Editorial Comments: On Meth 2.0; and for Veterans’ Day

1. Methamphetamine: The USA Today piece below (“Cheap and powerful ‘meth 2.0’…”) seeks to build a case for response to an ostensibly new addiction threat, from methamphetamine (MA).  It is not clear that the author demonstrates a difference between the MA in circulation three decades ago and that currently available; or between the effects then and now.  Imported MA (Philippines, Korea, Mexico) has been remarkable for its purity throughout; any signal changes in its risk have been related to the routes of administration, of which inhalation became the most recent in 1990.   MA use in any form poses profound treatment challenges, so any attention drawn to its risks by the lay press is welcome; but as we have reiterated here, a sole focus on any one drug of use leads us on another incomplete tangent, distracting from arrival at the desired destination:  arrest of addiction, independent of the substance.
2. Veterans’ Day: The previous two issues of ASAM weekly have provided vignettes drawn from experience. The latter described a setting in wartime. What needs providing is the face of a warrior.  Slender, tall and tawny and sunburned, his hair color unidentifiable from the Marine haircut, Sam was a 20-ish single Native American private stationed in a region where alcohol seemed difficult to obtain.  He carried the legacies of an alcoholic father, alcoholic uncles, and an alcoholic grandfather.  And through cunning and the feckless cooperation of his comrades, he managed to accumulate four alcohol-related incidents.  He sat before me not denying the relationship between his drinking and the consequences, any two of which would suffice for punishment and ejection from the Corps.  The treatment options in this setting, a Muslim country and with military medical support largely focused on trauma and infectious disease, were limited to:  restriction to the unit and to the base, an attempt to prevent access; individual counseling, either pastoral or from an enlisted general-duty Corpsman; or attendance at the local, weekly Alcoholics Anonymous meeting.  We went together to the last.  Taciturn but civil, even deferential, he sat quietly with me through two such meetings.  And when we reviewed his experience, he acknowledged that the message and the milieu, the shared feelings of the group of expatriates and day-laborers and robed bearded men with their chauffeured Mercedes were remarkable and encouraging. 

And he didn’t need it, now.  I could order him to go to the meetings, and to sit with me or the Navy Corpsman or the Chaplain and listen, and he might do those things.  I could order him to not-drink (sic), and thank you, but that would be one order too many.  He wanted to serve, was not so afraid of fighting, but his drinking was not to be my concern. He was discharged under other than honorable conditions, and returned to his home in the Southwest, from one hot and arid country to another; neither the first nor the last of my failures.  There are wars within wars.

Please join us at ASAM Weekly in extending our appreciation to those who have served in the nation’s defense.

- Editor-in-Chief: William Haning, MD, DFAPA, DFASAM