Work in Progress: Addiction, Pragmatism, and History

I’ve been working on a paper recently with a colleague of mine, Nathan Crick at Louisiana State University, and for a bit of a change of pace I thought it would be nice to see if any of our esteemed readers would be interested in – or willing to – take a look at it and offer us their feedback. It’s an effort to use a pragmatic approach to understanding addiction research in order to move the conversation beyond what is often a vituperative debate between proponents of social-constructionist approaches and proponents of biologically reductionist ones. At the same time, it argues that we need to take the perspectives of those we study seriously, and make their perspectives a part of our research endeavors. (A few of you may also recognize it as a further iteration of a paper I gave several years ago at a conference at Emory on addiction, society, and the brain – it has, I think, been improved significantly since then, in large part through Nathan’s efforts. He’s a lot smarter than I am).

I’d love to have anyone who is interested take a look at it and offer some feed back, either in the comments or via email to me at joseph.gabriel AT med.fsu DOT edu. The document is in PDF format, and is encrypted and password protected so that it doesn’t get picked up by Google and other search engines. (You may have to open it in a new tab to get it to work). The password is “pointsadhsblog.” I’m only going to leave the paper up for a week or so, and will delete whatever feedback is posted at that time, so that the paper won’t be considered “published” when I eventually get around to submitting it somewhere.

Anyway, the paper is here. Many thanks.

[update, 9/12/2012: I’ve taken the paper down. Many thanks for the feedback, both in the comments and the private messages. It has been very helpful. If anyone else would like to read the paper please let me know.]

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The Points Interview — Mark Christensen

Editor’s Note:  Those who follow the Points Interview series know that Joe Spillane has managed this aspect of the blog since our founding.  While in today’s iteration we mourn Joe’s departure, we are also delighted to announce that Contributing Editor Ron Roizen has agreed to take over as our official interview steward.  A member of the merry research staff at the Alcohol Research Group at “Berzerkeley” in the early 1970s, it’s fitting that his first Points Interview is a “Freaky Friday” confab with Mark Christensen, another denizen of the Wild West.  In addition to publishing several novels, Christensen has written for Rolling Stone, Playboy, and Oregon Magazine.  Here he graces Points with his replies to our series of probing interrogatives on Acid Christ: Ken Kesey, LSD, and the Politics of Ecstasy (Schaffner Press, 2010).

How did you come to write Acid Christ?  And what’s its focus?

I was contacted by a former editor working for my eventual publisher, Tim Schaffner.  Tim had an idea for a new kind of nonfiction book,  a “shepherd and his sheep” biography in which the writer would tell the story of  a major modern “culture changer” and the change the “shepherd” brought from the writer’s own  perspective. As one of the sheep.  That would be me.  A former upper middle-class “suburban-urchin,” I’d written about counterculture icons like David Crosby, Richard Pryor and Paul Krassner for Rolling Stone and High Times and, so to speak, the paradise that was “pre-AIDS ‘Freak Freely’ America.” So I guess I was a good get.

As for the shepherd, larger than life Ken Kesey was an easy choice.  By age 28 he had two critically acclaimed bestselling novels, One Flew Over the Cuckoo’s Nest and Sometimes a Great Notion, a feat never bested by Ernest Hemingway, William Faulkner, Saul Bellow or John Updike.Read More »

The Anti-Methadone Movement: Just Say “Yes” to Heroin

Editor’s Note: Today closes out our series on methadone by guest Grey Ryder, the pen name of a methadone activist and patient who blogs at aboutmethadone.com.  Following on his overview of the drug’s history and discussion of its benefits, this piece looks at recent attempts to make access to methadone maintenance more difficult and costly in the name of “morality.”

Methadone’s success in reducing the harmful effects and behaviors associated with heroin addiction have led to its status as the “gold standard” in opiate addiction treatment.  Despite the phenomenal success of methadone, and its proven track record over the past fifty years, it has made its share of enemies.  Methadone’s foes, once a small group of people primarily concerned with keeping clinics out of their neighborhoods, have coalesced in to a major movement.  They have allied with legislators to enact laws that are posing a very real threat to addiction treatment in this country.

Jesus’ Son

“Disgusting and immoral” was how Senator John McCain described methadone in 1998.  He was seeking support for his “Addiction Free Treatment Act” which would, among other things, cut off Medicaid payments for methadone after six months of treatment.  His wife, Cindy, is an addict herself: she stole the painkillers she was addicted to from her own medical organization.  McCain’s bill (which never became law) was followed by then New York Mayor Rudolph Giuliani’s own crusade against methadone.  Giuliani vowed to shut down New York’s methadone clinics, again describing the treatment as “immoral,” before finally reversing himself in the face of overwhelming criticism.

Methadone opponents across the country are ready to clamp down on treatment.  Many methadone patients – perhaps the majority – are poor and on Medicaid.  States have begun to target this population by cutting off tax dollars for their treatment.

It is true that methadone deaths have risen exponentially over the past several years, due to a massive increase in pain relief prescriptions.Read More »

Teaching Points– Christine Grella Comments on “Addiction Research”

Chris Grella Brings the Nuance

Editor’s Note: Yesterday, psychologist Chris Grella presented a syllabus that lays out the institutional history (or histories) into which new researchers will intervene as they pursue their work– whether as bench scientists or as service providers.  Today, the rationale behind the class, and the nuances it hopes to add to work that will take place in a rapidly changing policy and funding environment.

This course is the introductory seminar for pre- and postdoctoral trainees in our  training program, funded by the National Institute on Drug Abuse (NIDA), at the UCLA Integrated Substance Abuse Programs (ISAP).  The ISAP training program is focused on health services research to improve the quality of drug abuse treatment services, consistent with NIDA’s Services Research Branch. Our goal is to equip researchers with the skills needed to undertake research in the area of addiction health services, broadly defined to include: (1) organization and delivery of drug treatment services, including integration with mental health, primary care, and other health and social services; (2) workforce issues, organizational development, and implementation research; (3) economics and financing of drug treatment services; (4) criminal justice systems and interventions for offenders; (5) longitudinal drug use, treatment use, and recovery outcomes; and (6) treatment/services utilization among diverse groups, including women, racial/ethnic groups, impoverished/homeless individuals, youth and older adults, and individuals with or affected by HIV/AIDS.

We believe that our training program meets a critical need in addiction health services research, especially within the context of changes anticipated with the full implementation of the Patient Protection and Affordable Care Act (ACA), otherwise known as “health care reform.”Read More »

Teaching Points– Addiction Research: History, Policy, and Practice

Editor’s Note: The Teaching Points series is a celebration of pedagogy on drugs.  In our second installment for the back-to-school season, we look at a rare specimen– a med-psy class that emphasizes history and its relevance for clinicians, researchers, and treatment providers.  Guest blogger Christine Grella is Professor of Psychiatry and Biobehavioral Sciences at the Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, and Associate Director of ISAP.  Her research focuses on the relationship of service delivery to addiction treatment outcomes, and she brings that “meta” perspective to graduate students and postdocs when she teaches “Addiction Research: History, Policy, and Practice.”

Addiction Research: History, Policy, and Practice
This course will take a big-picture view of research on substance abuse and its relationship to social interventions and policies that attempt to address problems related to substance use.

Teaching the Big Picture

The goal is for you to understand the history and evolution of the field of substance abuse research, so that you can situate your own research interests within this context, as well as understand the influences that continue to shape research priorities (and associated funding streams), social policies regarding substance abuse, and the organization and delivery of drug treatment within the context of the broader health care system. Moreover, because prior research on drug users, especially those who were incarcerated, was interwoven with the development of current policies regarding research with human subjects, we will examine these issues.  We will address questions such as:

  • What is the origin and evolution of research on drug use and addiction in the United States?
  • What is the relationship of the federal government to addiction research and how has this relationship changed over time?
  • What is the relationship of basic research on the effects of psychoactive substances, pharmacology and behavioral pharmacology, treatment-outcome and patient-oriented research, market-oriented research on drug development, and emerging new fields of addiction research (e.g., neurobiology, behavioral economics, translational research)?
  • In what ways does (or does not) research on drug abuse and its treatment inform social policies aimed at eradicating problems that stem from drug misuse?
  • What are implications of health care reform for the organization, financing, and delivery of drug treatment?
  • How do we determine the effectiveness of substance abuse treatment and what are current efforts to improve the quality and delivery of treatment services?

Readings:
N.C. Campbell.  (2007). Discovering Addiction:  The Science and Politics of Substance Abuse Research.  Ann Arbor:  University of Michigan Press.

Report of the Blue Ribbon Task Force on Health Services Research at the National Institute on Drug Abuse. (2004). Bethesda, MD: National Institute on Drug Abuse.

Institute of Medicine. Committee on Crossing the Quality Chasm. (2005). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, D.C.: The National Academies Press.

NIDA 35th anniversary papers in Drug and Alcohol Dependence, 107(1), 80-118.

National Center on Addiction and Substance Abuse at Columbia University.  (2012).  Addiction Medicine: Closing the Gap between Science and Practice.  New York:  CASAColumbia.

Course Schedule
Week 1: Introduction to addiction research and social policy in the U.S.:  History, policy, and practice
The field of addiction research has been described as having amnesia with regard to its history.  What can we learn from the history of addiction research about our current research priorities and practices?  What are the social policy precursors of our current efforts to regulate alcohol and drug use?  This class will present a “Brief History of Alcohol & Drug Use and Social Policy in the U.S.”Read More »

Monitoring Drug Use through Sewage: A Helpful Supplement?

 Editor’s Note: Today we welcome guest blogger Toine Pieters, senior lecturer and researcher at the VU-Medical Center in Amsterdam (since 1998) and professor of the History of Pharmacy at the universities of Groningen and Utrecht (since 2008). Working at the intersection of psycho-pharmacology, addiction studies, genetics and eugenics, he is the author of Interferon: The Science and Selling of a Miracle Drug (London, 2005) as well as a host of diverse papers. In addition to teaching and writing, he also is the project manager of WAHSP and BIland: Web applications for historical sentiment mining in public media.  Pieters will be guest blogging at Points intermittently through the fall– we hope with a whole slate of provocative topics like today’s.

Archaeologists love to dig into trash as a source of information for reconstructing the past. Biochemical researchers have followed suit with another kind of waste: sewage.

Sewage Epidemiology

Over the past decade a new promising technique based on the analysis of urinary drug biomarkers in sewage has been developed to estimate drug use by specific populations. This approach has been referred to as ‘sewage epidemiology’. Throughout last year, researchers from 19 different European countries studied illicit drug use by chemically sifting through the sewers. What does the study tell us about monitoring drug use?

The claim is that screening for drugs that pass through the body and then get flushed down the toilet is a faster and more reliable way to assess a community’s drug use than the time consuming data gathering tools currently available: population surveys and indirect estimates of drug production and seizure. The major assumption is that a sample of waste water is representative of a pooled urine sample of the entire population in the study area.Read More »

Addiction in African Literature

“Where is my African counterpart?” asks MaryKarr.

Where are the African tales of personal struggles with alcoholism and drug addiction?  I’ve been studying the history of alcohol use in Africa for more than twenty-five years and more recently I’ve also been looking at drug use.  Yet I can’t recall a single such story in my unsystematic sampling of African creative writing.  Here in the United States, hardly a week goes by, it seems, without publication of a memoir or fictional account (or public celebrity testimony) of the individual torments and collateral damage associated with alcohol and drug abuse and the redemption (and royalties) found in sobriety.  Why don’t we have an African Mary Karr? Why aren’t African writers cashing in?

Are Africans simply more abstemious?  This is hardly the case. Scholars have amply documented African drinking practices.  The history of drug use is much less studied, but in the recent past at least illicit drug use has become ubiquitous in many African societies.  And the fact is that African fiction and autobiography are awash in alcohol—and increasingly provide rich accounts of local drug cultures as well.  But the addiction story is mostly missing.  Why is that?Read More »

Better Living Through Methadone

Editor’s Note: Today brings the second in our guest series by Grey Ryder of aboutmethadone.org.  His first piece gave a brief overview of methadone’s history, with an eye to its bad reputation among the public at large. Today: a look at the drug’s beneficent clinical and social effects.

Ask Your Pharmacist

The tools for treating opiate addiction are sparse.  The front line treatments are rehab and twelve step groups.  Most of the pharmacological treatments are still in their experimental stages, and there don’t appear to be any silver bullets on the horizon.  However, there is one treatment that offers real hope.  Over the past fifty years, researchers studying methadone have determined that it is one of the most effective treatments for drug addiction ever created.    While it is a far cry from a cure-all – some patients don’t respond to it at all, and some continue using drugs during treatment– it is a godsend for many addicts.

Defining success is of critical importance when assessing any treatment’s effectiveness.  The simplistic view looks at whether a treatment stops an addict from using their drug of choice.  This absolutist approach is problematic for a number of reasons.Read More »

Teaching Points– Matt Crawford Comments on “History of Drugs in the Modern World”

 Editor’s Note: Today, historian of early modern drugs Matt Crawford reflects on his seminar “The History of Drugs in the Modern World,” the syllabus of which inaugurated this fall’s “Teaching Points” series.  In his commentary today, he discusses the abiding aims of the class as well as what he changed from its first iteration– the syllabus of which was posted yesterday– to its second.  That syllabus is available in full right here.

“Mexico is a failed state and the United States should invade it,” exclaimed a student in my “History of Drugs in the Modern World” course. His impassioned statement was in response to other students’ critiques of the United States’ policy on drug trafficking in Latin America—a  part of our discussion of Paul Gootenburg’s book Andean Cocaine(2008). Even if it was one of the more contentious moments that semester, I took this exchange as evidence that the course had achieved one of its goals: to provoke engaged (and informed) discussion about the course material.

Matt Crawford (left) Sparks Engaged and Informed Discussion

One advantage of teaching the history of drugs is the intrinsic interest that students have in the topic. Many of them also come to class with strong feelings and pre-conceptions regarding drugs, drug use and drug regulation. Consequently, while it is a topic that works well in a primarily discussion-based course, one of the challenges can be encouraging students to recognize and grapple with perspectives and historical narratives that don’t always fit with common and deeply held beliefs about drugs in our culture.

Course Design
I begin the course by asking the students to name some drugs and then ask a deceptively simple question: What is a drug?

This exercise serves two functions. It helps to assess their thinking about drugs, while setting the tone of the course as a serious intellectual endeavor. One of the central goals in the course is to encourage students to understand drugs as substances whose properties are defined as much by the societies and cultures in which they exist as by their chemical composition and physiological effects. In addition, I ask students to consider how the ways in which individuals, societies, and states use or regulate drugs depends on how they understand and define those substances. Finally, I use several of the course readings to highlight the forms of social and cultural regulation of drug use beyond the legal regulations of states, with which students are most familiar.

In the first iteration of my “History of Drugs in the Modern World” in Spring 2010, the course organization was fairly straightforward and focused on five drugs: tobacco, opium, cocaine, Taxol (a cancer drug), and Viagra. Three main principles informed the selection of these cases. Read More »

Teaching Points– A History of Drugs in the Modern World

Editor’s Note: Continuing in a great year-old tradition, Points kicks off this back to school season as we did last year, with a celebration of drug and alcohol pedagogy from various fields.  Over the next five weeks, the “Teaching Points” series will present the syllabi from relevant classes in history, criminology, international relations, economics and behavioral sciences.  The day after the syllabus appears, the instructor will offer a “Comment on the Class” that discusses their highs (as it were) and lows, their middles and muddles.  Our first foray in the series comes from Matthew Crawford, Department of History at Kent State, whom some Points readers may know from his superb stint as a guest blogger last winter.  We’ve positioned him first in the series because of the modest scope and ambition of his senior history elective “A History of Drugs in the Modern World.”

Course Description and Objectives
What is a “drug”? How are they discovered and produced? Why and how do some drugs get distributed widely and others do not?  Why do societies and states regulate the distribution of some drugs and not others?  These are some of the central questions that this course seeks to answer.  We will employ a comparative and historical approach to examine the ways in which societies identify, develop, produce, consume and regulate (or not) various pharmacological substances.  Course readings will cover a range historical case studies of primarily plant-based drugs from Africa, Asia, Latin America, and North America.  One of the main features and forces of world history since 1500 has been globalization.  As a result, we will pay special attention to what happens when drugs move across political, social, economic, and cultural boundaries. Possible case studies to be covered include: kola, coffee, tobacco, cocaine, opium, quinine, anti-cancer drugs and contraceptives.  Members of the course will do a short project on a drug of their choice in order to sharpen their skills at exploring the history of modern societies and cultures through material objects.

Our objectives for the course include:
• Be able to describe and discuss major trends in the history of drugs in the early modern and modern periods (c. 1500 to the present)
• Understand the use of material culture and objects in historical understanding of the modern world and its development
• Learn how to identify, evaluate and compare different historical accounts of drugs, their development and their regulation
• Learn how to analyze primary sources and relate them to their historical context
• Learn how to synthesize information from primary and secondary sources into a coherent historical narrative and how to use evidence to support a historical interpretation or argument

Transnational, Transtemporal

Course Readings
Required Readings
Brandt, Allan M. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. New York: Basic Books, 2007.

Dikötter, Frank, Lars Laamann, and Zhou Xun. Narcotic Culture: A History of Drugs in China. Chicago: University of Chicago Press, 2004.

Goodman, Jordan and Vivian Walsh. The Story of Taxol: Nature and Politics in the Pursuit of an Anti-Cancer Drug. Cambridge: Cambridge University Press, 2001.

Gootenberg, Paul. Andean Cocaine: The Making of a Global Drug. Chapel Hill: University of North Carolina Press, 2008.

Reidy, James. Hard Sell: The Evolution of a Viagra Salesman. New York: Andrews McMeel Publishing, 2005.

Additional readings or links to reading may be posted on our course website on Blackboard.  You MUST bring a copy of these readings to class.Read More »