ABR is a New DPNC Project

MAKING THINGS EASIER

ABR is a new non-profit.

Addicts should have the same claim to real health care as any other patients. Some addicts may be good candidates for a lifetime of narcotic subsistence, but most really would like to be free of these dependencies.

This is a numbers game.

We need thousands of signatures from every kind of citizen supporting this cause.

So, as of today, we have made access to our PETITION SIGN UP earlier and more visible on our https://abrnow.ca/ website.

The JOIN button appears twice very early on in the website

And each time it leads you directly to our SUPPORT LIST SIGN UP

Help us help more people begin their wonderful journey of real recovery to a full bodied life and full citizenship.

All we want from you NOW is your name and email address.

Please encourage all your friends, family and colleagues who feel as passionately as you do about this important matter to add their names and email addresses as well.

Many thanks!

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Impact: A socio-economic review of supervised consumption sites in Alberta

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BEAUTIFUL PIECE IN THE COURIER


Odd Squad out to make a difference


Toby Hinton a 23-year veteran of VPD

Vancouver CourierJune 29, 2012

Sgt. Toby Hinton, a beat cop on the Downtown Eastside and 23-year veteran of the Vancouver Police Department, has seen firsthand the devastating effects of drugs and alcohol. He works in an overwhelmingly negative environment. But with unprecedented access to tragic life stories, Hinton was determined to do something positive to educate at-risk groups of the dangers of substance abuse and other criminal behaviour. He, along with six other officers founded Odd Squad Productions, a volunteer band of police officers who produce movies to keep kids clean and off the street.

The non-profit group, which recently marked its 15th anniversary, has produced more than 15 documentaries telling real stories of the pitfalls of drug abuse, gangs and other high-risk behaviour.

Through a Blue Lens-perhaps their most notable documentary that was produced in partnership with the National Film Board-has been viewed by millions in 22 countries. Scathed & Stolen Lives and Tears for April have both received accolades at the New York Film Festival. The squad also makes presentations to schools, community centres and boardrooms. The group has also enlisted high school students to spread the word. Its On Track program takes young achievers on a one-day workshop that includes a stroll through the Downtown Eastside. Students return to their schools as ambassadors sharing lessons learned with their peers.

Why did you choose a career in policing?

I disliked authority and needed to come to terms with that. I thought the best way was to become authority and then try to find out why I hated it so much. Not sure if that worked or not, because I still don’t like authority.

How did the Odd Squad come about?

I was doing presentations with boring visuals. I asked Ret. Const. Al Arsenault if I could borrow some slides. Immediately, the presentation was a lot more interesting. Right around this time, a bunch of beat cops sat down and decided to start doing some prevention work. We wanted to get a strong message out to youth about the consequences of bad decisions, particularly around drug use/abuse. The marriage of presentation and stills/video, along with support from the department, led us to making videos. A well-done educational film can go a lot further and reach a much wider audience.

What do you hope to achieve?

We hope to prevent people from ending up in the type of grim situation we often see on the street. We want to encourage youth to reach their potential in life and not fall victim to the consequences of bad decisions around risky behaviour. Educated and informed youth are in a better position to make healthy decisions with their bodies, and that this knowledge will carry them well through life.

What do you say to kids who may want to experiment with drugs?

I would want kids to be well educated on what they are putting in their bodies, and this starts with diet, and extends to everything else. Your body is the biggest investment you have in life: look after it! The No. 1 killer out there is tobacco. Alcohol is a huge problem in society. There are some serious consequences to the drugs that are being used by youth, starting with alcohol and tobacco.

There is virtually no quality control in any of the illicit street drugs (witness the large number of youth lost in the past year to PMMA-contaminated ecstasy). I would want to have the youth delay the experimentation as late as possible in life, so that their social bonds are developed, they have started identifying their passions and interests, their brains are maturing, and they have established a healthy lifestyle. Chances are if they are 13 or 14 they could have much more significant issues with drug use and experimentation than someone who is on their way in life at age 19.

Your advice to parents?

Get engaged. Know your kids and their friends. Educate yourself about drugs and current trends with youth. Be there for your kids no matter what. Make sure that you are a good role model and leader at every waking moment. This is what you signed up for.

How did you get your subjects to open up?

Most of the drug addicts we work with don’t want anyone else to end up in their situation. For the most part, they are united in wanting to get a strong deterrent message out to youth. In a way, I think it helps them reclaim some dignity by contributing to valuable prevention work.

How do you solve the problems of the Downtown Eastside?

That question deserves a little more space for a response. There are a number of problems including crime, housing, drug addiction/dealing, poverty, mental health and prostitution. All of these are interrelated. Overall, I think there needs to be a bit more accountability into the money spent here, and we need to change our mindset from “non-judgmental” and “low-threshold” to focusing on getting people healthier (sacrilegious to say it nowadays but helping people become clean and sober) and into a structured and safe living environment. Just maintaining a pulse is not necessarily the best goal to strive for.

Are we making progress?

In some areas there has been great progress. In other areas there has been great slippage. For example, years ago 80 individuals a year (primarily First Nations) were being killed from consuming rice wine (non-potable due to sodium content). Ret. Insp. Ken Frail took this project on and forced change to the regulation banning corner stores in the Downtown Eastside from selling rice wine. We no longer have these deaths, although there is a substitute effect, nothing to the extent that we were dealing with 15 years ago.

On the other hand, a number of rooming houses are actually doing a good job. The conditions in a few have become worse. We now regularly attend to these hotels to deal with criminal issues, police complaints, and other problems. We were not doing this in the past.

yvrflee@hotmail.com
© Copyright (c) Vancouver Courier

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DR. MANGHAM DOCUMENT – Easier to Read Version

COLIN

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SWITZERLAND IS NOT ALL CHOCOLATE & CLOCKS

Below you will find the entire text of a recent report on The Four Pillar Drug Policy in Switzerland – 20 years after. What is more interesting are the comments of our colleague Calvina Fay, of Drug Free America, which precede the Swiss report.

Many thanks to Hans Koeppel for this overview of the last 20 years of drug
policy and a current update from Switzerland. Interesting how the Swiss
government declares its heroin distribution program a “success.”
The retention in the program is good because who wouldn’t want to stay in it
and get free heroin…. The employment rate improves because the government
creates jobs for the addicts. Their overall health improves because the
government provides regular healthcare for them. Their housing situation
improves because the government provides housing for them. I suggest that
all of these things could be provided without providing the heroin but
instead providing abstinence based treatment to get them drug free and they
would be MUCH better off. The fact that addicts, aged 50-60, are being sent
off to retirement homes for the elderly, due to their declining health, is
just plain sad. Their lives are being wasted on drugs, compliments of the
government. Most people (who don’t use drugs) remain healthy and active
well into their 80s these days.

Calvina

The Four Pillar Drug Policy in Switzerland – 20 years after

Hans Koeppel, M.D.
Swiss Physicians against Drugs, June 2012

In the 1980s, Switzerland had a drug policy consisting of three pillars: Prevention, Therapy, and Law Enforcement. At that time, as the number of heroin addicts increased to tens of thousands, the authorities in several cities tolerated so-called “Needle Parks”. An open drug scene was established where thousands of addicts injected heroin in public, slept in parks, dealt in all drugs, and lived in slum-like misery, most of them in poor health. Several overdosed every day. The media published hundreds of reports on this scandalous situation and, eventually, the police were forced to close the parks and send addicts back to their own region.

In order to cope with the increasing number of heroin addicts, methadone programs were expanded. More than 17,000 heroin addicts were included in those programs which previously were very strict. Concomitant heroin or cocaine use was sanctioned by exclusion. Thenceforwards addicts received unusual high dose of daily methadone. Positive urine tests of heroin and cocaine had no consequence; nobody was excluded because of breaking the rules. Injection rooms were installed. Most of them still exist and they recently celebrated their 20th anniversary. During this time period, the concept of harm reduction was created. Drug liberalizers proposed to add it to the national drug policy as a fourth pillar. In this context, drug use was seen as a lifestyle – a human right. Harm reduction meant providing substitution programs for the majority of heroin addicts, which included the distribution of methadone as well as heroin. To introduce heroin distribution, a so-called trial was established. Although it failed to help addicts stop drug use, the maintenance of 70% of the addicts on these programs was celebrated as a success. As a result, the health authorities set up these so-called heroin-assisted treatment programs in several cities.

These events were accompanied by thousands of articles in newspapers to promote drug liberalization. Each article started with the sentence: “The drug war has failed”. “Law enforcement criminalizes sick people.” Pictures of people injecting heroin, needles and syringes or joints, were part of the message to habituate the public on drug paraphernalia. The continuous media campaign had a big impact on prevention and therapy.

Prevention

As a consequence, drug use skyrocketed. The consumption of marihuana, ecstasy, heroin, and cocaine was seen as a recreational activity. The Green Party, which started a referendum to legalize marihuana, claimed drug use as a human right.

The media praised the positive effects of the high evoked by drug use, while deriding those who warned of its dangerous effects on body and mind. These people were described as hard-liners, sectarian, or extreme right, by the media

All jobs in the field of drug prevention and counseling, among health authorities and social workers, were occupied by advocates of the drug liberalization movement. They became the experts in all drug issues and other opinions were excluded. Eventually, information about the harmful effects of drug use, was no longer distributed.

The prevailing opinion among members of the younger generation was that it was only a matter of time before marihuana and other drugs were legalized. Fortunately, the voters rejected any form of legalization of marihuana in two referendums, the last in 2008.

The drug problem is no longer publicly discussed and has vanished from the political agenda. In some sense, the establishment of heroin distribution has had a positive effect on drug prevention. Heroin is no longer attractive, but is now seen as a “loser drug”, therefore, very few young people ever start using heroin.

Unfortunately, the young generation is not so worried about recreational use of cocaine, ecstasy, and marihuana. At weekend parties, all these drugs are excessively used. During these parties, drug counselors limit their intervention on organizing laboratories testing the purity of illegal substances.

Drug prevention, which means informing people to avoid drug use because of the harmful effects, no longer exists. The health authorities prefer to emphasize the dangers of eating disorders, smoking, gambling, and other addictions. Despite this situation, the perception of marihuana has changed, and more people now realize the negative consequences of drug use.

Drug use in Switzerland is an interesting and evolving situation. Unfortunately, no continuous monitoring exists, therefore casual studies, such as the following, provide insight into what is happening.

Cannabis Monitoring in 2008

The study shows the changes in Marihuana use, comparing 2004 and 2007. The diagram relates to young people between 13 and 29 years of age. The lifetime prevalence went down from 46.1% in 2004 to 43.5% in 2007 (total of former and present users of Marihuana). In 2007, 11.2% used Marihuana in the six months before questioning. In 2004, the figure was 13.3%.

Women

Men

Total

2004

%

2007

%

2004

%

2007

%

2004

%

2007

%

no use

60.3

61.9

47.7

51.3

53.9

56.5

former use

31.1

31.2

34.5

33.5

32.8

32.3

present use

8.6

6.9

17.8

15.3

13.3

11.2

Source: Arbeitsgruppe Cannabismonitoring (Annaheim B. et al.)(2008) Veränderungen im Cannabiskonsum 2004 bis 2007. Edited by Bundesamt für Gesundheit (BAG)

The rate of marihuana use remains at a high level and does not appear to be going down significantly. However, it seems to have lost a little of its attraction.

Therapy

Drug addiction must be seen as a severe chronic disease, which eventually results in premature death. The most effective solution for addicts, to avoid this outcome, is to terminate the use of the toxic substance. This way out of drug use is very difficult to achieve. Very often addicts will experience several cycles of withdrawal, rehabilitation, and relapse, before they are finally physically and mentally weaned off the drug.

This idea of abstinence-oriented treatment has been clouded by the conception of harm reduction. Drug addiction is seen as similar to diabetes; people with diabetes need insulin, and addicts need heroin. So the logical solution is to distribute heroin to those who need it. In this climate, facilities which offer abstinence-oriented treatment are rare. They have difficulties being acknowledged and financed by health authorities. Many of them have had to close because of lack of money, and their clients are being redirected to substitution treatment. Most of the rehabilitation programs offer “partial withdrawal” (cocaine or heroin withdrawal, but not methadone) and substitution of methadone.

Harm reduction

Together with injection rooms, needle and syringe exchange, the drug policy is primarily based on methadone, buprenorphine (Suboxon) and heroin distribution. The following, from the summary of the annual report “Heroin assisted treatment 2007” (HAT), edited in 2008 by the Federal Health Authorities, gives a good picture of the present situation.

Heroin assisted treatment 2007

(in alphabetical order)

Age: The mean age of the patients was 40 years, and the median was 39. The ages ranged from 19 to 70.

Centres: Heroin-assisted treatment is currently being offered in 23 institutions (including two centres in prisons) which have an interdisciplinary structure and hold special authorization from the Federal Office of Public Health.

Concomitant substance use: Especially with regard to alcohol, cocaine, cannabinoids and tobacco, it can be seen that patients who had been in treatment for a year or more consumed the relevant substance on fewer days and hence had less concomitant substance use than the newly enrolled patients.

Costs: One patient-day in a HAT centre cost on average 57 francs in 2007 with an overall benefit to the economy of 104 francs. Treating a heroin-dependent in a HAT centre therefore saves society 47 francs per day, mainly in the form of costs for criminal proceedings.

Delinquency: A study published in 2002/3 revealed that, according to statements by patients themselves, there is a dramatic short-term and long-term decrease in the delinquency rate (particularly serious theft and drug dealing – by more than -80%) and patients’ victim experience. Similar figures emerge from analyses of criminal offences recorded by the police (downward trend of -65% after one year’s treatment or longer and more than -80% after four years’ therapy) and Criminal Records entries (downward trend of more than -80% after four years’ treatment).

Discontinuations: 169 patients discontinued HAT in 2007 (not counting 7 discontinuations arising from a transfer to another HAT centre.) Discontinuation questionnaires recorded six deaths in 2007. 71% of the patients who left the programme changed to either abstinence-oriented treatment (16%) or to methadone substitution (55%).

64% of those who enrolled between January 1994 and March 1995 were available to answer questions as part of a six-year follow-up study: 111 had completed either methadone treatment or abstinence-oriented therapy since discontinuing HAT, and 16% said they had not consumed any illegal drugs in the last six months before the survey.

Dosage forms: About 2/3 of treatments were given in an injectable form, and 1/3 in an oral form.

Employment situation: With regard to the employment situation, 19.0% of the patients were active in the employment market and 20% were seeking employment when they enrolled in the treatment. By contrast, a year or more after the start of treatment, 33% of all the patients had a full-time or part-time job, 9% were seeking employment, 5 people were in training and 2 had been offered a job.

Enrolments: 130 patients newly enrolled in the HAT programme in 2007. The mean age of the enrolling patients was 38 years. 69.8% of the patients stated that they started HAT on their own initiative.

Gender: 76% of the persons treated were male, 24% female.

Heroin dependency in Switzerland: In 2002 the FOPH put the number of heroin-dependent people in Switzerland at between 18,500 and 25,500. The total number is estimated to be falling by 4% per year.

International: Studies from the Netherlands, Germany, Spain and the UK confirm the positive results from Switzerland. Other studies are ongoing in Canada and Belgium. Treatment with diacetylmorphine is thus one of the best evaluated treatments in the field of addiction, and both the scientific and clinical evidence can be regarded as proven.

Housing situation: Patients who had been in treatment for at least a year were more likely to lie in a stable housing situation (96%) and be living alone (58%) than newly enrolled patients (73% and 46% respectively).

Patient numbers: The number of patients was 1283 at the end of December and the maximum number of HAT places available 1444, which gives capacity utilization of 89%.

Physical stress: Among the people tested at enrolment, 75.5% had positive hepatitis C virus (HCV) test results, 39.7% positive hepatitis B (HBV) and 56.2% positive hepatitis A (HAV), the lowest prevalence being for HIV at 7%. Vaccination was planned for the majority of the HAV and HBV-susceptible patients.

Psychological stress: Compared with a representative survey of the general population using SCL-27, the HAT patients in Switzerland have higher average scores on all scales, which indicate a higher level of psychological stress in the HAT patients. The scores on the enrolment questionnaires in 2005-2007 are higher than those in the questionnaires to monitor progress in 2006-2007: a sign of diminishing psychological stress during the course of treatment. At enrolment another confirmed psychiatric disorders is diagnosed (apart from the addiction diagnosis) in 49% of the patients (suspected diagnoses not included because they cannot be confirmed until a later stage).

Retention rate: More than 70% of all the enrolled patients were still in HAT after one year and 60% after two years or longer. The period spent in heroin-assisted treatment which 50% of all the treated patients at least achieved (median retention rate) was three years.

Satisfaction: 91.1% of patients are generally very or largely satisfied with the treatment they have received in the HAT centres.

Staff: At the end of 2007 a total of 370 people with an average workload of 60% were employed in the 23 HAT centers operating 365 days a year.

Substitution treatments: In 2006 HAT accounted for 8% of the total of 16,388 substitution treatments carried out in Switzerland, while 87% of the substitution patients were maintained with methadone. The remaining treatments included buprenorphine, morphine and codeine.

HAT Annual Report 2007

More than 50% of addicts leave heroin distribution programs because they no longer want to attend a treatment center daily, as is required. However, if they are on a substitution program such as methadone, they are given the dosage for a whole week, rather than daily. Because the effect of heroin vanishes after 3-5 hours, most of these heroin patients receive an additional, high dosage of methadone for the night and next morning, in order to avoid withdrawal.

The average age of addicts in substitution programs goes up yearly. Some of these addicts are in heroin distribution programs for more than fifteen years. Heroin addiction has changed to an illness of old men. Most of the addicts are in a poor state of health and get support for their daily needs. In 2010, in the city of Berne, the number of addicts who moved to a home for the elderly peaked at 5%. They were no longer able to live alone and take care of themselves, though most of them were only between 50-60 years of age. The staff in these institutions administers the daily dose of heroin.

Heroin programs were conceived to support addicts until they were ready to stop consumption and live drug free. The reality is that these substitution programs are not working, as addicts are not ready or strong enough to go to drug free therapy even after years of substitution. Drug consumption has become a life style, until death. To be drug free is a long-term objective, never achieved by the majority of heroin addicts. They never get the chance to live drug free. They continue to be monitored by the health administration for life.

Drug death rate in Switzerland over the last 25 years

The decreasing number of deaths indicates that the Swiss drug policy is successful, in some sense. During the time of the Needle Parks, “Platzspitz” and “Letten”, the death rate was at a record high, but has fallen since. After the turn of the century, the number of overdose deaths, per year, has remained at approximately 200. Addicts dying of other harmful consequences of long-term drug use are not included in these statistics.

To have an idea what this high number means, it can be compared to the number of deaths that occur in road traffic accidents. In Switzerland that figure is approximately 450 per annum.

Drug death rate from 1985 – 2005:

Drogentodesfälle in der Schweiz 1985-2005, Fedpol (Federal Police statistics), BAG)

Between 2005 and 2010 the figure remained high. Astonishingly health authorities did not take measures to bring numbers down, as did the traffic control authorities.

Law enforcement

Twice, activist of the Green Party and drug liberalizing promoters collected signatures to start a referendum. In 1998 their proposal called for legalizing all drugs. The voters rejected it. Then in 2008 there was another proposal to legalize Marihuana only. Again it was rejected. Unfortunately, the voters agreed in 2009 to make heroin distribution legal. The perception was that it is an act of humanity to give addicts the “needed” medicine.

Every year the police confiscated high amounts of all different drugs. Dozens of hemp shops were closed by the police. These shops had sold hemp plants, seeds and products like pipes, hemp beer, hemp shampoo, soaps, T-shirts with hemp plants on it, cushions of dried hemp plants. Farmers are prohibited to feed their cows with hemp, because THC could pollute the milk. There is a strong hemp lobby in Switzerland planting hemp. Very often the police confiscated them.

Still the police must be very strict to stop the establishment of new drug scenes. Parents of under aged people are informed, when the police catch those smoking marihuana. Actual, there is a change of law in discussion. Instead of punishing marihuana user by a judge, they should be fined by the police. Police departments are against this, but most political parties do not oppose to it. Last week, the new law was discussed in the Swiss Parliament. The majority said yes to a fine of 100.- sfr. (at about 94 dollars).

In conclusion, after revision of all pillars of Swiss drug policy, the result is that drug use is at a high level for marihuana, ecstasy, and cocaine. Nobody is warning of the harmful effects of these substances. Public perception is that these drugs are as good as legalized, and that law enforcement, as it relates to drugs, is useless and old fashioned.

On the other side, the majority of the population is strictly against easing the rules in direction of drug liberalization. The promoters of legalization had once the intention to make Switzerland an outstanding model for legalization. They were successful to introduce so called heroin assisted treatment. Fortunately they failed in any further liberalization.

Heroin is no longer used by the young, as it is seen a loser drug, leading to sickness and death. This opinion may be the only prevention message of heroin distribution. The continued high death rate related to heroin addiction leads to the conclusion that harm reduction is not working. It is clear that a new, more effective drug policy has to be established.

Sources:

Heroin assisted treatment 2007, published 2008, BAG

Source: Arbeitsgruppe Cannabismonitoring (Annaheim B. et al.)(2008) Veränderungen im Cannabiskonsum 2004 bis 2007. Edited by Bundesamt für Gesundheit (BAG)

Drogentodesfälle in der Schweiz 1985-2005, Fedpol (Federal Police statistics), BAG)

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THE FALLACY OF THE ‘HIJACKED BRAIN

Wonderful article in this morning’s New York Times

Opinionator – A Gathering of Opinion From Around the Web
June 10, 2012, 5:00 pm
The Fallacy of the ‘Hijacked Brain’
By PEG O’CONNOR

The Stone is a forum for contemporary philosophers on issues both timely and timeless.
Tags:

Addiction, determinism, free will, Philosophy

Of all the philosophical discussions that surface in contemporary life, the question of free will — mainly, the debate over whether or not we have it — is certainly one of the most persistent.

A popular analogy clouds our understanding of addiction.

That might seem odd, as the average person rarely seems to pause to reflect on whether their choices on, say, where they live, whom they marry, or what they eat for dinner, are their own or the inevitable outcome of a deterministic universe. Still, as James Atlas pointed out last month, the spate of “can’t help yourself” books would indicate that people are in fact deeply concerned with how much of their lives they can control. Perhaps that’s because, upon further reflection, we find that our understanding of free will lurks beneath many essential aspects of our existence.

One particularly interesting variation on this question appears in scientific, academic and therapeutic discussions about addiction. Many times, the question is framed as follows: “Is addiction a disease or a choice?”

The argument runs along these lines: If addiction is a disease, then in some ways it is out of our control and forecloses choices. A disease is a medical condition that develops outside of our control; it is, then, not a matter of choice. In the absence of choice, the addicted person is essentially relieved of responsibility. The addict has been overpowered by her addiction.

The counterargument describes addictive behavior as a choice. People whose use of drugs and alcohol leads to obvious problems but who continue to use them anyway are making choices to do so. Since those choices lead to addiction, blame and responsibility clearly rest on the addict’s shoulders. It then becomes more a matter of free will.

Recent scientific studies on the biochemical responses of the brain are currently tipping the scales toward the more deterministic view — of addiction as a disease. The structure of the brain’s reward system combined with certain biochemical responses and certain environments, they appear to show, cause people to become addicted.

In such studies, and in reports of them to news media, the term “the hijacked brain” often appears, along with other language that emphasizes the addict’s lack of choice in the matter. Sometimes the pleasure-reward system has been “commandeered.” Other times it “goes rogue.” These expressions are often accompanied by the conclusion that there are “addicted brains.”

The word “hijacked” is especially evocative; people often have a visceral reaction to it. I imagine that this is precisely why this term is becoming more commonly used in connection with addiction. But it is important to be aware of the effects of such language on our understanding.
Leif Parsons

When most people think of a hijacking, they picture a person, sometimes wearing a mask and always wielding some sort of weapon, who takes control of a car, plane or train. The hijacker may not himself drive or pilot the vehicle, but the violence involved leaves no doubt who is in charge. Someone can hijack a vehicle for a variety of reasons, but mostly it boils down to needing to escape or wanting to use the vehicle itself as a weapon in a greater plan. Hijacking is a means to an end; it is always and only oriented to the goals of the hijacker. Innocent victims are ripped from their normal lives by the violent intrusion of the hijacker.

In the “hijacked” view of addiction, the brain is the innocent victim of certain substances — alcohol, cocaine, nicotine or heroin, for example — as well as certain behaviors like eating, gambling or sexual activity. The drugs or the neurochemicals produced by the behaviors overpower and redirect the brain’s normal responses, and thus take control of (hijack) it. For addicted people, that martini or cigarette is the weapon-wielding hijacker who is going to compel certain behaviors.

To do this, drugs like alcohol and cocaine and behaviors like gambling light up the brain’s pleasure circuitry, often bringing a burst of euphoria. Other studies indicate that people who are addicted have lower dopamine and serotonin levels in their brains, which means that it takes more of a particular substance or behavior for them to experience pleasure or to reach a certain threshold of pleasure. People tend to want to maximize pleasure; we tend to do things that bring more of it. We also tend to chase it when it subsides, trying hard to recreate the same level of pleasure we have experienced in the past. It is not uncommon to hear addicts talking about wanting to experience the euphoria of a first high. Often they never reach it, but keep trying. All of this lends credence to the description of the brain as hijacked.
Related More From The Stone

Read previous contributions to this series.

Analogies and comparisons can be very effective and powerful tools in explanation, especially when the objects compared are not overtly and obviously similar at first glance. A comparison can be especially compelling when one of the objects is familiar or common and is wrested from its usual context. Similarities shared between disparate cases can help to highlight features in each that might otherwise escape notice. But analogies and comparisons always start to break down at some point, often when the differences are seen to be greater than similarities. This, I submit, is the case with understanding addiction as hijacking.

A hijacker comes from outside and takes control by violent means. A hijacker takes a vehicle that is not his; hijacking is always a form of stealing and kidnapping. A hijacker always takes someone else’s vehicle; you cannot hijack your own car. That is a type of nonsense or category mistake. Ludwig Wittgenstein offered that money passed from your left hand to your right is not a gift. The practical consequences of this action are not the same as those of a gift. Writing yourself a thank-you note would be absurd.

The analogy of addiction and hijacking involves the same category mistake as the money switched from hand to hand. You can treat yourself poorly, callously or violently. In such cases, we might say the person is engaging in acts of self-abuse and self-harm. Self-abuse can involve acting in ways that you know are not in your self-interest in some larger sense or that are contrary to your desires. This, however, is not hijacking; the practical consequences are quite different.

It might be tempting to claim that in an addiction scenario, the drugs or behaviors are the hijackers. However, those drugs and behaviors need to be done by the person herself (barring cases in which someone is given drugs and may be made chemically dependent). In the usual cases, an individual is the one putting chemicals into her body or engaging in certain behaviors in the hopes of getting high. This simply pushes the question back to whether a person can hijack herself.

There is a kind of intentionality to hijacking that clearly is absent in addiction. No one plans to become an addict. One certainly may plan to drink in reckless or dangerous ways, not with the intention of becoming an addict somewhere down the road. Addiction develops over time and requires repeated and worsening use.

In a hijacking situation, it is very easy to assign blame and responsibility. The villain is easy to identify. So are the victims, people who have had the bad luck to be in the wrong place at the wrong time. Hijacked people are given no choice in the matter.

A little logic is helpful here, since the “choice or disease” question rests on a false dilemma. This fallacy posits that only two options exist. Since there are only two options, they must be mutually exclusive. If we think, however, of addiction as involving both choice and disease, our outlook is likely to become more nuanced. For instance, the progression of many medical diseases is affected by the choices that individuals make. A patient who knows he has chronic obstructive pulmonary disease and refuses to wear a respirator or at least a mask while using noxious chemicals is making a choice that exacerbates his condition. A person who knows he meets the D.S.M.-IV criteria for chemical abuse, and that abuse is often the precursor to dependency, and still continues to use drugs, is making a choice, and thus bears responsibility for it.

Linking choice and responsibility is right in many ways, so long as we acknowledge that choice can be constrained in ways other than by force or overt coercion. There is no doubt that the choices of people progressing to addiction are constrained; compulsion and impulsiveness constrain choices. Many addicts will say that they choose to take that first drink or drug and that once they start they cannot stop. A classic binge drinker is a prime example; his choices are constrained with the first drink. He both has and does not have a choice. (That moment before the first drink or drug is what the philosopher Owen Flanagan describes as a “zone of control.”) But he still bears some degree of responsibility to others and to himself.

The complexity of each person’s experience with addiction should caution us to avoid false quandaries, like the one that requires us to define addiction as either disease or choice, and to adopt more nuanced conceptions. Addicts are neither hijackers nor victims. It is time to retire this analogy.

Peg O’Connor teaches philosophy at Gustavus Adolphus College in St. Peter, Minnesota. This year she is a recipient of an A.A. Heckman Fellowship scholarship for study at the Hazelden Pittman Alcohol Archives collection.

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IMPORTANT NOTICE from the WORLD FEDERATION AGAINST DRUGS

Please click on the “Statement from the Congress” below to get the full text of a declaration made in Stockholm, Sweden on May 23d by the WORLD FEDERATION AGAINST DRUGS.

It is a clear and courageous call for renewed efforts to further the goals of Prevention and Treatment world wide.

Statement from the Congress

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LEGALIZATION ON ANOTHER FRONT

Al Arsenault has sent us this piece in the Vancouver Courier by columnist Mark Hasiuk.

It shows clearly how the legalization mentality is not limited to drugs. We have been paying tax dollars in the DTES for social service agencies to run brothels.

These folks believe they are being compassionate and sensible.

They are neither.

I work with prostitutes every week. I don’t know one – I have never met one – who wants to be safe and secure in her or his renting out of body parts by the half hour.

Every prostitute I have ever met is sick and consumed with shame and wants to leave “the life.”

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NEW SURVEY INDICATES MASSIVE SUPPORT FOR TREATMENT

The following is the summary of an Angus Reid poll done for he Salvation Army and forwarded to us by Mario Conseco of Angus Reid.

The key indicators are these:

– 82% believe we need more services to help people with addictions.

– 73% think we’d have far fewer homeless people if we had better care for people with addictions.

– 77% say treating addictions to drugs and alcohol should be a higher priority for our government.

The complete 12 page report is available here.

Canada Speaks 2012: New Report Reveals Canadians Empathetic Towards Those Suffering From Mental Illness & Addiction

Results from national opinion poll indicate public wants to see more done for those affected

TORONTO, May 1, 2012 /CNW/ – For the second consecutive year, The Salvation Army is announcing May as Dignity Month, and is releasing a report, “Canada Speaks 2012: Mental Health, Addictions and the Roots of Poverty.” The report reveals perceptions and attitudes among the Canadian public about individuals dealing with addiction or suffering from mental illness.

The survey of more than 1,000 Canadians, conducted in February by Angus Reid Public Opinion, revealed that many Canadians have been personally touched by the issue, with 80 percent reporting that they have either a friend or family member who has experienced mental illness and/or addiction. Due to this surprising number, many Canadians empathize with those that suffer from either mental illness and/or addiction and are looking to the government and social service programs to provide additional assistance to these individuals and their families.

Key findings from our report include:

Most Canadians recognize the linkage between mental health and addiction with 71 percent agreeing that “a lot of people with addictions have mental health problems.”
80 percent of survey respondents reported their belief that mental illness causes many Canadians to experience poverty.
87 percent of respondents believe that mental illness should be a higher priority for the government.
84 percent of those surveyed think that there should be more services to help people with addictions.

“In previous reports that we have released, we have seen a Canadian public that hasn’t always been sensitive to, or didn’t understand the needs of vulnerable people in our society,” said Commissioner Brian Peddle, Territorial Commander for The Salvation Army in Canada and Bermuda. “Our latest report revealed an entirely different population, one that is extremely empathetic to those struggling with mental illness and addiction and hope for a better and brighter future for them.”

The Salvation Army is highlighting the issue of mental illness and addiction this month as part of its annual May Campaign and the ongoing Dignity Project. Funds raised during the campaign will directly support those living in poverty today through social services like emergency shelter care, substance abuse counselling and employment training.

The Dignity Project is designed to inspire and educate the public about what it means to live in poverty – and what they can do to help. Through social networking and other communications outreach, The Salvation Army will engage Canadians about the reality of poverty in the 21st century.

“The findings from this year’s report are promising and reveal a population that recognizes the barriers and obstacles facing Canadians that suffer from either mental illness or addiction and how it can lead to a life of poverty,” said Commissioner Peddle. “Many people who seek the assistance of The Salvation Army are affected by one of these issues, so we are pleased that the public is eager to do more to help. The Salvation Army is working today and everyday to restore hope and dignity to all who need our help, regardless of their circumstance.”

The Salvation Army provides direct, compassionate, hands-on service to more than 1.7 million people in Canada each year, restoring hope and dignity to the most vulnerable in society. As an international Christian organization that welcomes everyone, The Salvation Army’s faith motivates its mission to serve and to treat everyone with dignity and respect.

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George Will on Legalization

The following article from the National Post was sent to us by Darcy Ulmer of our member organization Baldy Hughes Therapeutic Community.

George F. Will: Legalized drugs would solve one problem, create many more

George F. Will Apr 5, 2012 – 8:59 AM ET | Last Updated: Apr 5, 2012 8:55 AM ET

WASHINGTON — The human nervous system interacts in pleasing and addictive ways with certain molecules derived from some plants, which is why humans may have developed beer before they developed bread. Psychoactive — consciousness-altering — and addictive drugs are natural, a fact that should immunize policymakers against extravagant hopes as they cope with America’s drug problem, which is convulsing some nations to our south.

The costs — human, financial and social — of combating (most) drugs are prompting calls for decriminalization or legalization. America should, however, learn from the psychoactive drug used by a majority of American adults — alcohol.

Mark Kleiman of UCLA, a policy analyst, was recently discussing drug policy with someone who said he had no experience with illegal drugs, not even marijuana, because he is of “the gin generation.” Ah, said Kleiman, gin: “A much more dangerous drug.” Twenty percent of all American prisoners — 500,000 people — are incarcerated for dealing illegal drugs, but alcohol causes as much as half of America’s criminal violence and vehicular fatalities.

Drinking alcohol had been a widely exercised private right for millennia when America tried to prohibit it. As a public health measure, Prohibition “worked”: Alcohol-related illnesses declined dramatically. As the monetary cost of drinking tripled, deaths from cirrhosis of the liver declined by a third. This improvement was, however, paid for in the coin of rampant criminality and disrespect for law.

Prohibition resembled what is today called decriminalization: It did not make drinking illegal; it criminalized the making, importing, transporting or selling of alcohol. Drinking remained legal, so oceans of it were made, imported, transported and sold.

Another legal drug, nicotine, kills more people than do alcohol and all illegal drugs — combined. For decades, government has aggressively publicized the health risks of smoking and made it unfashionable, stigmatized, expensive and inconvenient. Yet 20 percent of every rising American generation becomes addicted to nicotine.

So, suppose cocaine or heroin were legalized and marketed as cigarettes and alcohol are. And suppose the level of addiction were to replicate the 7 percent of adults suffering from alcohol abuse or dependency. That would be a public health disaster. As the late James Q. Wilson said, nicotine shortens life, cocaine debases it.

Still, because the costs of prohibition – interdiction, mass incarceration, etc. — are staggeringly high, some people say, “Let’s just try legalization for a while.” Society is not, however, like a controlled laboratory; in society, experiments that produce disappointing or unexpected results cannot be tidily reversed.

Legalized marijuana could be produced for much less than a tenth of its current price as an illegal commodity. Legalization of cocaine and heroin would cut their prices, too; they would sell for a tiny percentage of their current prices. And using high excise taxes to maintain cocaine and heroin prices at current levels would produce widespread tax evasion — and an illegal market.

Furthermore, legalization would mean drugs of reliable quality would be conveniently available from clean stores for customers not risking the stigma of breaking the law in furtive transactions with unsavory people. So there is no reason to think today’s levels of addiction are anywhere near the levels that would be reached under legalization.

Regarding the interdicting of drug shipments, capturing “kingpin” distributors and incarcerating dealers, consider data from the book “Drugs and Drug Policy: What Everyone Needs to Know” by Kleiman, Jonathan Caulkins and Angela Hawken. Almost all heroin comes from poppies grown on 4 percent of the arable land of one country — Afghanistan. Four South American countries – Colombia, Ecuador, Peru and Bolivia — produce more than 90 percent of the world’s cocaine. But attempts to decrease production in source countries produce the “balloon effect.” Squeeze a balloon in one spot, it bulges in another. Suppress production of poppies or coca leaves here, production moves there. The $8 billion Plan Colombia was a melancholy success, reducing coca production there 65 percent, while production increased 40 percent in Peru and doubled in Bolivia.

In the 1980s, when “cocaine cowboys” made Miami lawless, the U.S. government created the South Florida Task Force to interdict cocaine shipped from Central and South America by small planes and cigarette boats. This interdiction was so successful the cartels opened new delivery routes. Tranquility in Miami was purchased at the price of mayhem in Mexico.

America spends 20 times more on drug control than all the world’s poppy and coca growers earn. A subsequent column will suggest a more economic approach to the “natural” problem of drugs.

George Will’s email address is georgewill@washpost.com.

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