Friday, January 30, 2009

Obama Sends Drug Warriors to UN, DEA to CA: Stop Fighting Bush's Wars

Maia Szalavitz
Posted January 29, 2009 01:43 PM (EST)
The Huffington Post

As someone who cares about humane drug policy, I expect politicians to disappoint me. Obama created a rare glimmer of light here with his honesty about his own experience -- but his choice of drug warriors like Joe Biden and Rahm Emmanuel for high level posts has made me wary.

Now, with a new raid on California's medical marijuana dispensaries and with Bush holdovers trying to push the UN to drop support for needle exchange and other harm reduction programs in its document to set drug policy for the next ten years, I am beginning to lose hope.

Amazingly, however, progressives in Congress (!) are speaking out about the possible UN fiasco -- sending a letter to our new UN Ambassador Susan Rice to protest the actions of these officials. Reps. Henry Waxman, Jose Serrano and Barbara Lee write:

Unfortunately, we understand that the U.S. delegation in Vienna has been actively blocking the efforts of some of our closest allies -- including the European Union -- to incorporate into the declaration reference to harm reduction measures such as needle exchange. We find it hard to understand how the U.S. delegation could object to language which would not obligate any country to adopt particular policies with which it disagrees.

I will go further. Obama has said that he supports lifting the federal ban on funding for needle exchange programs in the U.S. and that he supports science-based policy, which backs this action. He has said that he will end the raids on medical marijuana in states that have legalized it.

I suspect that he's afraid that any action in this direction will be jumped on with glee by right-wing critics. I think he fears a repeat of the Clinton administration's "Don't ask, don't tell," culture war disaster. But as he pointed out to his critics in relation to economic policy, "I won."

That's right, Mr. President, you won! And you won not despite taking evidence-based positions on tough issues -- but because you did so.

I think you'll find that when people are worried about their jobs, it's hard for them to work up steam about imaginary bogeymen like those hyped by drug warriors. When you face real problems like feeding your kids, false hypotheticals like needle exchange "sending the wrong message" and turning us into a nation of junkies just don't get traction. (Quick question: would making clean needles available make you start shooting up? Didn't think so -- and same is true for everyone who is not already doing so!).

When your financial future is at risk, it's hard to see spending money on raiding and incarcerating medical marijuana users and distributors as a good investment -- or even to see medical marijuana use as a problem, let alone one worthy of expensive and ineffective police intervention. (Has medical marijuana made your or your kids into dope fiends? Surveys find states with it tend to have *less* use by youth).

Take advantage of this rare opportunity to expose the tired rhetoric of the drug war and do the right thing, as you promised. Support harm reduction like the rest of the developed world does. Recognize how out of touch the U.S. has become in its drug strategy.

This is not the 70s or even the 80s or 90s -- like Bush's economic policies, his drug policies have visibly and risibly failed. The main power drug warriors have left is politicians' outsized fear of their past success. Don't give them undue credit--and don't underestimate how the ground has shifted in favor of sane, humane drug strategy, not war.

Thursday, January 29, 2009

Obama's Choice: Sane U.N. Drug Policy or the Same Old Failed War-on-Drugs Routine?

By Allan Clear, AlterNet
Posted January 27, 2009

America's current foreign policy has very little impact on reducing supply, consumption or cultivation. Obama has a big chance to turn it around.

Everyone knows that Barack Obama became the 44th president of the United States last Tuesday, Jan. 20. As an advocate for sound, sane drug policy and HIV prevention, I hope that his inauguration will mark a change to an administration that chooses science over dogma.

By contrast, practically no one knows about the Commission on Narcotic Drugs meeting that will take place in Vienna, Austria, six weeks from now, March 12-13. This meeting of United Nations member states will review the results of the1998 U.N. General Assembly Special Session on drugs that set the framework for the last decade's international drug policy. They will then release a political declaration that will set the framework for the next decade -- and, by implication, the course for the global response to the HIV epidemic as it affects drug users.

It is imperative that the new Obama administration act quickly to ensure that the U.S. delegation to this upcoming UNGASS review reflect Obama's publicly stated position that he, per the official White House site, "supports lifting the federal ban on needle exchange, which could dramatically reduce rates of [HIV] infection among drug users."

Otherwise, our new president will miss a vital early opportunity to lead us back into an era of evidence-based policy.

Our current U.S. delegation is primarily made up of State Department bureaucrats soldiering in the war on drugs. They promote policies that have had dramatic negative consequences (intended and unintended) on the lives of drug users, their families and their communities but very little impact on reducing drug supply, consumption or cultivation.

By making drug use as dangerous as possible, the United States has facilitated the spread of HIV and viral hepatitis, has allowed death from overdose to remain unchecked and has created a prison system unlike anything since the Soviet gulags. At the same time, U.S. commitment to providing effective drug treatment on demand is virtually nonexistent. Moreover, in critical negotiations in international settings, Team USA is rabidly hostile toward harm reduction and syringe exchange at a time when Australia, Canada, Iran and most European Union countries embrace them as important drug policy tools.

The UNGASS review presents an opportunity for the Obama administration not only to lose these Bush-era ideologues, but also to join with other nations to create a genuinely balanced and useful blueprint for international drug policy.

We should follow the example of other U.N. member states, including some countries in the Caribbean as well as the U.K., and the Netherlands, and expand the U.S. contingent to include members of civil society -- people with a distinct viewpoint who can engage in the proceedings and represent the views of drug users.

After all, countries around the world, including the United States, have long understood the importance of including people living with HIV/AIDS at U.N. meetings. Yet, when it comes to making U.N. drug policy, the current U.S. framework renders the most affected community, individuals who use drugs, silent. It will be easier to design effective solutions with input from all affected parties.

Click here to continue reading this article at AlterNet...

Public Health and Human Rights Advocates Ask Obama to Ensure That US Delegation to UN Drug Meeting Reflects His Support for Syringe Exchange


NEW YORK CITY - The Harm Reduction Coalition published an op-ed today urging the Obama administration to send delegates to an upcoming meeting of United Nations Member States that will reflect the President’s public health and drug policies. Per the official White House site, President Obama supports “lifting the federal ban on needle exchange, which could dramatically reduce rates of [HIV] infection among drug users.”

“Our current US delegation is primarily made up of State Department bureaucrats that have been hostile towards syringe exchange and harm reduction at a time when Australia, Canada, Iran, and most European Union countries embrace them as important drug policy tools,” said Allan Clear, Executive Director of the Harm Reduction Coalition and the writer of the op-ed. “We don’t want President Obama to miss this vital early opportunity to lead us back into an era of evidence-based policy.”

The upcoming Commission on Narcotic Drugs meeting, which will take place in Vienna on March 12-13, 2009, will review the results of the1998 UN General Assembly Special Session (UNGASS) on drugs that set the framework for the last decade’s international drug policy. Delegates from UN Member States will then release a political declaration that will set the framework for the next decade — and, by implication, the course for the global response to the HIV epidemic as if affects drug users.

In addition, the op-ed urges the Obama administration to expand the US delegation to include members of civil society. Notes Rebecca Schleifer, an advocate for Human Rights Watch's HIV/AIDS program, “The UNGASS meeting must be opened up to include civil society. This is the standard for UN conferences about women, HIV/AIDS, and disability. However, when it comes to drug policy, we see again that the voices of those who are most affected are missing.” Sanho Tree, a Fellow and Director of the Drug Policy Project at the Institute for Policy Studies in Washington, DC, concurs: “It will be easier to design effective solutions with input from all affected parties.”

In a letter co-sponsored with Physicians for Human Rights and co-signed by 60+ public health and human rights organizations, the Harm Reduction Coalition has asked the Obama administration to immediately appoint a more progressive US delegation to the UNGASS review process. As of today’s date, January 27th, a mere six weeks from the 2009 UNGASS, there has been no response from the Obama administration.

To speak with Allan Clear or other media spokespeople, including Rebecca Schleifer and Sanho Tree, contact Nancy Goldstein at 347 563 1647 or

Click here for a PDF version of this article...

Harm Reduction Coalition’s UNGASS Sign-On Letter to Obama

January 1, 2009

Dear President-elect Obama,

Congratulations on your historic election. As advocates working to address US government policy on drug use and HIV, we hope that your administration will shift US policy in this critical area away from ideology and to positions based firmly on evidence, public health principles, and human rights.

We are fast approaching a very important meeting of the United Nations Commission on Narcotic Drugs. In March 2009, UN Member States will gather in Vienna for a high level meeting to assess progress since the 1998 General Assembly Special Session addressing world drug problems. The political declaration coming out of this two-day meeting will set the framework for the next phase of international drug control and will set the course for the global response to the HIV epidemic.

This political declaration is being drafted right now and will be largely completed by the end of January, shortly after you take office. Bush Administration State Department negotiators are currently taking advantage of the US government's status as a world power to undermine and block accepted World Health Organization (WHO) and UNAIDS approaches to HIV prevention among drug users – strategies that are now strongly supported by the vast majority of UN Member States. The negotiators for the outgoing US administration are defending positions that will inhibit essential public health interventions in the many parts of the world where HIV epidemics are driven by drug injection.

We are concerned that because this key international meeting comes at a time shortly after you assume office and will be facing extraordinary demands, the default response may be a continuation by the US negotiators of the harmful status quo. We believe that those currently representing the US government in Vienna do not reflect the values you espoused in your successful election campaign, and that your own administration will wish to chart a quite different course. The March 2009 meeting represents an immediate and important opportunity for the US government to adjust course, and to work with other UN Member States in supporting a new, evidence-based drug and HIV policy.

Click here to continue reading this letter...

Letter to Ambassador Rice from Reps. Serrano, Waxman and Lee

Congress of the United States
Washington, DC 20515
January 28, 2009

The Honorable Susan E. Rice
United States Mission to the United Nations
140 E. 45th Street
New York, NY 10017

Dear Ambassador Rice:

We wish to congratulate you on your new post. We look forward to working closely with you to address the enormous challenges before us.

Among those challenges, as you well know, is the spread of HIV/AIDS. Within the United States and globally, intravenous drug use has been a significant factor in the spread of HIV and other infections, such as Hepatitis B, that are major threats to public health.

Within the Congress, we three have worked to try to allow federal funding to support domestic needle exchange programs, which have been shown to reduce rates of infection among drug users without increasing illegal drug use. In the United States and around the world, needle exchange is recognized as a practical and proven way to help minimize the terrible harms associated with illegal drug use.

We are pleased that President Obama supports lifting the ban on federal funding for needle exchange, and we look forward to working with the Administration to bolster this critical HIV prevention strategy.

Click here to continue reading this article...

Obama Names Ed Jurith as Interim Drug Czar

January 28, 2009
News Report
by Bob Curley

Edward H. Jurith, the longtime lead lawyer for the White House Office of National Drug Control Policy (ONDCP), has been named the interim director of the agency by President Barack Obama.

Obama announced the appointment on Jan. 20 -- Inauguration Day. Jurith replaces Patrick M. Ward, named interim ONDCP director just eight days earlier by former President George Bush. Ward is ONDCP's acting deputy director of supply reduction.

This is Jurith's second stint as acting "drug czar" -- he was appointed acting ONDCP director by President Bill Clinton in the waning days of his administration, replacing Barry McCaffrey, and led the agency for nearly a year before President Bush named John Walters to lead ONDCP in December 2001.

Jurith has served as ONDCP's general counsel since 1994; prior to that he worked as staff director and counsel at the House Select Committee on Narcotics Abuse and Control, founded by Rep. Charles Rangel (D-N.Y.). During his time in Congress, Jurith helped draft the Anti-Drug Abuse Acts of 1986 and 1988, which remain cornerstones of federal drug-control policy.
Jurith's responsibilities at ONDCP include providing legal advice on compliance with federal law and as related to the National Youth Anti-Drug Media Campaign and other ONDCP programs.
Jurith also has served on the American Bar Association's Standing Committee on Substance Abuse and, since July 2008, has served as an at-large member of the board of Faces and Voices of Recovery.

Pat Taylor, executive director of Faces and Voices, called Jurith a "dedicated public servant."

"We have a lot of respect for him," she said.

Jurith also has occasionally represented ONDCP in public forums, such as a December 2008 debate on medical marijuana with Dan Bernath, assistant communications director of the Marijuana Policies Project. "Jurith didn¹t lie, bully, or accuse me of secretly trying to get children hooked on marijuana," wrote Bernath on his blog after the debate. "His arguments at least had some basis in legal fact, although I believe they were far too narrow to justify denying seriously ill patients access to safe, effective medicine, let alone arresting them for it. But he was civil and thoughtful."

Wednesday, January 28, 2009

Battling Addiction: Are 12 Steps Too Many?

By John Cloud Tuesday, Jan. 27, 2009
Time Magainze: Health & Science

January is a big month for winter sports and post-Christmas sales. It's also — as people who treat substance abuse know — a big month for drinkers who want to quit. The holidays are over and bank accounts are thin, but addicts can't stop partying. Many choose January to ask, at long last, for help. But what sort of help is the most useful? (See "The Year in Medicine 2008: From A to Z.")

For decades, the primary approach to rehabilitation in the U.S. has been 12-step programs like Alcoholics Anonymous (AA). Twelve-step doctrine defines addiction in a contradictory way: as a medical problem, like a lifelong illness, with a spiritual solution (surrendering to a higher power).

The model has become so culturally hegemonic that it's hard for many to imagine any other way to stop getting drunk or doing drugs — or gambling, overeating or watching porn, for that matter. When we see Anne Hathaway's character in the film Rachel Getting Married at a 12-step meeting or when we watch D-list celebrities work the steps on VH1's new reality show Celebrity Rehab Presents Sober House, it's easy to think 12-step is not only the best way to get well, but the only way. There's a growing body of evidence, however, that suggests that's not so. (Read a 1940 TIME article about Alcoholics Anonymous.)

Last month, investigators in the U.S. reported good test results for a monthly dose of the common antidrinking drug naltrexone — a medication that currently must be taken every day to be effective. But naltrexone is controversial because for some, it doesn't do anything to reduce the craving for alcohol until those addicts actually take a drink, whereupon it helps them resist taking more — a twisted bit of physiological irony if ever there was one. Twelve-step believers say the only proper response to alcoholism is total abstinence, and that a drug that allows you to drink a little puts you on a slippery slope to drinking a lot.

bout 1 in 5 people with alcohol dependence stop drinking without any treatment, according to the Diagnostic and Statistical Manual of Mental Disorders, the field guide mental-health professionals use to diagnose illnesses. That means we have to figure out a way to help the 80% who won't get better through willpower. The latest evidence suggests that those who think that spirituality or a pill alone can save them are wrong. The answer almost certainly lies deeper inside ourselves.

In last month's Journal of Substance Abuse Treatment, University of New Mexico addiction specialist William Miller and his colleagues presented findings from two controlled trials in which patients underwent drug treatment. Some of the patients received spiritual guidance as part of the treatment — learning such practices as prayer, meditation and service to others, all of which are central to 12-step programs. Others received secular psychotherapy. Because of the enduring popularity of AA and similar programs that involve a spiritual component, Miller and his team expected the patients in the spiritual group to do better than those in the secular group. They were wrong — at least in the short term.

While both groups eventually benefited relatively equally from their treatment — abusing substances on fewer days — it took longer to see improvement among those in the spiritual group. What's more, those who received spiritual guidance reported being significantly more anxious and depressed after four months than those who got secular help. Those problems abated at about the eight-month point, but because substance abusers are at high risk for suicide, some worry that it may not be a good idea to put them through demanding spiritual calisthenics in the early months of their recovery. (Read a 2007 TIME cover story, "How We Get Addicted.")

Last month, investigators in the U.S. reported good test results for a monthly dose of the common antidrinking drug naltrexone — a medication that currently must be taken every day to be effective. But naltrexone is controversial because for some, it doesn't do anything to reduce the craving for alcohol until those addicts actually take a drink, whereupon it helps them resist taking more — a twisted bit of physiological irony if ever there was one. Twelve-step believers say the only proper response to alcoholism is total abstinence, and that a drug that allows you to drink a little puts you on a slippery slope to drinking a lot.

About 1 in 5 people with alcohol dependence stop drinking without any treatment, according to the Diagnostic and Statistical Manual of Mental Disorders, the field guide mental-health professionals use to diagnose illnesses. That means we have to figure out a way to help the 80% who won't get better through willpower. The latest evidence suggests that those who think that spirituality or a pill alone can save them are wrong. The answer almost certainly lies deeper inside ourselves.

Thursday, January 22, 2009

A Colleague Introduces The Politics of the Science of Drug Policy into the Discussion

I am pasting below a response to our discussion that I think will broaden what we are considering about the future of drug policy and the leadership of ONDCP and SAMHSA to include the political dimension. Joyce Rivera, the contributor, is a long time pioneer in the harm reduction movement who has made important contributions to our fields.

Andrew Tatarsky, PhD

Dear Andrew,

Bart forwarded me the email thread and I'd you to share with the listserve my thoughts on the appointment of the next drug czar. These thoughts are based on over twenty years of working with substance users in several capacities.

I do not share the belief that addiction is a chronic, relapsing disease. This belief is a cornerstone to our current, dehumanizing, punitive approach to drug care. The approach continues to fail millions of individuals and families. Support for this belief system consigns our creative efforts to dyads that make research easier but have little relevance to life as it is actually lived, i.e., using a range of substances, in a variety of ways, over the course of a life;

Why a Ph.D? In my experience the possession of the degree makes you a good writer. Sometimes. In the pursuit of the degree, a lot of reading is required; less so after securing the degree. Notwithstanding, Dr. McClelland as editor of the Journal of Substance Abuse, appears as a well-read man with years of social-political experience. Do you think that makes him more or less open to new approaches? After investing a career in support of a limited range of ideas, my sense is that he will be open to novel ways to link substance use, the disease, to neurobiology and neuropsychology. While we remain curious as to the contributions onthose subfields, by continuing to underspend on social context, we are reducing understanding of the social underpinnings of human agency.

I'm uncertain of your actual experiences with SAMHSA. We were recently rejected with fair scores. Some opinions were strikingly narrow-minded. Nevertheless, SAMHSA stands out among the CDC branches for its respect and funding for ethnography. When you work out in the community -- where street level dealing and use occurs ethnographers are your Go-To field people; their work opens program/policy directors to the multilayered meanings inherent in specific communications.

Why do we need another White Male? At the receiving end of our country's punitive drug approaches are people of color. A change in our field has to come from the bottom - up. We need leadership of a different kind, and I say this without apology.

As I write, someone is working on 'manufacturing' a different kind of high; some others are working on pricing for optimal market share; business plans are fine-tuned to maximize the downturn in the global economy; while new methods of eluding suspicion amid heightening scrutiny of financial institutions are drawn. The global drug traders may be scheduling a skype session, obstensibly as a less expensive global retreat. The point is that our interest in a psychologist to head SAMHSA represents a narrow reading of the phenomenon of drug use.

Drug use is politicized. Science is politicized: Science, and the specific field of psychology, has been throwninto the news, almost daily for the last eight years, for its role in torture. The last 100 years have seen the growth of a 'science' of human behavior that is consistent with the juridification of everyday life. I'm hardly stating anything new regarding the politicization of science, see Habermas, Kuhn, Popper,.... Copernicus, Newton, Aristotle,...Sophocles!!

We have an opportunity to institutionalize a social science that is critical, not sycophantic to power. The price of the latter has been measured and for many they remain unacceptable. We're in the 21st century: evolutionary scientists point to our agentic role in the evolutionary process.


Joyce A. Rivera
Founder & Executive Director
St. Ann's Corner of Harm Reduction

New York Times Letter to the Editor: Drug Prosecutions

January 20, 2009
The New York Times Editorials / Letters

Drug Prosecutions

To the Editor:

In “Cocaine and White Teens” (column, Jan. 10), Charles M. Blow writes that white teenagers use more cocaine than black teenagers, and cites a ratio of 10 to 1 of white versus black teenagers entering drug treatment for crack and cocaine use.

A significant but missing statistic is white versus black teenagers entering the criminal justice system. F.B.I. statistics for many years have shown more whites than blacks arrested for drugs, while more blacks than whites are incarcerated. We should not lose sight that our war on drugs has been a war on people of a certain color.

Howard Josepher

The writer is president of Exponents, which helps people affected by drug addiction.

Sunday, January 18, 2009

The Drug Czar: Harm Reductionists, Treatment and Recovery Advocates Come Down on Different Sides of Rumored Ramstad Nomination

from Drug War Chronicle, Issue #568, 1/16/09

Former Minnesota congressman, self-acknowledged recovered alcoholic, and treatment and recovery advocate Jim Ramstad is widely rumored to be in the running for head of the Office of National Drug Control Policy (ONDCP -- the drug czar's office), and he is garnering both support and opposition from within the drug reform community, broadly defined.

It may all be for naught. Ramstad himself has asked the Obama transition team to consider him to head SAMHSA, the Substance Abuse and Mental Health Services Administration, a post where his appointment would arguably be less controversial. And President Bush's last-minute appointment Monday of current acting ONDCP deputy director Patrick Ward to replace outgoing drug czar John Walters only muddies the waters further.

While Ramstad has serious credentials on treatment and recovery, his opposition to needle exchange programs spurred drug policy analyst and author Maia Szalavitz to oppose his nomination in an article in the Huffington Post. "Ramstad may be a drug warrior in recovering person's clothing," she wrote, noting that he also opposes medical marijuana.

"While Ramstad has opposed some interdiction efforts and called for more treatment funding, someone who doesn't even believe that addicts have a right to life if they aren't in treatment is not the kind of recovering person that I want representing me as drug czar," Szalavitz, a former injection drug user herself, continued. "That's not change, President Obama -- that's more of the same. Don't make the mistake that Bill Clinton did and install a drug czar who will ignore science and push dogma. While it's great to have a recovering person as an example, just having a disease and talking with others who've recovered the same way you did does not make you an expert. We need someone who knows the science, recognizes that there are many paths to recovery -- and understands that dead addicts can't recover."

Szalavitz wasn't the only alarmed harm reductionist. Psychologist Andrew Tatarsky authored an open letter signed by more than 450 substance use and mental health treatment professionals warning that both SAMSHA and the drug czar's office need leadership that "supports evidence-based policies and that will make decisions based on science, not politics or ideology" and "we have reason to believe that Congressman Ramstad is not that person." In addition to Ramstad's opposition to harm reduction measures, Tatarsky noted that throughout his congressional tenure, Ramstad had failed to take any action on sentencing reform.

Click here to continue reading article at Stop The Drug

Saturday, January 17, 2009

A Randomized Controlled Trial of Goal Choice Interventions for Alcohol Use Disorders Among Men Who Have Sex With Men

This is an article by Jon Morgenstern, a leading scientist/clinician who demonstrates the non-ideological, evidence-based perspective that should guide SAMHSA. People like him could provide the leadership for this organization that we need.

Journal of Consulting and Clinical Psychology
Copyright 2007 by the American Psychological Association
2007, Vol. 75, No. 1

A Randomized Controlled Trial of Goal Choice Interventions for Alcohol Use Disorders Among Men Who Have Sex With Men

Jon Morgenstern
Columbia University

Thomas W. Irwin and Milton L. Wainberg
New York State Psychiatric Institute

Jeffrey T. Parsons
Hunter College and the Graduate Center of the City University of New York

Frederick Muench
Columbia University

Donald A. Bux Jr.
New York State Psychiatric Institute

Christopher W. Kahler
Brown University

Susan Marcus and Jay Schulz-Heik
Mount Sinai School of Medicine

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N - 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n - 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI CBT). Other participants (n - 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.

Keywords: cognitive– behavior therapy, motivation enhancement therapy, alcohol abuse, alcohol dependence, men who have sex with men

Substantial advances have been made in the last 20 years in the development of behavioral interventions to treat alcohol use disorders (AUD). We now have a number of modestly effective interventions, including proven treatments for abstinence as well as moderated drinking goals (Miller & Wilbourne, 2002). Among the important challenges facing treatment research today is finding strategies to improve the potency of existing interventions as well as to extend research to broader, more representative populations, such as those with co-occurring disorders, who might have been excluded from initial efficacy trials. In addition, the majority of individuals with AUD do not seek treatment (National Institute on Alcohol Abuse and Alcoholism, 2000). Thus, it is important to extend well-developed treatment research methodologies to test strategies to engage and treat individuals with AUD who do not typically seek treatment. As described below, the current study addresses these issues in the context of developing and testing a behavioral intervention for men who have sex with men (MSM) with AUD and at high risk for HIV transmission, who were in early phases of readiness to change drinking behavior.

Extending Research on Brief, Moderated Drinking Goal Interventions
Experts have argued that the current specialty care substance use disorder treatment system impedes access to care because it requires a precommitment to abstinence and seeks to place patients in intensive treatments (e.g., Humphreys & Tucker, 2002). More people would seek care if treatments were briefer and allowed for the selection of drinking goals. Although evidence strongly supports the efficacy of brief, moderated goal interventions (Moyer, Finney, Swearingen, & Vergun, 2002), there are some important limitations. Moderated goal intervention studies typically select a limited spectrum of individuals with AUD, often referred to as problem drinkers. These individuals may have mild to moderate alcohol dependence but are relatively socially stable and do not have co-occurring drug use disorders or other significant psychological or social problems. An examination of the efficacy of brief, moderated goal interventions in more problem-prone populations, similar to the vast majority of those currently seeking treatment, is needed. Second, although brief, moderated goal interventions are effective, many individuals continue to drink at hazardous rates following treatment. Thus, it is important to consider whether the potency of these interventions could be improved.

Click here to view the entire article as a PDF

Thursday, January 15, 2009

The Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of the Substance Abuse and

The following is a policy statement prepared by a colleague that discusses the rationale for having leadership at SAMHSA (Substance Abuse and Mental Health Services Administration) that is guided by science rather than ideology and politics as the agency has been for some time. It discusses the problems that have resulted from political leadership over the past and why we need a scientist who knows addiction and is committed to supporting evidence-based treatment for substance use and mental health problems and ongoing research to inform improved treatment efficacy of these very common human problems that effect us all.

I welcome comments, support and dialogue on this policy statement.

Andrew Tatarsky, PhD

The Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA)

Virtually every family in America is affected by mental illness or addiction. The cost in personal suffering and economic loss is staggering. Part of the tragedy of mental illness and addiction is that these diseases typically strike in late adolescence and early adulthood, between 18-25 years of age. By contrast, most major medical illnesses occur much later in life. The World Health Organization found that mental illness and addiction were the leading causes of disability among Americans ages 18-45, confirming that these diseases rob young Americans of their most productive years.

The last two decades have witnessed dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, unlike standard protocols for advances in other areas of medicine, these treatments are not reaching the vast majority of the public who need them. For example, the United States spends about $120 billion annually on behavioral health care[1]. Yet, less than 25% of this care is evidence-based, with 75% of questionable value. The result of the mediocre quality of behavioral health care is that many Americans are suffering needlessly and some are dying because they are not receiving treatment has been shown to work.

What can be done to solve this problem? Most advocacy groups call for increased spending. While lack of resources is part of the problem, increasing funding alone will not solve the problem. Currently, Americans are not receiving adequate value for the $120 billion that are spent annually and much more could be accomplished using existing resources. This is the main conclusion of a landmark report on the state of behavioral healthcare issued by the Institute of Medicine of the National Academy of Science in 2006.

The federal government’s response to this situation has been woefully inadequate. The federal agency responsible for overseeing the quality of behavioral health care and prevention is the Substance Abuse and Mental Health Services Administration (SAMSHA). SAMSHA has a $3.3 billion budget. An OMB review of this agency rated the agency’s programs as largely ineffective; an assessment shared by most mental health and addiction experts. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.

One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to the lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. By contrast, the recent heads of FDA and CDC have been nationally prominent scientists with accompanying expertise and stature to effectively lead their agencies.

President elect Obama has a unique opportunity to improve the treatment and prevention of mental illness and addiction by breaking with the past tradition of placing a political appointee with regulatory and administrative experience as the Administrator of SAMSHA. Instead, the Obama transition team should seek a professional with a national reputation of excellence as a scientist and innovator in implementing science-based mental health and addiction programs and public health models in communities. This move would be consistent with President elect Obama’s approach to attract the highest caliber professionals into government, has the potential to improve the lives of many Americans, and would elicit uniform praise from advocates, the scientific community, and the press.

[1] Behavioral health care means addiction and mental health services combined.

Saturday, January 10, 2009

Addiction pablum at the New Yorker

Posted on December 2, 2008 by Trevor Butterworth
Maia Szalavitz

Last week, an extraordinary example of the sorry state of addiction coverage and treatment in the United States appeared in the New Yorker.

The story focused on “luxury rehab” as practiced in California’s Wonderland program; unfortunately, the magazine seemed to take the program’s outdated views on addiction as representing the consensus among addiction experts about the appropriate medical treatment for this disorder.

What’s sad and bizarre is that what would pass for alternative treatment in any other area of medicine — telling people to turn their lives over to God, meet, confess and pray, as 12-step programs suggest — is seen as top-notch care in 21st century America for drug problems.

While it’s true that 90 percent of addiction programs still push this approach, decades of research have shown that portraying the 12-step model of Alcoholics Anonymous as the only way to recover from addiction is not only inaccurate, but harmful. Twelve-step programs have not been found superior to other techniques, and implying that they are can do harm by making those for whom they fail feel hopeless and avoid help.

Nonetheless, there in the New Yorker is Wonderland’s executive director, saying that most addicts will relapse “until they finally surrender to the reality of doing it through AA.” In fact—unmentioned by the magazine — studies find that many, perhaps most, addicts and alcoholics recover without AA or any formal treatment program. Though there’s no doubt that 12-step programs are useful for some, they shouldn’t be seen as the only way.

The article did note that the “attack therapy” widely practiced in addiction treatment in the 1980’s and 90’s — and still common in care for teens — has “fallen out of favor.” But it didn’t mention that this is because research found it to be both ineffective and sometimes harmful.

Further, the line taken by many of the “experts” quoted in the article — that addicts “need frustration,” that “the more you cater to an addict’s demands, the more you support their disease,” and that they need to “Get with the program or get out”— is also unsupported.

The reporter clearly buys their approach, talking about how “granting so much agency” to addicts by allowing them to have their way in treatment might be problematic. But in what other conditions do doctors get to choose whether to “grant patients agency”?

If you went for cancer care and were told that you “need frustration,” and you must obey what the doctor tells you without question or “get out,” you would probably find such high-handedness unacceptable. It would certainly be seen as poor bedside manner. For addicts, however, such paternalism is not even questioned — even though, again, the research finds that empathetic and supportive care is more effective.

The New Yorker didn’t pull its punches on Wonderland — it noted the low success rate of residential rehabs and clearly highlighted the absurdity of some of its practices. But it could have done a much greater service by talking to academic addiction experts about why even the rich and famous don’t get evidence-based care for addiction.

Friday, January 9, 2009

If Obama Is Pro-Science and Honest, He'll Put the Kibosh on the Drug War

By Alexander Zaitchik, AlterNet.
Posted December 23, 2008.

Obama was frank about his own drug use, so why isn't he more honest about what a disaster war on drugs has been?

One of the many things that made Barack Obama such a refreshing candidate was his frank and unapologetic admission of drug use. True, Anderson Cooper extracted curt "yeses" from some 2004 Democratic candidates when he asked them point-blank if they had ever smoked pot. But Obama has written openly and without prompting about his experiences, not only with marijuana, but cocaine, a "hard" drug. On the campaign trail he even joked about inhaling deeply -- "that was the point," he said more than once. Unlike George W. Bush, Obama didn't hide behind evasive murmurs about "irresponsible behavior," or turn his drug experiences into a setup for some maudlin born-again conversion story.

As recounted in his memoir, Dreams From My Father, Obama was a normal American kid. Which is to say he used drugs, had fun and survived. The book doesn't romanticize the president-elect's days of smoking pot and snorting "a little blow when [he] could afford it," but it's easy to take what details he provides and imagine him with his basketball buddies on some Oahu beach blazing bowls of Maui Wowie, alternately laughing until his guts hurt and sitting in quiet wonder before a magnificent pink-and-yellow Pacific sunset. Obama has even written about his pursuit of heroin's moon-shot high. As a teenager, he went so far as to ask a junkie friend for an assisted first hit, but recoiled when presented in a deli freezer with the surgical tools of the mainliner's trade: rubber tubing and second-hand syringe.

Partly because Obama was so reasonable and matter-of-fact about his own All-American experiences getting high, drug-policy reformers were among those most excited by his candidacy. If any aspect of America needs change, it is the country's prohibitionist and punitive approach to drugs and drug use. Obama, it seemed, was the right politician to take an executive hammer to the cracked marble pillars of America's disastrous war on drugs. Throughout the primaries and general election, Obama gently encouraged these hopes by advocating commonsense drug-policy reforms. He criticized federal paramilitary raids on state-sanctioned greenhouses and called for ending racist discrepancies in cocaine sentencing laws. (As a little-mentioned footnote to the first of these positions, Obama's mother died from cancer five years before the Hawaii legislature legalized medical marijuana.)

Nobody expected Obama to tap Tommy Chong to run the Office of National Drug Control Policy. But maybe, just maybe, Obama would have the political courage to publicly acknowledge what an emerging majority of Americans now grasps: that the war on drugs is a failure, that it is unjust, and that it is an epic waste of law-enforcement time and resources.

Still a month before inauguration, the hopes of drug-policy-reform advocates have had their wings clipped several times, beginning with the announcement of the Democratic ticket.

"The pick of Joe Biden was my first sign of digestive tumult," says Keith Stroup, founder and legal advisor of the National Organization for the Reform of Marijuana Laws (NORML). "Rather than oppose the Reagan-inspired War on Some Drugs, Biden became an enthusiastic supporter and legislative booster. He was at the center of creating the ONDCP [in 1988], mandatory minimum sentencing, civil forfeiture laws, the Rave Act, funding for DARE in public schools and the ad campaigns for the Partnership for a Drug Free America."

NORML board member Dominic Holden says: "Biden is the drug war embodied."

The selection of the emblematic Democratic drug warrior of the 1980s was followed by the selection of his 1990s counterpart, Rahm Emanuel. As President Bill Clinton's liaison with the ONDCP, the incoming chief of staff advised on and defended that administration's tough-on-crime punitive approach to drugs and its cowardly opposition to medical-marijuana initiatives and needle-exchange programs. While Clinton has since expressed regret over some of these positions, the tightly wound Emanuel has not.

Obama's pick for attorney general, meanwhile, has a mixed record on drug policy reform that will hopefully be clarified during the expected Senate dogfight over his nomination. But the record is not encouraging. As D.C. attorney general in the 1990s, Eric Holder supported mandatory sentences of 18 months to six years for selling a range of drugs that included marijuana. He is also on record supporting the "broken windows" theory of neighborhood policing most closely associated with Mayor Rudy Giuliani's NYPD and the conservative Manhattan Institute. Holder's iron-fist drug politics find a public health counterpart in the confused mind of Obama's Transition Team point man on the ONDCP, Don Vereen, who as recently as November explained his opposition to medical marijuana by saying, "[It] sends the wrong message to children."

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Thursday, January 8, 2009

Update on January 8, 2009 of the progress of: Substance Use and Mental Health Treatment Professionals

Update on January 8, 2009 of the progress of:

Substance Use and Mental Health Treatment Professionals
Letter to President Elect Obama

Regarding the Selection of Directors of the Office of National Drug Control (the Drug Czar) and the Substance Abuse and Mental Health Services Agency (SAMHSA)…

As of today over 260 mental health and substance use treatment professionals and over 160 researchers, academics and other concerned citizens have signed on to our letter expressing concern about the possible choice by President-elect Obama of Rep. Jim Ramstad to direct either the White House Office of National Drug Control Policy or the Substance Abuse and Mental Health Services Administration. The concern is based on Rep. Ramstad’s voting record over 28 years in congress that suggests his views on substance use treatment reflect ideology and politics rather than science. The letter goes on to urge President-elect Obama to choose leaders for these agencies who will put science first in formulating drug and drug treatment policy and goes on to make six specific recommendations regarding support for treatment and criminal justice issues.

The letter is historically significant in two important ways. First, it reflects the recognition by a large cross section of substance use treatment and other professionals of the need to take political action to address social policies that negatively affect substance users in this country in addition to the work we do in our offices. It is also significant that these professionals, many of whom are national leaders in their fields, are speaking up on behalf of progressive, innovative, non-abstinence only treatments that are well supported by science that shows they effectively treat addiction and save lives. Many of these treatments have not been supported by Rep. Ramstad and previous administrations.

To date the letter has been hand delivered to President-elect Obama’s transition team by a sitting congressperson. It has been posted on President-elect Obama’s transition team website, It has been mentioned in numerous blogs, most notably John Tierney’s Tiernylab at and the Huffington Post and I have been interviewed about the letter on WBAI and Air America. There are several other avenues being pursued to ensure that our views are considered in the selection of these leadership positions.

You can provide more support for this important movement by forwarding this note, the press release and the letter to any journalists and others who may be interested in knowing about what we are doing. You may also have your own creative ideas for further publicizing the letter. You can also urge colleagues who have not yet signed on to consider doing so.

You can view the letter at

I welcome any feedback, suggestions or other opinions on these very important issues.

Thank you for your support!

Sincerely, Andrew Tatarsky, PhD

Friday, January 2, 2009

Up in smoke: Will Ramstad’s faith-based earmark hurt his chances to win drug czar post?

By Andy Birkey , Minnesota Independent
December 10, 2008

During his time in Congress, retiring Republican Rep. Jim Ramstad championed the needs of those experiencing mental illness or chemical addiction, often through the lens of his own experience as a recovering alcoholic. For that reason, his name tops the list of possible appointments by the Obama administration as either drug czar or as the administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). But one earmark by Ramstad could prompt some questions from Senate Democrats during a confirmation hearing if Ramstad is nominated for either position.

Earlier this year, Ramstad sponsored a $235,000 earmark for the Minnesota Teen Challenge (MNTC), an Assemblies of God drug treatment center with a history of controversial therapies and overt religious indoctrination.

MNTC is part of a national network of drug treatment and “discipleship training” centers called Teen Challenge.

Teen Challenge programs across the country typically describe themselves in these terms:

“Being a Christian discipleship program, it endeavors to minister to the whole
person, helping them to become mentally sound, emotionally balanced, socially
adjusted, physically well, and spiritually alive through a relationship with
Jesus Christ.”

Teen Challenge’s overt Christian message is extends to outright conversion — at least according to its leaders. During a congressional hearing in May 2001, Congress members challenged the ability of Teen Challenge and other faith-based initiatives to offer government services without overt religiousness. Rep. Mark Souder (R-Ind.) asked Teen Challenge Executive Director John Castellani if the organization hired non-Christians. Castellani said no. When asked if Teen Challenge takes non-Christian clients, Castellani said they did and he then bragged that some Jews who complete Teen Challenge programs become “completed Jews.”

In Minnesota the program requires signing a statement acknowledging the program’s Christian nature:

I will participate in daily devotions, Bible reading, and prayer. I will
participate in the Teen Challenge choir which performs Christian songs at weekly
church services and special events. I will participate in lecture classes,
individualized study courses, group counseling, individual counseling, and other
program components that are based on Christian principles. I will attend church
services when scheduled. If offered the opportunity to partake in communion or
water baptism my participation is voluntary. If I object to the religious nature
of this program and its requirements, I will notify the Dean of Students and
receive a referral to another program of my choosing.

Despite those voluntary statements, a number of MNTC participants are ordered by the courts to complete the program — or else end up in jail. Just this Monday, a Minnesota judge sentenced a 27-year old Crystal man to MNTC. And dozens of others are sentenced to the faith-based treatment center each year.

Working for MNTC is also difficult for non-Christians, even if the program welcomes non-Christian applicants. The employment application contains this statement:

I understand that MN Teen Challenge is a Christian church ministry affiliated
with the Assemblies of God denomination. I understand that should my application
be accepted, I will be working in an environment that is decidedly Christian in
nature, and I hereby agree to abide by the bylaws, policies, and procedures of
Minnesota Teen Challenge. I further understand that although my religious
beliefs and practices may differ from those of Minnesota Teen Challenge, I will
respect the religious views of MnTC and its leadership. I will refrain from
promoting any beliefs or publicly demonstrating any behavior that contradicts
the teaching, philosophy, or beliefs of the MnTC program during working hours,
or while on MnTC property.

For non-Christian employees at a federally funded program, even leaving the office to privately pray in a vehicle in the parking lot could be grounds for immediate dismissal. For non-traditional families, bringing in pictures of loved ones could be grounds for dismissal. For Catholics, displaying any symbols that disagree with Pentecostalism could get an employee fired.

Know the Truth

MNTC is using its federal funds in Minnesota for a program called “Know the Truth.” The program works in middle schools, high schools and churches to encourage students to abstain from drug use and to help teens and parents talk about tough issues like drug use.

While MNTC has been attacked over the earmark, it contends it hasn’t used the money for religious purposes. The MNTC administration director offers this statement about the Know the Truth program:

Minnesota Teen Challenge is scheduled to receive a direct grant from the federal
government to be used exclusively for a non-religious drug and alcohol abuse
prevention program. This program contains no religious content whatsoever and
has been presented to over 30,000 junior and senior high school students across
the state. Minnesota Teen Challenge is aware of, and in agreement with the
constitutional restrictions placed on receipt of government funds. We take great
care to ensure that all federal money is strictly accounted for and that none of
the dollars are ever used for religious purposes.

Know the Truth is one of those gray areas that separation-of-church-and-state advocates watch carefully. While MNTC says religious purpose is scrubbed from the program, the program itself is a referral to the overtly religious drug treatment programs. The name “Know the Truth” is a common theme in evangelical Christianity owing to the New Testament verse John 8:32, “Know the truth and the truth shall make you free.”

The Know the Truth program relies on the life stories of graduates from MNTC’s drug treatment programs, and those stories invariably have overtures of religious awakening as a route to freedom from addiction.

One such Know the Truth night at a Leroy, Minn., church highlighted the stories of Gina, Shaun and Bethany as recounted in the Leroy Independent.

“The bottom came, [Gina] said, when she was in jail for the second or third time
and she was told by a person to ‘pray to God, just like you’re talking to me.’
This helped she said because she did need help desperately, and she knew God had
heard her plea when her mother called that Gina’s children were being returned
to her mother’s home, rather than being adopted out as had been the plan,” it
read. “Shaun and Bethany also shared their stories of drug addiction and with
God’s help had recovered and are now working with MN Teen Challenge.”
Is the Know the Truth program different when offered in a church instead of a high school?

Federally funded faith-based programs are controversial for the very reasons that make faith-based programs work for those who share the programs’ beliefs. The faithful cannot remain true to their faith if the government demands that faith be removed from a part of the program. The government cannot fulfill its commitment to the taxpayers if it supports a program that requires a certain faith from the staff and participants.

Ramstad’s position on faith-based recovery programs will come under further scrutiny if he secures a top job in the Obama administration.