Some weeks, the topics reviewed combine into a cacophony.   Like a grade-school class,  their voices all call for attention, with separate needs. In this week's issue, we read of the social and occupational impacts of opioids, the inevitable growth of cannabinoid use in electronic vaporizers, the ethical and therapeutic roles of physicians in court-mandated treatment, funding of the national response to opioid deaths with an overview of the territory needing attention – and a clarion call -  by ASAM’s President, Dr. Kelly Clark.  An epidemiologic study of non-gender-conforming  high school youth unsurprisingly demonstrates increased suicidality in that marginalized population and a finding of increasing drug use among males. One item that all will find exciting if even a little quirky is the identification of a human endogenous retrovirus as possibly instrumental in the development of substance use disorders; it is, of course, the realization of all fears for those with a zombie obsession.  It comes about, this great cacophony, exactly because of the pervasiveness of addiction. Listen long enough, and themes overlap, the voices begin to harmonize.  It is euphony.   

When I left emergency medicine to take an addiction fellowship, I hardly expected that I would ultimately become a psychiatrist. There were actually some decent reasons for this, most deriving from a friendship with a former chair of psychiatry, the late Jack McDermott, past Editor-in-Chief of the Journal of Child and Adolescent Psychiatry ("orange Journal").  The attraction that psychiatry would offer, he suggested, included seeing some things differently from what my preceding 43 years of life had instructed. And one of the more useful lessons, whether in psychiatry or emergency medicine, is to read for or listen for what is not being written or said.  In this week's offerings what stands out to me that isn’t listed, at the same time that it is certainly being discussed trans-continentally, is the impact of alcohol on both intimate relations and adolescent development. Regardless of the outcome of the Supreme Court nomination hearings this past week, alcohol use has played a substantial part in the national debate.   And it is unsurprising. The number of ways in which alcohol use is woven into social life as well as into pathologic human behavior provides the bases for many of us having entered the field in the first place. There aren’t too many among you who just stumbled into the specialty, awakening one morning and thinking, "Oh, I think I will go and concentrate in addictions, I wonder what people with those problems are like." It could have been a fear of making too much money that engendered this decision, but it certainly wasn't a lack of knowledge about the behaviors of people who use alcohol and drugs. It’s a familiar theme for us, this wayward thread in the skein of human development; and it is no surprise that alcohol again takes a prominent place in deliberations about responsibility and suitability. How wonderful if that insidious, nasty little retrovirus-distorted length of genetic material could be snipped, and with it one more human frailty could be abolished.

- W. Haning, MD