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.
51lfsids0ql-_sx331_bo1204203200_

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.

assam
“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.

r-n-20chopra
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 »

Archive Report: The Psychoactive Substances Research Collection at Purdue University

Today’s post is by contributing editor David Korostyshevsky, a history PhD candidate at the University of Minnesota. 

It was a cloudy, rainy, late-March week in West Lafayette, Indiana when I first encountered Purdue University’s Psychoactive Substances Research Collection (PSRC). Maintained by the university library’s Archives and Special Collections, the PSRC offers the papers of important figures in American psychedelic research, from American LSD studies during the 1960s to the resurgence of international medical and scientific research about psychedelic substances during the 1990s. The collection also boasts an incredible shelf list of psychedelic science literature dating to the 1950s, including books, periodicals, and newsletters.Read More »

Technology Use and Drug Using Outcomes: 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.

A New Kind of Therapeutic Relationship: Exploring Factors that Influence the Effectiveness of Computer-Delivered Interventions for Alcohol Use Disorders

Author: Campbell, William P., IV

Abstract: Computer-delivered interventions (CDI) for alcohol use comprise a relatively new treatment for individuals struggling with problematic drinking. While CDIs for alcohol misuse have proliferated over the last decade, much remains unknown about factors that influence their effectiveness. This study evaluated the performance of Overcoming Addictions (OA), a CDI based on the principles of SMART Recovery (SR). Subjects were drawn from a sample of 189 participants enrolled in a randomized clinical trial (RCT) that compared three and six-month outcomes for two interventions for problematic alcohol use: control participants were enrolled in SR meetings (face to face and/or online); experimental participants also had access to OA. Primary analyses of between group differences were conducted to detect an additive effect of OA. Further, this study explored variables thought to mediate the effectiveness of OA, and CDIs for problematic alcohol use more generally. Within the experimental group, analyses were conducted to examine whether participants’ amount of experience navigating the Internet accounted for any variance associated with positive outcomes; also, the study examined the mediating effect of two other closely related variables: participants’ sense of how easy the website was to use, and whether participants were satisfied with the amount of content on the website. Primary analysis indicated that both the control and experimental groups showed significant improvement across outcome variables, although no additional benefit of OA was detected. Finally, no evidence was found to support the hypotheses for the identified variables thought to mediate the effectiveness of OA. Implications of this null finding are discussed.

 

Publication year: 2015

 

Advisor: Dougher, Michael J.

Committee member: Gangestad, Steven W.; Moyers, Theresa B.; Witherington, David C.; Woodall, William G.

University/institution: The University of New Mexico

Department: Psychology

 

Designing and Evaluating a Self-Help Website to Reduce Teen Alcohol Use

Author: Current, Brittany

Abstract: Teen substance use is an issue of major concern. Increasing numbers of teens are using alcohol and at earlier ages, resulting in severe and lasting consequences. Given teenagers’ developmental predispositions for risk-taking, illusions of invincibility, and limited attention to long-term consequences, it is critical for parents and other concerned adults to help teenagers think about and realistically evaluate the consequences of their actions in age-appropriate ways. Teens and young adults have been noted for being highly technically savvy, being regular online users, and obtaining much of their information online. Therefore, it would be helpful to leverage technical and online solutions for supporting teens in resisting pressures to drink. However, existing self-help websites are created and run by mental health professionals, generally without help or feedback from teens. The present action research project contributed to existing literature by inviting teens to participate in the design of a new self-help website by providing evaluative feedback through group interviews. This is the only research project involving focus group evaluations of teen self-help websites known to date. The present project involved designing, evaluating, and modifying a new self-help website for teenagers who are using alcohol or considering using alcohol, with the purpose of helping them avoid underage drinking and its consequences. First, a website was created based on an extensive literature review. Second, a 2-hour workshop of 15 college students was convened to present and evaluate the website. Focus group notes were transcribed and emerging topics for each question were summarized. Third, the website was redesigned based on participant feedback. Recommendations based on the results on the present study are to continue creating and maintaining alcohol and substance abuse self-help websites for teens and to create awareness about these sites so the target population may make use of them. Suggestions for continued research are to repeat the study with a larger sample and improved data collection tools. Another suggestion for continued research is to explore additional self-help options for teens to avoid underage drinking.

 

Publication year: 2016

 

Advisor: Willmarth, Eric

Committee member: Hoffman, Louis; Schmitt, Robert

University/institution: Saybrook University

Department: Psychology

Where Does Addiction Come From? Perspectives from the Past and Present

Editor’s note: It’s graduation season, which means a slew of new dissertations have been published. In today’s post, we include a few recent summaries of historical, psychological, and neurological perspectives on the etiology of addiction. 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.

Intoxication and Empire: Distilled Spirits and the Creation of Addiction in the Early Modern British Atlantic
Author: Burton, Kristen D.
Abstract: This dissertation exams how the spread of imperialism in the British Atlantic led to the mass production and consumption of distilled spirits during the seventeenth and eighteenth centuries. Through transatlantic colonization, distilled liquors, once produced as medicinal remedies, developed into a thriving industry by the beginning of the eighteenth century. This change in the purpose and use of distilled spirits prompted political, religious, and medical leaders to ask new questions about the effects and possible threats of consuming such spirits. This dissertation is a study of perceptions; it examines how spirits became the means through which people evaluated the place and proper behavior of women, the working poor, indigenous peoples, enslaved laborers, and backcountry famers, among others. While alcohol was thought by many to be spiritually and physically nourishing, mass production and distribution of rum in the mid-seventeenth century created new questions and concerns among elites about intoxication, bodily health, and the perceived threat of lost control over the laboring poor in England, and over indigenous communities and enslaved peoples throughout the empire. Social elites constructed narratives around new notions of inebriation based upon the loss of physical, as well as moral, control. Through these narratives, physicians came to create new theories of habitual drinking as a compulsive act. Altered perceptions, constructed from unprecedented eighteenth-century drinking practices, redefined alcohol as an intoxicant. This established the framework of what became early addiction theory, which emerged during the initial decades of the modern era. Eighteenth-century imperial, medical, and religious debates over distilled spirits, in turn, established the foundation for early ideas of alcoholism and transatlantic movements advocating temperance.

Read More »