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We must kick our methadone habit

It is unusual for politicians to face up to the obvious, but the Scottish Executive seems for once to have done so: it has recognised what has long stared it in the face, namely that dishing out methadone to drug addicts is not the answer to their problems or to the problems that they cause society. A different approach is needed.

Perhaps in 100 years historians will wonder why so many of the governing elite, from senior doctors to Cabinet ministers, persisted for so long in the belief that doling out methadone was the answer. The explanation, I think, will be that they wilfully misunderstood the nature of the problem.

Many years ago I used to dole out methadone like the best (or the worst) of them. This was before I thought at all deeply about the question of drug addiction and accepted uncritically all that I had been taught about it by doctors senior to me. I began to change my opinion when I worked in prison where it was the clinical policy to give addicts methadone. I noticed that, far from creating an atmosphere of contentment and satisfaction, it created one of perpetual tension and irritation. Shortly after having been prescribed a dose, the prisoner would return and say, in an intimidating fashion: “It's not holding me, doc, it's just not holding me,” and sometimes announce that, unless he was prescribed more, he would end up attacking other prisoners, and then it would be the doctor's fault.

In Scotland the great majority of addicts prescribed methadone by their doctors never stop taking it, and most of them take other drugs as well. A particularly dangerous combination of drugs is methadone and benzodiazepines (drugs such as Valium), and yet drug clinics and other doctors persist in prescribing this often fatal combination - largely, I suspect, because they are too frightened of their patients to refuse them anything.

The number of people admitted to hospital having taken a dangerous overdose of methadone (556 in 2006-07) is greater, proportionately, than the number of people admitted to hospital having taken a dangerous overdose of heroin (1,530 cases). In Dublin recently, more people have died of methadone poisoning than of heroin overdose. The supposed cure causes as many problems as the supposed disease. If addicts prescribed methadone are given the opportunity to divert it on to the black market, they will: which suggests that they do not really need it in the first place.

In France, addicts are often prescribed a different drug, buprenorphine, which soon became the street drug of preference in Finland, to which it was illegally re-exported by the addicts. More recently, a huge epidemic of buprenorphine addiction has occurred in Georgia (the ex-Soviet republic), numbering scores of thousands of addicts, who take buprenorphine diverted from France. If the addicts really needed the drugs, they would take them rather than divert them on to a black market.

In the prison in which I used to work, a buprenorphine tablet that had been prescribed for an addict to alleviate the symptoms of withdrawal from heroin on arrival in the prison, and which an addict had put in his mouth and spat out for sale to another prisoner, was known as a “furry” because of its rough surface. Again, this suggests that addicts did not really need what they were prescribed, and that the whole basis of prescription was flawed.

The fundamental error that the Scottish Executive has now admitted is in having regarded addiction to heroin as a technical medical problem, to be solved by technical medical means. But that old approach amounts to a surrender to blackmail: give me what I want or I will continue to behave badly and to hold you responsible for the ill-effects of my own behaviour.

Suppose we gave money to burglars to induce them to stop burgling. No doubt most of them would stop for a length of time depending upon how much we gave them. But this does not mean that money is the treatment of the dreadful disease of burglary, or because we prevented certain individuals from continuing to burgle it means that we had reduced the disease of burglary in society as a whole. Rather, we would have encouraged its spread.

This is precisely the logic that has been applied to drug addiction. Just how precisely is evident from the Government's recent declared policy that clinics should now give drug addicts money or other rewards for not taking drugs (as least as proved by drug-free urine samples, something experienced drug addicts have long learnt to provide). This is the first time in the history of medicine, so far as I know, that bribery has been considered a medical treatment.

Contrary to what everyone supposes, withdrawal from heroin is not a serious medical condition - unlike, say, withdrawal from alcohol when it results in delirium tremens (the DTs). The suffering is grossly exaggerated and, in so far as it is genuine, is largely produced by anticipatory anxiety that is itself the consequence of years of mythologising the fearsomeness of withdrawal.

Addiction to heroin is a medical problem only to a minor extent, which is why predominantly medical means will never solve the problem. Most of Britain's 300,000 addicts are drawn from broken families, have a poor education, are without much hope for (or for that matter fear of) the future and have no cultural life, intellectual interests or religious belief. Delusory euphoria - the paradise at three pence a bottle that De Quincey described in his Confessions of an English Opium Eater - is the best that they think that they can hope for in life. This is not a medical problem. Where addiction is concerned, it is time to throw physic to the dogs.
author: Theodore Dalrymple is a retired prison doctor and author of Junk Medicine: Doctors, Lies and the Addiction Bureaucracy

source: Times Online


Medical marijuana user files human rights complaint over smoking laws

Ontario regulations banning medicinal-marijuana users from smoking on bar and restaurant patios violate the human rights of people with disabilities, alleges an Ottawa man who has filed a complaint over the issue.

Russell Barth submitted the complaint to the Ontario Human Rights Commission on Monday on behalf of himself and his wife, Christine Lowe.

"We're not asking for special rights; we're just asking for the right to use cannabis where people use tobacco," Barth, an amateur comedian, said Tuesday.

The letter accompanying the complaint alleges that the Ontario ban "infringes on our rights to gain access to services and infringes on our ability to perform on stage and to seek possible future employment as performers.

"It has also caused us much stress, ill health, embarrassment and humiliation."

Barth said he obtained a Health Canada licence to use medical marijuana in 2003 after being diagnosed with a variety of disorders, including post-traumatic stress syndrome, asthma and fibromyalgia, a syndrome characterized by fatigue and multiple pain points in muscles throughout the body.

He lives on a disability pension and is a full-time care giver for Lowe, who has epilepsy and also uses medical marijuana.

Barth said he needs the drug every two to three hours to treat his own medical symptoms.

"If I am having a muscle spasm, if I'm having nausea or anxiety or an asthma attack, I need to have my medicine immediately," he said.

On May 7, after performing at the amateur night of a comedy club in Ottawa, Barth said he began to feel intense pain in his legs and went outside to the outdoor patio area, where people were smoking tobacco.

He walked to the edge of the patio and was about to light up a joint when he was approached by a friend who worked at the comedy club. The staffer asked him not to smoke on the premises because of provisions of the Ontario Liquor Licence Act that ban liquor-licence holders from allowing people to consume a controlled substance on their property.

Afterward, a friend suggested that the incident was the fault of the government's regulations, not the bar owner.

Barth read the regulations and agreed that was the case.

Ontario law has no exemption for medical marijuana

Lisa Murray, a spokeswoman for the Alcohol and Gaming Commission of Ontario, said there is no provision or exemption for the use of medical marijuana in the regulations on controlled substances as they are currently written.

Under Health Canada's medical marijuana rules, people who possess marijuana for medical use must follow all other federal, provincial and municipal laws regarding controlled substances.

"Smoking marijuana for medical purposes in a public setting, thereby potentially exposing others to the drug's effects, is unacceptable," states a federal government document on the issue. "The authorization simply allows possession but does not give patients permission to use marijuana wherever or whenever he/she chooses; the rights of others must also be considered."
source: Canadian Broadcasting Corporation


Adult ADHD 'linked to lost work'

Adults with attention deficit hyperactivity disorder do 22 fewer days of work per year than people who do not have the condition, a study says.

The research, which looked at 7,000 workers in 10 countries, found an average of 3.5% had ADHD.

Writing in Occupational and Environmental Medicine, the Dutch team said workplace screening should be used to pick up people with the problem.

A UK expert backed the idea, but warned they should not be stigmatised.

It's important that ADHD isn't stigmatised as many people with the condition can hold down jobs
Professor Philip Asherson, Institute of Psychiatry

People who have ADHD find it difficult to concentrate because they may be hyperactive, easily distracted, forgetful or impulsive.

It is commonly thought of as a childhood disorder, often picked up because of problems at school.

However, there are estimates that around two-thirds of those affected in childhood are still experiencing symptoms in adulthood.

More common in men

In the study, employed and self-employed workers aged 18 - 44 were screened for ADHD as part of the World Health Organisation World Mental Health Survey Initiative in Belgium, Colombia, France, Germany, Italy, Lebanon, Mexico, the Netherlands, Spain and the USA.

They were also asked about their performance at work in the last month.

Those results were extrapolated out to give annual figures.

Workers with ADHD were found to take an average of eight days off sick each year.

They also had, on average, 21 days where they did less work than they should have and 13 days where their work was of poorer quality - each of which was deemed to equate to half a day of lost performance.

ADHD was more prevalent in men and workers in developed rather than developing countries.

The study was carried out by a team who are part of a World Health Organization (WHO) research consortium at Harvard Medical School.

The team, led by Dr Ron de Graaf, said: "It might be cost-effective from the employer perspective to implement workplace screening programmes and provide treatment for workers with ADHD."

Professor Philip Asherson, an expert in adult ADHD at London's Institute of Psychiatry, said the condition did have an impact on people's timekeeping, their relationship with colleagues and the ability to focus on work.

He added: "ADHD should be included in general health screens, in the same way that people would screen for anxiety and depression. This is probably best done by GPs or occupational health departments.

"However, it's important that ADHD isn't stigmatised as many people with the condition can hold down jobs, or may be particularly good at certain tasks."
source: BBC Health News


Cigarette ban proposals welcomed

Plans to ban the open display of cigarettes in Scottish shops have been welcomed by the UK health secretary.

Alan Johnson said it was important to stop children from taking up smoking.

But he told BBC One's Andrew Marr show that Scottish Government plans to ban 10-packs of cigarettes would "have to be looked at".

Ministers last week announced a raft of plans to restrict and enforce tobacco sale in the drive to cut smoking - one of Scotland's biggest killers.

Other proposed measures, some of which would need the co-operation of Westminster, included tobacco licensing and a move to plain packaging for cigarettes.

Mr Johnson said the UK Government was considering similar moves.

He said: "Banning vending machines, where you can't have any control over the age of the person who's buying it, happened in many other European countries a long time ago, with startling results there."

The health secretary went on: "The ability to buy 10 cigarettes - I'm going to have to confess I started smoking very young when I was a kid, and you could get 10 woodbines, and you could get thrupenny singles.

Well they've taken thrupenny singles away. Whether you should still be able to buy 10 cigarettes or whether you should insist that you can only buy 20, that's an issue we need to look at."

It is two years since Scotland led the UK in banning smoking in enclosed public places, and six months since the legal age for buying cigarettes was raised to 18.

Mr Johnson's comments were welcomed by anti-smoking group Ash - but pro-smoking organisation Forest has dismissed the Scottish plans.

Smoking in Scotland is responsible for about 13,000 deaths and 33,500 hospital admissions each year at a cost of £200m to the health service.
source: BBC News


Half of women drink alcohol while pregnant

More than half of women drink alcohol while pregnant despite growing evidence that it can lead to low IQ, attention deficit disorders and more serious lifelong complications in children.

Older mothers are more likely to drink while pregnant than younger ones, the latest figures from the National Health Service show.

This has lead experts to fear the number of damaged children will grow as more women put off having a family.

Children born to mothers who drank while pregnant are more likely to grow up to have alcohol and drug problems, be excluded from school and have antisocial behaviour problems.

More than 8,500 under 18s were admitted to hospital because of their drinking in 2006/7 it was revealed on Thursday and a proportion of those are likely to have some degree of brain damage because of their mother’s drinking, experts said.

High flying women working as stockbrokers and traders in the City have called charity helplines after their children were diagnosed with Foetal Alcohol Spectrum Disorder, along with wives of MPs and members of the House of Lords, showing the problem is increasingly associated with middle class drinkers.

Damage to the child increases with the amount of alcohol drunk and the timing during the pregnancy. The full blown Foetal Alcohol Syndrome is the leading known cause of non-genetic intellectual disability in Western countries and causes severe learning difficulties, impaired intellect, certain facial characteristics and growth retardation.

Less severe damage is associated with hyperactivity, poor memory and planning skills, poor co-ordination and lower IQ, but this is often not recognised as associated with maternal drinking.

Last year the Department of Health revised guidelines to say women should not drink at all during pregnancy but if they choose to they should stick to one or two units once or twice a week and not get drunk.

Figures released by the NHS Information Centre revealed that 55 per cent of women in the UK admitted drinking alcohol while pregnant.

Of the women who drank before they conceived, only a third gave up alcohol altogether while pregnant and the rest said they cut down.

The survey also found 61 per cent of mothers aged 35 or over said they drank while pregnant compared to 47 per cent of those aged under 20.

Older mothers were also less likely to give up alcohol while pregnant.

Susan Fleischer, director of the charity National Organisation for Feotal Alcohol Syndrome, said women in powerful and male dominated careers had been calling their helpline after their children were diagnosed with the disorder.

She said these women were not alcoholics but had a regular habit of drinking with male colleagues and found it harder to stop while they were pregnant.

Ms Fleischer, who has an adoptive daughter with the condition, said: “Not all women who drink during pregnancy will harm their child but the only way to be sure is not to drink at all.

“Some of the children being admitted to hospital because of their own drinking will have brain damage caused by their mother’s drinking and there will be a smattering of middle class kids in there too.”

Survey by the charity Tommy’s in 2004 found one in four pregnant women drink between two and five units of alcohol a week, double the recommended weekly limit.

Reliable studies on the numbers of babies born affected by alcohol have not been carried out in the UK but in other European countries and in America and Canada it is estimated that between 20 and 40 children per 1,000 have feotal alcohol spectrum disorder and fewer have the full blown syndrome.
source: http://www.telegraph.co.uk


A Research On "Craving" Or The Intense Desire For Tobacco Establishes The Basis For Addiction Control

A research team from the University of Granada has carried out a study on the psychological process that triggers the "craving" or intense desire for tobacco, a study that could establish the bases to determine the brain mechanisms that activate this state and how to control them.

Miguel Ángel Muñoz García, from the Department of Personality, Evaluation and Psychological Treatment of the University of Granada has carried out this study, under the direction of the Professors Jaime Vila Castelar and Mª Carmen Fernández Santaella.

"Craving" is an expression used to define an uncontrollable desire for the administration or consumption of an addictive substance. It is usually used in situations of alcohol or nicotine dependence and it is considered as a pathology that affects cognitive resources, as it has an obsessive component.

The researchers of the University of Granada analysed, with the help of a device, 180 regular takers of an addictive substance (cocaine, in this case), to study the emotional mechanisms triggering the addiction for the substance. This study has helped to establish the behavioural mechanisms in cocaine addiction, and consists of the emotional control of different consumption situations.

These results have been the basis of a series of studies with smokers, in withdrawal for 8 hours, to measure the physiological and emotional variables present in withdrawal symptoms using a machine (a polygraph) to estimate the emotional mechanisms responsible for the addiction to that substance. The smokers were shown several images (48) connected with situations that produce desire (related with leisure, free time, coffee…), analysing the heart´s defensive cardiac response produced as well as the startle response. Lastly, brain modifications associated with emotional responses of frustration and impulsiveness in smokers in withdrawal were studied. This system was also used for regular smokers.

Miguel Ángel Muñoz García states that this research has studied for the first time behavioural mechanisms involved in the tobacco craving process determining the brain areas and body responses connected with the compulsive behaviour provoked by tobacco.
source: MediLexicon


Addiction –Dealing With It The American Way

A View from New York

Last Thursday I was invited to ‘Learning Thursday’, an addictions professionals’ seminar, at the New York State Office of Alcoholism and Substance Abuse Services. OASAS oversees the most diverse addiction prevention and treatment system in the US. It plans, develops and regulates the state’s system of chemical dependence and gambling treatment agencies and directly operates 13 addiction treatment centres providing inpatient rehab to 10,000 people a year. It licences, funds and supervises some 1,300 community based programmes which a further 115,000 people per day access and runs an inspection and monitoring division.

The session was led by the extraordinarily impressive Lureen McNeil, Director of Recovery Services and a former addict - she announced unblinkingly. She then described the female led families in which the addiction problem has now passed down through four generations, a profile that typifies New York’s addiction problem. In one appalling case history she showed the increasing vulnerability, psychological disturbance and dysfunction of each successive generation as final vestiges of familial support dissipated, how in the latest generation this has created the most difficult and disturbed cohort of young addicts they have ever had to help.

When the next speaker, Jackson Davis, the Director of the Recovery Network of New York, opened by stating that he too was a former addict, now in recovery for many years, my mind left his breakdown of criminal justice realities in the US: how many of his UK counterparts, I wondered, would be prepared to admit former addiction in public? And how, my mind went on, has continuing stigma and shame effected the development of policy in the UK? Is this what lies behind the continued dominance of ‘medico – clinical’ model of addiction and its negative connotations of a chronically relapsing disease? Has this view persisted because it has so rarely been openly challenged by those in positions of public authority but in private recovery? Is this ‘non recoverable’ view of addiction impregnable until doctors, treatment managers, counsellors and administrators or any other public figures, step forward and say, ‘yes, we too were addicts or yes, we too are in recovery, recovery is possible’?

For Jackson Davis and his federally funded Recovery Network the need to reduce the stigma of addiction is of first importance. And you can see why. Acceptance without examples is difficult. With examples it is inspirational. No wonder one professional there told me, “the recovery movement here is huge; we do not seem to make as big a deal about ‘abstinence’ versus ‘harm reduction’ as it seems the Europeans do.”

So while the UK remains locked in denial and a negative debate going nowhere, Lureen McNeil is charging ahead changing the social face of addiction in New York. Her goals are pragmatic - to reduce drug abuse, to improve patient’s ability to function and to minimize medical and social complications. If this means substitute prescribing for a while, she is all for it. But her goals are also aspirational. She will not be detracted from an overarching treatment goal of achieving lasting abstinence. She will not stop from communicating the message that recovery from addiction is peer based, not professionally directed by clinical services. She will not let pragmatism cloud her own experience and analysis of recovery – one that is primarily self defined and self directed.

Downtown Manhattan, at an inspired outpatient addiction treatment centre, I saw this philosophy in practice. The Director there was also a recovered addict. His mission ever since has been to help others reclaim their lives through a ‘non judgemental continuum of programmes and care’ and which represent a synthesis between ‘engaging’ clients (by giving them access to primary and mental health care, viral testing, medication and needle exchange) and ‘the therapeutic community”. I saw this symbolic and practical link in action - the clinic and nurses at one end of the blue and lavender painted building which connected by a corridor to peer led, abstinence based recovery programmes going on at the other. In one of them the men and women in the circle explained what the centre meant to them, the therapeutic effect for their recovery of seeing people everyday they knew and who understood them. They told of how this substituted for the families and supportive relationships they had never had.

This centre now has over 8,600 graduates from its recovery programme, employs 40 full time staff and has state funding to the tune of five millions dollars to run it and significant freedom to decide its own methods and programmes. A far cry from the UK’s state directed hegemony.
source: policystudies.cps.org.uk


Fun at 21?

Drinking to excess on one's 21st birthday has become a tradition on campuses nationwide. Tragically, some don't live to regret their binge.

When a young woman enters a bar wearing a glittery crown and a beauty-queen sash, bartenders know what to do: Pour a free shot; someone's turning 21.

"They're very eager," said bartender John Cordas of the Ugly Tuna Saloona near the Ohio State University campus. "You can always tell, because they come in with a group of friends (who) sit at the bar and take turns buying shots for that person."

Those turning 21 arrive at the Saloona nightly at midnight, but few try to drink their age in shots, a fad glorified in drunken videos on YouTube and MySpace.

"I've only seen one kid try it, and he didn't get very far before he got pretty sick," Cordas said. "After eight or nine shots, you're pretty drunk."

Twenty-one shots, at 1.5 ounces a glass, would be more than a fifth of liquor.

Every year, 21-year-olds drink themselves to death.

"It's probably the most dangerous drinking occasion for students," said Steven W. Clarke, director of the Campus Alcohol Abuse Prevention Center at Virginia Tech.

Clarke has studied 21st-birthday celebrations to determine why they encourage excessive drinking and how to make them less dangerous.

Free drinks are a major contributor to the problem, he found. Bars often give a free shot or drink to the newly legal, and then friends start buying the booze.

"College students don't typically buy drinks for each other, so they feel it would be rude not to consume them," Clarke said.

New drinkers also drain their glasses quickly, he said. They often start at midnight and try to down as many drinks as they can before the bar closes at 1 or 2 a.m.

Two states have found the practice so alarming that they outlawed it. Bars in Minnesota and North Dakota can't serve 21-year-olds until 8 a.m. on their birthday.

Ohio State junior Jeffy Mai said he doesn't know anyone who drank "21 at 21," but he said drinking on your 21st birthday is "a big thing" on campus. When he turned 21 in December, his friends bought all the drinks, he said. He drank enough to do a "weird chicken dance" at Hooters.

Toben Nelson, an assistant professor of epidemiology at the University of Minnesota, said about 1,700 college students die each year of alcohol-related causes. About 300 of those deaths are from falls or alcohol poisoning, he said.

At least two 21-year-olds have died in Franklin County from drinking too much on their birthdays, according to the coroner's office.

OSU student Adam Boncela had a blood-alcohol content of 0.37 percent when he died on July 25, 2005; that's the equivalent of drinking about 18 shots in two hours. Blackouts and nausea are common with a blood-alcohol content of 0.16 percent to 0.19 percent; death can occur at a level of 0.30 percent.

Ohio University junior Nathan A. Roberts of Findlay died of acute intoxication in a house near Ohio State after drinking heavily on his 21st birthday in 2001. His blood-alcohol content was 0.36 percent.

One way to reduce deaths is for bars and servers to be more accountable, said Nelson, who has written extensively about student drinking.

"There are laws about not serving someone who's obviously intoxicated, but they're rarely enforced," he said. "We've done studies by having people go into bars and act intoxicated, and three-fourths of the time they're served alcohol."

Ohio State sends an e-mail to students about to turn 21. The message is from the sister of OSU student Joey Upshaw, who died after ingesting drugs and alcohol in 2000. Erica Upshaw urges students: "Be careful on your 21st birthday" and "do not feel like you have to take 21 shots."

But Virginia Tech's Clarke said such warnings have "no significant effect" on how much students drink.

"We also tried weekly e-mails for four weeks before their birthdays, and that had no significant effect, either," he said.

Parents should encourage their children to take charge of their birthday celebration, Clarke said.

"Set a specific limit on drinks or the amount of time you're drinking," Clarke said. "Friends will be saying, 'We're going to take you out and get drunk.' It's your birthday. You'd think you could take control."
source: Columbus Daily Dispatch


Alcoholism is under-diagnosed. Why? It’s a hard subject to raise.

Whether their beverage of choice is a full-bodied red or an ice-cold Blue, Canadians love to drink. In fact, according to the most recent figures from the Canadian Centre on Substance Abuse (CCSA) in Ottawa, alcohol is the psychoactive substance of choice for nearly 80 per cent of the population over the age of 15. Most people tend to drink moderately—consuming one or two drinks a day, doctors say, is healthy. But others frequently drink a very unhealthy four or five drinks at a sitting. The CCSA puts that number at about seven per cent of the population, or 2.3 million people. “And if that doesn’t appear high,” says Doug Beirness, a senior CCSA analyst and a scientist, “the problems caused by those people are huge.” Not only do alcoholics lose jobs and destroy relationships, they cost our medical system untold millions in the treatment of alcohol-related diseases. Alcohol, say experts, goes to every cell in the body and can result in neurological and gastrointestinal disorders, high blood pressure and a whole raft of psychiatric illnesses including depression.

In Canada, certainly, selling alcohol is a booming business. During the fiscal year ending in March 2006, beer and liquor stores and their agencies reported sales of more than $17 billion worth of alcoholic products, up more than $1 billion in just two years. Says Dr. Peter Selby, the clinical director of addiction programs at the Centre for Addiction and Mental Health in Toronto, “Does that mean more people are drinking or people are drinking more? It could be both.”

Exactly who is drinking and how much, however, is a tricky thing to document, especially since any sort of survey depends on honest answers from the drinkers themselves. According to the latest Canadian Addiction Survey, released in 2004, those most likely to have a drinking problem fall into a number of different categories. Overall, people who are male, young, divorced, separated or widowed, have a good education and a high income, are likely to drink, but those who abuse alcohol tend to be less educated, young singles. Still, those findings aren’t hard and fast—they are “self-reported,” Beirness says.

This spring, Health Canada began a new Canadian Alcohol and Drug Use Monitoring Survey (CADUMS). It relies on questions and answers over the telephone to determine the prevalence, incidence and frequency of alcohol, cannabis and other drug and substance use in the Canadian population aged 15 years and older in order to measure the extent of associated harms. Will the 10,800 respondents answer honestly? “Sales data tells us more alcohol is being sold than people tell us they are drinking,” says Beirness. “And people are not buying it and pouring it down the drain.”

One thing experts are sure of, though, is that alcoholism is being under-diagnosed by Canadian doctors, probably because it’s a hard subject to raise. “The stigma has gone down for depression,” Selby says. “But doctors don’t feel comfortable about asking their patients how much they drink for fear of offending them.” This is unfortunate, Selby adds, because “there is good evidence that a brief intervention by a physician can help people who are drinking too much cut down.” In this Selby has support from the CEO of the most famous addiction treatment centre in the world, the Betty Ford Center in Rancho Mirage, Calif., Dr. Garrett O’Connor.

O’Connor points to a 2002 Columbia University study that said turning to a family doctor may be “a missed opportunity.” Says O’Connor, “It’s a terrible tragedy. It’s been shown in England that even a 10- to 15-minute chat with a patient can be almost as good as treatment in terms of helping people to stop drinking and stay sober for up to 18 months.” O’Connor himself is a recovering alcoholic, and, he says, the only person who ever suggested he might have a problem was a dentist. Plus, O’Connor says, many alcoholic patients are ambivalent—it’s like they want to get help and not get help at the same time.

But when it comes to stopping alcoholism in its tracks, experts say, someone in the medical profession should catch it in the very young before it becomes entrenched. Increasingly, studies are showing that some children as young as 11 or 13 are already alcoholics, and that the younger a child is when he begins to drink, the higher his risk of becoming addicted. It may be that adolescent drinking actually alters the growing brain. Says Selby: “That’s why a lot of people say if you can delay consumption until early adulthood, you can reduce the risk. Maybe the developing brain just learns more quickly.” Or maybe the brain’s pathways are altered.

A recent study done at Wake Forest University in Winston-Salem, N.C., on brain tissue samples taken from the superior frontal cortex (part of the brain that involves feelings of desire and reward) in chronic alcoholics post-mortem reveals that changes occur at the molecular level. In other words, the brain was irreparably altered. Even that is not wholly new. As far back as 2000, researchers at the University of Texas studying the same part of the brain discovered that chronic alcohol abuse changed its programming and corrupted decision-making and judgment. Still, Selby thinks addiction is both nature and nurture. “The more genetically disposed you are, the higher the chance that you will start drinking sooner,” he says. “And if the pattern in the home is drink to get drunk, rather than as part of a meal or a social lubricant, that will prime a developing brain.”

Whatever the cause, experts like Beirness say drinking tends to go in waves and right now Canadians are at a peak. But anyone looking to lay the blame on the boomers will have to look somewhere else, he says. “As people get older, they do tend to drink more frequently—but they consume less quantity. It’s a very complicated issue.” Adds O’Connor, “The most interesting statistic to me is that of the 23 million people in the U.S. right now who have a problem and don’t get treatment, 97 per cent of them don’t think they need it.”
source: Maclean's


Excess Drinking Boosts Cardiovascular Disease Risk

While research suggests that moderate alcohol consumption may have health benefits, heavy drinking increases blood pressure, stiffens blood vessels and causes more rigid heart muscles in men and enlarged hearts in women -- all risk factors for cardiovascular disease, a new study warns.

Men who drink more than 21 units of alcohol per week and women who drink more than 14 units of alcohol a week put themselves at serious risk for hypertensive heart disease, heart failure and stroke, the researchers found.

"These shocking findings illustrate the extreme risks that heavy drinkers are exposing themselves to -- some of which are particularly pronounced in women," lead investigator Dr. Azra Mahmud, a cardiovascular lecturer and hypertension specialist at the Trinity Centre for Health Science, St. James Hospital, Dublin, Ireland, said in a prepared statement.

"We want to make sure people aren't getting mixed messages about alcohol. The potentially fatal effects of heavy drinking may more than counteract the well-documented benefits of sensible alcohol intake," Mahmud said.

The study included 100 women and 100 men (mean age 46, all healthy) who were divided into three groups: non-drinkers, moderate drinkers (males, less than 21 units of alcohol per week; females, less than 14 units per week) and heavy drinkers (males, more than 21 units per week; females, more than 14 units per week).

The participants underwent a number of tests including ultrasound of heart to assess arterial stiffness and pulse wave velocity to measure aortic blood pressures and wave reflections in the aorta.

The results showed that heavy drinking is associated with arterial stiffening and impaired left ventricular (LV) relaxation in males, and LV structural changes, including LV enlargement (hypertrophy), in females. Of special note, women who were heavy drinkers had an enlarged heart even without high blood pressure or stiff arteries.

"The excessive consumption of alcohol causes significant arterial and ventricular stiffening and an enlarged heart; factors associated with poor cardiovascular outcomes in hypertensive populations," Mahmud said. "Trends in heavy drinking continue to rise, and it is high time to recognize the potential of an alcohol-induced epidemic of cardiovascular disease. Binge and heavy drinkers must consider their behavior and control their intake before it's too late."

The study was expected to be presented Wednesday at the American Society of Hypertension annual meeting, in New Orleans.

Cardiovascular disease (CVD) is the leading cause of death worldwide. About 17.5 million people die from CVD each year, and that toll could increase to almost 20 million by 2015.
source: Health Day


72 Percent of Men Drink Alcohol Every Day

Seven out of 10 Korean males and three out of 10 females drink alcohol every day, a survey showed Monday. About 8 percent of them drink an average of 40 grams of alcohol per session, equivalent to five glasses of soju distilled alcohol made from grain a day.

According to Prof. Park Jong-tae and Chung Hyung-jun of Korea University medical Center, about 72 percent of 3,578 male respondents and 32 percent of 4,298 female respondents in Korea drink alcohol seven times a week.

The older or the less educated they were, the chances of their drinking heavily were higher. In the case of males, the earlier a man started to drink, the more often he drank. The researchers also found that those who tend to binge drink were also more likely to drink often.

The drinkers themselves often perceived their drinking as a problem _ about 27 percent of men and 12 percent of women answered that they have a serious drinking problem.

Both groups said they feel they should quit drinking; are always being criticized for it; feel guilty about their drinking behavior; or always have to eat something to deal with a hangover.

'In Canada, only about 5.8 percent said they had a problem with drinking in a similar study. Now that people know it is a problem, society should help them solve it,' Park said.

Drinking has been a major concern in Korea for quite a long time. According to the National Tax Service, about 3.29 million kiloliters of liquor were consumed here last year, up 3.8 percent from 2006. The figure is equivalent to 72 bottles of soju or 107 bottles of beer per adult.

According to the Korea Center for Disease Control and Prevention, drinking eight or nine glasses of soju can double the risk of hypertension or diabetes.

The center suggested in 2005 that at most a man should drink less than two glasses of soju, and a woman one glass three times a week.

source: Korea Times


Binge Drinkers Think They Can Drive Drunk

A study of U.S. college students found that binge drinkers, even when legally intoxicated, believe they having adequate driving abilities.

"Binge drinkers are individuals who, when they drink, typically drink to get drunk," first author Cecile A. Marczinski of Northern Kentucky University said in a statement.

Study participants were 20 male and 20 female social-drinking college students -- 24 binge drinkers, 16 non-binge drinkers -- ages 21 to 29. All participants attended two sessions: one during which they received a moderate dose of alcohol, 0.65 g/kg, and one during which they received a placebo.

Following each session/dose, researchers measured the students' performance during a simulated driving task, and also measured their subjective responses, including ratings of sedation, stimulation and driving abilities.

"After being given an intoxicating dose of alcohol, all of these individuals -- both binge and non-binge drinkers -- were very poor drivers when tested on a driving simulator," Marczinski said. "However, when all of the participants are asked to rate their driving ability, the binge drinkers reported that they had a greater ability to drive compared to the non-binge drinkers."

The findings are scheduled to be published in the July issue of Alcoholism: Clinical & Experimental Research and is available online.
source: United Press International


Book Review: Toast To a Tippler

Alcoholism is among the most savage, heart-breaking and destructive of all forms of entertainment. Its awful legacy includes sundered families, highway fatalities and "Arthur 2: On the Rocks." But Kingsley Amis's drunkopedia "Everyday Drinking" renews one's faith in the bottle. How bad can it be to tuck away five glasses of wine and a couple of belts of Scotch on a Saturday night, one wonders, when the King did worse on a Tuesday afternoon (and lasted an above-average 73 years)?

The newly-collected volume of Amis columns and essays about how (and, crucially, why) to drink does not lack for authority. Amis was not just a tippler but a "drink-ist," in the formulation of fellow specialist Christopher Hitchens, who provides an introduction and an (invaluable, to Americans) glossary. (Poteen, Hitchens says, is "an aggressive species of Irish moonshine," while dipsography is "writing about drinking (in reverse of the more common practice)."

I'll go a step further than Hitchens: Amis was an alcoholite. In this (of course) bar-sized book you will find no nonsense about the dangers of crawling into the bottle but brisk advice on how to make yourself comfortable there. There are chapters on the boozer's diet (cut back on solids), a recipe for a morning pick-me-up ("an excellent heartener and sustainer at the outset of a hard day, when you have in prospect one of those grueling nominal festivities like Christmas morning, the wedding of an old friend of your wife's or taking the family over to Gran's for Sunday dinner") and maintenance of the hangover.

This last is helpfully divided by Amis into the P.H. (physical hangover) and the M.H. (metaphysical hangover). Other day-after analysts, Amis astutely notes, "omit altogether the psychological, moral, emotional, spiritual aspects: all that vast, vague, awful, shimmering metaphysical superstructure that makes the hangover a (fortunately) unique route to self-knowledge and self-realization."
source: New York Post


India's alcohol production increasing

India is one of the largest producers of alcohol in the world and there has been a steady increase in its production over the last 15 years, according to fresh statistics.

India is a dominant producer of alcohol in the South-East Asian region with 65 per cent of the total share and contributes to around seven per cent of the total alcohol beverage imports into the region.

More than two-thirds of the total beverage alcohol consumption within the region is in India, according to figures in the newly compiled Alcohol Atlas of India.

There has been a steady increase in the production of alcohol in the country, with the production doubling from 887.2 million litres in 1992-93 to 1,654 million litres in 1999-2000 and was expected to treble to 2300 million litres by 2007-08.

The prevalence of alcohol use is still low in India as per some studies done across the country. The consumption is two litres per person per year.

However, though the overall consumption is low, patterns of alcohol consumption vary throughout the country. Punjab, Andhra Pradesh, Goa and Northeastern states have much higher proportion of alcohol consumption in the country.

Women tend to drink more in Assam, Arunachal Pradesh, Sikkim in the North East and Madhya Pradesh, Chhattisgarh, Orissa and Andhra Pradesh in the rest of the country.

The statistics show an extreme gender difference in patterns of consumption of alcohol.

Prevalence among women has consistently been estimated at less than five per cent but is much higher in the northeastern states.

Significantly higher use has been recorded among tribal, rural and lower socio-economic urban sections. The unrecorded consumption and expenditure on alcohol still remains high in India as in other South East Asian countries such as Sri Lanka and Myanmar.

A substantial portion of family income is spent on alcohol, more so in rural households, which also tend to be poor and marginalised (32 per cent urban and 24 per cent rural).

The statistics also show that alcoholism increases suicidal tendencies, incidents of domestic violence and affects the ability of a person to concentrate at work.

A study conducted by the NIMHANS, Bangalore and sponsored by the World Health Organisation shows that 20 per cent of women reported domestic violence and 94.5 per cent of women identified their husband's alcohol consumption as a significant risk factor in incidents of domestic violence.

The study shows that people indulging in alcohol use are much more likely to skip work and college as well as indulge in gambling and lottery.

While non-users of alcohol missed going to college or work 13.8 per cent of the time, users skipped work and college 33 per cent of the time.

It also found that alcohol and crime are closely related.
source: http://www.financialexpress.com


Treatment centre closer to home

The Ottawa area will be getting two residential drug treatment centres for youth between the ages of 13 and 17, says the chief executive of the Champlain Local Health Integration Network.

The long-awaited plan, which will goes before the health network board for approval on May 28, calls for a 15-bed residential facility for English-speaking youth on the west side and a separate five-bed facility for francophone youth on the east side.

The program already has strong support from the province, the city and police Chief Vern White, Dr. Robert Cushman said in an interview yesterday. "It's gonna happen."

As it stands, there are no residential treatment facilities in the region for youth under the age of 16. Some addicted young people are sent to Thunder Bay and even farther away for treatment.

Community leaders have been pushing for a youth residential facility for about 20 years and a handful of plans have never come to fruition. In June 2006, for example, then-mayor Bob Chiarelli said he would ask fellow councillors for support to buy the former Rideau Correctional Centre near Burritts Rapids and convert it into a treatment centre. The proposal never coalesced.

The treatment centre, as outlined yesterday, is scaled down from earlier plans, which called for as many as 48 beds. The most recent report, delivered only last month, considered a 28-bed model.

Dr. Cushman said the new model is even smaller because the centre can't sacrifice quality. Research shows that the best residential programs result in a success rate of up to 80 per cent. This is what the Champlain region should aim for, he said.

That means the program must invest in the best interventions and staff and have supports in the community for youth when they return home from the residential program.

"You don't just want to parachute these kids back into the community," said Dr. Cushman. "It's better to start with a few beds and do it right and build it over time."

Although there has been no cost suggested for buying or renovating facilities to house the centres, the cost of running the residential program is estimated at more than $2 million a year, which would come from health network's budget for addictions and mental health.

The health network is considering a Carp Road facility as the west-side location. The building is currently used by the Royal Ottawa Health Care Group as the Meadow Creek adult addiction centre, but the program is scheduled to be moved into Ottawa this summer, said Dr. Cushman.

The youth program is to accept about 80 teens a year, each for a stay of about 90 days. Dr. Cushman estimates that triple that number of addicted teens would benefit from a residential program.

Pauline Sawyer, executive director at the Alwood Treatment Centre, said the residential facility with 14 beds for 16- to 22-year-olds near Carleton Place has a waiting list that is three to six months long.

"There's a huge need for beds for those 16 and under," she said. "We've been waiting for this for 15 or 20 years."

Mike Beauchesne, executive director of the Dave Smith Youth Treatment Centre on Bronson Avenue, said there may be considerable pent-up demand for the program because nothing like it has been available before.

He has sent teens as far away as Manitoba for treatment, which he admits is not an optimum solution because they are so far from their families. "We're seeing kids come through the door who commence use at 12 or 13 years of age."

While the number of beds in this proposal is smaller than the original plan, the important thing is that the centres are being established, he said.

"I can't say at this point that it is a fait accompli," said Mr. Beauchesne. "It looks good. I'm not ready to pop the champagne yet."

Dr. Cushman says youth addiction has been the "orphan" of health care. Although he can't explain why little has been done about establishing a residential program for drug-addicted youth, despite decades of effort, he says he should be held responsible for his term as head of the health network.

"What we're doing is building a foundation. We want to build from there."
source: © The Ottawa Citizen 2008