Sun Sets on Bupe
- posted by Jim Leitzel @ 9:53 AM

Just a quick note from Baltimore, where the Baltimore Sun recently has featured an investigative series of articles (first installment here) on the opioid agonist buprenorphine, a drug frequently used to treat heroin addicts. Sometimes buprenorphine itself is abused, and it is this possibility that garners the bulk of the Sun's attention. The Sun's Public Editor explains the coverage, and some of the fallout, here, without offering much of an assessment beyond a sort of tepid endorsement. A letter from a medical professional (with experience in the area) that appeared in today's issue of the Sun is illuminating:

It is telling that despite months of reporting and thousands of words, The Sun
did not find a single person in Baltimore whose life has been ruined by
buprenorphine.

Yet just walk the streets in East or West Baltimore and you
can find scores of people whose lives are being ravaged by the condition that
buprenorphine treats effectively.

Labels: buprenorphine, treatment

 
Drugs Blur Vision...
- posted by Jim Leitzel @ 10:48 PM

...oops, I mean, Blur's Drug Vision. David Rowntree, recovering addict, aspiring barrister/politico, and the drummer for the British band Blur has an op-ed on drug policy in Tuesday's Guardian. First, Rowntree points to the ineffectiveness of drug policy, or at least to the paucity of data pointing to policy efficacy: "there seems to be no evidence that any country's policy has had any lasting effect on the number of recreational or dependant [sic] drug users at all. Ever." He then suggests that in shaping policy it is sensible to consider dependent and non-dependent users separately, recognizing that for most users, there are no negative long-run consequences from a standard recreational drug career that fades away by the age of thirty. Eventually, Rowntree proposes "a strategy based on research, education and harm reduction." But en route he offers what I consider to be some profound insights into his own addiction. At first the alcohol and coke seemed to be problem solvers.

However, my experience of life when not on drink or drugs got progressively worse. The world became an increasingly hostile place, relationships got more difficult and an all-encompassing sense of dread and paranoia set in. Drink and drugs became progressively less effective in soothing those feelings. At some point, the drugs stopped working, but life without them had become impossible. It was a catch-22 situation where it was impossible to live without alcohol or drugs but impossible to continue using. I managed to get help before they destroyed my life, and these days I'm active in the recovery community. The key point is that all the way along, I thought my behaviour was normal and it was the rest of the world that had gone mad. I had no idea my experience was different to anyone else's because I had nothing to measure it against.

So if my experience is typical, and I think it probably is, many addicts aren't interested in treatment because they don't believe there's anything wrong with them.

Incidentally, both Rowntree and Blur hail from Colchester, where Vice Squad was happily seconded for a year in the mid-1990s. Speaking of secondments, I have returned (sans luggage) to Chicago, allowing me to pick up the Guardian in one of the too-many airports that I visited today; I hope that more regular Vice Squad posting will ensue.

Labels: addiction, Britain, drugs, treatment

 
Bupe in B-more
- posted by Jim Leitzel @ 12:10 AM

In 2002, new FDA rules made it possible for doctors to meet in their offices with addicts, and to prescribe the opiate agonist buprenorphine. In the form prescribed, the buprenorphine is combined with the antagonist naloxone, thereby rendering the compound ineffective in taking by injection for a high. Unlike methadone clinics, which generally require daily visits by patients, addicts treated with the bupe/naloxone mix could receive a month's supply at a time.

Vice Squad hometown of Baltimore, Maryland, is racked by a terrible heroin problem. In October, 2006 Baltimore announced that it was going to promote buprenorphine treatment for heroin addicts; the state of Maryland has earmarked $3 million for bupe treatment in the coming fiscal year. Unfortunately, Maryland doctors do not seem all that eager to climb aboard the bupe train, and those that do board find the journey to be arduous, according to an article this week in the Baltimore Sun:

"One of the biggest barriers to prescribing buprenorphine is dealing with the insurance companies," said Dr. Christopher Welsh, a psychiatrist and assistant professor at the University of Maryland School of Medicine in Baltimore. Welsh uses the drug to treat patients at the university's hospital. Some come from hundreds of miles away to get a prescription, only to have their treatment thwarted by red tape.

"A few hours later, you'll get a call, and the patient will tell you that the pharmacy said the prescription wasn't authorized," said Welsh, who participated in the survey.

He added that a physician who intervenes to help the patient is often "passed from voice mail to voice mail" by the health care provider, and the experience "can be very time- and labor-intensive."

Two years ago, Vice Squad noted a prescient Wired article detailing barriers to the spread of bupe treatment for heroin addicts.

Labels: addiction, buprenorphine, heroin, treatment

 
More on Self-Exclusion
- posted by Jim Leitzel @ 11:38 PM

A couple days ago Vice Squad mentioned self-exclusion as one component of a policy regime that can aid problematic gamblers, and noted the possibility that forms of self-exclusion (perhaps instituted as part of broader consumer licensing policies) could be applied to other vices. Even if self-exclusion does not work all that well, it has two appealing features, namely, it is voluntary and it does not impose on gamblers who are uninterested in being excluded.

I have tried to learn a little bit more about gambling self-exclusion, and have been aided by two articles: "Casino Self-Exclusion Programmes: A Review of the Issues," by Nadine R. Nowatzki and Robert J. Williams (18-page pdf here), published in July 2002 in International Gambling Studies; and, "Self-exclusion: A Proposed Gateway to Treatment Model," by Alex Blaszczynski, Robert Ladouceur, and Lia Nower, in the April 2007 issue of the same journal. Some things I learned from these articles:

(1) Gambling self-exclusion is quite recent, with the first formal program adopted in Canada in 1989. [Update! -- Looks like Austria got there, oh, more than a half century earlier.]

(2) Lots of folks who self-exclude from a gambling location breach their agreement by returning (sometimes disguised) to the location and gambling. Compliance with self-exclusion agreements is higher in the Netherlands, because entrants to casinos in the Netherlands must present identification, which can be checked against the self-excluded list. It also appears that the self-exclusion program in the Netherlands is accessed by a higher proportion of problem gamblers than are similar (but not identical -- there is lots of variation among self-exclusion rules) programs elsewhere.

(3) Despite the enforcement problems, self-exclusion programs are associated with some beneficial outcomes. Blaszczynski, Ladouceur, and Nower (page 62) describe a recent evaluation of one self-exclusion regime: "Participants reported that, at follow-up, the urge to gamble was significantly reduced while the perception of control increased significantly for all participants. The intensity of negative consequences for gambling was significantly reduced for daily activities, social life, work and mood."

(4) Though exclusion programs are designed to help those who have self-control problems with gambling, the decision to enter an exclusion agreement can itself be made in an o'er-hasty fashion, perhaps after suffering a significant gambling loss. Blaszczynski, Ladouceur, and Nower (page 69) suggest that gamblers who insist on immediate exclusion be provided with a 24-hour exclusion while their case is under consideration, thus giving them time to cool-off before a decision is taken regarding a longer-lasting exclusion.

Labels: gambling, self-exclusion, treatment

 
Self-Exclusion and Licensing
- posted by Jim Leitzel @ 10:44 PM

An effective tool for helping some problem gamblers is self-exclusion, whereby an individual registers to be prevented from entering commercial gambling establishments, and to be free of targeted inducements from casino marketers. Pennsylvania set up its self-exclusion program last year, and announced today that so far 52 people have placed themselves on the excluded list. Pennsylvania allows self-excluders to choose among a one-year ban, a five-year ban, and a lifetime ban, and 42% (22 individuals, presumably) have chosen the lifetime ban.

Last Monday (May 14, 2007 -- problem with internal links solved!), Vice Squad noted (in the case of an addiction to internet Scrabble) how a credible 'lack of access' might reduce or eliminate withdrawal and cravings. In the case of the gambling exclusion, here's the experience of one Keystone State participant:

J.D., a self-excluded individual, echoes those thoughts [of the effectiveness of exclusion]. "Since the day I signed up, I haven't really thought about gambling," J.D. said. "I sleep better at night. I feel better when I'm at home."

Requiring licenses for vice consumption would automatically set-up an exclusion system -- those who want to be excluded could refuse to acquire or renew their license, or even precommit to not acquiring a license. Or perhaps they would acquire a license, but voluntarily impose a ceiling on the extent to which the license allows participation. When currently illegal drugs such as heroin or cocaine are legalized, I suspect that such a licensing system -- and the accompanying self-exclusion possibilities -- will commonly form part of the control regimes.

I first learned of Pennsylvania's press release from earthtimes.org.

Labels: gambling, licensing, self-exclusion, treatment

 
Parkinson's Disease and Internet Gambling
- posted by Jim Leitzel @ 10:14 AM

It has been known for some time that some drugs (dopamine agonists) used to treat Parkinson's disease raise the risk that the patient will become a pathological gambler. (Still sort of amazing, though, isn't it?) This week's British Medical Journal includes an editorial warning of the danger that easy access to internet gambling poses to Parkinson's patients. (The 6-page pdf including the editorial, along with four others, is here.) The editorial contains some statistics on problem gaming: about 1 percent of the adult population can be considered to be pathological gamblers, but 3.4 percent of Parkinson's sufferers fit the bill, while 7.2 percent of Parkinson's patients taking dopamine agonists are pathological gamblers. The editorial is timely in that proposed British regulations for internet gambling will soon be released.

The British Medical Journal frequently features articles relevant to vice policy researchers. A second editorial in this week's issue concerns the over-regulation of opiates prescribed for pain, while a news item notes that in former Soviet Georgia, excessive recreational use of buprenorphine -- an opioid that has shown much success in treating heroin addicts -- has become the nation's leading drug problem.

Labels: Britain, buprenorphine, gambling, internet, treatment

 
Informal Heroin Maintenance
- posted by Jim Leitzel @ 6:40 AM

The Guardian today reprints (from Black Poppy magazine) a moving story about a family that is being devastated by a son's ten-years-and-counting heroin addiction. The author of the story is the addict's mom, who also serves as his drug dealer. (She's a college teacher, too.) That is, she decided that the best way to minimize the harms of her son's addiction -- and they have tried many, many alternatives -- is to buy heroin herself and to dole it out to him. But this measure has not made the situation bearable, in part because the purity of the black-market heroin is variable and the cost of street heroin, as her son's tolerance grows, is close to prohibitive.

The son tried various treatment regimens, including methadone maintenance -- all have failed. The article does not mention heroin maintenance, but it seems like it offers the best (short-term, perhaps) hope for improvement. After all, the son already is on a heroin maintenance scheme, but one that is partly undermined by variable purity and high cost. An official heroin maintenance scheme, one that would eliminate these two problems, could hardly be worse.

There are many small insights in the article. I'll only mention one here, the notion that an addict's knowledge of his own failure to handle his addiction can spur more drug use, as a way of blotting out a painful self-awareness.

Labels: addiction, Britain, heroin, treatment

 
Twelve-Step Success?
- posted by Jim Leitzel @ 1:18 PM

Treatment programs for addiction often have vocal adherents, but rarely is there much solid scientific evidence for dramatic (or even not so dramatic), replicable success. The sense of futility that infuses the war on drugs* has a parallel with respect to drug treatment. Here is Jon Elster, in the Introduction (page xvii) to his 1999 edited volume, Addiction: Entries and Exits: "There is a wide range of drug treatments. The main thing they have in common is that they rarely work."

Alcoholics Anonymous and similar 12-step-style treatment programs have been popular for decades, but again, the evidence for their success is more anecdotal than systematic. AA itself generally has not been subjected to randomized trials, which offer the best hope for gauging treatment effects. Claimed success rates often seem to cherry-pick, ignoring, for instance, those patients who drop out of treatment or who cannot be located post-treatment. But researchers have been chipping away at this longstanding dearth of evidence.

The May 2006 issue of Addiction opens with a two-page editorial by Keith Humphreys ("The Trials of Alcoholics Anonymous") that summarizes what has been learned so far from methodologically sophisticated analyses of 12-step programs. One study, for instance, documented a harm reduction-versus-abstinence-style result, in which intensive referral to couples therapy (AA and Al-Anon) led to more abstinence but also to more severe problems for those drinkers who did not achieve abstinence.

The systematic evidence remains far from conclusive. Here is how Humphreys, however, concludes his editorial:

Strong views about AA one way or the other will always survive, no matter what evidence accumulates, but the studies of the past 15 years have established beyond any reasonable doubt that high-quality AA trials are possible, and that such studies usually reinforce rather than undermine the excellent reputation the fellowship enjoys around the world.

Update: A less sanguine view, however, is found in a review undertaken under the auspices of The Cochrane Collaboration, an organization that evaluates the evidence concerning the effects of healthcare interventions. The Cochrane review of AA, written by M. Ferri, L. Amato, and M. Davoli, offers these "Authors' conclusions":

No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

*Incidentally, I don't accept that the war on drugs is futile -- if only it were! With respect to an alcohol-style regulatory structure, our current prohibition probably does lower the consumption of some drugs, while worsening a host of other social ills.

Labels: AA, addiction, alcohol, treatment

 
"Kids Helping Kids": A Bizarre Drug "Treatment" Program
- posted by Jim Leitzel @ 3:35 PM

What is it about Milford, Ohio? That's where an outrageous, $60,000 undercover sting operation was pulled off in a high school by the District Superintendent. Now we find that it is the home of Kids Helping Kids, an odd, and troubling, drug treatment program for kids.

I highly recommend that you watch the video available at this local TV news webpage. The sound starts a few seconds before the video, and it has some unfortunate local TV elements, but it is also quite informative.

One parent offers a sentiment that sounds about right to me: "No one should be abused emotionally or physically in the name of treatment." Incidentally, there don't seem to be any doctors involved in this "treatment".

Kids Helping Kids doesn't seem to be the worst treatment program out there.

Update: Radley Balko has more, a whole lot more, first here and then here. It's worse than I thought.

Labels: drugs, teens, treatment

 
Vicewire, 5/31/2005
- posted by Ryan @ 7:28 PM

1) Here is a different type of "rehab" for drug and alcohol abuse: doing time in the pew rather than in jail.

2) A story about the inability of convicted prostitutes to teach in Oregon.

3) Reminiscent of the Opium Wars 150 years ago, China has put out an appeal to the public to help stop narcotics trafficking and abuse.

4) In other Oregonian news, the recent rejection of an off-reservation Indian Casino has some wondering if this of less off-reservation casinos trend is gaining momentum: "There are many members of Congress who are ... deeply concerned about the proliferation of off-reservation Indian gambling casinos" - Rep. David Wu, D-Ore.

Labels: China, drugs, Native Americans, prostitution, treatment

 
The Heroin Equivalent of the Red-Headed League
- posted by Jim Leitzel @ 1:22 AM

Chris Rock once said "Drug dealers don't sell drugs. Drugs sell themselves." So it should be no problem to distribute free heroin, right? Well, those who are organizing the Canadian experiment with heroin maintenance are finding out that if you impose enough conditions, it's hard even to give the stuff away:

Addicts must have been on heroin for at least five years, must have tried methadone twice without success -- and must be older than 25.

Also, the addict cannot currently be on methodone [sic]-- and cannot have a criminal record.

The researchers aim for 157 participants, but so far, have come up with only 21 eligibles.

Here's the original Red-Headed League.

Labels: Canada, heroin, treatment

 
Alcohol Treatments Spreading Like...
- posted by Jim Leitzel @ 7:27 PM

...Kudzu. Yes, by taking a concentrated kudzu extract, heavy drinkers cut back their consumption, relative to those who took the placebo. They still drank, but somewhat less: "Study author Dr. Scott E. Lukas of McLean Hospital and Harvard Medical Center in Massachusetts explained that during the experiment, people drank their first beer right away, but were less likely to want more beer if they had taken kudzu the previous week."

I was mildly surprised at today's Supreme Court decision in the Internet Wine case. Probably not happily surprised -- even though I think that mail-order sales of wine direct to households should be legal -- as I am concerned about the eventual impact upon free trade or interstate commerce when these principles are used to trump the vice policy of individual states. But first I'll read the opinions, available here.

Labels: alcohol, free trade, Supreme Court, treatment

 
A Vaccine For Smokers
- posted by Jim Leitzel @ 4:29 PM

Most adult smokers in the US report that they would like to quit, but the vast majority of attempts to quit fail. Some pharmaceutical agents, including non-smoking sources of nicotine like patches or gum, seem to be effective in helping some people give up smoking. But now progress is being made on a nicotine vaccine. Vaccinated people have compounds in their bloodstream that quickly bind to nicotine, hindering the transport of nicotine to the brain, and thereby removing the "reward" from smoking.

Last month, Vice Squad noted the progress of an alcohol vaccine. One of the concerns about the development of these vaccines is that parents or the government might force teenagers to undergo vaccination. See this earlier Vice Squad post for some other concerns.

Labels: alcohol, smoking, tobacco, treatment

 
Alcoholics Anonymous at 70
- posted by Jim Leitzel @ 6:19 PM

The BBC has an article today about Alcoholics Anonymous, founded in 1935. It offers a couple short paragraphs on three participants, a "regular," a "newcomer," and a "professional." Then there is a section on critics of AA, where Stanton Peele is quoted. One criticism that isn't mentioned is that there is, as far as I know, almost no serious statistical evidence that AA is more effective than other treatments for alcoholism, or than no intervention. Here's a paper that provides some evidence in support of weekly 12-step-style meetings, but the literature review is valuable in pointing out the paucity of other evidence.

Labels: AA, alcohol, treatment

 
British Heroin Maintenance
- posted by Jim Leitzel @ 3:10 PM

Until the early 1970s, doctors in Britain could prescribe heroin to addicts. With increased addiction being tied to leakages from the prescription system, distribution of heroin for addiction maintenance was tightened. Today there are about 450 British addicts who receive heroin from some 100 specially-licensed physicians. But now, following the perceived successes of previous heroin maintenance experiments in Switzerland and the Netherlands, the British intend to initiate pilot programs that will expand prescription access by addicts to heroin.

Thanks to John Band at Shot By Both Sides for the pointer.

An alternative treatment for opioid addicts is the oral administration of buprenorphine. We noted a while ago some of the barriers to the spread of this treatment in the US; a detailed explanation of how buprenorphine treatment works, based partly on personal experience, is provided by Nephalim's Drug War Revealed.

Labels: Britain, buprenorphine, heroin, treatment

 
The Uphill Trek Facing Buprenorphine
- posted by Jim Leitzel @ 4:58 PM

Yesterday we looked at the use of naltrexone in the treatment of alcohol addiction; today's link is to a Wired story on the use of buprenorphine to combat opiate addiction. The article details the many barriers to making buprenorphine available to addicts, including the reluctance of doctors to welcome addicts into their waiting rooms and difficulties in first allowing and then easing the dispensing of buprenorphine from methadone clinics.

Relative to methadone, buprenorphine offers advantages to some patients, including the fact that a stock of bupe (its nickname) can be kept by the addict, with a pill taken daily to reduce opiate craving and withdrawal. Patient-managed inventories are possible because one form of bupe comes mixed with the opioid antagonist naloxone, thereby making it unattractive as a recreational drug. (The Wired article might even be a little too laudatory of bupe; opioids tend to have widely varying effects upon different users, so no doubt methadone or heroin maintenance would be preferable to bupe for some patients.)

Thanks to Ken Lammers at Crim Law for the pointer.

Labels: addiction, buprenorphine, heroin, treatment

 
Towards an Alcohol Vaccine?
- posted by Jim Leitzel @ 11:03 PM

Naltrexone is an opiate antagonist and long has been used to treat heroin addicts. For the last decade or so, naltrexone also has been given orally to some heavy drinkers, as it seems to aid some of them in reducing their drinking. The current issue of the Journal of the Amercian Medical Association includes an article by Garbutt, O'Malley, Gastfriend, et al. that reports on a clinical trial in which alcohol abusers were given a once-monthly injection of naltrexone. It's no magic bullet, but it seemed to aid some heavy drinkers in cutting back. Here are the study's results:

Compared with placebo, 380 mg of long-acting naltrexone resulted in a 25% decrease in the event rate of heavy drinking days (P = .03) and 190 mg of naltrexone resulted in a 17% decrease (P = .07). Sex and pretreatment abstinence each showed significant interaction with the medication group on treatment outcome, with men and those with lead-in abstinence both exhibiting greater treatment effects. Discontinuation due to adverse events occurred in 14.1% in the 380-mg and 6.7% in the 190-mg group and 6.7% in the placebo group. Overall, rate and time to treatment discontinuation were similar among treatment groups.

As such types of therapies develop, some parents might want to "vaccinate" their teenagers against alcohol and drugs.

Here's a BBC report on the JAMA study. Vice Squad briefly looked at pharmacotherapy last August.

Sorry for the blogging lapse/confusion. I am having mucho problems with Blogger.

Labels: addiction, alcohol, opium, treatment

 
"Methods of painful impact to treat addictive behavior." [Updated!]
- posted by Jim Leitzel @ 11:02 AM

That's the English translation of the title of a Russian paper presented at a conference on new treatment methods for narcotics. From Pravda:

Siberian scientists believe that addiction to alcohol and narcotics, as well as depression, suicidal thoughts and psychosomatic diseases occur when an individual loses his or her interest in life. The absence of the will to live is caused with decreasing production of endorphins - the substance, which is known as the hormone of happiness. If a depressed individual receives a physical punishment, whipping that is, it will stir up endorphin receptors, activate the "production of happiness" and eventually remove depressive feelings.

That 'eventually' takes some 30 of the therapy sessions. One of the co-authors of the study, Dr. Sergei Speransky, claims to have cured his own depression via punishment, and more amazing still, "he also recovered from two heart attacks with the help of physical tortures too." Dr. Speransky recognizes that people might think that he's a bit odd, but he offers a denial:

"People might probably think of me as a masochist," Dr. Speransky said. "But I can assure you that I am not a classic masochist at all," he added.

Come to think of it, that is not exactly a denial, is it?

Thanks to friend of Vice Squad and satisfied Pravda reader Dima Masterov for the link; "pravda," of course, is the Russian word for "surely we couldn't make this stuff up."

Update: If the Siberian addiction cure is too wimpy for you, consider that of the Thamkrabok monastery in Thailand: "Addicts are put through a series of bamboo floggings, prayers and manual labour which is designed to cleanse them physically and mentally." (Scroll down to the bottom of the linked article.)

Labels: addiction, drugs, Russia, Thailand, treatment

 
Controlled Drinking for Recovering Alcoholics?
- posted by Jim Leitzel @ 7:15 PM

Someone close to you has a serious drinking problem. Should this person be counseled to cut back on alcohol consumption, or to become completely abstinent? Like certain other zero-tolerance v. harm reduction issues (e.g., abstinence-only sex education for high schoolers), this question is very controversial.

This month the journal Addiction contributes to the debate, first with an article by Dawson, et al., "Recovery from DSM-IV alcohol dependence: United States, 2001-2002," and then with four responses to the article and a rejoinder by Dawson, et al.

The main finding of Dawson et al. is that lots of folks who meet the standard markers for alcohol dependence eventually change their ways. While many of these folks become abstinent, a movement to low-risk drinking is also a common outcome. And these "recoveries" are generally accomplished without treatment for alcohol dependence. The authors themselves are quite measured in their interpretation of these findings, and the responses by and large are further calls for caution.

My own not-well-informed view is that for some (but by no means all) alcoholics, controlled drinking is essentially impossible. [Update: perhaps years after the current crisis or in a radically different environment even these individuals would be able to drink "socially".] A similar view (I think) is provided in Deborah Hasin's response:

A very important result of Dawson et al.'s paper is that full remission from the symptoms of DSM-IV alcohol dependence can occur among individuals who continue to drink. At one time, this finding would have been revolutionary. Fortunately, our field has matured enough so that is no longer the case. However, we remain without guidelines concerning who really must stop drinking in order to recover from DSM-IV alcohol dependence, and who can recover stably from dependence even while drinking moderately. While many guidelines exist on how to cut down or stop in terms of psychological (e.g. motivation, cognitive planning) and environmental changes (new peer groups, avoidance of cues for binging), however, these do not address the question of abstinence versus controlled drinking....

Labels: abstinence, addiction, alcohol, harm reduction, treatment, zero tolerance

 
Alcohol in Russia
- posted by Jim Leitzel @ 6:32 PM

Yesterday Vice Squad drew upon the January issue of the journal Addiction to talk about slot machines; today, it's the February issue that catches our attention (but not our link -- the Addiction website is currently down.) There's an article on alcohol in Russia by Alexander Nemtsov, a leading Russian alcohol policy expert. Here's a brief more-or-less random assortment of points drawn from Nemtsov's article:

Before World War I, per capita alcohol consumption in Russia was less than 1/3 of that in Western European countries such as the UK, Spain, France, and Italy. The big increase in alcohol consumption in Russia started only in the early 50s, but continued up to Gorbachev's anti-alcohol campaign of 1985.

Just today The Lancet published an article indicating that alcohol is responsible for about 4 percent of 'the global burden of disease.' Nemtsov notes that alcohol is connected with about 4 percent of the deaths in the European Union and Norway. But in Russia, well, the drinking situation is vastly more severe: more than 30 percent of deaths are directly or indirectly tied to alcohol. [Vice Squad has previously noted the almost unbelievable extent of acute alcohol poisoning in Russia.]

I'll close by quoting Nemtsov's paragraph on treatment for alcoholism in Russia:

The most common form of treatment is in Russia is [sic] directive suggestive psychotherapy, undertaken during a single consultation. This so-called 'coding', based on the work of Dovzhenko, seems at best to have only a placebo effect. It has never been evaluated, but its widespread use is consistent with the beliefs of the Soviet population. Psychopharmacotherapy is provided in hospitals and in dispensaries but family and group psychotherapy are rarely used in Russia. Treatment of alcoholic dependence achieves relatively poor outcomes.

Labels: addiction, alcohol, Russia, treatment