Stanton's Blog Archive 2006
Good Luck Eliminating Underage Drinking
The House passed The Sober Truth on Preventing Underage Drinking (STOP) by a vote of 373-23 on Nov. 1. The bill awaits Senatorial approval and President Bush’s signature to become law. Its success seems likely, however, since it’s supported by a wide range of government agencies, alcohol producers and sellers, and public interest groups.
The bill’s name indicates its goal – to stop Americans under the age of 21 from drinking. The few objections to it center on its redundancy – underage drinking is, by definition, already illegal.
The bill is needed, according to Rep. Tom Osborne (R-Neb.), one of its cosponsors, because "the Centers for Disease Control and Prevention estimated the number of underage deaths due to excessive alcohol use at 4,554 a year.”
But we have been fighting underage drinking for decades, since the drinking age was raised nationally to 21. We should note that no other Western/European nation limits drinking to those 21 and older. One reason every other comparable country permits such “underage” drinking is that they want to keep it public, where it is less likely to become surreptitious, excessive, and dangerous – as such drinking typically is in the United States.
According to the government’s National Survey on Drug Use and Health, “In 2005, about 10.8 million persons aged 12 to 20 (28 percent of this age group) reported drinking alcohol in the past month. Nearly 7.2 million (19 percent) were binge drinkers” – that is, having five or more drinks at least once a month – “and 2.3 million (6 percent) were heavy drinkers (frequent binge drinkers).”
These are quite startling figures. More than a quarter of teenage and underage Americans currently drink, and one in five binge drinks. But even these figures don’t capture the peril of unhealthy drinking by young Americans. More than half of those 18 to 20, still underage, drink. When they can drink legally, between the ages of 21 and 25 year, more than two-thirds drink.
They don’t drink well. More than a third of those aged 18 to 20 (36 percent) binge drink, as do 46 percent among those aged 21 to 25. Thus bingeing gets even worse when young people can drink legally – at age 21, half of all Americans binge! When intoxicated, young Americans do dangerous things – 20 percent of 18 to 20 year olds, and 28 percent of 21 to 25 year olds, report having driven under the influence of alcohol in the past year.
So what is the problem here, and what can we realistically tackle? If our goal is to eliminate all underage drinking, we certainly have our work cut out for us. Underage drinking is commonplace, and by their late teens, typical of Americans. Striving to eliminate something that has reached this critical mass is impossible.
And what if we could eliminate such underage drinking? What would happen when all those abstinent youths can suddenly drink legally? Would they drink any better than young adults currently do?
They wouldn’t. After all, how would they have learned to drink moderately and sensibly? In a sister study to the National Survey, the University of Michigan measures attitudes towards drinking in its Monitoring the Future survey. This study finds that more high school seniors disapprove of regular moderate drinking than disapprove of periodic bingeing. Somehow, the alcohol education they have received has led them to prefer bingeing!
The drinking age cannot now be lowered in the U.S., whatever our NATO allies do. But is there, nonetheless, any way to discourage bingeing, even recognizing the high levels of underage drinking that will undoubtedly continue to occur? Of course, such efforts would also be focused on youthful legal drinkers.
Instead of stressing the elimination of all youthful drinking, we could use public service announcements to discuss the distinction between sensible and excessive drinking – which, after all, most adult Americans eventually learn. This could start with high school students. For instance, they could be taught that the government’s Dietary Guidelines for Americans recommends 1-2 drinks daily for adult Americans who drink, since this level of consumption is associated with reduced heart disease.
But high school alcohol education is unlikely to teach children that such a thing as healthy drinking exists. Unfortunately, this then leaves them susceptible to the most dangerous kind of excessive, periodic binges, both as teenagers and as young adults.
Barney Turns Against War
In his 60 Minutes interview, Bob Woodward told Mike Wallace, “Late last year, he [the President] had key Republicans up to the White House to talk about the war, and said 'I will not withdraw even if Laura and Barney are the only ones supporting me.' Barney is his dog."
Thus, late reports from Crawford, Texas that Barney has now joined other key Republicans, including Senators John W. Warner of Virginia and Chuck Hagel of Nebraska, in questioning the administration’s war effort has created a tremendous stir in the Capital.
It was not immediately clear what had caused Barney to change his position on the war. Some say it was news that Shiite militia had seized control of the Iraqi City of Amara. The conquest of a major city revealed just how little sway the Iraqi national government has over the nation it supposedly rules.
However, other reports were that Barney was deeply disturbed by Maj. Gen. William B. Caldwell’s admission that the U.S. drive to crush insurgent and militia violence in Baghdad had failed, as the American military could not control rampant bloodshed despite their concentration in the Iraqi capitol.
Caldwell’s announcement accompanied massive and increasing violence around the country; car bombs and snipers killed at least 66 people and wounded hundreds more in another day of raging sectarian violence. The dead included the Anbar province police commander, who was slain by gunmen who burst into his home in Ramadi.
For Caldwell to express such hopelessness was said to have rocked Barney’s world. Caldwell has been among the President’s most reliable supporters. For example, he often presented the administration view that the war was slowly but surely being turned over to Iraqi police and military forces.
But recent events have shown that Iraq armed forces have not been able to hold even a single neighborhood where they have been put in control, and American soldiers have quickly been pressed back into service patrolling Baghdad.
The Scottish terrier was said today to be resting, but to still be rejecting his favorite treats and toys.
When asked for a reaction to the news of Barney’s defection, Mr. Bush’s press secretary, Tony Snow, minimized its impact.
“In the first place,” Snow told assembled reporters, “Woodward misquoted the President. He actually said that he wouldn’t withdraw from Iraq ‘even if Laura and Cheney are the only ones supporting me.’” Vice President Dick Cheney remains steadfast in his support of the President, and continues to paint the war situation in glossy terms.
“Let’s just say,” Snow continued, “that Dick Cheney has turned out to be a much more loyal – I don’t want to say ‘pet’ or ‘lap dog,’ because really Cheney is in charge over there.”
Some people are wondering how much more support for the president’s Iraqi policies can waiver.
“Darling. Are you asleep? Do you really think it’s a good idea to keep our boys fighting in Iraq, when the government there can’t seem to hold it’s own over even one square mile?”
“Honey, would you mind sleeping in the Lincoln Bedroom? And could you let Spot (the Bush’s other pet dog) in here? I know he’s still with me.”
Mrs. Bush slowly took her comforter and left the president with his new favorite pet. As she left, she heard her husband mutter, “I don’t care if my only human supporters, other than anyone elected with me as a part of the Republican presidential ticket, do turn out to be those guys at Fox Network News.”
Stanton Peele is a pet therapist in New Jersey.
What’s the First Thing You Do After Committing a Crime?
Disgraced Congressman and child advocate Mark Foley has announced he is entering treatment for his alcoholism. His behavior, he said, drove home for him that he had a “long-standing and significant” drinking problem.
Nothing like being arrested or exposed for criminal behavior or being otherwise disgraced for alerting people to a substance abuse issue. That is, if you’re a high-profile individual who can afford treatment and have a public relations consultant. Most recently this group has included Mel Gibson, Patrick Kennedy, and Rush Limbaugh.
That most well-known people only decide that they need treatment after being caught suggests that this substance abuse can be fun. Pat O’Brien went to rehab after his explicit sexual phone call to a woman offering her a threesome became public. In case his escapades sounded remotely enjoyable to you working stiffs, O’Brien drove home how excruciating his behavior was to Dr. Phil:
Pat: Everybody has a bottom. And I hit my bottom that horrible weekend in New York. Do I remember most of it? No. And that's where the bottom is. It was a weekend of fun, I thought, a weekend of drinking, which turned into a little bit of craziness.
Dr. Phil: This ended badly with you being on the cover of every tabloid and many of the newspapers in the country, so it was more than a little bit of craziness.
For those of you not versed in recovery terminology, “bottom” means “hitting bottom” – that you did the absolutely worst thing ever which made you realize the extent of your addiction. As the interview indicates, one part of the process involves appearing on a television interview show to confess your sins, say how horrible it all was, and promise not to do it again.
But there is the nagging question of whether O’Brien would be happily doing the same thing the next weekend if the woman hadn’t shared his phone message with the world. Others in this category are former DC Mayor Marion Barry, who was caught on videotape smoking crack and cadging a woman for sex, and Oregon Senator Robert Packwood, who had multiple affairs and persistently propositioned and fondled female employees. Then there was Arkansas Representative Wilbur Mills, who was caught with stripper Fanne Foxe.
Patrick Kennedy represents a different variation. His hospitalization following a traffic mishap and run-in with the police was not his first. Rather, he rushed back to the Mayo Clinic where he has been treated before. In these cases, when the patient announces the typical recovery bromides to reporters, we can wonder why he and the rest of us should expect treatment to succeed this time.
In what has become the typical mantra on such occasions, Foley assured everyone that he is taking responsibility for his behavior. This part of the announcement is meant to head off accusations that he was only entering treatment as a ploy. Foley undoubtedly wants to make sure that no one cuts him a break because they’re thinking, “Maybe the booze made him seduce young men.” Whatever would make us believe he’s entering treatment for that reason?
One difference between show business personalities like O’Brien, Gibson, and Charlie Sheen is that they can’t get fired – although they may have to eat humble pie for a while.
Politicians are not usually so fortunate. The exception is Kennedy, who didn’t actually seem to be enjoying himself when he was apprehended. If they weren’t having fun or stealing, we are willing to forgive our public officials.
But, don’t despair on their behalf. Many of them have opportunities for alternative employment. Mills, for example, became a fixture on the alcoholism recovery lecture circuit.
New Jersey Donates $1.6 Million to Strapped Private Treatment Centers
I attended the annual meeting of the New Jersey Historical Society. Due in part to state cutbacks, the organization will no longer be opening their museum on Saturdays, staff has been laid off, and acquisitions and cataloguing are being curtailed. The same day I discovered that New Jersey had paid $1.6 million dollars over the past two years for beds it did not use in private drug treatment programs! The state prepaid for 115 beds, but about 30 percent went unfilled – and this rate has been increasing.
Meanwhile, the Department of Human Services' Division of Addiction Services has resisted renegotiating its contract with private providers. The Division, regarded as a great innovation in providing addiction treatment services, is already under a cloud. Division director Carolann Kane-Cavaiola is being investigated for awarding no-bid treatment contracts to Addiction Treatment Providers of New Jersey, which she previously headed.
There are two ways to regard these boondoggles: (1) they represent the standard New Jersey approach to awarding contracts, (2) they represent the standard futile approach to addiction treatment, where people are marched through useless programs led by former addicts who themselves have little grasp on how to assist others to develop full lives. Only now, New Jersey’s Division of Addiction Services has come up with the great innovation of eliminating the waste of actually having people show up for treatment, while still paying the programs and their staffs.
I was asked by Spiked to comment on British governmental proposals to expand gambling as a source of revenue. Primarily, in this interview, I take on the idea of gambling as a disease. Although I refute the disease proposition with regards to gambling, I of course believe that gambling can readily be addictive, and that governments are eager to finance and encourage this addiction. After all, they need the money after discouraging smoking and drug addictions and the tax revenues they do/could provide.
I was recently interviewed in The Guardian (April 12, 2006) explaining the nature of addiction, and the dangers of the disease theory.
Warning – Don’t Pray for Me!
Frequently, when news commentators describe someone undergoing an operation or suffering from an illness, the on-screen personality solicits prayers for the endangered person. This plea assumes that most, or all, viewers share a belief in the almighty and the value of prayer.
I know a woman who took the opposite tack. Since her seriously ill father was an atheist, when an acquaintance said she would pray for him, my friend requested that the woman not do so. Her father did survive his condition; it turns out that my friend may have saved her father’s life by asking the woman to refrain from praying.
The value of prayer to assist ill people has been studied a number of times over the years. It has only rarely been found to have any value.
Recently a researcher who has long been interested in mind-body phenomena like prayer, Harvard Medical School cardiologist Herbert Benson, published the results of such a study. Armed with a $2+ million foundation grant, Benson and his colleagues examined the benefits of prayer for patients who have received a heart bypass operation. Among his colleagues in the research was Dean Marek, a chaplain at the Mayo Clinic.
The research was of the highest order, a clinical trial of the therapeutic value of prayer in which patients receiving comparable operations were randomly assigned to receive prayer or not. Such research comprises a clinical trial like that required by the FDA in order to approve a medication or other therapy.
The bad news for Benson and other “believers” was that prayer had no impact on the likelihood of complications following the operation. This negative result was especially telling because the researchers were sympathetic to the efficacy of prayer.
In fact, over 1200 patients were assigned to three different conditions. In two of the conditions patients were told they might or might not receive prayer (in order to neutralize the impact of expectations). In one of these conditions, the patients were then prayed for by a religious group; in the other, they were not. Finally, in a third condition, patients were told they were being prayed for, which in fact they were.
The results were almost identical complication rates following the serious heart operation in patients who were prayed for and those who were not.
But there were two more disturbing findings. Patients who were told they were being prayed for had 13 percent more complications than those who were prayed for without being sure this was occurring. This result might be understood as a negative psychological consequence of believing that your condition requires prayer: “Am I really that bad off?”
Another negative finding in the study was even more damaging to the idea of prayer. Comparing patients who were prayed for without being sure this was occurring versus those who were equally uncertain but who were not prayed for, those receiving prayer had nearly 40 percent more major complications – typically a heart attack or a stroke.
The investigators were clearly uncomfortable with this negative reaction to being prayed for, and speculated it was an accidental result. But the research was conducted to measure the impact of prayer or its absence, and a negative finding like this cannot be ignored just because it is negative.
This result does require some interpretation, however. Perhaps God is offended by special pleadings for one individual – and he punishes those for whom such prayer is being offered.
If this is the case, then television or other public personalities, relatives, and ministers who request that people pray for a person everyone is concerned about are actually harming the object of the prayers. This is what the best research yet conducted on this question tells us.
There are three perpetual wars in which we in the U.S. are currently engaged. In each, we seek victory through applying force; in each, the problem never disappears, or diminishes – quite the contrary; in each, our response to our lack of success is to apply more of the force which has demonstrated its inefficacy – with predictable results. These three wars are with terrorism, illegal immigration, and drugs. We need someone or some group in power to rethink each situation de nouveau, the way Lincoln rethought our republic. In particular, we have to redefine and recharacterize the enemy. It is not that there are no people able to attempt this, some perhaps even in government. It is simply that all the rewards are for doing the same thing, only more so. This occurred with President Clinton’s/Barry McCaffrey’s anti-drug ad campaign (following on that by the Partnership for a Drug Free America). The government’s own research found the ads counterproductive – but parents and the media loved them. This is why Montana’s Governor is reprising this approach – even if it worsens the drug problem in his state, it will garner him more votes.
James Frey, after being adopted by Oprah for her book club, sold 3.5 million copies of A Million Little Pieces, a memoir about his treatment for alcoholism and crack addiction at Hazelden. The Smoking Gun then revealed that the most dramatic parts of Frey’s autobiography were fiction. That Frey felt free to make up stories about his criminal past and other consequences of his drug addiction is not unusual. That people believed these preposterous stories is commonplace. But what has been lost in the furor is that Frey attacked the entire disease-12 step treatment industry: “I did not use God or a Higher Power or a Twelve Step Group of any kind. I used my will, my heart, my friends, my family. Most people who use God or a Higher Power or a Twelve Step Group fail.”
Three things are true of this central part of his book: (1) it is true, and other Hazelden patients have supported his account, (2) Frey has continued to defend it while admitting his other falsehoods, (3) everyone ignores this spectacular “elephant in the middle of the room” (a phrase used to describe a family’s ignoring the alcoholism of one of its members). If a best-selling author who appears on Oprah’s show fights AA and the 12 steps to the death – and no one notices – we see the hold the 12 steps and AA have on America. I have explored this phenomenon with a colleague, Amy McCarley, in an effort to answer the question, “Why do people ignore Frey’s anti-AA, anti-disease, and anti-treatment message?
My Son Died Because of Our Kooky Approach to Drugs –
So Let’s Do More of the Same
Famed O. J. Simpson defense attorney Robert Shapiro appeared on several news programs following the death of his 24-year-old son, Brent, a student at USC in October, 2005, after the young man took Ecstasy. Shapiro announced the creation of the Brent Shapiro Foundation, “trying to use Brent's death as a means to let people know that there is an epidemic of a drug disease, not only in this city, not only in this state but in this country and perhaps in the world with kids starting at age 15.” 
Brent’s death was classified as an overdose by the coroner.  But, according to Shapiro, Brent had only taken a half tablet of the drug. He had also been drinking. Brent became ill and began vomiting. He was carried from the party by his fiancée and others, but they did not seek medical care. Later that night Brent turned blue and stopped breathing. 
Shapiro wants to educate people that drug addiction is a disease. Brent had been treated repeatedly for his substance abuse, and the failure of treatment was typical in Shapiro’s view. But Brent hadn’t used drugs for 18 months before his death. According to Shapiro, Brent had decided he was a drug addict but not an alcoholic and that he might drink, but should avoid drugs. Shapiro also revealed that Brent had taken Ritalin from the age of 5 until the age of 15. According to Shapiro, it was at age 15, when he ceased using Ritalin, that Brent started smoking marijuana and drinking.
Although Shapiro wants to spread the word about the ubiquity and virulence of the disease of drug abuse, he doesn’t believe current approaches to substance abuse work: “AA, which is the best of the best that we have, has in one year an 88 percent failure rate. Twelve percent of the people that go into AA are sober for a year. LARRY KING: So, if it's a battle, it's a battle that the society is losing? R. SHAPIRO: Losing big time.”
But, of course, Shapiro – by creating specters of drug disease for every one of the majority of children who ever use an illicit drug – is simply offering us more of the same. His feelings are understandable; but restating hysterically what kids – including his son – have heard hundreds of times will not produce better results. Since Ecstasy use very rarely causes death, young people familiar with the drug will simply disregard warnings like the ones Shapiro is offering.
And, of course, general warnings about the lethalness of Ecstasy misstate the cause of his Shapiro’s son’s death. Brent had probably been told hundreds of times in drug education classes and in treatment never to use drugs. Instead, someone as likely to use drugs as Brent, especially since he hadn’t used drugs in a long time, should have been instructed to avoid combining alcohol and drugs.
He and his fiancée and friends furthermore should have been prepared to get medical help when he encountered problems – particularly given his heart murmur. Instead, it seems his fiancée’s and friends’ worries about revealing that Brent had used drugs prevented them from getting help.
Mr. Shapiro is actually energetically creating a program more likely to lead to drug deaths than to prevent them.
How might we have communicated with Brent Shapiro, a young man who had depended on drugs and alcohol throughout his life – beginning with Ritalin as a young child – to prevent his horrible death? Brent was in most other ways a healthy, involved young man – he was a successful student at a good university, had many friends and a close relationship with a woman he wanted to marry, and was part of a close and supportive family (his brother and mother appeared on various shows with his father). But the odds of his using drugs at some point in his life were extremely high, despite every warning he had received not to.
Nearly all Brent’s life prognosticators were very good – even if he had had a long-term problem abusing substances. How would someone – a professional, a friend, or a family member – communicate realistically with a person like Brent (since we don’t know Brent) to help him prepare for safe drug use, even while reminding him that he had reasons not to use drugs in the first place? Let’s call this imaginary person “Sal.”
Helper: Sal, what’s your plan around drug use?
Sal: Well, I realize that I’ve had issues with drugs all my life. After all, I started using them as a child for my hyperactivity. I can really get in a hole with them, where I get sidetracked from the good things in my life – school, my future career, my family, my girlfriend.
Helper: Do you think you might ever take drugs again?
Sal: I plan not to. That’s been driven home to me at the drug rehab I’ve been through, by AA, by everyone.
Helper: What do you usually do on weekends? Who do you spend your free time with?
Sal: Well, I like to go to parties with my girlfriend and other friends.
Helper: Do people use drugs at these parties?
Sal: Sometimes they do.
Helper: How do you feel when you see friends using drugs?
Sal: I regret not being able to join them. (Hesitantly) I need to confess that I have begun drinking again.
Helper: Oh, what did they say about that in rehab?
Sal: They’d be so shocked – they’d scream at me if they knew. But I just don’t feel I’ve ever had a problem with alcohol. It’s drugs that get me in trouble.
Helper: Can you imagine yourself ever using drugs again?
Sal: It’s funny you should ask that. At the party I was at last week, I did take a toke of marijuana.
Helper: Speaking of alcohol, do you have any feelings about drinking along with using drugs?
Sal: You know, I’ve heard that can be really bad for you.
Helper: Is there any way you can avoid drinking while using drugs?
Sal: I never thought about that. Of course, one toke of mj isn’t going to cause much trouble.
Helper: But if you were to use a more serious drug, and you had been drinking?
Sal: Maybe I should think of a way to prevent that?
Helper: Let’s talk about that. By the way, is anything I’m telling you likely to encourage you to use drugs again. If so, I want to state strongly that’s not my intention – I hope you won’t take drugs at a party – or any other time.
Sal: I know that.
Helper: What are your girlfriend’s views on that matter?
Sal: She’s confused about it. She likes to indulge herself sometimes (laughs), but she worries that that will encourage me to use. But she also thinks I’m doing so well in my life that maybe it could be okay – (laughs again) – she’s never been to Betty Ford.
Helper: As I said, I’m not telling you to use drugs. But I worry a situation might come up where you will use them.
Helper: So I need to emphasize that, whatever you do, I want the best for you. And that especially concerns any bad reactions you might have to using drugs. As soon as you feel you are having any kind of trouble – even while you’re in the middle of using the drug – I want you to contact me or someone else who cares for you. And seek medical care – go to the Mt. Sinai emergency room or wherever is closest.
Sal: Okay, I understand.
Helper: Will you do that?
Sal: Yes, I promise.
Helper: What about your girlfriend?
Sal: What do you mean?
Helper: What would she do if you encountered any trouble with drugs?
Sal: Well, she’s a little iffy – she knows that people who care for me – and my AA sponsor and my drug counselor – would kill me if they found out I was drinking and drugging.
Helper: Would you mind doing something for me? Could you bring her the next time we get together? I’d like to get her into this conversation. In the meantime, maybe you could share what we’ve been discussing with her.
Sal: Good, I will.
Helper: One last thing. I understand that you have a heart condition?
Sal: Yes. I have an irregular heartbeat.
Helper: Are you receiving treatment for that?
Sal: I see a cardiologist from time to time. In fact, I got a postcard form his office that I should schedule an appointment.
Helper: Have you ever discussed your past drug use with him?
Sal: I never brought it up. I’m sure he would have disapproved. And I already know drug use is bad for me.
Helper: I wonder if there are some drugs he would particularly want you to avoid.
Sal: How could I ask him that?
Helper: How about something like this: “Doctor, I know you would advise me to avoid all illicit drugs. But are there some drugs that are especially bad for my condition?”
Sal: Hey, that’s good – mind if I jot that down?
Helper: Go right ahead. So you’ll be sure to discuss this with him?
Helper: That’s great. I look forward to continuing our conversation. How long has this taken (checking watch) – 30 minutes? (Laughing) We should be able to fit this into our busy schedules, compared with the hours you spend in AA meetings and counseling.
Ignore the last sentence – it is simply a reflection on the uselessness of all the counseling and drug treatment Brent Shapiro received.
- Interview with Robert and Grant Shapiro. CNN Larry King Live. Aired October 21, 2005 . Available at http://transcripts.cnn.com/TRANSCRIPTS/0510/21/lkl.01.html.
- Pelisek, C. Brent Shapiro’s final hours. LAWeekly, November 25 – December 1, 2005 .
- Brent also “suffered from a condition called mitral-valve prolapse, or a heart murmur, though it is not known whether it contributed to his death.”