Mythbusters, a regular feature in our Matters of Substance quarterly magazine, unpicks the hype, hysteria and fictions often found around drug policy debates (especially those covered in the press).
If we are to believe recent media hype about the link between cannabis and educational failure, the future for our youth is bleak indeed. Mythbusters digs behind the headlines to weed out the truth.
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“Potheads fail at school.” “Early stoners lose education.” “Smoke dope and become one, study warns.” These headlines all appeared on various high-profile New Zealand media outlets in response to new research evaluating cannabis use and educational achievement. If these claims are true, New Zealand is in serious trouble.
Our rates of cannabis use are among the highest in the world. According to the 2007/2008 New Zealand Alcohol and Drug Use Survey, about half the population aged over 16 (46.4 percent) had used cannabis at some point in their lifetime, representing 1,224,600 people. The median age at which this group had first tried cannabis was 17 years. Overall, one in three New Zealanders who had ever used cannabis had first tried it when they were aged 15–17 years, and one in six had first tried cannabis when aged 14 years or younger.
Tellingly, most news coverage did not report any actual numerical results from this research, preferring sweeping pronouncements such as “the younger people start smoking cannabis, the more likely they are to fail in the education system”.
But how much more likely are they to fail? And is this failure really due to smoking cannabis at a young age? The risk factors and life pathways for early cannabis use overlap considerably with those for poor educational outcomes. To find out more, Mythbusters studied the research paper behind the media claims and also reviewed other literature in this area.
The media’s interest stemmed from the combined findings of three Australasian cohort studies, including the long-running Christchurch Health and Development Study. The researchers analysed the relationship between the age of onset of cannabis use (<15 years, 15−17 years or never before 18) and measures of educational achievement (high school completion, entry into university and degree attainment).
Importantly, they attempted to take into account potential confounding factors such as socio demographic background, parental education, family functioning and childhood achievement prior to the onset of cannabis use.
Compared with those who first used cannabis before age 15, those who had never used by 18 had odds of high school completion 2.4−4.1 times greater, odds of university enrolment 1.8−2.9 times greater and odds of degree attainment 3.0−4.4 times greater. But once adjustments were made for the potential confounders the researchers had identified, these odds reduced considerably, though they remained statistically significant.
Risk estimates suggested that the early use of cannabis accounted for 17 percent of the overall rate of failure to complete high school, 5 percent of the overall rate of failure to attend university and 3 percent of the overall rate of failure to attain a university degree.
But is early use of cannabis the real cause of these poorer educational outcomes? It is notoriously difficult to make causal inferences from observational studies. Firstly, there is always the possibility of uncontrolled, residual confounding – for example, genetic factors or personality differences – that were not taken into account during the analysis. Secondly, there is the possibility of a reverse causal association, whereby educational under-achievement leads to the increased use of cannabis rather than the other way round. Other limitations from this research include between-study differences in data collection methods, confounders assessed and attrition rates.
The study authors themselves called for “further research that would discount possible alternative explanations of the association between cannabis use and educational achievement, including the issues of uncontrolled residual confounding and reverse causality”.
So what does all this actually mean?
There does appear to be an association between early age of first cannabis use and subsequent poorer educational achievement, but that does not mean, as the headlines suggest, that we can assume all youngsters who use cannabis are condemned to life on the educational scrapheap. We are a long way from conclusive proof of that. Mythbusters wholeheartedly endorses the study authors’ call for more research and hopes the media takes heed.
Sensationalist reporting may sell newspapers but does nothing to advance a mature debate on a complex social issue. There are many good reasons to discourage young people from using cannabis, but not all young people who experiment with cannabis are doomed to academic failure.
References
Fergusson DM, Horwood LJ, Beautrais AL. Cannabis and educational achievement. Addiction. 2003 Dec;98(12):1681-92.
Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009 Oct 17;374(9698):1383-91.
Horwood LJ, Fergusson DM, Hayatbakhsh MR, et al. Cannabis use and educational achievement: Findings from three Australasian cohort studies. Drug Alcohol Dependency. 2010 Apr 22.
Lynskey M, Hall W. The effects of adolescent cannabis use on educational attainment: a review. Addiction. 2000 Nov;95(11):1621-30.
Macleod J, Hickman M. Commentary: understanding pathways to cannabis use and from use to harm. International Journal of Epidemiology. 2006 Jun;35(3):680-2.
Macleod J, Oakes R, Copello A, et al. Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet. 2004 May 15;363(9421):1579-88.
Ministry of Health. 2010. Drug Use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey. Wellington: Ministry of Health.
Daylight saving is over, and the shorter colder days make snuggling on the couch with takeaways and a bottle of wine much more tempting than getting outside to exercise. The winter padding is setting in, and rising obesity prevalence figures suggest this padding will be permanent for many. Is our national weight gain related to changes in alcohol consumption? What effect does alcohol really have on our waistlines?
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Alcohol is a known appetite stimulant, and people tend to eat more when consuming alcohol. At 29kJ per gram, it’s also a high calorie beverage. One standard drink (100ml of wine, 30ml of spirits or 280ml of standard beer) contains 290kJ, about half the energy of a can of fizzy drink.
Theoretically, the potential for alcohol to increase weight is clear, but the evidence is surprisingly mixed. Some studies suggest calories from alcohol are more likely to cause weight gain in intermittent drinkers and in those already overweight than in heavy drinkers (the classic malnourished alcoholic). Others find alcohol is associated with weight loss in certain subjects.
This apparent contradiction is mostly because many of these studies are cross-sectional, looking at one point in time, and so cannot establish a temporal or causal link between alcohol consumption and weight. For example, an apparent association between higher body mass index (BMI) and ‘abstainers’ may be because overweight people have already stopped drinking for health reasons or to lose weight. More longitudinal studies are needed before firm conclusions can be made.
One recent and well publicised US longitudinal study found moderate alcohol consumption may help reduce weight gain in middle-aged to elderly women. However, before hitting the gin instead of the gym, it is worthwhile considering this study’s many limitations.
Firstly, only baseline alcohol consumption was used. The analyses did not take into account changing drinking habits over time. Secondly, participants self-reported their weight, which is notoriously unreliable. Thirdly, the selected subjects were predominantly white, female healthcare professionals who were not obese at baseline. This means the results cannot be extrapolated to men, less advantaged or non-white women, or women who are already obese.
Interestingly, a British study of middle-aged men that did account for changes in alcohol consumption over time showed higher BMIs in those with the heaviest alcohol consumption, which may point to the importance of collecting comprehensive data for these complex studies and perhaps a stronger association between alcohol and weight for men.
In addition to the identified limitations of the US study, the most important drawback with such observational studies is the many additional reasons people may drink (or abstain) and change weight that are unmeasured, such as personality, genetics, beliefs, health status and upbringing.
These confounding factors may make it appear alcohol is related to BMI, whereas the unmeasured factor is the real reason for the relationship. Unfortunately, observational studies are the best research tool for this question because ‘gold standard’ randomised experiments are not feasible – randomly allocating individuals to abstinence or heavy alcohol consumption to observe health effects is unlikely to be acceptable to either individuals or ethics committees!
But even if the results from the US study of women are true, what then? A single observational study cannot be used to recommend alcohol as a diet tonic to women because any potential weight-loss benefits must be considered against increased risk of cancer, liver disease, injury and other well known harms from alcohol.
Whatever the evidence linking alcohol and BMI ultimately shows, it is worth remembering that alcohol has three major characteristics: it is a nutrient (energy source), a psycho-active drug and a toxin. Alcohol is not solely a source of calories, but also a potentially addictive and lethal substance, and for many people, the effect of alcohol on their bodies may be far less significant than its effects on their lives.
References
Suter, P. 2004. Alcohol, nutrition and health maintenance: selected aspects. Proceedings of the Nutrition Society. 63(1):81-8
Suter, P. 2005. Is alcohol consumption a risk factor for weight gain and obesity? Critical Reviews in Clinical Laboratory Sciences 42(3):197-227
Wang, L. Lee, I-M. Manson, J. E. Buring, J. E. Sesso, H. D. 2010. Alcohol consumption, weight gain, and risk of becoming overweight in middle-aged and older women. Archives of Internal Medicine 170(5):453-61
Wannamethee, S. G. Shaper, A. G. 2003. Alcohol, body weight, and weight gain in middle-aged men. American Journal of Clinical Nutrition 77;1312-7
We all know prolonged heavy drinking and regular bouts of binge drinking are bad for our health. But what about light or moderate drinking? Is a small amount of alcohol actually good for the heart? Mythbusters investigates…
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Claims there were possible benefits for the heart from drinking moderate amounts of alcohol first emerged in the 1970s. Since then, a huge amount of research has focused on alcohol’s potential cardio-protective effect.
There are several plausible biological mechanisms for this idea – alcohol increases the profile of ‘good’ fats such as HDL cholesterol and has an anti-clotting effect on blood – but alcohol also has many other effects that are harmful to cardiovascular health, including raising blood pressure and promoting electrical rhythm disturbances.
Despite the popular notion that a little alcohol is good for the heart, the research is far from clear. For years, a J-shaped curve was used to describe this effect – teetotallers were thought to fare worse than moderate drinkers who in turn fared better than heavier drinkers. This view is now under serious challenge. Several early studies that looked at the association between alcohol and heart disease have been faulted for their design and methods.
Non-randomised trials may have overestimated the apparent benefits of light to moderate alcohol consumption on the risk of coronary heart disease because they were influenced by uncontrolled confounders. For example, people who only consume light to moderate amounts of alcohol also tend to have healthier lifestyles than heavy drinkers, while many abstainers do so because they already have health problems, not so they can avoid them.
Another source of error is the systematic misclassification of exdrinkers and occasional drinkers as abstainers, which negatively biases the health status of abstainers.
Most studies also failed to capture drinking patterns that may be more relevant to disease causation than overall consumption. As a result of these shortcomings, many researchers now believe that the size of alcohol’s cardioprotective effect has been exaggerated.
When it comes to the link between alcohol and cancer, there is little ambiguity. Any level of alcohol is harmful, and there is no level of consumption below which there is not an increased risk of cancer. For breast cancer, each additional standard drink per day increases the risk by 9 percent. The risk of mouth, pharynx and larynx cancer increases by 25 percent per standard drink per day.
Not surprisingly, the World Health Organization has classified alcohol as a Class 1 carcinogen, alongside asbestos and formaldehyde. Yet public understanding of the risks of moderate alcohol intake is low. In a recent US survey, almost one-third of all drinkers cited health benefits as part of their motivation for drinking. Just 10 percent correctly identified breast cancer as a possible risk from moderate drinking.
The underlying dynamics behind much of the research into the potential health benefits of alcohol reflect the powerful commercial interests at play as much as they reflect improvements in our knowledge about the biological effects of alcohol. A recent review of major studies investigating the alleged protective nature of alcohol on the heart made a startling discovery. Studies reporting a positive protective effect had all been funded by the liquor industry whereas those that showed a negative or no effect had not received any industry funding. This does not mean that industry-funded research is deliberately biased, but it should encourage a more cautious approach when interpreting and reporting results.
Coronary heart disease affects 35 percent of men and 28 percent of women in New Zealand during their lifetime. The idea that alcohol might somehow prevent this may sound attractive but is not substantiated by the evidence.
The overall harms from alcohol overwhelmingly outweigh any potential cardiovascular benefit for most people. Worldwide, at least 2.3 million people died of alcohol-related causes in 2002, and in New Zealand, alcohol is associated with an estimated net loss of 12,000 years of life annually.
While there are many valid reasons to drink alcohol – sociability and relaxation to name just two – Mythbusters thinks improving cardiovascular health should no longer be among them.
References
Chikritzhs T, et al. A health dose of skepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug Alcohol Review. 2009 Jul;28(4):441-4.
Connor J, et al. The burden of death, disease and disability due to alcohol in New Zealand. NZ Medical Journal 2005 April 15;118(1213):U1412.
Mukamal KJ, et al. Beliefs, motivations and opinions about moderate drinking: a cross-sectional survey. Family Medicine 2008;40(3):188-95.
Mukamal KJ, Rimm EB. Alcohol consumption: risks and benefits. Current Atherosclerosis Report. 2008 December ;10(6):536-43.
Sellman D, et al. Alcohol cardio-protection has been talked up. NZ Medical Journal 2009 Sepember 25;122 (1303).
“Many teenagers in the school system of last resort are smoking pot. The high rates of drug abuse are among concerns about the alternative education system that have prompted Education Minister Anne Tolley to review its funding.”
“Drug use by at risk teens causes alarm”, The Press, 10 August 2009
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If you read the story from The Press quoted above, you could well get the impression that attendance at alternative education (AE) classes is in some way linked to drug use by its students.
The story quotes the New Zealand Council for Educational Research (NZCER) report: Background of students in alternative education: interviews with a selected 2008 cohort.
But are AE teachers really giving students lessons on how to roll joints?
Here at Mythbusters, we sensed something was fishy, so we decided to see what the NZCER report really had to say about drug use in our education system.
Many AE students come from troubled homes
Students that attend alternative education classes are comprised of ‘at risk’ individuals between the ages of 13 and 16 who have been truanting for more than two school terms or who have been expelled from mainstream schools. In 2008, there were approximately 3,400 alternative education students attending 200 centres throughout New Zealand.
Most of the young people spoken to by the report’s authors had experienced domestic violence in some form, and nearly a third had experienced life in or around gangs.
Many come from homes where drug and alcohol use is the norm
The NZCER report found that, “Nearly 40 percent of the students in our study mentioned the significant use of drugs and alcohol in their family homes.” It also pointed out that this was likely to be an understatement, as only students who had offered this information freely were counted.
One pupil said, “My family still takes drugs. It was what I thought was normal. I got brought up around it, but it’s not good because it influences me and my sister, and we smoke drugs, drink alcohol, smoke cigarettes. No one ever talked to me about this before I got to AE.”
Is alternative education working?
The NZCER report concludes that AE is highly valued by its participants, but is insufficiently resourced – resulting in students leaving without the qualifications they need.
A lack of funding meant some students required more learning than their AE centre could provide, making reintegration into secondary schools out of the question.
The report states: “There appears to be little or no resourcing to assist these students to return to mainstream settings and very little expectation that they are entitled to the regular New Zealand curriculum.”
Amanda Drogemuller, an alternative education tutor from Motueka, said her seven-student programme was run on its bones.
“For years, we have been hoping for more funding because we see the value in it, but we haven’t been given the opportunity to show that to the wider community."
What does the future have in store for alternative education?
The Ministry of Education has recently completed a review of alternative education funding, the findings of which have yet to be released. And while Minister of Education Anne Tolley says there are no plans to scrap it, some within the sector are sceptical.
Those who are anxious about the future of AE point to National’s recent scrapping of adult learning night courses and the $84.5 million sum that has recently been set aside for military-style boot camps for troubled youth.
Chris Jessep, an alternative education coordinator and counsellor at Waimea College, said, “Where are their priorities? Had that funding been tagged to alternative education [rather than boot camps], those students would be far better resourced.”
So, to get back to our original question: did the NZCER report find AE classes to be the cause of drug use by students, as was implied by The Press article?
No.
Drug use amongst AE students was found to be linked strongly with what was going on in their homes.
And as for what the future has in store for alternative education… only time will tell.
This year is a particularly significant one for alcohol policy in New Zealand. Amendments to the 20-year-old Sale of Liquor Act are currently at select committee stage, and the Law Commission is conducting its comprehensive alcohol law review. Acceptance is high that alcohol-related harms are significant, and there’s a high level of media interest in proposals to mitigate those harms.
So there’s a lot being said about alcohol policy right now, and Mythbusters are here to help with a special edition that separates the straight talking from the fast talking.
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As with any complex health and social issue, the debate relating to effective alcohol policy has been characterised by the frequent brandishing of half-truths, scare mongering and, at times, deliberate misinformation At stake, after all, are the profits of an industry worth tens of millions of dollars annually. The discourse on alcohol policy also taps into deeply rooted philosophical beliefs regarding individual freedoms and the extent to which they may be curbed by government intervention.
We think it timely to draw attention to some of the often heard myths around alcohol policy. We have identified several spurious claims commonly made by those opposed to making alcohol more expensive and less available. These claims have been grouped under six common ‘myths’, which Mythbusters here refutes.
1. Myth: Alcohol consumption is a matter of individual responsibility.
Blame for our binge drinking culture is more often directed towards the irresponsibility of users than the producers and marketers. The constant refrain from the industry is that, if people took more personal responsibility for themselves, the harms associated with their product would be mitigated. Industry is supposedly only there to help responsible people enjoy themselves and fulfil their chosen lifestyles. Those who call for increased prices and tighter restrictions on availability have even been labelled ‘health Nazis’.
This claim overlooks important factors about alcohol itself and the environment in which it is consumed, both of which can have a strong influence on individual decision making.
Firstly, alcohol is an addictive substance. Addiction and dependency seriously impair the ability to make rational decisions. Secondly,consumers find themselves in an environment in which several millions of dollars are spent on alcohol marketing. The messages are very clever and subtle, come via a variety of media and draw on the best marketing science available. They exploit human needs, which are most intensely expressed in youth. These include the need for inclusion as part of the ‘in crowd’ and the need to feel grown up. Marketing tactics used by the alcohol industry appear very similar to those formerly used by the tobacco industry. There is now strong evidence that alcohol marketing promotes a culture of drinking and has a reinforcing effect on young people’s drinking.
Another important aspect to keep in mind is that harmful alcohol use is rarely an individual problem. Rather, it impacts on family, friends, neighbours, work colleagues and, ultimately,society as a whole. Alcohol is a contributory factor in a wide range of social problems including crime, violence, family breakdown, child abuse and child neglect. The concept of ‘passive drinking’ to capture the damage done to the innocent when people drink too much is useful in this regard. Focusing on individual responsibility for a problem with far-reaching consequences across society is short-sighted and ignores the obligations governments have to protect the most vulnerable.
Far from being health fascists, those who advocate for greater restrictions on alcohol availability and increased prices are champions for those whose lives are blighted by alcoholfuelled disorder, violence and abuse.
2. Myth: We should not penalise the entire community for the drinking behaviour of a problematical minority. Alcohol policy should focus on the minority groups that are most at risk, such as youth and binge drinkers.
This is a common myth actively pushed by industry and with some notable success. When the Chief Medical Officerin England called for a minimum unit price for alcohol, the proposal was instantly dismissed by Prime Minister Gordon Brown, who said, “We don’t want the responsible, sensible majority of moderate drinkers to have to pay more or suffer because of the excesses of a small minority.”
Contrary to the widely held misperception, alcohol harms are not confined to the heaviest drinkers in a population but are much more widespread. For example, recent research from Finland found that the majority of problems occurred in 90 percent of the population consuming moderately, compared to the 10 percent of the population drinking heavily. In addition, the purported cost to moderate drinkers of measures such as raising the price of alcohol has been greatly exaggerated. Recent modelling in the UK has shown that setting a minimum price of 50 pence per unit would likely increase the average weekly spend on alcohol of moderate drinkers by only 23 pence per week, but would decrease the consumption by underage and heavy drinkers by 7.3 percent and 10.3 percent, respectively.
Overwhelming, evidence demonstrates that efforts to reduce the burden of harm from alcohol need to reach the majority of drinkers and not just the high-risk groups. The World Health Organization (WHO) says populationbased policies can have a protective effect on vulnerable populations and reduce the overall level of alcohol problems. It has recognised the need for both population-based strategies and interventions and those targeting particular groups. A WHO-sponsored review of 32 alcohol strategies found the most effective alcohol policies included restricting availability and raising price, drink-driving laws and brief interventions for hazardous and harmful drinkers. By contrast, the least effective policies included education in schools, public service announcements and voluntary regulation by industry. It concluded that, if the less effective measures are used, they should form part of a comprehensive, population-based strategy.
3. Myth: Raising prices has no effect on heavy or binge drinkers.
This myth is widely disseminated by certain sectors and frequently cited in media reports. Yet the evidence shows the opposite is true. Price increases and a set minimum price have a much greater effect on heavier than on lighter drinkers, with modest or only small extra financial cost to lighter drinkers.
When all other factors are equal, increased alcohol prices generally lead to decreased consumption and vice versa. At-risk groups such as youth and heavy drinkers are particularly sensitive when it comes to pricing. Recent research from Scotland, for example, found that overall consumption decreased following a tax increase that exceeded the cost of living, and heavier drinkers cut down the most. There is also good evidence to show that policies that increase alcohol prices delay the start of drinking, slow young people’s progression towards drinking large amounts and reduce the volume of alcohol consumed per occasion.
The relationship between alcohol price and consumption has been extensively evaluated and forms the basis for the WHO’s recommendation that raising price (along with restricting availability) is among the most effective measures to decrease harms from alcohol. On the basis of the overwhelming body of evidence to date, we are confident that higher prices will lead to a reduction in alcohol-related harms across society.
4. Myth: It is important to work with industry when formulating alcohol policy.
This is a call often made by the liquor industry and its allies. Variants include the much touted lines that ‘we are allin this together’ or ‘we need to involve all the stakeholders when formulating policy’. Unfortunately, this argument does not stand up against closer scrutiny.
The supposed commonality of interest between public health and the alcohol industry is difficult to reconcile with the direct correlation that exists between overall volume of consumption and levels of alcohol-related harm. Furthermore, the majority of alcohol consumed in New Zealand is done so in the context of excessive or harmful drinking. It is naïve to believe the industry would voluntarily support measures to reduce overall consumption when this would clearly undermine profits.
At the very heart of the matter is a fundamental conflict of interests between public health and pursuit of profits. Recognising this, a WHO Expert Committee has recommended that the global public health body continues its practice of no collaboration with the alcohol industry. Governments should take a similar stance when it comes to formulating policy.
However, engaging in a dialogue with industry on specific ways to reduce harm is an entirely different matter to collaborating on policy. It is reasonable (and necessary) to engage industry when it comes to matters such as working to provide safer drinking environments.
Alcohol producers are well organised and effective lobbyists for industry-friendly policies, both nationally and internationally. There are many parallels between their strategies and tactics and those of the tobacco industry. A major focus is to campaign against effective strategies and for ineffective strategies.
Another industry tactic is to instil doubt about non-industry research. A recent disclosure of hitherto unpublished documents provides a revealing insight into how the alcohol industry operates. It shows that industry holds grave concerns that alcohol will be viewed through a public health lens in the same way as tobacco and has invested in co-ordinated strategies to divert attention away from programmes it perceives will do the most damage to its interests. Among the measures it has opposed most strongly are tax increases, controls in advertising and sponsorship, health warnings and tough policing, especially on drink-driving. According to the lead author of this paper, “although [the alcohol industry] don’t want to be seen in the same way as big tobacco, they’re going down exactly the same path.”
5. Myth: Legislation can’t change our drinking culture.
While legislation alone won’t change our drinking culture, its role in shaping behaviour should not be dismissed outof hand. Our view is that legislation has a crucial role to play in influencing the drinking environment, which is currently oriented towards ease of access and excess. We also believe there are important parallels that can be drawn from the success of anti-smoking legislation, where a substantial culture change has occurred following the enactment of smokefree legislation. There has been a significant shift in attitudes towards smoking in public places since the smokefree legislation.
6. Myth: We should not interfere with the market by artificially setting minimum alcohol prices and restricting marketing.
Alcohol is no ordinary commodity. It is an addictive substance that can lead to long-term dependence. It isassociated with a range of acute and chronic health harms and has been classified by WHO as a Class 1 carcinogen, alongside asbestos, formaldehyde, mustard gas and plutonium-239. Were it to go before the New Zealand Government’s Expert Advisory Committee on Drugs, it would be classified as Class B (High Risk).
Alcohol’s association with crime and violence is well known. To argue it should be treated like any other commodity and then rely solely on market forces to determine supply and demand is therefore absurd.
Governments have a duty to protect and promote the public good. Setting minimum unit price levels and/or increasing excise tax are a very effective means of reducing alcohol-related harms. Marketing contributes to the uptake and spread of alcohol use and the consequent spread of harm. Regulation of marketing to mitigate these harms should be a core national response.
Mythbusters have some bad news for drivers keeping breath mints in their glove box for that special occasion when they’re invited to speak into the machine. Drinking and driving is bad enough, but if you think you can beat a breath test, you’re even more of a bloody idiot.
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High profile enforcement is an important component of laws designed to reduce the harms from drinking and driving. Breath alcohol testing gives police a quick and relatively non-invasive way of detecting whether people are driving under the influence of alcohol. Yet, almost immediately since their introduction, people have claimed to be able to defeat such tests.
In one of the more unusual cases, an Alberta, US, courtroom heard how a 28-year-old man, who was stopped on suspicion of driving while under the influence, ate his underpants in the belief they would soak up the excess alcohol in his system. Arresting officer Constable Bill Robinson says he heard “some ripping and tearing” from the back of his vehicle.
“I looked in the back and he was tearing pieces of the crotch of his underwear out and stuffing them in his mouth,” he testified.
The accused was eventually acquitted because he had passed the breath test, but we doubt eating his undies was a contributing factor.
In Ontario, Canada, a 59-year-old suspected drunk driver tried to foil a police breathalyser by even more bizarre means – stuffing his mouth full of faeces. He had been taken to the police station for testing, where he grabbed a handful of his own waste “and placed it in his mouth, attempting to trick the breathalyser machine”, according to Sergeant James Buchanan of the South Simcoe Police. It didn’t work. The machine registered two readings of more than twice the legal blood alcohol limit, and the man was charged with drunk driving. In 2003, our friends at Discovery Channel’s Mythbusters tested various commonly suggested ways to defeat a breathalyser, including eating breath mints, sucking on a penny, eating an onion and drinking mouthwash. None were found effective.
Underlying many spurious claims is a lack of understanding about how testing devices work. Although breath mints might mask the odour of alcohol on the breath, they do nothing to affect blood alcohol concentration (BAC), the only thing that really matters. Alcohol shows up in the breath because it is absorbed into the bloodstream rather than being digested. As blood flows through the lungs, some of the alcohol moves from the lungs’ alveoli into the air. The amount is directly related to BAC and can be measured accurately during exhalation.
Three main types of breath testing devices are in use – those that detect alcohol by a chemical reaction producing a colour change, those relying on a chemical reaction in a fuel cell and those using infrared spectroscopy.
Interestingly, substances that may have a theoretical basis for reducing breath alcohol concentration were not tested in the Discovery Channel episode. These include a bag of activated charcoal concealed in the mouth, an oxidising gas to fool a fuel cell type detector or an organic interferent to fool an infrared absorption detector.
However, none are likely to be practical, let alone guaranteed to work.
“I’m not sure that activated charcoal would remove much of the alcohol from a person’s breath,” says Dr Richardson of the University of Saskatchewan’s Department of Pharmacology. “You would have to be blowing into the breathalyser through a mouthful of activated charcoal. The authorities wouldn’t allow this. They don’t even allow you to chew gum during these tests.”
Failure to fool a breathalyser doesn’t mean that testing devices are always 100 percent accurate. Small false positives have been recorded immediately after the consumption of various foods and soft drinks, and after the use of mouthwash.
Breathing patterns also have an effect. According to Michael Hlastala, Professor of Physiology and Biophysics and of Medicine at the University of Washington, “The most overlooked error in breath testing for alcohol is the pattern of breathing.”
He says that alcohol concentration in the first part of a breath is much lower than the equivalent BAC, whereas that in the last part of a breath is much higher.
In real life, false positives are rare. A recent New Zealand study of paired blood and breath alcohol concentrations in over 11,000 drivers found a false positive rate of only 0.14 percent.
In light of the available evidence, we conclude there is no reliable and practical way of defeating a breath alcohol test.
But getting arrested is not the biggest risk of driving intoxicated – it’s getting killed or killing someone else. The best way to beat a breathalyser? Don’t drink and drive.
"Harm reduction increases the likelihood that drugs will be avaliable...It increases the drug harm that results from it. It decreases the efficacy of police and disempowers parents and the community." New Zealand 'war on drugs' zealot
So-called harm reduction leads to liberalisation of the use of drugs." The Vatican
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Ignorance is all too common in drug policy discussions, but it’s something we could do without, especially when it comes to life saving health interventions such as needle exchange programmes and opioid substitution therapy.
In the lead-up to the March UN drug policy meeting, the scale of individual, institutional and member state ignorance knew no bounds when various players sought to undermine the importance of harm reduction programmes which have proven critical to addressing drug harm.
A very small minority of member states even succeeded in striking references to harm reduction from the Political Declaration agreed at the High Level Segment of the 52nd meeting of the Commission on Narcotic Drugs.
It is estimated that 15.9 million people inject drugs in 158 countries and territories around the world. Up to 10 percent of all HIV infections occur through unsafe injecting drug use and evidence suggests that over 3 million people who inject drugs are living with HIV.
International evidence strongly supports harm reduction interventions as effective methods of preventing HIV transmission and improving the lives of injecting users.
This evidence has been compelling enough for harm reduction to receive endorsement by a raft of high level organisations such as the United Nations General Assembly, UNAIDS, the UN Office of Drugs and Crime, the World Health Organization and many others.
At least 84 countries (including New Zealand) explicitly support or provide harm reduction programmes such as needle exchanges, opioid substitution and drug consumption rooms. Further, the Legal Affairs Section of the UN Drug Control Programme has declared harm reduction programmes legal under international drug conventions, authoritatively refuting continued allegations by obstructionist governments that harm reduction is incompatible with treaty obligations.
While there is not a formal, internationally agreed definition of harm reduction, most commentators agree on its key features: a focus on harms rather than use; a pragmatic and achievable approach; an assumption that drugs are part of society; an underlying public health framework; and the use of an evidence base to evaluate interventions in terms of net harm.
In a systematic review of needle exchange programmes, the Drug Policy Modelling Programme (DPMP) concluded, “The body of evidence is very strongly weighted towards their effectiveness and cost-efficiency.” New Zealand needle exchanges have been world leaders in limiting HIV infections among injecting drug users.
Studies and clinical trials have found the provision of needles does not cause a rise in drug use or injection. In the US, federally funded reports conducted by the many reputable organisations such as the National Commission on AIDS and the Centers for Disease Control and Prevention have all concluded that needle exchanges reduce the transmission of HIV while not increasing drug use.
Far from “disempowering communities”, as critics claim, studies have also found needle exchanges highly successful in reducing the rate of unsafe disposal of injecting equipment in areas where they operate.
Tony Trimingham, Head of Australia’s Family Drug Support, says harm reduction interventions support the otherwise powerless families of drug users because they focus on helping rather than punishing those affected by drugs. “I’d rather my child was drug-dependent than dead, because while there’s life there’s hope,” he says.
Evidence suggests a number of public health and community benefits of supervised injecting facilities, including prevention of overdoses, reduced transmission of blood-borne viruses and better access to medical, welfare or treatment services.
Many critics argue that harm reduction has iatrogenic effects. Needle exchanges, for example, encourage users to inject more and result in greater numbers of new initiates to injecting. However, the DPMP review concluded: “Fears that harm reduction ‘sends the wrong message’ have no evidentiary basis.”
In light of the overwhelming supportive evidence, Mythbusters struggles to understand how the Pope, some member states and others can maintain such ignorant views of harm reduction. Surely everyone’s interests are best served when people who use drugs are provided high-quality, effective health services.
Reference:
Drug Policy Modelling ProgramMonograph #6 A systematic review of harm reduction
Ketamine is a short-acting general anaesthetic used for both human medical and veterinary purposes. It is termed a ‘dissociative’, because it impedes the brain’s sensory connection to the body. On 26 February 2008, Associate Health Minister Jim Anderton announced Cabinet had approved the reclassification of ketamine to Class C under the Misuse of Drugs Act to take effect as soon as Parliament approves.
In the meantime, however, media reports about the drug have left it ‘saddled’ with an inaccurate and unhelpful image.
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The media’s inevitable power to shape society’s attitudes is a dangerous game, with stereotypes often hidden under the poker-faced mask of balance and objectivity. Journalists will pick up one idea and blindly run with it until something blatantly unavoidable hits them right in the face. Then they will run with the latest revelation until something else hits them. Rarely does there seem time or motivation for them to provide a more complete analysis of drug policy issues.
This has been the case with ketamine aka ‘Special K’. Take, for example, this report from the tabloid The Daily Mirror: “Big Brother star Pete Bennett was a regular user of the horse drug ketamine, his friends revealed last night.”
Or this one by the BBC: “An anaesthetic used by vets as a horse tranquiliser, but becoming increasingly common on Britain’s dance scene, is to be made illegal.”
Or this one by the news agency Reuters: “Scientists have unravelled how a horse tranquiliser and hallucinogenic nightclub drug known as ‘Special K’ can ease depression.”
It is not hard to spot a common theme galloping through all of these reports – horses. A recent Mixmag cover story on ketamine actually pictured a ‘clubber’ wearing a pantomime horse head on the dance floor. It is no wonder then that clubbers and policy makers think of ketamine as something used to sedate our big equine friends.
In a study called It is the most fun you can have for twenty quid (2008), Karenza Moor and Fiona Measham from the University of Lancaster investigated motivations behind ketamine use in Britain. The following comments were made by the participants during the interviews: “It is embarrassing, cos people that don’t understand it are like ‘that is a horse tranquiliser’. It’s like someone starting taking dog worming tablets, why would you do that? Some people are just like ‘why?’”
Moor and Measham also came across a clear distinction made by clubbers between ketamine powder viewed as suitable for human consumption, and ketamine in injectable form for veterinary use, and therefore ‘inappropriate for purpose’. “Injecting it would be in liquid form, and that’s for knocking out horses,” says Cassie, a 22-year-old employed ketamine user.
Mythbusters cannot help but wonder why horses, and not guinea pigs, for example, have been receiving so much mention.
The substance is indeed used as an anaesthetic for horses, but it is also widely used as a human anaesthetic. It is used for the elderly, children and in emergencies because it does not suppress the respiratory system, although the powerful hallucinogenic effects – the reason it is used nonmedically – are an unwanted side effect.
Ketamine is used on a whole range of animals, including elephants, camels, gorillas, pigs, sheep, goats, dogs, cats, rabbits, snakes, guinea pigs, birds, gerbils and mice. But why do we never read about the ‘gerbil tranquiliser’ or the ‘bird tranquiliser’? Mythbusters suspects it’s because horses are quite large and the term ‘horse tranquiliser’ provides a more powerful scary drug term for the headline writers than, say, ‘guinea pig tranquiliser’.
Indeed, why does ketamine get the animal treatment at all given that many drugs, including morphine and diazepam, for example, used medically and non-medically on humans, are also used on animals? None of these drugs gets referred to in the context of their animal use as does ketamine. The media never seem to write about the ‘sheep drug diazepam’ or the ‘dog drug morphine’.
While it is hard to find any conclusive answers to these questions, Mythbusters suspects the modern link to ketamine probably stems from mid-90s reports of the drug being stolen from vets and misused. That the drug was a stolen veterinary tranquiliser probably just stuck with journalists. This is despite the fact that, subsequently, most of the drug was supplied to Britain from larger-scale illicit or grey overseas markets.
Obviously, the name filtered through to the New Zealand media in the same way. It is a reflection on the inaccuracies and laziness of drug reporting in the media generally. This sort of misunderstanding is not going to help rational policy development or educating young people about harms or relative risks of drugs.
"People are drinking more, because people tend to drink more during tough times." A US Beverage analyst, 2008
"It is an article of folk wisdom that heavy drinking increases during economic downturns: when people lose their jobs, they turn to alcohol." Business Week, 2007
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With the US economy leading the rest of the world into recession, Mythbusters thought it timely to check out the facts behind the widespread belief that hard times mean hard drinking.
At first glance, it seems to make sense, and research does suggest that some individuals ‘self-medicate' with alcohol in reaction to such stresses.
But does this always apply across the whole population, as Business Week implies?
There is no shortage of long-term data on the issue. In fact, economists are so interested in debating whether alcohol use is ‘pro-cyclical' (increasing in economic upturns, decreasing in downturns), they even hold regular ‘Beeronomics' conferences.
The data are clear that alcohol sales increase in economic upturns, as do drink-driving rates, alcohol-related illnesses and perhaps even alcoholrelated deaths.
When it comes to recessions, however, things get more complicated.
Long-term research from the US and Europe shows overall alcohol consumption doesn't rise much during recessions and can even decline. In the US, for example, a 1 percent increase in state unemployment corresponded to a 3 percent reduction in alcohol consumption. The decrease was even larger when unemployment went up nationally.
But just because overall consumption dips doesn't mean everyone cuts back on alcohol. Researchers using the same US dataset found a 5 percent increase in the unemployment rate corresponded to an 8 percent increase in binge drinking.
So who's most likely to cut back on alcohol, and who's most likely to binge?
Interestingly, the increase in binge drinking was concentrated among employed people rather than the unemployed. Researchers point out that, when the economy tanks, the wealthy can afford to keep drinking, while poorer consumers (despite often being stereotyped as the ones with drinking problems) are he first to cut back. It may be that, during hard times, it's the people that still have jobs that are the most stressed.
Some researchers have found that, in recessions, heavier drinkers reduce their alcohol consumption more than social or light drinkers, but there's still debate about this.
Recessions don't make people stop drinking alcohol altogether. Instead, they change how much and what kinds of alcohol they drink. In tougher times, people are less likely to eat and drink out and are more likely to stay at home - a pattern already showing up in the US economy. And there's a shift from expensive to cheaper types of alcohol - from imported to local beers, for instance, and possibly from spirits towards beers.
The last word goes to the Chief Economist for the US's Distilled Spirits Council, who went out of his way to dispel the "widely held myth" that alcohol is "recession-proof".
"We have the same ups and downs as anyone else," he said. "While liquor sales aren't nearly as cyclical as autos, homes or other big ticket items, typically in a recession, we see liquor sales go down."
References
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Dee, T.S. (2001). Alcohol abuse and economic conditions: evidence from repeated cross-sections of individual-level data. Health Economics, 10: 257-270.
Ettner, S.L. (1997). Measuring the human cost of a weak economy: Does unemployment lead to alcohol abuse? Social Science & Medicine, 44(2), 251-260.
Farrell, C. (2001, November 12). Out of Work and in the Bar? How downturns hit alcohol intake. Business Week.
Geller, A. (2008, September 7). During downturn, people find money for booze. Associated Press story, printed in San Francisco Chronicle.
Johansson, E., Böckerman, P., Prättälä, R., & Uutela, A. (2006). Alcohol-related mortality, drinking behavior, and business cycles. Are slumps really dry seasons? European Journal of Health Economics, 7, 215-220.
Kendall, R et al. 1983. Effect of economic changes on Scottish drinking habits, 1978-82, British Journal of Addiction, vol 78(4): 365-379.
Kesmodel, D. (2008, August 1). SABMiller sales fall after prices rise. Wall Street Journal.
Krüger, N.A., & Svensson, M. (2008). Good times are drinking times: empirical evidence on business cycles and alcohol sales in Sweden 1861-2000. Working Paper No. 2, Swedish Business School at Örebro University.
Luoto, R., Poikolainen, K, & Uutela, A. (1998). Unemployment, sociodemographic background and consumption of alcohol before and during the economic recession of the 1990s in Finland. International Journal of Epidemiology, 27(4):623-9.
Mui, Y.Q. (2008, September 6). Cold comfort in hard times. beer holds up as vice that's not too pricey. Washington Post, page D01.
Nielsen. (2008, June 3). Declining economy has little impact on consumers' alcoholic beverage purchases in stores.
Ruhm, C.J., & Black, W.E. (2002). Does Drinking Really Decrease In Bad Times? Journal of Health Economics, 21(4), 659-678.
San Jose, B., Van Oers, H.A.M., Van de Mheen, H., Dike-Garretsen, H. F. L., & Mackenbach, J.P. (2000). Stressors and alcohol consumption. Alcohol and Alcoholism, 35(3), 307-312.
Weil, D. (2007, November 6). Experts see boats, booze as economic indicators. Newsmax.
Mythbusters always enjoy a grain of salt or two while reading media stories about rampant methamphetamine epidemics. However, we do concede the drug is quickly addictive and incredibly difficult for addicts to give up.
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Is methamphetamine addiction untreatable, as many commonly believe? Mythbusters don’t think so. While treatment development is still in early stages, some standard therapies are beginning to provide very real and measurable results.
When methamphetamine use burst onto the scene in the mid 90s, treatment providers hadn’t seen anything like it. The psychotic behaviours associated with its use, though similar to those of cocaine, were far more intense, and so was resistance to traditional treatment.
Unlike cocaine, which interferes with the body’s ability to recycle dopamine, methamphetamine actually causes its excessive release directly within nerve cells. The euphoria and increased energy from these dopamine spikes are incredibly addictive. But resistance also rapidly develops, increasing dependency.
It’s the over-stimulation of dopamine that causes the psychotic episodes, but perhaps the most significant effect is the body compensating by releasing less dopamine naturally. The result is intense anhedonia – the inability to experience pleasure – which can last for months and be much more difficult to endure than the withdrawal effects of other drugs.
In 2001, the Cochrane Review said, “No available [medical] treatment has been demonstrated to be effective [for] amphetamine withdrawal.”
However, Fraser Todd, Deputy Director (Teaching) of the National Addiction Centre, says we shouldn’t understand these and similar findings to mean no medical treatment works – just that the evidence is inconclusive at this stage.
“We should note this review considered only controlled trials of pharmacological treatments for withdrawal. While no pharmacological treatment worked better than placebos in the studies reviewed, more than 80 percent of subjects still managed to complete detox.
“More importantly, it does not mean psychosocial withdrawa strategies are ineffective, just that the medications studied didn’t add to them. In the larger of the two studies reviewed, 36 out of 43 subjects successfully withdrew from amphetamines.”
This equates to a success rate of about 83 percent where standard treatments for withdrawal were used.
Cognitive Behavioural Therapy (CBT) is one psychosocial intervention that has had promising results in a number of controlled studies. It aims to help patients recognise and challenge their own beliefs and behaviours that reinforce their unwanted behaviour.
The Matrix Model, used by the Center for Substance Abuse Treatment (CSAT) in California, for example, boasts a 50–60 percent success rate after one year – better results than from behavioural therapy for heroin addiction (without the use of methadone), but not as good as figures for recovery from alcoholism.
The basic element of the Matrix Model is group or individual therapy, where patients are taught about their addiction and trained to manage cravings and avoid activities that could trigger relapse. Family therapy, urine testing and 12-step approaches are also part of the programme.
Fraser Todd says the components of the Matrix Model have been standard practice for some time in New Zealand, though we may have taken them further.
“The Matrix Model was developed in America as a way of moving beyond the incumbent 12-step programmes, which focus on confrontation of denial. But it has become highly systematised and manual-based. We’re much freer here to adapt techniques according to individual circumstances.”
In New Zealand, methamphetamine addiction is typically treated using a mix of therapies and techniques tailored for individual situations. These may include: detoxification, CBT, family interventions, community reinforcement and contingency management. In addition, associated problems such as mental and physical health and problems in other life areas – such as accommodation, employment, finances and relationships – would also be taken into account.
So far, there hasn’t been significant outcome research on treatments for amphetamine dependence here, but current approaches appear about as successful as they are for other serious drug addictions.
Meanwhile, all eyes are on the Methamphetamine Treatment Evaluation Study (MATES) currently underway in Australia. Managed by the National Drug and Alcohol Research Centre, it is the first large-scale community-based treatment outcomes study for methamphetamine use either in Australia or internationally.
The MATES study will conclude in 2009. With a large participant group and very high follow-up rates, its findings will be able to be extrapolated amongst the population with a high degree of accuracy.
There may never be a definitive treatment for meth addiction because there will never be a definitive addict. But by adapting the methods and ideas we have now with what we’ll learn from MATES and other studies, the number of treatment options should increase. We’ll also better understand how to apply them, and methamphetamine addiction, which is already very treatable in many cases, will certainly become more treatable.
References
Kongsakon R., Papadopoulos K.I., Saguansiritham R. Mirtazapine in amphetamine detoxification: A placebo-controlled pilot study. International Clinical Psychopharmacology. 20(5)(pp 253-256), 2005).
Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P. Treatment for amphetamine withdrawal. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003021. DOI: 10.1002/14651858.CD003021
National Drug and Alcohol Research Centre. Methamphetamine Treatment Cohort Study.
With the Misuse of Drugs Act and UN drug control reviews, Mythbuster wondered how successful other countries have been with drug policies.
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Sweden’s drug policy receives a lot of attention. UK Conservative party leaders are attracted to it as a possible policy for them, and Antonio Maria Costa of the United Nations Office on Drugs and Crime (UNODC) recently described Sweden as a “notable exception” to most countries’ experience. Costa said that Swedish drug use levels among students were lower than in the early 1970s and that lifetime prevalence and regular drug use among the population were considerably lower than in the rest of Europe.
What’s so special about the Swedish model?
Sweden’s drug policy aims for a ‘drug-free society’. With a zero tolerance foundation, the policy focuses on heavy enforcement against drug users, for example, people can be made to take urine and blood tests on suspicion of drug use, and those caught possessing drugs can be forced into treatment for up to six months whether they are drug-dependent or not. At the same time, drug treatment services are widely available, and Sweden also emphasises drug education.
Sweden does not classify drugs according to their relative harms as New Zealand does, so penalties for cannabis possession are similar to those for heroin. Since the 1960s, Swedish governments have also rejected harm reduction measures, so opioid substitution treatment is very hard to access, and there are only two needle exchange services.
Interestingly, over the same period, alcohol, previously subject to heavy restrictions, has been made more available.
How successful is Sweden’s drug policy?
At first glance, the statistics are convincing. Only one per cent of Swedes had used cannabis in the past yearcompared to nine per cent of people in the United Kingdom. Heroin use has stayed at low levels. On most drug use indicators, Sweden ranks below European averages.
However, it is not clear whether low drug use is a result of Swedish drug policies.
Trends are not as good as might be expected if increased enforcement was wholly effective. While drug use declined in the 1970s and 1980s, it rose again from the 1990s.
Critics also point out that the indicators chosen influence how ‘successful’ a country’s drug policy looks. While Swedish drug use indicators are below EU averages, so are those of the Netherlands, which has radically different drug policies.
Costs and benefits
Another feature of Sweden’s drug policy is high spending on drug control. However, while strong investment may reflect levels of use, research has found no inevitable relationship between expenditure and drug control successes. For example, Greece has the lowest rates of drug use in Europe, while its drugrelated spending per person is only a fiftieth of Sweden’s, and the United Kingdom has Europe’s third highest drug-related expenditure, but the highest use rates for most drugs.
Further, the Swedish rejection of harm reduction practices and its enforcement focus have had substantial human costs. Sweden has high rates of drug-related deaths, and its lack of harm reduction led to negative reports from the UN special rapporteur on rights to health. Injecting drug use has been a major contributor to Sweden’s HIV rate.
Taking a Swedish approach to New Zealand drug policy?
So are there aspects of the Swedish approach that could be used in New Zealand?
Sweden is culturally unlike most other nations. Its population is ethnically homogenous, and more than 80 per cent belong to the Lutheran church, so it has a long-standing temperance culture.
Sweden is also unlike New Zealand in having low income inequality and social deprivation, high median incomes and low unemployment. UNODC cites research showing that inequality and deprivation often go “hand in hand with criminal activities including drug trafficking”.
Expert reviewers believe that all these factors have significantly contributed to the “long-term creation of a strong consensus” in which, for instance, over 90 per cent of young people are opposed to legalising cannabis. As one researcher concludes, does drug policy cause a culture, or just reflect it?
It’s also unlikely New Zealanders would be ready to support some of Sweden’s authoritarian policies such as blood testing on suspicion of drug use.
However, we might be able to learn from Sweden’s strong focus on national mandated drug education programmes, as well as its commitment to providing drug treatment to anyone who needs it.
References
UN Office of Drug Control (2007). Sweden’s Successful Drug Policy: A Review of the Evidence. http://www.unodc.org/pdf/research/Swedish_drug_control.pdf
Steve Rolles (2007, May 28). Sweden's drug policy: A reality check. Transform Blog. http://transform-drugs.blogspot.com/2007/05/swedens-drug-policy-reality-check.html
Peter Cohen (2006), Looking at the UN, smelling a rat. Amsterdam: CEDRO.
http://www.cedro-uva.org/lib/cohen.looking.html
Marcus Roberts, Mike Trace and Axel Klein (2004). Law enforcement and supply reduction. Report Three. http://www.beckleyfoundation.org/pdf/report_lawenforce.pdf
Drug Policy Alliance. Drug Policy Around the World: Sweden
http://www.drugpolicy.org/global/drugpolicyby/westerneurop/sweden/
"Glass of wine aids memory" Auckland University Press release, 26 September 2007
"Don't forget: Drink a beer - or two - daily" Scientific American, 26 September 2007...
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Despite an awkwardly verbose title - Paradoxical Facilitatory Effect of Low-Dose Alcohol Consumption on Memory Mediated by NMDA Receptors - the September 2007 Journal of Neuroscience article received an awful lot of media attention.
After all, it did appear to carry such good news.
The research behind the article was not as complicated as its title might suggest. Rats given the equivalent of a daily glass of wine or two had enhanced memory.
But Mythbusters wonders whether things are ever that simple, especially when good news seems so obviously involved. One only has to look at the first word in the article's title to feel the beginnings of disquiet.
Neuroscientists Maggie Kalev of Auckland University and Ohio State University's Matthew During were the first to point out that their findings were paradoxical because many other studies have established alcohol can, in fact, stop memories being formed.
As well as giving some rats low doses of alcohol (comparable to two or three drinks a day), Kalev and During gave other rats high doses (equal to six or seven drinks a day). Later, they tested the rats for their recall of neutral memories, such as remembering objects, and unpleasant memories, such as mild electric shocks. The rats given low levels of alcohol had better recall of neutral memories than the control group.
The second paradoxical finding was that, at the same time, sustained heavy alcohol consumption inhibited the ability of the rats' brains to create new cells, and increased memories linked to heightened emotion. This led the researchers to comment that drinking to forget "could actually... promote traumatic memories and lead to further drinking, contributing to the development of alcoholism."
Maggie Kalev added that the research only lasted eight weeks, "and is certainly not a recommendation for a lifestyle of moderate drinking".
For the researchers, the real importance of the study was that it identified receptors that help form memories, which may lead to treatments for memory disorders such as Alzheimer's disease.
For Mythbusters, however, the story is yet another in the continuing debate about the good and bad effects of alcohol. November brought highprofile media coverage of an international diet and cancer review highlighting links between alcohol and some types of cancers. Other stories cover research associating health benefits with alcohol.
Mythbusters' point is that the media often fails to distinguish between different types of drinking patterns when reporting on alcohol's effects, as STATS (one of our favourite websites) found when reviewing media stories on the diet-cancer link. Regular, moderate drinking, which reduces heart disease in some groups, has very different health effects to binge drinking or sustained, heavy alcohol use.
Mythbusters believes it's important to look behind the first headline. What kinds of drinking are being studied, and in which groups? And how does the media coverage differ from what the researchers actually said or wrote?
Meanwhile, the research and the debate around the effects of alcohol on humans will need to continue, and Mythbusters suggests the jury is still out on whether moderate alcohol intake is always a good thing. Rats!
A glass of wine aids memory press release
Don't forget: drink a beer or two daily
Exactly how much do problems with alcohol and other drugs contribute to crime? And how do we know? We thought it was a good opportunity to bust a myth – or at least take a closer look at the numbers in our own recent story.
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Last issue’s cover story, Rehabilitating our criminal justice system, started with, “It is said up to 80 percent of New Zealand’s crime is alcohol and drug-related, and about half of all offenders are using at least one drug at the time of their arrest.” So far, so clear. But depending on what you read, you might also find that:
So: 60, 80 or 89 percent? And is it just drugs, or drugs and alcohol, affecting offenders?
As might be expected, different research produces different results. The figure cited in Matters of Substance came from a 2005 speech by Corrections’ Chief Executive Barry Matthews. The figure of 60 percent, widely quoted by ministers, comes from unpublished research cited in a 2006 Cabinet paper stating that, “Between 50 and 60 percent of offenders were affected by alcohol and/or other drugs at the time of their offending.”
References to “89 percent of serious offenders” originate from a 1998 report called A Seein’ “I” to the Future, on Corrections’ “criminogenic needs inventory” (“criminogenic needs” can be loosely translated as “factors contributing to offending that need to be addressed”). Prisoners’ alcohol and drug dependency data is from the 1999 National Study of Psychiatric Morbidity in New Zealand Prisons.
One reason that the figures differ is that one – 60 percent – refers to being affected at the time the offence was committed, while the larger number – 89 percent – is about alcohol or drug use in the period leading up to the offence.
The remaining question is, what evidence is there that alcohol and drug use contribute to offending?
Corrections’ view is supported by the evidence. Studies worldwide have found a high proportion of people convicted of crimes have alcohol or drug abuse or dependence. At the same time, people with substance use problems have much higher rates of criminal activity than the general population.
That drug use influences criminal activity has been known since the 1980s, when studies of “career addicts” found criminal activity was higher when they were more dependent, and lower in periods of low or no drug use.
As Canadian researchers found in 2002, the difference can be dramatic. Prisoners who had not used drugs or alcohol during a six-month period in freedom reported an average 1.7 crimes a week. Inmates who had used one or more substances while free, but were not dependent, had committed 3.3 crimes a week. Those dependent on drugs and/or alcohol had committed around seven crimes a week.
However, it is not as simple as saying, “drugs contribute to crime”.
Different drugs are linked to different kinds of crime, and while the media and public focus on illicit drugs, in fact, the strongest established drug-crime association is with alcohol.
The Canadian research is typical, finding that, with the exception of “gainful crimes” such as burglary, the highest proportion of crimes were connected to alcohol, or to alcohol and other drugs combined, with much lower proportions connected to illicit drug use. In general, alcohol consumption is connected to crimes of violence, while dependence on illicit drugs is connected to crimes for profit.
So while the numbers you come across may differ a little depending on the source, it doesn’t mean the relationship between drugs and crime is a myth. The correlation is demonstrably present and significant.
So, if we tackle addiction, do we reduce crime and re-offending? The Drug Foundation thinks so.
References
"France is often depicted as ‘a country where the natives drink, sing and dance till the wee small hours of the morning without experiencing any problem’." [1] "One does not see binge drinking in countries like France… where children and young people have grown up with a responsible attitude towards alcohol." [2]
We’re often told that very young French children are given wine mixed with water, which teaches them to be moderate drinkers. [3] Contrast that with almost 10 percent of New Zealanders claiming they drink to get drunk and many more of us saying that’s absolutely fine. [4] Is the way the French drink how New Zealand should model its drinking culture?
A quick look at the statistics shows if you drink like the French, you die like the French. Per capita, France has the sixth highest alcohol consumption rate in the world, with 13.5 litres of pure alcohol consumed per adult per year. New Zealand is 27th, with 9.2 litres. Alcohol is involved in half of the deaths from road accidents in France (31 percent in New Zealand), half of all homicides and one-quarter of all suicides. Rates of cirrhosis of the liver are more than double our own.
But they don’t ‘binge’, do they?
C’est vrai. School-age French children are among the lowest binge drinkers in Europe. Just 16 percent of French 15–16 year olds reported binge drinking in June this year. UK and Denmark rates are more than double that. But youth drinking is on the rise in France, with beer and alcopops driving the increase. [5]
But what about parents and caregivers teaching their kids to drink responsibly?
Introducing an entirely new concept to ‘drug education’, UK broadcaster Janet Street-Porter, at an event sponsored by industry lobbyists the Portman Group, said teenagers should be able to experiment with low-alcohol drinks in school, and that pubs should provide drinking rooms for 16 and 17-year-olds.
French politicians have a more modest proposal, recommending that children be given wine appreciation lessons from primary school age. They suggest teaching children about the origins, history and characteristics of French wines would increase “demand for quality and respect for nature”. [3]
Mythbusters wonders whether this proposal has anything to do with the plummet in French demand for domestic wines. In 1970, the French drank 100 litres of wine per capita per year but this amount has fallen to just 55 litres in recent years.
These proposals probably aren’t the brightest of ideas.
Research has found that the younger people begin drinking, the more likely they are to become alcohol dependent later in life. [6] Those who begin drinking in their teenage years are also more likely to experience alcohol related unintentional injuries – such as motor vehicle injuries, falls, burns, drowning – than those who begin drinking later in life. [7] Moreover, new research suggests that adolescent brain development may be irreversibly affected by heavy alcohol exposure, [8] and that young age drinking initiation is strongly related to high level alcohol misuse at ages 17 and 18. [9]
Responding to this, the Australian Drug Foundation advocates young people under 16 should avoid consuming alcohol altogether. They say young people do not need to drink to learn how to use alcohol safely. Most important, say our Aussie friends, is the example set by parents and others on how, where and why they use alcohol. [11]
UK’s Alcohol Concern takes this a few steps further, recommending parents who give alcohol to children under the age of 15 – even with a meal at home – should face prosecution. [12] This is precisely the case in the United States, as illustrated most recently by Elisa Kelly who, along with her former husband, will spend the next 27 months in jail for serving alcohol to minors at her son’s 16th birthday party. [13]
Mythbusters hopes the government review of the supply of alcohol to minors can fi nd more palatable policy solutions than NCEA credits for alcohol appreciation or sending parents who supply alcohol to prison.
References
1. Michel Craplet, ‘France: alcohol today’, Addiction, 100, 1398-1401
2. Patricia Schnauer, MP, Hansard record of the Sale of Liquor Amendment Bill debate, 20 July 1999
3. “When I was a child my father used to give me wine mixed with water because he was afraid plain water wasn’t good for my health,” Georges Casellato, a Paris wine merchant. French children to be taught joys of wine as industry faces crisis, The Guardian, 1 December 2006
4. The way we drink: The current attitudes and behaviours of New Zealanders (aged 12 plus) towards drinking alcohol, ALAC, 2003
5. ‘Disturbing trends in European youth drinking – latest figures’, The Globe Issue 3, 2004
6. Pitkanen, Lyyra, Pulkkinen, Age of onset of drinking and the use of alcohol in adulthood: a follow-up study from age 8-42 for females and males, Addiction, 100, 652-661; Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of substance abuse, 1997, 9:103-110
7. Hingson R et al. Age of drinking onset and unintentional injury involvement after drinking. Journal of the American Medical Association, 2000, 284:1527-1533
8. Australian Drug Foundation, The effects of alcohol on the young brain, Fact Sheet (3.12), February 2005; David Jernigan, The USA: alcohol and young people today, Addiction 100, 271-273
9. Hawkins JD et al. Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse. Journal of studies on alcohol, 1997, 58(3):280-290
10. Position on Teenagers and Alcohol, Australian Drug Foundation, www.adf.org.au/article.asp?ContentID=teenalcohol
11. Alcohol consumption amongst children reaches new heights, 27 April 2007, www.alcoholconcern.org.uk/servlets/doc/1189
12. Jailed parents' story is a cautionary tale, 10 June 2007, www.miamiherald.com/509/story/134739.html
Who says people undergoing addiction treatment can't give up smoking? Mythbusters reveals new evidence and research challenging the myths that have kept smoking interventions out of substance abuse programmes for so long.
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Te Rau Hinengaro - the 2006 mental health survey reveals around 56 percent of people with a substance use disorder are smokers compared to 24 percent in the general population. This means clients in substance abuse treatment are at much higher risk from smoking-related illnesses or death.[1]
Unfortunately, New Zealand addiction treatment services tend to ignore this important addiction, and Mythbusters say this needs to change - starting with some of the things we believe.
There are a number of prevalent myths about substance abusers and smoking. It is widely accepted that people in treatment either do not want to stop smoking, wouldn't be able to stop if they tried, or may relapse to other drug use if they make the attempt.
That treatment providers and their staff tend to believe and operate according to these myths has kept smoking interventions out of substance abuse programmes, and commonly, providers don't even discuss with their patients the issues of tobacco dependence and quitting [2]. Some staff members are even known to smoke alongside patients, further normalising tobacco addiction and perhaps even enhancing its perceived value as a therapeutic aid.
However, the belief that patients in addiction treatment do not want to stop is challenged by recent surveys finding most patients entering drug treatment do express an interest in quitting smoking when asked. [3]
There doesn't appear to be any research supporting the contention that alcoholics should not try to quit smoking at the same time as they are attempting to quit drinking. In fact, the research more closely supports the view that smoking and drinking are correlated behaviours; anything causing a reduction in one may be associated with a reduction in the other. [4]
New studies have shed much light on cross-addiction. For example, Dr Dzung Anh Le and colleagues from the Centre for Addiction and Mental Health, University of Toronto have found that nicotine increases the craving for alcohol.
Several other studies have reported overwhelmingly favourable responses to implementing concurrent intervention for nicotine and other substance dependence [5]. Treating multiple addictions at once does not seem to make recovery any more difficult. In fact, smoking cessation may be modestly associated with an improved abstinence rate.[6]
The treatment centre at the University of Texas Medical School reports that since it became smokefree in 1991, it observed no change in the rate of premature discharge, in the percentage of people who completed the programme or in patient stress or unusual incidents.
So there is plenty of evidence that smoking cessation interventions can be effective at increasing short-term quit rates in people with substance use disorders, and the attitudes and approach of treatment providers needs to change to reflect that evidence.[7]
The newly revised Smoking Cessation Guidelines recommend that advice to stop smoking should be given by healthcare workers - including alcohol and other drugs (AOD) staff - to all people who smoke, irrespective of whether they are ready to quit or not.
Treatment staff who are tobacco dependant should seriously consider quitting, and Mythbusters would urge employers to ensure that their staff who are smokers have access to the resources, support and encouragement to deal with their tobacco addiction.
You may also be eligible to become a Quit Cards provider. This means you can distribute nicotine replacement exchange cards for subsidised nicotine patches and gum to people who want to quit smoking. There are currently six AOD treatment centres who are Quit Card exchange providers.
To qualify some criteria needs to be met. For more information go to www.quit.org.nz or call 0800 778 778.
1. Campbell, Barbara K et al. Treating cigarette smoking in drug abusing clients. Journal of Substance Abuse Treatment Vol 12, Issue 2, March-April 1995 89-94
2. Bobo, J.K. and Davis, C.M. Recovering staff and smoking in chemical dependency programmes in rural Nebraska. Journal of Substance Abuse Treatment 10:221-227, 1993
3. Orlean, C.T. & Hutchinson D. Tailoring nicotine addiction treatments for chemical dependency patients. Journal of Substance Abuse Treatment 1993 10, 197-208; Ziedonia D.M et al Barriers and solutions to addressing tobacco dependence in addiction treatment programmes. NIAAA National Institute on alcohol abuse and alcoholism
4. Bien, T & Barge R. Smoking and Drinking, a review of the literature. 1990 International Journal of the Addictions 25 (12).
5. Schmitz, J.M. etc “Nicotine†substance abuse, a comprehensive textbook. 3rd edition, 1998 pg 286
6. Lemon, S C et al The impact of smoking cessation on drug abuse treatment outcome. Addictive Behaviours 28 (2003) 1323-1331
7. Sussman S. Smoking cessation among persons in recovery. Substance Use and Misuse 2002;37 (8-10): 1275-98
Drug users are giving free samples of P with marijuana teenagers bought.[1] Tinny houses are one of the main methods of cannabis distribution to young people and police have previously voiced concern that other drugs such as methamphetamine, known as P, have been pushed through their established channels.[2] The discovery of gangs selling cannabis laced with P to teenagers has spurred on Auckland police in the war against the cannabis drug trade. [3]
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Stories like these have been cropping up regularly in the New Zealand media since United Future MP Judy Turner issued her Tinny houses offer 'free' P samples media release in 2003.[4] The November NZPA story was widely reported, and led to considerable discussion around the sector (well, around Mythbusters' water cooler, at least). Just how true are such claims?
Are tinny houses selling methamphetamine?
Since 2003, Social and Health Outcomes Research and Evaluation has been tracking changes in drug use and selling by interviewing key drug scene informants including users, treatment workers and enforcement staff. According to its 2004 report,[5] a number of informants did say that some tinny houses and cannabis dealers were now selling methamphetamine.
The 2005 Illicit Drug Monitoring System survey [6] asked regular drug users where they bought drugs. Only 2 percent of methamphetamine users reported buying it from a tinny house in the previous six months. Most had bought it from a friend's house, at an "agreed public locations", or in a nightclub.
Many of the claims have come from unnamed police and are difficult to substantiate. Even when assertions can be attributed they appear to represent differing views. Claims about P and tinny houses were made by West Australian Superintendent Fred Gere at the 2003 New Zealand Annual Police Conference in 2003.[7] However, Dave Montgomery, the chair of the New Zealand Police Managers' Guild Trust, has written that, "Overseas suppliers have made links with ethnic and motorcycle gangs in this country who handle the local distribution. These drugs are not likely to be sold at 'tinny houses' but by people who know people, just like cannabis used to be." [8]
What about the freebies?
As yet no research has addressed the specific question of free methamphetamine being offered to those purchasing cannabis. However, drug surveys have asked current cannabis buyers whether their dealer had encouraged them to buy other drugs. Around a quarter of users (1.4 percent of the overall sample) said they "knew or thought they knew that their dealer sold other drugs", but only 9 percent of these (0.5 percent overall) said their supplier had encouraged them to buy other drugs.[9]
Wilkins, Reilly and Casswell reviewed whether buyers from tinny houses were more likely than other cannabis users to use multiple drugs. They concluded, "Those buying cannabis from 'tinny' houses did not appear to be subject to any additional persuasion to purchase other drug types than those purchasing cannabis from the personal market. 'Tinny' house cannabis buyers also did not appear to have any higher levels of other drug use than personal market buyers, except in the case of high potency cannabis." [10]
P-laced weed? Are you serious?
Claims that gangs are lacing cheap cannabis deals with methamphetamine are widespread among police,[11] and a former user made this claim on TVNZ's One News in 2004.[12] However, as yet Mythbusters has been unable to find any case where a drug seller or someone running a tinny house has been charged or convicted of selling cannabis mixed with methamphetamine, or with giving away samples of methamphetamine. We have also been unable to find any case where samples of laced cannabis have been produced.
Sceptics about these claims, including drug treatment workers, have noted that cannabis and amphetamines have significantly different effects. Cannabis is smoked as a relaxant, while methamphetamine is valued as a hyper-stimulant. In his Hard News blog, Mythbusters' favourite media commentator Russell Brown also pointed out that methamphetamine is not actually smoked like cannabis but is gently heated to release vapours. The result of smoking would be to burn most of the methamphetamine for little or no effect.[13]
Similar stories have circulated for decades, with opium and heroin taking the place of methamphetamine. An analysis of cannabis samples which regular users considered produced unusual effects found no evidence of adulteration.[14]
References
1. NZPA (2006, November 29). Lower priced P attracting more teens. Printed on Stuff, 29 November 2006.
2. Gower, P (2006, August 5). Porn movie plus tinny for $35. New Zealand Herald. Retrieved from http://subs.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10394708
3. New Zealand Herald. (2006 March 02). Cannabis laced with P sparking police raids on tinny houses. Retrieved from http://subs.nzherald.co.nz/topic/story.cfm?c_id=217&ObjectID=10370700
4.Turner: Tinny houses offer 'free' P samples. Press Release: United Future NZ Party Friday, 22 August 2003, 10:55 am. Retrieved from www.scoop.co.nz/stories/PA0308/S00439.htm
5. Wilkins C, Rose E, Trappitt D, Sellman, D., Adamson, S. & . DeZwart, K. (2004). Survey of New Zealand meth scene changes. Recent changes in the methamphetamine scene in New Zealand: Preliminary findings from key informant surveys of drug enforcement officers and drug treatment workers. Retrieved from www.police.govt.nz/resources/2004/meth-scene
6. Wilkins C and Sweetsur P. Research briefing: Key Findings from the 2005 Illicit Drug Monitoring System (IDMS). November 2005. (From report by Dr. Chris Wilkins, Melissa Girling, Paul Sweetsur and Rachael Butler) Retrieved from http://www.ndp.govt.nz/moh.nsf/pagescm/1078/$File/idmskeyfindings.pdf
7. Plowman, S (2003, November). Organised crime expert delivers simple message: Take the 'P'rofit out of organized crime by seizing ALL gang assets. Police News, 166-169. Retrieved from www.policeassn.org.nz/communications/newspdf/Nov03.pdf
8. New Zealand Police Managers' Guild Trust. [website] (not dated). Retrieved from www.pmgt.org.nz
9. Field and Casswell 1999b, cited in Wilkins C & Casswell, S (2002). The cannabis black market and the case for the legalisation of cannabis in New Zealand. Social Policy Journal of New Zealand, 18. Retrieved from http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj18/cannabis-black-market18-pages31-43.html
10. Wilkins, C, Reilly J.L. & Casswell, S. (2006). Cannabis 'tinny' houses in New Zealand:Implications for the use and sale of cannabis and other illicit drugs in New Zealand. Addiction, 100, 971-980
11. Plowman, S (2003, August). The timebomb of P. Police News, 106-7. Retrieved from www.policeassn.org.nz/communications/newspdf/Aug03.pdf
12. TVNZ One News, June 6, 2004. Claims cannabis laced with P. Retrieved from http://tvnz.co.nz/view/news_national_story_skin/429432
13. Russell Brown (2006, March 06). Three Things. Hard News. Retrieved December 21, 2006 from www.publicaddress.net/default,2976.sm#post2976
14. Le Vu S. Aquatias S. Bonnet N. Debrus M. Fournier G. Beauverie P. (2006). Chemical content of street cannabis [French] Presse Medicale. 35(5 Pt 1):755-8, May.