DEBUNKING "AMOTIVATIONAL SYNDROME"

"There is no such thing as laziness. Laziness is only lack of incentive."

Norman Reider, MD

A graduate student in the psychology department at the University of
Southern California, Sara Smucker Barnwell, has conducted a survey to
assess whether or not cannabis use undermines motivation. She emailed
a questionnaire to 200 undergraduates who had taken a course on drugs
and human behavior, and to 100 acquaintances of a co-author, Mitch
Earleywine, PhD, who in turn were asked to forward it to others. She
got responses from some 1,300 people. She then analyzed the responses
of everyday users (244) and those who had never used (243).

Barnwell's questionnaire comprised an "Apathy Evaluation Scale" and a
"Satisfaction with Life Scale." Apathy was measured by 12 statements
such as "I don't follow through on my plans" to which respondents
gave their level of agreement ("Not At All, Slightly, Somewhat, Very
Much"). Satisfaction was measured by agreement with five statements,
including "If I could live my life over, I would change almost
nothing." The mean age of the participants was 33. They were mostly
Caucasian (79%), with a preponderance of them students. One in three
frequent cannabis users described their use as medical.

Much of Barnwell et al's paper consists of statistical methodology
involving "T-distribution," "heteroscedasticity," "controlling for
unequal variances," "outliers (e.g. data points above/below three
standard deviations)," "standard transformations (e.g. square
roots)," "trimmed means," "alternative measures of effect size (the
estimated measure of the degree of separations between two
distributions)," "Cohen's delta calculations," "Pearson's
correlations," "Welch's heteroscedastic means comparison," "Yuen's
comparison of 20% trimmed means," etc. etc ...

The jargon is almost impenetrable, but it appears that statisticians
allow themselves to discount "outlier" responses that don't jibe with
the "central tendency" of the data. Barnwell et al's "robust
statistical analysis" certainly makes their somewhat fuzzy survey
seem supremely precise and worthy of publication in a peer-reviewed
scientific journal.

But why quibble when they're "good on our issue?" Barnwell et al
conclude: "Participants who used cannabis seven days a week
demonstrated no difference from non-cannabis users on indices of
motivation. These findings refute hypothesized associations between
heavy cannabis use and low motivation ... Daily users reported
slightly lower median subjective well-being scores (2 points less on
a 28-point scale) ... Post-hoc tests find that some portion of the
differences in subjective wellbeing arose from medical users, whose
illnesses may contribute to low subjective wellbeing more than their
cannabis use."

The authors acknowledge that their results may have been skewed by
not taking into account respondents' use of alcohol and other drugs.
They list some other realistic caveats and counter-caveats:
"Participant reactivity to questions of motivation may pose an
additional confound. Despite a lack of empirical evidence supporting
amotivational syndrome, the popular concept is well known among
cannabis users. Perhaps cannabis users demonstrate sensitivity to
questions regarding motivation, exaggerating their own motivation in
an effort to defy stereotypes. In contrast, users tend to attribute
low energy and motivation to cannabis even when they use alcohol
problematically, so there may also be a bias for cannabis users to
report lower motivation. Further, collecting data via the internet
may prevent some low education or low income individuals from
participating. Others may feel uncomfortable reporting drug use
online. Simultaneously, individuals experiencing low motivation may
be more likely to participate in internet-based research rather than
traveling to a laboratory."

Common sense tells us that the main motivator in this society is the
prospect of remuneration. Millions of Americans, young and old, are
destined to do unfulfilling work for wages that won't enable them to
support a family let alone own a home and retire with a sense of
security. To define our condition in terms of amotivational syndrome
or apathy is to conflate symptom and cause, to individualize a social
phenomenon, to medicalize the political. Anti-prohibitionists should
turn the meaning of amotivational syndrome around and peg it for what
it obviously is: a manifestation of socioeconomic hopelessness.

Barnwell's paper, "Cannabis, motivation, and life satisfaction in an
internet sample," co-authored by Rand Wilcox of USC and Mitch
Earleywine, PhD, of the State University of New York, was published
in the online journal Substance Abuse Treatment, Prevention, and
Policy Jan. 12. It was funded by the Marijuana Policy Project.

P.S. Have you seen the Jack-in-the-Box ad with the teenager in a van
unable to decide what to order? He's all "Uhhhh" A little Jack figure
on the dashboard comes to life and says, "Dude, why stress? Stick
with the classics like my tacos ..." And the kid (who looks like a
diminutive Troy Murphy) asks, "How many should I order?" And Jack
says, decisively, "Thirty!" Which causes the kid to crack up: "That's
what I was thinking!!!" Isn't 30 tacos just about what one of those
teenage boys would think he could handle?

Mikuriya to CSAM: "I Quit!"

Tod Mikuriya, MD, the prominent pro-cannabis clinician, has sent the
following letter(s) to the California Society of Addiction Medicine
and the American Society of Addiction Medicine:

Colleagues,

As I contemplated whether or not to renew this year with the not
unsubstantial dues, I asked myself "Why should I?" Over the years
since I joined the organization I have tried to raise the possibility
of a harm-reduction option for the treatment of alcoholism.
Notwithstanding my repeated and persistent entreaties, I have been
repeatedly denied any opportunity for a collegial and professional
forum. I have even offered to make my patients available for
questioning and review. Nothing. Lame excuses -not ready yet.

Forays into spiritualism with self-styled practitioners responding to
the "spiritual needs" of addicts was particularly disturbing. Somehow
I don't remember any training in medical school in theological
studies. The blurring of boundaries and confusion of identity
diminishes, attenuates medical leadership, and reduces professional
credibility to cultism. Medical Review Officers conducting forensic
examinations are not engaged in a medical activity. Preoccupation
with urinary metabolites instead of actual fitness for duty further
diminishes medical leadership and reduces ASAM/CSAM to corporate
shills and trough feeders. Donald Ian MacDonald of ASAM -Reagan's
drug czar-promoted piss testing along with Robert DuPont of Paraquat
fame. The societies support the federal government's irrational
drug-war policy while prominent addiction specialists seek to
maximize their share of court referrals.

I officially give up on ASAM/CSAM and any possibility of a magical
ethical transformation. I have been denied the opportunity to present
a viable, effective, and medically appropriate intervention: cannabis
as a substitute for alcohol and other addictive substances.

Retrospectively, I wonder why I waited so long to quit. I can no
longer maintain my wishful thinking that somehow ASAM/CSAM could be
fair, objective, professionally and medically correct.

I shall not be renewing my membership. Tod H. Mikuriya, M.D.

Member since 1974 Certified by ASAM 1986 MRO Certified by ASAM 1992

Dr. Mikuriya is feeling a lot better since a stent in his liver
restored the flow of bile and proper digestion two weeks ago. Also,
he has been released from "medical house arrest" (his term) imposed
after a bacillus associated with TB was detected in a washing from
his lung... He is working on several papers based on his clinical
findings and observations and his hypotheses re mechanism of action;
an electronic (and augmented) re-issue of his 1973 anthology,
Marijuana Medical Papers; and a second volume focusing on what
California doctors have learned in 10 years of seeing patients. He
plans to resume seeing patients. April 9 Dennis Peron is throwing a
party for Dr. Tod this Sunday, April 2, 1-6 p.m., at his house in the
Castro. Told it was to honor his work, Mikuriya said, "To continue my
work... a chance to pontificate!" Those wishing to support Dr.
Mikuriya's various project can contribute to the CCRMG, a 501(c)(3)
non-profit. The address is p.o. box 9143, Berkeley CA 94709.

Mikuriya strongly suspects that Lipitor, Pfizer's blockbuster statin
drug, had a deleterious effect on the lining of his biliary tract. He
was put on Lipitor three years ago to lower his cholesterol following
coronary bypass surgery. He has had three patients who attribute
similar adverse effects to Lipitor, including itching, a feeling of
cold, and digestion problems.

A lawsuit filed last week by a Teamsters health-insurance fund
charges that Pfizer execs promoted sales of Lipitor for off-label
uses. The marketers certainly succeeded -since 2001 they've sold $46
billion worth, including $12.1 million last year, making Lipitor the
world's best-selling drug. The suit, according to the Wall St.
Journal, "cites internal Pfizer marketing documents, Pfizer-funded
studies and physician-education programs that encourage doctors to
use Lipitor early in treatment, despite the risk of side effects in
some patients. Pfizer says side effects with Lipitor are generally
mild, such as stomach upset, but the drug has been associated in rare
cases with muscle damage and liver problems."

"Rare cases" of a drug taken by millions equate to thousands of
individual catastrophes. The pharmaceutical manufacturers claim that
the benefits their compounds confer on many far outweigh the damage
they cause a few. (The WSJ piece flatly asserts that Lipitor "has
helped millions of people avoid or manage coronary artery disease,
including heart attacks and strokes.") The sanctity of the individual
- -which once received great lip service in this country-couldn't stand
up to cost-benefit analysis.