Free, special addiction education opportunity

george-vaillantI wanted to make sure all of you know what a special opportunity this week’s Dawn Farm Education Series presentation offers.

The presenter will be George Vaillant. Who is he?

Well, he’s the source of one of our favorite quotes: “If you want to treat an illness that has no easy cure, first of all treat them with hope.”

Here are a few more things he’s known for:

He established much of the knowledge we now take for granted. Some of the findings from Dr. Vaillant’s alcoholism studies included:

  • That alcoholism is as much a social as a medical condition. “Alcoholism can simultaneously reflect both a conditioned habit and a disease.”
  • Factors predicting alcoholism were related to ethnic culture, alcoholism in relatives, and a personality that is antisocial and extroverted. An unhappy childhood predicted mental illness but not alcoholism—unless the family problems were due to alcoholism.
  • That alcoholism was generally the cause of co-occurring depression, anxiety, and sociopathic (delinquent) behaviour, not the result.
  • That even though alcoholism is not solely a medical condition, it is therapeutically effective to explain it as a disease to patients. The disease concept encourages patients to take responsibility for their drinking, without debilitating guilt.
  • That for most alcoholics, attempts at controlled drinking in the long term end in either abstinence or a return to alcoholism.
  • That there is as yet no cure for alcoholism, and that medical treatment can only provide short-term crisis intervention.
  • Achieving long-term sobriety usually involves (1) a less harmful, substitute dependency; (2) new relationships; (3) sources of inspiration and hope; and (4) experiencing negative consequences of drinking.[3]

You have two chances to see him:<

  1. You can see him on Tuesday night at St. Joe’s – Reception at 6:30 and presentation at 7:30.
  2. You can see him Wednesday night at U of M – Reception at 6:30 and presentation at 7:30.

The presentations are different. So, see him twice!

The presentations are free, there is no registration and there will be free food at the receptions.

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Where’s the hope?

nihilism by Brett Jordan

nihilism by Brett Jordan

Hot off the presses, Obama Administration Announces Prescription Opioid and Heroin Epidemic Awareness Week.

1945 words and the word “recovery” appears 2 times. (No, there are no uses of any other variation of the word.)

Zero times in the brief section on treatment.

American drug policy may finally be backing away from the war on drugs, but it’s still deeply inadequate.

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Changes ahead for the vaping industry

box-closed-pen-02_grandeNew FDA oversight of vaporizers could have a big impact on the vaping industry:

. . .the entire landscape is about to change…and it will most likely favor Big Tobacco, in one way or another.

But why the shift?

In May 2016, the FDA finalized a rule (a very dense 134 page rule, to be exact) extending their regulatory power established by the Tobacco Control Act in 2007 to cover all tobacco products, which now includes e-cigarettes. That rule officially went into effect on August 8, 2016,starting the clock for the entire industry to disprove that their products are “not appropriate for the protection of public health.”

. . .

The FDA defines a new group of cigarette technology as Electronic Nicotine Delivery Systems (“ENDS”), which includes “vaporizers, vape pens, hookah pens, electronic cigarettes (E-Cigarettes), and e-pipes,” among others. Despite the term “nicotine” being included in the terminology, the FDA extends their regulation to any tobacco-related product, regardless of whether it contains nicotine. Further, the regulation extends to ENDS and any component of ENDS products, such as e-liquids, atomizers, batteries, cartridges, flavorings, and even software.

. . .

k300_flavors_fruitsCoupled with that broad definition of regulated products is a broad definition of the term “manufacturer,” which includes all companies that “make, modify, mix, manufacture, fabricate, assemble, process, label, repack, relabel, or import ENDS.” This language is so broad that it essentially includes any company directly or tangentially involved in the ENDS industry.

. . .

What does it take to be approved by the FDA for ENDS products? Every manufacturer must submit an application to market each of their new tobacco products, which may not actually be new or a tobacco product. The term “each” is accurate, as an application must be submitted for each separate SKU (stock keeping unit), and each application must include studies that support their assertion that their product is appropriate for the protection of the public health. Estimates for each application submission range from two million to thirty million dollars, and most manufacturers must submit the applications within twenty-four months of the effective date of August 8, 2016.

Read the rest at Points. The author predicts “the near extinction of the e-cigarette market.”

It’ll be interesting to see how this plays out. Some words from Bill White have been on my mind as I’ve watched the emergence and evolution of vaping. He said something like, “I can’t tell you what the major drugs of misuse of the future will be. But, I can tell you that they are already here and someone will find a new way to use them. Look at the way the invention of the syringe and ‘rocking’ cocaine transformed the relationship between the user and the drug.”

We’ve only seen the tip of the iceberg with vaporizers and we know that regulation is a very imperfect instrument. Will FDA regulation help or create black markets that are worse than our current trajectory?

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Food for thought on marijuana

Marijuana AdvertisingFirst, a post on American use of and beliefs about marijuana:

There has been a significant increase in the number of Americans using cannabis, rising from 21.9m in 2002 to 31.9m in 2014. The number of regular users doubled over the same period to 8.4m. This coincides with an increasingly liberal approach to cannabis regulation in several US states. The authors of a new study, published in The Lancet Psychiatry, also found that people perceived cannabis to be less harmful. This perception seems justified as problems related to cannabis use, such as dependency, remained stable during the study period.

These findings are not what you would expect when cannabis use becomes more popular and is thought to be increasingly potent. This study also contradicts another study, using data over the same period, which found that disorders associated with cannabis use have doubled. So which one should we believe?

Second, a post examining the complicated questions around marijuana taxation:

Can I let you in on a little secret? No one knows the best way to tax either medical or recreational cannabis. Every option has trade-offs.

What should the tax be based on? What should the rate be?

Consider a price-based tax such as 25 percent at the retail level. While it would be easy to implement, the effective tax per joint would decrease as the price declines — something expected to happen as competition, innovation and scale-economies push down costs.

Taxing by weight, say $2 per gram, would also be easy to implement, but it means low- and high-potency products face the same tax. This creates incentives for producers to sell more potent cannabis to minimize the tax per hour of intoxication. Some public health researchers worry that more potent cannabis is associated with more health problems, an issue that is the subject of serious debate.

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Who’s “we”?


This article is making the rounds and getting some attention. The post below addresses the issues raised. (originally posted on 10/31/2014)


This article has been forwarded to me by several people. Its author has been writing a series of articles that seek to redefine addiction and recovery.

As Eve Tushnet recently observed, “There’s another narrative, though, which is emerging at sites like The Fix and” This sentence is representative of this alternative narrative:

“The addiction field has struggled with defining recovery at least as long and as fiercely as it has with defining addiction: Since we can’t even agree on whether it’s a disease, a learning disorder or a criminal choice, it becomes even harder to figure out what it means when we say someone has overcome an addiction problem.”

But are “we” really unable to agree that addiction is a disease? Who’s “we”?

It’s not unlike suggestions that there’s wide disagreement on climate change.

“Since we can’t even agree on whether it’s a diseasea learning disorder or a criminal choice, it becomes even harder to figure out what it means when we say someone has overcome an addiction problem.” “. . . just so you know, the consensus has not been met among scientists on this issue. Or that CO2 actually plays a part in this global warming phenomenon as they’ve come up with somehow.”
Health organizations that call addiction a disease or illness:

  • American Society of Addiction Medicine
  • American Medical Association
  • American Psychiatric Association
  • American Hospital Association
  • American Public Health Association
  • National Association of Social Workers
  • American College of Physicians
  • National Institute of Health
  • National Alliance on Mental Illness
  • World Health Organization
Scientific organizations that recognize human caused climate change:

  • American Association for the Advancement of Science
  • American Astronomical Society
  • American Chemical Society
  • American Geophysical Union
  • American Institute of Physics
  • American Meteorological Society
  • American Physical Society
  • Federation of American Scientists
  • Geological Society of America
  • National Center for Atmospheric Research
  • National Oceanic and Atmospheric Administration
Health organizations that dispute the dispute the disease model:

  • I can’t find any. If you have some that are similar in stature to those above, send them to me.
Scientific organizations that dispute human caused climate change:

  • None, according to Wikipedia.

To be sure, there are people who don’t accept the disease model, some very smart people, but they represent a small minority of the experts. (The frequent casting as David vs. Goliath should be a clue.) And, if you look at their arguments, you’ll find other motives (I’m not suggesting nefarious motives) like protecting stigmatizationdefending free will from “attacks”, discrediting AA and advancing psychodynamic approaches, resisting stigma and emphasizing environmental factors.

Attending to some of their concerns makes the disease model and treatment stronger, not weaker. Lots of diseases have failed to do things like adequately acknowledge environmental factors. And, one takeaway from these critics is the importance of being careful about who we characterize as having a disease/disorder explicitly or implicitly (by characterizing them as being in recovery).

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Why Does Alcoholics Anonymous Work?

This video addresses two important questions:

  1. Can evidence be trusted if it’s not from a randomized controlled trial?
  2. Does Alcoholics Anonymous involvement really help alcoholics stay sober? Or, do AA attenders just stay sober because they are more motivated than non-attenders to stay sober?

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“Growing a Healing Forest is a mentality”



“What’s called for in this metaphor is treating the soil — creating a Healing Forest within which the health of the individual, family, neighborhood, community, and beyond are simultaneously elevated. The Healing Forest is a community in recovery.”

Derek Wolfe, a recent University of Michigan grad (soon to be a medical student), just posted an ambitous series of articles on Ann Arbor, MI as a “healing forest.”


He profiles several elements/contributors to Ann Arbor’s recovery readiness. Here’s my favorite:

Just a short walk from Zingerman’s Deli in Kerrytown sits The Lunch Room, a popular vegan restaurant in Ann Arbor. Co-owner Phillis Engelbert, formerly a community organizer before moving into the restaurant business, has worked like Weinzweig [Zingerman’s co-founder] to cultivate an inclusive culture and positive workplace, which may explain why 11 out of 27 of her employees are in recovery.

“Well I think with the first (employee in recovery), it probably was just building that personal relationship,” Engelbert said. “But then everyone who came after, the word was out: Lunch Room will support you. Or you know, there’s no stigma here. Or like, if you need to go to court dates, they’ll give you time off. Or if you end up going to a court date and you get thrown in jail for a couple days and then come back out, you won’t lose your job. Or like, they’ll celebrate your sobriety anniversaries. Or, just whatever, they’ll understand and there won’t be a stigma.”

But removing stigma in a workplace can’t just be an effort from top leadership. The mentality must make its way into the minds of every employee. One of the ways in which Engelbert is able to maintain a stigma-free culture and family atmosphere is through a careful hiring process.

Removing stigma in a workplace can’t just be an effort from top leadership. The mentality must make its way into the minds of every employee.

“I’m also really really careful about who I hire because I don’t want to wreck (the inclusive, stigma-free culture),” Engelbert explained. “So I tell people when they’re interviewing, I say, ‘We have people here from all walks of life. We have people here of different income backgrounds, education levels, prison history, lesbian, gay, trans, whatever. You have to be happy about that or you can’t work here. Like you have to look at that as a positive and help us embrace all that or this isn’t the place for you.’”

The result of Engelbert’s efforts is an environment in which recovery is able to be discussed openly among the staff. Conversations about recovery occur often at The Lunch Room.

“Everyday. All the time. It’s just like talking about the weather,” Engelbert said.

One Lunch Room employee put it this way: “It’s nice to be open about (recovery), have a boss that understands and just not have like a drug-fueled kitchen environment ’cause that’s just not what I want to be around.”

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