Going Too Far: When the Ordinary Becomes Addictive

Fri 23 April 2004

New York State Psychological Association, Division on Addictions. Annual Conference.

The conference was co-sponsored by the 'Masters Program in Mental Health and Substance Abuse of the New School University' and was held at the New School University on 5th Avenue at 15th Street, near Union Square.

This conference was well attended with a series of august speakers and interesting addiction related topic including eating and sex.

Andrew Tatarsky discussed recreational drug use and just what this means. He pointed out that old fashioned immutable labels need to be changed as we now know much more about drug users moving from dependent, harmful and occasional use with OR without treatment. And people use a variety of drugs at different times making labelling even more difficult.

Sippio Michael Small spoke of his work with drug affected youth in central and east Harlem. He had many interesting anecdotes and observations on addictions. He responded to various questions with practical suggestions reflecting his wisdom and long work in the field.

Stanton Peele spoke eloquently about 'Recreational drug use and the path from pleasure to addiction'. He illustrated the talk with some crucial figures on the public record but rarely reproduced about the incidence of heroin addiction in Vietnam veterans. He said that about 60% of heroin dependent servicemen (nearly all were male) used heroin at least once back in America but only 10% of them were ever diagnosed as needing treatment for dependency, although this was widely available to veterans at the time.

Wendy Miller then spoke on eating disorders from her experience in a Women's Behavioural Treatment service. Her points about guilt, body image, depression and food as a cure to many of life's difficulties were well made. She made some other very valid points about 'perfectionism' in eating disorders, bulimia and obesity. We were told that having spent so long preparing her talk, in guilt over ignoring her pit-bull terrier she fed it a bone filled with cream cheese!! I was not sure if she was serious.

Afternoon sessions

Julie Barnes started the afternoon sessions with 'Psychiatric medications: when use IS abuse'. She quoted alarming figures about the proportion of Americans who have taken non-sanctioned, non-prescribed drugs. The variety was broad from antibiotics to tranquillizers to antidepressants to analgesics.

Bob Foreman was good enough to share his research on web sites offering 'prescription-free' drugs for home delivery. He pointed out that a single web search for a particular drug yielded over 100 sites, most of which turned out to be genuine. A few were non-existent when he tried to contact them. However, others would consign various drugs including strong, controlled drugs such as hydrocodone, morphine, methadone, buprenorphine, etc in various manners and with various marketing strategies. In one case a company offered to send the first 20 tablets free and after these had been paid for 40, 60 and then 80 would be consigned 'on approval' which is precisely the way street drugs are often sold! (the first dose is often free) We were told that such illicit operators can do their commerce from a foreign address using a foreign bank, local post and all can be changed overnight. Several web sites mention the very low probability of postal packages being intercepted and that just by giving another mailing address, they will send a second consignment free of charge. Since at least half of my own spam mail has been for Viagara and other drugs, I was interested to know just how it all works. It appears that the high cost of accessing medical services and pharmaceuticals in America is responsible for much of the spam mail on the 'net. It also appears that many Americans have become addicted to 'prescription' drugs which were never legally prescribed to them.

Dr Mark Green who is an addiction psychiatrist spoke on "Prescription Opioids: New Formulation - Same Old Addiction". Dr Green has recently opened the first methadone treatment service in Vermont, previously a 'dry' state regarding methadone. He is also prescribing buprenorphine in a 'shared-care' type of model utilising certain existing services.

He took over some points made by Stanton Peele in the morning sessions which Dr Green termed 'set and setting' (after Norman Zinberg) in drug use, abuse and dependency. Dr Green pointed out that a large proportion of entrants to methadone treatment in some parts of the country were not heroin users but were addicted to prescription opioids such as Oxycontin, Viocodin, etc. Such patients may be true chronic pain sufferers but most had tried opioids outside of the medical setting and enjoyed the effect. As was emphasised several times during the day's talkfest, medical use of opioids only very rarely was associated with continued opioid use and dependency (around 1 to 5%). We had a detailed description of the drugs, their actions and specific case of Oxycontin was aired. Treatment options and the principles of opioid maintenance were broached, including the "therapeutic dance" (which might also be termed 'give and take').

It was most instructive to me that among this broad audience of psychologists and other addiction professionals, many or even most were sympathetic to the harm reduction approach of dealing with clients/consumers in a nonjudgmental way. Not one person voiced any sympathy for punishment models, zero tolerance, etc although numerous speakers and audience members mentioned historical moves away from such out dated philosophies. [This is the state which tried more than anywhere with the Rockefeller laws which have proven so counter-productive in all respects.]

The later sessions were devoted to understanding and dealing with 'sex addiction' and involved Marlene Reil, J.P. Cheuvront and Joseph Cohen.

Participants were encouraged to put in their own views at the break-out session, discussing 'labels' or diagnostic categories. All in all a satisfactory conference on a 'hot topic' with lots of lessons from experienced clinicians.

comments by Andrew Byrne ..