The Brief Addiction Science Information Source (BASIS)

Addiction & the Humanities Vol 4. (6) - Can the spirit move you?

Research has linked spirituality with both physical and mental well-being (Hawks, Hull, Thatma, & Richins, 2005; Kass, Friedman, Lesserman, Zuttermeister, & Benson, 1991). Moreover, Alcoholics Anonymous and Narcotics Anonymous, popular 12-step programs, endorse the concept of addiction as a combination of spiritual, biological, and psychological disorders. However, few studies have examined the influence of spirituality on addiction recovery. This week’s Humanities reviews a study focusing on the relationship between the development of spirituality and relapse among individuals receiving treatment for alcohol dependence.

Methodology:

• Study Design
  
  • Retrospective case-control study
    
  • Participants and their survey responses were selected from 278 individuals after they completed a larger study about spirituality and treatment outcomes
• Participants
  
  • Participants: 72 individuals completed intake and 3 month follow-up: 36 who relapsed (cases) & 36 who did not relapse (controls). 50 (69.4%) completed end-of-treatment assessment.
• Survey instrument
  
  • At intake and end-of-treatment, all participants completed the Addiction Severity Index (ASI, McLellan, Luborsky, Woody, O'Brien, & et al., 1980) and questionnaires regarding spiritual and religious experiences (e.g., Spiritual Experience Index (SEI), (Genia, 1997)

Results:

• At discharge, 82% of participants reported spirituality to be a critical component of substance abuse treatment.
• Participants experienced significant increases on measures of spirituality from intake to end-of-treatment (See Figure 1).
• However, as can be seen in Figure 1, those who did not maintain abstinence in the past thirty days reported significant decreases in spirituality post-treatment.
• At three month follow-up, participants who reported maintaining sobriety during the past 30 days, reported significant positive growth of spirituality.

Figure 1. Relationship of SEI measured spiritual growth and follow-up relapse (adapted from Sterling et al., 2007)

 

Limitations:

• Recall bias: retrospective self-report might have affected participants’ responses to survey instruments.
• Selection bias: a small number of participants completed all three phases of the study suggesting that the results might not be generalizable.
• Relapse: participants were asked to report substance use during the previous 30 days, which might not be enough time to measure recidivism.

Discussion:
The findings from previous studies as well as the present study indicate a positive correlation between spirituality and health, specifically alcohol recovery. However, due to the difficulty in defining spirituality, there is a paucity of research examining this relationship. Arnold, Avants, Margolin, and Marcotte (2002), for example, found that although some members of a focus group equated spirituality with organized religion, other participants felt that spirituality was related to inner strength and individuality. Prevention and treatment programs for other addictions such as marijuana, nicotine, and even gambling might benefit from further research examining the correlation between spirituality and addiction recovery. Given the preliminary evidence suggesting the value of spirituality, clinicians also might want to pursue the study of this relationship to determine if a general understanding of spirituality or a spiritual component to treatment could improve treatment outcomes.

What do you think?  Comments can be addressed to Sara Kaplan.

References
Arnold, R. M., Avants, S. K., Margolin, A., & Marcotte, D. (2002). Patient attitudes concerning the inclusion of spirituality into addiction treatment. Journal of Substance Abuse Treatment, 23, 319-326.

Genia, V. (1997). The Spiritual Experience Index:  Revision and reformulation. Review of Religious Research, 38, 344-361.

Hawks, S., Hull, M., Thatma, R., & Richins, P. (2005). Review of spiritual health:  Definition, role and intervention strategies in health promotion. American Journal of Health Promotion, 9, 371-378.

Kass, J., Friedman, R., Lesserman, J., Zuttermeister, P., & Benson, H. (1991). Health outcomes and a new index of spiritual experience. Journal of the Scientific Study of Religion, 30, 203-211.

McLellan, A. T., Luborsky, L., Woody, G. E., O'Brien, C. P., & et al. (1980). An improved diagnostic evaluation instrument for substance abuse patients. Journal of Nervous & Mental Disease, 168, 26-33.

Sterling, R. C., Weinstein, S., Losardo, D., Raively, K., Hill, P., Petrone, A., et al. (2007). A retrospective case control study of alcohol relapse and spiritual growth. The American Journal on Addictions, 16, 56-61.

Addiction & the Humanities Vol 4. (5) - Song in the Key of Substance Use

Substance use is part of the scientific sphere and a persistent influence on the arts and humanities. The topic of substance use in the arts tends to come in waves; currently, it plays a significant role in the media, for example, because of numerous reports of actor and musician arrests for use and possession of various illicit substances. However, substance use imagery (SUI) as a part of the arts, specifically music, is not a new phenomenon; it also is not limited to US culture. To demonstrate the ever present nature of substance use in music, in this issue of Addiction & the Humanities we briefly deconstruct one example of substance use in music. We look at Myriam Munne’s exploration of drinking and alcohol imagery in tango lyrics from 1914 to 1977.

Munné analyzed 82 Argentinean tangos by focusing on the prevalence of drinking and drunkenness in their titles and lyrics. She explored the system of beliefs, myths, and attitudes related to alcohol through the tango. Munné described the tango as a phenomenon of mass culture and suggests that alcohol consumption is a social act1. She concluded that most tangos are about subjects with universal permanence: alcohol’s role in the tango is usually tied to love, and the use of alcohol in tango lyrics highlights its priority. Munné listed the pretexts for drinking: betrayal, rejected love, and sad themes; the different purposes for drinking: to forget and to drown sorrows; and the various effects: remembering, speaking, crying, being sad, and trusting others (Munne, 2003).

Table 1: Purposes & Effects in Tango Lyrics.

The increased amount of SUI imagery in the tango reveals the role of alcohol and drinking in Argentinean culture. In fact, in recent years the country was becoming increasingly aware of alcohol related problems (Munne, 2003). Munné writes that the tango “[served] as a medium for the expression of the feelings, desires, and frustrations of the population (pg. 417).” This compares well to the role of music in American society and its representation of changing ideas about substance use and consequences. Differences in popular opinion, society, artists lives (the experiences that they pull from), and traditions within cultures lead to a range, from positive to negative and from inflammatory to conciliatory, in SUI. Here in the United States, SUI in music enters the popular news sphere in waves. For example, in a 1999 study of SUI in popular movies and music, the Office of National Drug Control Policy found that of 1000 songs, a little more than 25% had direct references to various substances. This finding is reinforced by other studies from the Archives of Pediatrics & Adolescent Medicine (Primack, Dalton, Carroll, Agarwal, & Fine, 2008) and from discussions held at the November 2007 American Public Health Association Meeting (Content Analysis of references to substance abuse in popular music, 2007). Although these negative images stand out, in 2005, singer Kelly Clarkson’s SUI-free “Since You’ve Been Gone” was a top hit on music charts, proving that music with less SUI also can be popular.

Based on the above example, and report references, the presence of substance use images in the arts is not limited to specific genres, time periods, or cultures. The role of SUI in music is best described as two-fold: artists see it positively because it allows for free commentary on society; alternatively, those who focus on the influence that SUI has on listeners view it negatively. Artists use SUI as a positive outlet and a constructive way to comment on changes in society as these relate to substance use and addiction. As the popular music of the time and culture, the tango allowed the Argentinean population to look at themselves critically, and contemporary popular music should allow us to do the same. Researchers, educators, and parents often question how to curb the influence of references to substance use. It is evident that the prevalence of SUI in music reflects the society listening to that music. In reality, limiting the influence of SUI is as constant as SUI’s prevalence. Prevention programs, messages intended to limit substance use, and other forms of pre-emptive anti-substance abuse pressure have to be as strong and as persistent as SUI’s initial influences on listeners to succeed at demonstrating the possible negative consequences of substance use.

What do you think? Comments can be addressed to Ingrid R. Maurice.

Notes
1 Munne uses "An anthropological view of alcohol and culture in international perspective"(1995) by Heath as a reference for this definition.

References

Content Analysis of references to substance abuse in popular music. (2007). Paper presented at the American Public Health Association 135th Annual Meeting and Expo, Washington, D.C.

Munne, M. I. (2003). Drinking in tango lyrics: an approach to myths and meanings of drinking in Argentinian culture. Contemporary Drug Problems, 23(8), 415-439.

Primack, B. A., Dalton, M. A., Carroll, M. V., Agarwal, A. A., & Fine, M., J. (2008). Content Analysis of Tobacco, Alcohol, and Other Drugs in Popular Music. Archives of Pediatric & Adolescent Medicine, 162(2), 169-175.

Addiction & the Humanities Vol 4. (4) - "When I was a kid, I inhaled. That was the point."

Part of what affects politicians’ ability to lead is their use of personal biases and experiences to enrich leadership style and effectiveness, and create a positive public image. The current debate about the legalization of marijuana relates directly to politicians’ personal experiences with substance use. These personal experiences affect the public’s perception of the politician’s image and potentially influence the public’s perceptions of drug use. This week’s HUMANITIES uses Barack Obama’s honesty about drug use to consider the effect that politicians’ personal experiences might have on politics and the public.

Experimenting with drugs as a youth is an experience that most public figures try to keep quiet. Barack Obama is one of the few politicians who have been honest and forthcoming with information regarding his substance-related ‘skeletons in the closet’: marijuana and cocaine use. In interviews, debates, and a 1995 memoir, Dreams from my Father, Obama is candid about the personal internal struggles that he faced during his youth that led him to drug use. In Dreams from my Father, he says “I blew a few smoke rings, remembering those years. Pot had helped, and booze; maybe a little blow [cocaine] when you could afford it. Not smack [heroin], though - Mickey, my potential initiator, had been just a little too eager for me to go through with that. Said he could do it blindfolded, but he was shaking like a faulty engine when he said it…(Obama, 1995, p. 85)”

Obama’s reasoning for his honesty regarding past drug use is that he feels he owes it to younger voters to be frank about the situation. When questioned about this in the past, he responded “young people who are already in circumstances that are far more difficult than mine need to know that you can make mistakes and still recover”("Obama Admissions on Drug Use Could Signal New Era in Politics," 2007; Romano, 2007, p. A01). Obama maintains this view and told some students at a high school “You know, I made some bad decisions that I've actually written about. You know, got into drinking. I experimented with drugs,” he says. “There was a whole stretch of time that I didn't really apply myself a lot. It wasn't until I got out of high school and went to college that I started realizing, ‘Man, I wasted a lot of time’” (Saul, 2007, p. 1).

Many major news outlets (e.g., Fox, The Washington Post, The Daily News) have described Obama’s honesty as marking a new era in politics. Previously, admissions of substance-use might have been taboo for the public; the new era involves the acceptance of candidates whose life experiences might differ from the majority of voters. Further, according to Romano (2007) and articles on the Fox news website ("Obama Admissions on Drug Use Could Signal New Era in Politics," 2007), middle-aged voters who support Obama may continue to do so because, as baby boomers, they are part of a generation that spent a decade experimenting with drugs. For them, Obama’s current success proves that early substance abuse does not guarantee lifelong failure.

Despite his success, it is important to ask whether Obama’s honesty about his drug use marks a shift in public opinion about political leaders and their personal conduct. If so, the public should give potential adverse implications equal consideration. A shift towards accepting drug use and experimentation in adolescents could persuade observers to reason that addiction and substance use prevention for youth is unnecessary. However, a favorable shift in public opinion towards substance use is not reason to accept all substance use experimentation. Obama is not suggesting that adolescents can experiment with substances without worrying about short term negative consequences. Rather, he describes the circumstances surrounding his personal experimentation, while still admitting his error – turning to substance use as a solution. Far from implying leniency, this shift suggests that prevention programs and treatment for substance use and addiction are still a necessary part of youth education. Some adolescent experiments with substance use will have tragic consequences. It is for those unlucky individuals that prevention programs are continually further developed and improved.

What do you think? Comments can be addressed to Ingrid R. Maurice

References

Obama Admissions on Drug Use Could Signal New Era in Politics [Electronic (2007). Version]. FoxNews.com. Retrieved December 11, 2007.

Obama, B. (1995). Dreams From my Father: A Story of Race and Inheritance: Times Books, a division of Random House.

Romano, L. (2007). Effect of Obama's Candor Remains to Be Seen [Electronic Version]. The Washington Post. Retrieved January 3, 2007 from http://www.washingtonpost.com/wp-dyn/content/article/2007/01/02/AR2007010201359.html.

Saul, M. (2007). Barack Obama tells N.H. kids of his alcohol, drug use during teen years [Electronic Version]. The Daily News. Retrieved November 21, 2007 from http://www.nydailynews.com/news/politics/2007/11/21/2007-11-21_barack_obama_tells_nh_kids_of_his_alcoho.html.

Addiction & the Humanities Vol.4 (3) –The Buzz: Taking a closer look at addiction in pop culture.

Approximately one year ago, HBO launched The Addiction Project  in partnership with the Robert Wood Johnson Foundation, the National Institute of Drug Abuse, and the National Institute of Alcohol Abuse and Alcoholism (Leis, 2007). Mental health advocates lauded the film and education project as “groundbreaking” and hoped it would educate the public about addiction (Leis, 2007) and create a new dialogue about addiction. Fast forward one year and addiction is still in the headlines. Now, the very same organizations that praised The Addiction Project for its honest portrayal of addiction are upset by “Celebrity Rehab with Dr. Drew” on VH1 (Jesella, 2008). This week’s Humanities inquires whether presentations of addiction in the popular culture are potentially harmful.

HBO’s Addiction Project featured a documentary, a book, four independent addiction-themed movies, a website, and a national community grassroots campaign coordinated by Faces and Voices of Recovery, Join Together, and Community Anti-Drug Coalitions of America (CADCA). These three groups brought together elected officials, people in recovery, and community-based organizations to promote awareness and discuss new policies for addiction treatment. Many reviewers praised the series, which was honored by the Academy of Television Arts and Sciences Governors Award in 2007.

Two recent changes in the media have influenced the depiction of addiction: the public’s desire for celebrity gossip and the explosion of reality television shows.  Celebrity gossip has become so popular that following Brittney Spears, who has been to rehabilitation three times in the past year, has become an industry in and of itself. During the past year, millions of Americans have viewed her every move. You can see the importance of celebrity gossip in our daily lives by measuring the rapid growth of the celebrity gossip website TMZ.com. According to Alexa.com, a company that analyses web traffic, TMZ.com is one of the top 200 websites for Internet traffic in the U.S. and one of the top 1,000 websites worldwide. It has become so popular that photographs and footage shot by TMZ staff have found their way into national news broadcasts. 

The other vehicle driving this voyeuristic behavior is reality television. The popularity of reality television began with MTV’s “Real World” series in 1992. The show placed seven strangers together in an apartment for several months and followed their every move (MTV, 2008). Between 1992 and 2008 there has been a multitude of reality TV shows many of which aired on MTV and VH1. A spin-off of the “Real World” on MTV was “The Surreal Life” on VH1 that used celebrity participants. Reality television was recently bolstered by the 14-week writers’ strike (Mitchell & Goldmann, 2008) that left television executives without scripts. To fill open time slots, TV executives opted for a variety of new reality television shows.

Recent media depictions of substance use and unsuccessful attempts at rehabilitation have some addiction experts worried that celebrities (e.g. Lindsay Lohan and Britney Spears) are making a mockery of the rehabilitation experience and the seriousness of addiction (Reuters, 2007). The exposure of rehabilitation by Dr. Drew Pinsky, a practicing physician board-certified in addiction medicine, in the VH1 reality show “Celebrity Rehab with Dr. Drew” (Kotlyar, 2008) has fueled heated discussion. Groups  such as Faces and Voices of Recovery are mobilizing against “Celebrity Rehab,” arguing that the drama that plays out on the show sensationalizes addiction (Faces and Voices of Recovery, 2008) and takes advantage of vulnerable people. Can people suffering from mental disorder give truly informed consent to have their story televised? Concerned groups argue the show’s depiction does not match reality. For example, most people who seek treatment do not have access to the quality of the facilities shown on “Celebrity Rehab” (Faces and Voices of Recovery, 2008). Opponents of the show “believe that when people see this show, they’ll wonder why they should help people with addiction and why people should get insurance coverage for their care” (Calderone, 2008). This might make it difficult to fix inequalities in the reimbursement for addiction treatment compared with other chronic diseases.

“Celebrity Rehab” seems to be the logical marriage of the public’s incessant need for up-to-the-minute gossip on celebrities (e.g. TMZ.com), the popularity of reality television, and celebrity voyeurism. Dr. Pinsky defends his show arguing that the public’s focus is already on celebrities and their battles with addiction.  What he is attempting to do is harness that focus and help the public understand that rehabilitation is not easy and that it takes a lot of hard work (Celizic, 2008). VH1 executives defend the show stating “Celebrity Rehab is as real as it gets… this is about as scared straight as you’re going to get” (Miller, 2008). The show spans the entire 21 days inpatient rehabilitation process. However, the time restrictions of television allow VH1 to show only approximately one percent of everything that occurred during the 21 days filmed (Kotlyar, 2008). Despite the criticism, the show has opened to favorable reviews (Maynard, 2008; Rhodes, 2008).   

Celebrities and their public fight against addiction will continue to be the buzz in pop culture. Society’s desire for contact with celebrities does not seem to be waning.  Reality television shows offer television audiences an opportunity for guilt-free voyeurism.  Are people watching shows like “Celebrity Rehab” to understand the struggles of addiction?  Maybe, but just as many are probably watching because they enjoy seeing other people, especially the rich and famous, suffer. It gives them an opportunity to compare their lives to those they see on television. Their struggle with addiction in the public eye is an opportunity to educate the public at large.  Addiction advocates and treatment specialists need to constructively shape the discussion and ensure that the public is not misled, all the while making sure that those seeking treatment get the care they deserve. 

What do you think?  Does “Celebrity Rehab with Dr. Drew” glamorize substance use and take advantage of the mentally ill or is it a continuation of the dialogue started by the HBO’s Addiction Project, focused on a younger audience?

Comments can be addressed to John H Kleschinsky.

References
Calderone, T. (2008). Letter to President of VH1.   Retrieved March 09, 2008, from http://www.facesandvoicesofrecovery.org/pdf/01.25.2008_NAATP_celeb_rehab.pdf

Celizic, M. (2008, Jan 08, 2008). Dr. Drew treats celebrities' demons on new show: TODAY contributor helps the famous, and no-as-famous, with addictions.   Retrieved March 09, 2008, from http://www.msnbc.msn.com/id/22555361/

Faces and Voices of Recovery. (2008). Speak out about VH1's "Celebrity Rehab with Dr. Drew". Campaigns: Retrieved March 09, 2008, from http://www.facesandvoicesofrecovery.org/about/campaigns/celebrity_rehab.php

Jesella, K. (2008). Does 'Rehab' host go too far? [Electronic Version]. Chicago Tribune. Retrieved March 09, 2008 from http://www.chicagotribune.com/features/lifestyle/health/chi-0212_health_rehab_rfeb12,1,7277025.story.

Kotlyar, A. (2008). Celebrity Rehab with Dr. Drew. VH1.com   Retrieved March 09, 2008, from http://www.vh1.com/shows/dyn/celebrity_rehab_with_dr_drew/series.jhtml

Leis, R. (2007). HBO's Groundbreaking 14-Part Series, The ADDICTION Project, Kicks Off March 15. Announcement   Retrieved March, 09, 2007, from http://www.jointogether.org/news/yourturn/announcements/2007/hbo-the-addiction-project.html

Maynard, J. (2008, January 10, 2008). VH1's 'Celebrity Rehab' Could Become a Habit.   Retrieved March 09, 2008, from http://www.washingtonpost.com/wp-dyn/content/article/2008/01/09/AR2008010903434.html

Miller, M. (2008). VH1 puts reality into rehab. Los Angeles Times   Retrieved March 09, 2008, from http://www.latimes.com/entertainment/la-et-rehab9jan09,1,6990632.story

Mitchell, G., & Goldmann, S. (2008). Writers Guild Members Overwhelmingly Ratify New Contract. News Release   Retrieved March 14, 2008, from http://www.wga.org/subpage_newsevents.aspx?id=2780

MTV. (2008). The Real World New York. Real World   Retrieved March 14, 2008, from http://www.mtv.com/ontv/dyn/realworld-season1/series.jhtml

Reuters. (2007, July 26, 2007). Experts: Lohan, Spears making mockery of rehab. Health   Retrieved March 09, 2008, from http://www.cnn.com/2007/HEALTH/07/25/celebrities.rehab.reut/index.html

Rhodes, J. (2008). Shocking Celebrity Rehab Moments Revealed. TV Guide   Retrieved March 09, 2008, from http://seattlepi.nwsource.com/tvguide/349330_tvgif30.html

Addiction & The Humanities Vol. 4(2) - Live Fast, Die Young? Maybe Not.

Media reports and speculation associate celebrity status with early death. Supporting this relationship, qualitative research has concluded that celebrities are more likely to suffer from stress, substance use, and depression, which are risk factors for early death (Patalano, 2000; Raeburn, 1999). This week’s BASIS explores quantitative research about this topic. In “Elvis to Eminem,” Mark Bellis and his colleagues hypothesized that “popstars” would have a higher mortality rate than individuals from matching demographics (e.g., age, sex, and race) in the general population (Bellis et al., 2007).

Bellis et al. focused on European and North American music stars within six genres: rock, punk, rap, R&B (rhythm and blues), electronica, and new age. The researchers calculated celebrities’ total years of life since becoming famous and compared the result to the UK and US general populations’ expected rates of survival. They standardized the general population survival rates for age, sex, and for North American analyses, ethnicity. Bellis et al. found a significant difference between US and UK music stars’ survival rate after 25 years of fame. For European music stars, the relative survival probability increases until the difference between it and the general population’s survival rate is not significant. As shown in Figure 1, for North American “popstars,” the relative survival rate continues to deviate from that of their European counterparts and from that of their matched populations.

Figure 1: Comparative survival curves for North American and European pop stars and demographically matched general populations (Bellis et al., 2007).

The study of the 1,064 music stars also found that an overdose or a chronic drug or alcohol problem caused more than a quarter of music star deaths; however, the crude mortality (i.e., death rate for the entire population including all sexes, ages, and causes) of European music stars was only half of that for North American stars.

The findings of Bellis et al were limited by their operational definition of stardom (i.e., choice of an international poll from the year 2000 that determined the All-Time 1000 Albums). Another limitation was their definition of date of fame, which was not based on any epidemiological standards, but on the artists’ earliest date of chart success, which resulted in slightly more conservative results. A third limitation was their failure to use official cause of death records in their research, rather than a range of non-traditional sources (i.e., cross- referenced over 430 websites, books, etc.). Lastly, the use of US and UK life tables as substitutes for North American and European measures also limited the study.

Bellis et al propose greater collaboration between the health and music industries to help assure that pop star influence leads to better health among fans and rising stars that look to them as leaders. However, it may be more interesting to propose that the music industry provide newest music stars with preventative tools, treatment, and resources to prevent unhealthy lifestyles. Moreover, the same research conclusions and suggestion could be applied to other non-music celebrities. The nature of stress that celebrities face in combination with the easily accessible substances suggest that a certain amount of preparation for this change in lifestyle is necessary to successfully navigate the celebrity world and avoid widely publicized addiction or premature death.

What do you think? Comments can be addressed to Ingrid R. Maurice.

References

Bellis, M. A., Hennell, T., Lushey, C., Hughes, K., Tocque, K., & Ashtan, J. R. (2007). Elvis to Eminem: quantifying the price of fame through early mortality of European and North American rock and pop stars. Journal of Epidemiology & Community Health, 61(10), 896-901.

Patalano, F. (2000). Psychological stressors and the short life spans of legendary jazz musicians. Perceptual & Motor Skills, 90(2), 435-436.

Raeburn, S. (1999). Psychological issues and treatment strategies in popular musicians. A review, part 1. Medical Problems of Performing Artists, 4(1), 171-179.

Addiction & the Humanities Vol. 4(1) - Frank "Superfly" Lucas: American Gangster

In the last Humanities, we discussed the role of Khun Sa, "The Golden Triangle King", in international drug trafficking. Based out of Myanmar (formerly Burma) Khun Sa had enormous success in growing and trafficking opium. Continuing with the theme of drug trafficking, this week's HUMANITIES reviews the newly released Denzel Washington movie, American Gangster. The movie is similar to other Hollywood movies depicting gangsters and drug dealers (e.g., The Godfather I, II, and III, Scarface, Goodfellas, Hustle and Flow), but American Gangster's storyline is inspired by a real drug dealer: Frank "Superfly" Lucas.

The title American Gangster is the first clue to the movie's importance in American Culture. The movie explains the dry, meticulous business of successful drug trafficking in America, giving it an almost legitimate feel. Further, and more importantly, the movie also provides its viewers with an inside view to the world of successful drug dealers, giving considerable insight into what that world says about drugs and addiction in the United States.

In a move that focuses attention on the US's national drug market, the movie contains only 3 international links: Lucas's wife is of Puerto Rican descent, (although Puerto Rico is a US Territory its culture is distinct from US Culture), the Vietnam War serves as a historical backdrop, and Lucas's product supplier farms his opium in Asia. Although these international links are important, they do not detract from the fact that cutting, shipping, distribution and, most importantly, profit all happen within the US and to benefit US citizens. Even members of the US military participated in the illegal activities. Having been contracted by Lucas, some military personnel turned a blind eye to, and guided the illegal cargo across international lines. This imagery conveys the message to the American public that the leaders of successful drug trafficking operations (people similar to Khun Sa,) are not always based outside of the country. Furthermore, those in the US are often more successful due to the demand for high quality opioid in the West and the reduced price at which people like Frank Lucas could and did purchase purer drugs from the East.

Picture:
(left) Frank Lucas and his wife Julie Lucas
(right) Actors Denzel Washington & Lynmari Nadal as Frank and Eva Lucas.

Further substantiating the significance of the American drug dealer, with minimal glamorization, the movie American Gangster shows the cycle that perpetuates within successful American drug trafficking. This cycle is the same supply and demands cycle that influences international drug trafficking, as well as a lifestyle that rejects the use of addictive substances. However, the cycle has the added elements of familial hierarchy and business. In the movie, Frank Lucas "inherits" his drug business after the death of his former employer, for whom he was the driver. He subsequently expands it by using the services of his closest relatives: his brothers. Furthermore, Frank Lucas's character never uses any of the products that he sells. He doesn't drink excessively, smoke or gamble excessively or engage with any other addictive activities. In fact, various scenes in the movie (e.g., a party at his home in which he is infuriated by a "high"guest) show his disdain for those that use drugs and lack the self-control required to stay away from them. Frank's only addictive behavior pattern, and the reason for his steady success, is his penchant for working constantly.

American Gangster's geographical setting, Harlem, provides the viewing public with a familiar locale within which to place and understand one aspect of American drug trafficking. Because of its rich history -- the Harlem Renaissance, significant cultural diversity before the Great Depression, the 1968 riot following Martin Luther King's assassination, and David N. Dinkins 1989 election as mayor -- Harlem is familiar to most movie-goers. Even for movie-goers that will not recognize Harlem, the presentation of a poorer neighborhood with unsafe apartment complexes filled with illegal drugs is a well-known image with which viewers can easily identify. Movies, television, books, and news outlets repeatedly present these images as a common setting for drug abuse.

The American Gangster movie formula is not a new one: information about a drug dealer's pre-drug business life, his rise to power and notoriety, and his downfall. However, American Gangster is interesting and worth seeing. Both leads, Denzel Washington and Russell Crowe play their parts well, and the imagery in the movie is evocative. The movie's plot becomes even more interesting when viewers take the time to research the real Frank Lucas. In two New York Magazine interviews, from 2000 and 2007, images and quotes from the real Frank Lucas (Jacobson, 2000; Jacobson, 2007) immediately bring the reader back to specific scenes in the movie. Although the movie is not biographical, the attention to details and facts from Frank Lucas' life is captivating. For example, the left side of the above photo is not of Denzel Washington, but of the real Frank Lucas and his wife; movie-goers will remember that the same fur coat ultimately brings about Lucas' downfall in the movie.

What do you think? Comments can be addressed to Ingrid R. Maurice.

 

References

Grazer, B. (Producer), & Scott R. (Director). (2007). American Gangster [Motino Picture]. United States: Universal Pictures

Jacobson, M. (2000). The Return of Superfly. Retrieved on December 23, 2007 from http://nymag.com/nymetro/news/people/features/3649/

Jacobson, M. (2007). The Lords of Dopetown. Retrieved on December 23, 2007 from http://nymag.com/guides/money/2007/39948/

Addiction & the Humanities Vol. 3(10) - Supply & Demand: Looking at addiction through drug trafficking

The guiding principle of supply and demand plays a key role in the indirect exchange between drug suppliers and drug users. In addition to local drug traffickers, there are also international drug rings whose successful operations make them essential collaborators in the drug business. One leader of such a drug ring was Khun Sa, whose life and death highlights differences in international government practices related to drug control. In this issue of Addiction and the Humanities, we use Khun Sa as a lens to examine the role of drug trafficking in the supply and demand that feeds drug addiction.

From 1974 to 1994, Khun Sa had unrivalled success and control over the growth and transport of opium, and its derivative, heroin, in the Shan State of Myanmar (formerly Burma) (AlJazeera.net, October 30, 2007; Economist, November 8, 2007). His rise to control came from a combination of confused reasoning and a government whose wish for economic and military aid clouded its judgment on how to deal with drug trafficking. Although never formally educated, Khun Sa received military training from the Chinese Nationalist forces. This experience no doubt proved valuable in commanding a local militia, and running his part of the already present opium business.

After moving his life and business to Myanmar (formerly Burma) (Fuller, November 5, 2007), Khun Sa maintained a love-hate relationship with both the Shan people and the Burmese Government; he argued that providing economic stability for the Shan people motivated him to engage in drug trafficking. In addition, although it publicly condemned him, the Burmese Government tolerated his control of Myanmar’s most economically rewarding export, and his arrangements with local police, soldiers, and generals. In 1996, the government reached a tacit agreement with Khun Sa ensuring that he would avoid extradition, receive government protection, and could retire comfortably; in return he had to surrender his home, weapons, ammunition, soldiers, refineries, and crops to the Burmese Government.

In 1977, Khun Sa offered to sell his entire opium crop to the United States (Johnson, March 1, 1982); this proposal suggested that buying his opium crop was the only way for the US to take it off the market and minimize the amount of opium traveling from Asia to the US. Khun Sa knew that his products, business, and influence stretched internationally, and with the Burmese Government’s help, he was able to avoid the consequences (e.g., indictment, extradition, trials) of international illegal activity. With the majority of demand for illegal drugs originating in the West, more specifically in the United States, foreign government cooperation with drug traffickers poses a threat to international attempts to put a stop to drug business’s power. In Khun Sa’s case, the Burmese Government enabled him in multiple ways. While Khun Sa controlled a personal army, the government accepted the idea of opium as a profitable crop and chose to ignore the evident negative effects on international relations. In fact, Khun Sa’s January 7, 1996 surrender to the Burmese Government placed a significant amount of weaponry and property in their hands.

Myanmar’s exit from the opium (heroin) business (Liu, November 6, 2007) made room for other Eastern countries' re-entry. Afghanistan, for example, has regained its position as the number one producer of heroin in the East; 92% of the world’s heroin is now produced in Afghanistan (Liu, November 6, 2007). The situation in Afghanistan is similar to that in Myanmar: without sufficient government regulations, drug traffickers can impose their power and deceive nations into thinking that their drug transactions function like all other import/export businesses. The difference in philosophy between Eastern and Western government ideas explains why Khun Sa’s proposal to the United States was met with an indictment. In the US, illegal drug activity is punished on both ends of the supply and demand scale; however, similar to the Shan state, currently some Eastern nations have less demand and can focus on their role as suppliers to bring them financial stability.

What do you think? Comments can be addressed to Ingrid R. Maurice.

References

AlJazeera.net. (October 30, 2007). Golden Triangle drugs kingpin dies.   Retrieved November 26, 2007, from http://english.aljazeera.net/NR/exeres/FA91ECD1-59CA-4963-83EE-34DCB6557F71.htm

Economist, T. (November 8, 2007). Obituaries: Khun Sa (Chang Chi-fu), master of the heroin trade, died on October 26th, aged 73.   Retrieved November 19, 2007, from http://www.economist.com/obituary/displaystory.cfm?story_id=10097596

Fuller, T. (November 5, 2007). Khun Sa, Golden Triangle Drug King, Dies at 73. New York Times, Asia Pacific Section   Retrieved November 19, 2007, from http://www.nytimes.com/2007/11/05/world/asia/05khunsa.html

Johnson, M. (March 1, 1982). The Great Opium War. Time Magazine   Retrieved November 26, 2007, from http://www.time.com/time/magazine/article/0,9171,922799,00.html

Liu, M. (November 6, 2007). Death of the Golden Triangle's most powerful druglord. Newsweek   Retrieved November 19, 2007, from http://www.blog.newsweek.com/blogs/ov/trackback.aspx?PostID=65236

Addiction & the Humanities Vol. 3(9) - Holidays: A Time to Celebrate, a Reason to Drink, or a Time to Celebrate Drinking?

Addiction & the Humanities Vol. 3(8) - Examining racial and ethnic substance use differences following exposure to disaster.

Disasters, such as recent hurricanes and floods in North America, earthquakes in Indonesia, the 2004 tsunami in Southeast Asia, and the New York City World Trade Center attack, have killed thousands and exposed thousands more to ongoing trauma.  Survivors probably manage the aftermath of such disasters by utilizing coping methods dependent upon their current situation; specific strategies vary by culture. For example, researchers have found differences in social support and coping among different racial and ethnic groups (Pole et al., 2005; Kim et al., 2007.)  This week, Addictions and the Humanities considers whether people exposed to the World Trade Center attack from different racial, ethnic, and cultural backgrounds experienced different addiction-related health outcomes.

Unfortunately, it is difficult to conduct disaster research for a number of reasons. Disasters vary in many ways: geographic size, mortality rates, elapsed time, and displacement among others. Such differences make studying the effect and generalizability of findings related to disasters and their aftermath challenging.

To study the effect of the World Trade Center attack (WTC attack) on increased cigarette and alcohol use, Wu et al. (2006) drew a stratified random sample of all high school students in New York City and had the students complete a survey about their exposure (direct, family or media) and their cigarette and alcohol use after the WTC attack.  Researchers examined participants’ self-reports that they “started” or “increased” smoking/drinking after the WTC attack.  Analyses revealed that students directly exposed to the attack reported increased alcohol use after the WTC attack, Odds Ratio (OR)  1.8 (95% CI, 1.1-2.8).  Researchers compared African Americans, Asian American and Hispanic American students to their non-Hispanic white counter parts; these minority groups were protected from increased alcohol use after the WTC attack.  The OR for African American students was 0.4 (95% CI, 0.2-0.7), for Asian American students the OR was 0.5 (95% CI, 0.3-0.9), and for Hispanic American students the OR was 0.6 (95% CI, 0.3-0.9) (see Table 1).

There are several limitations to discuss.  The study is not longitudinal; therefore, it is impossible to determine if exposure to the WTC attack precipitated the change in smoking and drinking behavior.  Second, the population studied was high school students in New York City.  Consequently, the results should only be generalized to adolescents involved in disasters where displacement is minimal, as was the case in NY.  Finally, researchers asked only if subjects initiated or increased use of alcohol and cigarettes but not other substances of abuse.  This makes it difficult to determine the degree to which substance use increases after a disaster.

The finding that Asian, Hispanic and African-American students drank alcohol less than non-Hispanic whites is interesting and warrants further study.  This finding contrasts with results from the Youth Risk Behavior Surveillance System, which identified higher alcohol use prevalence rates among Hispanic and non-Hispanic white students compared to African-American students (Eaton et al., 2006).  It is possible that certain cultural values might have lead to protection against alcohol abuse or that certain cultures abuse other substances not measured in response to disasters.  Future studies must use comprehensive measures of substance use, focus more on cultural differences, and follow up with students over a longer period of time.  Researchers also must study whether coping mechanisms manifest differently in various geographical areas and cultures. If more research identifies cultural coping differences, these results should inform public health strategies and interventions.

What do you think?  Comments can be addressed to John Kleschinsky.

References
Eaton, D. K., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Harris, W. A., et al. (2006). Youth risk behavior surveillance--United States, 2005. MMWR Surveillance Summaries, 55(5), 1-108.

Kim, J. H., Knight, B. G., & Longmire, C. V. (2007). The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health. Health Psychology, 26(5), 564-576.

Pole, N., Best, S. R., Metzler, T., & Marmar, C. R. (2005). Why are hispanics at greater risk for PTSD? Cultural Diversity and Ethnic Minority Psychology, 11(2), 144-161.

Wu, P., Duarte, C. S., Mandell, D. J., Fan, B., Liu, X., Fuller, C. J., et al. (2006). Exposure to the World Trade Center attack and the use of cigarettes and alcohol among New York City public high-school students. American Journal of Public Health, 96(5), 804-807.

Addiction & the Humanities Vol. 3(7) - Higher education: Does obtaining an advanced degree help protect against risky behavior?

Many societies regard higher education as a protectorate against addiction.  Such culturally developed beliefs can create biases that preclude opportunities for early detection of problems and consequently early intervention. In this issue of Addiction and the Humanities, we review evidence of substance-related problems among the highly educated.  Although education tends to decrease the likelihood of substance-related addiction (Substance Abuse and Mental Health Services Administration, 2005), the highly educated are not immune to developing substance use problems. 

Researchers surveyed a highly educated workforce (Matano, Wanat, Westrup, Koopman, & Whistsell, 2002) to investigate the prevalence of risky substance use behaviors among a more educated workforce.  Matano et al. (2002) randomly selected 10% (N=857) of employees to receive surveys regarding their substance use behaviors during the previous 12 months.  Of these eligible employees, 504 sent back completed surveys. Respondents were 62.8% female and ranged in age from 21 to 78 (M=43.8).  Eighty one percent of the sample earned a bachelor’s degree or higher and 3% earned a high school diploma or less. 

Table 1 summarizes the survey results.  The results reveal that alcohol and licit drug use was more prevalent than illicit substance use among this sample.  A significant number of employees however, reported illicit drug use during the past year.  Based on responses to the CAGE (Ewing, 1984), 12% qualified for “likely to have lifetime alcohol dependence.” Responses to the AUDIT (Bush, Kivlahan, Mcdonnell, Fihn, & Bradley, 1998) indicated that 5% had a “high likelihood of alcohol abuse.” In addition, 3% claimed that their alcohol consumption caused injury to someone else.  Despite these results only a handful of employees reported receiving any substance abuse treatment over the last year.

Table 1. Past year substance use among employees (N=504)

There are several limitations to this study. For example, the 60% response rate might result in substance use differences between those that completed and those that did not complete the survey. In addition, this survey was conducted in 1999, and it is possible that substance use behaviors among highly educated employees have changed since then.  Finally, substance use might be a more sensitive topic for the highly educated, perhaps biasing the self-report in the direction of underreporting.

Despite constraints that might limit the extent of reported substance use and related problems, this study confirms that substance use and abuse is not an issue reserved only for less educated individuals.  There is a need for employee prevention and intervention programs in work forces populated by the highly educated. Assuming that educated individuals are immune to substance use problems might diminish their chances of getting the help they need.

References

Bush, K., Kivlahan, D. R., Mcdonnell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789-1795.

Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association, 252(14), 1905-1907.

Matano, R. A., Wanat, S. F., Westrup, D., Koopman, C., & Whistsell, S. D. (2002). Prevalence of Alcohol and Drug Use in a Highly Educated Workforce. The Journal of Behavioral Health Services & Research, 29(1), 30-44.

Substance Abuse and Mental Health Services Administration. (2005). Overview of findings from the 2004 National Household Survey on Drug Abuse: Volume 1. Summary of National Findings (No. SMA 05-4061). Rockville, MD.