College on Problems of Drug Dependence

For the past half-dozen years, I have been attending The College on Problems of Drug Dependence, better known as CPDD. The conference has been in existence since 1929 and this year is celebrating 75 years! It is the longest running conference on drug addiction problems in the US and is attended by the brightest minds in the field from all over the world (it even has its own blog).

This year it was held in San Diego and included poster sessions, oral presentations, and plenty of networking. Usually I go it alone, but this year decided to drag my family along to make up for the year I brought them to the same conference in Reno where, ironically, gambling, drinking and smoking permeated the hotel and conference (yuck!).

Top 4 take-away’s

There was a lot of great stuff this year as usual, so I thought I would highlight just a few things that really caught my attention.

1. Adverse Childhood Experiences predict later substance abuse and addiction

We have known for a long time that 80-90% of those who go down the path of addiction start their journey early in life – during teenage-age years – most often as an adaptive response to coping with one or more adverse childhood experiences.parent-yelling-child

I have written about the ACE study on this site, but what is new are studies that continue to evolve these findings in more detail, and help us really understand just how complex, pervasive, and critical it is to evaluate and treat underlying traumas in those who struggle with addiction.

Current stats on abuse and neglect are frightening, and sadly addiction is not the only outcome of these cases. The British Journal of Psychiatry recently published a paper linking childhood adversity to all classes of mental health disorders.

At the conference Cathy Spatz Widom presented some of her work that has involved following 1,575 kids from childhood through adulthood. This amazing study included 908 substantiated cases of childhood abuse and neglect processed by the courts from 1967 through 1971, and then matched this group with a control group of 667 children with no official record of abuse or neglect.

The results from interviews over multiple decades provides strong evidence that early life experiences make a difference in the trajectories of our lives. Bottom line for those who struggle with addiction: intervention must involve addressing unresolved issues from the past that perpetuate addictive behavior.

2. Legalization of marijuana

I have not written about this topic on this site before, largely because I continue to struggle with exactly how I feel about it. While it is now legal in two states (Colorado and Washington) many other states are moving to legalize recreational use as well.

On many fronts I agree that legalization makes sense, as the drug war has been a miserable failure. At the same time, Nora Volkow, the Director of NIDA, in her keynote address pointed out that marijuana use among teens is at an all-time high, while research findings are absolutely clear about the dangers of THC in young developing brains.

This year the public policy forum was dedicated to this topic, and two great speakers from the RAND Drug Policy Research Center – Beau Kilmer and Rosalie Pacula – provided a lot of food for thought.

Beau reviewed his seven P’s and Rosalie addressed the four primary public health goals:

  1. Prevent Youth Access
  2. Prevent Drugged Driving
  3. Regulate Product Content and Form (Potency)
  4. Minimize Concurrent use with Alcohol

The “how” of accomplishing these goals is beyond this post, but if you dig into the RAND site you will find a recent publication that provides all the details.

3. Abuse of prescription drugs

If the 80’s were about cocaine, the 90’s about meth, we are now deeply entrenched in a time where “the” object of addiction are prescription drugs. In the past decade there has been a five-fold increase in treatment admissions for abuse of opioids, and overdose deaths related to pills have tripled in the past two decades.

In some states more people die of pill overdoses than motor vehicle accidents. It is a problem that has gained national attention by many government agencies (and non-government groups), and was a hot topic this year at CPDD. Much of the focus was on abuse-deterrent formulations, which studies have shown have reduced abuse and diversion.

This is a good thing, but at the same time such formulations are not necessarily reducing the number of people who struggle with abuse/addiction – they are just pushing them in another direction to other more easily abusable products or illicit drugs (what we call the “balloon effect”).

The key point goes back to my first bullet point. We need to invest far more resources into prevention and early intervention since this is really the origin of the problem for most who struggle.

Psilocybin and quantum change

Of all the cool things I learned this year, the one that surprised me the most was a workshop focused on the treatment benefits of psilocybin, a hallucinogenic compound from mushrooms that operates mostly on 5-HT-2a/c serotonin receptors.

The session, led by Roland Griffiths and Herb Kleber, reviewed studies where psilocybin produced some remarkable mystical experiences for participants that rated among the most important events in their life!

Here is a video clip describing one of the studies.

The hope for those who struggle with addiction is that psilocybin may be an accelerated way to induce spiritual experiences that result in profound and lasting behavioral changes. The compound, when used appropriately in controlled conditions, appears to be non-physically toxic and virtually non-addictive.

While the early findings are intriguing, I am not so sure we will see it on the list of evidence-based practices any time soon.

If you want to read more about the conference, check out the CPDD Blog.

Lastly, I know many of you won’t believe this, but CPDD has workshops that go from 8pm until 10pm at night, even Sunday – on Father’s Day! My wife never believed me until she saw it for herself. This is a dedicated group of people! So, after one of these very long evenings, I ventured out into the evening and did a little picture taking.

Favorite images from San Diego:




  1. Milauna Troy says

    Your piece on psllocybin and quantum change and the hope for relief from addiction is so interesting. I watched the video attached, and I can truly understand how being in this state that is produced by this compound could be a tool for dealing with addictions and other issues.

    I have been studying and learning the “concept”, if you will, of non-dualism. My experience while reading several books on the topic has been extraordinary. I found myself entering into a state of what I believed to be non-dualism as I understand it to be defined. In that space nothing matters, in the sense that everything is complete, and there are no competing thoughts. NOthing but peace and and a sense of ease. A feeling of being bathed in love and totality. In that time frame which lasted weeks for me, any kind of addiction was not possible, including addiction to thought or attachment.

    This sense of oneness and complete integration with God feels like the answer. It didn’t last for me, but it always feels like it’s there waiting for me to wake up to it.

    The idea of taking a substance in a controlled safe environment to get oneself out of the way, and induce this divine, ultimate connection seems like a great idea to me.

    Thank you for posting this.

  2. admin says

    I agree completely with you. Awakening to non-dual awareness is the ultimate solution – not just to addiction – but for all of life. When we are able to see, understand and embrace our true nature, addiction loses all power, it is gone. And you are right, non-dual awareness is available to all, but it does take effort – namely contemplative/meditative work – to experience such a state. Psilocybin would probably be easier :)


  3. WDeleon says

    There is much debate concerning the legalization of Marijuana. Keeping it out of the hands of young adults is a problem and will continue to be a problem regardless of whether or not it is legalized. I understand the dangers and negative effects drugs can have on the adolescent brain. With that being said I am in between a rock and a hard spot. This is a bit off topic from the actual legalization of Marijuana, however, my 13 year old son has epileptic seizures as well as severe ADHD. The different medications (Lamotrigine, Vyvanse, Clorazepate) as well as the break-through-seizures are also having a highly negative effect on his developing brain, especially his hippocampus. I would be curious as to your opinion concerning the use of Marijuana with very low THC and high CBD as a treatment for his seizures.

  4. admin says

    I understand your challenge and wish I had a good answer. Unfortunately I am not in a position to comment on what I would do medically. As a father in your position, I would want to do whatever helped my son, balancing the benefits and risk as best I could. You might read “Powerful Medicines” by Jerry Avorn for some perspective.

  5. Jessica Macomber says

    It really is astounding to think about how the shift has changed from meth to prescription drugs. I think a lot of it comes from how over-prescribed pain medicine truly is. I experienced it first hand when I was in a bad car accident in 2008 and had multiple back and neck injuries and throughout my healing process doctor after doctor threw pain pills at me as a means to solve my pain, when in all reality all it did was mask it. It didn’t take long for people I know to start asking if they could just have a pill because their back hurt, their arthritis was acting up…whatever it may have been.

    Prescription pain pill addiction is an uphill battle I truly believe but one the government really needs to focus their time and resources into because it won’t go away anytime soon. It, like many other forms of addictions, is so hard to attack head on because there are so many facets of the addiction. Some people truly need pain pills but unfortunately many do not and our health care system cannot keep up and patients get lost in the mix which a lot of times allows for a person to bounce from doctor to doctor getting more and more pills and allowing those pills to be sold to the kid standing on the corner looking for an easy high.

  6. admin says

    Well said. Rx drug abuse is among the most challenging of public health problems we are facing. Fortunately, many stakeholders understand what is at stake and are taking steps to address the issue.


  7. Hannah Maxson says

    Very interesting topics discussed at that seminar. I liked the four P’s of public health goals that was mentioned. However, I don’t think that simply applying that to the legalization of marijuana is enough. I didn’t read further on the process, but I’m assuming they mean for all drug related health concerns.

    I find it interesting that the generations you mentioned have a drug addiction. Heroin, crack, prescription pill, and etc… This just goes to show that the war on drugs failed very miserably. Due to the increase of abuse on prescription drugs, this shows that our society doesn’t take medicine seriously enough. It’s to a point where someone can go into a doctor’s office, tell them a symptom and get medication just like that. How can we expect to put prevention practices in place when the professional settings don’t seem to be taking the matter seriously themselves?

  8. Rebecca Grillone says

    In this post in the section about childhood events being linked to addiction you said, “Bottom line for those who struggle with addiction: intervention must involve addressing unresolved issues from the past that perpetuate addictive behavior”.

    My question is do you believe that it is possible that the underlying issues to addiction could be locked up in a person’s sub-conscious? For example, I have a family member that I have watched tear their life up with meth and have continued to struggle with it for over ten years. She was sexually assaulted as a child and was left to walk a long distance home all alone. Unfortunately it was never reported and she never received any help for coping with the traumatic event.

    Her addiction to meth began when she started dating this guy that is very good at controlling her life with the drug and is abusive. I believe it is possible that the memory of the assault is sub-consciously affecting her because she continues to let another man abuse her and her addiction is her way of coping. She acts as if the childhood abuse never happened. Could it be that suppressing memories of trauma could be a contributing factor to drug addiction?

  9. Andie Grube says

    I have always been interested in the way childhood traumatic events affect the way a person thinks, acts, and feels later in life. There are many different perspectives to take. Drug addiction due to these events is well documented and possible as well as criminal involvement. I really like your point about how when addiction is addressed so must unresolved issues of the past be addressed.
    Legalizing marijuana is not really something that I am for, but I understand its use for medical reasons. I am interning in a crime lab right now where we test hundreds of marijauna cases a month. Talking with some of the specialists I learned that there are now marijuana pills. These pills are known to be used for chemo patients. The marijauna is supposed to boost their apetites so that they can gain nutrients and food intake. There is an article found here that explains it further. This is the type of marijuana that I think should be legalized. Although, I also agree with your point that this drug has been a failure. I also, liked the four points that came out of that section. Drugged driving is a particularly sensitive point that should be controlled. Like you said though, how is the hardest part.

  10. admin says

    Rebecca, no question this early event plays a significant role in your loved one’s addiction. The issue of being “locked up in a person’s sub-conscious” is really a question about what we know about trauma, memory and the brain. I would suggest reading “Waking the Tiger” by Peter Levine as a good introduction to this topic. One reason she acts like it did not happen is because returning to the event is likely very painful. And in general we tend to avoid things in life that are emotionally overwhelming. So short answer to your question – YES, early trauma most certainly contributes to addictive behavior.


  11. Gabriel Elias says

    Your section on the legalization of marijuana is quite interesting! You’re absolutely correct in the matter of the drug war being a complete failure, yet we’re still funneling money into helping this cause. It’s become quite the controversy here in Oregon, being so close to Washington as they passed their law recently. I find marijuana easily accessible in every part of Portland. This leave me the impression with only being a matter of time until it becomes legal here in Oregon. With Federal law considering it an illegal substance, how will people be able to open pot shops? Banks are government owned, so that would leave wanna-be business owners with no where to go for loan money. It’s interesting that Federal law prohibits it, but yet the State law will allow it. With the easy access, I don’t see the point anymore in trying to prevent or call it illegal anymore.
    Furthermore, is THC only harming young developing brains? Or does it also affect full-grown adults?
    Beau Kilmer’s 7 P’s are a great point and illustration. The production is something that I’m sure depending on the restrictions will send many new residents to Washington and Colorado to start businesses. With the potential for profit, it would make me want to get into the business if it weren’t for the stigma and the high possibility of things going wrong.

  12. Chris B. says

    I think when it comes to prescription drugs being abuse the number one usage it to relieve pain. Under the Obama administration’s focuses on the preventative action of prescription drug abuse in four areas; (I) education (to the youth, parents, and patients requiring prescribers to receive education on the appropriate and safe use, and proper storage and disposal of prescription drugs), (II) monitoring prescription drugs from doctors across the states, (III) proper medication disposal to help decrease the supply of unused prescription drugs in the home and (IV) enforcement to eliminate improper prescribing practices and stop pill mills ( Among research that data has shown that opioids are the most abused drug that causes the most overdose deaths 2x higher than cocaine. It is clear that prescription drug usage is on the rise which is likely to correlate more overdose deaths ( As a society we need to focus on preventative methods to reduce the amount of deaths and reduce the prescription drug abuse. Everyone is the community plays a role in reducing prescription drug abuse: patients, law enforcement, healthcare physicians, and local government agencies. We can start there to create policies surrounding prescription drugs and enforce them throughout the states.

  13. darius says

    I too have the same strong feelings about legalizing marijuana. The issue is that I have seen what it does to people around me and close friends when it is a hassle to get sometimes and cannot imagine what it will do to those same people once it becomes legal here in Oregon. I can understand marijuana being used as a medical treatment, but legalizing it to some extent make me uneasy.

    Furthermore, this conference that you mention, CPDD, has intrigued me enough to actually make it something to go and attend in the near future. I have always had questions about the world that we live in and the drugs that inhabit it and this sounds like the perfect place to have some questions answered and asked.

    Thank you!

  14. admin says

    Thank you for the comment. Before heading off to CPDD, check past programs to get a sense of what you will experience. It is not a conference for everyone, and a bit pricey.


  15. Sara K. Johnson says

    I find it very interesting how the focus on drug use has shifted over time (for example from cocaine to meth) and I wonder what exactly the next focus will be? I understand now that prescription drugs are the current hot topic, which they should be. As a 19 year old college student I am often overwhelmed just be how easy it is to get access to prescription drugs and how little users know about what they are taking. I do however want to stress that even if the larger focus may have shifted away from meth use to prescription use, meth is still a very real issue (especially here in Oregon). Your ideas about public health are wonderful, and it is rare to hear these concepts put it understandable terms. Thank you for giving me a new way of thinking about these issues. Great Website!

  16. Baileh Simms says

    I agree with the idea that childhood experiences do shape future addiction and drug use in life. I just finished reading the book Beautiful Boy in my drug education class. This book follows the journey of a father and his son’s addiction. Nic, the son, goes through a divorce as a young child and travels from home to home and family to family. That is one experience that i believe can shape the rest of a child’s life. Divorce is not something easy to go through especially when the families live in states apart.

    I also believe that there is a huge issue with Marijuana right now in the US. It wasn’t very smart for them to legalize it in Colorado and Washington. Especially with teenagers Marijuana is a popular drug. I think a lot of teenagers believe that Marijuana has no affect on them and is not considered a “bad” drug which is why it is such an issue in society.

  17. Remy Murfitt says

    I found this post to be completely intriguing-especially the part about legalization of marijuana. Being a young adult, I have experienced many close friends abusing the drug recreationally. I have noticed however, that these people often argue that marijuana use is less harmful/dangerous/destructive than the abuse of alcohol. While I can see some of the reasoning behind this, I also feel that this drug is way over used and can actually be very harmful, especially in the lives of teens/young adults who tend to over-use. I’ve seen various friends use marijuana on a daily basis and it largely affects their daily lives whether they want to admit to it or not. I have never used the drug myself, but I can see how it plays a huge role in the lives of others and it was interesting to see that you struggle with this same issue. With the legalization becoming much more realistic, I wonder where we can look next in order to make sure that this drug does not because one that is used and abused commonly by young teens/adults.

  18. Mi Pham says

    I also don’t know how I feel about legalized marijuana. As I know marijuana is categorized in control substance I means it is very addictive and abuse substance need to be control in use very tricky. However, marijuana is one of the most valuable plants in the world. Every part of the plant is used. Hemp for paper, fabric, plastic. The seeds can be used as a food source. It contains many of the necessary fats such as omega 3 and 6. The seeds oil has been used as a cheap source of fuel. The flowers have been used for medicinal purposes since ancient times and has been known to help people going through chemo therapy and people diagnosed with aids. The reason it was outlawed because many multi-millionaires and billionares felt threatened that it would make them lose money. Since it can’t be patented, no single person can use it to get wealthy. I say we the people have a right to grow and use this plant for recreational and medical use, and to use it for clothing, paper, food, etc.

  19. Alno99 says

    This post brought up a lot of current issues I think we all overlook. It’s obvious we have a plethora of different substances available to use in 2013. With marijuana being considered for legalization even for recreation use is a big deal. I completely agree that it is our youth we have to protect and consider in a lot of the choices we make for our system. Tying in that adolescence trauma can result in substance abuse even exaggerates this fact that if we don’t regulate properly we can be increasing a problem that isn’t being addressed properly as is….very thought provoking…

  20. Manizha Rezayee says

    In the section about Adverse childhood experiences, which predict later substance abuse and addiction is very interesting. I have heard so much on how growing up and childhood experiences play role in decision making as a adults. The Center for disease control and prevention shows that different types of adverse childhood experiences like abuse, neglect, and household dysfunction have prevalence in men and women. I found it very shocking that in those categories it had more effect on the women then it did men. Also children who watch parents using drugs are more likely to use themselves. Parents have to be aware of how their choices impacts their children.

  21. Daniel Rowe says

    One of your first points about early childhood abuse and the effects it has later on in life struck my interest. I think it’s very unfortunate that America has a legal system that does little to acknowledge why people do drugs and instead focuses plainly on punishing “drug-addicts”. A system that takes these people and puts them into a jail system that labels them as defective does nothing to help the problem that these people have or the society that they live in. The unfortunate individuals that had early childhood abuse that led them to drugs maybe sentence to jail and are from then on treated less humanely and have very limited options in life except to continue their current lifestyle. I hope that one day American society will see the short comings of it’s legal system and take the appropriate measures to improve upon it.

    Thank you for your article

  22. Briel Lee says

    I appreciate that this post brought up a lot of issues but there is one issue that I think would extremely beneficial to elaborate on, and that is the debate about the legalization of marijuana. My main concern with this issue of marijuana legalization is that there is insufficient data about the impacts of this drug to the developing brain and there are more myths about marijuana floating around the general public instead of solid facts. I think that it would be more important to dedicate research to marijuana use before the legalization of this drug expands; but on the other hand I am curious to see how the legalization of marijuana will affect our economy and if it will take the same economic route as tobacco in terms of advertisement and sales

  23. says

    Briel, I would have to disagree about insufficient data about the impact of this drug on developing brains – evidence is pretty clear youth should stay clear of pot. Check out this article form the California Society of Addiction Medicine:

    Also, there are some great resources on NIDA’s website as well:

    We do need more research into the public policy aspects of pot, as it is still unclear how legalization would impact so many different factors.


  24. Gina K. says

    Hi Dr. Fitzgerald,
    I really enjoyed this post because I feel like I can connect to it, being a college student. One part of your post stuck out to me the most. That was the part that talks about the legalization of marijuana.
    At the time when you wrote this, only Washington and Colorado had passed it. As of today, Oregon, Washington D.C., and Alaska have also passed the legalization of marijuana.
    I went back and forth on my feelings on the subject before the election. Some days I would read something that made me think, “huh, now that won’t be so bad” and other days I would think “Now this is just ridiculous!” Now that it has passed I can’t help but feel worried for our society. I start to worry that maybe it was better to have medical marijuana because although marijuana was still around and not that hard to get a hold of, it was still seen as unacceptable to use because it was an illegal drug. I think there are a lot of unanswered questions with marijuana. More research has to be done to study the effects of it on our mind and body.
    *For example, you listed those four topics of health concern:
    -Prevent Youth Access
    -Prevent Drugged Driving
    -Regulate Product Content and Form (Potency)
    -Minimize Concurrent use with Alcohol

    …and those are so very relevant! I’m scared that now that it is legal it will be even more accessible to people younger and younger. I worry that people will stop looking at it as a “drug” and start viewing it as OK to do whenever you want because it’s like tobacco or alcohol and you can buy it at the store (Not saying that either of those are ok to use all the time, they are both drugs that are used and abused, but many people confuse legal substances as being ok and ignore signs of addiction).
    Like the poster above me said, it’s very true that the brain is still developing well into your early twenties. Even though we put an age limit of 21 on marijuana there is a high chance that it will be used by people under that age, just like with alcohol.
    I am definitely worried about the driving aspect of it since there is yet to be a field sobriety test for marijuana. I think the potency and content of the product will be pretty well regulated. The THC and CBD properties will be tested and labeled (hopefully) on products.
    Yet there are good things to come of it. I say this coming from a medical standpoint. I was reading an article today about a little boy who takes CBD pills for seizures. Or people who smoke for chronic pain. Those are helpful things!! I don’t think it’s good when I see friends who smoke weed to get “goofy high and eat a lot” nor when I see friends who smoke to numb the pain of something in their life. Anyway, just my two cents. I really enjoyed this post and it got me thinking about the future of our community here in Portland and what may be to come of addiction to marijuana.

  25. says

    Thanks Gina, it is a complicated issue with no perfect solution. In the end we are society that likes our vices, and time will tell how the current generation of kids will fare with the new law.


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