08/18/14

Sigmund Freud was a Cocaine Evangelist and Addict

So here is the continuing story on Sigmund Freud and cocaine begun in “Raising the Stakes in the War on Cocaine Addiction.” To give a quick recap, Freud began experimenting with cocaine in April of 1884. He used it to treat depression, saying it was a “magic drug.” He hoped that with his help cocaine could “win its place in therapeutics by the side of morphine.”

According to Paul Vitz, Freud’s evangelism of cocaine seems to have been driven by three things:

his intense desire to get married to his fiancée and fear of losing her (a separation anxiety, in Freudian terms);
his drive to become a medical success story in championing the positive effects of a new drug, thus advancing his career and financial prospects (so he could marry); and
to treat his personal struggle with depression (largely induced by his separation anxiety).

When describing his personal experiences in treating his depression with cocaine, Freud said he felt “exhilaration and lasting euphoria, which in no ways differs from the normal euphoria of the healthy person.” He saw an increase in his self-control and capacity for work. He had no unpleasant after effects, as with alcohol and “absolutely no craving” for more cocaine, even after repeated use. “In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug.”

He recommended cocaine to family, friends and professional colleagues alike. A friend of Freud’s, Dr. Ernst Fleischl became addicted to morphine while attempting to treat a painful neurological disease. Freud attempted to counteract his morphine addiction with cocaine. At first, cocaine was a helpful substitute for the morphine.

But Fleischl had to increase his cocaine dose as tolerance set in. After one year of cocaine use he was taking a full gram of it daily—TWENTY TIMES the dose Freud personally used. Fleischl was now dually addicted to opiates and cocaine. He soon developed a full-fledged cocaine psychosis, with visions of “white snakes creeping over his skin.”

Freud and other physician friends had little success in weaning Fleischl from his drug use. By June of 1885, Freud thought his friend had about six months to live. Fleischl remained alive for another six pain-filled years. Freud later acknowledged he might have hastened his friend’s death, by “trying to cast out the devil with Beelzebub.”

In July of 1885 a German authority on addiction began publishing a series of articles on cocaine as an addictive drug. A friend of Freud’s, originally favorable towards cocaine, reported that it produced severe mental disturbances. One prominent doctor said Freud had unleashed “the third great scourge of mankind.” The first two were opium and alcohol.

By 1890, the addictive and psychosis producing nature of cocaine was well documented. Freud had moved on in his search for fame and fortune to other interests. And when he co-authored Studies on Hysteria with Joseph Breuer in 1895, psychoanalysis was born. However, Freud continued to use and prescribe cocaine until at least 1896.

Freud 1893 script — image credit: Robert Edwards Auctions.

A handwritten prescription for a “white powder”, signed by Sigmund Freud in 1893, is evidence of his continued cocaine use. In 2004, Robert Edwards Auctions sold this prescription for $2,875.

Freud’s letters to a friend and fellow cocaine user, Wilheim Fleiss, contained several references to his ongoing cocaine use. On January 24, 1895, Freud described to Fleiss how a “cocainization” of his left nostril helped him to an amazing extent. He wrote on April 20, 1895 that he pulled himself out of a miserable (depression?) attack with a cocaine application. On June 12th, 1895, Freud wrote: “I need a lot of cocaine.”

Several scholars have debated whether Freud’s use of cocaine influenced his developing theories. Both Fredrick Crews and E. M. Thornton have argued that Freud’s use of cocaine had a significant influence on his developing theories, especially their emphasis on sex. Thornton claimed that Freud’s psychological theory was the natural outcome of his extensive cocaine usage.

Paul Vitz took a more nuanced approach in Sigmund Freud’s Christian Unconscious, stating that much of Freud’s psychology was evident before he began using cocaine. Freud’s cocaine use may have contributed to sloppy thinking at times. It could have contributed to his preoccupation with sex, or made his depressions darker and more difficult to fight. “But cocaine did not create the primary content and structure of Freud’s mind and thought.”

Yet Thorton presented some rather convincing evidence of Freud’s cocaine “problem” and its potential influence on his theories. Freud himself said that psychoanalysis began with his research into hysteria: “The Studies on Hysteria by Breuer and myself, published in 1895, were the beginnings of psycho-analysis.” Freud began to have heart problems (one of the side effects of cocaine abuse) early in 1894. He suffered from “fainting” spells—four of which were publically witnessed by others. He had an obsession with dreams; some paranoid traits and a tendency towards grandiosity.

In The Interpretation of Dreams, Freud recounted a dream he had in 1895 where he saw a patient with scabs on her turbinal bones, which recalled a worry he had about his own health:

At the time I frequently used cocaine in order to suppress distressing swellings in the nose, and I had heard a few days previously that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. In 1885 it was I who had recommended the use of cocaine, and I had been gravely reproached in consequence. A dear friend, who had died before the date of this dream, had hastened his end by the misuse of this remedy.

By 1895 Freud had probably been using cocaine (nasally) for over two years. Physically, the effects of this heavy usage would have been essentially identical to the catalogue of symptoms noted by Fleiss as those for “nasal reflex neurosis” (headache, vertigo, dizziness, acceleration and irregularity of the heart, respiratory difficulties, etc.). So the physical problem that Freud treated with cocaine (nasal reflex neurosis) was essentially caused by his use of cocaine.

His paranoia was evident in the public breakups he had with formerly close associates like Breuer—with whom he wrote Studies in Hysteria (1894), Fliess (1900), and Jung (1913). Freud’s interpretation of Jung’s dream in 1907, just after they met face-to-face for the first time, was that Jung wished to dethrone him and take his place in the psychoanalytic movement.

07/18/14

How God Became Real for Two Modern People

Soon after Bill admitted himself to the Towns Hospital for what would be the last time, he cried out: “If there be a God, let Him show Himself!” His hospital room was filled with a white light. He was seized with an “ecstasy beyond description.” In his mind’s eye, he stood on the summit of a mountain, where a great wind of spirit blew right threw him. “Then came the blazing thought: ‘You are a free man.’” He became aware of a Presence, like a sea of living spirit. “This,” he thought, “must be the Great Reality. The God of the preachers.” Bill Wilson never took another drink. He had started down the path to become one of the cofounders of Alcoholic Anonymous.

Within our modern culture, “sensory override” encounters with the supernatural are met with skepticism or viewed as the ravings of fanatical individuals and groups. But rejecting the reality of the supernatural contradicts what William James described in The Varieties of Religious Experience and what T. M. Luhrmann reported in When God Talks Back. Bill Wilson read VRE to help him make sense of his encounter with the God of the preachers. And Bill would later refer to James as a “cofounder” of A.A.

Like William James, Luhrmann persuasively validated these experiences of the supernatural in When God Talks Back. She even provided some experimental evidence that “sensory override” experiences were not pathological. See a description here in “How Does God Become Real for Modern People?”

I have never worshipped in a Vineyard church. But I did spend some time in charismatic evangelical churches after my own personal encounter with God. A friend challenged me to read the book, More Than A Carpenter, by Josh McDowell. He said it had played a role in his own conversion. I remember being surprised by McDowell’s effective use of logical argument. But, I still wasn’t persuaded, as my friend had been.

One Saturday afternoon, I found myself wondering why McDowell said the death, resurrection and ascension of Jesus Christ was necessary for the redemption of humanity. Then in my mind (not audibly) I heard a voice say: “There was no other way.” I immediately knew the statement was true. And I immediately knew that voice was God.

I grew up in the Roman Catholic church, but had never been told that God would speak to you like that. Ironically, at that time one of the individuals I counseled actually believed he was Jesus Christ when he was in a psychotic state. I returned the book to Jerry, not saying anything about God speaking to me. My plan was to never speak of that experience to anyone. A few months later, some further, less profound experiences led me to acknowledge Jesus as my savior and Lord. I eventually did contact Jerry and tell him about God talking to me; and I have periodically told others of the experience as well.

God speaking to me is a part of my personal spiritual journey. But it is not an experience that I intentionally sought to cultivate (then or now), like the members of the Vineyard Christian Fellowship. This was over thirty years ago, and I have not had a spiritual experience of the divine that has ever come close to this encounter since then. I agree with T. M. Luhrmann that: “the problem of faith is not finding the idea of God plausible but sustaining that belief in the face of disconfirmation.”

You don’t have to have God talk to you in order to believe in Him. But if He does, it can make Him real to you in a profound way. Thanks Tanya for helping me to better understand my personal encounter with God. I look forward to your next project. And I have some suggestions, if you’re interested.

06/23/14

Breaking Bad and Living Next to a Meth Lab

Very early one morning in September of 2000, I left my apartment and headed to work. I passed by my landlord who was talking to a policeman in the parking lot. While this was unusual, I wasn’t concerned since my landlord nodded to me and continued talking to the policeman. I assumed if there was something I needed to know he would have said something. Wrong.

When I returned home after work, I found my street blocked off by the police. I could see a television crew setting up at a good distance from my apartment building. The police officer waving away cars said that a meth lab had been discovered in the apartment building. I explained that I lived in that apartment building and was just returning from work. He said no one could approach the building and he didn’t know how long the restriction would continue. I told him that all my things were in the apartment; could someone go with me so that I could get some of my things for overnight. He said I couldn’t and suggested I stay at a local motel.

The incredible irony was I was working full time for a drug and alcohol treatment agency. An addictions counselor who lived in an apartment building that had a meth lab! As it turned out, there technically wasn’t a lab in the empty apartment. But someone had been using it for storing the chemicals used in cooking meth. You can read an original newspaper article about this here.

Breaking Bad was by all reports a powerfully written and acted drama. Even Anthony Hopkins wrote Brian Cranston a fan letter (Yes, that Anthony Hopkins).

But the show may have also helped to revive the meth industry. According to statistics available on the DEA website, the number of “meth incidents” steadily dropped from a total of 23,829 in 2004 to 6,858 in 2007. The year Breaking Bad premiered in 2008 on AMC, the number of “meth incidents” known to the DEA increased to 8,810; then to 12,851 in 2009; and peaked at 15,196 in 2010. By 2012 the number of meth incidents had dropped to 11,210. You can find the DEA statistics here. There was a surge of almost 400 per cent in the number of meth labs dismantled between 2010 and 2012 in the United States. See the following graphic taken from the 2014 Global Synthetic Drugs Assessment.

The number of first time meth users increased from 97,000 in 2008 to 151,00 in 2009. The number of past month meth users in 2012 was 444,000, .2 percent of the U.S. population. This compares to the 18.9 million Americans (7.3% of the population) who reported using marijuana in month prior to the same 2012 survey. Marijuana is the most commonly used illicit drug in the U.S., while meth is the least commonly used illicit drug. You can find the 2012 National Survey on Drug Use and Health here.

I don’t believe that Breaking Bad alone revived the meth industry. But the show certainly gave it a high public profile just as DEA statistics seemed to suggest it was dying out. As they say, there is no such thing as bad publicity. I think it will be interesting to see if the national meth incidents continue to drop off now that the show is off the air.

06/9/14

The Dark Side of a Pill to Cure Addiction

22688197_s — andylid / 123RF Stock Photo

On December 23, 2013, The Wall Street Journal published an article with the provocative title: “A Pill to Cure Addiction?” The article was generally upbeat and positive about the research done at the Scripps Research Institute in La Jolla, California—a well known and reputable research institution. The original research article, “Gabapentin Treatment for Alcohol Dependence” is available in JAMA Internal Medicine. A news release by The Scripps Research Institute, “Clinical Trial Indicates Gabapentin Is Safe and Effective for Treating Alcohol Dependence,” is available on their website.

The study found that “gabapentin significantly improved the rates of abstinence and no heavy drinking.” In the placebo group, the abstinence rate was 4.1%, 11.1% in the 900mg dose group, and 17.0% in the 1800mg dose group. The no heavy drinking rate was 22.5% in the placebo group, 29.6% in the 900mg dose group and 44.7% in the 1800mg dose group. See the JAMA Internal Medicine abstract for the above data. The subjects who took the highest dose of gabapentin either stopped drinking altogether (17%) or refrained from heavy drinking (45%).

Barbara Mason, the lead researcher, reported in the Scripps Research Institute news release that the high-dose group refrained from heavy drinking twice as often (45% to 23%) and entirely abstained four times as often (17% to 4%) as the placebo group. Patients who received the lower, 900mg dose of gabapentin showed intermediate benefits. She concluded: “I think that we can now have confidence in the pharmacological effect of this drug.”

The WSJ article reflected this positive, upbeat attitude towards gabapentin as a treatment alternative for alcoholism. It also elaborated on the neurochemical mechanism gabapentin is theorized to influence—the brain’s stress response system—specifically CRF (corticotropin-releasing factor). Alcohol or drug use is thought to trigger the brain’s release of CRF in order to help the brain return to normal after the heightened sensation of pleasure from the chemical high. So years of drinking or drug taking are thought to make the brain more sensitive to CRF.

CRF is sometimes referred to as a “misery neurotransmitter.” It is thought to cause the anxiousness felt by addicts, which they “treat” by drinking again or taking more drugs. It also is believed to play a role in the difficulties that alcoholics and addicts have when trying to quit, particularly during situations that heighten feelings of tension and stress.

The neurochemical research into CRF and CRF-related neurotransmitters has an exciting and promising future into this so-called “dark side of addiction.” It seems to have something to say about the acute withdrawal and post acute withdrawal symptoms alcoholics and drug addicts must wrestle with and overcome to establish abstinence. But there is a dark side to gabapentin, the drug proposed to treat this dysregulation of the brain’s stress response system.

A previous blog, “Twentieth Century Snake Oil,” related the sordid, illegal history of how gabapentin became such widely prescribed drug for not just epilepsy and pain, but a slew of non-approved uses such as: anxiety, post traumatic stress, headaches and insomnia. In 2008 the FDA also mandated that anticonvulsant drugs such as gabapentin carry warning labels about the increased risk of suicidal thoughts and behaviors. A 2010 study confirmed that gabapentin and other anitconvulsants could be associated with an increased risk of suicidal acts or violent deaths.

An article in Psychiatric Times, “The Link Between Substance Abuse, Violence, and Suicide,” indicated that individuals with a substance use disorder are almost six times more likely to report a lifetime suicide attempt than those without a substance use disorder. Emerging research also suggested that a greater severity of recent drinking is associated with the greater likelihood of suicide attempts and successes. Co-occurring alcohol and drug use may also predict a greater likelihood of suicide.

The study by the Scripps Howard Research Institute did not report any serious side effects among the treated patients. But was the presence of serious side effects actively assessed within the study or were they simply noted if reported by the subjects? It should also be pointed out that within the group with the most promising response to the gabapentin treatment, 38% of the subjects were still drinking heavily while using high doses of gabapentin; and another 45% were drinking to some extent while using gabapentin. This alone is clearly contraindicated in the FDA approved Medication Guide for Neurontin (gabapentin).

Medication assisted forms of recovery are all the rage in addiction treatment and research these days. My fear is that well meaning researchers and clinicians could be putting the very people they seek to help at risk with the solutions they propose. This study does not alleviate that fear. Let’s stay tuned for future developments.

05/26/14

Raising the Stakes in the War on Cocaine Addiction

image courtesy of iStock

A 28 year old Viennese neurologist named Sigmund Freud read about the benefits of cocaine on Bavarian soldiers. He decided to use it to treat his own problems with depression and chronic fatigue and acquired some from Merck. On April 30th 1884, Freud used cocaine for the first time. He thought it was “a magic drug.”

Cocaine turned his bad mood into cheerfulness; it even helped his indigestion. He wrote to Martha, his fiancée: “In short, it is only now that I feel I am a doctor, since I have helped one patient and hope to help more.” Freud encouraged Martha to try cocaine, “to make her strong and give her cheeks a red color.” He warned her that when he came for a visit, she should expect “a big wild man who has cocaine in his body.”

He gave cocaine to his sisters and also to medical colleagues—both for themselves and for their patients. By July of 1884 he had written and published his first essay praising the therapeutic uses for cocaine. His hope was that he would become a pioneer in the medical uses of cocaine. But there would not be a happy ending to the story of Freud and cocaine.

These days the ongoing saga of medicine and cocaine is the quest to find a vaccine to cure those who become addicted to it.

I’ve been following the attempts to develop a vaccine for cocaine and other illicit drugs since 2009, when the National Institute of Health (NIH) reported on the work of Thomas Kosten with TA-CD. Nora Volkow, the Director of the National Institute on Drug Abuse (NIDA), said: “The results of this study represent a promising step toward an effective medical treatment for cocaine addiction.”

But some of the participants in Phase 1 of the clinical trials reported using TEN TIMES as much cocaine when trying to override the blocking action of the cocaine vaccine. The Washington Post, reported on the Kosten’s research in January of 2010, saying: “Some of the addicts reported to researchers that they had gone broke buying cocaine from multiple dealers, hoping to find a variety that would get them high.”

A 2011 article in the New York Times highlighted the work of Kim Janda who was working on a cocaine vaccine. His laboratory, the Scripps Research Institute, has also worked on vaccines for nicotine and heroin. In June of 2011 Janda published positive results with what he called an “anti-heroin vaccine.”

New York Magazine reported in September of 2013 that Ronald Crystal, the head of genetic medicine at Weill Cornell, had success with the third version of Janda’s original cocaine vaccine. He hopes to begin human trials by the middle of 2014. A side bar indicated that vaccines were in development for alcohol, nicotine, marijuana, heroin, methamphetamine and rohypnol (the date rape drug).

But as Clint Rainy commented in his New York Magazine article, the problem with addiction is it’s not just a physical problem, it’s also psychological. “Even if you can cancel the effects of drugs, can you make us not want to take them?” Crystal thinks that shouldn’t be a problem for his compound, as it was with TA-CD, because they tweaked their compound (dAd5GNE) to have a “more robust” immune response. Crystal’s response seems to miss an important limitation to a purely physiological attempt to cure addictive “disease.” The vaccine can only inhibit the physiological response to the drug; not the psychological one.

While Kosten’s work with TA-CD has begun clinical trials with humans, the work of Janda with heroin and Crystal with cocaine has yet to be tried on humans. But it’s coming soon. One person who responded to the New York Magazine article about Crystal’s cocaine vaccine said: “This would be a dream come true for me and save my life.” He believed that with the vaccine, he wouldn’t get high. After a few months, he imagined he wouldn’t be thinking about it anymore, but would “just keep getting vaccinated to be safe.”

But it seems that developing a cocaine vaccine as an attempt to end cocaine addiction merely raises the stakes for some addicted individuals by requiring larger amounts of the drug to overcome the vaccine. A vaccine doesn’t address the psychic desire for the drug. If a vaccine is successfully developed for heroin and other opioids, their current potential for deadly use could also increase tenfold.

05/19/14

Remembering Reefer Madness

Sometime around 1975, I went to see the film “Reefer Madness.” I was probably stoned, because that was what you did. You smoked pot and went to see the movie. But that was a long time ago. These days I’m on the other side of the movement to legalize marijuana. Being a drug and alcohol counselor for over thirty years and seeing the negative consequences of drug use and abuse can do that to you.

A few years ago I taught a Sociology of Deviant Behavior course at Grove City College, and showed the film to my class. The students didn’t express concerns; I didn’t think they would. But I heard that while some of their parents thought it was “cool” that a professor at a conservative Christian college would show the film, others weren’t pleased.

“Reefer Madness” was released as “Tell Your Children” in 1936. Financed by a small church group, it was supposed to inform parents of the dangers of smoking marijuana. During filming, the cast was asked to “hoke” it up—be campy and melodramatic. Scenes like the one pictured here where the character Ralph demands that the piano be played “Faster … Faster!” come to mind.

Soon after the film was completed, it was purchased by Dwain Esper, who renamed it “Reefer Madness” and put it on the exploitation cinema circuit. Several new movies each year would travel from town to town on the circuit. Each addressed a socially problematic behavior. Films like “Reefer Madness” and “Cocaine Fiends” would be announced in a town with huge posters that screamed, “THE MOST VITAL PICTURE OF ALL TIME” and “YOU MUST SEE IT.”

Theater lobby displays for movies warning of the dangers of drugs contained hypodermic needles, simulated reefers, and other drug paraphernalia. “Esteemed” lecturers would tell of the dangers of drugs, venereal disease, or whichever problem behavior related to the film—and then urge filmgoers to buy their educational booklets.

Amidst this onslaught of hype, the movie itself almost became an afterthought. After a brief release, “Reefer Madness” was forgotten for decades. Neither Esper nor the original filmmakers bothered to copyright the movie and it eventually fell into the public domain. Watch a version of “Reefer Madness” here on YouTube.

In 1971, Keith Stroup, the founder of NORML (National Organization for Reform of Marijuana Laws), bought a print of Reefer Madness for $297. He cleaned it up and started showing it at pro-pot festivals. Robert Shaye, the head of the newly formed New Line Cinema film company, saw the film and recognized its potential as a campy classic. Shaye booked the film onto the college and midnight movie circuits, where it was huge hit. That’s where I first saw it.

I was reminded of the theatre surrounding “Reefer Madness” recently when I read an article on The Huffington Post about the first hemp harvest in Colorado: “This is What the End of Hemp Prohibition Looks Like.” The farmer, Ryan Loflin, had volunteer harvesters from five different state and two different countries. They received a t-shirt and a free lunch for their efforts.

It does seem that the tide has changed, as the legalization of marijuana and hemp continues to gain political support. But it’s not necessarily heading to a better world. “Reefer Madness” was hokey and melodramatic, but it had a core of truth to it. A 2007 study found an increased risk of psychosis later in life from using cannabis. I’ve also gathered and summarized additional studies showing the negative consequences of cannabis use in “Marijuana Research Findings.” Hmmm … Maybe someone needs to make an updated, less hokey “Reefer Madness” film.

Faith Seeking Understanding

Charles Sigler, D.Phil.

Tag: Addiction and Recovery