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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.

FRED GARDNER is the editor of O’Shaughnessy’s Journal of the California Cannabis Research Medical Group. He can be reached at: fred@plebesite.com

 

 

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Fred Gardner is the managing editor of O’Shaughnessy’s. He can be reached at fred@plebesite.com

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