Between Addiction and Abstinence 

Between Addiction and Abstinence 
Posted by CN Staff on May 07, 2006 at 19:00:12 PT
By Benedict Carey
Source: New York Times 
New York -- A humiliating accident. An apparent memory lapse. A sudden, emotional confession.Representative Patrick Kennedy's car crash on Capitol Hill early Thursday and a news conference a day later had a familiar rhythm, especially for those who study addiction or know it firsthand.
Mr. Kennedy, a six-term Democrat from Rhode Island, said that his addiction was to prescription medication and that he planned to seek treatment at an addiction clinic, as he had done before. "I struggle every day with this disease, as do millions of Americans," said Mr. Kennedy, who is 38.But will a cure that apparently didn't take the first time be successful the second time around? Mr. Kennedy, for one, ruefully acknowledged how easy it was for him to backslide. Mr. Kennedy is seeking treatment at a time when the entire field is undergoing a transformation. Once akin to exorcists, committed to casting out the demons altogether, those who work with addictive behavior of all kinds are now trying less dogmatic approaches — ones that allow for moderate use as a bridge to abstinence.A government-financed study of alcoholism released last week, the largest to date, suggests how deeply this "moderate use" idea has taken hold. The study found that the treatment produced "good clinical outcomes" in about three-quarters of the almost 1,400 heavy, chronic drinkers in the study. Some quit altogether; most, however, had moderated their drinking — to 14 drinks a week or fewer for men, 11 or fewer for women. "The fact is that these moderate measures are becoming more and more accepted in judging treatments," said Dr. Edward Nunes, a professor of clinical psychiatry at Columbia University. Millions of recovering addicts and their families as well as counselors working in the trenches consider this approach to be foolhardy and immoral. Addicts are by definition unable to control or manage their addictions, they say, and leaving an opening for moderate use only encourages the experimentation that can lead to ruin or death. Cases like that of Mr. Kennedy dramatically illustrate how close to breakdown many addicts live, they say. "Implying you can simply cut down does a tremendous disservice to those who have this addiction," said Stanley L., a recovering alcoholic in Pennsylvania who still attends group counseling sessions. Yet the openness to moderate use is likely to increase, driven by changes in the science of addiction, like pharmaceutical treatments. The latest option for opiate addiction, bupenorphine, is a substitute drug, like methadone, replacing one habit with another. The drug naltrexone, which seems to numb the brain to the euphoria from drinking or gambling binges, is more likely to reduce the consumption than shut it down altogether. And perhaps the biggest recent advance in smoking cessation, the nicotine patch, is itself a badge of compromise, an admission that many smokers need a habit to lean on, temporarily or perhaps indefinitely, as they strive for life without. When studying these pharmaceutical crutches and prescribing them, doctors tend to emphasize improvement over abstinence for good reasons, researchers say. "Third-party payers," said Dr. Barbara Mason of the Scripps Research Institute, where she treats and studies addiction. "One way you can convince people holding the purse strings to cover treatment is to say, look, if you pay for this and it lowers the level of drinking or substance use you won't have to pay for E.R. visits. That's really important. If you prevent one case of fetal alcohol syndrome, you don't have to pay for a lifetime of care."Some studies of drug use and gambling have also contributed to shifting the thinking about addiction. For example, surveys find that most smokers who quit do so on their own, after many attempts and periods of moderation. An estimated 20 percent of compulsive drug users and drinkers have had similar recoveries, experts say. In a 2002 study, researchers at Harvard Medical School tracked the behavior of more than 6,000 casino employees, many of whom were heavy drinkers, gamblers or both. Over a period of three years, many of those with diagnosable disorders changed their behavior, moving from heavy use to moderate levels, and sometimes back up again. "The conventional wisdom is that you get the habit and start down this slippery slope and it just gets worse and worse, but that was not true for many of these people," said Christine Reilly, executive director of the Institute for Research on Pathological Gambling and Related Disorders, in Medford, Mass. Heavy gamblers and drug users are much more diverse groups, in short, than many presume, and their compulsions have different meanings in the context of their lives that are important guides for treatment. Some addicts are depressed and anxious and in need of psychotherapy but can't get it because therapists require that they give up their habits first, said Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington. "Maybe the drug use is responsible for the depression, or the depression led to the drug, but it's all mixed up and they never find out, because they can't get treatment," he said. Many addicts, it is true, spiral only downward, and must quit to stay alive. But others are ambivalent about whether they want to quit or not. Their routines, their pleasures, some of their most sustaining relationships are tied up with their habits, and it is far from clear what will nourish them if they suddenly give up. The very idea, common in abstinence-based programs, that one "slip" can lead to total loss of control may undermine their best efforts to self-regulate."It's very scary for them to contemplate life without this habit, because it has become very meaningful for them," Ms. Reilly said. Offering moderate use as a first step, some therapists say, is the only way of "meeting people where they are," and getting them down to a level of use that keeps them from driving under the influence, petty crime or other trouble."The idea is to reduce the consequences of the heavy use, and work from there," said Mr. Marlatt.This was more or less the view offered by Charles Barkley, the former N.B.A. star, in an interview on ESPN last week: "Do I have a gambling problem? Yeah, I do have a gambling problem but I don't consider it a problem because I can afford to gamble. It's just a stupid habit that I've got to get under control, because it's just not a good thing to be broke after all of these years."By treating the habit as just that — a habit — and not a disease, therapists may be able to make progress in reducing the bad consequences, whether a broken marriage or an embarrassing car accident. On the other hand, the risk to addicts of this approach is incontestably real, and no one knows in advance who can and cannot safely moderate their addictive behavior. "I am deeply concerned about my reaction to the medication and my lack of knowledge of the accident that evening," Representative Kennedy said on Friday. "But I do know enough to know that I need to seek expert help."Source: New York Times (NY)Author: Benedict CareyPublished: May 7, 2006Copyright: 2006 The New York Times CompanyContact: letters nytimes.comWebsite: Justice Archives
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Comment #22 posted by John Tyler on May 09, 2006 at 21:17:20 PT
Kennedy's car
Kennedy, drug usage, car crash. Nothing new here. I did notice he was driving an American car. That part was good.
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Comment #21 posted by FoM on May 09, 2006 at 09:36:15 PT
Max Flowers 
It is terrible the mess we're in now. It really is depressing.
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Comment #20 posted by Max Flowers on May 09, 2006 at 09:27:38 PT
This is pretty horrible. I just saw a piece of video (watch it here ) wherein this guy Hayden argues with a reporter about the meaning of the 4th Amendment, and Hayden denys in a very arrogant manner that probable cause is a key part of it. It was incredible, and very frightening, because this is a guy who may end up in charge of the CIA and has already been in charge of NSA, and he's totally clueless (or blatantly lying regarding his understanding of it) about the Bill Of Rights! That is completely unacceptable.We are in such deep poop I can't even believe it.
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Comment #19 posted by whig on May 08, 2006 at 19:55:37 PT
Hypothetically you could also use hushmail as your delivery address.
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Comment #18 posted by unkat27 on May 08, 2006 at 18:39:16 PT
thanx for the trashmail link. If I ever get a chance to use it, it might help. But since all emails get forwarded to a person's existing email address, I can't believe it is entirely safe. I'll just keep dreamin about canada for now and hope I get there before it's completely annexed by the DEA.
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Comment #17 posted by whig on May 08, 2006 at 18:08:04 PT
We've already got martial rule, the question is how to get out.
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Comment #16 posted by mayan on May 08, 2006 at 17:40:07 PT
If Hayden gets the nod there will be military people at the top of all of our "civilian" intelligence agencies! The stage will soon be set for martial law in the United States of America. Pentagon Is Winner Over CIA: the above linked article...A senior intelligence community official yesterday said the director of national intelligence, John Negroponte, has indicated "he is willing to give up covert operations to the Pentagon."
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Comment #15 posted by whig on May 08, 2006 at 17:27:22 PT
We really should establish a better underground railroad to help people in the states that don't have medical marijuana. I know we can't do it here on CNews but maybe somebody can help you offline if they could talk with you privately. I'm not in any position to help directly, but I just thought I'd throw the idea out there and people can always use trashmail to create a temporary e-mail address to let others communicate privately and directly.
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Comment #14 posted by b4daylight on May 08, 2006 at 16:19:09 PT
a reason
the second time I was in Amsterdam I did not even drink alcohol. Nor was I even thirsty for one. Although I did have a thirst. Note nothing about how the federal spends its money on the war and not treatment. Imagine if we spent 20 bilion on treatment?
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Comment #13 posted by whig on May 08, 2006 at 12:46:02 PT
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Comment #12 posted by FoM on May 08, 2006 at 12:35:56 PT
I just thought of words from Prairie Wind. It's a dream, it's only a dream.I find what this administration has done to us and the world like it's almost a dream. Actually a nightmare. 
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Comment #11 posted by afterburner on May 08, 2006 at 12:26:24 PT
OT Another Bush Crony Nominated
Air Force general Bush's pick to lead CIA"Talk of Hayden's nomination rekindled debate over the administration's domestic surveillance program, which Hayden used to oversee as the former head of the National Security Agency."
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Comment #10 posted by sam adams on May 08, 2006 at 10:54:07 PT
organ damage
Saw this article in today's paper. The gist of it is that kidney damage is becoming more common, and it's very hard to detect "until it's too late". is the kind of information that does not exist in the make-believe world of medical MJ prohibition. I've been told by more than one doctor than NSAID pain killers (Advil, Naproxen, formerly Vioxx, etc) are actually more damaging to the kidneys than they are to the GI tract (kills 13,500 per year) or the liver. Standard medical protocol for people with long-term arthritis or joint problems is NSAIDS, 24/7, 365 days per year, for 10, 20, 30, 40 years or more. Yet it's widely known and proven again and again in research that these drugs are damaging to the stomach, intestines, liver, and kidneys, and even the heart and cardiovascular system.But for medical marijuana to be legal, even for terminally ill people and people wasting away from cancer and AIDS, it must proven that it does damage even one cell of any organ in the body. Any sign of lung damage or irritation whatsoever is ample proof for banning every single patient in the US from using the herb. Even though no death or case of serious illness (cancer) has EVER been detected in ever one person!Welcome to the world of make-believe! Read the science today, but forget it tomorrow, when duly instructed by your masters.
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Comment #9 posted by unkat27 on May 08, 2006 at 09:59:32 PT
Moderation worked for me, until...
I had a problem with alcohol a few years ago and I did the moderation thing and it worked quite well, but what really convinced me to stop altogether was my ulcer, which doesn't respond well to alcohol.As for cannabis, well, I know it helps quite a lot, but I can't get it in this state because it is illegal and very hard to find. Also too risky. There are narcs and thieves everywhere that cannot be trusted.So, I did manage to stay off of alcohol, even without any cannabis, for about a year. Then, suddenly, this very obnoxious noisey neighbor with a sinus condition moved in over my head and began disturbing me at all hours with these very disgusting noises that he makes constantly, apparently to clear his sinuses. I told him to try and keep it quiet, but although he apparently tries to keep it down, the only real way for me to keep from being disturbed is to make my own noise to drown it out. I have to play the tv or music loud to do so.I am sorry to say that ever since this guy moved in over my head, I have had almost no peace and quiet whatsoever, because he is always there and always making those noises. It is very annoying. The worse of it is, it drove me back to the drink, because I know that alcohol can dull my senses and help me ignore such things. Needless to say, my ulcer is not at all happy with the situation. Of course, I'm quite sure that cannabis would help, but tell that to the fascists who "fear for the children" and claim that it is bad for everyone.
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Comment #8 posted by FoM on May 08, 2006 at 08:23:31 PT
Cannabis The Gateway Drug
I agree that cannabis can help a person quit addicting drugs legal or illegal. 
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Comment #7 posted by mai_bong_city on May 08, 2006 at 07:03:22 PT
mental illness
there is little mention about patrick kennedy's bipolar disorder. many with this disorder self-medicate to alleviate symptoms when they are undiagnosed....but he's been dx'd - i find it really odd that any physician would prescribe the kinds of drugs he's taking and also wonder what medications for bipolar he's on.....ambien is given out like candy these days but from experience it tends to disrupt the bp cycles and increases depression - plus, he's an addict in recovery, and ambien can be VERY habit-forming....i don't get it.
cannabis might have been helpful in treating his bp and addiction issues, they've found of course that people have less craving for alcohol when using cannabis.....and smoking a joint at bedtime is a sure way to get sleepy and not suffer effects of sleep medicine that stays in your system for 24 hours or more.
i wish the guy luck, and maybe he'll say a little more about dealing with bipolar, too, which is also likely genetic in nature, and causes a lot to turn to whatever will help them dull the pain.
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Comment #6 posted by Truth on May 08, 2006 at 06:31:38 PT
Praise Cannabis!
I concure.
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Comment #5 posted by mayan on May 08, 2006 at 04:20:58 PT
Off Topic
North Dakota's hemp farming rules aimed at clearing federal hurdle: WAY OUT... Reynolds: “Come Out of the White House with Your Hands Up!” - Ex-Bush Official Busts 9/11 Perps at U.W. Historical Society: 9/11 Truth Movement Is Not Anti-Semitic And Neither Is Ray McGovern: to screen controversial Sept. 11 film: Chance of Truth in WTC-7 Investigation:
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Comment #4 posted by BHicks on May 08, 2006 at 03:57:49 PT:
My uncle managed to kick his alcohol addiction after 30 years of non-stop drinking when an American (I'm Norwegian) alcoholic recommended cannabis as a substitute to alcohol, when he was on vacation in Thailand. Since then, both he and his ex-wife (who's still using pills and alcohol - but went from almost killing herself, to a moderat usage) have been pretty much 'clean' since then. My uncle got his job back and started enjoying life again, and his former wife doesn't have psychotic episodes anymore (which alcohol gave her all the time). They both thank cannabis for saving their life.Praise Cannabis!
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Comment #3 posted by global_warming on May 07, 2006 at 23:03:54 PT
a little nuze technique sheds new light on the composition of the brain of moderate cannabis users
Pot debate should take place
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Comment #2 posted by FoM on May 07, 2006 at 20:42:06 PT
I really find this article enlightening. The short time I was involved in any drug treatment ways was back in the 70s. We took classes at Kent State University and it was great. What we learned was self help was vital. That condemning a person was wrong. If a person thinks the drugs are taking over their life and ask for help they would get help. Help was listening. Listening to what they had to say was basically it. It was a fascinating time. They even had a doctor and first aid tent for people who might do too many drugs at a concert and needed help. I know because my husband and I did a concert and were with the medical crew to help people if and only if they wanted help. It was a good thing.Moderation is really the key.
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Comment #1 posted by whig on May 07, 2006 at 20:07:00 PT
Addiction and marijuana
Where they have identified addiction as a permanent part of the person they have suggested as a solution merely moderating the drug that they are on, or substituting with another of similar effect. There is a lot to be said for the fact that a person who has learned to alter his or her consciousness does not easily return to the world of sobriety for very long and it is not a matter only of willpower but of personality which must be changed to achieve this. Hence the approach of many schools of "rehab" has been to effect such a reformation of the personality, a brainwashing, to reconnect the person to goals and desires that they think better, to make the person religious and obedient to the church that is really the empire.We have another approach which is the sacrament of cannabis, which is as much a church in its way but there is no force and no compulsion. You have nothing to obey and nothing to believe and nothing to recite, but you will come to understand in your own time and in your own way and you will be part of our family and you will not need the drugs you had before. You will not need to take them moderately or at all, nor substitute them with similar chemicals, and you will not become dependent on marijuana because it is not addictive. This isn't to say it will be instantaneous, or easy, but it does work and it will help you get off your prescription treadmill. And you will be free.
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