It is therefore striking that libertarians, who are in fact uninclined to talk about family breakdown, seek to overturn a policy that does more damage to American families than any other.

Conor Friedersdorf arguing that the single best thing the US government could do for families is end drug prohibition.

When people talk about ending the War on Drugs, or decriminalizing marijuana, or reining in stop and frisk, they are not simply talking about the right of private citizens to get high, they are talking about the right of private citizens to not be subject to lethal violence at the hands of the state. … For all practical purposes, if an officer, pursuing an arrest, believes you have endangered his life, and can demonstrate that belief, he or she can kill you.

Now, this doesn’t suggest that our choices are criminalize or legalize and it doesn’t suggest that the costs of not enforcing drug laws are acceptably low.

There is no such thing as a problem-free drug policy, the questions we need to answer are:

• Which problems are we not willing to tolerate?
• Which problems are we willing to tolerate and how can we minimize them?

I have no interest in entering this debate on this blog, but I think the exchange offers a chance to step outside of the debates in our field.

Murray’s insistence that he was simply reporting a data point shows how blind we can be to our own narratives. He seems only vaguely aware that he has already attributed meaning to the data point—its source, its implications, its importance, and its characteristics. (fixed vs. static, that genetic determinants are powerful and important in comparison to other determinants, etc.)

The other host and the other guest were so troubled by the meaning that Murray ascribed that all of their responses focused on this meaning and they never really responded to the data point.

It seems like a lot of drug policy debates follow a very similar pattern. I find myself frustrated with people who argue that their position is empirically based as though the meaning they derive from their facts is self-evident, that they hold the only rational understanding and their conclusions are value-free.

In turn, I could do a better job of responding to their data and concerns.

Related articles

• The Math Problem
• When Words Fail
• Everybody Worships
• Towards a Smarter Drug Policy
• Genetics of IQ: not so simple (psychologytoday.com)

The writer captures my concerns:

I don’t foresee any negative results from dropping those two misguided terms. (abuse and dependence) But what does concern me is the fact that rather than still having two separate and distinct conditions—one, a short-term, self-limiting disorder and the other a condition likely to be chronic and relapsing—there will now be only one way to have a drug problem. The gradations of the condition will likely be delineated as “mild,” “moderate” or “severe” substance use disorder. While the word “addictive” will appear in the heading that labels the overall category, it will not figure in the diagnoses themselves. For example, you could have mild, moderate or severe opioid dependence disorder or gambling disorder. (So far, gambling is the only behavioral addiction to make the DSM cut.)

But this elision of the problems formerly known as abuse and dependence will, I fear, cause major problems for many people, especially teenagers and young adults. What it means, in a worst-case scenario, is that every college binge drinker will be at risk for being labeled an alcoholic and every high school stoner, an addict.

It’s unfortunate that the author trots out gross stereotypes and caricatures in paragraphs 9 through 12. She falls into the cognitive errors that Kathryn Shultz describes so well at 9:59 through 11:17 of this great talk:

Good thing we don’t use Jayson Blair, Stephen Glass, Jack Kelley and partisan medial outlets to slander writers in general

Related articles

• More on the DSM-V (addictionandrecoverynews.wordpress.com)
• Allen Frances: Can the Press Save DSM 5 from Itself? (huffingtonpost.com)

Image via Wikipedia

A few weeks ago I shared some great comments from Chris Christie about the moral imperative to provide treatment to offenders with drug and alcohol problems.

This week he called for New Jersey flags to be flown at half mast in honor of Whitney Houston.

Not surprisingly, the decision has received some criticism. But Chris Christie is pushing back:

Christie said he’s disturbed people are disparaging Houston’s accomplishments because of her troubles with substance abuse.

“This is a disease that some people struggle with and conquer on a day-to-day basis, and some people succumb to it. And I don’t believe that that should diminish the other contributions they’ve made in their life,” Christie said.

“I’m not saying that Whitney Houston is a role model. She’s not a role model in that respect, in every aspect of her life. But what she is is a cultural icon in the history of this state,” he said. “I’m disturbed by people who believe … because of her history of substance abuse, that somehow she’s forfeited the good things that she did in her life. I just reject that on a human level.”

Awesome.

I’ve never been a Whitney fan and I doubt I’d call for flags to be flown at half mast. So, I have no problem with criticism of that decision, but I’m bothered that so much of the criticism suggests that she’s unworthy because she was a drug addict.

Good for him for leaning into it.

it's all about me by randy willis

What he said.

Nice to see someone refrain from using this as an opportunity to advance their preferred narrative.

Awesome. A very cool tribe within the recovering community.

More than 4,700 people have participated in Phoenix, which Scott Strode started in 2007. Most join the group because they’ve struggled with drug or alcohol addiction.

“Life should be better once you get sober,” said Strode, 38. “(We want to) help people build a new life, a new self-image and have fun without getting high.”

…

Phoenix offers around 50 programs every week, ranging from casual walks and yoga to mountain biking and ice climbing. Activities are led by field instructors, all of whom are in recovery and happy to show beginners the ropes. The organization provides the gear and also offers grants to help people purchase their own equipment. Nearly all events — with the exception of overnight activities or ski trips — are free.

“It’s a great way to introduce people into something that then later becomes … sort of their coping mechanism, as opposed to picking up a drink or a drug, ” Strode said.

He notes that Phoenix isn’t a substitute for any other recovery support program; in fact, many in the group are also in 12-step programs. But Strode believes the natural “high” that people get from Phoenix activities can be transformative.

…

Anyone who has been sober for 48 hours is welcome to come to one of Phoenix’s open sessions to participate in an activity and learn about the group. After attending several events, individuals are invited to join, provided they sign a pledge to treat everyone respectfully and stay sober. Some members are hard-core athletes, but the group welcomes people of all fitness levels. Most participants have never been active.

The New York Times has a profile of Rabbi Shais Taub, who offers culturally specific recovery support to the Jewish community.

The focus on dependence also implied that cocaine—which does not produce physical dependence—isn’t “really” addictive. That lulled many people in the ’80s—including yours truly—to think that cocaine wasn’t likely to be hard to kick. We all know better now.

Moreover, with the term “dependence” in the medical definition of addiction itself, it became very difficult to teach people that needing a drug to function isn’t the essence of addiction. The misdefinition encapsulated the idea that suffering withdrawal—rather than compulsive use despite negative consequences—was fundamental to the problem. That meant that the drive to take drugs—now demoted to being called merely “psychological dependence”—was less important than getting sick if you couldn’t get the drug.

In reality, this desire—and related repetitive drug-taking—matters far more than how sick you get when you try to stop.

I’m in complete agreement. All of our public education on addiction has to go through explaining that only 2 dependence diagnostic criteria out of 7 focus on physical dependence (3 criteria are required for a diagnosis.) and that dependence and addiction are not the same thing.

That said, I’m pretty concerned about the spectrum approach planned for the DSM-V. While problem AOD use and addiction may behaviorally appear to be part of the same continuum, they are categorically distinct rather than being different degrees of the same problem.

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Saving lives is good an important, but something about this feels like building an addition on a house in hell.

Naloxone is a medication administered usually by injection which rapidly reverses the effects of opiate-type drugs such as heroin, including the respiratory depression which can cause what are normally referred to as ‘overdose’ deaths. … The 16 pilot projects trained 495 carers (family members, partners and other carers) to respond to an overdose using basic life support techniques, and all but one also trained them to administer naloxone.

Saving lives is a good thing, but what else might be done to prevent overdoses? Why this?

Yesterday’s post asked, “at what cost?” What are the costs of this to the family members?