Starting Points

Points (n.) 1. marks of punctuation. 2. something that has position but not extension, as the intersection of two lines. 3. salient features of a story, epigram, joke, etc.:  he hit the high points. 4. (slang; U.S.) needles for intravenous drug use.

#ADHS2017: Utrecht, The Netherlands

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The Alcohol and Drugs History Society convenes this weekend at Utrecht University in the Netherlands for its biennial meeting.  The conference theme is “Drinking and Drug Policies in History: Contextualizing Causes and Consequences.” There, participants are presenting new research and charting the future of the field. In an opening keynote address delivered Friday evening, “The Consumption of Intoxicants in the Past – Old Problems, New Approaches,” Phil Withington suggested innovative methodologies to make sense of how and why people – and, importantly, which people – used intoxicants in the past. (Also be sure to check out Dr. Withington’s Intoxicant Project for more information on drug use in early modern Europe.)Read More »

India’s Trysts with Prohibition

by Kawal Deep Kour (PhD, Indian Institute of Technology)

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Gandhi

As part of M.K. Gandhi’s call for non-cooperation with Indian colonial authority in 1921, abhorrence of drink and drugs were included on the agenda of the constructive programme of the movement. His promotion of temperance and adherence to the principle of non-violence were unique in Indian political culture and appreciated throughout the country. With Gandhi’s call to shun all intoxicants, including opium, ganja and liquor, prohibition as a policy initiative became a major plank of nationalist politics. The act of renouncing and liquor and drugs represented a sobering symbol of freedom from colonial bondage.

Under Gandhi’s direction, the self-purification movement implied that abstinence in regard of drink and drugs was to be the starting point in unshackling the country from imperial slavery. He said, “I hold drink to be more damnable than thieving and perhaps prostitution. If I was appointed dictator for one hour for all India, the first thing I would do would be to close without compensation all the liquor shops.”Read More »

The Points Interview: Pamela Donovan

Editor’s Note: Pamela Donovan is the author of Drink Spiking and Predatory Drugging: A Modern History (Palgrave Macmillan, 2016). She holds a PhD in Sociology from City University of New York Graduate Center. Donovan taught criminology and sociology courses for 20 years, and left academia to pursue freelance book editing and due diligence investigation. Her main areas of interest are drug and alcohol studies, as well as the small scholarly world of rumor studies. Her previous book was No Way of Knowing: Crime, Urban Legends and the Internet (Routledge, 2004).

1. Describe your book in terms your bartender could understand.
Well, there are bartenders as part of general audience that might be interested in this topic, and then there are bartenders as bartenders, particularly the ones at nightclubs, who no doubt have an interesting front line view of the current date-rape-drugs scare.
As an interested general audience, I’d say that my book is about the ways in which the fear, and occasional reality, of using drugs surreptitiously on people turns out to be related to other dramatic changes in modernizing societies. These changes include the psycho-pharmaceutical revolution that begins in the mid-1800s and really takes off in the mid-20th century. Governments and medical authorities try to create boundaries around usage that ordinary people resist and find ways around. We long for a series of precise and perfect cures, but we, at the same time, fear being controlled by chemically induced states of mind. We don’t feel like we can balance those benefits and risks ourselves. We are techno-utopians, when we feel as if psycho-pharma can deliver us to our real selves, and five seconds later, we are techno-dystopians, feeling as is we are at the mercy of bad actors who want to turn us into zombies. Read More »

Recent Publications in Contemporary Drug Problems: Europe Edition

Editor’s Note: Frequent readers may be familiar with the blog’s ongoing promotion of new, relevant dissertation research, but periodically we also highlight work published in journals and other peer-reviewed outlets. Each of the articles below appeared in recent issues of the journal Contemporary Drug Problems and concern topics of interest in countries across Europe. All titles contain links to the respective articles. Enjoy!

“Addiction in Europe, 1860s-1960s: Concepts and Responses in Italy, Poland, Austria, and the United Kingdom”

Virginia Berridge, Alex Mold, Franca Beccaria, Irmgard Eisenbach-Stangl, Grazyna Herczynska, Jacek Moskalewicz, Enrico Petrilli, Suzanne Taylor

Abstract: Concepts play a central part in the formulation of problems and proposed solutions to the use of substances. This article reports the initial results from a cross European historical study, carried out to a common methodology, of the language of addiction and policy responses in two key periods, 1860–1930 and the 1950s and 1960s. It concludes that the language of addiction was varied and nonstandard in the first period. The Anglo-American model of inebriety did not apply across Europe but there was a common focus on theories of heredity and national degeneration. After World War II, there was a more homogenous language but still distinct national differences in emphasis and national interests and policy responses to different substances. More research will be needed to deepen understanding of the conditions under which these changes took place and the social and policy appeal of disease theories.Read More »

The Points Interview: Claire Clark

Claire Clark teaches at the University of Kentucky, where she is an assistant professor of Behavioral Science, secondarily appointed in the Department of History, and associated with the Program for Bioethics. The Recovery Revolution: The Battle Over Addiction Treatment in the United States (Columbia University Press, 2017) is a history of therapeutic community treatment for drug addiction.
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1. Describe your book in terms your bartender could understand.

The Recovery Revolution explores the rise of addiction treatment in the United States since the 1960s. It does this by tracing the development of a peer-led treatment model called the “therapeutic community” (TC). TCs in the US had their roots in a controversial California commune, Synanon, whose residents promoted a unique, neo-Victorian brand of drug treatment. At the time, addiction treatment was mostly limited to a few hospitals and correctional facilities; both elites and people struggling with addiction were frustrated with the existing options. A small group of self-described “ex-addicts” ignited a treatment revolution in response, and their moral treatment philosophy had an outsized influence on the industry that developed in the decades that followed.Read More »

Drugs and African History

Editor’s Note: Frequent readers may be familiar with the blog’s ongoing promotion of new, relevant dissertation research (’tis the season!), but periodically we also highlight work published in journals and other peer-reviewed outlets. Each of the recent articles below by scholar Thembisa Waetjen offers new perspectives on the significance of drug use, commerce, and regulation in Africa. Enjoy!

“The Rise and Fall of the Opium Trade in the Transvaal, 1904–1910”

Journal of African Studies (2017)

Abstract: From 1904 to 1910, the transport and confinement of over 63,000 men from north-eastern China, recruited and indentured as unskilled mining labour, stimulated a new market for opium on the Witwatersrand, at the very moment when other British colonies and other empires were pushing towards co-ordinated action to curb the trade. This article plots the development and shape of opium commerce in the Transvaal colony, revealing local patterns of entrepreneurship and articulations between licit and illicit circuits in the narcotic supply chain. In a bid to monopolise control and profits, the Government set up a bureaucracy of drug provision, working with the Chamber of Mines and organised pharmacy and medicine interests. However, the continuing preference of indentured migrants for informal networks of supply, despite higher prices, points to the importance of the trade within the social and material economies of the mining compound. With political changes in both colony and metropole, and the termination of the Chinese Labour Importation scheme, the presence of opium on the Rand was drawn into the anti-opium politics of the imperial public sphere. White racial anxieties about the ‘spread’ of opium smoking were crystallised in the image of the opium den as a locus of depravity. However, it was neither moral nor social arguments, but rather the expulsion of the population officially targeted for drug use, that curtailed the trade in opium on the Witwatersrand.Read More »

New Research on Use and Abstinence at Work

Editor’s note: It’s graduation season, which means a slew of new dissertations! In today’s post, we feature two recent projects on the conspicuous use and abstinence of particular professional classes. These entries are part of an ongoing drug-related dissertation bibliography continuously compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Predictors of Excessive Alcohol Consumption Among U.S. Business Travelers

Author: Barrickman, Jennifer CloreRead More »

Mass Opium Addiction Treatment in Assam, 1939 (Part II)

(Editor’s Note: Continued from Part I)

by Kawal Deep Kour (PhD, Indian Institute of Technology)

The Assam Opium Enquiry Committee Report of 1933 had disapproved the idea of imposing Prohibition and accepted addiction as a medical problem. It stressed the treatment of opium addicts in hospitals where they were entitled to medical care and supervision. This, as mentioned in an earlier post was an expression of the increasing contemporary interest in addiction research and studies at both domestic and international level. The committee was responsive to the various forms of medical treatments that were being experimented with for the prevention and treatment of opiate abuse. In 1932, the League of Nations communicated the positive results of treatment of drug addicts by the “Modinos treatment” (or injecting serum obtained from blisters in the skin to enhance the immune system of the addicts) in the Netherlands Indies. The Inspector-General of Prisons in Burma introduced it to his country’s incarcerated population, and the news of these experiments with Modinos caught the fancy of the 1933 Opium Enquiry Committee who suggested a similar trial in Assam. Similar experiments were also being carried out at the School of Tropical Medicine Calcutta by Colonel Ramnath Chopra and his team which also found mention in the 1933 Assam Opium Enquiry Committee Report.  The findings of the team at the School of Tropical Medicine at Calcutta had greatly facilitated a scientific understanding of the progression of the opium habit including various forms of medical treatments available for prevention and treatment of opiate abuse. Highlighting the inefficacy of incarceration of opium users, it stressed the need to cure opium addiction in hospitals where addicts could be properly “policed.” Complete rehabilitation was however, ruled out.

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“Assam in the Clutches of Opium: Alas! Alas! What a Misery has Befallen Assam. Opium has Ruined Assam.” Image: Tinidiniya Asamiya, 1939

In February 1939, the coalition Congress ministry in Assam announced an “opium treatment campaign” to be launched on April 15, 1939. The task of the treatment scheme was entrusted to Col. Chopra and his team. Addressing a gathering at Sibsagar on February 24, 1939, the then Premier of Assam and a popular leader, Gopinath Bordoloi, appealed to all sections of people to extend their full cooperation towards ensuring success of the Kanee Barjan Andolan (The “Give Up Opium” Campaign). Colonel Chopra was convinced that considering the dearth of available resources and requisite infrastructure in the subcontinent, and also in keeping with the contemporary advances in addiction medicine, the focus of treatment should be managing the mechanics of gradual narcotic withdrawal as the most suitable mode of detoxification of Indian patients. He thought this best achieved with the help of a certain bio-chemical preparation of gentian and nux vomica. Colonel Chopra cited minimal discomfort as the major advantage of the gradual withdrawal method. Another advantage was that post-withdrawal insomnia, an extremely distressing condition, was much less frequent. It was believed that this would encourage other addicts to seek treatment and help prevent relapse. Moreover, with slow withdrawal, it generally took about 3–6 weeks to effect a cure in most Indian addicts. Further, due attention was to be given to the psychological rejuvenation of the patient. Building a congenial doctor-patient relationship was imperative for the recovery of the patient.

Thus in April 1939, in Assam, began one of the largest anti-addiction initiatives ever carried out in India to date. Colonel Chopra and his team at the School of Tropical Medicine, Calcutta, experimented with two methods for the treatment of addicts in Assam: the Vesicatory serum therapy of injecting fluids from water blisters developed by Dr Polyvios Modinos of the European hospital at Alexandria, Egypt and the glucose-lecithin therapy (described in more detail below) developed by Chinese anatomist, Dr. Ma Wen Chao and his team at the Peiping Union Medical College in 1931.

In the Modinos detoxification method, the patient was to receive an injection for about five weeks under strict observation in a hospital. Their consent was required for an incision to be made and an injection of serum to be produced from his blood. The process was excruciating and patients resisted the treatment. Trials of Modinos treatment had been conducted on drug addicts in Burma following its approval by the League of Nations in 1932. The trials, covering 353 opium addicts were confined to prison in Burma and were conducted under the supervision of the jail superintendents. The treatment was hailed as a valuable method of withdrawal and “denarcotisation.” However, contrary to claims of cure, it appeared to provide only temporary relief and came to be regarded as a difficult and painful treatment. (Where its reputation as a painless modality originated remains unclear.) It encountered opposition among the addicts in Assam also owing to the risks of septic infections and other complications. It was discontinued after only a few trials.

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Lt. Col. Ram Nath Chopra, a proponent of lecitin and glucose therapy.

The only treatment that appeared to suit the conditions prevalent in Assam, according to Chopra, was the use of lecithin and glucose. This therapy consisted of a three-phased intervention: (i) detoxification, (ii) withdrawal management, and (iii) recovery. The dosages of lecithin and glucose varied according to the severity of the symptoms. The duration of treatment was generally around 10 days. Throughout the period of treatment, addicts were encouraged to report voluntarily to treatment centres. On admission, they were subjected to a complete medical examination which included recording their detailed medical history as well as their name, age, sex, religion, occupation, social status, income, amount of opium consumed, duration of habit, reason for the habit, general state of physical and mental health. Based on the above, the patient was subjected to specific and “symptomatic” treatment. Lecithin was administered at a dosage of 10 grams twice or thrice daily while glucose was to be administered orally in solution or by intravenous injection (25% solution). Patients with signs of “toxaemia” (weak pulse, yellow eyes, “furred” tongue, and dry skin) were immediately put on isotonic saline intravenously along with a dose of diffusable cardiac tonic mixture. For “elimination of opium through the intestinal tract,” the patient was administered a full dose of calomel, ranging from 1 to 3 grams and some sodium bicarbonate at night. This was followed by a dose of magnesium sulphate to help restore the functioning of liver. However, this was discontinued if the patient had diarrhoea and then milk or curd was fed to the patient. Lecithin was administered in the form of pills from the second day, for a period of five to seven days. One pill thrice a day, along with one or two ounces of glucose, was believed to ameliorate the withdrawal symptoms.

Symptomatic treatment was followed for withdrawal symptoms that usually appeared within 36 hours. Nausea and vomiting were managed by sodium bicarbonate. In severe cases, ten drops of adrenaline hydrochloride solution (1 in 1000) were given under the tongue every two or four hours for relief. The most common complaint following the withdrawal was diarrhea, which was treated with minimal doses of opium, in the form of Dover’s powder, spread over a period of three to four days. Restoratives such as brandy, spirituous ammonia aromaticus, and digifortis strycnine were used to relieve low blood pressure, a feeble pulse and sinking sensation. To relieve insomnia, paraldehyde, sulphonal or chloral hydras were administered, while general weakness was sought to be alleviated by using tonics such as iron, strychnine or small doses of quinine. Other “intercurrent diseases” such as asthma, abdominal discomfort, dyspepsia, etc. were treated symptomatically.

Special attention was given to diet. During the detoxification phase, when the appetite was almost nil, the patient was fed well cooked rice with milk along with large doses of glucose (about one ounce per day), two or three times daily. This was believed to act effectively on patients suffering from jaundice and also to help the addicts in overcoming trauma. The first supplies of glucose for the experiment came from a German pharmaceutical company, Merck; these were later replaced by a solution of glucose, which was prepared and tubed locally at the Pasteur Institute at Shillong in India. Meanwhile, Messrs. Smith, Stani, Street, and Company of Calcutta were also approached at Chopra’s initiative for the local manufacture of lecithin. This not only ensured a steady supply but also stimulated local enterprise and generated great interest in various parts of the country.

It was found that during the preliminary period of treatment, when intravenous injections were given, the relief of the symptoms was so immediate that the addicts clamoured for these injections. Once it was found that it was possible and feasible to use the method safely under the prevailing conditions in the prohibition area, permission was given for its use in most of the centres. Though the normal practice was to examine the urine samples to determine the level of morphine, this could not be done in Assam, as the necessary reagents could not be obtained. Had it been possible to conduct such a test, it would have facilitated a comparison between the condition of those who had undergone specific treatment and those who had got over their withdrawal symptoms without any specific treatment. The official records reported on the positive results of treatment and their efficacy in the management of withdrawal symptoms and associated reactions. Col. Chopra, in an article, “Treatment of Drug Addiction in India,” hailed the experiment as “a unique campaign unparalleled in the history of drug addiction anywhere in the world.”

Its short-term efficacy aside, the combination of educative propaganda and therapeutic intervention was a novel initiative as it had certainly aroused public empathy for the opium users. It marked a paradigm shift in the outlook of the general public towards the opium users who were no longer looked down as offenders but as patients who needed medical care and attention. Such state initiative with medical collaboration was the harbinger of the emerging politico-medical discourse to effectively tackle drug addiction which had by then come to be regarded as a public health menace. It was expected that the involvement of the medical community would combine the twin objectives of scientific expertise and rational administration designed to promote social welfare by safeguarding public health.

Motivational Interviewing in Recovery

Editor’s note: It’s graduation season, which means a slew of new dissertations! In today’s post, we feature two recent projects on the use of motivational interviewing techniques in recovery settings. These entries are part of an ongoing drug-related dissertation bibliography continuously compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Motivational Interviewing Treatment Integrity and Client Change: Using ROC Analysis to Explore the Relationship Between MI Fidelity Level and Drinking Outcome

Author: Fischer, Daniel J.

Abstract: Those engaged in the research and practice of MI have shown interest in treatment adherence as an indicator of effective MI and have expressed curiosity in the threshold at which MI practice could be viewed as “good enough”. The most widely used and often cited of MI integrity measures are the Motivational Interviewing Skills Code (MISC) and the Motivational Interviewing Treatment Integrity code (MITI). These adherence tools share similar descriptive coding systems for therapist in-session behavior. MI fidelity standards are often used as reference points for therapist performance, yet practitioners rarely meet full criteria. Further, substandard ratings have been associated with positive client change. These findings have elicited questions about the necessary levels of therapist treatment adherence to promote client change and suggested the need for empirically-derived fidelity standards. This study analyzed existing data from a sample of Motivational Enhancement Therapy (MET) sessions from Project MATCH (Matching Alcohol Treatments to Client Heterogeneity) that were audio recorded and previously coded with the MISC. MI adherence variables were analyzed along with client drinking outcomes to test the relationship between therapist fidelity and client change. Therapist adherence was determined using behavioral codes common to the MITI and MISC. Client change thresholds were determined using clinically significant change standards developed by Jacobson and Truax. The relationships between therapist adherence level and client change thresholds were examined using Receiver Operating Characteristic (ROC) analysis. Findings showed mixed support for the relationship between therapist adherence level and client drinking outcomes, but yielded levels of therapist MI adherence associated with client changes in drinking outcomes.

Read More »

Problem Drug Use in Social Context: New Research

Editor’s note: It’s graduation season, which means a slew of new dissertations! In today’s post, we include a few recent projects concerning technological interventions in problematic drug use. These entries are part of an ongoing drug-related dissertation bibliography continuously compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Illness Representation, Coping, and Treatment Outcomes in Substance Use Disorders

Author: Prater, Kimberly A.

Abstract: This study examined the relationship between illness representation, coping, and treatment adherence in substance use disorders (SUDs). Illness representation refers to the way in which an individual cognitively understands his or her illness. Leventhal, Meyer, and Nerenz’s (1980) Self-Regulation Model (SRM) is one theoretical model of illness representation that addresses how cognitive factors influence illness coping behaviors and outcome. The SRM has been applied extensively to understanding patient perspectives of physical illness. More recently, the model has been applied to individuals with psychological disorders, including psychotic disorders, mood disorders, and eating disorders. In the mental health literature, illness representation has been found to be related to, and at times predictive of, behavioral outcomes, such as treatment adherence. The present study is notable because it is the first to examine the SRM in substance use disorders (SUDs). Moreover, this is one of the first longitudinal studies examining the relationship between the SRM and outcome in a mental health population. The sample was comprised of 70 patients with SUDs who were receiving outpatient treatment at the St. Luke-Roosevelt Hospital’s Addiction Institute of New York. The findings provided partial support for the study’s hypotheses. Specifically (a) patients who identified a psychological or behavioral cause of their SUD were more likely to be treatment adherent, (b) patients who perceived some personal control over their SUD were more likely to be treatment adherent, and (c) several illness representation dimensions were associated with various coping styles in SUD patients. The SRM appears to be a valid model for understanding SUDs, and the Brief IPQ a reliable and valid tool for assessing illness representation in SUDs. The current results underscore the necessity and value of conducting further research to inform the further development of empirically supported SUD treatment approaches.Read More »