Combating Substance Abuse and Addiction - From Rhetoric to Reality
With the Inauguration of President Barack Obama, the rhetoric of change echoes through the corridors of power in the nation’s capital. Nowhere is it more urgent or important to convert that rhetoric into reality than in the area of substance abuse and addiction. And nowhere would the return on investment of public funds be higher.
Just as the financial regulatory structure of the past is no longer able to protect the public interest in sound financial institutions and practices, so the government structure and policies relating to tobacco, alcohol and illegal and prescription drug abuse and addiction have proved incapable of protecting our children and their families from the ravages of substance abuse and addiction.
Take research. The National Institutes of Health spend almost $15 billion on research for cancer, strokes, cardiovascular and respiratory diseases and AIDS. But they spend less than two billion dollars on substance abuse and addiction, the largest single cause and exacerbator of those cripplers and killers.
The organization of the federal research institutes–separate ones for Drug Abuse (NIDA, for illegal drugs and nicotine) and for Alcohol Abuse and Addiction (NIAAA for beer, wine and distilled spirits)–ignores the science of the disease of addiction. For years CASA and others have demonstrated the tight statistical relationship of these substances-the greater likelihood that cigarette smokers and drinkers will use marijuana, and that marijuana users will get into drugs like methamphetamines, cocaine and heroin. Now we have scientific evidence that these substances affect dopamine levels in the brain through similar pathways. The recent findings of neurological science, and NIDA Director Nora Volkow’s work with brain imaging, reveal the similar impact of these substances on the brain. All science and logic cries out to combine the current separate institutes into a single National Institute on Substance Abuse and Addiction.
To effect this change, the Obama Administration will have to take on lobbyists for the alcohol industry (which doesn’t like being associated with other drugs) and for illegal drug researchers (who fear such a merger will reduce resources available to them since the alcohol industry has been able to hold down the NIAAA budget to half that of NIDA).
Take prevention of illegal drug use. When Richard Nixon first declared war on drugs, he allocated 60 percent of the funds for prevention and treatment, 40 percent for interdiction and related criminal activity. Today that original allocation has been flipped on its head. It’s time to return to the original Nixon allocation. Demand is the driving force in U. S. drug use: though only four percent of the world’s population, Americans consume two thirds of the world’s illegal drugs.
Take prevention of smoking and alcohol abuse and addiction. Precise figures are hard to come by, but a low estimate finds that almost a third of the nation’s health care bill is attributable to use and abuse of those legal drugs, as are more than half a million premature deaths (400,000 plus from smoking and 100,000 from alcohol abuse).
Here there is a quick fix to reduce use of these substances: higher taxes to increase the price. Research and experience has repeatedly shown that higher excise taxes on cigarettes and alcoholic beverages reduces use and abuse, especially by the teens that the nicotine pushers regard as replacements for adults who die or quit and underage drinkers targeted by alcohol merchants. New York City and state taxes, which brought the cost of a pack of cigarettes in New York City to more than eight dollars, have prompted a sharp drop in smoking, particularly among public high school students. When Alaska increased taxes on alcoholic beverages in 1983 and 2002, researchers found an immediate and sustained reduction in deaths from alcohol-related diseases. As they put it in the American Journal of Public Health, “Taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease.”
Pick up your pen, open your email and write your congressman and the new President to tell them: Those of us combating substance abuse and addiction are entitled to our share of the change you promised to bring to Washington. Act now to battle the nation’s number one disease: create and adequately fund a National Institute on Substance Abuse and Addiction, rebalance the allocation of resources between demand reduction and interdiction aimed at illegal drug use, and reduce smoking and alcohol abuse and underage drinking by increasing the cost of cigarettes and alcohol through higher excise taxes on these legal drugs.
Dear Mr. Califano,
Your efforts in educating the public about the dangers of drug abuse is greatly appreciated.
Please keep up the good work and hopefully we can all work together to combat drug abuse through education.
Regards,
Don Delgado
Drug Education
Narconon of Georgia
Thank you for your reference to research results that “Taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease.” An especially compelling case for tax rationalization is “Paying the Tab: The Costs and Benefits of Alcohol Control” by Philip Cook (http://press.princeton.edu/titles/8501.html).
Please focus on the issue of mis-use of prescription drugs and the state of the mental health system in the United States.
Dear Mr Joseph Califano,
I am the single adoptive parent of a 22 year old young man with Fetal Alcohol Syndrome, identified at his birth. A former foster child- he weighed 12 pounds at 12 months of age when first I fostered him. This is what Alcohol does to the fetus. He is the love of my life- of course. He has made good progress despite an IQ of 64, small scull, facial anomalies, 15 eye and ear surgeries, ADHD, eating disorder, high risk for vision loss, and -now- actively drinking on “weekends only”. Current supports like sheltered workshop employment, a protected dwelling of 21 single apartments with day and eve staff along with in-home trainers on shopping, cooking, money management and life skills have helped him gain strengths in his confidence, pride and adaptive skills of daily living. 4e Adoption Subsidy, Minnesota Medical Assistance, and all other community supports available [energy assistance, HUD housing, food support, medical cabs, WIC and respite care givers] have been poured into this one case. The financial worth of those supports added up along with my lost earnings as a 20 year full time stay-at-home caregiver/ educational advocate/ medical case manager and loving MOM have not- I think- been tabulated as yet in the costs of Alcohol to our society. Globally- Alcohol insult pre-natally and it’s life long costs need to be included in your thoughts and long term fiscal estimating. This is my humble opinion, respectfully submitted,
Most Cordially Yours, Linda Lee Soderstrom MA, LPN
PS: My Godfather and Uncle Richard Lee Bickerton was a colleague of yours in years past in the SBA and I have always hope to share our story of help and hope in adoption with you. Thank you for the opportunity so to do in your new blog venue.
The statistic of U.S. comparative consumption of illegal drugs is telling. We are a very prosperous nation with ubiquitous drug use – upstaging class-, income-, and race-based explanations. In light of that statistical reality, simple economic responses will fail to address predominating drug use among America’s elite and its cultural origins. For example, the rich, privileged, and intellectually endowed are using drugs illegally in America, but have means that prevent their criminal prosecutions and public exposure. Meanwhile, the proverbial “low-life” subjects of news programming and documentaries examining American drug use provide cover for their well-heeled counterparts in suburbia. These propaganda coalesce with the treatment/punishment disparity Mr. Califano decries by understating the class issues endemic to law enforcement efforts and drawing attention away from the statistically significant users (and sellers) at the top of the hill. One can only wonder how long that disparity would last if the punishment component were to be directed more plausibly and properly at those elite users who, when the policy discussion begins and the cameras start rolling, are represented by inner-city stand-ins. In sum, well-funded drug users will continue to outspend economic programs and the drug trade will continue to flourish unless someone exposes the core group of users.
My best wishes for your new “site.” I will peek whenever possible.
Stan
Mr. Secretary, as usual, you are taking on the challenging issues facing our country. Thank you for your tireless service in advancing the cause. I look forward to reading your blog entries on a regular basis.
Terry Cline
Mr. Secretary,
Thank you for your boldness in addressing these issues at the National level. We, in the field, need your support to change the way we have done business for the past few years. I will be sharing this information with our state represenatives, as well as those that represent us in Washington DC. Environmental strategies are what will change our communites and citizens for years to come.
Sincerely,
Dottie Kraemer, coalition project director and prevention specialist
Murray, Kentucky
Mr. Califano,
I admire your work and do all I can as a Prevention Specialist to support dissemination of your reports to the people who need to hear what you have to say, especially parents and teenagers who so desperately need information on AOD (Alcohol and Other Drugs) and its consequences.
I beg you to discontinue the use of the term “abuse.” Substance Use Disorder or Dangerous Use of Alcohol and Other Drugs are terms I submit as good replacements for terminology including the word “abuse.” SUD Treatment/Prevention may not be a euphonious as
SAP/T but words matter and “abuse” is a cruel and misleading word.
The term “abuse” clearly places blame on the victims of stages of addiction. It implies that those who make heavy use of alcohol (or other drugs) COULD use more moderately IF they simply WOULD, that they, unlike the dependant drinker, are free to choose moderation or to “Just Say No.” Recent research, however, is revealing the presence of specific genes and brain conditions (e.g., low serotonin levels) that appear to “cause” both of the sets of behaviors and consequences that the DSM-IV uses to distinguish between “abuse” and “dependence.” In fact, the DSM-IV bases its distinction not on the specific symptoms, but on the cumulative number of symptoms, ie, having one symptom is a sign of “abuse,” while having two symptoms is a sign of “dependence.” If the number of symptoms is the only difference, then we are not talking about two different conditions, but about the“stages” of a single condition. In other words, it appears that “abuse” is an interim stage between initiation of use and physical “dependence.”
You might respond by saying that not all heavy users go on to become addicted, thus we need a word for the interim stage. I urge you to consider, however, that we are talking about a process with infinite stages between immoderate and addicted, all of which justify the use of terms like “disorder” and “dangerous.”
It is becoming more apparent in a growing body of research that individuals with the identified genes do not have to become physically dependent in order to exhibit lack of control over AOD. At any given point in their lives, they may be exhibiting only the symptoms of what has been called “abuse,” but they are in fact genetically incapable of moderate drinking. Thus it makes no practical sense to treat individuals who drink heavily and have one or two symptoms as if they had choice (to abuse or not to abuse) and to consider them as in significantly less danger from AOD addiction than those who have three symptoms (those who have been called “dependent.”)
By doing away with the term abuse we can begin to make real inroads against the common belief that addicts are just weak or degenerate people who bring their problems on themselves and who could stop those problems by JUST not drinking. Please help us combat the destructive stereotypes evoked by the term “abuse.” Your leadership could make an even bigger difference if you accept this challenge.
Everyone who drinks/drugs too much needs help, not condemnation.
Thank you.
Dr. N.L. Harper, Director
Alcohol Laboratories for Education, Research, and Training (ALERT Labs)
Prevention Model Program of the U.S. Department of Education
My message is simple: STOP THE CONFUSSION….END THE SHAME,,,,TREAT THE MALIGNANCY….When we professionals treating addiction are sucessful in classifiying it as a MALIGNANCY, the confussion will end, and the shame which is associated with it will evaporate, and educational projects to save our nation will be forth comming. Until we defined cancer, diabetes, and other malignancys, we were unsucessful in reverseing their costs in human lives and missery. Obama saw the need for change and started in the neighborhood and moved outward. These same familys and neighborhoods know more about addiction and suffer with it. If we mobilize at that level we can force change. Addiction is a dirty word and powerful people stay away from it. I have tryed desperately for three years to solicit support from public officials and power brokers. They have thrown their influence behind more Contempory Socially visable groups. I comend you for all that you have done to attack addiction, and am certain much good has been accomplished. I have the backing of the Finest Medical Doctors in the Addiction field, and yet my pleas for help fall on deaf ears. It is large numbers of potential votes that catch a politicians eye. This along with campaign contributions can get action. The rightious cause we fight for, will be picked up as the politicians platform when we force it upon them. After an individual becomes powerful they totaly loose track of who made them. They become untouchable until we the people in large, swarm upon them. The most powerful Christian power brokers still refer to this diaease as ….THE SIN OF ADDICTION. These same men of the cloth strongly endorse medical intervention for all other malignancys. I beg your support in my iniative moveing forward. I have read all of the material that you have written on addiction, and you have created a leaders manual for us. We can use this tool as our bible, and proudy quote its authority, as we deciminate information virally on the internet. I have one plan,and that is to awaken the sleeping giants, with the voices of millions. Please feel free to contact me if you would like your voice heard in the chourus. WWGilman, Chairman, The Mychal Institute, 828 692 8506
Let us join the new prsident in his efforts for change: Where better is the ravenge of addiction more obvious then in the inner city neighborhoods. Where people of lower economic status exist, we find the perfect incubator for the growdth of this Chronic Malignant disease. How can I as an individual, who has personally funded millions to combat through education, reach the deaf ears of the present ruleing body. Sadly your own organziation has not reacted to any of my requests for information, other than to be sure you autrographed the book that I purchased. The exchange of white papers amoung professionals, is the path to future research and developementh about this malignancy. The eradication will come when a poor Afro American child learns that his father is in prison because he suffered from a malignant disease. This child can climb out of the same pit with the help of knowledge we can ingrain in them. This knowledge will allow him to love his father as a sick human, and not hate him as a sinfull weak moraled criminal. What a blessing to remove this shame from an entire generation, and at the same time teach them the importance of abstinance. Life in the neighborhood is full of fear. It is easy to find relief through addicting peer behavior. President Obama shows by example that there is no longer a skin color barrier at the top. I agree with you fully that the time is right for us to change the face of addiction. Our prisons are full, our health costs out of control, and we allow our Christan leaders to ask us to pray, to relieve us from the sin of addiction. I ask you, and the Almighty God, for help. I do not want money, but only support to reach the people in the neighborhoods who can lead the younger generations in our Presidents path. It is obvious to me that President Obama recognized the power of Pastor Lowery in his life. It is also obvious to me that these clergy have the ability to win trust. You and your organizatioon are needed to break through the walls of protection that surounds them with this message. Please leave the halls of academia and help me as a social activist to create, within the people of America, a clear vision of what we are dealing with. You have been in the White House. You have been in the halls of goverment. You have enjoyed Presidential banquets. How will you help us in the church auditorms, comunity centers and high school gyms as we talk loudly and clearly? STOP THE CONFUSION, END THE SHAME, TREAT THE MALIGNANCY.
Mr. Califano,
I whole-heartily agree that addiction/alcoholism is a disease and as such should fall COMPLETELY under the healthcare arena. Prohibition didn’t work with alcohol and we have made great strides through education about responsible use and treatment options for those who have problems with alcohol. Use or mis-use of any psychoactive substance is not a license or excuse to harm another and if a drug user harms someone (theft, assault, battery, etc.) then law enforcement should come into play. However in the land of the free an adult should be able to consume whatever he/she wishes - even if it is deadly - but they do so at their own risk and are responsible for their behavior. We have limited resources and the war on drugs has done nothing productive except increase the amount of illicit drugs and associated violence that comes with the black market; wasted untold amounts of money by locking up non-violent drug users (destroying their lives when they have harmed no one); mandated drug users or dealers into drug treatment thereby decreasing available beds/appointments for addicts who desperately need the help; and broken up families simply because of use of an illicit drug.
The fact that our government is willing to lock up adults for simply growing and using cannabis/marijuana has been an unjust act from its inception. There has never been any rational justification for it, yet the cannabis prohibition continues to the point where even patients are locked up for using it for its medicinal properties. As a former officer in the US Navy Nurse Corps I am completely appalled that many returning veterans with post traumatic stress syndrome (not a disorder), serious injuries resulting in chronic pain or other problems have actually been kicked out of the military or refused medical care if they are found to be using cannabis as medicine.
Yes, there are many persons suffering from addiction and help should be available for those who want it. But the notion of “someone” deciding that a certain drug is “bad” and that “they” can simply outlaw its use is totally un-American considering we have the right to our “pursuit of happiness” - even if it kills us. Our leading killer is tobacco and adults are free to take up this habit if they choose. You and I may think that is a stupid choice to make; you and I may realize how addictive nicotine can be, but it is still an individual choice. Education has helped decrease its use and research has helped find ways to treat nicotine addiction. Locking up mom or dad, a brother or sister, son or daughter is not and has not been the answer. Why does anyone think that prohibition will work for another drug?
After my thirty five years of experience as a leader in the substance abuse treatment field I am very aware of the effects of funding cuts over the past 10 years. Agencies operating on governement funds have been downsized to the point of non-existance, facilities closed, programs terminated, and staff reductions resulting in less treament for those most in need. All this only results in cost increases to other segments of sevice delivery and judicial systems, i,e. hospitals, courts, unemplyment compensation offices, jails, etc. We need to be mobilizing across the country, not for a BAILOUT, but, to be part of the STIMULUS PACKAGE. Just think what the enormous effects would be if the SAMHSA Substance Abuse Block Grant would be doubled from 1.5 to 3.0 billion dollars. When we are talking in terms of a Trillion, an allotment of 1.5 billion would hardly warrant a footnote and would revive the substance abuse treatment effort in the United States, save and increase jobs, increase spending and most importantly provide treatment to those in need suffering from the disease of addiction. The rhetoric of change would become a reality and nowhere would the return on investment of public funds be higher.
Dear Mr. Califano,
I hope you will help to publicize basic information not widely known that may impact the way we deal with drug abuse or dependence [A or D] per DSM-IV as reported by SAMHSA.
The data is largely from 2006 but it is almost identical for 2002 - when data collection was changed - through 2007.
I suggest we are not paying sufficient attention to alcohol. Alcohol accounts for about 5 out of 6 cases of A or D, 70% by itself and about half of the remaining cases (14%) where it is misused in conjunction with other drugs. There are overlaps but cocaine and prescription pain killers each account for about 8 % and marijuana is present in 18%. No other drug is involved in A or D to nearly as great an extent as any of these. (Even 90% of those who have tried cocaine,including crack, have never tried heroin.)
Further we need to focus on age. A or D rises dramatically to a peak during the period from about 18 to 25. The sharp decline after age 21 has been substantial by age 25, suggesting that a large portion of vulnerability might be classified as age dependent and transient as opposed to a base number with heightened vulnerability of some 10%. The A or D rate for the 18 to 25 group is over 20 percent compared to about seven percent for those over 26.
Thanks to MTF since 1975 and additional work by CASA we know that for over 30 years almost every one of us (not those as old as I) has grown up with “easy” access as teens to any drug if we were at all interested in using. This has been complicated by the more than a million teens (over 3%) who sell drugs.
We also need to understand that most of us abhor the very thought of drug addiction and that some 75% of us seem to be “invulnerable” and have never met the criteria for A or D even though we have used many of the drugs mentioned above. It seems that if we have never been classified with A or D before the age of about 21, less than one percent of us ever will be.
My point is partially that we need to be more attentive to the period between birth and 17 if we are to most effectively intercede with those most vulnerable to A or D, whether that vulnerability is for reasons attached to DNA or to a wide variety of cultural experiences such as child abuse.
All of this implies a possible misallocation of resources and I hope CASA will promote a national dialog to see if we as a nation can’t do better.
Dear Chairman Califano,
NIDA Director Nora Volkow, MD, yourself, pharmacogeneticist Kenneth Blum, PhD, and many other researchers and clinicians have confirmed addictive disorders are neurotransmitter imbalances linked through biochemical pathways to dopamine. Now that we have a new President who demands we use what works rather than cling to old paradigms, perhaps CASA, NIDA, NIAAA and other academic and government institutions will look at what truly works within minutes, and that is to give the brain’s nerve cells what they need to function correctly: L-Tyrosine and the other amino acids that are used to construct missing neurotransmitters and receptor sites. We’re doing it out West in the Sacramento County Adult Drug Court, and statistics confirm our success: saving our county $20 million 1995-2005, and keeping 83% of the graduates during those years out of the criminal justice system the two years following graduation. Our graduation rate skyrocketed during 2006-2008, which we suspect is from giving clients even more wholesome meals than previously. We give them daily acupuncture, wholesome food on site and to take home, and the nutritional supplements clients individual need, according to their drug of choice; weekly training in nutrition education and cooking; exercise; and an efficient treatment for PTSD called Emotional Freedom Technique which is a combination of psychology and self-applied acupressure.
We’re putting on a conference co-sponsored by the State of California Dept. of Alcohol and Drug Programs April 17-19th in Sacramento, called Brain Repair for Addictive Disorders: Cost-Effective, Successful, Drug-Free Therapies to help others achieve similar success. In a time of belt tightening we must use what works, based on strong scientific principles of neurochemistry. (Research references on request).
Speaker bios and registration are at http://www.carasac.org
I invite you and readers of your blog to attend! You may be inspired to redirect research at CASA to include targeted amino acids and acupuncture/acupressure. One result is guaranteed: counselors find their job’s easier when facing a group of clients whose brains function more normally, perhaps better than ever in their lives.
Carolyn Reuben, L.Ac.
Executive Director
Community Addiction Recovery Assoc.
Coordinator, Alliance for Addiction Solutions
(CARA) 916-485-2272 or cell: 916-214-0607
http://www.allianceforaddictionsolutions.org
http://www.carasac.org
I have read with great interest ‘Dr Nancy Harpers note to you regarding the word “abuse” as used in the context associated with addiction. I think that She has great insite in discussing this false discription when coupled with addiction. Abuse is created at any time that one uses anything outside of its common or perscribed aplication. Abuse by defination indicates doing something without useing control. In the case of the person born with a genetically transphered Chronic Malignant Disease of the Brain, such as addiction, there is no abuse. There can never be abuse without control. The addicted never has, nor ever will have control over useage. For the addicted, one drink is too many, and a thousand is not enough. If you believe in the fact that addiction is a chronic disease of the brain, you should never use the word abuse again. Useing this word substantiates the outdated beliefs, that the addicted is a weak moralled, weak willed degenerate. STOP THE CONFUSSION, END THE SHAME, TREAT THE MALIGNANCY…
Greetings Mr. Califano:
Hopefully you will recall our meeting’s in the early and mid 90’s. I very much appreciated your time and your understanding of AMS’ unique capability to ‘engage’ smokers in the behavior change training they require to ‘unlearn’ their psychological, habitual and emotional dependence on cigarettes.
Since then, at over 4,000 worksites, virtually every smoker has requested and used AMS Training to re-start the quitting process.
As you know,”change” has become the bellwether in America.
If “change’ is applied to smoking cessation; using proven methodologies, a country-wide cessation initiative on a scale never before imagined ,let alone attempted, can become a fait a compli.
One example of the need for “change” is Messrs. Gate’s and Bloomberg’s ‘tobacco control’ initiative. It focusses on third-world country’s and ignores the 44 million Americans who are desperate to quit; they spend more than a billion dollars every year trying to quit. What abou them?
The “experts” on this project ignored American smokers because they haven’t learned how to communicate with them. They don’t know how to restore smokers self-esteem and renew their belief that they too can join the millions who have successfully earned former smoker status. They advised Mr. Gate’s and Bloomberg it was necessary to go offshore because American smokers simply will not participate in a cessation program. Twenty years of AMS experience conclusively proves that nothing could be further from the truth.
Smokers need to know past failed quit attempts are positive and essential steps in the quitting process. They need to know NRT’’s are not the total answer even though they have solved smokers’ chemical dependence.
Communication of proven messages is what is required to reduce the number of adult smokersand; the more adult smokers engaged in the quitting process, the more effective ‘prevention initiatives become because; as you know,cessation and prevention are not mutually exclusive.
Smokers can be inspired and motivated. When they are empowered with guilt, threat and “failure-free” training that will enable them to earn former smoker status; they become eager to accept personal responsibility for the impact smoking has on their health and their medical costs.
As mentioned above, expanded communications is required. If you and your colleagues at CASA can contribute to promulgating AMS’ proven messages it will create a win-win-win scenario for America’s smokers’, their employers’ and CASA. My health dictates that what I have learned must be passed on for the greater good of the maximum number of smokers.
Respectfully,
Rick Weston
President
AMS Inc.
Where raising taxes on alcohol and specifically alco-pops has been tried, little change has occurred. (Victoria, Aust. for example).
It moves the discretionary spend to alternatives without affecting the overall public health burden.
What is required is wholesale reform centred around of recreational psychoactive ’soft’ drugs - firstly because it is the right thing to do, fiscally, secondly it will remove the double standards that are an impediment to credible anti-drug and harm reduction messages, and finally because we have to stop treating adults like children while expecting, indeed hoping children will behave like adults.
New Zealand has made significant legislative changes to enable this process to begin with the law restricting soft drugs receiving royal assent in November last. By adding a new class to the current illegal schedules, we now have a UN compliant ‘convention’ permitting sale, packaging, age of consent (R18), labeling, place of sale, manufacture and storage and transport, even Internet marketing, of recreational psychoactive ’soft’ drugs.
And folk said it would never happen.
Partial Prohibition is the answer. Like alcohol, like tobacco, party pills… responsibly managing the problems, where they occur makes much better sense than the market failure that is blanket prohibition with its unintended consequences that so afflict. often fatally, even those who have nothing to do with drugs.
Class D ring fences the problems where they occur acknowledging the realities resourcing social and academic research, funding adequate ‘problematic use’ interventions and enabling non-stigmatised treatment. (entirely Ottawa Charter principled.)
New Zealand is at the cutting edge of emerging ‘beyond prohibition’ drug policy. Watch this space…
To Our Friends at CASA,
In December the National Institutes of Health released a report looking at 28 plus years of “screen-time” (television, computers, electronic games and the like). The study found that increased use of these devises leads to greater use of drugs and alcohol, smoking, risky and early engagement in sexual activity, obesity and a host of other illnesses and anti-social behaviors.
As CASA knows, family mealtime and reduced screen-time are two of the most successful and two of the least expensive ways to prevent much of the sadness and tragedy that comes from using these substances, which are designed to addict us.
We have worked with CASA in the past and will continue to do so. Your energy and ability to address key issues will move us forward. Our united front when addressing government, federal, state and local, is essential if we are to make this a world we want our children and grandchildren to live in.
Robert Kesten
Executive Director
Center for SCREEN-TIME Awareness
http://www.screentime.org
202-333-9220
I agree Mr. Gilman. It is time to STOP THE CONFUSION, END THE SHAME and TREAT THE MALIGNANCY. If we can to that there will be freedom. We all know that addiction has many faces and discriminates against no one….not the rich or the poor; the black or the white; the male or the female; the educated or non-educated…the list could go on and on. Today addicts cower in fear succumbing to the vicious cycle of guilt, shame and defeat instead of getting the help they need. They are viewed as weak, morally broken and lacking will power. They are imprisoned, on the street and ostracized by society, family and friends. They cycle will only continue unless we scratch more deeply than mere surface. Getting to the root of the problem by ending the shame and treating the malignancy is truly the answer. Nelson Mandela once said that, “Education is the most powerful weapon which you can use to change the world”. I believe that he is right. The research and information regarding addiction as a fatal malignant disease has had an enormous growth spurt over the last decade. With this information we, as a community, have the power to join in our Presidents efforts to see lives changes, cycles broken and peace restored in place of shame. It is not within the halls of academia that we will affect change, but it is on the streets, in the media and through our government that we become social activists to build a new vision and to bring hope and freedom to our wonderful world. Thank you for your efforts and I hope to see this vision made into reality in the very near future.
No matter the many studies resulting in statistics, valid theories and development of relavant biopsychosocial models. No matter the individual or organized and funded efforts to decrease the prevalence of substance misuse and dependency… No matter the number of family dinners or the moderation excercised toward the engagement of “electronics”…All will continue to be inadequate in helping us to reach the desired scale of success in decreasing the harm to lives that comes with substance misuse and dependency. For as long as ego-serving blame and judgment are the predominant reactive inclinations belying our individual and collective efforts, we can expect that stigma will continue to loom. The mechanism of stigma operates as a cloud, blocking the light and promise of creditable aid. The impact of stigma is insidious. It is subtly and, often, unintentionally inserted through seemingly dedicated, altruistic, and scientifically-supported endeavors in the very name of advocacy, prevention and treatment.
Stigmas impact at the individual, family, and societal level.
In the presence of stigma all our best intended efforts are largely stifled. Until we all commit to authentically empathizing with the hardship and challenge that another is experiencing as not judgable and as unique to them, as individuals, we cannot expect a collective reduction in substance misuse and dependency in our society…No matter the funding demanded and awarded…No matter the advocacy or treatment approach. Genuine compassion, encouragement and respect inspires a sense of acceptance. Well being is fostered and strengthened in that climate. Afterall, anothers well being is the motivation, right?
Dear Mr. Califano,
I would also like to suggest there be more focus on helping the family members of the drug addicts / alcoholics. Because of the shame and secrecy (let’s face it, alcoholism is one of the few diseases you recover from in anonymity) that surrounds the disease of addiction, families collude for years in a joint effort to control something for which there is no control as long as the person is using or thinks he/she can use. In so doing, family members adopt coping skills that in time allow them to accept the unacceptable as acceptable (normal) – not just in their relationship with the alcoholic, but with others as well – and thus continue the craziness from one generation to the next.
I agree with and appreciate the genetic component of the disease, however the chemical and structural changes that occur in the brain during the years of alcohol abuse are horrifically powerful. If we can start a broad-based education program that helps parents, children, spouses and siblings understand what addiction is – a chronic, relapsing brain disease – then they can take steps sooner to effectively challenge and deal with their loved one’s drinking / drug using behaviors [something especially important when young people are the alcohol abusers – with critical brain development going on until age 25, it’s too important to intervene early and not presume it’s just a phase all teens/college students go through].
I had spent decades living with loved ones in various relationships who abused and/or were addicted to alcohol. One finally entered a residential treatment program in 2003 and that pushed me into a whole new world. Learning about the disease of addiction and what happens to the brain (thanks to NIDA Director Nora Volkow’s work with brain imaging and the similar brain imaging work of others) ended so many arguments and helped me to let go of the anger and sadness that they were “choosing” alcohol over me. This freed me to learn more about what had happened to me, and why I was still tolerating unacceptable behavior several relationships and several decades later and what I needed to do for myself to get help.
Addiction is a family disease, no doubt, and helping all members of the family, in addition to the alcoholic, is important for successful treatment of the disease and for ending the cycles. In the early 1970s, significant numbers of Americans smoked (on planes, in restaurants, at work, in their homes); there were no bike helmets; car seats were non-existent and most people did not wear their seatbelts. Yet, new research and talking about it across all areas of society (not just with the smokers, for example) resulted in changed behaviors and laws that today protect the health and safety of all of us.
Thank you for your decision to write this blog and offer this forum for discussion.
Lisa Frederiksen
Author, “If You Loved Me, You’d Stop! What You Really Need To Know When Your Loved One Drinks Too Much”
http://www.breakingthecycles.com
Dear Secretary Califano:
Thanks fof inviting us into your “Corner”.
You have hit the nail on the head, when you link the
deregulation of governmental financial oversight
to the failure to protect Americans from Alcohol., Tobacco
and other Drugs. The Go-Go policies of the last few decades
hav added insult to injury for millions who suffer from addicive
diseases, and the paucity of supportive services for these
dependencies and related illnesses. We need to shift the
techtonic plates on substance related illnesses; and this goes
far beyond the capacity and scope of SAMHSA./NIDA/ONDCP.
Best regards,
Ronald B. Brinn
New York
Dear Mr. Califano,
Your message is most inspiring to us in the Addiction Treatment field. Our Rehabilitation Center in central Philippines focus on Family approach and we listen to the drug dependents’ stories with concern and care realizing that drug taking is only a manifestation of deeper problems. Drug abuse is worldwide and problems in America is repeated in every corner of our planet. We pray that with the new President’s call for change much of your policy on drugs would also have positive effects of change. More power, I shall look regularly in your blog now that I have found you! Thank you and warm regards from the Philippines , Dr. Vision
Dear Mr. Califano,
I have a rather mundane question: Is this quote, attributed to you in several places online, actually yours? “A child who reaches age 21 twenty-one without smoking, abusing alcohol, or using drugs is virtually certain never to do so.”
I’d been searcing for how to cite this and stumbled upon your blog. I’d greatly appreciate the correct information, and I’m glad to have stumbled upon this dialogue.
Thank you for all you do to help kids grow up healthy.
Mr Califano, I applaud you for your interview on MSNBC last night with Al Roker.
Its evident to me that Oxycotin, more then any other drug that is being manufactured today is responsible for the continued increase in heroin abuse in our kids and society.
I lost my son to a heroin overdose 6 yrs ago after he became addicted to oxycotin and switched to heroin because its so cheap and the high is the same.
How long are we going to continue to bury our kids while Purdue Pharma makes billions off of them?
How much is our kids lives worth??
You see the trends, millions of parents like me see the trends, why is Purdue allowed to continue to manufactur oxycotin after being found guilty in federal court for falsifying information about how safe the drug is.
Didnt the FDA approve the drug under those assumptions?
Once the FDA became aware of the fact that the information about its safety was false and falsified by a company for profit why didnt the drug get pulled???
Who is going to answer to this questions.
Its too late for my son, i have to visit him at the cemetary but take a look around and see what this drug is doing to society
Dear Secretary Califano:
Before I became Chief Probation Officer in San Mateo, CA, I was the Chief Probation Officer in San Francisco for the Federal Courts (in the Northern District of CA)
When I was with the Federal Probation and Pretrial Services system, we had the GREAT honor or working with CASA and Dr. Herb Kleber. Is Herb no longer with CASA?
THANK YOU for continuing to be one of THE leading edge experts on substance abuse and other related issues. Lord knows San Mateo County, California, and the United States still have enormous substance abuse challenges with which we must deal.
Best regards,
Loren
As I read the comments it appears that we are preaching to the choir. We know that there is a problem and it has been a problem for a long time when are we going to do something about it. I work in the substance abuse treatment field and we were just notified that Missouri will probably cut services due to funding. We have the will to bail out whoever but not treat addicts. We have the inclination to build roads and bridges but not broken lives. We have the fortitude to encourage resignations of corporate leaders but not to encourage the convicted drug felon to stay in treatment. We,re ok with sending military hardware to our Southern border but we still refuse to treat addiction as a health problems. Here is a problem that affects almost every household in America one way or another and it is a non-issue. What is wrong.
I think we have missed a key area in that we expect way to much from the parents and give them way too little in support.
Parents don’t believe their child is using and certainly would never imagine their child becoming an alcoholic/addict. They are in denial and no one, I repeat no one, is addressing that denial.
When the parents are first approached by the school, the first person they talk to is a school counselor with little or no training in alcohol/drug addictions. They don’t have a clue –so therefore the parents are kept in denial and the problem and/or disease (addiction) get’s stronger and stronger. In fact few, if anyone, the parents come into contact with will understand what the parents are dealing with and how to approach them properly.
Even if the child ends up in juvenile court the judge nor his staff has a clue. No education whatsoever.
Are you starting to catch on here?
We have been dealing with this issue for 5000 years and we still don’t get it. Why?
Here’s the solution: You put someone with my experience/street smarts and education in that counselor’s office and/or the juvenile court and give me about 40 minutes and those parents will know exactly what they are dealing with and I will give them a path to take to bring the structure they need to heal the whole family.
Now, if the parents decide not to listen, then that is on them and they should be held accountable for their lack of commitment. In order for the parents to “get it” they have to suffer the consequences of “THEIR” action or inaction!!!
Send them to a 90 day inpatient for parents — that will correct the drug/alcohol issue a lot faster than focusing on the child or simply telling the parents to have more dinners with their child.
Thanks for letting me share. I should have this problem fixed by the end of the year
Just read your most recent book: High Society. It was great, down to earth and so relevant. I teach a course at college ): Intervention & Prevention Strategies for Youth at Risk…your book really pushed what I teach my students who are teacher education candidates. Thanks for continuing to make it real. Much appreciated. We do have some serious issues with substance use & abuse & addiction & availibility of illegal /legal drugs.
Dear Mr. Secretary,
I wondered what kind of strategy CASA might be employing to reach individuals in roles of public responsibility and try to counter the groundswell of interest in legalizing marijuana. I am attaching here an example of a message that I recently sent Governor Schwarzenegger. I would be interested to know if CASA has an “outreach” to Governors and legislators and other decisionmakers.
Thanks for all your efforts and the work of CASA.
Sincerely,
Paula Gordon
Dear Governor Schwarzenegger,
I hope you might find the attached article on “The Harm Caused to Individuals and Society by the Use of Marijuana” helpful in your consideration of the harmfulness of marijuana and the likely consequences that legalization of this mind-altering substance would have on individuals, families, and society. This article and other related articles, including references to scientific research, can be found at http://groups.google.com/group/GordonDrugAbusePrevention/.
I sincerely hope that for the sake of the innocent individuals currently being harmed by marijuana use and the many more who stand to be harmed were marijuana be legalized and the use of marijuana to increase, that you will do nothing to encourage or condone the legalization of marijuana. I hope you will take note of Joseph Califano’s statements that the $35 billion in taxes gained from alcohol and tobacco taxes are only one-tenth of the cost of the use of these substances, an amount estimated to be over $320 billion. (Joseph Califano heads the National Center on Addiction and Substance Abuse and was a former Secretary of HEW.)
.. I am concerned that California could become the Amsterdam of America and the poorest of role models for the rest of our nation and the world…
Sincerely,
Paula Gordon
The Harm Caused to Individuals and Society by the Use of Marijuana
Paula D. Gordon, Ph.D.
April 22, 2009
Copyright 2009 by Paula D. Gordon. All rights reserved.
(Also posted at http://groups.google.com/group/GordonDrugAbusePrevention/)
The view that marijuana is harmless or even “relatively harmless” is a view that is widely shared. That a view is widely shared does not mean that it is a sound view or that it has any basis in knowledge or fact.
Of course, the fact that marijuana is a plant that is widely available in nature has nothing to do with the potential harm that it can do if it is smoked or ingested. To assume otherwise is to engage in vague or magical thinking. It is common knowledge that there are plants and substances of all kinds that are harmful if ingested. For instance, hemlock is deadly as are some mushrooms. Smoking anything has some harmful consequences.
However widely shared a view it may be, the view that marihuana is harmless or even “relatively harmless,” it is a view that reflects a lack of knowledge concerning the immediate and the short term and long term effects of marijuana. It is also a view that reflects a lack of knowledge of the less widely recognized effects of marijuana use of contact highs and flashbacks (spontaneous recurrence of a drug high without using the substance at the time of the recurrence.) Similarly, the view reflects a lack of awareness of the civil liberties implications of being subject to contact highs and other effects as a result of being in the proximity of those who are using marijuana. Certainly, a rational public policy needs to be based on such a knowledge base.
One way I try to determine what the knowledge base might be of a person who seems unaware of the harmful effects of marijuana is to pose these questions:
• Do you know of research that shows that the use of marijuana can negatively affect motivation, long and short term memory, concentration, judgment, reasoning, and common sense?
• Do you know of the research of Harris Isbell and others who found that there can be idiosyncratic psychotomimetic (psychosis-like) effects from the administration of delta 9 THC in human subjects? (Delta 9 THC is the active principle of marijuana.)
• Do you know of the research findings that marijuana smoke can be inhaled by bystanders who then can experience marijuana highs and idiosyncratic effects?
• Do you know of the research in humans and animals showing the deleterious changes in lung tissue as a result of exposure to marijuana smoke?
• Do you know that contact high and flashback effects can occur as a result of the use of marijuana and do you think that the occurrence of such effects can have any negative consequences?
• Do you see any deleterious impacts to the civil liberties of others, including children, the elderly, mentally impaired, and other sensitive individuals, when they are unwillingly or unwittingly subjected to marijuana smoke or contact highs?
For further references and discussion of the effects mentioned here, see the articles and reports at http://groups.google.com/group/GordonDrugAbusePrevention/ or contact me at pgordon@erols.com .
With regard to the policies that are needed when it comes to psychoactive, mind altering substances, I believe that there should be an increasing emphasis on effective diversion programs (including drug court programs) and early intervention with judicial backup but no record if successful re-education and treatment are completed. Such approaches need to go on hand in hand with a massive prevention-education effort aimed at helping dissuade users from using a substance that has such negative effects on the mental, psychological, and physical health of users and on the health and functioning of those in their proximity, as well as on the overall well being of society.
After the conclusions of the deliberations in Independence Hall, Benjamin Franklin was asked later by a woman what kind of a government the new nation had. He is said to have replied: “A republic Madame, if we can keep it.” A new question: If we sanction or tacitly encourage the recreational and/or chronic use of psychoactive, mind-altering drugs, including marijuana, and if we do not actively discourage their use, can we still keep our republic? I think not, since keeping our republic depends on an educated and informed psychologically and mentally healthy and stable citizenry who value the common good and who are capable of bring sound reasoning, good judgment, the exercise of common sense, and understanding to bear on recognizing and addressing exceedingly complex and challenging problems and threats that are currently looming before us.
Answers to the six earlier questions in Parts 3 and 4 can clearly reflect a very different set of values and assumptions concerning what kind of nation we want America to be, and what kind of nation and what kind of world we want to pass on to the future generations. The answers can also reveal very different knowledge bases concerning the effects of psychoactive, mind-altering drugs and very different perspectives on what constitutes mental and psychological health and what the value of mental and psychological health is. From my vantage point, playing Russian Roulette with anyone’s mental and psychological health is simply not a smart thing to do. Turning any part or all of the United States into an Amsterdam or letting it evolve into an Amsterdam would seriously undermine our capacity to realize the promise of America and, from my perspective, it would throw to the winds the great gifts that the Founding Fathers bequeathed to us and entrusted to our keeping, the same gifts that following generations have fought and are fighting to keep.
*******
Dr. Paula D. Gordon is a consultant, researcher, analyst, writer, speaker, and educator. She has also served in a variety of capacities in the Federal government, including staff officer, policy analyst, and special projects director. She has an extensive background in several domestic policy arenas including drug abuse prevention and homeland security. Her websites at http://groups.google.com/group/GordonDrugAbusePrevention/ and http://gordonhomeland.com include her articles, reports, publications, and presentations on drug abuse prevention and homeland security respectively. Her doctoral dissertation, Public Administration in the Public Interest (posted at http://www.jhu.edu/pgordon) focuses on complex societal problem solving and governmental change. She is based in Washington, D.C. E-mail: pgordon@starpower.net
The drugs are there, the denial is there, the addictions are there…now what are we going to do? I am dealing with a teenager at home and those problems are very real for me…no denial here. My question is what do we do? Many of the Juvenile Delinquent Centers have had their budgets cut….so many of these kids can’t get help..only placing them from one unit to another. I will ask again, what can we do? Thank you!
It is amazing how there are always people who support stealing more and more money from Americans in the form of taxes.
Dr Califano
Congratulations on your well justified ‘awards’.
In the UK we are going the other (correct) way of raising taxes on alcoholic drink but at the same time we have extended opening hours of pubs and drinking establishments. These moves are not popular with the general public but I think it is right to try to stop or reduce, particularly young people, getting hold of alcohol. It does, however, affect those on low incomes, those on fixed incomes and pensioners and these groups often enjoy a drink and feel penalised because of the problems caused by inappropriate or illegal drinking (underage drinking or driving under the influence) of others.
Similar to the Sherrif’s comment, our hospital emergency sections are largely full of drink-related accidents and injuries on Friday and Saturday nights which affects us all and costs the UK tax payers a small fortune.
I have to deal with the worst end results of these stupid laws (extended opening hours), and shop keepers who sell alcohol to the young (under 18 in the UK) and I have to find the addicts/alcoholics rehab clinics at huge expense to their parents.
There are no simple answers but tighter controls and especially tough consequences for under age drinking and unsociable drink-related behaviour must be introduced very soon.
I have spoken at high level to both political parties here but it goes in one ear and out the other when tax income is likely to be lost! We too have powerful drink lobbyists.
In the UK it is said that 1 in 3 people have a problem with alcohol. It’s true that drugs and alcohol are a huge strain on the resources of our country and it is apparantly so of many other european countruies and of the USA. I seems illogical and an outrage that it should receive such little financial attention. I can’t help wonder sometimes if the government welcome addictive behaviours as a solution to increase the mortality rate to balance the economies.