more than one out of every three women in prison are serving time for drug-related crimes. In 2000, fed-up California voters passed Proposition 36, designed to steer nonviolent drug offenders into treatment and job training programs--but funding has been precarious. Other states, including Texas, have resorted to specialized drug courts and greater drug treatment efforts to cope with the overflow of drug addicts in the legal system. As John Whitmire, a Texas State Senator, told the New York Times (Reg. required), “we weren’t smart about nonviolent offenders. The [Texas] Legislature finally caught up with the public.” The Pew study reveals that addiction is as firmly criminalized as ever. The compressed essence of the war on drugs is simply to put as many people in jail as possible. Obviously, long prison terms will not cure addicts of their condition, any more than long prison terms for diabetics would cure that condition. As a forced cold turkey treatment for addiction, perhaps some would view prison as harsh but necessary. Yet drugs are known to be widely available within the nation’s federal prison system. As an inmate in an Oklahoma federal prison wrote in a letter to Time magazine: “If the Government cannot stop people from using drugs in a few fenced-off acres over which it has total control, why should Americans forfeit any of their traditional civil rights in the hope of reducing the drug problem?” The Sentencing Project, a Washington-based group that promotes alternatives to jail time, said recently that as of 2002, 45 per cent of all drug arrests were for marijuana. Simple possession is the rule--only one-sixth of the imprisonments involved charges of marijuana trafficking. According to Reuters, the latest drug czar, George W. Bush’s man John Walters, alluded to new research showing that “marijuana use, particularly during the teen years, can lead to depression, thoughts of suicide and schizophrenia.” Even assuming this dubious statement to be true, it would seem to argue against prison and in favor of treatment. The American criminal justice system cannot support the burden of a continual flood of minor drug possession cases. Plea-bargaining—the accommodation that keeps the legal edifice afloat—becomes the rule of the day. The legal system would break down in gridlock if every drug defendant insisted on his constitutional right to a jury trial. Prison sentences are bartered and sold like pork futures, and the jury trial has become an unaffordable luxury. For those accused of drug possession, pleading innocent sometimes looks like a risk they cannot afford to take. Drug prohibition itself is a major part of the reason why the more potent and problematic refinements of plant drugs keep taking center stage. Since crack cocaine is more potent, more profitable, and more difficult to detect in transit, it replaces powdered cocaine, which, in its turn, replaced the chewing of cocoa leaves. Just as bootleggers switched from beer to hard liquor, so international drug dealers switch from cannabis to cocaine whenever the U.S. enforcement engine lumbers off in the direction of marijuana interdiction and eradication. If addicted crack dealers sometimes receive stiffer sentences than wanton murderers (and they do), then it is a double irony, since people convicted of drug offenses are often good candidates for rehabilitation. However, public treatment programs are overbooked, and private programs are out of reach for those with little or no health insurance. Photo Credit: California Dept. of Corrections and Rehabilitation

Researchers from the Howard Florey Institute in Melbourne have identified a factor that may contribute towards the development of heroin addiction by manipulating the adenosine A2A receptor, which plays a major role in the brain’s ‘reward pathway’.Using mice specifically bred without the adenosine A2A receptor, Prof Andrew Lawrence and his team showed that these mice had a reduced desire to self-administer morphine; heroin is converted to morphine in the body.

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Addiction, Volume 0, Issue 0, Page ???, February 2004.

ABSTRACT Aims  In this exciting era of gene discovery, we review evidence from family, adoption and twin studies that examine the genetic basis for addiction. With a focus on the classical twin design that utilizes data on monozygotic and dizygotic twins,… (Source: Addiction)

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