Psyche, Science, and Society

Army in denial about PT-drug abuse link?

Phillip Leveque, M.D., takes on the army’s denial or deceipt about the extent of PTSD-realted drug abuse in an article in the Salem-News:

PTSD and Psychosis Among Army Psychiatrists

Dr. Phillip Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist.

(MOLALLA, Ore.) - I was a combat infantryman for about 18 months in WWII where things were really crazy with various levels of officers demanding of their underlings (anyone of lower rank) that such and such a military objective be taken even if it killed every attacking soldier.

If that isn’t psychosis, what is?

I was also stationed in General Eisenhower’s headquarters for about six months. Of about 15,000 personnel, half officers, half enlisted, they acted like there wasn’t a war.

If such a psychic denial isn’t psychosis, what is?

The current seeming denial of PTSD and drug use on the highest army medical levels MUST BE a further example of psychosis.

I was absolutely flabbergasted that on ABC News 20/20 Col. Elspeth Ritchie, the psychiatry consultant to the U.S. Army Surgeon General, implied that there is no battle-induced PTSD causing drug use by soldiers, but like all other people using drugs, there were other “reasons”.

I was reminded that in WWI the Army swept it under the rug too, naming PTSD as “homesickness” or saying that the soldiers “missed their mothers”. What comes to my mind is SNAFU, FUBAR and even JANFU.

The VA’s own information says up to half of all PTSD patients treated also have a substance abuse problem.

Colonel Ritchie would only say that PTSD is a “risk factor” for the abuse of drugs and alcohol, but that the Army has not been able to quantify how strongly the two are linked. She said she was unaware of cases of soldiers turning to drugs to cope with the trauma of their experiences in Iraq.

She said, “That has not been my experience. My psychiatrists and social workers who see soldiers report to me of their experiences with soldiers all the time, and none of them are seeing that particular explanation.”

The Army actually goes so far to say there has been NO increase in the rate of illegal drug use among soldiers since the beginning of the wars in Iraq and Afghanistan.

Who do they think they’re fooling?

I presume Dr. Ritchie got her MD from a real medical school, but I have heard that the Armed Forces has its own medical school. I was embarrassed as a physician at her comments.

Was she lying to maintain her quest for one star, or was she really ignorant about PTSD? It’s hard to believe she got to where she is today without intelligence, so that leaves: CHOICE. She is choosing her future star over the welfare of our troops.

Even other army spokespersons and the VA people say to expect about 20% of battle veterans to have PTSD. Paul Sullivan, Gulf War veteran, a former project manager at VA who monitored the disability claim activity of Iraq and Afghanistan war veterans, and now is the executive director of Veterans for Common Sense (VCS), said PTSD was a big problem. His reaction to the Army psychiatrist? “Shame on her!”

Some of the most pitiful comments were given by a woman described as the director of substance abuse programs, apparently with the U.S. Army. She spoke about their success. The 20/20 program didn’t indicate her rank, or even if she was a physician, but she obviously didn’t understand that a battle-scarred PTSD veteran will use anything he can get his hands on to remove the PTSD devils from his soul and mind, even if it is heroin, booze, or at the very least, cannabis.

Ten times the number of soldiers are using drugs now compared to when the Iraq war began. That’s the military’s number, a complete contradiction to what Col Richie said.

Hundreds of veterans have told me that cannabis works better than any prescription drug. It’s about time for a serious trial of cannabis for PTSD.

Some soldiers are breaking the rules and turning to drugs to give them relief from the consequences of trauma in war. We can help them seek the best treatment by not living in the psychosis of denial.

I have also heard that many VA psychologists are trying “fake battle sounds” as treatment. God preserve us.

We PTSD guys are trying to stay as far from that as possible.

5 comments December 16th, 2007

Supreme Court allows sentencing leniency

As the U.S. has filled its prisons with millions of, mostly young minority males, many on often minor drug charges. While the War on Drugs has been a total failure at addressing the extent of substance abuse in our society, it has been ripe with abuses. The symbol of this abuse in recent years has been the extreme sentencing discrepancy between those arrested for selling crack, as opposed to powered cocaine. Those of us in substance abuse treatment know that there is essentially no difference between crack and cocaine, except for the common differences in who sells and uses them: crack — poor blacks; cocaine — middle class to wealthy whites. As all attempts to reform theses sentencing disparities have failed, federal judges have taken to using modest discretion in interpreting sentencing guidelines. The Bush administration, terrified by the humanity exemplified by the judges actions, tried to get the Supreme Court to put a stop to judicial discretion. Today, in a 7-2 decision, the SCOTUS said “NO” to the Bush administration. Adam B at Daily Kos explains:

SCOTUS: Let judges be merciful

Derrick Kimbrough is, no doubt, a bad man. In 2004 he pleaded guilty to four offenses: conspiracy to distribute crack and powder; possession with intent to distribute more than 50 grams of crack (he acknowledged 56 grams); possession with intent to distribute powder (92.1 grams); and possession of a firearm in furtherance of a drug-trafficking offense. His plea subjected him to a minimum term of 15 years and a maximum of life, with the guidelines reccomending 19-22.5 years. The trial judge thought that such treatment exemplified the “disproportionate and unjust effect that crack cocaine guidelines have in sentencing,” noted that if Kimbrough had possessed only powder cocaine, his Guidelines range would have been far lower: 8-9 years. So the judge did the best he could, and sentenced him to the minimum of 15 years.

The Bush Administration didn’t like this and appealed, claiming that the judge should have had no discretion to consider the crack/powder disparity in sentencing him.

In a 7-2 opinion by Justice Ginsburg handed down this morning, the Supreme Court rebuked the Bush Administration and has given judges permission to deviate downwards from the draconian federal guidelines to consider the disparity in treatment between crack and powder cocaine.

Under the federal sentencing guidelines, a drug trafficker dealing in crack cocaine is subject to the same sentence as one dealing in 100 times more powder cocaine. These were guidelines drawn up in 1986 at the dawn of the crack epidemic, but they yield bizarre, unjust results. As the bipartisan U.S. Sentencing Commission had explained to Congress, “Although chemically similar, crack and powder cocaine are handled very differently for sentencing purposes. The 100-to-1 ratio yields sentences for crack offenses three to six times longer than those for powder offenses involving equal amounts of drugs.” More:

“[T]he Commission concluded that the crack/powder disparity is inconsistent with the 1986 Act’s goal of punishing major drug traffickers more severely than low-level dealers. Drug importers and major traffickers generally deal in powder cocaine, which is then converted into crack by street-level sellers. … But the 100-to-1 ratio can lead to the ‘anomalous’ result that ‘retail crack dealers get longer sentences than the wholesale drug distributors who supply them the powder cocaine from which their crack is produced.’

“Finally, the Commission stated that the crack/powder sentencing differential ‘fosters disrespect for and lack of confidence in the criminal justice system’ because of a ‘widely-held perception’ that it ‘promotes unwarranted disparity based on race.’ [] Approximately 85 percent of defendants convicted of crack offenses in federal court are black; thus the severe sentences required by the 100-to-1 ratio are imposed ‘primarily upon black offenders.’ ”

The Sentencing Commission has repeatedly urged Congress to act and amend this disparity; it has failed to do so. In the meantime, the sentencing guidelines have shifted from mandatory to advisory on trial judges (long story), so the question remained whether deviating from this 100:1 ratio was something that judges could do on their own. Today’s ruling says yes, they can, and you can read it here, along with much discussion of how LSD sentencing works in America.

Justices Thomas and Alito dissented, with Thomas venting about how he doesn’t like the Court’s whole approach to the sentencing guidelines, and Alito briefly arguing that the guidelines were entitled to more weight.

In a second 7-2 opinion today, the Court further extended judicial discretion in sentencing, allowing a trial court judge to sentence a University of Iowa undergrad low-dollar ecstasy dealer ($30K netted) to 36 months probation, rather than that same length in jail, based on his clean living as a construction subcontractor since his arrest.

Given the constant ratcheting-up of sentences by politicians looking to be “tough on crime,” today’s decisions should help tremendously in allowing judges to be just, humane and merciful.

Add comment December 10th, 2007

Claims military overmedicating soldiers

ABC News reports that the military, presumably in a rush to get soldiers back in the field, is overmedicating them. ABC News claims that this reliance on drugs can teach soldiers to rely on other drugs, including illegal ones, leading to a rising addiction rate.

Instead of providing proper counseling and care for Iraq war veterans suffering from physical and psychological pain, too often the U.S. military is trying to medicate the problem away, according to drug counselors and therapists.

Andrew Pogany, who works with service members nationwide as an investigator with the veterans advocacy group Veterans for America, said overmedicating veterans is a common problem.

“Pretty much every person in my caseload is medicated, heavily medicated,” said Pogany. “There’s potential for them to become addicted.”

According to Pogany, a reliance on prescription drugs often leads veterans to reach for other coping mechanisms — illegal drugs such as marijuana, cocaine and crystal meth.

The report attributes the overmedication to a lack of counseling resources.

 But Andrew Pogany said the reason why vets suffering from PTSD are not afforded better psychiatric care is clear — a lack of resources on the part of the military.

“Do they have enough trained providers to provide individual care? The answer is no,” he told ABC News.

And the military apparently agrees. Results from the DOD (Department of Defense) Task Force on Mental Health released in June 2007 find that “the military system does not have enough resources, funding or personnel to adequately support the psychological health of service members.”

“Handing somebody a bag of medication and then seeing them once a month for a half-hour appointment, that’s not adequate,” said Pogany.

Another factor that may contribute I’ve heard about from some vets, and from reporters investigating the issue is that military commanders simply cannot accept that military experience could lead to trauma, as in PTSD. These sources feel that the pervasive denial contributes to some of the abuses os soldiers and vets that have recently been reported in several media sources.

2 comments December 2nd, 2007

Respons to Padilla and ‘truth serums”

A psychologist reader responds to this morning post of Jeff Stein’s article Padilla Case Opens Old Questions on CIA ‘Truth Serums’.

But you know what always surprises when I hear this story, being someone in the drug and addictions field myself, is the sort of naivete of Padilla’s attorneys to say they think he was injected with PCP or LSD.

It would sort of be like a NUCLEAR WEAPON hitting a city and saying, we know it must be an enormous amount of DYNAMITE that they used.”

But we can’t figure out why they would even try using dynamite because it never produces an explosion that big.

The attorneys and everyone else in this case seem to have no scientific sense or even creative thinking about how drugs have evolved, how much they develop each decade, particularly with military funding. No one in the military is using LSD or PCP–unless it is just some soldier who snuck it on the ship–I guess that’s possible. Even ecstasy and methamphetamine are child’s play with what the government is likely to have at its disposal. The assumption is also that the government is giving detainees one drug at a time rather than combinations and sequences of far more advanced drugs.

Oxytocin that’s involved in natural infant attachment to the mother is a hormone that has been found to increase trust in adult research participants and could be used in conjunction with sensation producing euphorics like ecstasy to produce a situation far more conducive to interrogations than LSD or PCP. It is far more targeted but any subjective description from someone who was given this combination of these things a month before would make it sound like a typical hallucinogen. But the right combinations and the right sequences and how they interact with the procedures in the army field manual are probably what’s key and exactly what the military wants to test, and may be testing.

So I think we should not accept this argument that oh the government would never try to use truth serums because our research from 4 decades ago says they’re not effective. It comes back to our efficacy question. It may not be effective yet, but that’s not going to stop them from trying.

I guess in this whole thing I am guilty of underestimating the government’s savvy and dedication to science to increase their arsenal to win their “war”.

Add comment February 27th, 2007

Bush as dry drunk

Social Work professor and addictions specialist proposes an intervention for our President [From CommonDreams]

A Formal Intervention with a Dry Drunk President

by Katherine van Wormer

One of the rituals well known to the addiction treatment world is the formal Intervention. The classic Intervention starts with meetings of concerned significant others that are called during a time of crisis. The result is a confrontation of the individual in trouble and an ultimatum of some sort for a drastic change in course (the most famous examples are Interventions of Betty Ford and Elizabeth Taylor for pill use and drinking.)

The long-anticipated report of the Iraq Study Group has been likened in some media reports to the classic treatment Intervention provided to drug users and alcoholics who have “hit bottom.” Seething in its criticism, the report (Intervention) made a number of take-it- or-leave-it recommendations. “This is not like fruit salad,” the head facilitator later explained; the recommendations must be followed as a whole. Characteristic of a person with an addictive mentality, the president responded in a state of denial as do the “enablers” around him. His supporters are getting fewer and fewer, however. And even his father recently broke into tears. We will return to that later.

The addictive mentality I am talking about is a cognitive impairment that is associated with alcohol-drug use, and may have preceded or followed the addictive behavior. George W. Bush, over his lifetime, has gone from one extreme-extensive and long-term binge drinking and at least some cocaine use-to another-affiliation with religious fundamentalism and authoritarian belief systems that cannot be explained by his religious upbringing. From an elitist background, the junior Bush was able to build a political base from a cultural group that was arguably alien from his own. (See What’s the Matter with Kansas?)

For an understanding of this phenomenon of how the drinking and drug use affects patterns of thinking, we need to look at brain research. The most recent brain research, now revolutionized by technological advances in brain imaging, confirms what members of A.A. have known for years, labeled by them, the dry drunk phenomenon. Rigidity, poor impulse control, grandiosity, and all-or-nothing or black and white thinking are the classic characteristics. (See “the dry drunk syndrome” on google.) We now know that once the heavy drinking and/or other drug use stops, a certain amount of cognitive impairment may persist. We also know, however, that the brain can actually be “rewired” through cognitive work.

“You’ve got to work at it.” This is a commonly heard saying of George W. Bush. One thing he has not worked at, however, is what is sometimes called in alcoholism treatment parlance, “the second recovery.” Treatment centers specialize in cognitive work, as does A.A., in effect, aiding persons in recovery to replace irrational, grandiose, and self-centered thoughts, with healthier and more moderate ways of thinking.

The kind of intervention that our president needed was a personal intervention, one aimed at the reasons that Bush fool heartedly and dishonestly (pushing for false intelligence assessments of the international situation) led the nation in a fantasy mission that was doomed to failure against “evildoers” in the Middle East. As I described as early as 2002 and as psychiatrist Justin Frank later, in Bush on the Couch, also concluded, to understand the motives behind the ill-fated invasion of Iraq, we have to consider Bush’s role in his family, the unique psychological dynamics. As any Bush biography makes clear, the younger Bush was not only named for his father, but he was somehow destined to follow in his father’s footsteps most of his life- at Andover, Yale, as a military pilot, in the oil business-only to fail at each juncture until he would enter politics and as commander- in-chief be able to stride triumphant in 2004 and declare “mission accomplished” on the carrier flight deck. Then he would have proven himself to his father and to the world.

In December, 2006, the elder Bush’s tears shed at the tribute to his son, Governor Jeb Bush, told it all. “The true measure of a man is how you handle victory, and also defeat”-these were his exact words uttered at the moment that he got too choked up to continue. Though his loss of control was later claimed to be related to his younger son’s (Jeb’s), earlier defeat in a governor’s race in 1994, it seems far more likely that his tears were shed over the disgraced presidency of his elder son and in recognition for the significance of this debacle for the entire Bush dynasty.

In the future, it will be left to psychologists and historians to ponder the real reason for George W. Bush’s selection as members of his team, the very men like Cheney, Wolfowitz, Powell, and Rove, who, strikingly, had served under his father. Even Rumsfeld also had a historic relationship with Bush, Sr., albeit a problematic one. Above all, the challenge to psychologists and historians will be to ponder the real reason why the younger Bush was driven to an unnecessary and unbelievably costly war “mission impossible.” The Iraq Study Group, which, interestingly, was headed by Bush Sr.’s former secretary of state, James Baker, was summoned in desperation to find a way out of a disastrous course, failed to tackle causality, which, in the final analysis is the most significant issue of all.

Katherine van Wormer (www.katherinevanwormer.com) teaches social work and addiction treatment at the University of Northern Iowa and is the co-author of Addiction Treatment: A Strengths Perspective.

3 comments December 31st, 2006

Vijay Prashad on racism, binge drinking, and boredom

Today’s ZNet Commentary by Vijay Prashad is very interesting, drawing links between racism, binge drinking, and boredom:

Beirut

A series of flaps on campus. Racist incidents abound: the most public is at Texas A & M, home to the new Defense Secretary. Students donned “blackface” and played plantation life. They might be influenced by the sunny depictions of the slave economy from such notables as Eugene Genovese. He has, after all, converted from writing Marxist analyses of enslavement to a celebration of Southern hospitality and tradition. How the mighty fall!

In the midst of the revelations, and some of on my own campus, I, being “out of it,” heard of that my students enjoy a game called “Beirut.” It’s a “drinking game,” one of the legion that allow students to egg each other to get drunk faster and faster. These are the kinds of institutions that lead to the small-scale epidemic of death by binge drinking. The federal Substance Abuse and Mental Health Services Administration report (September 2006) found that over seventy percent of under-age binge drinking occurs in Wyoming, Montana, North and South Dakota. The government analysis is that these areas suffer the most because the youth are bored.

Our college students seem bored too. The NIH’s College Drinking Task Force reports that each year drinking by 18-24 year old college students contributes to an annual estimated 1,700 deaths, 599,000 injuries and 97,000 cases of sexual assault or date rape. Based on this data, and on extensive survey work, the NIH concludes, “Students form their expectations about alcohol from their environment and from each other. As they face the insecurity and stresses of establishing themselves in a new social setting, environmental and peer influences combine to create a culture of drinking. This culture actively or at least passively promotes drinking through tolerance, or even unspoken approval, of college drinking as a rite of passage.” The “when we were young, we got hammered” maxim perpetuates binge drinking, and with alumni pressure, suppresses the ability of college administrations to do what they should do about social life on campuses (including reigning in fraternities and other organizations of mayhem).

Our bored students dress up the weekend (and many week-nights) with games to hasten their entry into oblivion. One such is Beirut. It is an elaboration of “beer pong,” a ping-pong game that requires the players who miss to chug a glass of beer. Beirut is played without paddles. It was created in the early 1980s, during the U. S. fiasco in Lebanon. The students who throw the ping-pong ball imagine that they are bombing Arabs, and the losers have to bomb themselves by drinking the beer. This game was developed either at Bucknell or Lehigh.

Poor Beirut. In modern times, it has suffered gravely: a brutal civil war (1975-1977) attempted to settle unfinished social contradictions that resulted from the Ottoman withdrawal, and with the demise of any truly secular movement (such as the forces that led the 1958 uprising, of whom was the multi-ethnic Lebanese Communist Party); interventions by the great powers, be they the French or the U. S., often on the side of reaction against that of hope; and at least two invasions by the Israelis, once in 1982 and again this summer. So much death, so much mayhem. To play “Beirut” is to mock this history of suffering and hope.

The Tunisian scholar Albert Memmi offered the following paradox: everyone agrees that racism exists, but no-one admits to be a racist. Those who play games like “Beirut” would hasten to say that for them this is a game, and that it has nothing to do with Arabs, that they are not racists. That’s like George “Macaca” Allen saying that the noose in his office has nothing to do with Jim Crow and lynching. The coalition of the swilling is alive and well on college campuses, reproducing anti-Arab racism as beer-drinking patriotism.

Blackface, red-face, Beirut, the criminal use of Rohypnol (”roofies”), and what not: college campuses have become a hive of anti-social, dangerous behavior. On every college that I visit, the antidote to this behavior is either from the religious students or the radical students. These students, whether invested in God or Revolution, have something that defines their lives. They are not bored. The complaint about boredom is now over thirty years old. In an early issue of “New Left Notes,” Steve Golin (who went on to a distinguished teaching career at Bloomfield College in New Jersey) wrote, “By the time we graduate, we have been painstakingly trained in separating facts from their meaning. We wonder that our classes, with few exceptions, seem irrelevant to our lives. No wonder they’re so boring. Boredom is the necessary condition of any education which teaches us to manipulate the facts and suppress the meaning.” Our radical and religious students understand the importance of meaning in the world. The mainstream should learn from them.

Add comment November 26th, 2006

Does the National Youth Anti-Drug Media Campaign work?

The federal government has spent more than $1.2 billion on its anti-drug ad campaign, the National Youth Anti-Drug Media Campaign. From the beginning there have been concerns as to whether the campaign is effective. An evaluation by Westat, a private research firm, has questioned its effectiveness. The Government Accounting Agency (GAO) has now, in turn, evaluated the Westat evaluation, and supported it.

Thanks to Join Together, here is a summary of the GAO’s findings:

An evaluation of the National Youth Anti-Drug Media Campaign provides credible evidence that the campaign was not effective in reducing youth drug use, according to a report by the U.S. Government Accounting Agency (GAO).

Between 1998 and 2004 Congress appropriated more than $1.2 billion to the Office of National Drug Control Policy (ONDCP) for the National Youth Anti-Drug Media Campaign, a project that aimed to prevent and reduce youth drug use (primarily marijuana and inhalants).

In 2005, Westat, Inc., completed an ONDCP-funded evaluation of the campaign.

At the mandate of the Senate Appropriations Committee, a team of GAO social scientists reviewed and assessed Westat’s evaluation, applying generally accepted social science research standards.

Following are some of the conclusions from the GAO report:

* While the ONDCP does not believe that the Westat evaluation reflects the campaign’s effectiveness, the GAO concludes that the Westat study used “generally accepted and appropriate sampling and analytic techniques” and established “reliable and sufficiently powerful measures of campaign exposure.”

* Youth and parents’ recall of campaign advertisements increased over time and their impressions of the advertisements were favorable.

* There was no evidence that exposure to the campaign affected initiation or cessation of marijuana use, either during the entire period of the campaign or during the period from 2002 to 2004 when the campaign was redirected and focused on marijuana use.

* The campaign generally had no effect on the anti-drug attitudes and beliefs of youth who did not use marijuana. However, greater exposure to the anti-drug ads was associated with increases in the belief that their peers used marijuana regularly.

* Parental exposure was associated with changes in beliefs about discussing drug use with their children and the extent to which they had these conversations, but did not lead to increased monitoring of youth.

The GAO recommends that “Congress should consider limiting appropriations for the National Youth Anti-Drug Media Campaign . . . until ONDCP is able to provide credible evidence of the effectiveness of exposure to the campaign on youth drug use outcomes or provide other credible options for a media campaign approach.”

A full copy of the GAO report, including responses from ONDCP, is available online.

To make matters more complicated [as always, with real-world research], a new study coming out in the American Journal of Public Health found that the campaign, when reformulated, was effective with so-called high sensation-seeking youth. So the debate will continue.

Now we can wonder what the new Congress will do? Will they continue to appropriate these enormous sums of money for a program that may or may not work? We’ll see.

Add comment November 9th, 2006