A Nation Descends into Violence

By Mathieu von Rohr

The Mexican government has been using the army to fight the nation’s drug cartels for about four years. It isn’t working. Some critics say the army is part of the problem, even if the occasional mission removes a kingpin. But President Felipe Calderón has no one else to trust.
Ivana García didn’t flee when two headless bodies were found in front of the city hall, nor did she leave when a body without arms or legs was hanging above a downtown square. But when fighting erupted on the street in front of her house, when mercenaries working for the drug cartels began firing their Kalashnikovs from armored vehicles, and when house-to-house skirmishes went on for hours, as if Ciudad Mier were a town in Afghanistan, not bordering the United States, she had no choice but to flee. In fact, almost the entire population, about 6,000 people, left Ciudad Mier. When they realized there was no one to protect them — no government, no army — they packed their belongings and left their homes.
Ciudad Mier used to be an inconspicuous Mexican municipality on the Rio Grande River, consisting of a colonial center and a few rectangular blocks of houses. Now it is known throughout the country as a ghost town — one of those symbolic places that exist all over Mexico. Each of these towns can tell the story of a nation descending into violence.
Horrific, but Commonplace
One of them is Ciudad Juárez, where more than 3,000 murders were committed this year alone, making it the most violent city in the world. Criminals battle each other in broad daylight in the resort town of Acapulco. In the village of Praxedis, a 20-year-old woman became police chief because no one else dared to accept the job. On a ranch in northern Mexico, a 77-year-old man shot and killed four of the gunmen who had been sent to kill him, only to be murdered by the rest. He was celebrated as a hero. Horrific news reports have become commonplace in Mexico. Some 29,000 people have died in drug wars within the past four years, and this year the number of killings doubled to about 12,000. An astonishing 98 percent of the crimes committed in Mexico remain unpunished.
It has been four years since President Felipe Calderón came to office promising to defeat the cartels, multibillion-dollar organizations that supply the United States, the world’s largest drug market, with cocaine, crystal meth, heroin and marijuana. Calderón mobilized 45,000 soldiers and federal police officers for his campaign. There was no one else he could trust, including local police forces and governors. The army is his only reliable tool.
There have certainly been many spectacular arrests. Famous drug kingpins were arrested or killed, including the leader of the “La Familia” cartel, who died earlier this month. But have these successes weakened the drug cartels? There are few indications that this is the case.
At first, many citizens saw the violent excesses as the beginning of a necessary evil. Recent opinion polls, however, show that a majority now opposes the government’s strategy. The newspapers are filled with reports of kidnappings, blackmail and beheadings. There are blogs that specialize in publishing photos of severed limbs taken with mobile phones.
It is easy to picture the savagery with which this war is being waged. But it is more difficult to understand why the violence doesn’t stop, what its causes are and what can be done about it. Could the legalization of drugs be the answer, as some experts suggest? Or maybe more border controls? Would a new national police force and a reform of the government solve the problem? Or is it best to simply leave the cartels alone, which for years was the government’s policy?
These are the questions that Mexico is asking itself in 2010, the 200th anniversary of the beginning of its war of independence. The filmmaker Luis Estrada has given his native country a bitter film for its anniversary: “El Infierno” (Hell). It is the portrait of a world consisting of nothing but narcos, whores and corruption. “We have a national problem, and it’s called impunity,” says Estrada, a soft-spoken man with glasses and a gray beard. “People who break the law aren’t punished. That’s why many believe that honesty doesn’t pay. We Mexicans are in hell, that’s for sure. I just don’t know which pit of hell it is at the moment.”

A Ghost-Town Census

It is a hot day in late November, and Ivana García has screwed up the courage to return to Ciudad Mier for the first time since she left. She walks through the abandoned streets of the town that was once hers, a 34-year-old woman in jeans, wearing gold-plated earrings and carrying a plastic purse. The army has hired her to count the number of people still living in the town, but there are few left to count. They offered her 700 pesos, or €42 ($55) a week. She was afraid to take the job, but she needed the money to pay the exorbitant rent for her apartment in Ciudad Alemán, the next town, where she now lives.
García and two other young women walk from house to house, knocking on doors that no one opens. The few people they encounter couldn’t afford to leave or are very old. The questionnaires the women have brought along in clear plastic binders include questions about income and the remaining residents’ opinions about safety. They represent the government’s clumsy attempt to demonstrate that it still exists. Two dozen soldiers follow the women, on foot and in pickup trucks armed with machine guns, securing the streets. Most of the houses they pass are riddled with bullet holes. Starving dogs slink across the dirt roads.
Some 400 people still live in a refugee camp in the next town. They have been there for more than four weeks, and most do not want to return to Ciudad Mier. They say that when the army withdraws, in a few weeks or months, the whole thing will start again.

‘Some States Remind Me of Afghanistan’

Ciudad Mier is in the northwestern panhandle of the state of Tamaulipas, a narrow strip of land bordering Texas. It is one of the areas some experts compare to failed states. One expert, Edgardo Buscaglia, who specializes in drug-related organized crime, is currently working in Kandahar, Afghanistan. In a telephone interview, he said he had stopped using the expression “Colombianization” to describe what’s happening in Mexico. “There are now areas in some states that remind me of what I see here in Afghanistan,” he said. Narcos, or drug dealers, control about 12 percent of Mexican territory, according to some estimates.
There are no longer any police officers or mayors in large sections of Tamaulipas and the northern part of Nuevo León, two states in northeastern Mexico. They were either killed or have fled, and now the narcos operate checkpoints on the streets.
The two drug cartels that are at war in Tamaulipas were allies until a year ago: The Gulf cartel and its paramilitary arm, the Zetas. Here, the term drug war isn’t just a metaphor for a series of gang murders, as it is in Ciudad Juárez. Instead, it describes a level of almost military violence between cartels, which send armies of adolescent “sicarios,” or killers, into battle, often better equipped than soldiers in the Mexican army.
A Code of Silence
The mayor of Ciudad Mier, a perfumed man who wears his shirt open at the chest, is standing in the town hall. He says he cannot give an interview, or else — and he runs his finger across the neck of this reporter to demonstrate what could happen to him if he did. The citizens of his town want to talk, but they also want to remain anonymous. There has always been drug smuggling here, they say, and the Zetas have always been in power. In a town where there was hardly any work for young men, the drug lords were able to entice recruits with the promise of fast money, cocaine and the prettiest girls.
Their villas, built in the ornamental narco style, with gilded railings and decorative columns, are still standing. The owners fled when the Zetas broke with the Gulf Cartel, and today they live in the United States or in Mexico City. There was a victory parade of sorts when the Gulf Cartel captured the town on Feb. 22. A motorcade of 60 SUVs and pickup trucks carrying heavily armed fighters drove into the streets of Ciudad Mier.
They killed five police officers that had worked for the Zetas, beheaded a police chief and a female drug dealer, and laid out the remains on the village square. After that, say local residents, the new gangs were friendly. Unlike the Zetas, they said hello to people on the street. But the fighting wasn’t over yet. In mid-October, Ivana García found a dead Zeta fighter on the street. She had never seen the man. He must have been a mercenary from somewhere else, she thought, a young man wearing brown trousers and with a muscular torso. He was lying in a pool of blood.
On Nov. 2, the Zetas returned, driving 40 heavily armored SUVs with gun barrels poking out of their sides. The ensuing battle wore on for days and nights, killing many, and leading to the departure of residents and the arrival of the army.
The soldiers stalking along behind García as she walks through Ciudad Mier hold their rifles at the ready, as if someone could shoot at them at any moment. They storm suspicious-looking houses. The hooded commander says that he doesn’t know whether all of the bandits were driven out. The government of Tamaulipas claims the town is now safe and has called upon the local population to return to their homes. By the end of her first day of work, García has counted six inhabited houses.

‘Narco Saints,’ Money and Girls

Almost no other business in the world is as lucrative as the drug trade. The United Nations estimates that $72 billion (€55 billion) worth of drugs are sold each year. Cocaine is the most profitable of all drugs. Cocaine paste costs $800 a kilo (2.2 pounds) in Colombia, and in Chicago a buyer pays $100 a gram. The price goes up by 12,400 percent along the way. Mexican cartels smuggle an estimated 192 tons to the United States each year.
There are seven drug cartels in Mexico. While alliances often change, almost all the groups have their origins in Sinaloa, a state on Mexico’s west coast known as the birthplace of the narcos. The area is home to Joaquín Guzmán, also called El Chapo, the leader of the Sinaloa cartel. He’s the world’s most glamorous drug lord, as evidenced by the fact that Forbes includes him on its list of the wealthiest people in the world. (No one, however, has access to his bank statements. Culiacán, the capital of Sinaloa, is the Rotterdam of the cocaine trade, the place where prices are set. It lies between the Pacific Ocean and the green hills of the Sierra, where farmers grow marijuana and opium poppies. It is a friendly-looking city of 600,000 with whitewashed homes, though Culiacán has the second-highest murder rate in the country.
For the past two years, El Chapo has been battling his former allies, the Beltrán Leyva brothers. It is a war of kings, and when author Elmer Mendoza tells the story, it sounds like a Greek tragedy. Mendoza, 61, is a bearded, soft-spoken man born in Culiacán, where his crime novels are set. He portrays this world so realistically that some accuse him of being a narco author.
“I’ve been hearing their legends since I was a child,” he says. “These people had bigger houses and the most beautiful girls, and sometimes songs were even written in their honor.” There is a folk hero in Sinaloa, Jesús Malverde, who is known as the “narco saint,” a Robin Hood who took from the rich and gave to the poor. Many believe that El Chapo is his revenant, a hero of the people. Mendoza says that what is happening to his country is terrible. “But as an author, I admire people who do extraordinary things. Isn’t there something epic about bringing a shipment of cocaine from Medellín to Los Angeles?”

Culiacán, Ground Zero

The gang war that originated in Culiacán and eventually engulfed half the country began on Jan. 21, 2008, when the army arrested the drug lord Alfredo Beltrán Leyva, known as El Mochomo, in a simple house in the Tierra Blanca neighborhood. Did El Chapo tip off the army? Convinced that he did, the Beltrán Leyva brothers brought Zeta mercenaries into the city and began killing everyone who worked for him, including police officers, judges, politicians and journalists.
These people had believed that El Chapo would protect them, but then the Zetas shot and killed one of his sons in a shopping center parking lot. “People began to doubt their hero. They were afraid,” says Mendoza. “Isn’t that beautiful, from a purely literary point of view?” The author stands in the cemetery of Culiacán, the narcos’ final resting place. The graveyard is a city of marble and domed mausoleums known as Jardines del Humaya. It’s the size of several football fields, and it continues to grow.
They’re all buried here, side-by-side — the drug lords and their rivals, their children and the 18-year-old killers who, at the end of their brief lives, were at least able to afford some measure of splendor. The larger than life-sized portraits of young men with hard features hang in giant, 10-meter-tall mausoleums, next to pictures of their girlfriends and their weapons.
Nowhere in Culiacán is the power of the drug cartels as palpable as it is here. This is their temple city, and anyone who desecrates their graves can expect to receive death threats from the scouts and guards before long.
The Absent Government
Why isn’t El Chapo, the most powerful of all drug lords, in prison? He’s been living in a secret location for years. Is the government incompetent, or is it protecting a cartel? Many credible people believe the government has an agreement with the drug lord. Some believe that it is trying to solve the violence problem by handing over the drug trade to one cartel. In a recently published book, investigative journalists Anabel Hernández claims that former President Vicente Fox allowed El Chapo to escape from a maximum security prison in 2001 in return for a payment of $20 million. According to Hernandez, the Calderón government knows his whereabouts, but instead of arresting him it is eliminating his enemies.
There are many rumors and conspiracy theories in Mexico. What is perhaps most remarkable about them is what people believe their government to be capable of. They have little faith in federal institutions, which are weak. Mexico has been a real democracy only for the last 10 years, after being controlled for 70 years by a single party, the Institutional Revolutionary Party (PRI). The PRI protected organized crime, but also held it in check.
President Calderón declared war on the cartels, but he lacked the necessary tools. The police are corrupt at almost every level, and in some communities they’re identical with the ruling cartel, which helps to explain why so many municipal officers are murdered. The justice system is also viewed as corrupt. There are no independent prosecutors, and charges are never brought in many cases, because they are handled poorly or because defendants buy their way out.
The army is the only institution that Calderón can trust, although the story of Ciudad Mier reveals how ineffective it is. Soldiers can occupy a territory, but they cannot investigate or penetrate the structures of a cartel. According to security consultant Alberto Islas, a cartel is like a logistics company with a military arm. Instead of scrutinizing the structures, the government becomes embroiled in skirmishes with 18-year-old foot soldiers.

A ‘Decapitation Strategy’

The government has hardly any functioning investigative agencies. Mexico receives key information from US government agencies like the Drug Enforcement Administration (DEA). The Americans provide the army with information on the whereabouts of drug lords, allowing the Mexican soldiers to capture or kill them. This “decapitation strategy” produces reports of successes, but no real success. The cartels quickly replace their leaders.
The massive deployment of the military also poses a threat to society. Throughout Mexico, soldiers have been accused of hundreds of cases of human rights violations and torture, even murder. Critics say the large number of military operations is responsible for the violence in the first place, because it has destroyed equilibriums and triggered turf wars across the country.
The army cannot solve Mexico’s real problems — poverty, lack of education and weak government. Most experts agree on how Mexico ought to liberate itself. The only question is whether anyone has the political power to do it.
The country is a long way from being a stable democratic society, says Luís Astorga, a social scientist in Mexico City. The biggest challenge, according to Astorga, is to create a constitutional state strong enough to resist the power and money of the cartels. This requires nonpartisan political will; but Astorga says representatives of the three major parties all have their hands in the drug business. Astorga says he does not believe the government is cooperating with a cartel. But as long as there are no independent judges, he believes, there will always be rumors and speculation.
Many yearn for simple solutions; they believe in a return to the days when the cartels were allowed to do as they pleased. Even some high-level politicians say privately that the problem is drug consumption in the United States, and that it’s time to legalize marijuana. But the cartels are involved in up to 22 other types of crimes as well, including film piracy, human trafficking and extortion.
Vanda Felbab-Brown of the Brookings Institution in Washington says that bringing in the army was unavoidable, but that what is important now is to finally develop a functioning police force. Mexico does have plans for a national police reform, but they are making slow progress Edgardo Buscaglia, the expert on drug-related crime, and his team studied 17 countries that have successfully fought organized crime. He says that all of them took the same four important steps.
• First, says Buscaglia, comes a reform of the judicial system.
• Second, laws are needed to fight corruption in politics, because 70 percent of all election campaigns in the country are partially financed with drug money.
• Third, Mexico must investigate the flow of funds from the drug trade into the economy. According to Buscaglia, 78 percent of the Mexican economy has ties to the drug cartels.
• Finally, social programs are needed for young people, as the Colombian city of Medellín has demonstrated. Such programs are meant to turn young people’s attention away from a life working for the cartels — a life that can end quickly.

Taking Back Mexico, With PowerPoint

There are many ideas, but who is there to implement them?
Javier Treviño, the lieutenant governor of Nuevo León, has a plan that consists of a large number of PowerPoint slides. He wants to eliminate violence in Monterrey, the city where he lives, and in the surrounding state. Treviño, a short man with a moustache and glasses, speaks English with an American accent. He studied at Harvard, then worked as a diplomat and later in private industry, before he entered politics. He’s one of the few people in Mexico who have not lost faith in the ability of politics to shape the country.
Perhaps it is also a question of honor for Monterrey, Mexico’s wealthiest city. Located in the northeastern part of the country, 140 kilometers (88 miles) south of the US border and surrounded by mountains on three sides, Monterrey resembles an American city, with its glass and marble office towers. Many of the country’s most important companies are headquartered there.
It came as a shock to the city’s affluent citizens when, at the beginning of the year, members of the Zetas and the Gulf Cartel suddenly started shooting each other on their streets. The battle being waged in Ciudad Mier had moved to the middle of Monterrey, an economic center that was always immune to chaos elsewhere in Mexico. Many of the wealthy left town, or even the country — including the publisher of the country’s most important newspaper, La Reforma, who fled to Dallas.
Treviño is proud of the 29 slides in his presentation, which he shows to every visitor. His plan includes all the elements the think tanks have deemed necessary: social programs and reforms of the judiciary and the criminal code. The state of Nuevo León has also established a statewide police force that it hopes will finally be clean and effective. The officers will be required to take regular lie-detector tests. They will be paid well enough to end their dependence on bribes; they will receive scholarships for their children.
Nuevo León is to become a model for all of Mexico, says Treviño. It sounds like an effective plan. And who knows? It might even work. Once it is implemented, there might be at least one state in Mexico with a functioning police force. Treviño wants to make a start by strengthening institutions and society, and what better place to launch such an effort than Monterrey, the most advanced city in the country?
He continues clicking through his slides. The next one shows the country’s highway network. Two of the five main highways in the north are colored dark red, which means that they are safe for travel. The goal for 2011, says Treviño, is to make the three other highways safe as well.

Translated from the German by Christopher Sultan

Source: www.spiegel online 23rd Dec. 2010

Marijuana used for medical purposes has the same long term effect on the user as marijuana used for recreation. Marijuana use can cause impairment of short-term memory, attention, motor skills, reaction time, and the organization and integration of complex information. Marijuana use alters perceptions and creates time distortion and can cause drowsiness and lethargy. Heavy marijuana use can cause apathy, decreased motivation, and impair cognitive performance and can cause mental health problems. Employees who use marijuana off-duty are still effected by it. Impaired cognition that can cause lapses in judgement can remain for a long period. Memory defects can last as long as six weeks. See: Abbie Crites-Leoni, Medicinal Use of Marijuana: Is the Debate a Smoke Screen for Movement Toward Legalization? 19 J. Legal Med. 273, 280 (1998) (citing Schwartz, et al., Short- Term Memory Impairment in Cannabis-Dependent Adolescents, 143 Am. J. Dis. Child. 1214 (1989)

Employers may be liable for the actions of employee who use marijuana especially those employees in safety sensitive positions. The more chronic the use of “medical” marijuana the higher the risk.

VIOLATIONS OF FEDERAL LAW

Will employers have to accommodate marijuana use that violates federal law? Marijuana, remains illegal under federal law because of its “high potential for abuse,” its lack of any “currently accepted medical use in treatment in the United States,” and its “lack of accepted safety for use … under medical supervision.”Gonzales v. Raich, 545 U.S. 1 (2005); United States v. Oakland Cannabis Buyers’ Cooperative, 532 U.S. 483 (2001)

IF THIS BILL PASSES “MEDICAL” MARIJUANA WILL RESULT IN MORE MARIJUANA USE AMONG EMPLOYEES

As consumers we all pay for lost productivity and job-related accidents in the final costs of the produced goods and higher insurance premiums due to workplace accidents. Drug using employees are not as safe. They are 3.6 times more likely to be involved in a work-related accident than their non-using employee, and 5 times more likely to file workers’ compensation claims. As many as 50% of all workers’ compensation claims may involve substance abuse.[ EN1]

The U.S. Postal Service did a study that showed that substance abusers have 55% more accidents, experience 85% more on-the-job injuries, and have a 78% higher rate of absenteeism when compared to non-substance abusing employees.[ EN2] A report by the National Safety Council claimed that 80% of those injured in serious drug-related work accidents are not the drug using employees, but innocent employees and others.[ EN3]

Drug using employees commit workplace crimes. There is a very significant statistical correlation between drug use and criminal conduct.[ EN4]

Substance abuse also causes:

Domestic and financial difficulties for employees;

Poor judgment in employment decision making;

Potential embarrassment to the employer as a result of off-duty conduct, which may be publicized, including criminal charges, diversion of supervisory and managerial time;

Damage to company property; and

Time devoted to discipline and grievance matters.[EN5]

While the studies vary somewhat, it is clear that there is substantial substance abuse in the workplace and it has a powerful negative impact on our economy and productivity. The increased use of “medical” marijuana will magnify all these problems.

References

[EN1] Current, The Truth About Drug Testing: Answers to the Questions Everyone Is Asking, p. 3 (1st Ed., Fort Lauderdale, FL, 1998).

[EN2] “Pre-employment Drug Testing: Association with EAP, Disciplinary, and Medical Claims Information” U.S. Postal Service, Personnel Research and Development Branch, Office of Selection and Evaluation, July 1992.

[EN3] Wisotsky, The Ideology of Drug Testing [Ideology of Drug Testing], 11 Nova L Rev 763, 768 (1987).

[EN4] See Stewart, Proof Positive of Drug Link to Crime, Wall St J, May 28, 1987, at 26, col 3.

[EN5]Alcohol & Drugs in the Workplace: Costs, Control and Controversies, A BNA Special Report [Costs, Control and Controversies], 7 (Bureau of National Affairs, Washington, D.C. 1986)

Source: Attorney David Evans in email to Drug Free America Foundation June 2010

In the 15th Judicial District of Louisiana

Introduction and Review of Relevant Literature

During the second half of the twentieth century, two opposing views of drug use and abuse began to coincide. First, the disease concept of drug abuse and addiction became commonplace, as seen in the action of Congress passing the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act in 1970. This led to the designation of monies for federal treatment programs, while simultaneously major health insurers began to include treatment plans for same in their coverage (Lemanski,2001). As a result, the numbers of treatment facilities increased dramatically.

Second, there was a simultaneous increase during this time period in the criminalization of drug use, with harsh penalties attached to drug related crimes (Andrews et al, 1990). The consequence was a growth in the criminal justice system’s control over drugs, resulting in a dramatic increase of drug-related incarcerations (Lock et al., 2002). Recognition of the futility of the effort to use entirely punitive measures, and overcrowding in correctional facilities and court systems has led to a search for viable alternatives. Into this abyss has entered the drug court treatment program.

The first such program began in Miami in 1989, and by the year 2000, more than 650 drug courts were in existence across the country (Dechenes et al., 2002). A decade later, there were 2,038 fully operational drug courts in the United States and 226 that were in the planning stages, as of July 2009 (Office of National Drug Control Policy, 2010). The U.S. Department of Justice, in association with the National Association of Drug Court Professionals has defined ten key components for the establishment of drug court programs, though some variation exists from program to program.

Specifically, eligibility and suitability requirements vary, as well as what types of treatment are offered. Essentially, drug courts are a compromise between punitive and treatment strategies (Dorf and Fagan, 2003). These programs combine the extensive supervision of punitive models of justice with the treatment model of drug addiction to seek a reduction in criminal recidivism and improve the life chances of participants (Belenko, 1998; Gottfredson et al., 2003). Empirical evidence has supported the view that recidivism is reduced, as well as the corresponding monetary spending on drug cases throughout the justice system (Banks et al., 2003; Gottfredson et al., 2003; Hora et al., 1999; Kalich and Evans, 2006).

The evaluation of the effectiveness of drug court programs has been necessitated by the tremendous proliferation of such programs across the United States. This paper is a follow-up report of one such program, upon the request of the program particularly due to the amount of time that has passed since program inception and also due to the
implementation of a particular type of therapy into the program (moral reconation therapy). At a time when drug court monies may be looked to for utilization in other budgetary locations, it is especially important to know whether drug court participants fare better than non-participants who qualified for drug court but refused to participate
and were instead assigned to either straight probation supervision or to a modified educational probation supervision. In only this way is it possible to really begin to address any possible savings in terms of criminal recidivism and therefore monetary and other costs. The report detailed below also examines the perceptions of drug court
graduates toward the drug court program, in order to investigate the meaning and impact of the program on the lives of its participants. The most rigorous evaluations of drug court programs compare drug offenders who enter the program to those who qualified but chose not to enter the program. Additionally, rigorous studies include those that randomly assign clients to receive drug court services. These have consistently indicated lower recidivism rates for drug court participants and graduates (Deschenes, et al., 1995; Finigan, 1998; Gottfredson et al., 1997; Peters and
Murrin 2000, Wolfe et al., 2002).

The two primary components of all drug court programs are intensive supervision and drug treatment. The implementation of these two components varies across jurisdictions. Intensive supervision typically combines elements such as small caseloads for probation officers and frequent court appearances and urinalysis testing. Treatment typically fuses several well documented types of drug abuse treatment programs. Very few studies have attempted to differentiate the impact of these two components on drug court participants and even fewer have specifically focused on long-term effectiveness. However, they do suggest the need for further evaluation of drug court outcomes, with particular attention to identification of predictors of those outcomes.

Background of the F.I.S.T. Drug Court Program and Parameters for this Study

The general criminal justice system in the 15th Judicial District is actually one which
utilizes two types of drug courts via what is known as Tract 1 and via the F.I.S.T.
(Focused Intervention Through Sanctions and Treatment) Drug Court Program.
However, of the two, only the F.I.S.T. Drug Court Program is eligible to receive federal monies from the 1994 Crime Act, and it is restricted further by that Act to accept only defendants with drug-related crimes and no history of violent offenses. Tract 1 processes all other drug defendants. Thus, Tract 1 remains the traditional adversarial drug tract, with the F.I.S.T. drug court technically under that tract as a special non-adversarial court to which eligible non-violent felony offenders may be referred (if identified as eligible by the Assistant District Attorney assigned to Drug Court).
The prosecutor is obliged to prosecute only when there is proof of guilt. Consequently, prior to declaring a defendant eligible, he is to check all available information to insure the appropriateness of prosecution. Eligibility also depends upon the lack of exclusionary factors. Exclusionary criteria for entry into the program include: violent criminal history and conviction of four or more felonies. Misdemeanor offenders are usually excluded unless they aggressively seek inclusion.

Upon referral to the Drug Court by the prosecutor, potential participants are then
clinically screened for suitability using the Substance Abuse Subtle Screening Inventory (SASSI3), the Substance Abuse Questionaire, and a personal interview. Clinically, exclusionary criteria for entry into the program include: mental illness that has not received clearance from a doctor indicating participation will not negatively affect the illness (for example, no schizophrenia diagnoses are accepted into the program because the clinical structure of the program has been deemed unacceptable for said diagnosis). Acute health problems are excluded on a case-by-case basis,

depending on the level of function present. If deemed suitable, the offender is referred for a consultation with the public defender or a privately retained defense attorney. After consultation with a defense attorney, if the offender is interested in participating in the drug court program, the defense attorney notifies the F.I.S.T Drug Court prosecutor, who files a Bill of Information. Some offenders choose to participate in drug court as a condition of probation (after admitting to the crime and receiving a suspended sentence), while others choose to remain in Tract1 and go to trial, or plead guilty and receive a suspended sentence with less intensive conditions of probation. Still others opt to participate in drug court as a condition of bond, while awaiting motion hearings in Tract 1. If found guilty in Tract 1, the probationers must attend drug education classes, monthly meetings with the judge, and comply with periodic random drug screens. One year of sobriety completes the program for these individuals.

However, if the random test is positive for drugs, drug treatment is ordered (drug
education has proven insufficient) and graduated sanctions are imposed. At the third
positive drug screen, and pending a positive determination of both eligibility and
suitability for Drug Court, probationers in Tract 1 (as of August 2002) will be given a
coerced choice: participate in drug court or go to jail for one year. This choice will not
be offered, however, if the defendant was offered drug court before entering Tract 1 and rejected that treatment option. Such rejection is final, and is justified by the F.I.S.T. Team on the grounds that although addiction to drugs is an illness, the choices individuals make also have consequences. The goal of such a stance is to encourage responsible decision-making; therefore, if an addict chooses against treatment, he/she must endure those consequences. Thus, at this stage in Tract 1, if the choice of entering the F.I.S.T. program has never before been offered, and if the probationer chooses jail rather than treatment, upon the fourth positive drug screen, probation is revoked, and a sentence is imposed.

If, however, the probationer chooses drug court at any point, the sanctions for continued positive drug screens increase according to the F.I.S.T drug court schedule of sanctions. Unless the individual has been rearrested for another felony or violent offense, no definitive point marks the termination of a drug court client=s participation. When revocation from drug court does occur, the previously suspended sentence is reinstated, minus any reductions the probationer may have earned for compliance to program requirements up to that point.

Drug court participants who are initially offered and choose drug court must plead guilty to their crime in order to receive a suspended or deferred sentence and participate in the program as a condition of probation, the outcome of their sentence pending the successful completion of the F.I.S.T. Drug Court Program. Individuals deemed eligible and suitable can also try the F.I.S.T. Drug Court Program as a condition of bond, while awaiting the outcome of their case in Tract 1. All drug court participants have 30 days to opt out of the program and to choose adjudication via Tract 1. Incentives to remain are strong, such as dismissal of the prosecution upon satisfactory completion of the drug court program (the equivalent of an acquittal) and expungement of the charge from the participants record. Defendants in the F.I.S.T. Drug Court Program, then, are voluntary participants, who agree to comply with a number of general and special conditions of their suspended sentence with active supervised probation and treatment.
A third option also exists for drug offenders in the 15th JDC, aside from the assignment to Drug Court or Tract 1. Individuals may be deemed both eligible and suitable but refuse to participate in drug court and receive supervised probation instead. In this case, the individual must report to the probation officer, comply with random urinalyses, and otherwise not violate the conditions of his/her probation. These individuals are on Tract 3 or “straight probation.” Successful completion of probation means that probation is not revoked, nor is a sentence imposed.

Statement of Purpose
The primary goal of this evaluation is to explore the effectiveness of the F.I.S.T. Drug
Court Program at reducing recidivism rates of participants when compared to nonparticipants of varying kinds. The universe of offenders who were deemed both eligible and suitable and who were offered the F.I.S.T. Drug Court Option is the population under examination. This examination will determine whether the outcome target has been met (the number and % of participants who achieve the outcome, in this case, lower recidivism rates) for all eligible and suitable individuals, regardless of the tract to which they belong. Tests of significant differences between the tracts will also be determined between the previously described tracts: Tract 1 completers (Prevention Plus), Tract 3 completers (Straight Probation), and Drug Court Completers. In the analyses that follow, the Drug Court population is further divided into two groups, those who completed the Program prior to the introduction of MRT (Moral Reconation Therapy), and those who completed the program with the MRT component in place. All analyses are controlled for time in tract and recidivism rates are calculated from time of initial arrest for which Drug Court was offered to 6 months, 6 months to 12 months, and 12 plus months. Finally, Drug Court Alumni are interviewed about their drug court experiences.

Methods
Data were obtained from several sources: F.I.S.T. Program Records, Tract 1 Program
Records, the State of Louisiana Office of Probation and Parole, and F.I.S.T. Alumni
interviews. Only variables available for all offenders were included in these analyses.

F.I.S.T. Program records have been maintained since program inception in 1998. As
such, a list of names and identification information was available for use by the Office of Probation and Parole to locate arrest records for each individual. For some individuals no records were found by the Office of Probation and Parole,and
therefore, these individuals were excluded from the analyses due to missing information. Similarly, some participant names were on some lists and not others, or on multiple lists. In each of these cases, the participants were excluded from the analyses. All coding was double coded and entered by hand into an SPSS database in electronic format. While it is possible that some bias might be present in the resulting dataset, this is not likely, as excluded cases were statistically examined for patterns in demographics or other key variables of interest. None were identified. Descriptive statistics were performed using SPSS to produce percentages, averages, and frequencies. Additionally, tests of significance were performed using the Chi Square statistic
.
In addition, qualitative interviews were obtained from 30 F.I.S.T. Alumni who were
willing to be interviewed. The interviews were conducted in Spring 2010 via

telephone. Not all participants who were contacted were willing to be interviewed (n=5), and not all of the phone numbers were still working and accurate numbers (n=22). However, it is important to note that this information was given voluntarily, and did not take place under the supervision of any Drug Court Personnel.

Findings

Most of the sample was not re-arrested in the first six months after the initial eligible drug court arrest (79%). However, the re-arrests were nearly 3 times as many for drug arrests as for violent or other crimes (n= 362 v. 143 v. 79). During the 6-12 months after the initial eligible drug court arrest, again, 79% of the total sample was rearrested. Again, the pattern emerged of nearly 3 times as many drug re-arrests than violent or other crimes (n= 376 v. 138 v. 89). Thus, the pattern emerges that for all persons in the sample, during the first year after the initial eligible drug court arrest, most re-arrests were drug related.

However, these initial data are over-general and need to be examined more closely to
identify the makeup of each tract within the drug offending population. Specifically,
when examining the total dataset by tract, it becomes clearer that those who choose to
complete drug court are slightly older than those completing Tract 1 or Tract 3 (52% are age 26 and older v. 46% and 49%, respectively). In addition, those who choose to
complete drug court are much more likely to be white (64%) than those completing Tract 1 (54%) or Tract 3 (53%). Finally, those who choose to complete drug court are much more likely to include females (31%) than what is found in Tract 1 or 3 (15% v. 20%). This pattern of older, more white and more female participants may suggest that drug court is a more appealing choice for such a population to choose to complete, or to complete successfully.

Drug Court Completers V. Prevention Plus/Tract 1 Completers
In any evaluation of outcomes, it is important to evaluate the differences between groups for statistical significance. This component of the evaluation seeks to examine the differences between drug court completers and Tract 1 completers in terms of statistical significance. Recall that participants in drug court are subject to rigorous educational and therapeutic tools, while there is a small educational component in Tract 1. First, the data were analyzed for statistically significant differences in age, and the differences that were found were found not to be significant (chi square < .12). However, this changes when the data are analyzed according to race and gender there is clearly a significant difference between completers in Tract 1 and Drug Court completers in that Drug Court completers are significantly more likely to be white. Likewise, there is a significant difference between completers in Tract 1 and Drug Court completers in that Drug Court completers are significantly more likely to be female. More importantly, when examining the effectiveness of these two programs with regard to recidivism, statistically significant differences are found in re-arrest records. Specifically, when comparing Tract 1 completers to Drug Court completers Tract 1 completers are twice as likely to be re-arrested within the first six months than are Drug Court completers This is especially the case with drug crimes, where Tract 1 completers are nearly 5 times more likely to recidivate a drug crime than are Drug Court completers. Finally, when looking at long term completers of either Tract 1 or Drug Court where re-arrests occur at 12 plus months, those participants who complete Drug Court are significantly less likely (30% v. 52%) to be rearrested after 12 months, especially for drug crimes and violent crimes than are those participants who complete Tract 1.it is clearly significant that more completers of Tract 1 are re-arrested for drug crimes than are Drug Court completers (37% v. 20%) at this point in time. It is clearly also the case that completers of Tract 1 are significantly more likely to be re-arrested for violent crimes than are Drug Court Completers at this time (25% v. 12%). Drug Court Completers V. Straight Probation/Tract 3 Completers

This component of the evaluation seeks to examine the differences between drug court completers and Tract 3 completers in terms of statistical significance. Recall that participants in drug court are subject to rigorous educational and therapeutic tools, while there is no therapeutic or educational intervention in Tract 3. First, the data were analyzed for statistically significant differences in age, and the differences that were found were found not to be significant (chi square < .45). However, this changes when the data are analyzed according to race and gender . There is clearly a significant difference between completers in Tract 3 and Drug Court completers in that straight probationers are significantly more likely to be non-white . Likewise, there is a significant difference between completers in Tract 3 and Drug Court completers in that Drug Court completers are significantly more likely to be female. Furthermore, when examining the effectiveness of these two programs with regard to recidivism, statistically significant differences are found in re-arrest records at all levels. Specifically, when comparing Tract 3 completers to Drug Court completers in Tract 3 completers are nearly 6 times more likely to be re-arrested within the first six months than are Drug Court completers (28.3% v. 5.4%, Chi square <.00). This is especially the case with drug crimes, where Tract 3 completers are nearly 8 times more likely to recidivate a drug crime than are Drug Court completers. Likewise, straight probationers are 3 times more likely to recidivate a violent crime than are Drug Court completers within this time period . Likewise, straight probation completers are significantly more likely at the 6-12 month time period to recidivate, and especially to recidivate drug and violent crime when compared to completers of Drug Court . Finally, straight probation completers on Tract 3 are also statistically more likely to reoffend after one year than are drug court completers, and they do so with both drug and violent crimes .In sum, then, Drug Court completers have a better recidivism rate at all times and for all crimes, especially drug and violent crimes in comparison to both groups of eligible and suitable persons who were offered drug court during the same time period. These other groups, tracts 1 and 3, are interesting comparisons further in that the former offers some prevention education and seems to have a better rate of recidivism than does the latter which offers no prevention education and which has the worst rate of recidivism. Certainly these findings offer strong support for the continued use of drug courts and prevention education to reduce recidivism rates in the communities where they are provided. Drug Court: Pre v. Post Moral Reconation Therapy

As part of this evaluation, analyses were conducted within the Drug Court Completer
population by further subdividing the population into those who finished the program
before Moral Reconation Therapy (MRT) was introduced (n=74) and those who finished the program after MRT was introduced in February 2005 (n=112). MRT is conducted via structured facilitated groups in order to overcome problems encountered in individual therapy for substance abusers, such as over-exploration of a client’s past and over discussion of their feelings at a particular time. MRT is a cognitive-behavioral group method which allows problems such as this to be avoided.

Furthermore, the use of MRT as a group treatment is economical and efficiently incorporates more clients with fewer hours by the group counselor. Group sessions have always been a part of Drug Court, but the MRT group is special in that it is goal oriented and present-focused. For these reasons, analyses were conducted to determine if clients receiving MRT have a lower recidivism rate than do clients receiving more traditional drug court therapies. It is important to remember, however, that regardless of the subgroup analyses, Drug Court Completers are significantly lower in recidivism than other drug crime offenders.

For the analyses between pre-MRT and post-MRT completers, the total sample of
completers (n=186) was subdivided. Each group was compared for significant
differences in age, race, and sex, and no statistically important differences in the two
groups were identified. Furthermore, time since completion of the program was
statistically controlled (as with the above analyses). Interestingly, there are no significant differences between pre and post MRT completers at time periods less than 12 months (analyses available upon request). However, over the long term, post-MRT completers appear to respond better and to recidivate less frequently than do pre-MRT completers, especially in drug and violent crimes. Thus, it seems in the short term there is no MRT advantage but over a longer period of time the advantage is statistically significant.

Qualitative Component: Drug Court Completers Perceptions of Drug Court
In this final component of the evaluation, Drug Court Completers were interviewed and asked a series of questions about their experience with drug court. Thirty interviews were obtained with detailed responses for these interviews. Each interviewee was asked the following set of open-ended questions:

1. How did you feel when you were assigned to drug court?
2. If pleased, what pleased you…
3. If disappointed, what was disappointing…
4. What was the first session like for you?
5. What do you feel worked best for you in the program?
6. Why was , best for you in the program?
7. What do you feel did not work?
8. Why do you feel did not work?
9. How did you feel when you finished?
10. If you will miss the group, why?
11. If you are just glad it’s over, why?
12. What benefits did you receive from this program?
13. Do you have any suggestions for changes to the program?

Below, a random representation of the comments given in the responses are presented in composite form for qualitative purposes.

Interview 1: I felt lucky when I was assigned to drug court; my choice was drug court or jail. I was lucky to go to drug court. What worked best for me in the program was
putting me in jail because I had never been in jail where I could not bond out and this
time I couldn’t. It’s not that drug court does not work; it’s that you don’t want it to work. If not for drug court, I would not be clean today.
Q: Do you have any suggestions for change for the program? Yes, I believe they should have more involvement with the people who graduate because I disagree with [the person] running the alumni program. She is a self admitting crack head and still drinks to this day, and if you go to NA they will tell you alcohol is a drug too. Everybody else, except for her, was very helpful to me.

Interview 2: My counselor worked best for me. He enlightened me and let me know that there was life without dope and I am grateful for that. I think it worked. I have a life. I have been clean and I am grateful I have had the same job for over two years. The day I graduated I felt good, it was the first time I had finished something in a long time. I felt accomplished. I am still active with Drug Court because I want to share with others what I learned about structure, honesty, and integrity. I have my family back in my life and God I live without drugs, life is good. I’m back in school getting my Master’s.
Q:Do you have any suggestions for change for the program? Just maybe offer the
program to more people; it will benefit them. The doors should maybe be opened to
repeat offenders so they may have this opportunity. The criteria should maybe be looked at.

Interview 3: The thing that worked best for me was the complete package. It was
probably at the very beginning they left no room for failure; it was very intensive. They had all the bases covered and there was no time to go out and relapse. I don’t think there was any part that was a waste of time. When I graduated, I was elated but scared but I had my support group in place so that when I left their nest I still had people who I could call on. I also still have a few friendships that were forged. There is a certain sense of being glad it is over due to the fact that it was time consuming, but it needed to be.
Q:What benefits did you receive from this program? The program gave me the tools I needed to continue recovery. It made me confident to become a contributing part of society. There are also legal benefits and one being having my record expunged
Q: Do you have any suggestions for change in the program? They are out-growing the building they were in; they need more space. It’s an awesome program – well worth it – it saved my life – it gave it back to me.

Interview 4: Q: What was the first session like for you? It was probably the hardest because I was miserable. I wanted to get high. I was fearful of the unknown. The first session was overwhelming. I was still loaded. I had several sanctions that were due to my use. I was still confused. But Drug Court gave me the structure to save my life. That was what worked best for me. The structure of drug court and the length of time. The different phases are really strenuous and we need the structure, we need the time because it takes all of that. What did I feel did not work? What does not work is the individual. Drug court works. It’s not drug court that failed me, but me that failed drug court. I have the experience of knowing today that at first the sanctions don’t work and then it happens that you stop and surrender to the program.
Q: If you are glad it’s over, why? One of the reasons I’m glad it’s over is because now I get to use what they taught me. I get to get back into society and make amends for the wrong I’ve done.

Interview 5: There are two types: those that need and those that want it. The ones who want it stay sober. Drug court is a long treatment that not only gives you a stable
environment but it gives you guidance. There are people like me who have flaws and
drug court has given me all of the tools I could ever need to keep me going. Now with
this change, everybody whose life I touch is better because of my experience with drug court. I am just so grateful. I was a convicted felon looking at 60 years. Drug court gave me a chance.

Interview 6: What worked best for me was the MRT book was absolutely wonderful. By the time I reached the 40th meeting it started to all click for me. I got a sponsor and saw how the MRT’s worked with the 12 steps. The discipline worked really good.
Q: How did you feel when you graduated? Relieved. I felt I had learned so much. I had high respect for the counselors there. Actually I wanted to cry. I had bonded with the people there – it was kind of sad. I love group and I still make 4 meetings a week. I really would not feel right if I didn’t go to at least 3 meetings a week, so I’m still working the 12 steps. Q: What benefits did you receive from this program? Definitely I kicked my addiction, I also quit smoking, I was given an opportunity to look at myself living life on life’s terms. I just never realized how it affected my spiritual growth. Q: Any suggestions for change to the program? I would incorporate the 12 steps into the program. The MRTs are important but I would add the 12 steps, and the meetings are very important. Something else I would add is alternate NA and AA to the meetings and what it is that the alcohol began you on your journey to drugs.

Interview 7: What worked best for me was the MRT book and the involvement of the
counselors. The book explains how and talks about social and moral responsibilities.
The involvement of the counselors gave you someone who was not your peers to
encourage you and go over things with. Q: Any suggestions for change to the
program? In some respects I think they should have more restrictions on how they
present themselves to society.

Interview 8: After graduation, I felt great, but a little nervous about stepping out into the world without being drug tested. Twenty five months sober, I feel good! Q: Are you glad it’s over? Well because of the time it took you know, to leave work early and go and UA or go to a meeting. Q: What did you learn from this program? I learned to not depend on drugs. I learned tools about what I can do when I’m stressed out about a situation instead of using.

Interview 9: Q: What do you feel worked best for you in the program? Having a
very close set of peers, because as peers it’s easier for them to relate to you on the same level. What did NOT work for me was the numerous meetings because Phase 1 is 4 of everything a week. There is no time to do anything else. Q: Any suggestions for change to the program? I think they should let people choose. I went because I wanted to andothers were forced and it makes it difficult going through phase 1 and 2 for those that want to be there. Everyone is grown enough to make their own decisions.

Interview 10: Everything worked – if you work the program it will work you. When I was finished I was happy but felt like I was losing a family. Q: What benefits did you receive from the program? I got an apartment, job, a bank account, friends, my
respect, dignity, family, peers. I benefitted a lot. Q: Any suggestions for change to the program? If they could just not have call in everyday – not weekends – and it could give people the chance to be responsible to come back on Monday. It’s too much everyday; they need to want for themselves.

Interview 11: Q: What was the first session like for you? I honestly can’t tell you
because I didn’t want to be there. I closed my mind and one week later I got sanctioned and went to the halfway house. When I came back from the halfway house I was so ready to change until I was ready to do anything and everything they told me to do. I can’t think of anything that didn’t work. Probably the assignments for each phase worked best because it got deep into the way reality really was; it helped me to be a better mother and daughter. I got my GED, I held a job for almost 2 years, I became independent, I got engaged, I mended the wounds between my parents and I, I became a friend and sponsor. They gave me my life back. I was able to keep my little girl and I really feel that if not for Drug Court I would probably be dead on the side of the road.

Interview 12: I think what worked best for me was the MRT book – it made me go deep into ME and not just blaming other people but holding myself accountable. Everything worked, but especially the MRT book. Q: How did you feel when you finished? I was proud of my accomplishment, it was the first thing I ever accomplished in my life. It will forever be a part of my life. I wear a shirt that says DRUG COURT WORKS. Q: What benefits did you receive from the program? That drug court introduced me to Narcotics Anonymous. Q: Do you have any suggestions for changes to the program? Drug court has changed a lot and now the clients are doing different drugs and they’re taking coricidin as a drug. I learned this through Narcotics Anonymous.

Interview 13: Q: What do you feel worked best for you? The meetings – they got me to interact with a bunch of people just my kind. Q: What do you feel did not work? Sanctions because I felt that drug court was being vengeful for my actions. I think they need to do away with the sanctions. What benefits did you receive from this program? Sobriety, gained new sober friends, much more clearer thinking, a new aspect on life, a greater relationship with God.

Interview 14: Q: What do you feel worked best for you? The immediate consequences if you do something wrong. Q: What do you feel did not work? They have stuff that they make you do like case management and gender group. It’s the same thing over and over. I’m sure that with their time they can come up with more and you see the same people over and over like housing – you can learn something else. Q: Any suggestions for changes to the program? Yes, just for the upper part of the program – be more equal – don’t let personal feelings get in the way they treat people.

Interview 15: Q: How did you feel when you got assigned to Drug Court? I was
glad. I had been in jail for 8 months. It was like a ticket out of jail at first. Q: What
was the first session like for you? It was kind of questionable; it was like how could
these people really help me – I like getting high. It was something I had to do to stay
free. Q: What worked best for you? It would have to be the rules that they gave me. I had to make 4 meetings, I had to UA, I had to attend meetings and go to the outside
meetings. This was what stood out to me and what helped me because my life had no
rules. I had nowhere to be. I had no structure. You see, I just lived. I would be out all
night, so when I had rules then I was there you make meetings and you hear things that relate to your life and you get exercises. They did a lot of exercises that would make you think about your life. It gave me structure. I spent a year and a half in drug court, and you know I never missed one group, I wasn’t glad it was over, but I was glad I had finished something because you know I didn’t finish much in my life. I had accomplished something. Q: Do you have any suggestions for change to the program? If it’s not broke, don’t fix it. If my car comes with a certain type of rims, and I like it, I ‘m not going to put any 20’s on it.

(Interviews 16-30 available upon request)

Conclusions and Key Findings

While different interviewees preferred different parts of the program, it seems that all
agreed that drug court worked for them and changed their lives for the better. In the U.S. we house proportionately more of our population in prison than does any other country and for longer periods of time than do many countries (Tischler, 1999). Recidivism rates of inmates suggest that prison is not successful at rehabilitation, and alternatives to incarceration such as the F.I.S.T. drug court therefore seem to offer a more viable and affordable option to the thousands of dollars spent per year on housing individual prisoners. This evaluation supports a previous evaluation completed in 2005 for the F.I.S.T. program in which findings strongly suggest the success rate of the program supersedes that of other alternatives to incarceration such as Tracts 1 and 3. Furthermore, the effect is stronger over the long term when participants have been exposed to the MRT component of the program.

Re-arrest rates are dramatically and statistically significantly lower for Drug Court completers than for Prevention Plus (Tract 1) or Straight Probation (Tract 3). This is especially true for drug crimes and violent crimes. While there may be some differences in the population of drug court versus these programs, these differences fail to explain the success of the program relative to the other two programs. This, along with the interviews of graduates of the program demonstrate overall positive perceptions
on the part of the participants. The findings of this evaluation should clearly show that a need for continued financial support of the F.I.S.T. Drug Court Program will be money well spent.

Source: www.ind.com 6th August 2010

References

Andrews, D.A., I. Zinger, R.D. Hoge, J. Bonta, P. Gendreau and F. Cullen. 1990. “Does
Correctional Treatment Work? A Clinically Relevant and Psychologically Informed
Meta-Analysis.” Criminology 28(3): 369-404.
Belenko, S. 1998. “Research on Drug Courts: A Critical Review”. National Drug Court
Institute Review 1(1): 1-43.
Deschenes, E.P., S. Turner, and P.W. Greenwood. 1995. “Drug Court or Probation? An
Experimental Evaluation of Maricopa County’s Drug Court.” The Justice System Journal
18: 55-73.
Deschenes, E., Peters, R., Goldkamp, J., and S. Belenko, 2002. Drugs courts. In J.
Sorenson, R. Rawson, J. Guydish, & J. Zweben (Eds.), Research to practice, practice to
research: Promoting scientific clinical interchange in drug abuse treatment. Washington,
D.C.: American Psychological Association.
Dorf, M.C. and J. Fagan. 2003. “Problem-Solving Courts: From Innovation to
Institutionalization.” The American Criminal Law Review 40(4): 1501-1511.
Finigan. M.W. 1998. “An Outcome Program Evaluation of the Multnomah County
S.T.O.P. Drug Diversion Program.” Portland, ORE: NPC Research Inc.
Gottfredson, D. C., K. Coblentz, and M.A. Harmon. 1997. “A short-term Outcome
Evaluation of the Baltimore City Drug Treatment Court Program.” Perspectives (Winter):
33-38.
Gottfredson, D.C., S.S. Najaka and B. Kearley. 2003. “Effectiveness of Drug Treatment
Courts: Evidence from a Randomized Trial.” Criminology and Public Policy 2(2): 401-
426.
Lemanski, M. 2001. A History of Addiction and Recovery in the United States. Tucson,
AZ: See Sharp Press.
Lock, E., J. Timberlake, and K. Rasinski. 2002. “Battle Fatigue: Is Public Support
Waning for ‘War’ –Centered Drug Control Stategies?” Crime and Delinquency 48: 380-
398.
Office of National Drug Control Policy. 2010. “National Criminal Justice Reference
Service.”http://www.ncjrs.gov/spotlight/drug_courts/facts.html Accessed 15 June 2010.
Peters, R. H. and M. R. Murrin. 2000. “Effectiveness of Treatment-Based Drug Courts in
Reducing Criminal Recidivism.” Criminal Justice and Behavior: 27(1): 72-96.
21
Wolfe, E., J. Guydish and J. Termondt. 2002 “A Drug Court Outcome Evaluation
Comparing Arrests in a Two Year Follow-Up Period.” The Journal of Drug Issues: 1155-
1172.
References
Andrews, D.A., I. Zinger, R.D. Hoge, J. Bonta, P. Gendreau and F. Cullen. 1990. “Does
Correctional Treatment Work? A Clinically Relevant and Psychologically Informed
Meta-Analysis.” Criminology 28(3): 369-404.
Belenko, S. 1998. “Research on Drug Courts: A Critical Review”. National Drug Court
Institute Review 1(1): 1-43.
Deschenes, E.P., S. Turner, and P.W. Greenwood. 1995. “Drug Court or Probation? An
Experimental Evaluation of Maricopa County’s Drug Court.” The Justice System Journal
18: 55-73.
Deschenes, E., Peters, R., Goldkamp, J., and S. Belenko, 2002. Drugs courts. In J.
Sorenson, R. Rawson, J. Guydish, & J. Zweben (Eds.), Research to practice, practice to
research: Promoting scientific clinical interchange in drug abuse treatment. Washington,
D.C.: American Psychological Association.
Dorf, M.C. and J. Fagan. 2003. “Problem-Solving Courts: From Innovation to
Institutionalization.” The American Criminal Law Review 40(4): 1501-1511.
Finigan. M.W. 1998. “An Outcome Program Evaluation of the Multnomah County
S.T.O.P. Drug Diversion Program.” Portland, ORE: NPC Research Inc.
Gottfredson, D. C., K. Coblentz, and M.A. Harmon. 1997. “A short-term Outcome
Evaluation of the Baltimore City Drug Treatment Court Program.” Perspectives (Winter):
33-38.
Gottfredson, D.C., S.S. Najaka and B. Kearley. 2003. “Effectiveness of Drug Treatment
Courts: Evidence from a Randomized Trial.” Criminology and Public Policy 2(2): 401-
426.
Lemanski, M. 2001. A History of Addiction and Recovery in the United States. Tucson,
AZ: See Sharp Press.
Lock, E., J. Timberlake, and K. Rasinski. 2002. “Battle Fatigue: Is Public Support
Waning for ‘War’ –Centered Drug Control Stategies?” Crime and Delinquency 48: 380-
398.
Office of National Drug Control Policy. 2010. “National Criminal Justice Reference
Service.”http://www.ncjrs.gov/spotlight/drug_courts/facts.html Accessed 15 June 2010.
Peters, R. H. and M. R. Murrin. 2000. “Effectiveness of Treatment-Based Drug Courts in
Reducing Criminal Recidivism.” Criminal Justice and Behavior: 27(1): 72-96.
21
Wolfe, E., J. Guydish and J. Termondt. 2002 “A Drug Court Outcome Evaluation
Comparing Arrests in a Two Year Follow-Up Period.” The Journal of Drug Issues: 1155-
1172.

The power of an attractive fallacy    

Manuel Pinto Coelho*Dr, Chairman of Association for a Drug Free Portugal – member of World Family Organization; Member of International Task Force on Strategic Drug Policy; Member of Drug Watch International

We grew up believing that no matter how many times affirmed, no matter how insistently repeated, a lie, as convenient as it could be, would never become the truth. Does that principle still apply today? We wonder…

Last year, Mr. Glenn Greenwald an American lawyer and writer, fluent in Portuguese, was invited and sponsored by Cato Institute – Washington think-tank committed to libertarianism that has been a long-time advocate of drug legalization – to come to our home country Portugal, with a certain task at hand. He was to develop a study concerning the results of the Portuguese drug decriminalization policy. After 3 weeks he went back to the United States and wrote a book. And on that book he characterized the Portuguese drug policy as being a huge success. An example. A lesson to the world. A model worth being replicated.

Those 33 pages do look appealing. The book was a tremendous sensation. So many attractive indicators and positive statistics really pleased a lot of minds, including the media, which boosted the proliferation of the “good news”. The TIME magazine published an article commending the book and its content.
It had a record number of viewing hits that day. “The Moderate Voice”, “The Kansas City Star”, the “Pittsburgh Tribune-Review”, “The Examiner”, the “Scientific American”, are just a few of the publications that mimicked the phenomena. In Portugal, the magazine “Visão” dedicated two articles in two consecutive numbers to this “happening” with the flashy title “Portugal inspires Obama”. “The Economist” was next in line and many others followed. And so the book was flying around the world and speeding through the internet,
inflaming people all over the globe.

But…
Was the book truthful? Was the information in it reliable? Was it worth all that credit? Is that the truth?
Let’s take a look at some statements that might have helped trigger the libertarian euphoria.

It says:
–“The total number of drug-related deaths has actually decreased from the pre-decriminalization year of 1999 (when the total was close to 400) to 2006 (when the total was 290)”.

And regarding consumption, it gives the general notion of decreasing tendencies
affirming that:
-“Prevalence rates for the 15 to 19 age group have actually decreased in absolute terms since decriminalization.” -“Most significantly, the number of newly reported cases of HIV and AIDS among drug addicts has declined substantially every year since 2001.”

It looks rather good doesn’t it?

Unfortunately it does not comply with the truth. So lets abandon the artefacts and move to the real facts.

Consumption
Looking closer at the data regarding prevalence, it’s curious that the only 3 graphics presented in Mr. Greenwald’s book, mainly focus on an age span population comprised between 13 and 19 years old. Only a brief reference is made to the adjacent 20 to 24 age group, that already doesn’t show any mild decrease, but rather a boosted 50% increase. +50%

And still concerning the 13 to 15 age group in school environments, if we want to look at the same data in a different perspective, we can attest to an increase in every drug category from 1998 to 2002, with cannabis sky-rocketing the charts with its 150% raise.

Only to have a mild decrease on to 2006, with the exception of heroin, and although numbers are still not available regarding subsequent years, there is a general sense that the numbers are ascending yet again.

If we look below the age of 34 it’s nearly a 50% escalation. If one glances at the numbers related to prevalence in the total Portuguese population, there isn’t a single drug category, not one, that has decreased since 2001.

Between 2001 and 2007, the drug consumption in Portugal increased by 4.2% in absolute terms – the percentage of people who have experimented with drugs at least once in their lifetime, climbed from 7.8% in 2001 to 12%.in 2007.

The following statistics are reported:
• Cannabis: from 12.4% to 17% (15-34 years old)
• Cocaine: from 1.3% to 2.8% (15-34 years old)
• Heroin: from 0.7% to 1.1% (15-64 years old)
• Ecstasy: from 1.4% to 2.6 (15-34 years old)
(Portuguese IDT – November 2008) +40%

Cannabis
It is difficult to assess trends in intensive cannabis use in Europe, but among the countries that participated in both field trials between 2004 and 2007 (France, Spain, Ireland, Greece, Italy, Netherlands and Portugal), there was an average increase of approximately 20%. (EMCDDA – November 2008)

Cocaine
“There remains a notorious growing consumption of cocaine in Portugal, although not as severe as that which is verifiable in Spain. The increase in consumption of cocaine is extremely problematic.”
(EMCDDA´s Executive Director, Wolfgang Gotz, Lisbon – May 2009)

In the chapter “Trends” of cocaine use, the new data (Surveys from 2005-2007) confirms the escalating trend during the last year in France, Ireland, Spain, United Kingdom, Italy, Denmark and Portugal. (EMCDDA – November 2008)

While amphetamines and cocaine consumption rates doubled in Portugal, cocaine drug seizures have increased sevenfold between 2001 and 2006, rating us the sixth highest in the world in that matter. (WDR – June 2009)

Heroin and drug related Deaths and Homicides
In Portugal, heroin is the most responsible for internments in drug rehabilitation facilities and for overdose deaths.
Behind Luxembourg, Portugal has the highest rate of consistent drug users and IV heroin dependents. (Portuguese Drug Situation Annual Report – 2006)

Concerning drug-related deaths, in 2005 Portugal had 219 deaths, representing an increase of 40% relative to 2004 (156). (Portuguese Drug Situation Annual Report – 2006)
In 2006, the total number of deaths as a consequence of overdose did not diminish radically compared to 2000. In fact, the opposite occurred.

“With 219 deaths by drug ‘overdose’ a year, Portugal has one of the worst records, reporting more than one death every two days. Along with Greece, Austria and Finland, Portugal is one of the countries that recorded an increase in drug overdose by over 30% in 2005”. (EMCDDA – November 2007)

The number of deceased individuals that tested positive results for drugs (314) at the Portuguese Institute of Forensic Medicine in 2007, registered a 45% raise, climbing fiercely after 2006 (216). This represents the highest numbers since 2001 – roughly one death per day – therefore reinforcing the growth of the drug trend since 2005. (Portuguese IDT – November 2008)

In Portugal, since decriminalization has been implemented, the number of drug related homicides has increased by 40%. “It was the only European country with a significant increase in (drug-related) murders between 2001 and 2006”  (WDR – June 2009).

HIV and AIDS
On to the HIV and AIDS issue, by no means have the numbers declined substantially. Again, the exact opposite takes place. Portugal remains the country with the highest incidence of IDU-related AIDS and it is the only country recording a recent increase. 703 newly diagnosed infections, followed from a distance by Estonia with 191 and Latvia with 108 reported cases. We’re top of the list, with a shameful 268% aggravation from the next worst case. (EMCDDA – November 2007)

The number of new cases of HIV / AIDS and Hepatitis C in Portugal recorded among drug users is eight times the average found in other member states of the European Union. “Portugal keeps on being the country with the most cases of injected drug related AIDS (85 new cases per one million of citizens in 2005, while the majority of other EU countries do not exceed 5 cases per million) and the only one registering a recent increase. 36 more cases per one million of citizens were estimated in 2005 comparatively to 2004, when only 30 were referred ” (EMCDDA – November 2007).

It’s rather simple and easy to grasp the reality of the facts, with one look at the real figures, the official figures. Still Mr. Glenn Greenwald managed to picture it otherwise, and most of the world press bought it, and subsequently some governments disgracefully did too.

That’s the power of an attractive fallacy.

In the same line of thought as Mr. Greenwald’s misleading book, there were recently published on the foreign press, two articles that deserved our attention. The first one by Danny Kushlik of the Transform Drug Policy Foundation entitled “Portuguese style decriminalization and legal regulation”. And a second one published in Oxford Journals – British Journal of Criminology with the partial funding of Beckley Foundation (usually very active in criticizing the United Nations drug Conventions) signed by Caitlin E.

Hughes and Alex Stevens: “What Can We Learn From The Portuguese Decriminalization of Illicit Drugs?”
Both , underestimating the readers understanding, suggest the contrary to what the numbers show clearly and unequivocally. In this last one, the authors are peremptory in their “Conclusion”: “ …since decriminalization in July 2001, the following changes have occurred:

• reduced illicit drug use among problematic drug users and adolescents, at least since 2003;
• reduced burden of drug offenders on the criminal justice system;
• reduction in opiate-related deaths and infectious diseases;

… and continues:
• “It is also an ethical and political choice of how the state should respond to drug use. Internationally, Portugal has gone furthest in emphasizing treatment as an alternative to prosecution. Portuguese political leaders and professionals have by and large determined that they have made the right policy choice and that this is an experiment worth continuing.”… “As this paper has shown, decriminalization of illicit drug use and possession does not appear to lead automatically to an increase in drug related harms. Nor does it eliminate all drug-related problems. But it may offer a model for other nations that wish to provide less punitive, more integrated and effective responses to drug use”.

Articles like these ones were so effective, that, as we mentioned before, already the Czech Republic, Mexico and Argentina copied the model and adopted the famous Portuguese drug decriminalization model.

Decriminalization and CDT’s

Let’s recede in time back to 2001. In early summer July 1st a law takes effect that decriminalizes every single drug, provided that it is for personal use only. This means that yet illegally sold, purchased or consumed, you will never be criminally charged for any of it, unless you possess a quantity superior to an estimated 10 day supply, then transforming yourself into a drug dealing criminal.

Compared with this law, the Dutch famous permissiveness is a strict dictatorship! So what did the mentors of this new law have in mind when they idealized it? Their belief was that by eliminating the social stigma of guilt associated with criminalized drug consumption, users would be more willing to enrol in drug dissuasion programs. This is based on the conception that most addicts avoid treatment for the fear of criminal charges.

In a article dedicated to Portugal´ s drug policy “The Economist” in it’s printed edition (August 27th 2009) says:
“Officials believe that, by lifting fears of prosecution, the policy has encouraged addicts to seek treatment. This bears out their view that – sanctions are not the best answer. ´Before decriminalization, addicts were afraid to seek treatment because they feared they would be denounced to the police and arrested,´ says Manuel Cardoso, deputy director of the Institute for Drugs and Drug Addiction, Portugal´ s main drugs-prevention and drugs-policy agency. ´Now they know they will be treated as patients with a problem and not stigmatised as criminals´.”

So the current Portuguese reality, that one reality the world has recently been invited to follow, is that anyone who’s drug dependent and commits a crime is not a criminal, because drug dependents are sick poor people.

In almost 20 years of experience – we directed the first private Portuguese drug
dependency rehabilitation clinic (Health Ministry Licence 1/1996) – neither ourselves nor any of our several collaborators, have ever heard or even slightly sensed this supposed fear of seeking treatment over the risk of criminal indictment.

Not even 1 of the 14.000 addicts that went through our clinics has ever showed any kind of fear concerning the authorities. Even in long sessions with psychologists, never was that a topic of conversation.This conception is a seriously distorted projection of reality. It is an unfounded lame argument.
This statement is also a serious and painful attempt against all the crowd of medical doctors, followers by obligation of the Hippocratic oath that ensures professional secrecy.

These doctors, although without proper conditions to do their job, as a consequence of a total absurd drug dependency policy, are giving their best to help drug dependents and their families.

As to the differentiation of dealers from users, official reports from the National Institute of Administration state that since 2001 is very hard to distinguish between dealer and consumer, since it is fairly easy for a dealer to organize his distributing method through smaller, below the line quantities.

As matter of fact that important document reports on Chapter XIV – The Future of the National Strategy: Main Questions – How to distinguish the consumer from the Traficant? ”Doubts rises in what concerns the main criteria explicated on the Decreto- Lei n.º 130-A/2001 of 23 de April, in which is considered a consumer everyone that does not carry drug quantity superior to10 days of use. So, it is possible to exert drug traffic with more distributed logistics avoiding the possession of quantities superior to that limit. How can we ameliorate this criterion?”

Since this neutral (INA) report was published – November 2003 – until today, nothing was done to improve the situation. Absolutely nothing was changed, and despite the disappointing results, the Portuguese strategy was renewed up until 2012. In fact, nowadays, in this country that some people insist on preaching as a role-model to the world, if you walk alone through any crowded street in Lisbon’s Bairro Alto or in certain populated spots of historical downtown, you are likely to be approached by individuals sneakily alluring with hashish, cocaine and others on their swift hands, even in broad daylight. Such daring characters were inexistent 5 years ago in places like these. There is a growing sense of fearlessness in the selling of small quantity drugs, since most police officers find it unworthy of their attention and
effort.

According to this ideology, a beneficial distinction is created when putting this law to practice: on one hand we would have dealers and traffickers sent to prison and on the other, we would have more dependents sent into treatment facilities. Furthering this notion, was the creation of the CDT´ s (Commissions for the Dissuasion of Drug Addiction) where users caught in the act, would be sent for evaluation, and if so justified, they would be persuaded to follow treatment in order to avoid Administrative fines and other light penalizations. Better explaining the CDT’s: there is no better way to illustrate how these new facilities, created as a form of diversion from imprisonment, truly work, than to present the reader the desperate appeal from the director of one of the most significant units.
The letter that follows was posted on IDT’s intranet services:

“The Portuguese CDT’s were created one for each district under the entry into force of Law 30/2000, which decriminalized the consumption of narcotic drugs and psychotropic substances. Becoming, then, the institutions or authorities with the responsibility to take knowledge of the offenses which began to be originated by the situations of consumption, leaving the realm of the courts: they began by depending on the Presidency of the Council of Ministers and subsequently by the Ministry of Health. Usually the cases that reach the CDT’s are sent by the PSP (Portuguese Public Police Force), GNR (Portuguese Military Guard) Courts and Prisons. Hence the law itself specifies in particular the existence of a multidisciplinary team in each CDT, covering the fields of psychology, sociology, social service, law and administrative and directive part. The same law provides and requires different processing in each case, since the hearing, the technical evaluation, measures of deterrence, any work of motivation for treatment, monitoring process in its different moments (suspension, sanction if any, etc.). Similarly, the law requires that the hearing and the taking of any decision must be made only with a quorum, is to say, with at least two of the three members set out in the Board of Directors the Commission. The same law also recommends that any decision is adequately supported by a report of the technical team, observing this team the monitoring of cases in stage of suspension, creating networks and linking with support institutions or treatment.

Accordingly – and taking into account the different stages of the process (from receipt of the case, sealing of seized drugs and its transmission to the State safe deposit, the service of police officers and defendants, hearing, evaluation, decisions, reports, minutes, quotas and several information to attach to each case, the statement of measures taken and the corresponding bureaucratic processing,

correspondence sending, creation of maps and databases in constant update, ordering of the destruction of drugs after each archiving process, meetings, etc..) the law provides for eight persons employed by each Committee,
being one President, two vowels, two elements in the technical support team (psychology and social work) and three elements in the administrative support team.

What happens, however, is that despite many statements giving notice of the longstanding lack of resources to the minimum requirement: the CDT Braga as always seen increased the volume of work and decreased the number of staff to do it. In the first year, in December 2001, the Social Service Technician left, as she lived in Vila do Conde and was admitted on Welfare Services of that city. She has never been replaced.

In January 2003, a member of the Board of Directors, the one specialized in the field of psychology, left to engage in private practice. In May of that year it was the time for one of the administrative employees, because she lived in Esposende and was able to be placed at the local Health Centre. Also in October of the same year, the psychologist of the technical support team leaves the service, being this team, since then, without any of the two members
provided by law. In February 2004, the second administrative official leaves, as she lived in Guimarães and managed to be employed in a private company in this city.
At that time, the CDT Braga was left with only one administrative employee, on top of all in nursing license which reduced in two hours her daily work schedule. Only later, in November 2007, after much insistence, another administrative employee was placed in system of mobility from the IRS of Braga. The situation deteriorated again in August 2009, when the oldest administrative employee moves to Lisbon at her request, to accompany her husband who had been placed in a company at the capital city. In November of this year, the IRS requires the employee who is in mobility in this service but belongs to their staff.

Thus, of the three elements of the administrative team provided by law, this team – which was often short of staff and with board members assisting the many secretarial work – is now also without anyone. Like this, the CDT with one of the largest work volume in the country has currently two members of the Board (President and Juridical Vowel), totally depleted, for more than five years, of any element in the technical support team and also completely lacking, up to the moment, administrative support. Of the eight elements that the law provides, there are only two resistant ones.

These problems have often been reported by different ways, at different times and for various departments. It is even reported that in the present context, it is almost impossible to open the doors of this service in good conditions of functionality and safety. It was further added that, given the holiday season where there will be only one person present at the service and that, even if there are two, they will have to unfold to the main administrative services and to assist to the basic office tasks: it is not possible under law to carry out hearings or to take decisions in the many cases that will be piling up, some on the verge of expiry. It should be understood that everything was always done and the effort always ensured to give the best prestige to a public service with internationally recognized merit. And everything was always reassured even at times when the situation had become uncomfortable and suffocating. We are proud of it and feel duty done and with a clear conscience. I also believe that people who I address to could and can in many contexts be somewhat hamstrung to resolve these serious and urgent issues, denoting intention to solve… The difference is that now it became impossible to this service to give a minimally satisfactory response and with dignity – even at the level of assuring the existence of conditions to open doors… Considering this situation, we would appreciate to whom it might consider the possibility of eventually working for the CDT of Braga or had knowledge of someone available to perform duties here, either in the technical team of psychology and social work, either in the technical and administrative staff. Thanking you in advance for the attention that you could dedicate in order to a better cooperation or easing to overcome this major constraint, we remain at your disposal.
The Chairman of the CDT Braga Jorge Tinoco”.

Note: the underlined parts are APLD’s responsibility.
For a better understanding of this new Portuguese reality let us give some more statistical insight on these entities – the CDT´s:

From a total number of 7.346 processes instated to caught users, 2.816 were classified has being non dependents 2.075 are pending evaluation and 783 were considered to be dependents.

Of these 783, 661 voluntarily accepted to be treated in order to temporarily suspend the legal process. From this group of 661 people, 166 had never had any prior contact with treatment facilities. 127 resumed abandoned treatment and 368 were already following treatment when they got caught practising the illegal offense.
So we can attest that the CDT units, one for every district, with a total of 99 technicians working in them, only managed to conduct towards treatment 166 addicts. Since the remaining (127 + 368) were already referenced and being followed in the CAT facilities.

This means that those supposed indicators of statistical success, come from referencing the dependents that are already referenced, once again misleading everyone into factual misinterpretation. Plus, the 2.816 referenced as not constituting risk cases, in other words, yet not having a drug dependency, were dismissed from any kind of intervention. This is equivalent to saying that they wait for users to get hooked on drugs, before they grant them any support. This is disastrous.

As well confirmed by the IDT 2008 Report that says that there is evident lack of response upon this population. Five of these CDT units don’t even have any technical element on their staff, and many others lack professionals too.

Health
On the very recent 2010 World Drug Report released last June 26th, the Executive Director of the United Nations Office on Drugs and Crime (UNODC), Mr. Antonio Maria Costa (Executive Director) signed an extremely preoccupant Forward ED was peremptory:
“…Most importantly, we have returned to the roots of drug control, placing health at the core of drug policy. By recognizing that drug addiction is a treatable health condition, we have developed scientific, yet compassionate, new ways to help those affected. Slowly, people are starting to realize that drug addicts should be sent to treatment, not to jail.”… …

“While the pendulum of drug control is swinging back towards the right to health and human rights, we must not neglect development.”

…“Above all, we must move human rights into the mainstream of drug control.” …“Just because people take drugs, or are behind bars, this doesn’t abolish their right to be a person protected by law – domestic and international.”

What a strange world this we are living in, where it’s becoming increasingly difficult to distinguish right from wrong, even for good willed people sharing the same moral and ethical values. Surprisingly the United Nations still most representative official, in applying in his speech the two favorite arguments, the two “jewels of the crown” of the well known economic-social-political group that insistently and restlessly wishes to legalize drugs – “health” and “human rights” – indicates eventually that, he too was influenced by the “resounding success” of the Portuguese experience, and maybe did not find the strength to resist the pressure, dropped the towel and capitulated!

Amazingly UNODC’s Forward speech is coincident with pro-legalization organizations like Drug Policy Alliance, Cato Institute, Transnational Institute, Beckley Foundation, Encod, among many others who claim that the War on Drugs cannot be won and that drug use and dependency should be treated as a health problem and not as a criminal one.
By joining his voice to others who consider prohibition a violation of human rights, giving the idea that drugs are not the vehicle responsible for violence and crime but instead the war against drugs is, as that pledged group usually says. The ED’s Forward doesn’t invite as it should the drug dependent to live without drugs, considering instead, between the lines, a “responsible use” and not less surprisingly attracts the world to follow the so original as promptly condemned example of Portugal and, likewise, decriminalize drugs too!

Who could have imagined this some years ago? After the ED’s speech, the model of society (in what concerns narcotic dependence), that always used to address the phenomenon in a winning optimistic and positive way, a society that would not allow drugs to be part of it, that used to carry the message that narcotic dependent behavior should always be considered unacceptable and marginal (the drug addicts used to feel uneasy on the streets), and would adopt regulation that makes life more difficult for those who decide to take drugs, surprisingly and unfortunately gave place to another model. A pessimistic, negative and ineffective one which considers utopian a society free from drugs, that doesn’t follow necessarily the goal of abstinence (in the name of compassion…), pretends above all to make the use of drugs less dangerous by making them more acceptable in society (narcotic dependents feel protected, not to say stimulated) and bases itself essentially on the concept of taking care of and supporting rather than reaching a cure – the unfortunately famous Portuguese one.

It is our understanding that contrary to what it is suggested on the last UNODC’s Forward, by the Executive Director Antonio Maria Costa (ED) we should not place health but welfare at the core of drug policy. As a matter of fact these are two completely different situations: if the key word for “health” is disease, the key word for welfare is discomfort.

Considering drug dependency a “treatable health condition” like Portuguese officials and the ED do, is another way to call it a disease – the ED labeled it countless times…”drug addicts need treatment as much as patients of chronic diseases such as cancer, diabetes and tuberculosis” (UNODC Annual Report – 2008). This opens the door to medical treatment and other harm reduction strategies, hiding that before the (un)health conditions are installed, before diseases like AIDS and other co-morbid situations are installed, there is an important panoply of other conditions much more related with psychological and social discomfort – personal and societal factors that drive the drug dependent into drug dependency.

Health problems are essentially consequences of a prior uneasiness felt by the individual. The disease model linked to “mainstream healthcare” prevents the correct scientific research of all these situations, a crucial research which could evolve into effective treatment.

Talking about “health problems” is to the public opinion the same than talking about”disease”-that-must-be-dealt-naturally-by-doctors.

But what is treatment? What can we interpret treatment to be? – This is the heart of the matter, the mother of all questions.
• Can the perpetuity of a called chemical dependency be considered a treatment?
• Can we interpret the massive 70% majority of dependents in substitute drug programs in Portugal to be an indicator of success, or are they just a deluding form of social control?
• Can dependents aspire to a life free of drugs?
• Can drug-free treatments do the job?

Deep underneath all these questions lies the fundamental one: Is the drug dependent a condemned victim of his own biology or can he work himself around that issue through the process of discovering himself and his will power?In other words, is drug dependency an incurable disease or is essentially a cognitive behavioral entanglement? This is the fundamental question and the answer to it is determinant in the choice of treatment to be approached and the politics to be drawn. As we can see in further detail later on, the society as a whole feeling dismissed of its obligations, keeps itself away from the scene, so perpetuating the discomfort, sorry, the “illness” of the drug addict!
“Harm reduction” strategies are used in Portugal – a country where drug dependency is officially considered a disease – as the main tool to fight drug dependency, as can be confirmed by such a high percentage of drug dependents in substitution programs. This means that those strategies are prioritized, much to the detriment of prevention and treatment. In political terms, this also means that, surely well intentioned, Portuguese officials understand that to treat the drug dependent is indeed a very difficult task and that the majority of them relapse one time after another when they try to stop using drugs.

So to the Portuguese people, drugs are awful and they are (poorly) persuaded to stayaway from them. But if someone is already using them, then… that’s OK, because they are “sick” and they don’t have any power to change that for the rest of their lives.  A letter we received some years ago from the Portuguese Prime Minister portrays
eloquently the situation and the Portuguese reality:
“…substitution treatment (methadone) that in the beginning were considered as just a means to achieve abstinence,have now been accepted as therapeutic maintenance programs, eventually definite in character, but that can in some cases work as a starting point for dependency liberation.”

UNODC’s 2008 slogan “use music, use sports, do not allow drugs to come into your life” had been in Portugal, in a symbolic way, replaced since 2001 by “use methadone, use buprenorphine, don’t allow drugs to abandon your life…!”
With a policy like the Portuguese one, Portuguese narcotic dependents feel more and more protected not to say stimulated. When they listen to their “drug czar” – Portuguese IDT and EMCDDA President’s thoughts: – “as a diabetic needs insulin, some people need an opiate”…”the demonization of drugs and the message that drugs kill is outdated”…”I am not a fundamentalist with drugs since people can live in balance with them”… “cannabis is not already seen as a gateway to other drugs” their soul disposition is not hard to guess – jumps of joy! More or less unconscientiously, policies like the these, give up helping drug dependent in their changing process on the way to abstinence and prefer to take care and support them.

Drug dependence as a chronic disease arises from this desistance process. It is pessimistic, negative and inadequate, and all in the name of “compassionate humanism”, and as we said before, does not lead to abstinence.

But does abstinence work? Even if the regular citizen and drug therapists experience did not tell us that abstinence and spontaneous remission are familiar realities, a well known study revealed that people who completed successfully a treatment program (even if one year only after the beginning of the abstinence) reduced 60% illicit activities. The sALE of drugs fell close to 80%, imprisonment decreased more than 60%, drug dependents without a roof decreased to numbers close to 43%, dependence to Social Institutions fell 11% and finally the employment increased 20%. (National Institute on Drug Abuse, Drug Abuse Treatment Outcome Study (1997); Department of Health and Human Services, National Treatment Improvement and Evaluation Study (1996).

“Health at the core of drug policy” like has been done with an excused rigor since 2001 in Portugal is now also stated by the ED? False medical therapies have been used by successive governments not only in Portugal as a smoke curtain behind which have been hidden some of the most pressing problems that sicken our societies.
By transferring it to the authority of medical profession, they have successfully managed, so far, to transform political problems (that can not be resolved in a commission time…) into medical problems requiring specialized medical intervention, depriving us as society of the responsibility of an accurate and correct research of the true causes of entering and exiting drug dependency.

But is “drug addiction a treatable health condition”? It is very sad and worrying when the noble science of Medicine is emphasized as the solution for drug dependency. People must understand that what drug addicts really need is psychological help, not medical (while medical doctors can prescribe medicines, psychologists “prescribe” psychotherapy). To send away the indispensable psychologists with their fundamental emotional control strategies and skills to avoid the situations that lead to drug abuse, is to open perversely the door to the fantastic paraphernalia with which doctors usually feed (the Government calls it “treating”) the “disease” – syringes, needles, methadone, buprenorphine, condoms, etc. – with the aid of large staff on the street, ingloriously and willingly doing their best to care drug abusers.

This is the case happening in Portugal. If instead the world understands the phenomenon less like a disease (of the will or whatever) and more like a psychological state, a way of dealing with life, if people understand that what those unfortunate people need is a reason to live and for this purpose doctors (as ourselves) can offer nothing, a decisive step forward will be performed.

When the ED states that “we have developed scientific, yet compassionate, new ways to help those affected” we agree that we must go on searching new ways of scientific research but as we stated previously, oriented in a different direction. In a direction that can help us better understand the discomfort or the privation of well-being induced by the unhappy situations that are mostly responsible for drug users to fall into the drug dependency.

Not the current research that tries to find out (with the disguised enthusiasm of pharmaceutical industrials) biomedical/bio-chemical reasons for one essentially cognitive-behavioral phenomenon. Betting on this “treatable health condition” betting on this conveniently shy disease conception of drug dependency, Governments like the Portuguese do not understand that on dependence people “get in”, while on the disease people “fall”. As a result, drug dependents go on pretending they are sick and the government goes on pretending they are treating them! That is the very thing.

This is turning political problems into medical ones, like sweeping dust under the carpet, pretending to recover people by patting them on the back and allowing them to maintain the same addictive pattern… This is neither humanization nor compassion.

What is indeed human and compassionate is the urgent creation of a new paradigm to the drug dependency phenomenon – the creation of a culture of observation, the creation of a new culture where one would look at the drug dependent instead the drug dependency. Attentions should be directed to individual´s health, social, familiar, economic and psychological idiosyncrasies thus leaving the “one size fits all” model and returning to tailor-made hand giving that makes him or her finally feel… like a human being. That would be the real work, the decisive one on the way to the drug dependents and their families welfare. That would be the real work, the decisive one to cure the drug dependent of his “disease”.

We can resume by saying that in philosophical terms, to confuse the concept of “treatment” with the concept of “social control” as nowadays is done in Portugal is an incorrect attitude. In psychological terms, to convince drug dependents that their metabolism is unbalanced and that they have to maintain it dependent of anopiate as methadone, buprenorphine or any another, instead of fighting for their autonomy, is distorting and deluding. Any policy that drives a significant fringe of its society to a situation of defeat or inability to fight for its growth and personal development is unethical.

Jail
“Slowly, people are starting to realize that drug addicts should be sent to treatment, not to jail” expressed the ED on the UNODC’s Forward.  Most respectfully, this is another unhappy statement by the ED, that if adopted by the international community as it was already in Portugal, can be very harmful as well.

Firstly, as we said before, this opens a precedent as it clearly invites other countries to do the same that Portugal did, to decriminalize the consumption, the possession and acquisition of drugs. And what is more extraordinary, is that it sounds like a prize to a country that did it with very bad results against the rest of the world and against UN Conventions that the ED represents…!

The APLD can imagine everyone who is wishing to legalize drugs clapping their hands vibrantly – Mr. Soros, Mr. Nadelmann, Mr. Trebach and relatives must feel very happy indeed, with their abstruse goal getting a little closer…

By the way, we remember when that happened in our country Portugal in July 2001, United Nations INCB was fast, as it should, to condemn our original attitude – we were the only country in the whole world to do it! Secondly, it is a nonsense and an incongruity. Who wins by weakening drug laws?

Is it not true that like the ED several times stressed out, “the rule of law” is one (the main one?) of the three pillars where any winner drug addiction policy, and not only, should sustain on? “We are slaves of the law in order to be free” said Cicero (106 aC-43 aC). He did not mention any exceptions!

Don’t send drug addicts to jail? To legalize crime committed by drug dependents (or by “patients” – sic) doesn’t seem to be the most effective way to fight it. As a matter of fact (and as we’ve mentioned before) in our country, since decriminalization has been implemented in July 2001, the number of homicides related to drugs has increased 40%. It was the only European country with a significant increase in (drug-related) homicides between 2001 and 2006.  (WDR- June 2009).

Confirming national and international official data, a recent report commissioned by the IDT, the Center for Studies and Opinion Polls (CESOP) of the Portuguese Catholic University, based on direct interviews regarding the attitudes of the Portuguese towards drug addiction revealed that 83.7% of respondents indicated that the number of drug users in Portugal has increased in the last four years, 66.8% believed that the accessibility of drugs in their neighborhoods was easy or very easy and 77,3% stated that crime related to drugs had also increased.(IDT “Toxicodependências” No. 3, 2007).

What is happening in Portugal is very peculiar; drug dependents, with the support of the government since 2001, rely on their status as “sick people” to not be punished for their crimes. The same is to say that they do crimes but they are not criminals because they are drug dependents… But then afterwards, these addicts forget that they are “sick” and are assumed as free and responsible people who are able to decide whether they want treatment or not!

After the decriminalization in Portugal, the law punishes only when another illicit act is added to the effect of use, which works almost every time as attenuation. The example of Portugal shows clearly that facilitating access to drugs, will not be the way to reduce the use, the decrease of drug dependencies or related crime.
In considering, through decriminalization, the drug dependent as a patient and not as a delinquent, the State cannot then choose, through a policy which prioritizes “harm reduction” measures, to feed the “disease” instead of healing it.

But people may wonder; must drug dependents be sent to prison? Of course, if they commit a crime within a certain penal frame, a crime that deserves that type of punishment, yes they must go to prison like any other citizen. Is the prison the right answer to the drug dependent problem? Although it might seem strange, yes it can be. First of all, if the drug dependent is not only a user but is also someone who carries drugs to deliver/sell to others, then yes, he deserves and he must go to the jail. What happens in Portugal – the most liberal country in the world where any citizen, as we’ve said before, is allowed to carry drugs up to a ten day supply, so being considered for personal use only, thus not being considered a dealer, and punished only with a fine – is a perfect absurdity. No one in a civilized society should have the “human right” to harm his neighbor.

Secondly, it all depends on the prison policy system. if, as is the case in Sweden where one has a nearly perfect system that really treats the criminal drug dependent in a drug free program, with a wilful multidisciplinary team taking advantage of possessing the most important tool to help someone in his recovering process – Time, they have it in a large amount – and using it properly, then yes, it can be good. We can even go farther and say, that it can be a blessing to be arrested, to stop the dependency and to rehabilitate oneself.

In Sweden they do not feed drugs to drug dependent prisoners as it happens in Portugal, Spain – where needle machines and shooting rooms are available (in Portugal the Government has been trying every year without success – much to officials surprise and anger, for the last two years, although a nurse has been patiently available 24 hours a day, not even one prisoner has required it ever…) and a few more ingenuous countries. In Swedish prisons, drug needle machines and shooting rooms are not available and hopefully, they never will be. There’s the understanding that if you cannot make a prison a drug free place, how on earth can someone even imagine that would succeed anywhere else?!

By using drug detection dogs, searching visitors as well as staff working, the Swedish system gives the first step to clearly indicate that drugs are not welcome. Drug detection dogs are available at almost every prison in Sweden.
There are drugs in Swedish prisons as it happens in the rest of the world but at least there are very serious efforts in order to get rid of them. In Sweden, when drug dependent prison inmates leave the prison, they have less chances
to return back by drug dependency reasons. They do their best to care and rehabilitate the human being and they do not use drugs to treat drug problems.

Human rights
”Above all we must move human rights into the mainstream of drug control.”
(UNODC’s Forward) Before starting to discuss the problem of human rights, the first question we should point out is; from what point of view are we interested to discuss this so controversial subject? The economic? The political?
The legal?

Or are we going to discuss above all the drug dependents and their families’ so precious welfare? Considering that the reader elected this last one, if there is a correct understanding of it, then one should be absolutely familiar with commentaries like the one from “Sandra”, a former drug dependent, one among millions in drug rehabilitation centers throughout this world: “If it was not so troublesome for me being a drug dependent, I am sure that I would not have cured myself. If, everyday, when I’d wake up, I knew that it was easy for me to get my drug of choice without any worries, I am positively convinced that I would not be able to stop using it ever. The opposite should happen. Drugs are like that”.

People should understand that this statement is the real paradigm of the drug dependent thought – everything he/she needs, is definitively not more drugs, available or not, in the name of their “human rights”. What he/she wants, what he and she are begging for is help to escape that “life” the circumstances dropped them in. If anyone has any doubts about this, please make an enquiry and ask them what they’d prefer: a costless and painless drug free program versus more drugs, and listen to the answer!

So addressing the question: In a free society, shouldn’t everyone have the freedom to do what they want with their body since that does not harm any third party? Answer: no. First of all, although the individual could be free when he begins using drugs, once he gets dependent, he looses that freedom immediately. The consumption, becoming imperative, ends-up subverting the rules of any society, no matter how authoritarian that society may be.

Secondly, we all are gregarious by nature. In modern societies nobody can be an island, we all depend upon each other. To the alcoholic or to the drug dependent, the surrounding ambience – the husband/wife, the children, the neighbour, the friends, the co-workers, the society in general – shall always be affected by his/her deviant behavior. Not to mention the suffering of the families, often greater than the dependent’s own suffering, because adding to their own sorrows and suffering they are punished as well by their relative’s drug problems. That is why, regarding the collective, each and every individual ought to always subordinate to limitations, which mean that living in society implies to accept restrictions to individual liberty.

As it was said by the, so considered to be, father of the modern liberalism, the English philosopher John Stuart Mill (1806-1873) in his classic “On Liberty”, in 1859:
“Over himself, over his own mind and body, the individual is sovereign… …The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others…”

It is a fact that drugs destroy the brain structure that allows us to decide freely. And free decision making is the pillar of man’s dignity and man’s right to assume responsibilities. In being enslaved to drugs, man is discarding his most fundamental right: the right to control his own actions. Man has the right to his free decision making abilities. Furthermore – in being indebted to do it in a responsible way, he cannot escape that obligation. And drugs reduce or retire him from that right of free choice.

So, we can affirm that human rights are incompatible with drug abuse. Consequently, politic officials have the moral and civil obligation to protect them. Each and every policy that undermines human rights, each and every policy that supports, encourages and promotes the use of drugs, questions essential values like health and safety and violates established rights. Each and every policy that allows one significant part of the population to remain enslaved chemically and psychologically by drugs, is a cruel and inhumane one, and must not be accepted.
Let’s make it clear; sometimes people do not understand, or pretend not to, that drug abuse aggravates social and emotional misery and undermines human rights. By facilitating drug consumption, addicts such as all the “Sandras” in the world are being neglected and penalized.

If society as a whole, doesn’t emerge in refusal of the concept that it is a human right to take drugs, one of these days we could be waking up in a world where the common understanding is that… the marginal ones, are those who do not use them! As someone once said, the message should be explicit: “It is in our best interest to help find solutions for drug dependency, not to let the dependents destroy themselves and all those around them!”

One may ask people who use the human rights argument to reach the goal of legalization, if, to their understanding, legalization would make drugs become less available? Would then they be less attractive? Or be less addictive? Would they raise productivity? Or diminish road accidents? Diseases? Crimes? Can it ever be the solution the drug dependents and the world are expecting it to be? Can it solve these problems? There is no need for expertise in this subject to understand that legalization, sustained by the human right to use drugs, definitely is not the best way to protect and improve the wellbeing of the individual and society. It is definitely not the most intelligent way to protect public health and to offer security and a balanced approach to the drug problem. Very often when we think about the drugs market, we forget what is primary and secondary.

The fact that Mother Nature produces plants like poppy, or that international crime cartels took property of drug distribution, is not a primary factor. The primary factor is that millions of people are ready to break the norms and rules for the goal of using drugs, be them natural or synthetic – most of these people are children, they’re young people! We dont have to read the declaration of children’s rights to understand that, as a responsible society we have the obligation to protect them and to not allow those who carry drugs destroy them.

“Legalize drugs and send the dealer to unemployment” we very often hear. Concerning this, there is a lot of misconceptions about the drug seller role. Most people have the misconception that the classic “dealer” – that evil guy we see on movies usually in black clothes – is the entity responsible for a considerable amount of the miseries drugs carry to our youth. Eventually for them, were drugs to be legalized, the consequent free market of drugs
could definitely put them out of business and consequently children released from their influence could recover their normal lives and perspective a better future.
Unfortunately, anyone who studies the problem with any accuracy knows that the reality is very far from that. In real life what happens is that, the very first accountability for the very first contact with drugs is…mine, yours. It concerns most of our beloved ones, as well as our regular relatives and friends. They’re the ones who naively and without dimensioning properly or understanding what they are really doing, want to share – since they feel good using them – through friendly complicity with their beloved ones, the source of their ever ready easy way to “happiness” – in the beginning drugs feel good, if they didn’t, they wouldn’t be the problem they are and we would not be speaking about them now.

The classic “dealer” usually appears later on when the dependence is already well established and/or when they feel that someone wants to stay clean. Then, has it happens a lot of times, they come very nicely and give their product money free, as the “good friends” they are. With this bit of knowledge, the reader who has the responsibility to raise his children, can now easily understand why for us, the ED’s statement ”Above all we must move human rights into the mainstream of drug control”, is so, to say the least… hugely polemic!

Shall prevention strategies acting by dissuading the youth from drug use, be considered at any time obstructive or oppressive of human rights? No they can´ t. Not for the drug user, nor for all those around him or her. In the name of liberty, solidarity, equality, democracy, human dignity and…human rights, we all, be us children or adults, have the right to grow up in drug free places. To treat the drug dependent (inside or outside prison) is not a question of compassion. It is a question of love for his neighbor, a question of respect for human rights.

AWe are afraid that moving human rights into the mainstream of drug control, as the UNODC’s ED proposes, might be scarily similar to Goethe’s (1749-1832) pessimistic prescience anticipating the “humanist medicalization”.
He wrote: “I believe that in the end humanitarianism will triumph, but I fear that, at the same time, the world will become one big hospital, with each person acting as the other´s nurse”.
(J.W. von Goethe, “Letter to Charlotte von Stein” (June 8, 1787) in Gedenkausgabe, 11: 362. – Szasz, T. in Pharmacracy, Syracuse, 2003, pag 165.)

Manuel Pinto Coelho August 4, 2010

A Blueprint to build strong Foundations for Change.
Professor Carlo DiClemente’s Stages of Change model is feted worldwide for enhancing the understanding and skills which make a substance-abuse treatment provider effective. It helps clinicians develop thoughtful, individually tailored, scientifically grounded treatment plans – here he extends it to policy and programmes.
This article was originally published in Addiction Today journal, March 2005. As we prepare for new – and hopefully more progressive -policies to address addiction treatment, this information is increasingly relevant.
Research tells us that central qualities of the effective clinician are empathy, warmth and positive regard. It also tells us that developing and implementing a clearly articulated treatment plan and providing treatment for the problems a client presents are effective skills. But putting these qualities and skills into action is a challenge.
How does an individual clinician learn to express these central human qualities of caring and compassion with clients who are often difficult and unhappy about being in treatment, and whose central disorder is often characterised by behaviours which do not easily elicit empathy? And given the incredible heterogeneity among substance-use clients, how can a clinician develop a personalised treatment plan grounded in science?
Further, how can we apply those same principles to other workers in the field of substance-use treatment, including members of drug/alcohol action teams? Is there a common framework? Can the process of change be applied at a systemic level as well as at an individual level?
We answered these questions at ARF’s UK/European Symposium on Addictive Disorders in London (where photo on this page was taken). But let’s open up the issue… Deepening our understanding of addiction can also deepen our understanding of the implications for policy and programmes. It can let us see that we need a common framework – such as Models of Care – and a common assessment tool, which has eluded drug/alcohol action teams, to their increasingly vocal frustration. Deep understanding of what our clients are all about, and the meaning of what we are doing, can lead us to a conceptualisation of the entire process of change and the entire continuum of care.

WHAT IS THE STAGES OF CHANGE MODEL?

Developing genuine understanding of – even empathy for – a client requires professionals to look beyond that client’s behaviour when using alcohol or drugs, and to understand the nature of substance-use disorders and difficulties inherent in changing long-standing, pervasive patterns of thought and behaviour. They are helped in this by the ‘stages of change’ model, combined with a good treatment plan.

The current model posits five stages of change:
o precontemplation
o contemplation
o preparation
o action and
o maintenance.

People in the first stage show no sign of intent to change a problem behaviour, be it because of a lack of awareness, unwillingness or a lack of hope because previous attempts failed. Contemplators are more visibly distressed about their problem behaviours than precontemplators and have begun to weigh the positives and negatives of change.
The preparation stage covers people who are ready to change both attitude and behaviour, and to change soon. When people are in the action stage, behaviour change has clearly begun. So they need skills to implement specific change methods. They also need to be aware of the psychological – cognitive, behavioural and emotional – events which can work against their best efforts. And they need to learn how to prevent major reversals, such as having a relapse and returning to pre-change patterns. The action stage lasts an average of about six months.
The last major stage of change is maintenance, where people sustain and strengthen improvements they have made. They can take a few years to eel “secure”.
_____________________________________________
“The stages of change are a model of ‘how to think’
rather than ‘how to do’…
They describe attitudes, intentions and behaviours
related to tasks of change”
_____________________________________________
All of this is voluntary rather than coerced change. Indeed, the stages of change are a model of “how to think” rather than “how to do”. They describe attitudes, intentions and behaviours related to the tasks of change. Note that the “change” sought is specific: commitment to change one behaviour might say nothing about commitment to change a related behaviour. And each stage refers to a time period and to tasks which a person or organisation must complete before moving to the next stage.

COMMON CHARACTERISTICS

Let’s look at the commonalities of clients in the five stages of change – then readers can draw their own conclusions as to the similarities at a systemic level for change in our field.
The common characteristics of people in the precontemplative stage are: defensive, resistant to suggestion of problems associated with their use/ behaviour, uncommitted or passive in treatment/work, consciously or unconsciously avoiding steps to change their behaviour, lacking awareness of a problem, often pressured by others to change, feeling coerced and ‘put upon’ by significant others.
The characteristics of contemplators of change are: seeking to evaluate and understand their actions, distressed, desirous of exerting control or mastery, thinking about making change, have not begun taking action and are not yet prepared to do so, many previous attempts to change, evaluating pros and cons of their behaviour and of changing it.
Now we come to the preparation stage, where people: intend to change their behaviour, are ready to change attitude and behaviour, are on the verge of taking action, are engaged in the change process, are prepared to make firm commitments to follow through on the action option they choose, and are making or have made the decision to change.
Common characteristics of people in the action stage are that they have: decided to change, verbalised or otherwise shown a firm commitment to change, tried to modify behaviour and/or environment, demonstrated motivation, and are willing to follow suggested strategies and activities for change.
And what do we share at the maintenance stage? Characteristics are: working to sustain changes achieved to date, focusing considerable attention on avoiding slips or relapses, feeling fear or anxiety about relapse and facing high-risk situations, and less frequent but often intense temptations to return to old habits.

MOTIVATIONAL STRATEGIES to promote change include giving advice, practising empathy, removing barriers, providing feedback, providing choice, clarifying goals, decreasing desirability of unhealthy habits, and active helping.
CLINICAL STRATEGIES for people in the action stage include maintaining engagement in the change process/treatment, supporting a realistic view of change through small successive steps, acknowledging the difficulties, helping people to identify high-risk situations through a functional analysis and developing coping strategies to overcome these, helping people to find new reinforcers of positive change, and helping people to assess if they have strong support networks.
Clinical strategies for people in the maintenance stage include helping them to identify and sample drug-free sources of satisfaction, supporting lifestyle changes, affirming people’s resolve and self-efficacy, helping them to practise and apply new coping strategies to avoid a return to unhealthy habits, and maintaining supportive contact.

TREATMENT/ACTION PLANNING

Based on information gathered during assessment, this is created in collaboration with each person wishing to change and addresses mutually agreed goals. It serves a variety of purposes, including prioritising short- and long-term goals, choosing the optimal interventions for specific goals, identifying barriers to the achievement of goals, and monitoring progress towards goals over time.
For our new purposes, goals can be as much on a national or local level as they can be on a personal level. They can include decrease in or cessation of substance use, which can impact on other goals such as improving family and employment situations, extending social support networks, and returning to school or college. One obvious benefit of prioritising goals is that attention is focused on the most pressing problems.
Another is that successes in these main areas often place people in a better position to address secondary goals.
It is important to recognise the treatment/action plan as flexible and changeable. Unexpected needs or problems can arise. Some goals might depend on others. Some might take longer than anticipated.

Common features of treatment plans include:
o developed as a result of a comprehensive assessment and modified over time as warranted
o reflects participation from appropriate disciplines – medicine, psychiatry, psychology, social work or vocational rehabilitation – as warranted
o reflects the person’s presenting needs and specifies their strengths and limitations
o consists of specific goals which pertain to the attainment, maintenance and/or re-establishment of physical and emotional health
o identifies specific objectives which relate directly to the treatment/change goals
o specifies the frequency of treatment/change contacts
o includes provisions for periodic re-evaluations and revisions, as needed, of the plan, and
o identifies criteria for determining if goals have been achieved, as well as for terminating change.
Some qualities of well-formed treatment/change goals are that they are: salient and meaningful to the person or organisation wishing change, incremental and so more manageable, concrete, specific and behaviour focused, able to increase desired behaviours, realistic and achievable, seen as requiring work and effort, and are appropriate for the projected change period.

FUTURE DIRECTIONS
In addition to its popularity with many addiction counsellors and researchers, the stages of change model should prove useful in tracking and predicting change. Most people have followed problematic paths over many years and made multiple attempts to change before being successful. They get stuck at certain points in the process of change and invest more time and energy in not changing than in activities to promote change. There is an ebb and flow, and important, distinct tasks which mark the process.
People can move forward and backward through the stages, and they can do so quickly. Their tasks involve a number of dimensions – motivation, decision making, efficacy, coping activities – which have an ongoing influence on the change process, can be accomplished quickly or slowly, and can be done more or less completely. These stages of change seem to resemble the stage dimensions of personality development proposed by Erickson in 1963.
Moving through change does not appear to be a case of doing more of the same thing, but instead doing the right thing at the right time.

There is also a growing body of literature which appears to support the relationship of stages to important outcomes.
One advantages of model is that the process of change is assumed to be the same for substance-abuse problems as well as other life problems.

It has been applied to changes related to many behaviours, including anxiety, medication compliance and health protection. The stages cover considerable ground, since the process of intentional behaviour change is central in the life of an individual, with major implications for growth and development.
There are few models which can be applied to such a variety of behaviours with such consistent results… Let’s change together.

Source: Addiction Today Aug.1st 2010

July 30, 2010

We have been monitoring ALL scientific research on marijuana/cannabis since about 1994 (and before that we purchased reference material from NIDA of all previous scientific studies). My husband is a nephrologist and clinical pharmacologist and my son is a rheumatologist. Both of these medical specialties require a depth of knowledge of pharmaceutical drugs that far surpasses that of most other subspecialties. One of the most important aspects of prescribing drugs of any sort is knowing the potential side effects and knowing how the drug will interact with other drugs or foods the individual may be taking. Every person is unique and drugs that are benign to one individual may be deadly for another. Penicillin is an excellent example because though it has saved millions of lives, it is also deadly for some. To date there are more than 20,000 published studies on marijuana and none of them offer proof of its safety or efficacy. That being said, I am attaching a file of documents relating to marijuana being a leading cause of drug-related emergency room episodes.

Fifteen years ago I attended a medical conference in Auckland, NZ with my husband. The doctor sitting next to me at dinner asked what I do. I told him that I was the unpaid head of a non-profit drug prevention organization. He said he didn’t think NZ had a drug problem. The doctor sitting across from us interjected that not only did NZ have a drug problem but that it was impacting the medical system. He said that he was head of the psychiatric unit at Auckland’s main hospital and that he would venture that at least 50% of those admitted for emergency psychiatric problems were there because of marijuana. I had heard that marijuana could cause psychiatric problems because two individuals I knew had kids who would go “round the twist” as they say in Auckland, whenever they smoked pot, and would end up in psychiatric care, but I had no idea is was that severe.

Then, about ten years ago, just after my husband became director of transplant for Legacy Hospital Systems, we went to dinner with one of the administrators and his wife. The wife asked what I do and I told her. She then volunteered that she was head of a triage unit in a psychiatric ward at another hospital and that it was her opinion that at least 65% of those admitted for emergency psychiatric problems were there because of marijuana.

re ingesting cannabis. One does not always know the potency of the cannabis being used or how much is in the product. Below is an exchange between a doctor who ingested “space cakes” and the editor of High Times Magazine. You will see that Ed Rosenthal (then the editor) acknowledges that marijuana can cause problems for even experienced users.

Marijuana is such an insidious drug that it may be years before we see the full extent of its potential to do harm. But a couple of things I think are VERY important and that is that marijuana has become a major factor in infertility (see Science Magazine for starters), and it destroys brain cells.

I am also attaching a document put together in 1999 (when there were only about 10,000 studies on marijuana) by a drug prevention specialist out of Canada. This document is called The Marijuana Connection and it categorizes the studies by side effect.

Source: Marijuana Research Review July 2010

Constituents of Cannabis Sativa L. (Marijuana)

In a document entitled “Constituents of Cannabis Sativa L. (Marijuana)” published by the University of Mississippi, Research Institute of

Pharmaceutical Sciences, Department of Pharmaceutics” (Ross SA, Elsohly MA. Constituents of Cannabis Sativa L. XXVIII A review of the natural

constituents: 1980-1994. J. Pharm Science. 1995;4:1-10, it states that marijuana contains 483 substances, 66 of which are cannabinoids. No

other plant contains cannabinoids.

Up to January, 2001, over 15,000 scientific papers have been published on cannabis and its constituents and many reviews have been written on

cannabis constituents and cannabinoid chemistry. A total of 483 natural constituents have been isolated and/or identified in Cannabis sativa

L., and they have been delineated as follows:

Cannabinoids 66
Nitrogenous Compounds 27
Amino acids 18
Proteins, Glycoproteins, Enzymes 11
Sugars & related compounds 34
Hydrocarbons 50
Simple Alcohols 7
Simple Aldehydes 12
Simple Keytones 13
Simple Acids 21
Fatty Acids 22
Simple Esters & Lactones 13
Steroids 11
Terpenes 120
Non-Cannabinoids Phenols 25
Flavonoids 21
Vitamins 1
Pigments 2
Elements 9

During the last quarter of the 20th century recreational use of
cannabis increased greatly across the world.1 Cannabis consumption
came to be seen as a normal leisure activity, and was regarded
as safe even by the medical establishment.2 However, in recent
years there has been considerable controversy over the use of
cannabis, with, for example, the UK government repeatedly
reviewing its safety.3 This concern has arisen from large prospective
epidemiological studies which have reported that use of
cannabis increases the risk of schizophrenia-like psychosis.4,5
However, these studies have not collected detailed data on the
patterns of use or potency of the cannabis used, which may be
important factors moderating the associated risk.6
The principal constituents of cannabis are D9-tetrahydrocannabinol
(D9-THC) and cannabidiol. The former is the main
psychoactive ingredient and in experimental studies it produces
transient psychotic symptoms and impaired memory in a dose dependent
manner.6,7 In contrast, cannabidiol does not induce
hallucinations or delusions, and it seems to antagonise the cognitive
impairment and psychotogenic effects caused by D9-THC.6
Until the early 2000s the most freely available type of cannabis
in the UK was cannabis resin (‘hash’), which had approximately
70% of the ‘street’ market, followed by traditional imported herbal
cannabis and then sinsemilla (‘skunk’). Cannabis resin contains
2–4% D9-THC and a similar proportion of cannabidiol, whereas
herbal cannabis contains a similar percentage of D9-THC but no
cannabidiol.8,9 However, sinsemilla (skunk) has increasingly taken
over the UK market and its THC concentration, and to a lesser
extent that of imported herbal cannabis, has been consistently
rising. For example, seizures of cannabis on the streets of England
in 2008 by the police showed that sinsemilla had a market share
of more than 70%, and had reached a D9-THC concentration of
12–18% with virtually no cannabidiol.8,9

Smith has suggested that such high-potency cannabis might be
especially harmful to mental health.10 We therefore compared
patterns and types of cannabis use in people experiencing their
first episode of psychosis and in a healthy control sample.
Specifically, we sought to test the hypothesis that daily use of
high-potency cannabis is associated with a particularly high risk
of psychosis.

Method
Sample
We approached all patients aged 18–65 years who presented with a
first episode of psychosis to the Lambeth, Southwark and Croydon
adult in-patient units of the South London & Maudsley Mental
Health National Health Service (NHS) Foundation Trust between
December 2005 and October 2008. We validated clinical diagnosis
by administering the Schedules for Clinical Assessment in
Neuropsychiatry (SCAN).11 Patients who met ICD–10 criteria
for a diagnosis of psychosis (codes F20–F29 and F30–F33)12 were
invited to participate in the study; cases with a diagnosis of
organic psychosis were excluded. During the same period we
recruited a healthy control group (n = 174) from the local
population living in the area served by the Trust, by means of
internet and newspaper advertisements, and distribution of
leaflets at train stations, shops and job centres. Cannabis was
not mentioned in these advertisements. Particular attention was
directed to attempting to obtain a control sample similar to the
patient sample in age, gender, ethnicity, educational qualifications
and employment status. Those who agreed to participate were
administered the Psychosis Screening Questionnaire,13 and
excluded if they met criteria for a psychotic disorder or reported
a previous diagnosis of psychotic illness.
Ethical permission was obtained from the Trust and the
Institute of Psychiatry research ethics committee. All study
participants signed a consent form allowing publication of data
originating from the study.

Background
People who use cannabis have an increased risk of
psychosis, an effect attributed to the active ingredient D9-
tetrahydrocannabinol (D9-THC). There has recently been
concern over an increase in the concentration of D9-THC in
the cannabis available in many countries.

Aims
To investigate whether people with a first episode of
psychosis were particularly likely to use high-potency
cannabis.

Method
We collected information on cannabis use from 280 cases
presenting with a first episode of psychosis to the South
London & Maudsley National Health Service (NHS) Foundation
Trust, and from 174 healthy controls recruited from the local
population.

Results
There was no significant difference between cases and
controls in whether they had ever taken cannabis, or age at
first use. However, those in the cases group were more
likely to be current daily users (OR = 6.4) and to have smoked
cannabis for more than 5 years (OR = 2.1). Among those who
used cannabis, 78% of the cases group used high-potency
cannabis (sinsemilla, ‘skunk’) compared with 37% of the
control group (OR 6.8).

Conclusions
The finding that people with a first episode of psychosis had
smoked higher-potency cannabis, for longer and with greater
frequency, than a healthy control group is consistent with
the hypothesis that D9-THC is the active ingredient
increasing risk of psychosis. This has important public health
implications, given the increased availability and use of highpotency
cannabis.

Source: The British Journal of Psychiatry (2009)
195, 488–491. doi: 10.1192/bjp.bp.109.064220

A report of a recent heroin prescription trial in Britain published in the Lancet (29th May 2010) was widely promoted as a success. The fact is that for a very costly intervention a surprisingly small minority got off street heroin.
Of the 43 clients that received a heroin dosage of 450mg twice a day plus a nightly oral methadone supplement over a 26 week period, just 5 of them managed to get off street heroin. Hardly a measure of success.
That means that the remaining 38 although they decreased their consumption of street heroin (hardly surprising) are still involved in the illegal heroin market, and still involved in the crime, harm and misery related to it.
Regardless of the at best mixed results, the authors make the following recommendation based on their study: “UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts.” This is not the way policy making should be informed.
It would be a surprise if a free handout of 900 mg a day of heroin would not decrease street heroin consumption to some extent. What is a significan and surprise finding is that even when offering free heroin, the program has such a limited impact on the use of street heroin.
The cost of heroin prescription per client is estimated to be about €18.000 a year, far more than for other treatment options. The UK government has spent about €700.000 on two heroin trials last year.

Misleading media reports

Reports in the press pretend that the project kept people “off street drugs”. That is stretching the truth quite a bit. This is how Reuters (Reuters Health) quote the researchers: “Prescribing heroin to addicts who can’t kick their habit helps them stay off street drugs, British researchers said Friday”, under the headline “Prescription heroin helps addicts off street drugs”. This is clearly misleading, and it reflects badly on the researchers that are clearly unable or unwilling to present a correct picture of their results.
The clients were measured on their reduction of street heroin, not other drugs. They were in fact not even tested for other drugs. For a specialist in drug treatment and for health politicians this is not very helpful. Drug addiction must be seen as a whole and not as unrelated consumption of various substances.
Associated Press reports that “Some heroin addicts who got the drug under medical supervision had a better chance of kicking the habit than those who got methadone, a new study says”, under the title “Study: heroin better than methadone to kick habit”.
First of all, to “kick the habit” means to get off the addiction. But the aim of the trial was not to get people off addiction. It did not even measure that. Second, the study does not say that treatment with heroin is better than methadone, it suggests that for some hard to treat/reach clients (5-10% of the heroin addicts) heroine may give better results. For the vast majority of problem heroin users methadone would be more suitable.
To see such inaccurate and misleading reporting by the world’s two most serious news agencies should worry everyone who is interested in how science is translated. Much of the responsibility should however lie on the researchers since they presumably were given the text for verification before release. In any case one would expect the researchers to immediately ensure that the grossly misleading reports were corrected.

“A ripple of excitement”?

The journalists’ reports lack precision and insight; the researchers however seem to have engaged in pure spin.
Professor Strang is quoted by The Independent in an article from September last year that the “the findings have sent a ripple of excitement through the addiction treatment community, which is unused to seeing progress with hard core addicts.” The researchers claim they have uncovered “”major benefits” in cutting crime and reducing street sales of drugs”.
See Kathy Gyngells blog at Centre for Policy Studies from September last year where she reports on some of the spin behind this affair while searching for the facts behind the “excitement”.
How is it possible to be positively surprised about these results, one may ask. Anyone would understand that if you give addicts heroin they will not have to buy it. The surprise is that so many of them continue to buy street heroin nevertheless.

Moralism, determinism and a bit of science

The biased approach of the researchers gets even more evident by reading the quote by Thomas Kerr, one of the researchers. He is director of the Urban Health Research Initiative at the University of British Columbia in Vancouver. He says to Reuters “I would argue it’s completely immoral and unethical to fail to treat those individuals and to allow them to suffer and allow the community around them to suffer”.
The first question to consider is if this is at all treatment. Treatment per definition should address the addiction and the health problems. This does not. If anything, it is primarily crime prevention. If treatment was paramount then why are treatment outcome indicators not measured? Their findings of psychosocial benefits are only anecdotal.
Second, the term, “allow them to suffer” assumes that their suffering is caused by “street” heroin and relieved by prescribed heroin. This represents a very narrow and simplistic understanding of the harm and problems related to addiction and drug use.
The researcher seems wedded to the myth of the demon drug. A basic social profile of the 43 clients would show that a host of social and psychosocial problems was well established before the drug problem and the addiction became the dominant issue.
Kerr question may therefore be turned around: Is it not equally “immoral and unethical” to fail to treat those individuals’ underlying problems and “allow them to suffer and allow the community around them to suffer”?
Why is it apparently more moral and ethical to substitute street heroin with prescription heroin and thereby reducing crime levels than actually treating their addiction and underlying social problems?
Do they know what addiction is?
The researchers seem to display a profound lack of understanding of what addiction is. Strang says the results shows they have “turned around” the users drug problem. “Turned around”? What happened with the few people that started to use less street heroin and more prescribed heroin cannot be called a turnaround. Some of them would commit somewhat less crime and spend a bit less time running for the next fix. Some contact is established. But where is exactly the “turnaround” in terms of the addiction and health problems? Their drug problem is not turned around and certainly not the addiction.
What this trial illustrates is the limitations of such harm reduction measures rather than its strengths. It also illustrates how scientific results may be distorted and misleading, possibly intentionally. Heroin prescription may have some benefits for some people, but they appear to be very limited, very costly and we know too little about it to make a judgement anywhere near what the researchers did in this case.
The simple question remains: what exactly is the treatment objective? What is the health related benefit? And where is the continuum of care and treatment? The programme has managed reach this very difficult group that is hard to reach and hard to treat. A politician would ask: OK, you’ve reached some of them, so what do you do?

Source: Report by Anders Ulstein, Updated 12.06.10 , published by Drug-Watch International
The study is called “Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial”, written by John Strang and colleagues.

Background

The associations between age of onset of cannabis use and educational achievement were examined using data from three Australasian cohort studies involving over 6000 participants. The research aims were to compare findings across studies and obtain pooled estimates of association using meta-analytic methods.

Methods

Data on age of onset of cannabis use (<15, 15–17, never before age 18) and three educational outcomes (high school completion, university enrolment, degree attainment) were common to all studies. Each study also assessed a broad range of confounding factors. Results

There were significant (p < .001) associations between age of onset of cannabis use and all outcomes such that rates of attainment were highest for those who had not used cannabis by age 18 and lowest for those who first used cannabis before age 15. These findings were evident for each study and for the pooled data, and persisted after control for confounding. There was no consistent trend for cannabis use to have greater effect on the academic achievement of males but there was a significant gender by age of onset interaction for university enrolment. This interaction suggested that cannabis use by males had a greater detrimental effect on university participation than for females. Pooled estimates suggested that early use of cannabis may contribute up to 17% of the rate of failure to obtain the educational milestones of high school completion, university enrolment and degree attainment. Conclusions

Findings suggest the presence of a robust association between age of onset of cannabis use and subsequent educational achievement.

Source: www.sciencedirect.com April 2010

Academics at Northumbria University have demonstrated a link between teenage binge drinking and damage to prospective memory.

Prospective memory is an important aspect of day-to-day memory function and is defined as the cognitive ability to remember to carry out an activity at some future point in time. Examples include remembering to attend an appointment at the dentist or to carry out a task such as remembering to pay a bill on time.

In the first study to examine the effects of binge drinking on prospective memory in teenagers, researchers tested the ability of fifty students from universities in North East England to remember a series of tasks. The students were shown a 10-minute video clip of a shopping district in Scarborough and were asked to remember to carry out a series of instructions when they saw specified locations.
Twenty-one of the students were categorized as binge drinkers. For women, this meant that they drank the equivalent of six standard glasses of wine or, for men, six pints of beer, two or more times a week. The remaining 29 participants were categorised as non-binge drinkers.

The study found that the binge drinkers recalled significantly fewer location-action/items combinations than their non-binging peers. These findings were observed after screening out teenagers who used other substances (such as ecstasy, cannabis and tobacco), those who had used alcohol within the last 48 hours, and after observing no between-group differences on age, anxiety and depression.

Dr Tom Heffernan led the study. He comments: “The mechanisms that may underlie such everyday cognitive impairments associated with binge drinking are not yet fully understood. It is possible that excessive drinking may interfere with the neuro-cognitive development of the teenage brain.

“It is important to realise that there no ‘safe’ levels of drinking set for teenagers and that the amount of bingeing revealed in the present study represents a high volume of alcohol intake across the two to three bingeing sessions which were the norm in the group. The high levels of drinking amongst teenagers is particularly worrying given the mounting evidence that the teenage brain is still maturing and undergoing significant development in terms of its structure and function.
“Given that teenagers are inexperienced drinkers who have both a low tolerance for alcohol and immature neuro-physiological systems, they should therefore be drinking much less than the ‘safe’ levels recommended for adults.”

Intriguingly, one other finding of the study is that binge drinkers do not perceive themselves to have a poor memory, suggesting teenagers do not appreciate the damage that is being done.

Source: T. Heffernan, R. Clark, J. Bartholomew, J. Ling, S. Stephens. Does binge drinking in teenagers affect their everyday prospective memory? Drug and Alcohol Dependence, 2010; 109 (1-3): 73 DOI: 10.1016/j.drugalcdep.2009.12.013 Northumbria University (2010, July 29).

A new study released by the U.S. Department of Education Institute of Education Sciences conducted an experimental evaluation of mandatory random student drug testing (MRSDT) programs in 36 high schools within 7 school districts.i About half of the schools in each district were randomly assigned to the treatment group and half to the control group. Treatment schools began implementing MRSDT programs while control schools did not. MRSDT programs in public schools are limited to students who participate in athletics and extracurricular activities. In this study, some of the testing pools in schools with MRSDT were comprised of only athletes while others included athletes and extracurricular activity participants, leaving many students untested in those schools.

The frequency of drug testing and drug test panels in schools with MRSDT programs varied. All seven school districts tested for marijuana, amphetamines, and methamphetamines. Cocaine and opiates were included in six of the seven district panels. Districts also tested for an assortment of other substances. Students in all schools were surveyed and tracked over one year. Researchers compared students who participated in activities which made them subject to drug testing in schools with MRSDT to students who participated in the same activities in schools without MRSDT. Results are encouraging and provide extensive supportive of MRSDT programs.

Students subject to MRSDT reported a statistically significant lower rate of past 30-day use of substances included in their schools’ drug testing panels (16%) than comparable students in schools without MRSDT (22%). This included alcohol for three districts and nicotine for two districts. Similar differences were also found between the two groups on other substance use measures, though were not
statistically significant.

Contrary to what USA Today reports in “High school drug testing shows no long-term effect on use” (July 15, 2010),ii this study has demonstrated the value of MRSDT. Specifically USA Today highlights that MRSDT did not impact students’ plans to use drugs in the future. It is true that there was no difference between the percentage of students subject to MRSDT (34%) and the percentage not subject to MRSDT (33%) that reported they planned to use substances within the next 12 months. However,
MRSDT programs subject eligible students to random drug testing during the school year only; the summer months are a time when student substance use is no longer monitored. MRSDT programs are designed to deter substance use when students are in school. This study demonstrates that MRSDT is effective at achieving this goal.

Commentary August 12, 2010

It is sometimes claimed that drug testing programs deter student participation in extracurricular activities. In this study, MRSDT had no effect on the participation rates by students in activities that subjected them to drug testing. Nearly the same percentage of students in schools with MRSDT participated in activities covered by their schools’ testing programs (53%) as the percentage of students in schools without MRSDT who participated in such activities (54%). This indicates that students in
schools with MRSDT programs knew their participation in such activities subjected them to testing and it did not deter them from participation.
USA Today is critical of this study because there was no spillover effect on students who were not subject to MRSDT in schools with testing programs. This is not a surprise considering the MRSDT programs were studied for one year of implementation. As drug testing programs expand and include options for students to voluntarily enter the testing pool (as opposed to mandatory participation only
through extracurricular activities), a spillover effect in time is possible. Random student drug testing programs reinforce schools’ comprehensive substance use prevention programs as a deterrent against youth substance use. These programs offer students a good reason not to use drugs, including alcohol and tobacco which can be included in testing panels along with other illegal drugs.

Voluntary random drug testing programs also are used in public schools either as a single option or in combination with a mandatory program. This allows students, with a parent’s permission, to make an active choice to participate in random drug testing. The U.S. Department of Education is to be commended for supporting this ambitious study and shedding light on the many benefits of school-based random student drug testing programs. For more information on IBH and random student drug testing visit www.ibhinc.org and www.PreventionNotPunishmment.org.
Robert L. DuPont, M.D.

Source: Institute for Behavior and Health. USA 12th August 2010

1. 12/17 states (including DC) with “medical” marijuana” have 20% + traffic fatalities involving drugs
70.6% of states with MMJ laws have driver fatalities testing positive for drugs of 20% or greater

2. 13/17 states with “medical” marijuana” has 19% + traffic fatalities involving drugs (Arizona)
76% of states with MMJ have driver fatalities testing positive for drugs of 19% or higher

3. 3/17 states with “medical” marijuana” laws that have low rates of driver fatalities also have low rates of testing for drugs (Oregon, Rhode Island, Maine: not tested 79%, 41%, 100% ).

4. 1/17 states with “medical” marijuana”, New Mexico, tests all, but has anomalous 1% positive tests (an outlier, along with Mississippi, North Carolina).
Drug testing of drivers in fatal accidents should be 100%!

STATES WITHOUT “MEDICAL MARIJUANA” LAWS HAVE LOWER PREVALENCE OF DRIVER FATALITIES INVOLVING DRUGS: 27%

1. 24/33 states with no “medical” marijuana” laws have fewer than 20% of driver fatalities involving drugs
73% of states with no “medical marijuana” laws have fewer than 20% driver fatalities testing positive for drug.

2. 9/33 states with no “medical” marijuana” approval have 20% or more driver fatalities involving drugs.
27% of states with no “medical marijuana” laws have 20% or more of driver fatalities involving drugs

3. Ct, state with highest number of fatalities also has highest rate of testing, 99%
Prevalence of driver fatalities involving drugs is three times higher, on average, in states with approved “medical marijuana” laws.

Source: Bertha Madras PhD Harvard Medical School Dec. 2010

A new study suggests that genetic factors influence size variations in a certain region of the brain, which could in turn be partly responsible for increased susceptibility to alcohol dependence.

It appears that the size of the right orbitofrontal cortex (OFC), an area of the brain that is involved in regulating emotional processing and impulsive behavior, is smaller in teenagers and young adults who have several relatives that are alcohol dependent, according to a study led by Dr. Shirley Hill, Ph.D., professor of psychiatry, University of Pittsburgh School of Medicine.
In the research, which was published this week in the early online version of Biological Psychiatry, Dr. Hill and her team imaged the brains of 107 teens and young adults using magnetic resonance imaging. They also examined variation in certain genes of the participants and administered a well-validated questionnaire to measure the youngsters’ tendency to be impulsive.
The participants included 63 individuals who were selected for the study because they had multiple alcohol-dependent family members, suggesting a genetic predisposition, and 44 who had no close relatives dependent on drugs or alcohol. Those with several alcohol-dependent relatives were more likely to have reduced volume of the OFC.
When the investigators looked at two genes, 5-HTT and BDNF, they found certain variants that led to a reduction in white matter volume in the OFC, and that in turn was associated with greater impulsivity.
“We are beginning to understand how genetic factors can lead to structural brain changes that may make people more vulnerable to alcoholism,” Dr. Hill said. “These results also support our earlier findings of reduced volume of other brain regions in high-risk kids.”
These differences can be observed even before the high-risk offspring start drinking excessively, she added, “leading us to conclude that they are predisposing factors in the cause of this disease, rather than a consequence of it.”

Source: University of Pittsburgh Schools of the Health Sciences (2008, November 7). Impulse Control Area In Brain Affected In Teens with Genetic Vulnerability for Alcoholism

Admiral Regina M. Benjamin, released a new report that shows that tobacco smoke, even occasional smoking or secondhand smoke, damages the human body and leads to disease and death.

The 700-page report, “A Report of the Surgeon General: How Tobacco Smoke Causes Disease-The Biology and Behavioral Basis for Smoking,” finds that cellular damage and tissue inflammation from tobacco smoke are immediate, and that repeated exposure weakens the body’s ability to heal the damage.

Even brief exposure to secondhand smoke can cause cardiovascular disease and could trigger acute cardiac events, such as heart attack. The report describes how chemicals from tobacco smoke quickly damage blood vessels and make blood more likely to clot. The evidence in this report shows how smoking causes cardiovascular disease and increases risks for heart attack, stroke, and aortic aneurysm.

The report also explains why it is so difficult to quit smoking. According to the research, cigarettes are designed for addiction. The design and contents of current tobacco products make them more attractive and addictive than ever before. Today’s cigarettes deliver nicotine more quickly and efficiently than cigarettes of many years ago.

You can read the full report at www.surgeongeneral.gov. Last week, CADCA hosted a webinar on tobacco cessation and smoking prevention. A recording of this session, as well as the PowerPoint presentations used during the session, can be accessed online.

Source: www.cadca.org Dec. 2010

 

R. Gil Kerlikowske, Director of the Office of National Drug Control Policy, this week called attention to the high percentage of fatalities on USA roadways involving drivers who had drugs in their system and called on communities to continue to prevent drug use before it starts. Kerlikowske’s announcement was shared in light of a new traffic fatality analysis released by the National Highway Transportation Safety Administration.

According to the inaugural analysis of drug involvement from NHTSA’s Fatal Accident Reporting System census, one in three motor vehicle fatalities (33 percent) with known drug test results tested positive for drugs in 2009. Additionally, according to the new analysis, the involvement of drugs in fatal crashes has increased by five percent over the past five years, even as the overall number of drivers killed in motor vehicle crashes in the United States has declined.

Kerlikowske said campaigns against drunk driving have been effective and should continue, but more emphasis should be placed on ‘drugged driving.’

In a news release, Kerlikowske said, “It is critical that communities across the nation address the threat of drugged driving as we redouble our efforts to make America’s roadways safer by increasing public awareness, employing more targeted enforcement, and developing better tools to detect the presence of drugs among drivers.”

According to a 2007 NHTSA Roadside Survey of Alcohol and Drug Use by Drivers, 1 in 8 nighttime weekend drivers tested positive for an illicit drug. The most recent Monitoring the Future survey revealed that one in 10 high school seniors reported that in the two weeks prior to the survey they had driven after smoking marijuana.

Source: www.CADCA.org Dec.2010