Race, addiction, science, public policy: Carl Hart writes an oversold book

I just got done reading a pretty new addiction-related book, and no, it's not (yet) that hot new book by Dr. Dodes, profiled on Salon, The Atlantic and NPR. Rather, this is "High Price," by Ph.D. neuroscientist Carl Hart.

Carl Hart is good on the basics of what we know, and don't know, about addiction and neuroscience. He's decent on telling the story of his life, and on public policy, minorities and the "War on Drugs." However, where parts 1 and 2 intersect, he sometimes seems to soft-pedal part 1 for the sake of part 2.

Basic point 1 is that he is African-American, and grew up in lower-class neighborhoods in greater Miami, and therefore in a unique position to talk about race and addiction, race and other races' beliefs about addiction, etc.

But, that's not my first primary point. Rather, per ideas I've heard from people who think that AA is unscientific, it's about "following the science" on addiction. More specifically, it's about updating one's scientific knowledge of what may cause addiction, the little knowledge we have, being updated rather than being 20 years old. More specifically yet, that involves moving beyond simple, or simplistic, ideas that we can reduce addiction to a matter of brain neurotransmitters.

Neurotransmitters and neuroscience

And, specifically, addiction is NOT "All about the dopamine," or anything similar. I quote from his book:

When dopamine's prominent role in reward was first proposed, there were only about six known neurotransmitters: dopamine, norepinephrine, serotonin, acetylcholine, glutamate and GABA. Now there are more than a hundred. Furthermore, we now know that there are specific receptors -- or specialized structures that recognize and respond to a particular neurotransmitter -- for each neurotransmitter, and most neurotransmitters have more than one type of receptor. For example, dopamine has at least five receptor subtypes -- D1-D5. We also now know that hormones like oxytocin and testosterone can act as neurotransmitters.

But despite these ever-intensifying complexities, our theory about dopamine's role in reward has not been appreciably revised since it was first proposed [in the early 1990s]. And, as you will see later, a growing body of evidence casts doubt on this simplistic view of reward.

I knew a fair amount of this before I read Hart's book. But, his directly applying it to addiction, combined with his ethnicity and sociological background, gave me the perfect excuse, or reason, to blog about it more directly.

For more on neurotransmitters, which may, depending on how widely the term is defined, include a variety of peptides and even minerals like zinc, see Wikipedia. I mean, histamine and products related to several amino acids are neurotransmitters. It's much more than the few neurotransmitters that health-food stores, and Big Pharma, try to pitch us on. More on that in a minute

And, folks, that's why addiction isn't all about the dopamine. And why truly understanding addiction will proved to be more complex than current ideas.

Related to this is why an anti-craving drug like Naltrexone doesn’t work equally well for different addicts with different addictions and never will.

And bingo on who might be behind the “cravings” idea. Per Wikipedia, anti-craving drug Naltrexone's first clinical trials? 1992. And, also per Wiki, all the different addictions it's now possibly supposed to help on cravings? I think we've struck Big Pharma gold, or at least silver.

Also, while Naltrexone is an opiate receptor antagonist, Campral, also marketed as an anti-craving drug for alcoholics, works, or “works,” as a GABA receptor agonist. Different mechanism entirely than Naltrexone. Campral was first approved, in Europe, in 1989. That’s a bit earlier than the 1990s, but still in the same framework. Don’t let the European start fool  you, though; Western Europe is at least as Big Pharma friendly as the US. And Wellbutrin, marketed to help smoking cravings as well as being a non-SSRI antidepressant? It targets, in various ways, dopamine, norepinephrine, and acetylcholine. And, its actions on dopamine don’t seem  to be enough to explain its alleged effectiveness. (All three of these may target neurotransmitters beyond members of the “original six,” which Big Pharma hasn’t looked for. Material on Campral and Wellbutrin is also from Wiki.)

There’s more, just from basic browsing of Wiki. We’ve long known that nicotine is an agonist for certain acetylcholine receptors and triggers the release of sever al “old” and “new” neurotransmitters; why would we focus on dopamine?

And, even if dopamine has a fair role to play in addiction, Wellbutrin alone shows that it’s not a primary role.

Oh, and substitute "serotonin" for "dopamine," and what's said above about addiction is just as true for depression. And, the "serotonin deficiency causes depression" idea was proposed at the same time as the "dopamine shortage causes addiction" idea. Yet, despite early hype, we still don't know a lot about depression, other than knowing SSRIs often don't work a lot better than older anti-depressants.

Beyond that, other neurotransmitters, like acetylcholine, have various types of receptors, too.

Hart himself addresses the issue of “craving” near the end of the book. He says that for apparently non-addicted but regular users of various drugs, as tested in laboratory settings, “craving” did not seem to be a significant concern, on average. I question that. Also, given some libertarian-type political "connectedness" the book and Hart apparently have, I also "question" that he did not spell out how much of the "low dopamine = addiction" idea, like "low serotonin = depression," was pushed by Big Pharma. And, that may be why he doesn't talk about anti-craving drugs that much, and minimizes the issue of craving.

Unfortunately, Nora Volkow, head of the US government's National Institute on Drug Abuse, is one of the biggest pushers of the dopamine theory. I'm not sure if I would go so far as to claim this is a new version of the "disease theory" of addiction, though, as Stanton Peele does. Especially given that Peele is one of the most tireless promoters of theories of addiction that largely deny the existence of addiction, one can usually depend on him to overswing, and therefore, take what he says with a 1/3 off grain of salt.

Now, public policy issues in the book

Hart, as noted, is a black male, of about the same age as I am, who grew up in greater Miami in the late 1970s and 1980s. As such, he remembers the Reagan-era paranoia about crack cocaine vs. powder, which he covers in detail, including showing no difference in addictiveness levels, just as other researchers have done.

From there, he looks at what he sees in many ways as being a very similar alarm over methamphetamine, or “meth,” in the past decade. He notes that the number of meth users is much lower than cocaine users, first. Second, most stories about superhuman strength, etc. of alleged meth addicts are anecdotal, he adds. Third, and to the point, he notes how there is little chemical difference between amphetamine, the main ingredient in Adderall and other anti-hyperactivity drugs, and methamphetamine. After all, per basic chemistry, methamphetamine is just a methylated version of amphetamine, with a single methyl radical added. Or, in other words, it’s like Celexa and Lexapro. But, both of them are legal and heavily prescribed. On stimulants, Adderall and Ritalin are legal and heavily prescribed; meth isn’t.

Skepticism of some of his claims

I don’t totally agree with Hart. I think he tilts the scale toward “abuse” rather than “addiction” at times, and doesn’t allow for even people who are addicts, not just abusers, still having enough self-control to moderate their behavior in lab settings. I mean, the stories of alcoholics and addicts trying to pull one over on people are legion, and at some point, per the old cliche, "anecdotes" become "data." Hart talks about how some of his test subjects appeared intimidated about getting to the lab, but doesn't ask if any were still intimidated later.

Nor does he seem to ask himself if he’s over-reacting to some of his own personal, and his larger background as an African-American’s, take on things like the “crack menace” or “reefer madness” long before that.

Related to both points, he doesn't ask, as a very rare minority Ph.D. neuroscientist, if some of his test subjects are "trying to help a brother out." I hate to stereotype, and I'm not a minority, but, I've been around a boatload of drinkers and users. I'm liberal enough to know the War on Drugs is a crock, but I've been plenty a person be sober or clean for years, even a decade or more, "slip," and not be able to get back on track.

Nonetheless, he’s right indeed, in my opinion, that addiction is a complex issue. And why should this surprise us?

Some “purely physiological” issues are far more complex than originally claimed and even than some claim today. Cancer immediately comes to mind. Fifty years on, we’re not close to “winning” a “War on Cancer.”

At the same time? His wanting to make it look like addiction isn't that common approaches simplicity itself. I gave this three stars on book review sites. It's barely that, I think.

Political issues, of his own

Finally, I raise at least a partial eyebrow at his crediting Maia Szalavitz for helping get the book done. Szalavitz at least has a few of her toes in the pool of right-wing funded journalism, or "journalism," or is at minimum a "fellow traveler." Her association with places like STATS.org, which, per Wiki, has connections with Scaife money, American Enterprise Institute, etc., and is affiliated with George Mason University, is a red alert right there. That would probably explain, per some Amazon reviewers, Hart visiting Fox News, and ... more than once! I suspect, per those Amazon reviewers who would be clueless as to why, this was to get "in" with libertarian Fox watchers, not the religious right. Hart explicitly calls for decriminalization, which is neither neuroscience nor memoir.

Related to that, I'm tired of libertarians, starting with Glenn Greenwald, talk about what a success drug decriminalization is in a place like Portugal when most of them know that Portugal has a better "safety net" than we do and spends more government money on it than we do now, and than many libertarians here are willing to pay.

Greenwald, and Hart here, if they want to propose this, then fine ... be honest with how much this costs. And, if you're either too lazy to have researched that, or are afraid to tell people that, or else are a committed enough economic libertarian that you don't want the government paying that price, then shut up about the "Portugal solution."

Summation

You can find the neuroscience work, including on neurotransmitters and related issues, from other neuroscientists, or else from psychiatrists doing research work. In many cases, it won't be explicitly tied to the decriminalization issues, and possible peddling of harm reduction over abstinence, which reportedly Hart has done on some of his TV appearances.

This is a book that has more froth than substance, after a first look.

There is a sort of political silver lining. Maybe the US needs a few more black libertarians of prominence, if that's what Hart is becoming, as well as black social conservatives.

New MLB-players roiding agreement even better than I expected

When Major League Baseball, in conjunction with the MLB Players Union, first announced the idea of toughening sanctions to 100 games for a first offense and full season for the second, instead of the current 50 and 100 games, I was in semi-agreement; I liked that, but only without the loophole of just 25 games for an inadvertent test.

I worried about Barry Bonds, who alternated between saying he didn't know what was in the "clear" and the "cream" and that flaxseed oil did it? And Manny Ramirez claiming he had no idea how a woman's fertility drug got in his body? Or Ryan Braun and "chain-of-custody" claims on his first positive test. If a player sees a loophole, he's going to try to drive a Mack Truck through it.

The ESPN link provides two more such examples:

Philadelphia infielder Freddy Galvis was suspended for 50 games in June 2012 for a Clostebol Metabolite, which he later claimed was contained in a foot cream he used. Reliever Guillermo Mota, then with San Francisco, was suspended for 100 games in May 2012 after taking a cough syrup with Clenbuterol.

And, I'm sure we could get more with easy digging.

But ...

The new agreement is in, and it looks like we won't have to worry about "inadvertent" testing.

• Random urine samplings will more than double;
• HGH testing will increase;
• First suspension will be 80 games, second one a full year.

As for the "inadvertent"?

Players will get a chance to appeal on grounds that they weren't seeking a competitive edge. I guess this would be something like Andy Pettitte's use of HGH for healing? Because, with him, what he said rang at least halfway true. That said, per discussion at the NBC link, we don't know that HGH does that much for healing, anyway. And, it looks like, instead of a 25-game ban, it's half of the original.

And there's this:

Additionally, the league and the union are creating a safe harbor of sorts: they have established a program in which players will have year-round access to supplements that will not cause a positive test result. This should reduce confusion on banned over-the-counter substances and reduce the use of the “I got this from GNC and thought it was OK” defense many have raised in the past.

Agreed. Let's hope the commissioner's office pushes this hard, especially in Spanish and outside the US, for Caribbean players to be clean, and to not have excuses.

At the same time, per the full agreement, there's this twist. Even if you don't have a full-year suspension, you're banned from the playoffs for that year. And, lose postseason money; you can get a partial share, but you can't get a full player's share of money. And, can't vote in distribution of postseason shares. (In other words, a suspended Roger Clemens couldn't vote Brian McNamee, or some late-year call-up player, etc., a full World Series share.)

Craig Calcaterra doesn't like it at all. I think it's great, and will make teams be more serious about what individual players are doing. In other words, managers and GMs ... that's you in the Oakland dugout, Tony LaRussa, and you in New York, Joe Torre, and you in Atlanta, Bobby Cox, have one less excuse now, too. Managers can't ignore Jose Canseco and the infamous Canseco milkshakes.

Maybe you can't patrol everywhere, but, if you think you need to tighten up dugout access, that's what you do.

David Schoenfield likes the idea, too.

Finally, new items may be added to the prohibited substances list next week. Stay tuned.

Tigers overpay for Miguel Cabrera at an Albert Pujols and A-Rod level

Speaking of that, congrats to Miguel Cabrera and his agent, firm SFX. With a 10-year contract worth nearly $30M per year (and, with two vesting years, I'm counting this as a likely 10-year contract AFTER the buyout of the two years remaining on his current/old contract1), he's now officially passed Alex Rodriguez in the payroll pantheon.

And, per the "Insider" head-scratchers on the sidebar of the ESPN piece, yes, Dave Dombrowski, you've joined Hank Steinbrenner and Arte Moreno, on the Albert Pujols contract, as "biggest bonehead overpay."

Let's look at it the way I laid it out. I've not seen details of the vesting options, but, given how dumb this was in general, I'm assuming they are player-friendly, and my general scenario holds.

The new contract starts when he's 33. That's one year older than when Pujols was at the start of his current deal and also one year older than A-Rod was at his 2008 extension. Miggy's less of a fielder, even at first, than Pujols. Certainly less in the field than A-Rod was at the start of his contract, and arguably less than A-Rod was at the time of his extension. Even without the two vesting years, this would be an overpay. With them, it's a massive one.

As for the Tigers? I was willing to consider that Dombrowski was still a smart GM after the Doug Fister trade, and definitely after he refused to meet Scott Boras' price on a Max Scherzer extension. No longer. Trading Prince Fielder to save and free up money, then blow it like this?

Per this Twitter pic, unless Miggy has the Honus Wagner, or Mel Ott, or even Frank Robinson fountain of youth somewhere, it's a huge overpay. Not just an overpay, but a huge overpay. And, I doubt it. Wagner and Robinson were both known for defense, one indication of why they aged better. Ott was playing his older years against undrafted "leftovers" during WWII. (Related: This Dave Cameron piece at Fangraphs.)

And, speaking of, Pujols can probably still log at least three more years as a first baseman first without any serious defensive loss. By the time he's 36, Miggy will almost surely have to be installed as a DH first.

Plus, per this blog, what if Miggy pulls another David Freese move behind the wheel? He's been sober a few years, but, still ...

1 — Update: Dombrowski says each of the two additional years vests only if Miggy is in the top 10 in the previous year's MVP voting. So, given Pujols' and A-Rod's track records, it may turn out to only be eight years after the two "eaten" years of Cabrera's old contract have passed.

That said, I still think this is a bad contract. Another reason why? Jon Heyman likes it.

Lesser prairie chicken — Time for more batshit-crazy Rick Perry et al vs. Fish and Wildlife

Lesser prairie chicken/Texas Parks and Wildlife photo

Remember a few years ago, when the dunes sagebrush lizard was listed as environmentally threatened? Little lizard, meet the lesser prairie chicken. (Oh, and lesser prairie chicken, get ready to meet Texas Comptroller Susan Combs and members of the Texas Railroad Commission.)

Because your habitat, like the lizard's, is in oil country. And, because Kenny Boy Salazar, like Dear Leader, has the environmentalism backbone of a chocolate eclair, the dunes sagebrush lizard didn't get an Endangered Species Act listing after all. And Combs bamboozled the feds to make that happen.

Given that the lesser prairie chicken's protection isn't supposed to start until May, I'll not take your bet that it stays protected, even if you give me odds. It's time for Greg Abbott to go to his office and sue Obama again, obviously.

And, the fact that Combs considers Endangered Species Act listings to be like "incoming Scud missiles" says a lot.

Looks like Bill Self has plenty of #Jayhawks hoops rebuilding to do

Joel Embiid/New York Times photo

I am assuming, like just about every other college and pro hoops fan, that Andrew Wiggins of the Kansas Jayhawks will be a one-and-done player.

Meanwhile, unless he changes his mind before the cutoff period, center Joel Embiid, with his back stress fracture and all, has made it official that he's coming out.

Everybody has said that Embiid could go No. 1, but they said this before the phrase "back stress fracture" came out.

(Update, March 31: Wiggins is joining him.)

That said, pro teams will draft "tall" even if they know a player will miss most his rookie season. Right, Nerlens Noel? Or if they know you have legs of different length, enough different to cause other problems. Right, Greg Oden? Or, if they know that you've got two knees bad enough you're ice-bagging both. Right, Bill Walton?

On the other hand, Ben Medro at this medical website says his injury isn't that big of a deal, if he's careful:

Making the diagnosis in the early stage of spondylolysis is important because the injury is treated with time and rest allowing bones to heal. Patience is needed because it can take 12 weeks or more and there are complications to be had if the athlte rushes back to activity. If there are bilateral pars defects or fractures, there is a possibility that the vertebral column might slide forward potentially causing irritation and inflammation to the nerves leaving the spinal canal. This slippage is called spondylolisthesis (listhesis=dislocation). Should this occur,, CT or MRI imaging may be required for diagnosis and surgery needed to stabilize the lumbar vertebrae.

Spondylolysis and spondylolisthesis are common injuries that afflict young athletes. Population studies show that 3-4% of the general young adult population will have spondyloysis, but up to 15% of athletes will have damage that can be seen on plain x-ray. Of those athletes with spondylolysis, almost half will have spondylolisthesis. Athletes increase their risk of developing a stress fracture if they have poor technique, poor posture, lack core stability, strength and flexibility and are guilty of overtraining. While it is a medical mantra that most overuse injuries can be prevented, it’s tough understanding the mechanical stresses that are placed on the lumbar spine of a seven foot tall athlete. With time, Joel Embiid will likely heal nicely and by next fall will be playing in the pros instead if college.

So, there we go. So, if Wiggins also comes out, and Jabari Parker as well, it's probably a three-person race between them for the No. 1 pick. And, per Medro, it sounds like "rest" is the best prescription. Unfortunately, since Kansas is now out of March Madness, he doesn't have to worry about being tempted to not follow that prescription.

As for his potential? Maybe a few people would call him a junior Dwight Howard. Actually, I'd call him a junior Hakeem Olajuwon. I see a lot of the same type of athleticism.

And, the New York Times is certainly high on his NBA potential, too. though I can't believe it when it says Wiggins could fall as low as No. 7.

High speed rail in Texas? #HSR before California?

Jeff Turretine says that the Pointy Abandoned Object State could zip past the Leaden State (California, y'all) on high speed rail. A Texas consortium is organized to back HSR to connect the Texas Triangle.

I've long said that Dallas/Fort Worth, Houston, and San Antonio/Austin are perfectly situated for HSR. There's cities of big enough size to justify it, cities that are connected to each other for business reasons (or politics, with Austin), and just the right distance apart that HSR can easily compete with planes, especially with airport parking and boarding times, etc., on travel time.

The Texas group is also pitching this as a totally private issue, no "gummint" involved.

Flip side? Beyond the eminent domain Perry mentions (he'll have an update tonight or tomorrow) as part of his take, along with the conservative politics of the no "gummint," will be related issues. Among them, I'm sure, will be attempts to railroad through (I see what I did there) all the environmental parts of the permitting process. We've already seen that if it's oil vs. lizards, or water vs. cranes, we know who wins, damn the paperwork and damn the feds who are part of that "gummint."

Anyway, since the biggest push right now is coming from H-town, go back to Perry's website and look for updates. Or click this link; it's a fairly detailed update from him, linked to one from another Houston blogger.