The Differences Between Moderate Drinking Programs and Harm Reduction Programs Part 1: Moderation Drinking Programs and Moderation Management By Kenneth Anderson, MA Moderate drinking programs and harm reduction programs start from opposite assumptions and wind up in very different places. This doesn't necessarily make one type of program better than the other--different people will find different programs to be a good fit. A Brief Overview of Harm Reduction Programs Harm reduction programs start from the assumption that the more harm there is associated with behavior such as the use of a substance, the more the person who engages in that behavior can benefit from harm reduction services. Harm reduction services are low-threshold and are provided unconditionally. For example,...

By Kenneth Anderson, MA Alcohol and the Cerebellum Some drugs like opioids, benzodiazepines, and amphetamines have been called chemical scalpels because each affects only a single neurotransmitter system. Alcohol, on the other hand, is a dirty drug which affects large numbers of neurotransmitter systems, including GABA (gamma-aminobutyric acid), glutamate, and dopamine. Hence, alcohol has been referred to as a chemical hand grenade. In this post, we will be looking at alcohol's effects on the GABA system to see how it causes staggering (aka ataxic gait) and slurring of speech (dysarthrias), sedation, and memory loss. First, let's take a look at the GABA receptors. Although there is only one type of GABA, there are two types of GABA receptors: type A, which are known as GABA-A recep...

By Kenneth Anderson, MA Normal and Retrograde Neurotransmission Delta-9 THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol) are the two most commonly found cannabinoids in the cannabis plant. The plant contains over 100 other cannabinoids as well. THC and CBD both affect the endocannabinoid system. "Endo-" is a Greek prefix meaning "inside." "Endocannabinoid system" refers to all the systems of the body which contain cannabinoid receptors and are affected by cannabinoids. We will be primarily focused on the effects of cannabinoids in the central nervous system, and on the CB1 receptor, which is the main cannabinoid receptor there. Drugs like THC can affect the central nervous system because there are also naturally occurring cannabinoids in the central nervous system, the endo...

By Kenneth Anderson, MA Alcohol treatment wasn't always divorced from alcohol science; the divorce between the two can be largely laid at the feet of Hazelden CEO Daniel John "Dan" Anderson, PhD (Mar 30, 1921 - Feb 19, 2003). Anderson's attitude towards science was one of hubris and arrogance. The History of Alcohol Treatment in the United States Treatment for alcohol problems in the United States occurred in two major waves: The first was prior to Prohibition (January 17, 1920), and the second followed Repeal (December 5, 1933). Demand for alcohol treatment dried up almost completely during the period from 1915 to 1920 due to state and local prohibition laws, the so-called Wartime Prohibition Act, and other factors, and all but a handful of alcohol treatment facilities had shut do...

By John de Miranda Innovation does not come quickly or easily to the addiction treatment sector. For example, harm reduction strategies had been employed in the public health sector for decades before their recent adoption by the federal government as a latecomer to fighting our nation’s opioid epidemic. Similarly, the Minnesota Model of addiction treatment, which emerged in the 1950s, still accounts for the model preferred by the majority of treatment programs. At its core, this approach draws heavily from 12-step ideology and requires a commitment to abstinence as the key focus of treatment goals. “If you have had enough and are ready to quit, then we can help you,” is the metamessage sent to potential clients by most addiction treatment programs. The problem with this approa...

By Kenneth Anderson, MA The history of alcohol treatment since the 1960s has been a history of practitioners ignoring science and the scientific method and forming conclusions based on observations of clinical populations without testing hypotheses, then self-publishing these hypotheses or publishing them in the popular press rather than in peer-reviewed scientific journals. Some of the most notorious examples of this are Hazelden and the Johnson Institute, which will be discussed in later blog posts. Another notorious example is Lakeside Milam, founded by James Robert Milam (Mar 3, 1922 - May 6, 2016). This is a far cry from Shadel Sanitarium, which meticulously published its data in peer-reviewed journals in the 1940s and 50s. James Robert Milam Milam was born in the state of Was...

By Kenneth Anderson, MA The Wegscheider-Cruse Family Roles Theory is one example of how “chemical dependency” treatment does not have the firm scientific foundation that it is suggested to have. Despite this lack of foundation, to become a certified addiction counselor today one must study Wegscheider-Cruse's theory. Below I present the history of the development of this theory, and some of the specific problems with it. Sharon Wegscheider-Cruse Behind the Wegscheider-Cruse Family Roles Theory was Sharon Wegscheider-Cruse (Nov 16, 1938 - living), born Sharon Rae Roelandt in Jasper, Minnesota, the daughter of Emil Leonard Roelandt (Jan 19, 1915 - Dec 24, 1961) and Marjorie Annadell Roelandt nee Olson (Aug 7, 1919 - Aug 11, 1986). The Roelandts were Catholic, and Sharon attended Cath...

by Kenneth Anderson, M.A. THIQ is an acronym which stands for tetrahydroisoquinoline, a chemical which is formed in the brain when a metabolite of alcohol combines with dopamine. The THIQ theory of "alcoholism" became very popular in the 1970s and 1980s, when it was erroneously believed that THIQs were formed in the brains of "alcoholics," but not in the brains of normal drinkers. The theory became so popular that it was regularly taught to clients at Hazelden, both in a document riddled with historical errors and in a videotape which I recall seeing in the 1990s. THIQ theory is discussed in more detail below. Although THIQ theory was debunked in the 1990s when it was found that THIQs were formed equally well in the brains of both normal drinkers and "alcoholics," recent research sug...

By Kenneth Anderson All too often I hear people erroneously lay the blame for the current war on drugs on Nixon; however, this is historically inaccurate. The focus of Nixon's war on drugs was treatment, and under Nixon, the harsh drug laws of the 1950s were eased. Ronald Reagan was the true architect of the evil known as today's war on drugs. Let's start by looking at some historical background. The US Rise of Substance Use There was an explosive growth in the use of marijuana from 1967 to 1979, with LSD bringing up the rear. Although marijuana and LSD were promoted in the early 1960s by both Timothy Leary at Harvard and Ken Kesey at his ranch in rural La Honda, California, about 42 miles from San Francisco, their influence was quite local and had little impact on the US as a whol...

By Kenneth Anderson, MA Two people of the same weight, height, and sex can drink the same amount of alcohol over the same period of time, and when they stop, one will have few if any symptoms of alcohol withdrawal, while the other will go through severe alcohol withdrawal. Why is this? Although environmental factors (e.g., kindling) may have some influence, the primary reason for this difference appears to be genetics. One of Several Studies on Genetics of Alcohol Withdrawal A 2005 study conducted at a detoxification unit in Germany by Martin Driessen et al. gives us an idea of what percentage of people will develop alcohol withdrawal. There were 217 patients in this study, and they had drunk an average of 15.6 US standard drinks per day during the 30 days prior to the study. The r...