ILLEGAL ACTS

The drug laws are complicated, and the states differ from each other and from the federal system. So, there is no easy way to explain them in detail. However, there are a few very powerful and relatively unknown aspects of the law that should be explained to everyone.

First is the difference between a felony and a misdemeanor. A misde­meanor is a minor crime that might result in a fine, public service, or a short prison sentence—typically less than one year (in the federal sys­tem)—and usually is associated with traffic violations, minor theft, or sometimes possession of a very small amount of an illegal drug. A felony (murder, armed robbery, sale of drugs) usually carries a sentence in excess of one year and is considered such a serious crime that convicted individ­uals lose many rights that ordinary citizens enjoy. This includes the right to hold many kinds of highly paid jobs. A felony conviction is truly a life-changing event. Understanding this is important for drug users because possession of some amounts of some drugs can be considered a misdemeanor, while larger amounts are always felonies.

The law always sets the level of punishment based on the amount of a drug that one possesses or distributes, and in this case size counts a lot.

For example, there is a current public controversy because the federal laws are terribly tough for possession of even a few grams of crack cocaine, but one would have to possess much more powdered cocaine to receive the same punishment. Anyone who contemplates drug usage should under­stand the severity of the penalties that various levels of drug possession invoke. (As we write this, the US Department of Justice has decided to modify the way US attorneys may charge cocaine/crack dealers. Now they can make the charge without stating the amount of drug, so that the pen­alties are more consistent between crack and powdered cocaine. The problem is that this is an executive decision and can be reversed in any case and at any time. The actual law regulating possession and distribu­tion of these drugs has not been changed.)

Most people know that conviction for selling drugs (distribution) results in stiffer penalties than for possession. What they don't know is that sim­ply possessing certain amounts of a drug can be considered an "intent to distribute" and thus may subject a person to the much stiffer distribution penalties. Moreover, money may not have to change hands for distribution to take place from a legal perspective. Simply handing a package of a drug from one person to another can be considered distribution.

Another obscure criminal area is conspiracy. In drug cases, there are many convictions for conspiracy to commit a crime because very often a drug deal involves much more than the simple transfer of money and drugs. The conspiracy laws are broad and powerful, and even people peripheral to the planning of a crime, who may not have participated in the crime itself, are often charged under these laws, sometimes in the hope that they will cooperate with the court officials to convict others. Anyone hanging around individuals involved in drug possession and dis­tribution should be aware of the risk of being charged with conspiracy for seemingly innocent acts, such as lending a boyfriend a car, cashing a check, or allowing a friend who is a dealer to use a telephone if it can be proven that in doing any of these seemingly innocent acts you knew why the person wanted you to do them. From the standpoint of law enforce­ment, drug dealing is considered a business (although it is illegal), and just as in a legal business, different people play different roles and have different levels of importance. In general, being around drug dealing is legally very risky.

Finally, there is the issue of the confiscation of property. Most of us have heard about auctions where the property of drug dealers is sold. This hap‑

pens because of forfeiture laws that allow property used in drug dealing to be confiscated and sold by the government. The particularly devastating aspect of this is that the property of a more or less innocent individual might be confiscated because it was being used in violation of drug laws. Imagine, for example, a student distributing cocaine from his father's home and car. Suppose the father knew something about this and told the student to stop it. If the prosecutor could prove that the father knew some­thing and allowed it to continue, it is possible that both the home and the car could be confiscated as part of the criminal prosecution.

What about marijuana? It's now legal, right? Some states have "legal­ized" marijuana possession for medicinal purposes; others have made the possession of small amounts for recreational use either legal or punish­able as a misdemeanor. But the US federal law makes it a crime in all fifty states. In general, federal law overrules state law, so you might well be in a state in which possession is legal but prosecuted under federal law. As we are writing this new edition, President Obama has asked the Department of justice to refrain from enforcing the marijuana laws in certain circum­stances for states that permit its possession. But that is an executive deci­sion that can he reversed at any time. Moreover, the specific conditions under which the federal law might be enforced may not be crystal clear. So, be aware that no matter what a state law says, federal law still has this drug illegal everywhere in the United States.

THE LATEST AND GREATEST , IMAGING THE BRAIN

THE LATEST AND GREATEST(?): IMAGING THE BRAIN

It's hard to find a media story about the brain that doesn't refer to the lat­est technology for imaging the activity of the brain, most often using Functional Magnetic Resonance Imaging (fMRI). This is a powerful tool for imaging ongoing brain activity in humans as well as animals. As with structural MRI that yields "still" images of the brain, fMRI uses magnetic fields rather than radiation to image the tissue. So, as far as we know, there is no safety issue about long or repeated exposures (unless you have something in your body that can be magnetized).

fMRI depends on a particularly useful property of hemoglobin, the molecule in red blood cells that carries oxygen to all tissues, including those in the brain. As you may have learned in biology class, oxygen is bound to hemoglobin in the blood and is released from hemoglobin as blood perfuses tissues that need oxygen for producing energy The mag­netic properties of hemoglobin change as the hemoglobin releases oxygen to tissues. Thus, the fMRI system looks for changes in magnetic signals as

tissues consume oxygen. The signal is called the blood oxygen level dependent (BOLD) signal.

When neural circuits are active, blood flow increases in those areas and oxygen is stripped from hemoglobin in the blood. Thus the BOLD signal changes to reflect that shift in the amount of hemoglobin that has oxygen bound to it. So literally, one can lie in an fMRI machine and decide to wig­gle one's thumb and watch the brain activity associated with that move­ment. What you are really looking at is blood flow and oxygen-consumption changes in the brain areas that control that movement—not the electrical activity of the brain. The BOLD signal lags the neuronal activity for one to two seconds, and there is still controversy about what exactly triggers the

increased blood flow and oxygen delivery. But it is safe to say that fMRI is measuring brain activity.

fMRI has its limits. First, there is the time issue we just mentioned, because the signal lags the neural activity for a long time compared to the firing rate of neurons. Then there is the issue of spatial resolution. The very best fMR. I resolution (at this writing) is a cube that's about one milli­meter on each side—and that requires a machine with a very strong and expensive magnet. That one-millimeter cube contains many neurons and synapses between them. So, using an fMRI to examine brain circuits is a bit like looking at a low-resolution TV—there is information there, but not as much as one would like. Another problem is that it is not possible to determine whether a BOLD signal in a brain area is a result of that area transmitting information or receiving information. All we can say is that

the area is active. Furthermore, we don't know the result of that activity_

it may be stimulating or shutting down its neighbor by activating neurons

that normally slow down cells they contact.

Finally, the BOLD signals are very small compared to the background activity. This requires that the fiVIRI system average the images to reveal the relevant activity of an area. To further emphasize the active area, col­ors are used and the contrast is enhanced. Those techniques are very help­ful to scientists but can produce images that are misleading to nonscientists. One of us was consulted by a major television network talk show about the effects of ecstasy as shown by brain images (not fMRI, but it doesn't matter) of individuals who had used the drug. The images had very high contrast, and it appeared that the ecstasy users had "holes" in their brains. In fact, there was just a small percentage difference in the true signals, but the images had been enhanced to emphasize those differ­ences. Nevertheless, they talked about ecstasy producing holes in the brains of users.

fMRI has been used to monitor brain activity in a vast array of studies, ranging from epilepsy to lie detection. It has also been used to image the response of the brain to various drugs as scientists try and determine where in the brain a drug acts to produce a change in behavior. To some extent this works. For example, one can show pictures of cocaine to non­users and compare their response to the response of cocaine addicts. The BOLD images can vary remarkably between brain areas. But it is hard to know exactly what these changes mean.

First, individual variations make it hard to draw conclusions about a particular individual's responses. Doing studies with groups of people and averaging the group results produces reliable images, but we are not yet at the point of being able to image one individual and draw firm con­clusions. Second, even if a brain area is reliably activated in some circum­stance, we don't know enough about the brain to know exactly what each area does. Probably most important, brain activities are executed by coor­dinated signaling between a variety of areas, and fMRI may not be able to tell us the direction of signal flow or what role an area is playing. Finally, variations in signal strength may obscure proper interpretations. This could easily happen if a very small collection of neurons exerted powerful effects on a much larger circuit. The BOLD signal from the small number of neurons initiating the activity might not even be visible, while the larger circuit would dominate and appear to be the source of the activity

All of this is not to say that fMRI and other brain imaging tools should be ignored. They are truly fantastic tools to begin to understand the rela­tionship between behaviors and brain activities. As they become more refined, they may be able to reveal individual differences that have diag­nostic meaning. But our advice at this moment is to view the nonscientific media with a degree of caution and to not be seduced by pretty pictures.

WHY SHOULD ANYONE CARE ABOUT ALL OF THIS?

We hope that this chapter offers some good reasons to develop a respect for the brain and the body that supports it, as well as some insight into why drugs do what they do. This is especially important for teenagers, because as every teenager knows, they are different from adults.

What adults may not know is that the teenagers are right. For some time we have known that the very immature brain, as in babies, has a number of characteristics that are different from the adult brain. Now we are finding that the adolescent brain may be different also. It may respond differently to drugs, and it may learn differently.

A psychologist at Duke University, Dr. David Rubin, carried out a fasci­nating series of experiments showing just how different young people may be. The basic experiment was to take adults at various ages and ask them questions about events that occurred in every ten-year period of their lives, including a lot of trivia. Of course, recent events were remembered fairly well, but other than those, the events best recalled were those that occurred during young adulthood (from age eleven to age thirty). This means that a senior citizen recalled his life events and what was going on in the world during his adolescence even better than those events that had occurred just

a few years earlier.

If our conclusions from this research are correct, then there is some­thing very special about either our brain biochemistry or our psychologi­cal state during adolescence that enables us to store our experiences for life. Whatever the explanation, the implications are clear—the experi­ences, good or bad, that we have during our youth are very well stored in our "sober" memory systems and can be recalled for the rest of our lives. Thus, when teenagers say they are different, they are right, and when adults say that these are formative years, they, too, are right.

THERAPIST'S LEVERAGE

THERAPIST'S LEVERAGE

A number of factors can markedly increase or decrease the therap st's leverage during the recruitment effort.

Principle 14: The chances for successful family recruitment are increased if the therapist does the recruiting. There are several advantages to this. First, it avoids the problem of passing the family from one treater to another, with the accompanying increase in dropouts; the process is not diluted between an intake worker or recruiter and a therapist. Second, as mentioned earlier, by seeing the family during engagement the therapist can sell himself, helping to instill trust and assuage fears about being blamed and so forth.It is probably an advantage if the therapist is of the same race as the family. Our research design dictated that, whenever logistically possible, therapist and family should be matched as to race. This was achieved in 84% of the cases. While we feel that such matching may be less important during the actual therapy, it did seem to help at the time of recruitment. In addition to getting around the barriers that can occur in many instances when people of different races interact, it facilitated the task of getting information. Often our therapists made visits to the home or neighborhood to locate the IP or his family, and being of similar race engendered more cooperation from relatives and neighbors. The safety factor also cannot be ignored. Many of the families lived in "rough- neighborhoods, and it could actually be dangerous for a Black man to be walking around at night in a White

neighborhood, or vice versa.*

Principle 15: The therapist should be the primary treater of the index patient and his family. Below, in Chapters 6 and 16, we state that we believe family therapy will fail with these cases without this provision. It is likewise extremely important in the recruitment effort. In the early days of our project the IP had both a drug counselor and a therapist. The procedure was for the IP to become enrolled in the clinic and have his program and medications deter-mined in conjunction with his drug counselor. Then the counselor would serve as a kind of middleman or "matchmaker- in introducing him to the family therapist. (In the meantime the counselor con-tinued with the patient in monitoring therapeutic issues, providing individual counseling, and the like.) This procedure frequently fell on

its face 

The decision was made for the therapist to also function as drug counselor for those cases selected for our program. This modification was crucial: wearing both hats, the therapist was brought into the treatment process immediately upon intake. As mentioned earlier in this chapter, he had the advantage of being the first treater en-countered by the client. He had the added leverage of control over decisions about medications such as methadone. With the advent of the dual role model, a major recruiting hurdle was removed, leading to a marked decrease in the amount of effort needed to engage families, and an increase in the rate of recruitment success.