Is alcohol good for you? Can’t tell for sure… (But we KNOW it can be bad for you)

Can alcohol consumption be good for your health? The answer is – it’s impossible to know. A recent study in the British Medical Journal wine-malesays that many studies showing health benefits to alcohol are very probably wrong. The reason is that there are too many “confounding” factors when measuring alcohol-related questions for researchers to control.

And besides, many studies about the health benefits of alcohol lumped former drinkers and never drinkers into the same group, the study said. As any recovering alcoholic knows, that’s not quite correct. People who used to drink and stopped may have done so because of severe alcohol-related problems. They frequently have much worse health problems, including depression, and higher risk of mortality, than people who never drank. So there are selection biases in many studies on alcohol and health, the study said.

But the real problem with these studies is the confounding factors when it comes to alcohol – there are so many of them. Alcohol is not an ordinary product that you can test through traditional Western deductive scientific methods, where you control all or most of the variables and then test an isolated question.

With alcohol, there are a million variables – its use differs from society to society, from community to community, from group to group, from house to house. And there are separate, significant health factors – toxicity, intoxication and addiction. The latter two pose countless health, safety and economic impacts that spread far beyond the individual users.

Here’s a simplistic look at why it’s so difficult to determine whether alcohol may be good for you. You’re a researcher and your study group is 26- to 32-year old men who drink two drinks a day. In real life, you’ve got a 30-year-old guy who drinks two glasses of wine while sitting home at night watching Law & Order reruns. No problem, right? Easy to research?

But how big is his wine glass? It may be a big glass filled to the brim. And then, what if he decides to go out to check the pool vacuum in the dark? Or he plans to finish painting the crown molding standing on a ladder? Or his ex-wife calls up and wants him to cover over right away to discuss money problems? Or he’s a recovering alcoholic? Or he has stomach ulcers? Or he works the night shift in a factory starting in two hours? Or he takes medication the interacts with the alcohol? He only drank two glasses of wine, but look how different his risks may be.

Economic and social changes also affect his risks. Maybe his favorite label is on sale at the grocery store a block away. Or the friends he runs with have started drinking more heavily, so he does, too. A magazine ad on the table shows a group of happy young men and women drinking wine, and he’s lonely. He calls his cousin, who he knows is a heavy drinker, for consolation, and she counsels having another one. He usually only drinks two glasses, but one if he drinks a few more some nights and then adds in a few of the endless list of risk factors?

So many variables, each potentially changing the health and safety risks to the drinker and those around him.

The BMJ study suggests a truth: Researchers can never control for all the factors that influence consumption of our favorite drug. Researchers can never control for all the risks that accompany alcohol use. We should give up trying to prove that alcohol can be good for you and instead just focus on reducing the problems that it causes.

Posted in Addiction, Alcohol, Alcohol abuse, alcohol health, Alcohol research, Alcoholics Anonymous | Tagged , , , , , , , , , , | Leave a comment

If electronic cigarettes can help people quit smoking, then why is Big Tobacco investing heavily in them?

News that the tobacco industry is investing in e-cigarettes should make people reconsider the notion that e-cigs will help you quit smoking. In a piece naively entitled “Want to Quit Smoking? Big Tobacco Is Ready,” CNBC unabashedly bought the marketing claims that e-cigarettes are made for smoking cessation. Then the business news cable station stated fatuously that Big Tobacco would now be able to help you quit smoking.

The syllogism that e-cigs help you quit smoking, so Big Tobacco buying into e-cigs means it wants to help you quit smoking is faulty on both ends. To begin, the tobacco industry has never and will never do anything to help people quit smoking. Researchers found that Big Tobacco’s anti-smoking public service announcements are nothing of the kind, instead being manipulative messages that push the brand. Big Tobacco’s anti-smoking paid advertisements over the last two decades actually induced people to smoke more, according to a 2012 study.

So why would the tobacco industry invest heavily in e-cigarettes? Maybe the truth is that the tobacco industry understands that e-cigs are no threat to reduce smoking on a population-wide basis. They’re just another way to make money.

Tobacco has the smartest marketing people in the world. They have to be smart to sell a product that kills half the people who use it as prescribed – and have approximately 1 billion customers. So, assuredly, tobacco industry market researchers did their homework on electronic cigarettes and found that these devices pose no threat to Big Tobacco.

I know it seems like a no-brainer that electronic cigarettes would help people quit real cigarettes. But it’s not that simple. According to the U.S. Food and Drug Administration, e-cigs may increase nicotine addiction among young people – who will think e-cigs are cool to smoke and, hey, they’re not tobacco. Then, it’s an easy next step to real tobacco, the ultimate nicotine delivery device, once they are addicted. E-cigarettes are sold in many different flavors, including chocolate, strawberry and mint, which make them very appealing to youngsters. Tobacco industry marketers love that kind of thing.

The FDA and World Health Organization warn that e-cigs contain toxic chemicals. But most importantly, electronic cigarettes haven’t been adequately tested or developed to support claims that they can help people quit smoking.

Studies show that e-cigarettes are not as harmful as real cigarettes. But that’s not the question. The question is whether and how e-cigarettes could help millions of people quit smoking. So far, there’s no evidence they can. We don’t know if e-cigarettes can be a long-term nicotine replacement or if they are just a fashion. If they’re just a fashion, they are no real help in the global tobacco epidemic that will kill 8 million people a year by 2025.

Until an evidence-based tobacco cessation therapy is built around e-cigarettes, and they are regulated to be as harmless as possible, today’s plethora of unregulated products and wild health claims are just noise.

Believe me, Big Tobacco has not met its match

Believe me, Big Tobacco has not met its match

E-cig marketers are bombarding the Internet with ads and “marticles” (marketing articles), claiming their products are safe alternatives to smoking that can help you quit. Just google “e-cigarettes,” then duck. But the tobacco industry knows something that some harm reduction theorists don’t realize, and that the e-cigarette industry doesn’t care about: Electronic cigarettes can be an adjunct to smoking instead of a replacement.  And that’s why Big Tobacco is investing millions in them.

Posted in Addiction, Big Tobacco, Cigarette warning labels, e-cigarette, electronic cigarette, Prevention, Recovery, Second-hand smoke, Smoke-free, Smoking, Substance abuse, Substance use disorder treatment, Tobacco, Tobacco cessation, Tobacco lies, Tobacco marketing, Treatment | Tagged , , , , , , , , , , , | 3 Comments

Deadly scourge will kill three-quarters of a million AA and NA members

Alcoholics -- drunk or sober -- smoke at three times the rate of the general population

Alcoholics — drunk or sober — smoke at three times the rate of the general population

By Jim Gogek

It’s not alcohol. It’s not cocaine. It’s not heroin or opiate painkillers. It’s the most common and deadly drug, which a majority of 12-steppers still use with impunity, even though it’s destroying their lives. It’s tobacco.

Alcoholics are more likely to die from tobacco than from alcohol.

In a December 2012 article in the magazine Addiction Professional, David Macmaster, co-founder and managing consultant for the Wisconsin Nicotine Treatment Integration Project, projected that 724,153 worldwide members of Alcoholics Anonymous and Narcotics Anonymous – who are alive today — will die prematurely from tobacco, including 499,410 in the United States and Canada. He developed these figures by taking the estimated AA and NA membership, times the percent using tobacco, times the 50 percent mortality rate for tobacco users.

The rate of smoking among alcoholics is three times higher than the general public, and that’s true whether the alcoholic is still practicing or in recovery. Tobacco rates for drug addiction are estimated to be about the same.

bill wilson and bob smith

Nicotine addicts — AA founders Dr. Bob Smith and Bill Wilson

Macmaster rightfully takes AA and NA members to task for doing nothing to stop this carnage. If a half-million members of any other organization in North America were going to die from a preventable cause, you can bet that would be a major issue for the organization to address. Even though Alcoholics Anonymous founders Bill Wilson and Dr. Bob Smith were tobacco addicts and likely died as a result, AA, per its 12 traditions, will not take a stand on tobacco, deeming it an outside issue.

Macmaster suggests that AA groups use the group conscience to make tobacco an inside issue. Another option would be for individual members to make tobacco use part of the personal inventory process in steps 4, 5 and 10 of the 12 steps. The personal inventory is a “searching and fearless” effort to identify and admit “the exact nature of your wrongs.” If the alcoholic is more likely to die from smoking than alcohol, what can be more wrong than the self-destruction of tobacco addiction?

Other pillars of AA and NA are service work and clearing up the wreckage of your past, both of which are intended to stop self-centeredness, which AA literature calls “the root of our troubles.” What is more self-centered than tobacco addiction? Smoking takes an average of 14 years off your life, with some estimates as high as 25 years. That’s a lot of lost years that the recovering alcoholic could have spent helping others. And while AA literature exhorts the recovering alcoholic to “clear away the wreckage of your past,” the smoking alcoholic is creating wreckage of the future, especially for his or her family members who must bear the emotional and financial burden of early sickness and death from cancer, heart disease and lung disease.

While AA maintains its 1935 attitude toward smoking, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) states: “…Evidence suggests that combining (alcohol and tobacco) treatments might be the most effective way to address concurrent addictions.” More and more treatment centers are now pushing tobacco cessation and even going entirely smoke-free. It’s time that the world’s leading alcohol and drug self-help programs – AA and NA – face up to the scourge of alcoholics and addicts.

Posted in Addiction, Alcohol, Alcohol abuse, Alcoholics Anonymous, Big Tobacco, Drug treatment, Recovery, Second-hand smoke, Smoke-free, Smoking, Substance abuse, Substance use disorder treatment, Tobacco, Tobacco and kids, Tobacco cessation, Tobacco marketing | Tagged , , , , , , , , , , , , , , | 1 Comment

Top Substance Abuse Research Findings of 2012 from

aboutdotcomBuddy T., anonymous recovery writer for, penned a wonderful column on the most important research about ATOD in 2012. And, leading the way are — new findings on the harms of marijuana. Our knowledge about the science of marijuana has dramatically changed in the last 20 years, and 2012 was no exception.

According to Buddy T., the top research about MJ was:

His other citations were equally as important, though marijuana is much more in the news with the recent legalization votes in Washington and Colorado. Since marijuana use will continue to rise, the public needs to know as much as we can about the dangers of the drug. Anyway, read his column and check out his alcoholism newsletter, too. He does an excellent job of interpreting research into policy and practice and also citing the evidence. Wish there were more writers like him…

Posted in Addiction, Alcohol, Alcohol abuse, Alcoholics Anonymous, Binge drinking, Cannabis, Drug abuse, Drug treatment, Drugged driving, Marijuana, Marijuana legalization, Recovery, Substance abuse, Substance use disorder treatment, Treatment, Weed | Tagged , , , , , , , , , , , , | Leave a comment

“…Drugged driving is a highway safety threat on the level of drunk driving”

Robert DuPontComment from Dr. Robert DuPont, founding President of the Institute for Behavior and Health, Inc., about the previous post. Dr. DuPont was the first Director of the National Institute on Drug Abuse (NIDA) from 1973 to 1978 and was the second White House Drug Chief from 1973 to 1977.

With respect to its having “proven to be very difficult” to find a 0.08 g/dL BAC equivalent for drugs of abuse (especially marijuana), seeking such a level for drugs is dangerously misleading because it implies that additional research will solve the problem and get us those numbers. Far from it. There has been abundant research showing that the search for an acceptable blood or other tissue level which equates with drug impairment of driving is a mirage that stops needed action now. Today drugged driving is a highway safety threat on the level of drunk driving. And yet, it is overlooked and ignored. The search for the BAC equivalent for drugs is a major reason for this continuing and deadly public safety failure.

The zero-tolerance per se standard (where any detectable level of an illegal drug in a driver is a violation – and not a measure of impairment) is the only workable standard to use. We have more than two decades of experience using if for safety-sensitive jobs, including commercial drivers. This is the standard used in Western Europe and Australia. The per se standard for drugged driving is strongly supported by the Office of National Drug Control Policy (ONDCP) and by the U.S. Department of Transportation.

No doubt legalization of marijuana will increase levels of marijuana use, not marginally but massively. Look at alcohol and cigarettes. Among Americans 12 and older, 51% used alcohol in the past 30 days. For cigarettes, it was 27% and for all illegal drugs combined it was 9% — 7% for marijuana alone. THAT is the evidence for the positive impact of “prohibition” (who says making drugs illegal has failed as a public health strategy?). With the legalization and commercialization of marijuana as envisioned in the Colorado and Washington ballot initiatives, the marijuana use figure will zoom, eventually matching alcohol and tobacco.

There will be huge increased costs to be paid for this rise in marijuana use in highway safety, but so there will be major adverse effects on education, including poor academic performance and dropping out, and increases in substance abuse treatment admissions. Those are just the start of the high costs of marijuana legalization. The laws in Washington and Colorado make the United States the only nation in the world ever to legalize and fully commercialize marijuana in the model of alcohol and tobacco.

Marijuana legalization is the wrong way to go in the search for a better drug policy. We need policies that reduce drug use, not policies like legalization that increase drug use.

Posted in Addiction, Cannabis, Drugged driving, Drunk driving, Marijuana, Marijuana legalization, Prevention, Recovery, Smoking, Weed | Tagged , , , , , , , , | 1 Comment

Legalization may mean more drugged driving — and more drunk-drugged driving

drugged drivingBy Jim Gogek

The marijuana lobby likes to say that marijuana isn’t as dangerous as alcohol. Technically speaking, that may be true. But the reality of drug and alcohol use is that danger comes in many ways. The effect on driving is the biggest one.

Driving under the influence of marijuana, the most common driving-under-the-influence drug after alcohol, is dangerous. A 2012 meta-analysis in the British Medical Journal found that driving under the influence of marijuana “significantly increased risk of motor vehicle collisions compared with unimpaired driving,” and especially for fatalities. People who smoke marijuana and drive are twice as likely to cause a fatal crash compared to clean and sober people. The same study related that the risk of a car crash for people with a blood alcohol concentration of 0.8, the legal limit, is about 2.7 times higher than for a sober driver. So, not a whole lot of difference.

The study also showed that:

  • Cannabis impairs cognitive and motor task abilities necessary for safe driving
  • Drugs other than alcohol are increasingly found in injured and fatally injured drivers
  • In some jurisdictions, marijuana has surpassed alcohol in DUIs among young people

And, just like with alcohol or any other drug, the more pot you smoke, or the stronger the weed, the more likely you are to crash your car.

Drug and alcohol use among drivers Drugged driving poses a widening threat. The reality of getting high is that many people use drugs and alcohol together. Drinking beer and smoking weed is very commonplace partying. And it’s particularly dangerous for driving. A study about combined alcohol and marijuana use and driving found that the two used together caused severe impairment for driving, particularly in slowed reaction time.

A 2012 study in California showed that twice as many weekend nighttime drivers test positive for drugs, with as many using marijuana as alcohol. A national survey in 2007 showed that weekend night-time drivers in the United States were seven times more likely Percentage of CA drivers using alc and drugsto be using drugs compared to alcohol. In general, research shows that the percentage of fatally injured drivers who test positive for drugs is going up.

Determining the level of drug use that causes impairment, or that compares to illegal blood alcohol concentrations, has proven very difficult. So, some States (Arizona, Delaware, Georgia, Indiana, Illinois, Iowa, Michigan, Minnesota, Nevada, North Carolina, Ohio, Pennsylvania, Rhode Island, South Dakota, Utah, Virginia, and Wisconsin) have passed “per se” laws: It’s illegal to drive if there is any detectable drug level in the driver’s blood.

With the legalization of marijuana, more people will be smoking marijuana, so drugged driving will likely increase. The marijuana lobby likes to suggest that more people smoking weed will mean fewer people drinking – therefore, less drunk driving. But researchers say there’s no evidence of that. So, we will probably have an increase in drugged driving while drinking and driving remains the same. If so, it follows that drinking and drugging while driving may increase. That’s not a good situation, to put it mildly.

Posted in Addiction, Cannabis, Drug abuse, Drugged driving, Drunk driving, Marijuana, Marijuana legalization, MJ lobby, Recovery, Substance abuse, Weed | Tagged , , , , , , , , | 5 Comments

Is there “proof” that AA works? There’s certainly a ton of evidence…

AA logoBy Jim Gogek

Critics of Alcoholics Anonymous often say there’s no proof that AA works. But then, “proof” is a term that scientists don’t use. The outcome of research is evidence, not proof. The strongest “laws” in science, such as gravity and evolution, are theories.

Basically, the criticism is that AA hasn’t undergone rigorous randomized controlled trials (RCT). RCTs are what we use to show efficacy and safety of medicine: One group gets a placebo while the other group gets the real medicine, each without knowing it, and we see whether the real medicine works better than the placebo. That would be almost impossible with AA. Permission to attend AA cannot be denied to create a control group. But just because successful RCTs haven’t been done doesn’t mean there’s been no effective research on AA. A search in Google Scholar of research since 1980 with “Alcoholics Anonymous” in the title shows more than 1,000 hits and another 1,000 hits for “12 Steps” and “Twelve Steps.”

Let me cite a couple in particular:

  • Research just published in Drug and Alcohol Dependence culled control and experimental groups for testing AA from the data of Project MATCH, an RCT of alcoholism treatments. Researcher Stephen Magura at Western Michigan University compared outcomes for people who attended AA only because it was part of their treatment program against people who did not attend AA because it wasn’t part of their treatment. This second group would have gone to AA if it had been part of their treatment, but it wasn’t. The results were that the group that went to AA as part of treatment had greater abstinence and less problem drinking.
  • Researcher Lee Ann Kaskutas from the Alcohol Research Group has published many studies on AA; along with Marc Galanter, she edited a book on research about AA that contained many dozens of studies. In her 2009 paper entitled “Alcoholics Anonymous Effectiveness: Faith Meets Science,” a review of several dozen published research reports on the effectiveness of AA, Kaskutas notes that because randomized trials are so difficult with AA, many researchers instead use statistical methods to assess its effectiveness. She looked at six criteria for success and found that AA nailed five of them and showed middling success in the sixth.
  1. Rates of abstinence are about twice as high for those who attend AA
  2. Higher levels of AA attendance are related to higher rates of abstinence
  3. The above two successes are found among different samples and follow-up periods
  4. Prior AA attendance is predictive of subsequent abstinence
  5. Mechanisms of behavior change are evident at AA meetings

But the sixth criteria – labeled “specificity” — showed mixed results. It’s somewhat difficult to specifically identify AA attendance as leading to abstinence. Because there are so many variables, it’s hard to show precise cause and effect. Nonetheless, of four studies that examined specificity, two were positive, one was negative and one was null.

Kaskutas put together an informative Power Point on this paper, which I found on the Internet and share with you here:

Of course, people who go to AA couldn’t care less about the research; they just know what works for them. True, AA doesn’t work for everybody. But then, many treatments for other chronic diseases work for some but not others.

We know alcoholism is a chronic disease. The research shows that AA is an effective treatment for it.

AA cartoon

Posted in Addiction, Alcohol, Alcohol abuse, Alcoholics Anonymous, Binge drinking, Drug treatment, Recovery, Substance abuse, Substance use disorder treatment, Treatment | Tagged , , , , , , , , , , , , , | 1 Comment