Life After Cigarettes: Book Review

Why Women Smoke.

Women are different from men. Well, maybe you already knew that.  But did you know that women smoke differently than men, and quit smoking differently than men?

Dr. Joseph Califano, the U.S. Secretary of Health, Education, and Welfare under President Jimmy Carter, once said that even though he gained thirty pounds when he quit cigarettes, he did not then appreciate the importance to women of the link between smoking cessation and weight gain. As Dr. Cynthia Pomerleau, formerly the director of the Nicotine Research Laboratory at the University of Michigan and now Research Professor Emerita in the Department of Psychiatry, remarks in her new book, Life After Cigarettes: “If we’d had a woman HEW Secretary at that time, and she had stopped smoking, I’m sure a thirty-pound weight gain would have grabbed her attention!”

In her book, Dr. Pomerleau makes clear that the challenges of quitting smoking are even greater for women than they are for men. She is refreshingly frank: “Face it; There are definitely some plusses to smoking. If there weren’t, you wouldn’t have done it, and neither would anyone else.”

For women, one of the primary pluses is, and has always been, weight control.  Pomerleau offers up the image of smoking ballerinas, women performing in a business where gaining two pounds can mean the loss of a job. Models, gymnasts, and ice skaters have also looked to cigarettes for help with weight control.

When women quit smoking, here are the facts of the matter: They will begin gaining weight almost the minute they quit—as much as three pounds in the first week—and will stabilize within three to six months. The average weight gain for women, writes Pomerleau, is ten pounds, with a quarter of female quitters gaining five pounds or less, and about a quarter gaining more than 15 pounds.  And the longer women smoke, the harder it is to battle the weight gain when they eventually quit.

The problem, Pomerleau discovered when screening patients for her Nicotine Research Lab, was that 75 per cent of the women who wanted to quit smoking said that they were unwilling to gain more than five pounds while doing so. 40 per cent of the women responded that they were unwilling to gain ANY pounds in pursuit of tobacco abstinence.

In an email exchange with Addiction Inbox, Professor Pomerleau was kind enough to expand on her message.  

When I asked her about reports that the dopamine D2 receptor gene has been implicated in both weight gain and smoking, she responded:

“In a laboratory study of food reward in smokers attempting to quit, Caryn Lerman and colleagues found that carriers of the DRD2 A1 minor allele exhibited significant increases in the rewarding value of food following abstinence from smoking, and that higher levels of food reward after quitting predicted a significant increase in weight by 6-month follow-up in participants receiving placebo.  Both effects were attenuated in participants receiving bupropion, leading them to conclude that bupropion’s efficacy in attenuating abstinence-induced weight gain may be attributable, in part, to decreasing food reward.  How well these findings will hold up to further scrutiny in larger samples remains to be seen.”

On smoking and bulimia: “As I’m sure you’re aware, the question of ‘self-medication’ is a complicated one, but it seems likely that some women ‘use’ nicotine to hold the symptoms of bulimia in check; when they quit, the underlying predisposition reemerges – which helps to explain why these women may be more prone to larger weight gain than other quitting smokers.” 

On smoking as a weight management tool: “Using a variety of different measures, it’s probably safe to say that around 40% of women qualify as serious weight-control smokers.  (The proportion is much lower in men.)  By the way, though findings are mixed, these women don’t necessarily fare worse than other women when they quit, even if they do gain weight; the real challenge is bringing them to the point of even considering quitting.”

And finally, when I asked Professor Pomerleau about the role of primary care physicians in promoting smoking cessation, she noted that she was “concerned about possible attempts to downplay the amount of weight quitters can expect to gain or to overstate the ease with which it can be avoided – which can backfire and lead to relapse when the needle on the scale begins to creep up.  I personally think it’s better to be realistic about the likelihood of weight gain after quitting and to concentrate on keeping it in the 5-10 pound range (approximately one unit of BMI and less than a dress size) – something that is in fact an achievable goal for most women.”

Photo Credit: http://www.mapleplaceventures.com/

X-ed Out.

Another look at MDMA and serotonin.

A study by Canada’s Centre for Addiction and Mental Health (CAMH) has confirmed earlier findings that chronic users of ecstasy (MDMA) have abnormally low levels of serotonin transporter molecules in the cerebral cortex.

While a decade of research on the effects of ecstasy on brain serotonin has been controversial and largely inconclusive, the latest study used drug hair analysis to confirm levels of MDMA in 49 users and 50 controls. An additional division was made between chronic X users who also tested positive for methamphetamine, and those who did not. Regular usage of MDMA was defined as two tablets twice a month.

The Canadian study, funded by the U.S. National Institute on Drug Abuse (NIDA) and published in the journal Brain, suggests that the serotonin surge responsible for ecstasy’s effects results in a net depletion in regular X users. That is not a new finding--but the Canadian study goes further, suggesting that the serotonin depletion is localized in one area of the brain.

“We were surprised to discover that SERT was decreased only in the cerebral cortex and not throughout the brain,” said study leader Stephen Kish in a press release, “perhaps because serotonin nerves to the cortex are longer and more susceptible to changes.”

Low serotonin transporter (SERT) levels in the cerebral cortex were found in all X users, with or without amphetamine. Dr. Kish noted that the CAMH findings replicate what Kish referred to as “newer data” from Johns Hopkins University. In 1999, a controversial serotonin study of ecstasy users at Johns Hopkins laboratory was criticized for overestimating the level of danger posed by ecstasy-induced serotonin impairments.

Okay, the finding is becoming more robust. But what does it mean? According to co-author Isabelle Boileau, a low SERT level does “not necessarily” indicate structural brain damage. “There is no way to prove whether low SERT is explained by physical loss of the entire serotonin nerve cell, or by a loss of SERT protein within an intact nerve cell.”

For his part, Dr. Kish indicated that his concerns centered on the connection between lower serotonin measurements and MDMA tolerance levels. “Most of the ecstasy users of our study complained that the first dose is always the best, but then the effects begin to decline and higher doses are needed,” he said. “The need for higher doses, possibly caused by low SERT, could well increase the risk of harm caused by this stimulant drug.” The published study concluded that “behavioural problems in some ecstasy users during abstinence might be related to serotonin transporter changes limited to cortical regions.”

However, in addition to the confounding variable of methamphetamine (see my post, “How Pure is Ecstasy?”), it remains unclear whether the SERT alterations detected in the study are transient or permanent. Moreover, the nature of the link that “might” exist between lower SERT levels and cognitive impairment in the brains of regular ecstasy users remains a subject of dispute in the drug research community, as in this earlier post.  (And just to emphasize that drugs are complicated things, a spate of promising recent research has suggested that ecstasy might be an effective option for treating people with post-traumatic stress disorder).

The CAMH, affiliated with the University of Toronto, is Canada’s largest mental health and addiction teaching hospital.

Kish, S., Lerch, J., Furukawa, Y., Tong, J., McCluskey, T., Wilkins, D., Houle, S., Meyer, J., Mundo, E., Wilson, A., Rusjan, P., Saint-Cyr, J., Guttman, M., Collins, D., Shapiro, C., Warsh, J., & Boileau, I. (2010). Decreased cerebral cortical serotonin transporter binding in ecstasy users: a positron emission tomography/[11C]DASB and structural brain imaging study Brain DOI: 10.1093/brain/awq103

Graphics Credit: pubs/teaching/teaching4/Teaching3.html

Cannabis for Multiple Sclerosis

Nasal spray to be approved in Europe.

A cannabis-based nasal spray will receive approval later this month for marketing in the United Kingdom and Spain as a medicine for multiple sclerosis, makers of the compound announced this week.

GW Pharmaceuticals, makers of Sativex, won earlier regulatory approval for the use of Sativex in Canada in 2005. Users spray the cannabis mist under their tongues for the relief of spasticity due to M.S. It is intended primarily as an “add-on treatment for symptom improvement,” according to The Pharma Letter, in patients “who have not responded adequately to other anti-spasticity medication.”

The London Evening Standard reported that the company, which grows its marijuana in undisclosed locations in England, expects the treatment to be offered as early as June under marketing agreements with Bayer of Germany and Almirall of Spain. A Japanese pharmaceutical firm has marketing rights to Sativex in the U.S., but the drug has not garnered any significant attention or approval here.  The Evening Standard reported that marketing rights from Bayer and Almirall could add up to more than $20 million when the medicine is formally approved.

European regulatory officials stress that they still have to finalize local wording on product packaging and associated documents before final marketing approval can be granted.

GW Pharmaceuticals has been working on Sativex for more than a decade now, as a medication for  multiple sclerosis patients, as well as patients suffering from advanced cancers. Chairman Geoffrey Guy said that the company was “transitioning from a late-stage development company to a commercial pharmaceutical business with excellent growth prospects.”

Photo Credit:  http://www.medicinskmarijuana.com

Al Hubbard, the Johnny Appleseed of LSD

“The Original Capt. Trips.”

The scientists, therapists, and artists who experimented with LSD therapy in the late 1950s were not prepared for the likes of Timothy Leary, novelist Ken Kesey, poet Allen Ginsberg, and the assorted freaks, pranksters, con artists and runaways of the Woodstock Generation. Ken Kesey, in particular, delighted in stinging the Feds by insisting that it was Uncle Sam who first got him high, paying Kesey and others to take LSD, guinea pig-style, in certain government-funded research programs in Palo Alto and at Stanford University in the early 1960s.

It made a great story, and it happened to be true. However, the original chapter of the acid story began ten years earlier, when a former intelligence agent, rogue businessman, and general intellectual gadfly named Al Hubbard took his first LSD trip. Captain Alfred M. Hubbard, who has been dubbed the “Original Capt. Trips,” was part of a select cadre of World War II veterans who had been involved in creating intelligence institutions like the Office of Strategic Services and the CIA, and who had immersed themselves in cryptology and truth serums and interrogation drugs in the service of the war effort. (Thomas Pynchon caricatured some of this work in his novel, Gravity’s Rainbow.) Hubbard broke ranks with the intelligence community early on, but continued to share his clandestine stash of LSD with certain friends and acquaintances. This odd and extraordinary businessman is said to have arranged private LSD sessions in the late 1950s for scientists, captains of industry, members of the British parliament, UN representatives, prime ministers, and various artists. For a time, Al Hubbard settled in Vancouver, where he became Canada’s only legally licensed, FDA-approved importer of Sandoz LSD. In certain North American research circles, Al became a very popular man.

Hubbard is credited by various parties with being the man who put together the basics of the North American psychedelic therapy sessions and hippie acid tests to come—high doses of LSD, amplified music, strobe lights, and experiments with ESP. Along with Huxley, Hubbard came to believe that the more mystical or “transpersonal” experiences LSD sometimes afforded might hold considerable psychotherapeutic potential. With LSD provided by Hubbard, Canadians Abram Hoffer, Ross Mclean, and Humphrey Osmond pursued the idea of LSD as a treatment for alcoholism. In the U.S, research on LSD and alcoholism was undertaken by Oscar Janiger, Sanford Unger, and others on the West Coast.

Throughout this period, there were LSD clinics operating in England and Europe. European LSD therapists tended to use very low doses as an adjunct to traditional psychoanalytic techniques. But North American researchers took a different, bolder approach. When “psychedelic” therapy began to catch on in Canada and the United States, therapists typically gave patients only one or two sessions at very high doses. These early efforts were aimed at producing spontaneous breakthroughs or recoveries in alcoholics through some manner of religious epiphany or inner conversion experience. The only other quasi-medical approach of the day, the Schick Treatment Center’s brand of “aversion therapy,” was not seen to produce very compelling long-term recovery rates, and subsequently fell out of favor.

In this light, the early successes with LSD therapy, sometimes claimed to be in the 50-75 per cent range, looked noteworthy indeed. However, the design and criteria of the LSD/alcoholism studies varied so widely that it has never been possible to draw definitive conclusions about the work that was done, except to say that LSD therapy seemed to be strikingly effective for certain alcoholics. Some patients were claiming that two or three trips on LSD were worth years of conventional psychotherapy—a claim not heard again until the advent of Prozac thirty years later.

Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008, 2009.

Photo Credit: http://www.declarepeace.org.uk/

Feel Lucky, Drunk?

Sobering stats on alcohol-impaired driving.

Somewhere just before the stages veteran drinkers sometimes refer to as “bulletproof” and “invisible” comes a stage known as, “Can I drive home drunk, and avoid arrest?”

In the small town where I live, the college kids have it lucky: They can park their cars at the afterparty, and walk, or rather weave, to their respective domiciles, leaving a trail of frustrated cops parked in squad cars, waiting for fresh meat to slide drunkenly behind the wheel.  Not much point in breathalyzing pedestrians. 

Summer is approaching, and with it, new opportunities for drunk driving. Your chances of safely driving home drunk, without arrest, are 49 out of 50, according to figures from the AAA Foundation for Public Safety. Roughly 1 in 50 drunk drivers gets arrested while driving. However, considering the stiff penalties associated with DUI and DWI-type offenses, are those odds really good enough to take the risk?

Consider a few additional numbers from the Centers for Disease Control and Prevention (CDC): The annual cost of drunk-driving crashes is somewhere in the neighborhood of $51 billion. Every day, 32 people in the United States die in crashes that involve an alcohol-impaired driver.  This results in a truly appalling number: 1 in 45, or 1 death due to drunk driving every 45 minutes--all day, every day.  Almost one-third of all traffic-related deaths in the U.S. each year. That is the true cost, the daily dice throws, caused by being drunk behind the wheel.

But there is another set of equally appalling numbers, relating to that 1 in 50 figure we started with. In 2008, over 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics--less than one percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year. The CDC estimates that 2.5 million parents drive under the influence of alcohol each year. Drunk drivers involved in fatal crashes were eight times more likely to have a prior conviction for DWI than were drivers with no alcohol.

Oh yes, and here is another number you should remember: 0.08 per cent.  That is the blood-alcohol content limit in all 50 states, at this writing.  According to the CDC, fatal alcohol-related crashes have dropped by 7 per cent since the adoption of the 0.08 standard.

Photo Credit: http://letsfightalcoholism.wordpress.com/

Cocaine Treatment and the Stroop Test

Treatment dropouts do poorly on color/word match.

It’s commonly used to demonstrate behavioral inhibition, but it’s also a nifty parlor game. It is called the Stroop Test, and it plays off the fact that people are far better at reading words than they are at intentionally ignoring them. To prove it, John Ridley Stroop’s 1935 Ph.D. thesis showed how difficult it is to interfere with the automatic processing of words. In the basic Stroop test, a list of color names is presented. However, the word green might be printed in red ink, and the word red might be printed in blue ink. The task is to quickly name not the word itself, but the color of the word. As an example, for the word “green” printed in red ink, the correct verbal answer is “red.” Because of a phenomenon called directed attention, this is hilariously difficult to do. The subject must actively inhibit the automatic response—reading the word—in order to do something else.

What’s all this got to do with drug addiction?

Psychologists have known for some time that drug craving focuses attention on drug-related stimuli in the environment, and draws attention away from environmental cues unrelated to drugs. Naturally, researchers began to wonder whether the Stroop test could be brought to bear on the matter of addiction, and employed as a tool with which to predict the likelihood of relapse among the addict population. 

As researchers at the University of Wales have pointed out,  “Decisions about drinking and drug use can be highly automatic, with users being unaware of the factors that influence their decisions.” At the same time, addicts are hyper-aware of addiction-related environmental stimuli, compared to non-addicts. As a result, “the automatic processing of addiction-related stimuli might elicit conditioned responses such as withdrawal… or they might invoke automatic patterns leading to substance use.”

In a recent study of treatment dropouts among 74 cocaine-addicted subjects, published in Neuropsychopharmacology, Dr. Chris Streeter and coworkers at the Boston University School of Medicine and Harvard University provide strong evidence for the use of the Stroop Test as a diagnostic tool in addiction treatment.  Variations on the Stroop Test were better predictors of dropout than addiction severity, depression, and other clinical variables.  Dropouts took 24 per cent longer, on average, to finish the tests than cocaine addicts who stuck with treatment, the researchers reported.  “These finding suggest that the Stroop test can be used to identify cocaine-dependent subjects at risk for treatment dropout,” say the researchers, and that it can serve as another instrument with which to “identify and tailor interventions of at risk individuals in the hope of improving treatment compliance.”

Furthermore, other studies suggest that attentional bias may serve as a useful predictor of opiate relapse and smoking cessation failure as well.

Streeter, C., Terhune, D., Whitfield, T., Gruber, S., Sarid-Segal, O., Silveri, M., Tzilos, G., Afshar, M., Rouse, E., Tian, H., Renshaw, P., Ciraulo, D., & Yurgelun-Todd, D. (2007). Performance on the Stroop Predicts Treatment Compliance in Cocaine-Dependent Individuals Neuropsychopharmacology, 33 (4), 827-836 DOI: 10.1038/sj.npp.1301465

Photo Credit: http://www.edge.org

White House Releases New National Drug Strategy

The official press statement.


The White House
Office of the Press Secretary
For Immediate Release
May 11, 2010

WASHINGTON, DC – Today, President Obama released the Administration’s inaugural National Drug Control Strategy, which establishes five-year goals for reducing drug use and its consequences through a balanced policy of prevention, treatment, enforcement, and international cooperation.   The Strategy was developed by the Office of National Drug Control Policy (ONDCP) with input from a variety of Federal, State, and local partners.

“This Strategy calls for a balanced approach to confronting the complex challenge of drug use and its consequences,” said President Obama. “By boosting community-based prevention, expanding treatment, strengthening law enforcement, and working collaboratively with our global partners, we will reduce drug use and the great damage it causes in our communities.  I am confident that when we take the steps outlined in this Strategy, we will make our country stronger and our people healthier and safer.”

The 2010 Strategy highlights a collaborative and balanced approach that emphasizes community-based prevention, integration of evidence-based treatment into the mainstream health care system, innovations in the criminal justice system to break the cycle of drug use and crime, and international partnerships to disrupt transnational drug trafficking organizations.  

During a nationwide listening tour soliciting input for the development of the Strategy, National Drug Policy Director Gil Kerlikowske met with police and medical professionals, drug treatment providers and people in recovery, elected officials, corrections officials, academics, parents groups, faith leaders, and others.  Throughout the consultation process, significant themes emerged which connect the drug issue to major Administration policy priorities, including the economy, health care reform, youth development, public safety, military and veterans’ issues, and foreign relations.

“In following President Obama’s charge to seek a broad range of input in the Strategy, I gained a renewed appreciation of how deeply concerned Americans are about drug use,” said Director Kerlikowske. “It touches virtually all of us, whether we know a family member, a friend, or a colleague who suffers from addiction or is in recovery, a police officer working to protect the community, or a parent striving to keep a child drug free,” said Director Kerlikowske.

The 2010 Strategy establishes five-year goals to reduce drug use and its consequences, including:

• Reduce the rate of youth drug use by 15 percent;
• Decrease drug use among young adults by 10 percent;
• Reduce the number of chronic drug users by 15 percent;
• Reduce the incidence of drug-induced deaths by 15 percent; and
• Reduce the prevalence of drugged driving by 10 percent.

In addition, the Strategy outlines three significant drug challenges on which the Administration will specifically focus this year: prescription drug abuse, drugged driving, and preventing drug use.  Prescription drug abuse is the Nation’s fastest growing drug problem, driving significant increases of drug overdoses in recent years.   Drugged driving poses threats to public safety, as evidenced by a recent roadside survey which found that one in six drivers on weekend nights tested positive for the presence of drugs.  Preventing drug use before it starts is the best way to keep America’s youth drug-free.  In addressing each of these issues, the Strategy outlines a research-driven, evidence-based, and collaborative approach.

New Strategy elements also include a focus on making recovery possible for every American addicted to drugs through an expansion of community addiction centers and the development of new medications and evidence-based treatments for addiction.  Continued support for law enforcement, the criminal justice system, disrupting domestic drug traffic and production, working with partners to reduce global drug trade, and innovative community-based programs, such as drug courts, play a critical role in reducing American drug use and its effects.

For more information about the 2010 National Drug Control Strategy visit www.whitehousedrugpolicy.gov.

Photo Credit: http://www.whitehouse.gov

What Would a Genuine Drug War Look Like?

An essay on biomedicine and the body politic.

Millions of addicts in America want effective treatment, and cannot get it. Funds for research and treatment are still scarce, compared to money for interdiction and law enforcement. What would happen if we took the billions spent on interdiction and let it flow into addiction research and treatment? What would happen if we gave people truthful, accurate information about drugs, and trusted them to make intelligent decisions more often than stupid ones? Can it end up any worse that the present state of affairs?

Susan Sontag’s warnings about the danger of disease as metaphor still ring true. In modern American society, heart disease, cancer, AIDS, alcoholism, and cigarette addiction account for millions of deaths. They are all disease entities with strong psychological and behavioral components—complicated, multicellular, multi-organ disorders. But they have all been associated, at one time or another, with negative personality traits and moral flaws. The less we know about the mechanics of a human disorder, the more likely we are to view its external symptoms as signs of laziness, or neuralgia of the spirit, or as a form of damage caused by specific kinds of thoughts and emotions. Without a doubt, all kinds of flaws are sometimes expressed in the behavior of people who have these disorders. Yet none of these flaws can be considered the root cause of the diseases.

The genuine drug war is being fought in the arena of biomedicine. Addiction is being added to the roster of physical disorders once thought to be symptoms of insanity, but which are now seen to be physiological disease entities with mental components. The real crisis is the indisputable fact that there exists today an appalling shortage of funds for biomedical research. The cause of the dilemma is a fundamental misunderstanding among politicians and the public about how diseases can be understood and conquered. Research into the viral mechanisms of the common cold may ultimately yield more insights into AIDS then all of the directed research now underway. In biomedicine, there is no guarantee that goals can be reached through the front door, by a systematic assault akin to an engineering project. We cannot, for example, hope to cure addiction, or even the common cold, by means of the same methods we used to put a man on the moon.

There are, however, certain things we can do immediately, if we are serious about drug abuse. To begin with, we can attend to the staggering number of drug-related deaths, injuries, and hospitalizations caused by the abuse of prescription medications. The government itself has proven the case for this contention in numerous reports issued by the National Institute on Drug Abuse and other official bodies. According to the U.S. Department of Health and Human Services, older Americans account for more than half of all deaths from drug reactions, leading one to suspect that the majority of drug fatalities in this country stem from accidentally fatal overdoses by heavily medicated senior citizens. Our national fixation on illegal drugs has blinded us to the verifiable facts about prescription drug abuse.

We also need to recognize the problem of underprescribing morphine and other addictive painkillers for children and adults in hospital settings. One of the great scandals to come out of the drug war is the growing understanding that potent painkillers are not being offered in sufficient amounts to patients suffering intractable and agonizing pain.

“There’s a certain amount of hysteria about narcotics among doctors,” maintains one researcher.

At least half of all cancer patients seen in routine practice report inadequate pain relief, according to the American College of Physicians. For cancer patients in pain, adequate relief is quite literally a flip of the coin.

A September 10 New York Times report highlights studies by the World Health Organization which amply document the ongoing scandal in pain management. At least 6 million cancer and AIDS patients currently receive no appropriate pain treatment of any kind. In addition, WHO estimates that four out of five patients dying of cancer are also suffering severe pain. The numbers of untreated patients suffering intractable, unrelieved pain from nerve damage, burns, gunshots, sickle cell anemia, and a host of other medical conditions can only be guessed at. Typically, non-addicted patients take morphine therapeutically for pain at doses in the 5 to 10 mg. range. But experienced morphine addicts regularly take several hundred milligrams a day—a huge difference. In many cases, pain relief is the one thing doctors can offer their patients, and the one thing they withhold

These outcomes, rather than flashy cocaine seizures at the border, represent the lasting fruits of the drug war.

Photo Credit: www.foreignpolicyjournal.com

Origins of the Disease Model of Addiction

Roger Williams and “deranged cellular metabolism.”

                                                  (with Linus Pauling, 1974-------------->)

The idea of addiction as a disease first began to gain a tentative foothold in scientific and government circles in the early 1960s, after the publication of E.M. Jellinek’s The Disease Concept of Alcoholism. Jellinek may not have invented the “alcohol science movement,” as he called it, and he may not have been much of a scientist himself (the evidence suggests that he faked his doctorate), but he was the first to describe the “disease syndrome” of alcoholism—chronic relapse leading to death by liver failure. A salesman by nature, Jellinek ardently presented the disease model of alcoholism to the world of the social sciences just as zealously as he had previously done banana research in Honduras for United Fruit, and biostatistics work for Worcester State Hospital in Massachusetts. The trouble was that the “science” part of alcohol science was murky at best. No real progress was made in loosening the grip that traditional psychology exerted upon the prevailing public view of addiction.

A few years earlier, in 1959, a colorfully maverick dissenter named Roger J. Williams, professor of chemistry at the University of Texas, had proposed a specific disease model of his own; one that went all but unnoticed at the time. The late Roger Williams was best known as the biochemist who discovered vitamin B-5, commonly known as pantothenic acid, one of the so-called “anti-stress” vitamins. This discovery produced a nice revenue stream for Williams’ home university through the patents he took out on various processes for synthesizing B-5.

 One of the problems with traditional theories of alcoholism, Williams believed, was that it was very difficult to identify the specific psychosocial pathologies psychiatrists insisted were behind alcoholism—such things as infantile regression and oral fixation. Those few researchers who did pay attention to alcoholism, he asserted, “have been so diverted by the rather vague and ill-defined personality disorders that alcoholics allegedly have that they have failed to concentrate upon the one thing that all alcoholics have—whether they are rich or poor... introverts or extroverts, dominant or submissive, repulsive or charming—namely, an excessive appetite for alcohol.”  The idea of appetite was, for Williams, the essential semantic shift. As Williams insisted in his book, Alcoholism: The Nutritional Approach:

“Alcohol is a physiological agent and the urge which the initial drink produces, in my opinion, arises because of deranged cellular metabolism. Except for the fact that derangement is involved, the urge is fundamentally similar to the urge we have for water when our tissues become dehydrated, for salt when our tissues become salt-hungry... or the unfortunate craving some diabetics have for sugar....”

Dr. Williams was saying that after a certain point, the burning urge for alcohol, or the insatiable craving for heroin became, for “addiction-prone” people, indistinguishable from the primal drives of food, thirst, or sex. “This is something that it is impossible to understand unless we take into account the tremendous biochemical individuality that exists.” If alcohol and addictive drugs didn’t effect you that way, well then, they just didn’t, and you thanked your lucky stars for it, the way you would be thankful for not having allergies or diabetes. Blood composition, enzyme levels, endocrine activities, excretion patterns, and nutritional needs all vary from person to person, argued Williams, and the effect of any given addictive drug was going to vary widely from person to person. This neglect of biochemical individuality, Williams was convinced, was the reason physicians had no medical treatment to offer. They had the wrong paradigm—they were focusing on the drugs themselves, and not on the bodies and brains of the users.

There were, Williams insisted, periodic references in the literature to what he called the “X” factor—some particular defect, or excess, or absence, that was present in alcoholics, but absent in moderate drinkers and abstainers. The hunt for the X Factor, for Substance H, was fast becoming the Holy Grail of addiction research.

Williams thought the X factor was genetic.

Photo Credit: http://bioinst.cm.utexas.edu

Five Science Blogs You Should Know About

(If you don’t already).

Mind Hacks

“Neuroscience and psychology tricks to find out what's going on inside your brain.”

Mind Hacks was originally a book by Tom Stafford and Matt Webb, subtitled “Tips and Tools for Using Your Brain.” Mind Hacks the blog has top-notch coverage of everything you can think of having to do with the brain. On Fridays, Vaughan Bell writes a weekly post, “Spike Activity,” which summarizes and links to the worldwide blogodome’s best posts about mind, brain, and culture from the preceding week.  Truly one of my first stops when it’s time to surf. Refreshingly, the site does not take ads or sponsored links.

Brain Blogger

“Topics from Multidimensional Biopsychosocial Perspectives.”

Dr. Shaheen Lakhan, editor of Brain Blogger and executive director of the Global Neuroscience Initiative Foundation, writes: “When we started blogging a few years ago, there were excellent science and medicine blogs, but none that truly captured the multidimensional aspects of health from biological, psychological, sociological, technological, and economical perspectives.” Topics covered include mental health stigmatization, living with a brain disorder, deep brain stimulation for depression, and addiction issues. Disclosure: I occasionally write articles for Brain Blogger.

Research Blogging

“ResearchBlogging.org is a system for identifying the best, most thoughtful blog posts about peer-reviewed research.”

According to information posted on the site, “Since many blogs combine serious posts with more personal or frivolous posts, our site offers a way to find only the most carefully-crafted posts about cutting-edge research, often written by experts in their respective fields.” Posts that meet the blog’s guidelines are displayed in easy-to-follow lists, and there are also weekly roundups.  Bloggers are able to mark their submitted posts with a Research Blogging icon for easy visibility on their own site. More or less exactly what you want out of a science blog aggregator.

The Corpus Callosum

Psychiatry, biology, medicine and mental health posts from an anonymous psychiatrist working “at a small community hospital somewhere in the USA.”

At The Corpus Callosum, editor Joseph puts up detailed, scrupulously accurate posts about everything from predicting antidepressant-related suicidality to post-traumatic stress disorder, and does so in a calm, measured tone of authority.  Another favorite of mine.

The Frontal Cortex

 “Jonah Lehrer is a contributing editor at Wired. He's also written for The New Yorker, Seed, Nature, and the New York Times and is a contributor to Radiolab.”

The hyperkinetic Jonah Lehrer is also the author of Proust Was A Neuroscientist and How We Decide. The former Rhodes scholar recently published a thought-provoking look at depression in the New York Times Magazine. On his blog, he’s likely to post about anything that catches his eye, and he’s got a good eye.

Photo Credit: http://www.aschoonerofscience.com