Archive for November, 2011
By MICHAEL D. LEMONICK Thursday, July 05, 2007
I was driving up the Massachusetts Turnpike one evening last February when I knocked over a bottle of water. I grabbed for it, swerved inadvertently–and a few seconds later found myself blinking into the flashlight beam of a state trooper. “How much have you had to drink tonight, sir?” he demanded. Before I could help myself, I blurted out an answer that was surely a new one to him. “I haven’t had a drink,” I said indignantly, “since 1981.”Read more: http://www.time.com/time/magazine/article/0,9171,1640436,00.html#ixzz1f3lBA1wS
It was both perfectly true and very pertinent to the trip I was making. By the time I reached my late 20s, I’d poured down as much alcohol as normal people consume in a lifetime and plenty of drugs–mostly pot–as well. I was, by any reasonable measure, an active alcoholic. Fortunately, with a lot of help, I was able to stop. And now I was on my way to McLean Hospital in Belmont, Mass., to have my brain scanned in a functional magnetic-resonance imager (fMRI). The idea was to see what the inside of my head looked like after more than a quarter-century on the wagon.
Back when I stopped drinking, such an experiment would have been unimaginable. At the time, the medical establishment had come to accept the idea that alcoholism was a disease rather than a moral failing; the American Medical Association (AMA) had said so in 1950. But while it had all the hallmarks of other diseases, including specific symptoms and a predictable course, leading to disability or even death, alcoholism was different. Its physical basis was a complete mystery–and since nobody forced alcoholics to drink, it was still seen, no matter what the AMA said, as somehow voluntary. Treatment consisted mostly of talk therapy, maybe some vitamins and usually a strong recommendation to join Alcoholics Anonymous. Although it’s a totally nonprofessional organization, founded in 1935 by an ex-drunk and an active drinker, AA has managed to get millions of people off the bottle, using group support and a program of accumulated folk wisdom.
While AA is astonishingly effective for some people, it doesn’t work for everyone; studies suggest it succeeds about 20% of the time, and other forms of treatment, including various types of behavioral therapy, do no better. The rate is much the same with drug addiction, which experts see as the same disorder triggered by a different chemical. “The sad part is that if you look at where addiction treatment was 10 years ago, it hasn’t gotten much better,” says Dr. Martin Paulus, a professor of psychiatry at the University of California at San Diego. “You have a better chance to do well after many types of cancer than you have of recovering from methamphetamine dependence.”
That could all be about to change. During those same 10 years, researchers have made extraordinary progress in understanding the physical basis of addiction. They know now, for example, that the 20% success rate can shoot up to 40% if treatment is ongoing (very much the AA model, which is most effective when members continue to attend meetings long after their last drink). Armed with an array of increasingly sophisticated technology, including fMRIs and PET scans, investigators have begun to figure out exactly what goes wrong in the brain of an addict–which neurotransmitting chemicals are out of balance and what regions of the brain are affected. They are developing a more detailed understanding of how deeply and completely addiction can affect the brain, by hijacking memory-making processes and by exploiting emotions. Using that knowledge, they’ve begun to design new drugs that are showing promise in cutting off the craving that drives an addict irresistibly toward relapse–the greatest risk facing even the most dedicated abstainer.
“Addictions,” says Joseph Frascella, director of the division of clinical neuroscience at the National Institute on Drug Abuse (NIDA), “are repetitive behaviors in the face of negative consequences, the desire to continue something you know is bad for you.”
Addiction is such a harmful behavior, in fact, that evolution should have long ago weeded it out of the population: if it’s hard to drive safely under the influence, imagine trying to run from a saber-toothed tiger or catch a squirrel for lunch. And yet, says Dr. Nora Volkow, director of NIDA and a pioneer in the use of imaging to understand addiction, “the use of drugs has been recorded since the beginning of civilization. Humans in my view will always want to experiment with things to make them feel good.”
That’s because drugs of abuse co-opt the very brain functions that allowed our distant ancestors to survive in a hostile world. Our minds are programmed to pay extra attention to what neurologists call salience–that is, special relevance. Threats, for example, are highly salient, which is why we instinctively try to get away from them. But so are food and sex because they help the individual and the species survive. Drugs of abuse capitalize on this ready-made programming. When exposed to drugs, our memory systems, reward circuits, decision-making skills and conditioning kick in–salience in overdrive–to create an all consuming pattern of uncontrollable craving. “Some people have a genetic predisposition to addiction,” says Volkow. “But because it involves these basic brain functions, everyone will become an addict if sufficiently exposed to drugs or alcohol.”
That can go for nonchemical addictions as well. Behaviors, from gambling to shopping to sex, may start out as habits but slide into addictions. Sometimes there might be a behavior-specific root of the problem. Volkow’s research group, for example, has shown that pathologically obese people who are compulsive eaters exhibit hyperactivity in the areas of the brain that process food stimuli–including the mouth, lips and tongue. For them, activating these regions is like opening the floodgates to the pleasure center. Almost anything deeply enjoyable can turn into an addiction, though.
Drug treatment courts (DTCs), which are judicially mandated treatment alternatives to theincarceration of illicit drug offenders, were introduced in Canada in late 1998. Recent announcements from the federal government suggest that the drug treatment court model will continue to operate and expand in a number of Canadian jurisdictions. Two major evaluations of these programs — in Vancouver and Toronto — have been conducted. In this article, D. Werb et al. analyze the results of these evaluations. Their analysis reveals that, despite the evaluations, little is known regarding the success of DTCs in contributing to the long-term reduction of drug use and recidivism among their participants; and that the cost-effectiveness of these programs requires further study. The authors conclude that further funding for DTCs in Canada should be dependent on the implementation of randomized controlled trials that measure the success of these programs in reducing drug use and recidivism in the long term; that measure the impact of DTCs on societal end-points such as rates of crime and incarceration of injection drug users; and that include components to measure the cost-effectiveness of DTCs compared with other interventions aimed at reducing the negative effects of problematic drug use and drug-related crime.
Below is the site for the full 17 pages of this document.
The Toronto Drug Treatment Court, the first of its kind in Canada, has been in operation since 1998. The Toronto Drug Treatment Court (TDTC) was designed specifically to address the unique needs of non-violent offenders who abused cocaine or opiates. Clients were accepted into the project based on a clinically-assessed addiction to either cocaine or heroin. They were also identified as having been actively involved in criminal activities, such as prostitution, possession and trafficking of heroin or cocaine. The initiative involved a number of government departments and agencies in the fields of criminal justice, addiction, mental health and community-based service agencies.
TDTC clients were required to attend court as stipulated by a judge and addiction treatment was provided through the Centre for Addiction and Mental Health (CAMH). Court and treatment services worked together as a team to supervise clients and provide them with the resources required to successfully complete the treatment program. By providing project participants with treatment instead of punishment, it was hoped that the cycle of repeat offending would be averted and that it would lead to a decrease in substance abuse problems and the costs associated with the prosecution and incarceration of drug-dependent offenders.
Evaluation of the project consisted of a process, outcome and cost-comparison analyses.
The process evaluation focused on several elements including:
- characteristics of the TDTC project and its clients
- client-related, short-term outcomes
- clients’ status at discharge
- characteristics of the TDTC treatment services
- community partnership involvement
- review of committee structures and policies
The outcome evaluation focused on post-project substance abuse, criminal activity and the physical and psychological health and social stability of TDTC clients compared to a judicial comparison group. The cost analysis examined the direct costs associated with the TDTC project compared to those of traditional judicial adjudication.
The outcome evaluation used a quasi-experimental design involving an experimental group and two comparison groups. Comparisons were also made using sub-groups within the experimental group, both graduates and others. Overall, 593 clients were admitted to the TDTC project and were included in the data analysis.
The process evaluation findings indicated that:
- TDTC clients had more serious problems with substance abuse and criminal behaviour than was originally expected leading to low retention rates. Only 57 clients (15.6%) graduated from the court.
- Clients in the experimental group said that the TDTC project helped them reduce their dependence on drugs and criminal activity and find assistance for treatment. It was less helpful when it came to areas such as finding employment, assistance with housing, and financial and vocational counseling.
- TDTC participants stated that the project helped them gain a better self-image and improved their quality of life.
- Clients who did not reach the maintenance phase of the treatment program were found to have more difficulties with project requirements and, once out of jail, were more likely to return to their previous life-styles and behaviours.
- Clients in the experimental group expressed the view that being held accountable for their behaviour was the greatest strength of the TDTC. In particular they stated that verbal commendations from the court and acknowledgement of their progress were the most effective rewards.
- The introduction of a 30-day probationary period for new client applications appeared to be an important addition to the program as it kept people who were not serious about participating from using valuable court and treatment resources.
The outcome evaluation findings showed that:
- Graduate clients were found to be in breach of approximately 25% of their court appearances compared to between 50% and 90% of participants who left the program or were expelled from it.
- All graduates said that the project helped them reduce their drug dependency, compared to 84.4% of the expelled-engaged clients and 60% of expelled non-engaged clients.
- Of the graduates, 96% said the program helped them reduce their involvement in criminal activity.
- All groups had fewer convictions at the time of the first post-project follow-up and again at the end of the first, second and third year post-project, than they did at the time of their assessment. The longer clients spent in the TDTC, the less likely they were to be reconvicted.
- Less than 15% of graduate clients re-offended post-project compared to 90% of comparison clients. Rates of reoffending for members of the experimental group who did not graduate from the program were in between these two figures.
- For each year post-project follow-up, graduates were less likely to be re-convicted than any of the other client groups. However, post-project follow-up results indicate that reconviction was similar among the experimental group and the comparison group.
- The small number of participants left in the program meant that the results cannot be generalized to other situations.
A number of lessons were learned in the project, including the following:
- Susbstance-abuse treatment for offenders requires collaborative partnerships between the court, treatment staff and community-based organizations.
- Encouragement from the judge and treatment staff is important along with the use of rewards and incentives rather than sanctions. Limited use of severe sanctions, such as incarceration, are recommended.
- It is important to hold clients responsible for their own behaviour.
- A significant number of women and young people under the age of 25 failed to return to the project after their initial assessment or dropped out early in the project. More attention should be given to this client population during program planning. As well, the use of monitoring techniques to assess and address their needs is recommended.
- Regular feedback from the evaluation team is helpful in continually assessing and adapting the TDTC project to meet client needs.
- Drug-dependent criminal offenders are a challenging population to locate for follow-up interviews. A more carefully planned follow-up strategy including detailed consent forms may help to locate clients for interviews.
The reduction in substance abuse and criminal activity among drug dependent offenders of the Toronto Drug Treatment Court can be characterized as promising, given the limitations of the evaluation, such as the small number of graduates, different response rates among groups, and the decrease in program’s participation over time.
The evaluation of the TDTC adds to the growing body of research on specialized courts, and in particular, on collaborative justice and community responses to substance abuse by offenders in the criminal justice system.
For more information or to receive a copy of the final evaluation report please contact the National Crime Prevention Centre at 1-800-830-3118.
You can also visit the web site of the Centre for Addiction and Mental Health at: www.camh.net.
Sudbury pharmacies now only carry a limited amount of prescription narcotics, and patients have to call ahead to get prescriptions filled.
People who normally wouldn’t engage in criminal acts can be influenced to do so, particularly is they are overcome by an addiction to drugs.
Greater Sudbury police are drawing a link between a rise in the number of people hooked on prescription pain pills and a recent spike in property crime.
The city saw a jump in the number of thefts and break and enters in 2010 — a rate that topped the provincial and national average.
Sudbury’s police Chief Frank Elsner said the rise in property crime is related to a rise in the abuse of pills like Oxycontin.
According to Elsner, the desperation of addiction has forced many people who normally wouldn’t break the law to do just that.
“We had a man last year or the year before who was responsible for two or three robberies downtown,” Elsner said.
“And when we finally caught him, there was no criminal record other than that. What had happened is he became so addicted to the Oxys that he started doing armed robberies of pharmacies just to get the drug.”
Help can’t come soon enough
Elsner said police created a special unit last year to investigate break and enters and roberries. He said the so-called B.E.A.R. unit has helped to reduce property crimes so far this year.
But he noted it will take more supports in the community to solve the problem.
For people like Robert, who is in a Sudbury treatment program, help can’t come soon enough.
Robert (CBC has agreed to use only his first name) is trying to overcome an Oxycontin addiction.
“It pretends it’s your best friend and then it destroys your life,” he said, adding that his addiction costs hundreds of dollars a day.
He said people will do just about anything to get the pills.
“They will just rob somebody on the street,” he said.
“They will sell their bodies for pills or money in return.”
Pharmacy robberies tackled
Elsner said a crackdown on pharmacy robberies has almost put a stop to these crimes. Suspects were demanding prescription pills like Oxycontin.
“We knocked from an all-time high of robberies to zero,” he said.
“And that was because the community came together. What I don’t want to happen is now is … go on to the next thing. What we need to do is … continue on from there.”
Sudbury pharmacies now only carry a limited amount of prescription narcotics, and patients have to call ahead to get prescriptions filled.
But Elsner said, with security tightening locally, a growing number of prescription pills sold on Sudbury streets now come from outside the city.
Robert said he has managed to avoid run-ins with the law during his addiction — and that addiction is something he’s hoping to put behind him.
“I am just trying to get help and get myself better.”
Posted: Oct 26, 2011 11:09 AM ET
Last Updated: Oct 26, 2011 10:56 AM ET
Crimes motivated by drug addiction have increased over the past two decades across Newfoundland and Labrador, a forum was told Wednesday night.
Royal Newfoundland Constabulary Chief Robert Johnston said crime rates are relatively low in this province, compared to other parts of the country, but he said the reason why many people commit crimes in this province has changed.
“They’re committing criminal activity to pay for their addictions,” said Johnston, who addressed Neighbourhood Watch groups.
Johnston gave the example of a conversation he had with a man who admitted that he broke the law to feed an addiction to prescription drugs.
“We chatted for awhile and I said, ‘At the height of your addiction to oxycodone, how much would you spend a day?’ ” Johnston said.
“And he said, ‘Well, $500 a day.’ That would be $3,500 a week — how would you be able to pay for that habit?’ And he said, ‘I’m a good thief.’ ”
Johnston said the RNC has also seen significant increases in fraud and online crime, as well as marijuana grow-ops on the northeast Avalon Peninsula.
Posted: Oct 6, 2011 10:54 AM NT
Last Updated: Oct 6, 2011 10:49 AM NT
Police say addicts are shifting from illicit drugs to prescription narcotics
Greater Sudbury police and community outreach workers say prescription narcotics have become the drug of choice in the city.
They say a growing number of people are getting hooked on pain pills like Oyxcontin.
“I think we are at a crisis,” said Vicki Kett, who works with Reseau Access Network, an HIV and Hepatitis agency . “But it’s so easy to say it’s not happening to me.”
According to Kett, there are a growing number of people in Sudbury who are snorting, smoking and injecting prescription pills.
“They’ve had a big hold on me,” said Oyxcontin addict Felicity.
CBC has agreed to use only her first name.
“I started prostituting myself, everyday, all day long,” the 31-year-old mother of two said.
“I would go out there in winter when there is snowstorms going to make money to buy these pills.”
—Felicity, Oxycontin addict
“I would go out there in winter when there is snowstorms going to make money to buy these pills.”
Greater Sudbury police Chief Frank Elsner said there’s been a shift in the drug of choice, from illicit drugs like crack and cocaine, to prescription pain pills.
“There’s not the same stigma with pharmaceutical drug as with cocaine,” he said.
“Somehow people think, because it’s a pharmaceutical drug, you can get a prescription for, it’s far safer.”
Growing number of Oxy-related arrests
But Felicity knows it’s not safer.
She is now HIV positive and no longer has custody of her two children. She watched her sister die after years of drug abuse.
The experience was a turning point and she is now seeking treatment.
“I want to see my kids grow up and get married and finish school and all that,” she said.
“And I know if I keep going down that path it won’t happen.”
She is not yet completely clean, but she said she hopes sharing her story will prevent someone else from experimenting with pills.
Sudbury has seen a jump in the number of possession and trafficking offences related to prescription narcotics such as Oxycontin.
“What we are seeing is that it is cheap for urban youth to get a hold of this [and] that anybody can get it,” Elsner said.
The number of arrests involving prescription narcotics in Sudbury has tripled since 2006. The number of offences related to cocaine has dropped by a similar amount over the same time period.
Offenses related to cannabis remain the most prevalent.
Police officials say statistics on offences show basic trends. However, when enforcement efforts are focused on certain areas, it can lead to a rise in the number of arrests.
Posted: Oct 24, 2011 9:08 AM ET
Last Updated: Oct 25, 2011 7:33 AM ET
This is my simple religion. There is no need for temples; no need for complicated philosophy. Our own brain, our own heart is our temple; the philosophy is kindness. ( Dalai Lama)
When things in your life seem almost too much to handle,
When 24 hours in a day is not enough;
Remember the mayonnaise jar and 2 cups of coffee.
A professor stood before his philosophy class
And had some items in front of him.
When the class began, wordlessly,
He picked up a very large and empty mayonnaise jar
And start to fill it with golf balls.
He then asked the students if the jar was full
They agreed that it was.
The professor then picked up a box of pebbles and poured
It into the jar. He shook the jar lightly.The pebbles rolled into the open areas between the golf balls.
He then asked the students again if the jar was full. They agreed it was.
The professor next picked up a box of sand
And poured it into the jar. Of course, the sand filled up everything else. He asked once more if the jar was full. The students responded
With an unanimous ‘yes.’
The professor then produced two cups of coffee from under the table
And poured the entire contents into the jar, effectively
Filling the empty space between the sand.
The students laughed.
‘Now,’ said the professor, as the laughter subsided,
‘I want you to recognize that this jar represents your life.
The golf balls are the important things - God, family,
Children, health, friends, and favorite passions
Things that if everything else was lost
And only they remained, your life would still be full.
The pebbles are the things that matter like your job, house, and car…
The sand is everything else – The small stuff.
‘If you put the sand into the jar first,’ he continued,
‘there is no room for the pebbles or the golf balls.
The same goes for life.
If you spend all your time and energy on the small stuff,
You will never have room for the things that are
Important to you.
Pay Attention to the things that are critical to your happiness.
Play with your children.
Take time to get medical checkups.
Take your partner out to dinner.
There will always be time
To clean the house and fix the dripping tap.
‘Take care of the golf balls first –
The things that really matter.
Set your priorities. The rest is just sand.’
One of the students raised her hand
The professor smiled.
‘I’m glad you asked.’
It just goes to show you that no matter how full your life may seem,
there’s always room for a couple of cups of coffee with a friend.’
Pot Can Mimic Brain Changes Seen in Schizophrenia
Rats given a marijuana-like drug showed disrupted communications between brain regions, or ‘cognitive chaos.’
TUESDAY, Oct. 25, 2011 (HealthDay News) — Marijuana causes disruptions in concentration and memory similar to those that occur in people with schizophrenia, according to a new study.
U.K. researchers measured the electrical activity from hundreds of neurons in the brains of rats given a drug that mimics the effects of cannabis, the psychoactive ingredient of marijuana.
The effects of the drug on individual brain regions were subtle but the drug completely disrupted the coordinated brain waves across the hippocampus and prefrontal cortex. Both of these brain structures are essential for memory and decision-making and play a key role in schizophrenia.
Due to the “decoupling” of the hippocampus and prefrontal cortex, the rats were unable to make accurate decisions while attempting to find their way through a maze, the University of Bristol researchers said.
“Marijuana abuse is common among sufferers of schizophrenia and recent studies have shown that the psychoactive ingredient of marijuana can induce some symptoms of schizophrenia in healthy volunteers. These findings are therefore important for our understanding of psychiatric diseases, which may arise as a consequence of ‘disorchestrated brains’ and could be treated by re-tuning brain activity,” lead author Matt Jones said in a university news release.
The study appears Oct. 25 in the Journal of Neuroscience.
“These results are an important step forward in our understanding of how rhythmic activity in the brain underlies thought processes in health and disease,” study first author Michal Kucewicz said.