Ezra Klein directs us to a NY Times Book Review piece on doctors, research, evidence-based medicine and drug companies:

Conflicts of interest affect more than research. They also directly shape the way medicine is practiced, through their influence on practice guidelines issued by professional and governmental bodies, and through their effects on FDA decisions. A few examples: in a survey of two hundred expert panels that issued practice guidelines, one third of the panel members acknowledged that they had some financial interest in the drugs they considered. In 2004, after the National Cholesterol Education Program called for sharply lowering the desired levels of “bad”…

1. Alcoholics Anonymous (AA) Recovery Outcome Rates: Contemporary Myth and Misinterpretat
2. Heroin Anyone?
3. The History of Gay People in AA
4. FDA fast-tracks first cocaine, meth addiction fighter
5. The super adventure club helps kids say “no”
6. What Addicts Need
7. Narcan outrage
8. More on recovery in the U.K.
9. Co-occurring Social Anxiety and Alcohol Use Disorders
10. More from Pat Deegan
11. Cocaine self-medication for insomnia
12. Kicking methadone in the U.K.
13. Sick of watching people die
14. Recovery and the Conspiracy of Hope
15. Drug policy freak show

People who know me well know that I often make loose associations that leave other people scratching their heads. I Here are two loosely related articles that I wanted to draw your attention to.

First, an article on batterer’s intervention programs that provides an overview of some of the history and the philosophical tensions that exist among programs.

Second, an article on happiness as a social phenomena.

While there are many determinants of happiness, whether an individual is happy also depends on whether others in the individual’s social network are happy. Happy people tend to be located in the centre of their local social networks…

More evidence for the healing power of one alcoholic helping another.

If you read my posts at Everyone Needs Therapy, especially the more recent post about Friend Poaching, then you know I go to a lot of weddings.  I’m at the age where the children of my friends are all either married, or they’re getting married.  Not everyone, but enough of them to really give my credit cards a beating.

I’m not complaining.

The last wedding had an open bar.  I personally appreciate this very much.  I like to walk into a shmorg and either get a mixed drink or a glass of wine, because the two go together so well sometimes, appetizers…

PLoS has an article taking an economist’s look at the publication process for pharmacological studies. The paper offers some potential remedies:

Potential Competing or Complementary Options and Solutions for Scientific Publication

1. Accept the current system as having evolved to be the optimal solution to complex and competing problems.
2. Promote rapid, digital publication of all articles that contain no flaws, irrespective of perceived “importance”.
3. Adopt preferred publication of negative over positive results; require very demanding reproducibility criteria before publishing positive results.
4. Select articles for publication in highly visible venues based on the quality of study methods, their rigorous implementation, and astute interpretation, irrespective of results.
5. Adopt formal post-publication…

SHOCKING, I tell you. New Scientist published a thoughtful article about cannabis policy that attempts to present the evidence in a unsensational manner.

There are just some days that I want to start over. Today was one of those. I won’t go into specifics but suffice to say that someone I care about has been more than a little irritable lately. I had a moment today that I wanted to say, “Okay, I give up. You can do whatever you like. But just leave me alone.”

It’s my fear and resentment rising up again. There are times when I feel wronged and can’t deal with it. I want to wallow in self-pity and think about what a jerk the other person is. It’s so…

San Francisco is about to open the first legal injection site in the country.

I’ve had a lot to say on the topic in the past. To sum up my view, context is key. A program like this can be an expression of despair, fear and/or contempt, or it can be a way to engage addicts and try to keep them healthier until the enter recovery.

Recovery is the key. I’d pose the following questions:

• Does treatment on demand exist? If not, does the facility consider it their responsibility to advocate for treatment on demand?
• Does the program view recovery as the ultimate goal?
• Does the…

Something to piss everyone off and challenge the premise of that recent Times article. A meta-analysis of studies comparing “bona fide” treatments found “no evidence of differences among treatments for alcohol use disorders.”

More interesting is this:

Although the variability of effects about zero was small, we also found evidence of an allegiance effect. Specifically, our analyses indicated that as allegiance to compared treatments became more unbalanced, the expected difference between treatments increased, in favor of the treatment forwhich there was researcher allegiance. Allegiance accounted for most of the variability in treatment differences in alcohol measures.

Not shocking to anyone who reads journals often.…

This seems like wishful thinking to me. I could see him implementing more incremental reform, but not this:

Meanwhile, economists have been making the beer argument. In a paper titled “Budgetary Implications of Marijuana Prohibition,” Dr. Jeffrey Miron of Harvard argues that legalized marijuana would generate between $10 and $14 billion in savings and taxes every year — conclusions endorsed by 300 top economists, including Milton “Free Market” Friedman himself.

And two weeks ago, when the Obama team asked the public to vote on the top problems facing America, this was the public’s No. 1 question: “Will you consider legalizing marijuana so that…

Just in case the holiday spirit was dulling your cynical side, here’s a story about white collar criminals and corrupt politicians are trying to save their skins with claims of addictions.

I’ve no doubt that some of them are truly addicts, but this pattern reinforces stigma associated with addiction being a convenient scheme to avoid accountability.

Prevention initiatives in the U.S. have often had an anti-addict tone to them. Federal prevention initiatives often make me queasy because of the policies they espouse and the hysterical tone of their education efforts. However, it’s good to see them start to embrace recovery. It’s especially heartening with meth when one considers the history of the crack epidemic.

Another hidden cost of addiction.

The New York Times paints a dim view of addiction treatment and foreshadows a financial black hole once parity takes effect. The word recovery does not appear once, no mention of findings regarding the positive outcomes and  cost-effectiveness of treatment, no mention of twelve step facilitation as an evidence based practice, no mention of duration of treatment as an important factor in outcomes, and, as Bill White has said, these arguments about MET vs. TSF vs. MET are all arguments within the acute care paradigm. Systems change needs to focus on long term recovery management strategies for chronic addicts.

[hat tip: Matt]

…

• Special Treatment: The rise of luxury rehab
• Something In the Air: When a Smoker Gets Lung Cancer, Sympathy Is Stained With Blame
• Law gives strength in fight against heroin
• College Students Say ADHD Drugs Help Them Study

The New York Time yesterday published an opinion piece entitled “Drunkenfreude ” by Susan Cheever, the author of “My Name is Bill” and “Note found in a Bottle,” where she recounts some of the details of the last time she saw anyone obviously drunk at a party in New York City.

The New York apartments and lofts which were once the scenes of old-fashioned drunken carnage — slurred speech, broken crockery, broken legs and arms, broken marriages and broken dreams — are now the scene of parties where both friendships and glassware survive intact. Everyone comes on time, behaves well, drinks a…

Odd that there’s growing cultural pressure toward greater criminalization of tobacco and decriminalization of marijuana and other drugs.

Michigan’s Department of Community Health has fleshed out the medical marijuana program. It will be interesting to see how the role of caretaker takes shape.

This writer suggests that smoking warnings actually trigger cravings.

There’s something a little too neat and a little too certain about his op-ed, particularly from a study of 32 subjects.

It’s easy to imagine how a warning that contains the words cigarettes, tobacco or smoking might trigger craving. It’s a little more difficult to understand how an image of a tumorous lung would provoke craving, unless subjects have been desensitized to the image and have developed an association between the image and a cigarette. The op-ed suggests that all warnings are useless, but only explicitly addresses subject response to the text warnings.

I…

A troubling trend continues:

15.4 percent of 12th-grade students reported nonmedical use of legal prescription or over-the-counter medications

This is particularly troubling for 2 reasons. First, as JAMA recently pointed out, overdose deaths associated with prescription drugs are skyrocketing in some areas. Second, people who develop problems with prescription opiates often end up switching to heroin because it’s cheaper. They often start out by snorting heroin and end up switching to injecting.

A harm reduction group reports that half of the homeless people in Toronto use crack.

This seems difficult to believe. Worth watching.

Celebrities and politicians aren’t the only ones using ghostwriters.

Good news - drug deaths decline

Bad news - 1 in 10 drivers test positive for drugs, and 1 in 12 drivers test positive for alcohol

Dirk Hanson makes several important points–that medical training on addiction is inadequate, that doctors don’t respond well to patients with addiction, that the medical reimbursement system does not support a response to the problem, and that there are enormous barriers for doctors who do want to respond to addiction.

This is even more important as we attempt to implement recovery management approaches. Physicians are a natural point of contact for recovery checkups and long term monitoring.

So what exactly does Santa prefer? Milk or beer?
There is one list that needs to be checked twice; the beer industry’s advertising and marketing code, which explicitly forbids the use of Santa Claus in beer marketing materials.

MillerCoors are the sponsors of a fundraiser for childrens leukemia called, “The Running of the Santas.” The fundraiser dates back to at least 2005. The videos on youtube show how this event, despite it’s charitable intent, actually promotes binge drinking. The event takes place in two pubs and involves people dressed in Santa suits running down the street from one, to the other.

This year however, there…

I’m persuaded.

The other name I’d heard was Thomas McLellan. He was always my preference. Let’s hope he gets it.

Hmmm.

The HBO Addiction documentary played like a baclofen ad. I honestly don’t know much about it and don’t have a lot to say, but I did admit someone who was treated with baclofen for neurological pain and used it to get high. The patient was eventually cut off by the prescribing physician because she overdosed on it several times and required hospitalization.

OMG. I’m speechless.

If you answered, “giving Mexico 200 million to fight drug trafficking,” you get 400 points!

For the article, go HERE.

For the daily double:
Spending much needed money on long term treatment. Better prevention education. Helping starving people on the street.

The correct answer:
Ways Congress could have better spent the money!