DOING YOUR OWN RESEARCH

DOING YOUR OWN RESEARCH

If reading this book has raised your level of interest and you want more specific information, or you want the straight story about a new develop­ment, there is no substitute for doing your own research.

Reading both scholarly review articles and original research papers is much easier than most people believe. In fact, one of the first steps in writing this book was gathering such research. Much of the library work for the first edition was done by two college students, neither of whom had any previous experience using a medical library. Should you decide to investigate for yourself, here are some suggestions about where to begin.

Public libraries are not likely to have the sorts of journals and books you will need. Because there is such a vast amount of medical literature pub­lished, most universities with a medical school have a separate library just to house all this information. Find a medical library at a nearby medical school. If for some reason you cannot get to a medical school, check to sec if there is a college or university biology department nearby and use the

library they use.

Next, go to the library and make friends with the reference librarian, because you will need his or her help until you are familiar with the library and the search mechanisms. The most efficient way of searching the literature is to use MEDLINE or PubMed, databases of the National Library of Medicine, a US government institution that allows you  

search almost all the published medical literature on any subject you can think of related to health. You can search by author, title, subject, key­word, institution, and many other descriptors.

In most cases you will find far more information than you need. A good place to start is with reviews. Reviews are documents that consoli­date and summarize the research and literature available in a given area, and they are usually written in less technical language. Reading several recent reviews about the topic you are researching will help you form a base of knowledge about the subject. Practice using MEDLINE by start­ing out with simple concepts; for example, search for marijuana articles. There are hundreds of them, and many of the titles will be so technical that they might seem indecipherable. So tell the computer to select mari­juana review articles. This will reduce the number markedly.

If you have read Buzzed, then you know that one of the active ingredi­ents in marijuana is THC. Try searching for THC and you will get more articles. Refine your search by asking for reviews of THC and you will get articles different from those you did when you searched for marijuana in general. Play with the database and have fun. Search for all kinds of com­binations of keywords, like THC and learning, or THC and adolescent. You will soon have an idea of the enormous amount of information there is about just this chemical. Understand, though, that no one study tells the whole story.

As a final note, we caution you not to accept everything you read as directly applicable to the human condition. Often scientists employ very high levels of a chemical to test for toxic effects in animals, and sometimes the chemical levels they use in/on animals are hundreds or thousands of times higher than a human would ever use, taking into account the weight of the human compared to the animal. Consequently, some of the toxic effects seen in animals may not apply to humans. On the other hand, ani­mal experiments cannot reveal many subtle effects of chemicals, particu­larly psychological ones, and thus animal studies almost certainly miss some important effects that humans will experience. So, as you read a sci­entific paper, remember that it is just a small part of the literature about a drug, and while the data may be true, it is important to understand that data in the context of everything else known about the drug.

GETTING CONVICTED: THE PENALTY BOX

GETTING CONVICTED: THE PENALTY BOX

The penalty laws of most states and countries are built on a series of leg­islative acts that happened over a long period of time, and thus, they are complicated and not easily summarized. Possession of modest amounts of marijuana can result in a slap on the wrist in some places and serious jail time in others. The same is true for other drugs, although they are usually taken more seriously, even in very small amounts. Often the prosecuting attorney has some leeway about the level of crime with which to charge an individual. The problem is that it is difficult to be sure of (1) the latest changes in the law, (2) the attitude that the prosecu­tor is taking toward drug crimes, and (3) whether that individual will be charged under state or federal statutes. Thus, conviction for the posses­sion of a small, recreational amount of heroin or cocaine could result in either a modest sentence or a huge fine and a long prison term, depend‑

ing on the exact circumstances and the mood of the legal officials over­seeing the case.

It is important to recall that in some states and in the federal system there is structured, or guideline, sentencing. That means that once an individual is convicted of some drug crimes, the sentence is regulated by law and might not be alterable by the judge no matter what the circum­stances. Coupled with the fact that there is no parole in the federal system (and increasingly in the state systems), a conviction can mean long prison time, even if the prosecutor and judge wish it were otherwise.

Here's an example of how things can go terribly wrong as a conse­quence of alcohol, a prescription drug, and harsh laws. One of us (WW) testifies as an expert in legal cases, and a recent one illustrates how the law, the prosecutor, and the courts can interact to ruin the life of an indi­vidual. A man was at a party with his neighbors outside of his home. He consumed a modest amount of alcohol throughout the evening, but at some point he decided to go to bed and took his nightly medicine, which included the sleeping pill zolpidem (generic for Ambien). Before going to bed, he came back to the party but soon appeared intoxicated. He then prepared for bed and went to sleep. Shortly thereafter, he awoke and came out of the house without his shoes, false teeth, or hearing aid, clearly hav­ing just awakened. But he had a gun, which he had retrieved from his bedside where he kept it. He fired twice as he yelled an obscenity to the individuals at the party. No one was hurt. The police were called, and he was arrested.

The man was charged with aggravated assault, and everyone thought he was intoxicated with alcohol. In the law of most states, that is consid­ered "voluntary intoxication" and thus is not a defense against any charges. His defense team argued that he was not intoxicated with alco­hol, but with his prescribed zolpidem, which is known to produce odd behaviors such as sleep driving, sleep sex, sleep shopping, sleep eating, and so forth. If it were the zolpidem, that would be "involuntary intoxica­tion," and that is a defense against such charges.

The jury heard the case and decided that he was intoxicated by alcohol and was therefore guilty. Now, here is where the disaster occurred. In that state, commission of many crimes (such as aggravated assault) with a gun is a mandatory ten-year sentence. If the gun is fired, the mandatory sen­tence is twenty years. In this case the prosecutor chose to charge the man for each of the six people present at the party, and the law requires that the mandatory sentences apply to each charge and be served consecu­tively. This means the man (who has not been sentenced at this writing)

must, by law, be sentenced to 120 years in prison. The judge has no discre­tion in this case.

This is a terrible example of the interaction of intoxication, harsh laws, vigorous prosecution, and finally, the presence of a gun where a sleepy, intoxicated person could access it and fire it. This man had no history of behavior like this and was a decorated soldier. It is very likely that the zolpidem produced the bizarre behavior, but the prosecutor and jury did not see it that way.

The lesson from this is that if a person chooses to intoxicate himself and then commits a crime, that intoxication is usually not a defense against any crime he committed, no matter how impaired he was at the time of the crime.

LEGAL ISSUES

IT IS SAID that your life can change forever in a matter of seconds. When a person mixes alcohol or other drugs and the legal system, the combina­tion can easily become life-changing. For a variety of reasons, the law­making bodies of most countries, especially the United States, have decided to suppress illegal drug use by making drug laws harsh and cer­tain. All who deal with drugs in an illegal manner are thus at risk for penalties that can disrupt their own lives and those of their families.

The use of almost all the drugs discussed in this book could involve violations of the law, depending on the circumstances. Many of these drugs are illegal in all circumstances—manufacturing, distribution, and possession. Others are legal when prescribed, but not for recreational use. Still others, such as alcohol, can be legal for adults, but their use is prohib­ited for underage individuals and for activities such as driving a car or operating a boat.

This chapter is written to inform readers about very basic laws and principles that come into play around drug issues. It is not intended to give advice about dealing with the law-enforcement community or the judicial system. If you feel that you need that advice, find a good lawyer and ask her all of your questions before you become legally involved.

THE PRINCIPLES

I While laws exist regarding the rights of a law officer to search some­one's car or home, this very complicated issue is often decided in the courts in individual cases. Generally you have the greatest "expecta­tion of privacy" in your home. There is less expectation of privacy in a car, and the least when you are out in public.

2. If a law-enforcement officer suspects you of a crime and really wants to search you or your car, you will be searched, whether or not you give permission. If you give your permission, the search will almost certainly be considered legal. If you refuse permission, the search may or may not be legal, but it may happen anyway. The debate over whether the search was permitted and legal will begin in the court system. The easiest way to avoid trouble is to avoid situations in which a random and unexpected search will yield anything illegal.

3. A person who is innocent of any crime but is with someone arrested for possessing drugs may become involved with the legal system until her innocence is proven. By that time, she may have incurred large financial burdens (e.g., an expensive lawyer), terrified her family, and spent some time under arrest.

4. 'the penalties for drug-related activities can be horrendous, especially in the United States federal judicial system, and particularly for selling drugs. Many casual drug users do not realize that simple possession of a modest amount of a drug can automatically be considered "intent to distribute," whether or not they actually plan to sell the drug.

5. You do not have to be on government property to be in violation of federal law. The federal drug laws apply everywhere in the United States and US territories at all times.

6. State and federal laws can be extremely strict about the use of guns in the commission of crimes. The possession of a gun—even just having one in the vicinity of a drug-law violation canadd many years onto the sentence for the original crime.

Many people believe that they are "safe" from serious legal consequences because they know the local officials, or because they believe the penal­ties are not serious. They are wrong. First, it a local official were to inter­fere with a prosecution, she could be prosecuted for obstruction of justice or public corruption. Second, an arrest by a state or local officer can eas­ily be referred to federal prosecutors not subject to local political influ­ence. Third, in many states and in the federal system there is no parole. Even worse, in some cases "minimum mandatory" sentencing laws give the judges practically no leeway for reduced sentences.

8. Your rights as a US citizen do not apply in foreign countries, and the legal consequences of drug-law violations in some places can literally mean death.

TREATMENT CONTEXT

TREATMENT CONTEXT

The research design and the various family-treatment modalities of the Addicts and Families Program(AFP) have been described irl Chapter 2 and Appendix C and are not germane to this chapter. Rather, our concern here is with the means used for getting the families actually involved in treatment. Again, the study demanded that (1) the addict, (2) both parents or parent surrogates,* and, whenever possible, (3) siblings, attend an (initial) Family Evaluation Session before being assigned to a family-treatment group. For theo-retical reasons (Chapters 1 and 6) and purposes of research design,''' wives, while usually included in treatment, were not required to attend the evaluation exercise. This session included videotaped family interaction tasks and family perceptions tests. Each member age 12 or over was paid 810.00 for participating. The therapists did not know beforehand to which treatment group the families they were recruit-ing would be (randomly) assigned. These stipulations, while perhaps more stringent than those of most clinical programs, had their benefits. Although they made our job more difficult, they also pro-hibited us from either taking the easy way out and settling for partial family representation, or excluding family members who we later determined were crucial for the success of treatment. Further, we had to recruit a high percentage of families in order both (1) to meet the requirements for a certain number of cases within the grant period, and (2) to avoid the criticism that our sample was nonrepresentative because we had skimmed off the "easy," -compliant" families.

Initial recruitment efforts were made with 125 families. Of these, 33 were deemed ineligible for the study, usually because the IP was not addicted at intake. This left 92 families with which full engage‑

ment attempts were made.

At the outset of the study we anticipated that our biggest prob-lem would be in retaining these families beyond one or two family sessions—the dropout issue. In this we were wrong. First, 94% of those who attended the Family Evaluation Session continued with treatment. Second, once they were -hooked," the majority of families tended to be fairly conscientious in their attendance, especially when compared with results reported elsewhere in the literature. Even the treatment group with the least optimal retention potential averaged six sessions, that is, 64% of their prescribed number of sessions '65' ""; attendance rates for the other two treatment groups were 88%, and 94%. What we did not foresee was the inordinate amount of difficulty we would have in simply getting the family members in for the initial Family Evaluation Session (since, at the time, almost none of the literature on engaging addicts' families had been published). Recruit-ment became one of the most demanding aspects of our work. This unexpected hurdle forced us to reconsider our situation and attempt to be innovative. The substance of this chapter is derived from our responses and experiences in the face of this dilemma.

THE BOTTOM LINE ON ADDICTION

THE BOTTOM LINE ON ADDICTION

The bottom line on addiction is that anyone with a brain can get addicted to drugs. However, most people don't, and there are a lot of reasons. First and foremost, if a person does not experiment with addictive drugs, then she won't get addicted. Second, if a person is mentally healthy, has a stable family and work life (including supportive and non-drug-using peers), and has no family history of substance abuse, she lacks some important risk factors and is less vulnerable. However, she still has a brain, and she is not immune to addiction. During the cocaine craze of the 1970s and ¹80s, plenty of constructive, highly educated, well-employed professionals became addicted to cocaine despite positive factors in their lives.

Finally, there may be some people for whom the pleasurable experience of these drugs is exceptionally high, and the drive to use the drugs is thus more compelling than for others. If these people do not try drugs, this underlying quality will not present a problem. However, if they have access to them, and if they do choose to use them, they are at significant risk. It is no accident that the rate of drug addiction among professionals in the United States is highest among medical personnel, who have easy access to such drugs.

MENTAL ILLNESS AND DRUG ADDICTION

MENTAL ILLNESS AND DRUG ADDICTION

Depression and some other mental illnesses also occur more frequently in substance users. Did the drugs cause the problem, or did the problem cause the drug use? Once someone's life has become complicated by sub­stance addiction, the turmoil that has been created can certainly contrib­ute to the development of depression. This fact makes it very difficult to understand the complicated relationship between mental illness and drug addiction. However, some recovering addicts will describe an opposite cycle: that their anxious or depressed mood led them to drink or to use other substances to deal with feelings of inadequacy or despair. Then, as time passed and substance use became more frequent, the substance use became the dominant problem. This "self-medication" process probably contributes to addiction in many people.