A high percentage of recovering alcoholics and other drug addicts smoke cigarettes, and nicotine itself is considered to be an addicting drug. Many alcoholics allege that they “can handle only one addiction at a time,” yet they balk at the thought of using a therapeutic drug to help overcome their addiction, fearing that the new drug may itself be addicting.
A new study by Glassman and co-workers in the Journal of the American Medical Association suggests that the drug clonidine (trade name: Catapres, a drug used to lower blood pressure) may be effective in helping heavy smokers stop smoking for over six months. The double-blind (subjects randomly received active drug or placebo) study performed at the Columbia Presbyterian Medical Center in New York City showed that more than twice as many clonidine-treated subjects had stopped or reduced their smoking during the first four weeks of the study, compared with 5% of the placebo-treated subjects. All subjects had previously attempted to stop smoking (average 4-5 unsuccessful attempts), and all were classified as heavy smokers (average, 30-31 cigarettes/day).
The authors caution that relapse rates in smoking cessation programs are high, and follow-up studies (greater than 12 months) are needed to determine clonidine’s long-term effectiveness. Clonidine is also an aid in reducing withdrawal from nicotine, as it is with opiate and alcohol withdrawal; however, how it works in this regard is unclear.
Should research dollars be spent trying to find ways for diagnosed alcoholics to return to normal drinking? The advocates for such pursuits usually argue as follows: By making abstinence the only acceptable treatment outcome for alcoholism, the door is closed on efforts to develop therapies or remedies aimed at restoring “normal” drinking. The supporters then cite controversial studies alleging that a small percentage of alcoholics can be taught how to return to “normal” drinking. The obvious implication is that drinking alcohol is a prerequisite for drinking “normal.” Accordingly, they then derive that it is a desirable research goal to seek means to return these poor deprived alcoholics to “normalcy.”
Now, the validity of these studies or the probability of science finding the magic potion to “cure” alcoholism can be argued forever. But doing so misses the point: Why would science or society at large want to consider the ability to drink or drug as an important life skill, let alone a desired therapeutic or research outcome? There is not a single positive human activity that can be performed better under the influence of mood-altering substances. I’ve encountered a couple of authors who insisted they could create only while under the influence. But in recovery, they admitted that not only were they as creative — they also began to meet their deadlines.>There are literally millions of recovered abstaining chemically dependent persons whose lives bear testimony to the preferability of a chemical-free lifestyle. They can sing, dance, tell jokes, be creative, make love, act spontaneously; and be happy, joyous, and free without the aid of chemicals. Mood alterers, on the other hand, are physically toxic and cause the user to become something other than his/her authentic self.
What should be rejected, however, is the idea that there is any legitimate clinical or scientific need to restore mastery of these substances in someone whose life has once been severely disrupted by their use. To my knowledge, the concept of controlled drinking as a treatment outcome for diagnosed alcoholics has never been seriously proposed by any respected professional with extensive experience in the treatment of chemical dependency. Certainly, the desire to be returned to some kind of “safe” drinking is rarely expressed by recovering alcoholics who have once gained quality sobriety. So my suggestion is that in the research war on drugs we focus on prevention, finding causes, developing diagnostic tools, expediting the road to abstinence and preventing relapses.
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