Drugs and Alcohol Issues Many Americans have trouble getting to sleep. As a results they may turn to sleeping pills to help them get some ZZZs. How do you feel about the prescribing of sleeping pills for people to assist them with sleeping? Should our medical industry instead be writing prescriptions for vigorous activity which would also help people sleep better? How about a prescription for caffeine avoidance?

There is nothing wrong with physicians recommending non-pharmaceutical alternatives to insomnia or any other medical or health problem. However, the autonomous rights of patient make it inappropriate for the physician to substitute his or her values for those of the patient. The physician's duty is to disclose all relevant information and to provide good-faith advice; but the ultimate choice of modality to address a given problem must always remain with the patient.

On some level, the same criticism of using sleeping pills could be leveled at many other drugs: a physician could prescribe biofeedback pain control classes or meditation or a reduction in work hours for a patient complaining of headaches. If a drug is available that is intended for the treatment of headaches and it is medically safe for that patient, the physician may not intrude into the decision-making process if the patient prefers to skip the biofeedback or work-hour reduction and treat his or her headaches with aspirin or acetaminophen.

That is not necessarily to say that there might not be some value to changing the culture of treating everything with drugs. The problem is any such approach would have to be encouraged strictly on a voluntary basis. Ultimately, patients have the final say in their treatment and the absolute right to determine their course of treatment from among all of the available modalities that are medically appropriate for them. Therefore, in my personal opinion, it is perfectly alright for patients to request and take sleeping pills for the purpose of getting better sleep.

7) Considering the following: 1. Alcohol kills more young people than all illicit drugs combined. (Grunbaum, 2002) 2. Alcohol-related motor vehicle crashes kill someone every 31 minutes and non-fatally injure someone every two minutes (NHTSA 2006). 3. During 2005, 16,885 people in the U.S. died in alcohol-related motor vehicle crashes, representing 39% of all traffic-related deaths versus 18% rate for Marijuana and Cocaine (NHTSA 2006). Do you think that alcohol should remain a "legal drug" free of regulation on consumption?

All of those concerns are extremely legitimate and important to consider in connection with policy making and law making functions. However, I believe that we have already witnessed the colossal failure of the Prohibition Era when alcohol manufacture, sale, and consumption were absolutely prohibited by law in all fifty states. It is virtually impossible to prohibit alcohol consumption without generating a lucrative black market that poses all of the same risks in addition to additional risks to society, such as the production and distribution of liquor that is unsafe for consumption. In my opinion, the better approach would be to focus on increasing the penal consequences of any instance of driving under the influence of alcohol as a deterrent. If there were mandatory jail terms for the first infraction of this type instead of legal slaps on the wrists and an endless pattern of minor consequences that are insufficient to deter the behavior, the rate of driving under the influence would likely be much lower.

To my mind, the real question is whether alcohol and similar substances capable of being abused should continue to be treated so differently under the law. Marijuana in particular poses the same types of risks and would be appropriately controlled through the same type of regulation as applies to alcohol products. Moreover, cigarettes are the most deadly of all recreationally consumed substances and actually account for more annual deaths than motor vehicle accidents, alcoholism, position on red wine consumption as a protective factor for heart disease. What is it specifically in red wine that is considered cardio protective? Or is this just another excuse for people to regularly drink wine?

According to the information available, red wine apparently contains various antioxidants that are believed to promote better health by reducing the rate of DNA copying errors during cell division that are the primary mechanism behind the phenomenon to which we generally refer as aging. More specifically in relation to heart disease, the red wine antioxidants such as polyphenols are believed to contribute to the health and elasticity of the tissues that line the heart blood vessels. One particular polyphenol, known as resveratrol is also believed to reduce the production and accumulation of the low-density cholesterol that is typically implicated in strokes and other blood clots.

Naturally, people who are already inclined to drink excessively and especially those who are psychologically predisposed to rationalizing their behavior will typically latch onto any justification (such as the possibility that red wine may be heart-healthy) of the behavior that they have difficulty controlling. However, the known harms associated with excessive alcohol consumption (even in the form of red wine) undoubtedly outweigh any health benefits associated with red wine. Therefore, the point may be moot since people who limit their alcohol consumption to the maximum that still conveys the medical benefits of red wine do not need to rationalize that behavior. Meanwhile, those who consume more alcohol (even in the form of red wine) than the maximum that can be consumed without negative consequences cannot reasonably use the antioxidant excuse, since it does not apply where the harms associated with the "benefit" outweigh any such benefit.

9) How do you feel about the wide availability of medical marijuana cards and clinics?

Frankly, I think it is a shame that the entire issue has been dealt with the way it has. The only reason there is such widespread abuse of the medical marijuana cards and clinics is that marijuana use has been inappropriately regulated through criminal prosecution in the first place. In principle, it is simply impossible to justify the long-standing differential treatment of marijuana, alcohol, and tobacco. That is because tobacco is, by far, the most harmful substance to society in terms of annual premature deaths caused by its consumption, not to mention its causing tremendous waste of public health care and employment disability funds. Cigarettes are products that cause death and serious disease in substantial numbers of users who use the product exactly as it is intended to be used. Furthermore, second-hand and third-hand tobacco smoke injures thousands of nonsmokers every year as well. Yet tobacco is permitted to be manufactured and sold and it is regulated and taxed by the government. Likewise, alcohol is a known cause of thousands of vehicular deaths and disease and personal and family dysfunction. Yet is also legal to manufacture and sell and it is regulated and taxed by the government.

Marijuana should be regulated, controlled, and taxed by the government in the exact same way as tobacco and alcohol. That would obviate the need to distinguish between recreational and medicinal consumption. In principle, the notion that the government would allow drinking alcohol recreationally and smoking tobacco but would presume to prohibit the medicinal use of another smoked herb in the privacy of one's home is ethically offensive. Inappropriate behavior, such as smoking marijuana and driving, should be addressed as criminal behavior just the same as the alcohol analogs.

10) Do you feel that "abstaining" from a substance which one is addicted to is crucial for treatment? For example, do you believe that if one is being treated for alcoholism that they must "abstain" from drinking any alcohol in order to be in recovery?

Not necessarily. I believe it depends largely on the personal history and abuse pattern of the individual. There are probably recovered…