In conversation with…Jason Schwartz: Part 1

Our own Jason Schwartz is interviewed by Pea Pod on Binge inking.

I discovered the Addiction & Recovery News blog fairly early in my own recovery and got hooked quickly. I’ve built up respect for Jason Schwartz (JS) and his team and the work they do at Dawn Farm. We’ve corresponded by email from time to time, but recently I invited Jason to a question and answer session to share a bit about Dawn Farm, his own experience and to compare and contrast his perspective on the recovery movement in the US and in the UK. Here’s the first instalment.

Pretty cool stuff!

Behavior Change

by Jeremy Brooks

Behavior change and motivation to change are interesting to me.  I have spent a lot of time thinking about how to maximize the likelihood that someone “gets it” (hope) while they are in treatment or detox and starts to take action.  When all of the stars line up it is a beautiful and rewarding thing to witness and be part of. We can help set the stage, but that there is so much that we cant see, predict or control.

This paper by Ken Resnicow and Roger Vaughan looks at behavior change through the lens of Chaos Theory. It nicely articulates many of the observations I have had over time and makes a lot of sense to me. It is full of gems, but I especially like this quote which focuses on what our role may be in helping our clients. It provides hope that even the most seemingly “tough” cases can get it. Our role may be to just do what we can to ensure that the ping pong balls keep spinning.

“In the complex system approach, the role of health communications may be analogous to the spinning of ping pong balls in a lottery machine. Say that each ping pong ball represents a chunk of knowledge, attitude, efficacy, or intention. On each ball lies a few strips of Velcro; the soft side. Inside the human psyche lies strips of the opposite, hard side of Velcro, which serve as potential motivational “receptors”. Some of the motivational ping pong balls may have resided in the system for years while others may have been more recently implanted through a health education program, clinical counseling encounter, or health communication campaign. Rather than attempting to predict which piece or pieces of motivation may “tip” the individual, from the chaotic perspective, the role of the health professional is to ensure the balls are kept spinning at various intervals and velocities to maximize the chances that they adhere to their receptors. When sufficient balls have adhered a tipping point may occur. Which balls or combination of balls may trip the motivational switch as well as when and why they may stick, are chaotic events that defy accurate prediction. From a non-linear perspective, the goal of health professionals may be to encourage wing flapping.”

A.A. Journal Articles

Two articles on mechanisms of change in AA.

The first looks at spirituality and concludes:

“Findings suggest that AA leads to better alcohol use outcomes, in part, by enhancing individuals’ spiritual practices and provides support for AA’s own emphasis on increasing spiritual practices to facilitate recovery from alcohol use disorder.”

The second at A.A. related helping and the helper therapy principal:

“Helping others in the program of AA has forged a therapy based on the kinship of common suffering, a social pioneering having a vast potential for the myriad other ills of mankind. A large body of research supports the HTP in clinical populations sharing a chronic condition beyond addiction, such as AIDS or pain. When humans help others regardless of a shared condition, they appear to live longer and happier lives.”

Cultivating executive function

1 jour, 1 photo 27/01/11
by BlondieISfuckinCrazy

A few months ago I was listening to this episode of Being on an education researcher who believes that the development of executive function should be a central focus in classroom education. The conversation was fascinating and I kept thinking that this could represent an important developmental task in early recovery and treatment. (We know that one aspect of the neurobiology of addiction is that the frontal cortex, the part of the brain responsible for executive function, is impaired.) She talked about a multidimensional approach to this that includes strategies as diverse as play, rote memorization and teaching strategies that encourage students to pause before acting and train students to pay sustained attention to a subject.

Over the last day, one of our staff, Matt, shared this link with me.

They found that this type of training improved working memory and also reduced their discounting of delayed rewards.

“The legal punishments and medical damages associated with the consumption of drugs of abuse may be meaningless to the addict in the moment when they have to choose whether or not to take their drug. Their mind is filled with the imagination of the pleasure to follow,” commented Dr. John Krystal, Editor of Biological Psychiatry. “We now see evidence that this myopic view of immediate pleasures and delayed punishments is not a fixed feature of addiction. Perhaps cognitive training is one tool that clinicians may employ to end the hijacking of imagination by drugs of abuse.”

Dr. Bickel agrees, adding that “although this research will need to be replicated and extended, we hope that it will provide a new target for treatment and a new method to intervene on the problem of addiction.”

He also shared this story on recent findings from neurological studies of meditation:

…scientists say that meditators like my husband may be benefiting from changes in their brains. The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

Could strategies focused one developing executive function become important in addiction treatment?

Monitoring the Future 2010

Monitoring the Future 2010

Among the findings:

ONDCP reponse

“The increases in youth drug use reflected in the Monitoring the Future Study are disappointing. And mixed messages about drug legalization, particularly marijuana legalization, may be to blame. Such messages certainly don’t help parents who are trying to prevent young people from using drugs.”

Another take

“One reason teens have such easy access to drugs is because dealers are embedded in their social networks. It’s usually easier to ask a peer for a dime-bag than it is to ask an older sibling for a pack of smokes or a six-pack.”

The LA Times

“This year, 21.4% of high school seniors said they had used marijuana in the last 30 days, while 19.2% reported smoking cigarettes in the same time period, according to the annual “Monitoring the Future” survey from the National Institute on Drug Abuse. It was the first time since 1981 that pot surpassed tobacco in that age group.”

PBS NEWS HOUR did a segment on the report

Addendum: Here is a comment from a friend which I found interesting.

“I also wonder if anyone else finds it ironic that the ONDCP took full credit for the previously declining rates of youth marijuana use (attributing it to their Youth Anti-Drug Media Campaign) and now blames “drug legalization” for the rising rates. The ONDCP’s support of draconian measures against marijuana users has probably done more to fuel support of marijuana legalization than the rhetoric from legalization advocates has.”

I hadn’t thought about the trend toward liberalization of pot laws as backlash, but it makes sense. Maybe we can find some middle ground. In any case there is a lot of solid evidence that marijuana is bad for kids and the fact is that more kids are using it and that attitudes toward it are shifting. Is this really a result of “mixed messages” as the ONDCP claims? I would guess so.

Iranian Harm Reduction

A couple of articles in the NYT recently on harm reduction in Iran. I could write a lot about this, but I won’t.

A few points:

The Iranian H.I. V. problem, unlike the one in the U.S., is largely driven by intravenous drug use (IDU).

The author notes:

“By recent measures, 62 percent of H.I.V. infections in Russia came directly from a shared needle. In Malaysia it is 76 percent, in Iran 68 percent.”

In comparison, according to the CDC , in the U.S. the percentage of new H.I. V. infections related to IDU is around 12-16%. Not insignificant, but obviously a very different state of affairs.

Also, the author suggests that:

“Doctors could be particularly influential in opening up the last frontier for methadone and needle exchange in America: prisons. Prisons hold large numbers of drug users, at the peak of their motivation to change, who make up quite literally a captive audience.  They are not just the place where harm reduction is most needed, they are also the ideal place to offer help.  If only we could.”

“The peak of their motivation to change” and we should give them clean syringes and methadone? Ouch! What about recovery oriented treatment?

Looking at addiction solely through a public health lens leaves much to be desired. Nothing in the article about recovery and only a little about treatment, which I assume was not recovery oriented.

The impact of the Iranian policy is not all bad, it does sound like people suffering addiction in Iran are being treated more humanely than they were in the past and that move toward harm reduction has helped to shift the focus from one that is criminal/moral to a more health oriented model. Addicts are also being engaged and offered services that they may never have had access to in the past. Yet, harm reduction without an emphasis on recovery is so hopeless.

I really like this paragraph from one of Jason’s past posts:

“Ideas like this are rooted in despair, rather than hope.  We get overwhelmed by the problem. We’re too cheap to offer adequate help. We don’t believe that these people can recover. We think they have no chance. We’re scared that they’ll hurt us and get us sick. So, we offer them these kinds of interventions. Often, these programs represented in the name of choice, when, the addicts themselves, want better from us. They actually want to get well, but often lose hope that it’s possible for them. The system starts patting them on the head an encouraging them to be more realistic. What they need from professional helpers is for us to lend them our hope to cultivate some of their own. They need a system that stops talking about if they recover and starts talking about when they recover.”

It has been said that “the good can be the enemy of the best” The following quote from the article says a lot:

“‘There is a rule in Islam that between bad and worse, you have to accept bad,’ said one Iranian drug expert, ‘Having needle and syringe programs is bad, but having H.I.V. is worse. There is no third option.'”

Yes there is, and many more …

Propranolol Shows Early Promise for PTSD

When I saw the post on disrupting memory retrieval to prevent relapse it brought to mind this from a couple weeks ago. Similarities between addiction cues and PTSD are interesting. Both articles discuss the relative ineffectiveness of exposure therapy and the promise of propranolol in mediating the super charged memories.

Here is a paragraph from the addiction article:

“Along with the discovery of propranolol’s cocaine-memory blocking effects, the researchers also have identified the primary players in the brain responsible for ‘extinction’ learning – the ability to replace cocaine-associated memories with associations that have no drug ‘reward.'”

And here is one from the PTSD article:

“Propranolol treatment takes a different approach. It is based on the notion that memories, once they are consolidated, can be retrieved, and they exist in a labile state during which they are susceptible to modification until they are reconsolidated. During the labile window of opportunity, which is believed to be several hours, administration of propranolol can strip the memory of its emotional meaning, making it less stressful, he explained.”

Treating Nicotine Addiction

More substance abuse treatment centers are providing nicotine replacement therapy to help patients quit tobacco use

Tobacco use remains the single most preventable cause of death — causing about 440,000 deaths per year in the United States. Almost half of these deaths occur among people with mental and substance use disorders.