THE ROLE OF MODERN SCIENCE IN ADDICTION TREATMENT

At A Better Life Recovery, we believe that the gifts and skills of modern science can contribute significantly to the 12-step process of spiritual transformation.

Introduction

Recently there have been some Tweets and other opinions from folks out there on the Internet who believe that traditional addiction treatment is ineffective. They often point to high relapse rates, high costs, etc. Some even advance the notion that “disease concept” of addiction is hogwash and it remains largely a moral, ethical, and criminal symptom of weak character and self-control.

The same people also often suggest that all that is needed instead of traditional treatment is some kind of injection or magic pill that will keep addicts (including alcoholics) from using. In short many people believe that a technological or scientific “cure” is the ultimate solution.

Unfortunately addiction is a disease that displays an array of physical, mental, emotional and other symptoms. Moreover the vast majority of those that have recovered since the birth of AA in 1935 would no doubt agree that at its core addiction is fundamentally a spiritual malady.

There is no way around the central need for a spiritual solution.

To paraphrase from the book Alcoholics Anonymous, “We hope one day science finds a cure for addiction, but it hasn’t done so yet.” However, this same book also speaks to the important role of science and health care professionals in contributing to the battle against addiction.

To paraphrase from the book Alcoholics Anonymous, “We hope one day science finds a cure for addiction, but it hasn’t done so yet.”

However, the “Big Book” also speaks to the important role of science and health care professionals in contributing to the battle against addiction:

“But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case after.”

- Alcoholics Anonymous, p. 133

The idea that some new found chemical molecule can cure addiction is analogous to the notion that putting criminals in prison will cause a psychic change in criminal thinking and behavior.

Albert Einstein, perhaps the greatest scientific mind in history, found deeper meaning in his theories of special and general relativity. The precision and elegance of his mathematical equations led Einstein to conclude that an intelligent force behind the creation and continuation of all matter and energy. Simply put his scientific vision led him to become a deeply spiritual person.

At A Better Life Recovery we believe that science and faith are not opposing concepts, but harmonious allies in the fight against addiction. We believe that modern science, technology, and medicine have important contributions to make in

Some Useful Scientific Tools

Here are some of the tools of modern science and medicine used by A Better Life Recovery. Note that we do not utilize and are philosophically opposed to the use of synthetic opiate substitutes for heroin such as Methadone and Suboxone.

Vivitrol: Vivitrol is a slow release injection form of Naltrexone, an opiate and alcohol receptor blocking medication. A single Vivitrol injection essential “locks” receptor cells in the brain from feeling the effects of opiates and/or alcohol. In short, a recovering addict who has had a Vivitrol injection simply can’t get high for the next 30 days or so.

A Better Life Recovery endorses the selective use of Vivitrol when appropriate as a component of an overall treatment regimen. The value of such medical tools is in their ability to assist in reaching a true, long-term solution. They do so by giving clients some temporary relief and breathing room while they begin a journey of lasting spiritual progress.

Vivitrol does not solve the core desire among addicts to use and get high; it just temporarily deprives them of the result of using. If an addict does not undergo profound spiritual, psychological and emotional change, he/she will often simply stop taking Vivitrol, or switch to a substance not blocked by Vivitrol, so that they can once again get loaded.

Here are some specific reasons why Vivitrol is a useful tool especially in the early stages of addiction treatment:

· By preventing an addict from getting high if he uses, Vivitrol may help prevent the addict from suffering some the additional serious consequences that result from behavior and choices made while high.

· Vivitrol possesses a psychological deterrent in that an addict who has had injection consciously is informed and aware that he simply can’t get high, so why bother.

· Studies have shown that Vivitrol actually reduces the craving sensations common to addicts during early detoxification and treatment.

Once study on Vivitrol is particularly worthy of mention (article 1 below). The study concluded that the rate of continuous abstinence at end of study was 32% for patients on Vivitrol versus 11% for a control group. It should be noted that all the patients received counseling during the study; this implies that Vivitrol can indeed be a helpful tool in support of traditional addiction counseling.

Please see the following publications and scientific articles for more information on Vivitrol.

1. The Journal of Clinical Psychopharmacology, October 2007 edition, “Efficacy of Extended-Release Naltrexone in Alcohol-Dependent Patients Who Are Abstinent Before Treatment.”

2. The Lancet, April 28, 2011, “Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicenter randomized trial.”

3. SAMSHA Advisory, Winter 2012, Volume 11, Issue 1, “An Introduction to Extended-Release Injectable Naltrexone for the Treatment of People with Opioid Dependence.”

On the downside, like any medication Vivitrol does have some side effects. Another negative is that in rare cases alcoholics and addicts have been known to ingest large amounts of substances in the hope of overwhelming the blocking effects of Vivitrol, leading to overdoses.

Other Slow Release Injections: Patients on certain psych medications such as Haldol and Depakote often struggle with taking daily pills as prescribed, and thereby never obtain the desired relief and mood stability these medications are intended to provide. At A Better Life Recovery, some of our clients have experienced substantial benefits by receiving monthly, slow-release injections of these psych meds.

Anti-Depressants: Addicts often present with co-occurring issues such as depression and anxiety. Careful prescription of appropriate anti-depressants by a licensed psychiatrist can often give clients much needed relief and “breathing room” so they can focus on their addiction counseling program. A Better Life Recovery works closely with a Psychiatrist who specializes in addiction issues; all of our clients receive an initial consultation and follow-up visits as needed to determine if anti-depressants are warranted and to calibrate them as needed.

Prescription Sleep Medications: People in the early stages of sobriety and recovery are often faced with serious sleep deprivation issues. Carefully prescribed non-narcotic, non-addictive sleep medication can often help clients get much needed sleep so their minds and bodies can properly function as they begin their journey of recovery.

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Conclusion

These are just a few of the many tools modern science has made available in the fight against addiction. A Better Life Recovery will continue to seek the input of our colleagues in medicine and science regarding any and all new means supplementing and improving our treatment program with cutting-edge innovations. Addiction is a formidable and resilient foe; the fight against it will continue to require the full attention of the brightest minds and most dedicated people on the planet.

- Paul Stackhouse, December 2015

(Mr. Stackhouse is one of the founders of A Better Life Recovery. He holds an A.B. degree in Economics from Harvard University and an MBA degree from the University of Chicago. He currently serves as Director of Finance and Administration.)


HOW I LEARNED TO RESIST FAMILY TRIGGERS DURING THE HOLIDAYS

Through trial and error, I've learned how to apply ACOA to the two most primary triggers.

It’s a common refrain every year during the holidays: Dealing with your family, particularly parents, can be a real nightmare. There’s the usual concerns. Will they talk to you like you’re still 12? How long until your weird uncle says something racist? But for anyone from an alcoholic family, the concern gets piled upon: How long til someone triggers one of those character defects from no-longer-useful childhood survival skills? What if one of those parents is still drinking? How long til we’re screaming at each other?

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LONG WAY HOME: REST IN PEACE SCOTT WEILAND

Coming up as an angst-filled teen in the late ‘90s, grunge and alternative rock were a regular staple in my musical diet. I remember being around 11 years old when I discovered Nirvana and fell in love with the voice of Kurt Cobain, a man who would be my introduction to musical loss. At 12 years old, I mourned for Kurt as much as I could. When I saw older kids in school weeping and congregating to memorialize the fallen rock star, I got it, but I didn’t get it. Until now.

In three days, I’ll be 33 years old, but for tonight, I am 17 again and the death of singer/musician Scott Weiland has left me gutted and vacillating in a thick fog of nostalgia, sorrow and anger.

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VIVITROL NOW RECOMMENDED FOR ALL CLIENTS

 

 

“…Vivitrol is a valuable addition to the recovery toolbox, along with methadone and buprenorphine…medical research unequivocally shows that most individuals addicted to opiates require some form of medication to recover from their addiction, a chronic brain disease…Vivitrol, like any other medication for opioid dependence, must be accompanied by a firm commitment to recovery, including substance abuse counseling, outpatient programs and support systems.

–Dr. Mark Publicker, President, Northeast Society of Addiction Medicine as reported by the Bangor Daily News August 27, 2014 in article “Once-a-month shot that blocks high from opiates making inroads in Maine.”


Most people are unfamiliar with the injectable medication Vivitrol and how it used in the treatment of opiate addiction. While there is no generic available for Vivitrol, there are oral medications that contain the same ingredient. The oral version is available as the generic naltrexone and may also be known as ReVia.

The following questions and answers are provided to educate, dispel myths and familiarize people with Vivitrol and its use in opiate treatment. As always, if you have any additional questions or would like to share your comments you can always contact Center for Behavioral Health or any of our individual Treatment Locations.

 

What is opioid dependence?

Opioids, such as some prescription pain medications or heroin, attach to the opioid receptors in the brain, which stimulate the release of dopamine and produce pleasurable feelings. When the opioid eventually detaches from the receptors, people experience withdrawal and cravings and have a strong desire to repeat the experience. The need to satisfy cravings or avoid withdrawal can be so intense that people who want to stop taking opioids find this difficult to do. Or, they may find themselves doing things they would not ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.

Drug use often begins as a choice, but frequent use can cause the brain cells to change the way they work. The brain is re-set to think that the drug is necessary for survival. Researchers have discovered that many drugs, including opioids, cause long-term changes in the brain. These changes can cause people to have cravings years after they stop taking drugs. Research has shown that addiction is a chronic, relapsing brain disease, but treatment can help achieve recovery.

What is Vivitrol?

Vivitrol is one of the newest medications available and can treat both opiate and alcohol addiction. It blocks other opioids from acting on the receptors in the brain and can also help ease drug cravings. By blocking the effects of other opioids it takes away the pleasurable effect, which can help with preventing relapse. Although it is not fully understood as to why an opioid antagonist works in treating alcoholism, it is believed that Vivitrol blocks the pleasurable effects of alcohol by blocking the release of endorphins caused by alcohol. This treatment can help you stop misusing opioids and alcohol and, when combined with counseling, can help you rebuild your life.

What is an opioid antagonist?

An antagonist is a non-opioid that binds to opioid receptors in the brain. The way different opioids work can be explained using a lock and key example. Receptors are like a lock to a door. Only the right key will fit the lock, and only opioid-like drugs fit opioid receptors. With a full opioid agonist such as oxycodone, hydrocodone, morphine, or heroin, the key fits the lock, opens the door wide, and produces full opioid effects (the feeling of euphoria, or being high, as well as the side effects). With an antagonist, such as Vivitrol, the key fits the lock but does not open the door at all, it simply blocks other keys from fitting the lock.

How effective is Vivitrol treatment?

Studies have shown that opioid-dependent patients who received counseling and Vivitrol had significantly more days of complete abstinence, stayed in treatment longer, reported less craving, and were less likely to relapse to physical dependence. Complete abstinence was defined as having a negative urine drug test for opioids and no self-reported opioid use. Craving was measured by self-reported “need for opioids”.

In a study of alcohol-dependent patients participating in counseling plus Vivitrol, patients had significantly fewer heavy drinking days (defined as a self-report of 5 or more drinks on a given day for males and 4 or more drinks for females). A small group of alcohol-dependent patients who completely stopped drinking one week prior to their first dose of Vivitrol and had counseling had significantly fewer drinking days and more success maintaining complete abstinence.

How does Vivitrol work?

Vivitrol is an opiate antagonist with a series of actions that make it possible to block cravings and the pleasurable effects of opioids and alcohol. Vivitrol binds to the opioid receptors in the brain, produces no opioid effects, and does not allow other opioids to enter. Because Vivitrol is an antagonist it will cause withdrawal if you still have any opiates in your system when you take the medication. For this reason, you will need to have gone through detoxification prior to starting the medicine and have ideally not taken any opiates for 7 to 14 days before your first Vivitrol injection. While it is not required for you to stop drinking prior to your first injection, research has shown that patients have a better response to the medication if they stop drinking at least one week prior to their first Vivitrol injection.

Once you have received an injection of Vivitrol, the medication acts on the receptors in the brain causing the blocking effect. This effect will slowly decrease over time, allowing you to only have to receive the medication once per month.

Is Vivitrol addictive?

Because Vivitrol is a non-opioid, an antagonist, it is not addictive nor does dependence on the medication develop.

How long does treatment take?

You and your treatment team decide what will be an appropriate length of treatment to ensure the best outcome for you. Although short-term treatment may be an effective option for some people, it may not allow others enough time to address the psychological and behavioral components of their disease. Since physical dependence is only part of opioid dependence, the chances of relapsing can be higher with short-term treatment because patients have less time to learn the skills necessary to maintain an opioid-free lifestyle. There is no risk of withdrawal when Vivitrol is stopped; however, you are still encouraged to talk with your treatment team about any plans to discontinue treatment so they may assist you with your relapse prevention plan. Treatment with Vivitrol for as long as you need, combined with counseling and support, can often increase the level of treatment success.

What will Vivitrol treatment be like?

Please call our individual treatment locations to speak with a professional counselor that specializes in opioid addiction to book an appointment with our treatment team. On your first visit, the treatment providers; including a doctor, a nurse and a counselor will ask questions about use in order to provide the best treatment. If it is determined that Vivitrol is appropriate for you, the treatment team will take the necessary steps to get the medication and a nurse will give you the Vivitrol injection. You may be asked to wait for a period of time so staff can monitor you for any adverse effects. While there are some side effects to Vivitrol, they are usually mild and go away fairly quickly.


HONESTY, INTEGRITY, AND OPEN MINDEDNESS

From time to time, I like to reflect on the changes I have made to myself that have made my sobriety so much more rewarding. When I was in my addiction, I did not practice honesty or integrity, and I had been unknowingly very close minded.
I thought open mindedness had to do with not being homophobic or racist and accepting climate change and evolution, but there's so much more to it. Every time I shut myself out to an idea that wasn't mine, I was being close minded - my feelings on organized religion are a perfect example. Every time I looked for differences between myself and those around me as an excuse not to accept those people, I was being close minded. I still don't practice organized religion, but I have learned to at least try to keep my mind open. Ideas can change, but yours never will if you refuse to listen to anyone other than yourself.

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THE DRUG POLICY REFORM MOVEMENT WANTS TO END THE WAR ON PEOPLE

By Will Godfrey 11/29/15

Record numbers of reformers gathered in Washington, DC, recently to explore ways to extend their growing influence far beyond drugs.

The Drug Policy Reform Movement Wants to End the War on People
Photo via @CatchFireCX

"I'm Ross Ulbricht's father," said the gray-haired man on the stage. "Ross was arrested two years ago and convicted. He was sentenced to double life in prison a few months back and is now appealing his sentence. I'm here as his advocate."

His story was unusual in that his 31-year-old son, Ross, aka “Dread Pirate Roberts,” founded Silk Road, the pioneering deep-web, drug-dominated marketplace that was shut down by the FBI in October 2013. Devastating prison sentences, on the other hand, have long been normal in the US.

Just this month, Washington, DC, hosted the biggest drug policy reform activists’ conference in history. Over 1,500 delegates from 71 countries packed out dozens of plenaries, panels and town hall meetings over several days, extending their activities to a lobby day on Capitol Hill and a vigil on the National Mall.

The numbers reflect something more significant. Ethan Nadelmann, executive director of the Drug Policy Alliance (DPA), which organizes the biennial Reform conference, described in his opening speech how the movement “increasingly has something most of us are unfamiliar with: That's power.”

Some national politicians participated. A video message from Senator Cory Booker opened the conference, and speakers included Rep. Earl Blumenauer, Rep. Hakeem Jeffries and Mark Golding, Jamaica’s Minister of Justice.

Yet the movement’s determination to keep its feet on the ground, and its eyes on its reason for existing, was reflected by the presence of many who have been personally victimized by the War on Drugs but are now determined to be agents of change.

They included Jason Hernandez, who in 1998 was sentenced to life without parole for selling crack, aged 21 and the parent of a seven-month-old baby boy. His sentence was eventually commuted by President Obama in 2013. He shared his message for Obama now: “I love you like a father for giving me my life back...but you need to do more. If you don't act, our brothers and sisters doing life without parole for nonviolent drug offenses, they're going to die in there—and their blood will be on your hands.”

They included Edo Nasution. As a drug user in Indonesia in 2007, he was shot in the leg, hung upside-down, tortured and left for dead by police who were trying to obtain information about his suppliers. After that incident, he became an activist: “My outrage and my anger became more powerful than my fear.”

Healing the rift between law enforcement agencies and the populations they’re supposed to serve was another widespread theme.

They included many others who had experienced incarceration or violence—mothers who had lost children to overdoses that might have been prevented by better public health policies, people with serious illnesses, and veterans with PTSD who had been denied legal access to marijuana to alleviate their symptoms.

Their presence, and their determination to prevent others' suffering, was a powerful reminder that the War on Drugs is better understood as a War on People.

Further progress in ending it will require concerted effort. But to most observers, a pronounced shift in public and political mood, and a raft of recent legislative victories—marijuana legalization in four states plus Washington, DC; medical marijuana and harm reduction laws in dozens of states; sentencing reforms at state and federal levels—seem to have created unstoppable momentum in the US and a ripple effect around the world.

And the newfound power Nadelmann mentioned opens up broad possibilities. Yes, this movement wants to legalize marijuana, and either decriminalize or legalize other drugs, and expand access to life-saving harm reduction measures. But the view expressed constantly here was that its ambitions should extend beyond drugs—that changing drug laws should be part of a wider human-rights vision, intersecting with other social justice causes.

One acutely obvious overlap is with the issue of racial inequality. #BlackLivesMatter,which arose in 2013 after Trayvon Martin’s killer was acquitted, and gathered steam after the events in Ferguson and other police killings, permeated this event. Mass arrests, mass incarceration and police killings inflict grossly disproportionate harms on communities of color—and all are unambiguously related to the enforcement of drug laws.

One evening, hundreds of delegates attended a town hall meeting on this issue. “The reason people are burning shit down in the street is because people are devaluing our lives every day,” said Lumumba Bandele of the NAACP. “Until we see that our flesh, our blood is more valuable than a store, than a car, then we're going to be here.”

“What I find hard to believe is that if we can win the War on Drugs without winning the War on People of Color, we're doing something different,” said Kassandra Frederique, DPA’s New York policy director. “If our drug policy reforms don't include systematic recommendations for how we can help people of color, then we should stop using the talking points!”

Elsewhere, current models of marijuana legalization were fingered as one way in which reforms are not benefiting people of color as they should. In Colorado, for example, overall arrest rates have fallen since legalization, but a dramatic disparity between arrests of black and white people remains.

More subtly, legalization can occur in ways that hurt communities of color economically. “The only benefit the drug war has ever brought has been to give well-paid [black-market] jobs to poor people,” said Ernesto Cortés of the Costa Rican Association for the Study and Intervention in Drugs. Yet rules around the burgeoning legal US marijuana industry—such as bans on people with marijuana convictions getting a license, or large fees—reserve most of the profits for people who don’t live in heavily policed communities and are already wealthy.

The difference between a legislative victory and its effective implementation can also be stark. “There is a sweet faith we have, that if we write law and pass law, that's the way it is,” cautioned Harry Levine, professor of sociology at CUNY and co-director of the Marijuana Arrest Research Project. “In 1977, New York decriminalized marijuana, yet by the late ‘90s we had more arrests than anywhere, nearly 90% people of color. The law is one thing and what happens on the street is another. In fact, when the police do obey the law, it's cause for celebration.”

Healing the rift between law enforcement agencies and the populations they’re supposed to serve was another widespread theme. A program named LEAD (Law Enforcement Assisted Diversion) could be one path to better relations. Pioneered in Seattle, Washington, in 2011, LEAD has since been adopted in New Mexico, and there are plans to roll it out in several more states.

Captain Deanna Nollette of the Seattle Police Department explained that for low-level drug law violations, “If you're arrested in Seattle, and if your criminal history is not disqualifying, you have the option of either being charged or doing a session with a case worker.” The session is used to discuss problems and goals and refer clients to relevant services; abstinence from drugs is not a required goal, and the criminal charge will be held in abeyance.

“Public safety should be our role,” Nollette said. “I’m looking to recruit guardians, not warriors. We're trying to internalize the ideas of harm reduction and procedural justice.”

Washington State has legalized marijuana, of course, and Nollette revealed one of the ways this has affected her force: “We're having to retire our drug sniffer dogs, because you can't un-train dogs who have been trained to detect marijuana, so you can't tell if they're detecting marijuana or other drugs.”

Marijuana legalization remains a primary goal of this movement, and a hugely popular one. So one question on many lips is how far legalization will spread, and how fast.

Rob Kampia, executive director of the Marijuana Policy Project, confirmed that 2016 should be another breakthrough year: “Vermont is most likely to legalize through its legislature in the spring, and Rhode Island also has a good shot at legalizing through its legislature,” he said. “Then there will be ballot initiatives in California, Nevada, Arizona, Maine and Massachusetts, and it could very well be that four or five of those states legalize.”

Many delegates predicted that change will be irresistible at a federal level if California, with its great size and influence, legalizes in November. Kampia speculated that after the next wave of state-level legalizations, Congress “could very well pass a states’ rights bill in 2019.” This would effectively end federal marijuana prohibition, leaving a few holdout states to continue banning marijuana on their own.

But the US is still a very long way from legalizing, say, cocaine. “They don’t grow it here,” said one delegate, “so there’s no money to be made.”

Allen St. Pierre, the longtime leader of NORML, suggested: “The cultural narrative around marijuana has been stupid stoners, cops and robbers—it's funny. But the narrative for ‘hard’ drugs—The Man With the Golden Arm, Trainspotting, Drugstore Cowboy—is not positive and typically ends in death or criminal justice consequences. I'm worried that there isn't a [positive] culture behind heroin, cocaine and meth use, so there isn't going to be this easy transition.”

Photo via @jessicagwyn

The idea of a “positive” culture around heroin is anathema to some, but others point out the double standards at play. Eliot Ross Albers, executive director of the International Network of People who Use Drugs, reminded an audience of “people who use heroin every day, but don’t find it a problem for them.” He complained that “many in the recovery community still assume that we need recovery, that the fact that I prefer to use heroin rather than drinking wine is fundamentally a problem.”

Definitions of recovery and addiction were a battleground at several sessions. Maureen Boyle, chief of NIDA’s science policy branch, had the thankless task of defending her organization’s brain disease model of addiction from concerted criticism. “Addiction impacts a number of brain circuits in a way that impairs people's ability to stop taking drugs,” she said. “[The model] doesn’t say that environmental impacts, social or genetic factors, don’t have an influence—all these things impact those same circuits.”

“What NIDA are doing is placing the brain at the top of the hierarchy; it is a cultural decision to privilege the brain above everything else that makes us human,” respondedPatt Denning of the Center for Harm Reduction Therapy. “This continues the demonization of drugs and undermines our attempts to legalize or decriminalize.” Rebecca Tiger, associate professor of sociology at Middlebury College, VT, rejected “the idea that science can define the line where ‘pathological’ is—that’s a cultural and social judgment.” Like many present, she accused the brain disease model of perpetuating stigma through “addict” and “normal” categorizations.

A panel following a screening of The Business of Recovery, a documentary that attacks the mainstream addiction treatment industry, devolved into yelling between proponents of different responses to addiction. “I think one of the biggest problems in this field is the ‘one-truthers,’” intervened Andrew Tatarsky, founder of the Center for Optimal Living. “Our job is to create a facilitative relationship for people to discover the path that best suits them.”

Panelists discussing young people and drugs reached more of a consensus around “Just say know”—applying not only to accurate information about drugs, but to open, safe-space communication between young people, family members and other responsible adults. Frances Fu of Students for Sensible Drug Policy related how she “came out” to her mother as a teenage cannabis user. Jeff Foote of the Center for Motivation and Change discussed evidence-based strategies that have helped families, such as CRAFTand Motivational Interviewing.

“One interaction I frequently have with people is they talk about drug-testing [their kids],” added addiction theorist and Fix contributor Stanton Peele. “I think: Huh, what do you want to know exactly? Don't you want your child to do their school work, show up on time, and develop as a human being? Aren't those the variables that we care about here?”

The idea that a person’s overall wellbeing matters much more than whether or not they use a particular drug informs work to expand legal access to harm reduction services. But ignorance and prejudice remain; for example, although syringe exchange programs have conclusively proved to reduce the spread of HIV and hepatitis, federal funding for such programs is still banned in the US, while laws and law enforcement hamper syringe access in numerous states.

Meanwhile Insite in Vancouver, a supervised injection facility (SIF) which has been shown by dozens of studies to reduce overdose deaths and other harms to drug users and the wider community, remains, as Liz Evans of Open Society Foundations put it, “the only legally sanctioned demilitarized zone [of the War on Drugs] on this continent.” Campaigns are currently being waged to bring these benefits to US cities like San Francisco and New York. Other harm reduction measures, like heroin-assisted treatment—successful in Europe and Canada—also face major political obstacles in the US.

Photo via @cmoraff

Yet US harm reductionists know that their cause has advanced further than ever, and expect the rapid progress to continue. Several delegates remarked that legal access to naloxone, the drug that reverses opioid overdose, is such an obvious, visibly good thing—somebody is OD-ing; you administer naloxone; they don’t die—that it opens the doors to other kinds of harm reduction thinking among people who might not otherwise have been receptive.

Forty-four US states have so far passed some kind of naloxone access law, while 32 have passed 911 Good Samaritan laws (11 in 2015 alone), granting limited immunity from prosecution to people who call for help for overdose victims.

This movement will not be short of new challenges, however. Novel psychoactive substances, or “synthetic drugs” (”as opposed to all that all-natural, organic LSD...” observed Mitchell Gomez of DanceSafe) are being developed at a dizzying rate, with new compounds continually produced to circumvent existing laws.

Predictably, scaremongering, misinformation and knee-jerk legislation are among the responses. That said, in yet another harmful side-effect of drug prohibition, many of the new substances are significantly more dangerous than the ones they’re designed to mimic—“K2” and “Spice,” for example, are much riskier than regular old marijuana—so some nuanced messaging is required of drug policy reformers. Yet the practical difficulties of banning these moving targets could also present an opportunity. "These drugs are the new front of the old drug war,” said Stephanie Jones, DPA’s nightlife community engagement manager. “We cannot be caught sleeping on this."

Then there’s the question of how all these drugs will be bought and sold. The closure of Ross Ulbricht’s Silk Road resulted in a profusion of other deep-web marketplaces, leading to law enforcement playing an online game of whack-a-mole—like the one it has already pursued across different countries, and from drug-to-drug. But are Silk Road’s imitators really such a bad thing?

Monica Barratt, a research fellow at the University of New South Wales, Australia, argued that such sites reduce the risk of harm for people who buy illegal and therefore non-quality-controlled drugs. “The rating systems [for online drug vendors] and the repercussions mean that it’s much more likely to be what it says it's going to be.”

James Martin, criminology program coordinator at Macquarie University, Australia, agreed. “There’s no ‘Scarface moment’ because you never physically interact with someone,” he said. “Online drug sales represent the biggest threat to prohibition, because they challenge the idea of inherent violence in the drug market.”

Millions of people around the world continue to be persecuted for nonviolent drug law violations. But at this event, where suited wonks rubbed shoulders with tattooed and dreadlocked activists, where veteran campaigners mingled with bright-eyed students, where the Democrat majority knocked along (mostly) with libertarian Republican allies, it was impossible to escape the optimism born of shared purpose and an unprecedented succession of legislative wins.

Ethan Nadelmann admits to plenty of worries: whether the momentum of this movement can be sustained despite the efforts of the prison-industrial complex to reverse it; whether dedicated marijuana activists will continue to campaign for wider reforms post-marijuana legalization; whether an extraordinary external event might, as 9/11 and the ensuing War on Terror did for a while, derail progress. Yet here, he could not avoid sounding bullish.

“We are not going to stop,” he told the crowd. “We are going to get bigger; we are going to get stronger; we are not going to let our internal conflicts tear us apart, because we have a commitment to freedom and justice.”

“Two years from now [at the 2017 Reform conference in Atlanta], we're going to havedouble the number of victories under our belt!”

Will Godfrey is the former editor-in-chief of The Fix. He was also the founding editor-in-chief of Substance.com, and previously co-founded a magazine for prisoners in London. His work has appeared in Salon, Pacific Standard, AlterNet and The Nation among others.

 
For original article see: https://www.thefix.com/drug-policy-reform-movement-wants-end-war-people?page=all 


WHAT IT WAS LIKE AND WHAT IT'S LIKE NOW

My name is Jessica, and I'm an alcoholic.
 
I was born on New Year's Eve 1985 in Philadelphia, PA. For all intents and purposes, I grew up as an only child, I have 3 half siblings, one of which I never lived with, and only lived with the others for brief periods. My parents were loving and I was never physically abused, I had everything I could've wanted or needed. My parents did drink more than the average people, and I would consider my father an alcoholic today.
 
I lived most of my young childhood in Virginia Beach, VA and I moved to the town I now call home, Fredericksburg, when I was 7. I was a pretty normal kid, I did well in school, I played sports, and I had a lot of friends. When I was in about 6th grade, I started to feel uncomfortable. I felt like I could not relate to a lot of my peers, and even back then I was a chameleon with lots of different groups of friends. I decided I preferred the company of the kids that liked to smoke behind the library, and by 10th grade I was a seasoned drinker and drug user.
 
I started out small, like most people do, smoking pot for the first time in 6th grade and drinking wine coolers in 7th. By 9th grade I was smoking weed daily and drinking a couple times a week. By 10th grade I was dabbling in pain killers and muscle relaxers and I remember one time having to sign my entire paycheck over to a dealer because I was eating X like candy. From age 17 - 20 I mostly drank and smoked and on the weekends ate mushrooms and acid.  I got my first possession charge in September 2004, I was 18.  I loved hallucinogens and swore to myself never to try "hard drugs" like cocaine and heroin.
 
I tried heroin for the first time in 2006 and tried cocaine at a party in 2007. Comparatively, I was an old maid when I tried the hard stuff, but my addiction took off like a rocket.
 
I didn't really care for heroin when I first tried it, it made me vomit and black out, but I continued to do it anyway. I decided I preferred Oxy to dope and I had a long love affair with pills. I could take or leave coke, and alcohol was a staple in my life. In 2010 I caught my first felony possession charge, my co-defendant took the wrap, I skated, and the idea that I was untouchable as far as consequences due to my drug use was born.
 
Around 2011 pills started to become expensive and scarce, so what is an addict to do when their drug of choice becomes unavailable? They switch. Heroin was much, much cheaper, and I had been IVing pills, but the first time I shot heroin, I was in love.
 
I stumbled through 2011 and 2012, but 2013 was about to be MY year. I was introduced to speed balling and smoking crack, and I decided that speed balling just ruined the rush from both drugs, and I really loved that ole' ringer you got from IVing crack or coke, so that became my drug of choice. I would do just enough heroin to come down and keep me from being sick, and now I had two drugs I was addicted to. I had been obtaining drug money by desperate means for years, payday loans, pawn shops, title loans, my parents' wallets, but I became reckless and I was being investigated for credit card fraud and other things.
 
In June 2013 I was arrested for possession, and by the end of July I had been arrested on the same charge two more times in two different jurisdictions. I got a few driving on suspended charges and in mid July was picked up for failure to appear in court. I spent a few days in jail, and when I got out I was very, very sick. I begged my parents for money but they wouldn't give it to me and they threw me out, so I called my drug dealer. He paid for me to get a hotel room, but he refused to give me any drugs for free. It just so happened someone that owed me was in a hotel across the street, so I went over there and got 2 points and rushed back over to my hotel. I sat on the toilet, I cooked a shot, and as I was looking at the dark brown liquid I thought to myself "If I do all this it's probably going to kill me." I did it anyway, and within seconds I KNEW I was in trouble. I made it from the toilet to the phone by the bed, I tried to dial 911, but I was fading fast and you had to dial 9 to get out and I couldn't think. I woke up on the floor, the phone beeping from being off the hook, my lip and eye busted from hitting the table. I have no idea how long I was out, but when I came to I had a brief moment of clarity, all I could think about was that if I hadn't woken up, some maid would've found me on the floor at an America's Best Value Inn and my poor parents would've gotten a call to come identify my blue, lifeless body. I knew I needed help, but I didn't know how to ask.
 
About a week later, I got a call from my dad because I had missed court, again. I was living in a Super 8 Motel with 4 other addicts, I was panhandling to eat a $1 cheeseburger from McDonald's and a couple of 40's of Steel Reserve a day, and I was robbing to support my drug habit. He begged me to let him come get me and to do the right thing to turn myself in. I was miserable, so I surrendered. I was released on bond, and I reached out to my best friend that lived and worked at a treatment center here in California.
 
Little did I know, she had been in contact with my family and some friends for a couple months, and 2 weeks later I was on a plane to California. I was considered a fugitive in Virginia, my future was uncertain, but I chose the rest of my life over the courts. My first sobriety date was August 19, 2013.
 
I stayed in California for 9 months, in that time I received 90 days of in-patient treatment, one on one counseling, group therapy, I went to hundreds of 12 step meetings, I got a get well job at a sandwich shop, I got my license back, I started a meaningful relationship with a man that I am still with today, my life went from chaos to serenity in 9 short months.
 
I left California on April 15, 2014 to go back to Virginia and face the legal music. I turned myself in on my dad's birthday, April 28, 2014, I ended up only having to do 30 days in jail and I was released on probation. I stayed sober 6 more months. By November 2014 I had stopped going to my court ordered 12 step meetings and I was flying under the radar with my probation officer. I decided I could drink normally, and before you knew it I was making excuses to go to Fredericksburg to do drugs and drink behind my boyfriend's back.
 
September 7, 2015 I was back on a plane to California for treatment. My new sobriety date is September 8, 2015. In 79 short days I have done about 45 days of out patient treatment, gotten a sponsor that has me do a tremendous amount of work, I've done a few couple's counseling sessions, I got a job at A Better Life Recovery, I got my car back, my relationship has open honest communication, I am on medication for depression, I am genuinely happy and comfortable for the first time in a very, long time.
 
Addiction is hell, and getting sober is painful. I hope by sharing my journey I am able to help others that continue to suffer. If one person decides to reach out for help by reading my story, all the pain will have been worth it.
 
My name is Jessica, and I am an alcoholic.


ADDICTION: THE DISEASE THAT LIES

Whenever someone with addiction dies, I grieve the lost potential and wonder about the limitations of our ability to address this cunning, baffling and powerful disease.

I am also humbled by my own experience with addiction and recovery, and grateful for the help I received.

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THE SCIENCE OF ADDICTION: DRUGS, BRAINS, AND BEHAVIOR

Two NIH institutes — the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) — have joined with HBO to reveal startling new advances in the fight against alcohol and other drug addiction.

The personal and family tragedies related to addiction are heartrending and, quite often, desperate. The struggles to break addiction and restore lives are uniquely challenging. And the scientific breakthroughs now taking place to help understand, prevent, and successfully treat addiction are nothing short of astonishing. Two NIH institutes that are already on the forefront of research into drug and alcohol addiction recently joined with cable TV network HBO to present an unprecedented multi–platform film, TV, and print campaign aimed at helping Americans understand addiction as a chronic but treatable brain disease. The eye-opening documentary, Addiction, first aired on HBO in March and is one part of the campaign. Developed with funding from the Robert Wood Johnson Foundation, Addiction and related video and print materials seek to help Americans understand addiction as a chronic yet treatable brain disease and spotlight promising scientific advancements.

Many Americans today do not yet understand why people become addicted to drugs or how remarkable scientific advances are literally redefining the arena of addiction, notes Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA).


"Groundbreaking discoveries about the brain have revolutionized our understanding of addiction, enabling us to respond effectively to the problem," she says. "We now know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease."

With nearly one in 10 Americans over the age of 12 classified with substance abuse or dependence, addiction takes an emotional, psychological, and social toll on the country. The economic costs of substance abuse and addiction alone are estimated to exceed a half trillion dollars annually in the United States due to health care expenditures, lost productivity, and crime.

"The National Institutes of Health is proud to be part of this effort to educate Americans about the nature of addiction and its devastating consequences," says NIH Director Dr. Elias A. Zerhouni. "We especially appreciate the opportunity to inform the public about the scientific research that is transforming our understanding and treatment of addictive disorders."

Addiction is now understood to be a brain disease because scientific research has shown that alcohol and other drugs can change brain structure and function. Advances in brain imaging science make it possible to see inside the brain of an addicted person and pinpoint the parts of the brain affected by drugs of abuse — providing knowledge that will enable the development of new approaches to prevention and treatment.


"Addiction is a disease — a treatable disease — and it needs to be understood," says NIDA's Dr. Volkow. "Our goal is for HBO's
Addiction documentary and project to educate the public about this disease and help eliminate the stigma associated with it.""Media depictions of addiction are often very sensationalized," says Mark Willenbring, M.D., Director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). "This is an opportunity to support a more accurate depiction of addiction."

Dr. Volkow and Dr. Willenbring were featured in the HBO documentary, as were scientific research results and new understandings developed through the work of their respective institutes.

Currently, addiction affects 23.2 million Americans — of whom only about 10 percent are receiving the treatment they need. "HBO's project offers us the opportunity to directly acquaint viewers with available evidence-based medical and behavioral treatments," says NIAAA Director Ting-Kai Li, M.D. "This is especially important for disorders that for many years were treated outside the medical mainstream."

Consisting of nine segments, the film presents an encouraging look at addiction as a treatable brain disease and the major scientific advances that have helped us better understand and treat it. From emergency rooms to living rooms to research laboratories, the documentary follows the trail of an illness that affects one in four families in the United States.

One segment, "The Adolescent Addict," explains that the adolescent brain differs from the adult brain because it is not yet fully developed. According to NIDA's Dr. Volkow, adolescent brains may be more susceptible to drug abuse and addiction than adult brains. However, because it is still developing, the adolescent brain may also offer an opportunity for greater resilience. Although treatment can yield positive results, many families are unwilling to look outside the home for help due to concerns about stigma.

Medications for use in treating alcoholism also are a focus of the program, including a segment on topiramate, under study by NIH-supported researchers at a clinic in Charlottesville, Virginia. At present, there are three FDA-approved medications available to treat alcohol dependence: the older aversive agent disulfiram, and two newer anti-relapse medications. Naltrexone, available by tablet or monthly injections, interferes with drinking reward and reinforcement, and acamprosate works on multiple brain systems to reduce craving, especially in early sobriety. According to NIAAA's Dr. Willenbring, these medications are not addictive and can be helpful adjuncts to treatment.

"There is a lot of exciting new scientific research information and treatments that we need to get out to the public," says Dr. Willenbring. "I think that we are on the cusp of a paradigm shift in the treatment of alcohol abuse."

The Addiction project also includes 13 short feature films from different directors on innovative family training and treatment approaches, interviews with leading experts, successful drug court programs that reduce relapses and re-arrests, and dealing with the dynamics of a disease that sometimes requires as much investment from family and community as it does from the individual struggling to recover. A comprehensive four-DVD set of the documentary and the 13 short films is available nationally.

NOTE: Although the dangers of nicotine addiction were not a part of this study, tobacco's impact on the health of Americans will be included in future issues.

For original article see: https://www.nlm.nih.gov/medlineplus/magazine/issues/spring07/articles/spring07pg14-17.html


LAUNCH OF A BETTER LIFE RECOVERY LIBRARY

In this age of hectic instant gratification fueled by digital obsession, it can be very relaxing and healthy to enjoy a good, mind expanding book. Just as physical exercise in recovery helps to restore our bodies to a healthy state, we also need mental exercise to help our brains properly function once again. There is no better exercise for our minds than reading and digesting a worthy book, even if it's just one chapter or even one page at a time.
To this end A Better Life Recovery announces the launch of the "Better Life Recovery Library." Categories include books on Psychology & Philosophy, Prayer & Meditation, Faith & Religion, as well as standard Recovery Literature. We are also building a collection of inspirational fiction and non-fiction titles worthy of being called "great literature" - classic tomes that everyone can benefit from reading whether for pure entertainment, inspiration or education. Lastly our library will include reference materials on a wide variety of basic life skills and related information to assist readers in the practical aspects of recovery.
We welcome appropriate donations of used books, and encourage all our clients, alumni, staff members and friends to drop by and borrow any title that might pique their interest.
At A Better Life Recovery, we believe recovery is the path to a better, richer life, one that includes expansion of our knowledge and understanding through the contribution of great literature.

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