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ethics of family work in a world with domestic violence
Domestic Violence is a common enough occurrence it should be planned for in all family sessions. To not is a serious ethical lapse on the part of the practitioner.
A routine inquiry about domestic violence should be done with everyone who has ever been in a relationship with a man. Routine inquiries can be done with potential perpetrators or survivors but the results of inquiries with perpetrators are suspect. Approaching it obliquely can often yield a more accurate response. “Do you two ever fight?” “What does that look like?” “Does it ever get violent?” Questions should be made without judgment in a matter of fact manner. We also go over arrest information and assault charges can be a good lead in.
Domestic violence is rooted in power and control and there is a strong correlation with traditional gender roles. Men and women believe these myths.
Two Fundamental Principles
- Victim Safety
- Personal Accountability
DV perpetrators do not engage in domestic violence at any higher rates then men who don’t abuse drugs and alcohol. Acts of abuse while intoxicated can be more severe but our actions are governed by our attitudes and beliefs whether we are intoxicated or not. Sobering up in and of itself will not correct issues of domestic violence though the level of violence may decrease power and control will still hold sway until it is conscientiously dealt with over time.
Domestic Violence is Purposeful and Instrumental, meaning its done on purpose and its done for a reason. Those reasons are rooted in male privilege, are often invisible to those who receive them and are difficult to eradicate.
Counselors must help client perpetrators take responsibility for their actions. Facilitate pledges to stay nonviolent. Safety plan trigger situations. Learn basic skills like time outs/cool downs. Be able to be honest about what is occurring.
Domestic Violence is difficult to address in individual sessions and best practice is to refer to a batterer intervention program of at least 6 months. Less intensive interventions should only be instigated when that is not possible.
A nice basic primer is “Why Does He Do That: A Guide to Angry and Controlling Men”
Higher rates of substance abuse are found in domestic violence survivors. The rights of survivors to make choices about continuing or not continuing cannot be abrogated without the clinician putting themselves in the place of the abuser. Survivors know best on how to continue to survive and leaving can precipitate an act of violence. No one wants to be abused that is a myth. Efforts are best focused on validating the survivors feelings, normalizing their experience, safety planning, and referral to specialized services. Co-dependency can be victim blaming and is never appropriate in issues surrounding domestic violence.
The batterer is solely responsible for the violence and for ending the violence. Domestic violence should never be broached by the counselor in a couples session. Couples counseling is not appropriate and potentially dangerous and should be studiously avoided in cases of domestic violence and this includes family conferences.
The Miracle Question
Yesterday I did an education group on solution focused therapy. I love the solution focus approach and have been an advocate for it in our agency and we have incorporated it into our treatment planning. Its based on the idea that when working with someone with problems you don’t really have to know the origins of those problems but you just have to identify where you would like your life to go and what are the steps you need to take now that will move you in that direction. Prior to a solution focused approach we took a problem solving approach which is not as motivating which is really the key factor in personal change. Its far more about motivation than it is about knowledge. You begin with “the miracle question”. “If you woke up tomorrow and your life was perfect how would you know it was different?” Its phrased in the form of a miracle because a lot of people mired in nonsense have lost any notion that their lives can be any different. It has to be a miracle for them to wrap their minds around the possibility of change. I also like it because it moves me out of the problem solving business and into the miracle business. Most people’s miracle is to have a safe home with their family with or without a relationship and with or without a dog. On rare occasions people have impossible miracles, bringing back dead relatives, winning the lottery, living in glass domes on mars and the like. The follow up question is “how would that make you feel?” There’s their real miracle. Its future focused rather than driven by hindsight and regret. I wove in some stuff from narrative therapy, looking at your life like a novel only instead of turning back to look for lessons you skip to the end. Ask the character who has it all figured out and is leading a happy life what did they do now that made that happen? It was well received and a really big group. Afterward I did the process group and it had hit home with folks. After dinner Dad and I watched The Time Traveler’s Wife (not to bad but no where near as good as the most excellent novel). It opens with a future version of the main character coming back to advise his younger self. Just beautiful.
marijuana’s effect on the brain – notes
Neurological effects
Experiments on animal and human tissue have demonstrated disruption of short-term memory,[10] which is consistent with the abundance of CB1 receptors on the hippocampus, the region of the brain most closely associated with memory. Cannabinoids inhibit the release of several neurotransmitters in the hippocampus, like acetylcholine, norepinephrine, and glutamate, resulting in a major decrease in neuronal activity in that region. This decrease in activity resembles a “temporary hippocampal lesion.”[10] In the end, this process could lead to the blocking of cellular processes that are associated with memory formation.
Cannabis consumption affects motor skills, reflexes, and attention, which is important when considering its effects on driving; however, this does not necessarily reflect impairment in terms of performance effectiveness, since few studies report increased accident risk.
Fungi
The fungi Aspergillus flavus,[28] Aspergillus fumigatus,[28] Aspergillus niger,[28] Aspergillus parasiticus, Aspergillus tamarii, Aspergillus sulphureus, Aspergillus repens, Mucor hiemalis (not a human pathogen), Penicillin chrysogenum, Penicillin italicum and Rhizopus nigrans have been found in moldy cannabis.[27] Aspergillus mold species can infect the lungs via smoking or handling of infected cannabis and cause opportunistic and sometimes deadly Aspergillosis.[citation needed] Some of the microorganisms found create aflatoxins, which are toxic and carcinogenic. Researchers suggest that mouldy cannabis thus be discarded.
Mould is also found in smoke from mould infected cannabis,[27][28] and the lungs and nasal passages are a major means of contracting fungal infections. “Levitz and Diamond (1991) suggested baking marijuana in home ovens at 150 °C [302 °F], for five minutes before smoking. Oven treatment killed conidia of A. fumigatus, A. flavus and A. niger, and did not degrade the active component of marijuana, tetrahydrocannabinol (THC).”[27]
Bacteria
Cannabis contaminated with Salmonella muenchen was positively correlated with dozens of cases of salmonellosis in 1981.[29] “Thermophilic actinomycetes” were also found in cannabis.[28]Research shows that although marijuana is in many ways detrimental to a person’s health, it is not so much on the physical side, but more psychological that is apparent. You can get in the habit of using it to fall asleep and get the mind to stop racing or review the thoughts about the day, a person in your past or job and financial anxiety. The body’s cerebellum and serotonin then gets used to this being a way to tune things out rather than developing a way to process emotions and stay calm in the midst of negative feelings. Over long term marijuana use (over five years, per adum), there have been numerous harmful effects of marijuana to the body’s ability to create natural and necessary “feel good” chemicals. In a recent study conducted by Imperial College London, subjects who had smoked cannabis during a five trial, presented with 68% less serotonin than subjects who were unexposed to cannabis.
Marijuana’s Effects Linger in the Brain
WebMD Health News
Feb. 7, 2005 – The effects of marijuana in the brain may linger long after the last joint goes out.
A new study shows that blood flow to the brain in people who smoked marijuana remained altered up to a month after they last smoked pot.
Researchers say the findings may help explain the problems with memory and thinking found in previous studies of chronic marijuana users.
Marijuana’s Effects on the Brain
In the study, which appears in the Feb. 8 issue of Neurology, researchers studied the blood flow in brain arteries of 54 marijuana users and 18 nonusers.
The marijuana users volunteered to participate in an inpatient program and abstained from marijuana use for a month.
Blood flow in the brain was analyzed at the beginning of the study and at the end of the month for the marijuana users.
Researchers found blood flow was significantly higher in marijuana users than in nonusers, both at the beginning and at the end of the study.
However, the marijuana users also had higher scores on the pulsatility index (PI), which is a measure of resistance to blood flow.
Researchers say the level of resistance to blood flow among light and moderate marijuana users improved over the course of the abstinence month. But there was no improvement among heavy marijuana users.
This resistance is thought to be caused by the narrowing of blood vessels that happens when the body’s own ability to regulate the circulatory system becomes impaired.
“The marijuana users had PI values that were somewhat higher than those of people with chronic high blood pressure and diabetes,” says researcher Ronald Herning, PhD, of the National Institute on Drug Abuse in Baltimore, Md., in a news release. “However, their values were lower than those of people with dementia. This suggests that marijuana use leads to abnormalities in the small blood vessels in the brain, because similar PI values have been seen in other diseases that affect the small blood vessels.”
Light marijuana users smoked two to 15 joints per week, moderate users smoked 17 to 70 joints per week, and heavy users smoked 78 to 350 joints per week.
ScienceDaily (Oct. 15, 2008) — Brain imaging shows that the brains of teens that use marijuana are working harder than the brains of their peers who abstain from the drug.
At the 2008 annual meeting of the American Academy of Pediatrics in Boston, Mass., Krista Lisdahl Medina, a University of Cincinnati assistant professor of psychology, presented collaborative research with Susan Tapert, associate professor of psychiatry at the University of California, San Diego.
Medina’s Oct. 12 presentation, titled, “Neuroimaging Marijuana Use and its Effects on Cognitive Function,” suggests that chronic, heavy marijuana use during adolescence – a critical period of ongoing brain development – is associated with poorer performance on thinking tasks, including slower psychomotor speed and poorer complex attention, verbal memory and planning ability. Medina says that’s evident even after a month of stopping marijuana use. She says that while recent findings suggest partial recovery of verbal memory functioning within the first three weeks of adolescent abstinence from marijuana, complex attention skills continue to be affected.
“Not only are their thinking abilities worse, their brain activation to cognitive tasks is abnormal. The tasks are fairly easy, such as remembering the location of objects, and they may be able to complete the tasks, but what we see is that adolescent marijuana users are using more of their parietal and frontal cortices to complete the tasks. Their brain is working harder than it should,” Medina says.
She adds that recent findings suggest females may be at increased risk for the neurocognitive consequences of marijuana use during adolescence, as studies found that teenage girls had marginally larger prefrontal cortex (PFC) volumes compared to girls who did not smoke marijuana. The larger PFC volumes were associated with poorer executive functions of the brain in these teens, such as planning, decision-making or staying focused on a task.
Medina says adolescence is a critical time of brain development and that the findings are yet another warning for adolescents who experiment with drug use. She says more study is needed to see if the thinking abilities of adolescent marijuana users improve following longer periods of abstinence from the drug. “Longitudinal studies following youth over time are needed to rule out the influence of pre-existing differences before teens begin using marijuana, and to examine whether abstinence from marijuana results in recovery of cognitive and brain functioning,” says Medina.
garden production
Its a rainy Sunday so a good chance to update my readers on how the garden has done so far in 2010. I knew the rain was coming so I got my grass mowed and cleaned up the flower bed around the mail box. The little blue asters are looking lovely. I also pulled out the grass around the original lilacs and some other this & that’s. The “low car challenge” (only using my truck for one weekend trip this month) is forcing me out of my usual pattern. I couldn’t pick up a mum or or other fall plant and am largely stuck with what i have at home to work with which is plenty.
Looking back it hasn’t been a great year for the garden. We got a lot of rain and it came down in buckets turning my clay like soil into cement. Nonetheless I eat out of it a couple times a week most of the year. The big hitter was my strawberry patch where I pulled out a good 10 quarts. I added 4 new plants for some genetic diversity and it continues to spread so next year promises to be that much better. My other berries, well maybe next year. Both the blackberries and the black raspberries flowered and then it seems I missed a critical watering and they produced nothing. I ate some nice blackberries on some hikes and they were plentiful in the market so next year I will try to be more on it.
I did OK on lettuce, arugula, and such. I did a green leaf, arugula, and a mescalin mix and got a lot of salads or at least salad supplements. At $12 per pound at the market its worthwhile to grow your own organic mixed greens.The kale struggled but nonetheless I’ve served kale at least 5 times and will have it again this year. The rabbits had their share but it bounced back. Fido is on varmint patrol and the plants i got from Malavika did better than seed so if I get Dad to build my cold frame I should do well next year.
Okra has done well, except for the half the deer ate obviously. I’ve had it four times with at least two more to come. Tomatoes struggled but I’ve had fresh sliced tomatoes more days then not since they came on and have made a few dishes with the uglier ones. The yellow teardrop tomatoes which came up volunteer in the rhubarb bed where my biggest producer and the black plumb did well. Everything else not so much. Just too much rain is word on the street. Next year I’m re-tooling as I put a lot of time into them for not so much tomatoes. I am going early with plastic around the cages with some and some I am waiting and putting in after it warms. I am also going to lime the soil I had a lot of tomato rot (especially the green zebras, a total loss). My hybrids sucked so i will try another variety.
The herb garden is another high point. I pull all the thyme, oregano, basil, tarragon, and sage I can use fresh. Sage was huge and I had more than I need for the whole year by March. I gave away a lot of plants and have 27 smudge sticks going and still have some fresh. Marjoram washed out and I let my big beautiful rosemary die, my most tragic loss of the year. Trying to motivate to deal with and dry herbs.
cucumbers I got in late and let them get overgrown with grass but I’ve had 3 meals out of them with one more coming. Garlic struggled and I came out with 2 survivors. Very tangy and tasty one was. the other I planted. My peppers were almost a complete loss with only coming up with 2 banana peppers. I have a hot pepper on the way. Again just two much rain. I continue to try to build up my beds adding 3-6 inches of organic matter every time I turn it over.
Which brings me to soil development. It just looks better and better. I am not hitting the totally red clay anymore its all black and the topsoil is deeper. Lots more earthworms and moles have moved in so I can assume I have more grubs. I only added outside compost twice so I have almost closed the loop. My compost produces well and is odor free and not drawing bugs.
What else. Second try at rhubarb was an utter failure. First little plants and then roots. Third time is the charm right??? Horseradish looks good though I am curious to see how that is going. My witch hazel looks good and am looking forward to making my own this fall (european style). I had a delicious volunteer pumpkin and I have a butternut coming as well as two acorns.
I also even planted squash this year. I did just a few yellow summer squash and two made the cut and were doing great with some decent production and then they were dog trampled and quickly died. This is going to be a bigger problem as Fido and friends get bigger and not yet calmed down. Yesterday he and his friend trampled my new garlic and tore up my new bed of lettuce. It hasn’t come up yet so i’m hoping its still OK. My fall chard bed was almost a total loss. Heavy rain blasted all the little seedlings except some under the shelter of the mighty Okra. but the dogs trampled the couple of survivors and I am not optimistic. I plan to put in a lettuce bed in the front yard. Ha, take that dogs.
Onions were almost a total loss. they need to be earlier to be bigger when the big summer rains hit. I don’t have the soil for root crops but I still got a handful of little tasty onions with one survivor holding on trying to get bigger in the clay while the dogs jump on him. I am not optimistic.
Lets see what am i forgetting. The persimmon got bigger and i put in a new paw paw tree as well. Behind the fence, take that deer. Sunflowers were a wash. some bugs ate them all. Well that’s all I remember there may have been more. Best innovation was moving the bird bath into the garden. Get a drink eat some bugs while you’re in the neighborhood.
MDMA’s effect on the brain – wikipedia notes
The effects of MDMA (3,4-methylenedioxy-N-methylamphetamine, commonly known as “ecstasy”) on the human brain and body are complex, interacting with several neurochemical systems. It induces serotonin, dopamine, and norepinephrine release, and can act directly on a number of receptors, including a2-adrenergic (adrenaline) and 5HT2A(serotonin) receptors[1]. MDMA promotes the release of several hormones including prolactin, oxytocin, ACTH, dehydroepiandrosterone (DHEA), and the antidiuretic hormone vasopressin (which may be important in its occasional production of water intoxication or hyponatremia).
It’s not fully understood why MDMA induces these unusual psychoactive effects. Most explanations focus on serotonin release. MDMA causes serotonin vesicles in the neurons to release quantities of serotonin into the synapses. Studies using pretreatment with an SSRI to block the ability of MDMA to release serotonin in volunteers suggest serotonin release is necessary for most effects of MDMA in humans.[2] Released serotonin is believed to stimulate several receptors that contribute to the experiential effects of MDMA. Laboratory rodent experiments have shown MDMA to activate oxytocin-containing neurons in the hypothalamus by stimulating 5-HT1A receptors.[3] This appears to contribute to some of the social effects of MDMA: upon administering a drug that blocked brain receptors for oxytocin, the effects of the drug on social behavior were reduced.[4] A second serotonin receptor, 5-HT2A receptors (which are important for the effects of hallucinogens), makes mild contributions to MDMA effects. When the receptor was blocked, volunteers given MDMA reported decreases in MDMA-induced perceptual changes, emotional excitation, and acute adverse responses [5]. In contrast, blocking these 5-HT2A receptors had little effect on MDMA-induced positive mood, well-being, extroversion, and most short-term sequelae. One possible explanation for some of these 5-HTA-mediated effects is that 5-HT2A stimulation induces dopamine release.
Although serotonin is important to the effects of MDMA, other drugs that release serotonin, such as fenfluramine, do not have effects like MDMA.[6] This indicates that other neurochemical systems must be important for the MDMA experience. In addition to serotonin, dopamine and noradrenaline may play important roles in producing MDMA effects. The dopaminergic D2 receptor antagonist haloperidol selectively reduced the euphoric effects of MDMA in volunteers while increasing feelings of anxiety.[7] Although not yet examined in humans, several studies in rodents, indicate the noradrenergic mechanisms contribute to the stimulating effects of MDMA.[8] Finally, currently unexplored effects of MDMA may turn out to be important, such as trace amine receptors.[9]
The effects of MDMA on regional cerebral blood flow (CBF) have been studied in humans using [H215O]-Positron Emission Tomography (PET)[10] MDMA was found to produce alteration of brain activity in cortical, limbic, and paralimbic structures. The dose of MDMA, 1.7 mg/kg, was psychoactive and participants reported heightened mood, increased extroversion, feelings of altered reality, and mild perceptual alterations. Feelings of “extraversion” correlated with CBF in the temporal cortex, amygdala, and orbitofrontal cortex.
Effects beginning after the main effects of MDMA have ended, which can last several days, include:
- Lowered mood or even depression (comedown) after the effects have worn off
- Increased anxiety, stress, and other negative emotions
- Residual feelings of empathy, emotional sensitivity, and a sense of closeness to others (afterglow)
short-term effects
Acute physiological effects include:[14]
- Increased heart rate and blood pressure
- Increased body temperature
- Increased perspiration and sweating
- Pupil dilation
- Blurred vision
- Nystagmus (rapid involuntary eye movements and jittering)
- Trisma (jaw-clenching) and bruxia (grinding of the teeth)
- Difficulty sleeping
- Loss of appetite
- Nausea and emesis
Hyponatremia
An important cause of death following MDMA use is hyponatremia, low blood sodium levels as a result of drinking too much water.[20] While it is important to avoid becoming dehydrated, especially when out dancing in a hot environment, there have been a number of users suffering from water intoxication and associated hyponatremia (dilution of the blood that can cause swelling of the brain).[21] Although many cases of this clearly involved individuals drinking large amounts of water, there are cases where there is no evidence of excessive water consumption. Their cases may be caused by MDMA inducing release of the antidiuretic hormone vasopressin by the pituitary gland.[22] The action of vasopressin on the renal tubules leads to the retention of water, resulting in users producing less urine. (This is unrelated to having difficulty passing urine, a phenomenon known colloquially as E-wee).[23] Hyponatremia also affects marathon runners and bodybuilders, who have been known to die from similar causes, as a result of drinking too much water and sweating out too much salt. It affects women more than men.
Hyponatremia is preventable by drinking fluid containing sodium, such as that contained in sports drinks (typically ~20mM NaCl).[24]
[edit] Hyperthermia
The primary acute risks of taking MDMA resemble those of other stimulant amphetamines. The second most important cause of death from MDMA use is hyperthermia, core body temperature rising too high until the major organs shut down at about 42°C. This is comparatively more problematic than blood salt imbalance, harder to treat and to avoid. Ecstasy-related hyperthermia may occur as a symptom of serotonin syndrome, which is where too much serotonin is released into the brain. This can occur with MDMA if too much 5HTP or other serotonergic drugs are consumed together. 50–200 mg of 5HTP is believed by some users to make MDMA work better and last longer, but anecdotally more than 300 mg 5HTP may increase risk of serotonin syndrome[citation needed], which can lead into lethal hyperthermia if it becomes too severe. It has been suggested that hyperthyroidism may also increase risk of ecstasy-related hyperthermia.[25]
Note that this is different from normal hyperthermia. Dance parties are an obvious hyperthermia risk environment, the venue often being hot and crowded, and the attending public dancing whilst on stimulant drugs. Ideally the temperature inside the dance rooms should be maintained in the range 24–27°C; ecstasy affects the body’s ability to regulate temperature and it is easy to become either too hot or too cold if the temperature is outside of this range.
Mild hyperthermia and/or dehydration can occur from dancing too long, and users may recover with administration of fluids and rest in a cooler environment. However, if the user expresses concern about how hot they feel, or if their body temperature is still rising even when they have stopped dancing and are in a cooler environment, and their skin is hot and dry to the touch, then they may be developing more dangerous drug-induced hyperthermia, and these cases should be taken to and handled by a medical professional immediately.
Overdose
Due to the difference between the recreational dose and the lethality dose, it is extremely rare for a death to be accredited just to the consumption of MDMA. While a typical recreational dose is roughly 100–150 mg (often being measured by eye and dealt with as fractions of a gram), this dose is often then repeated but remains well below the lethal dose. Consumption of the drug can be self-reinforcing while under the influence, and overdoses can occur. People who are grossly obese, or who have diabetes, high blood pressure or heart conditions have a greater risk of overdose death from any stimulant, and should generally avoid MDMA and similar drugs.In very rare cases, MDMA has been associated with serious neurological problems such as subarachnoid hemorrhage, intracranial bleeding, or cerebral infarction. Similar problems have been noted with amphetamines. The mechanisms are thought to involve the short-term hypertension leading to damage of cerebral blood vessels, especially in patients with pre-existing conditions such as arteriovenous malformations or cerebral angiomas.
Serotonergic changes
Experiments indicate that both moderate and high dose or rapidly repeated MDMA exposure may lead to long-lasting changes in neurons that make serotonin. Serotonergic changes have been demonstrated experimentally in the brains of all mammalian species studied, with most studies involving rats. In these studies, the brains of animals who are given high or repeated doses of MDMA show long-term decreases in all measures of serotonergic functioning, including concentrations of serotonin, tryptophan hydroxylase, and binding of the serotonin transporter protein. Although measures of serotonin are decreased, there are no decreases in the number of cells in the dorsal raphe, which indicates that the serotonin neurons have not died. Limited studies attempting to stain and photograph serotonergic axons shortly after high-dose MDMA exposure have reported that axons appear swollen and misshapen, as if they might be degenerating. However, few studies have attempted to stain and examine axons and with the measures commonly used in MDMA studies it is difficult or impossible to distinguish axon loss from decreases in production of markers of serotonin.[41][42]
Animal studies show that there is recovery of serotonergic markers. However, if axons are actually regrowing, there is no assurance that they will reform their original connections. While rats show extensive recovery that sometimes appears complete [43][44], some primate studies show evidence of lasting alterations in serotonergic measures. Human studies, discussed below, show recovery, but these studies use indirect measures that may lack sensitivity for detecting subtle changes.
It is not known what dose(s) of MDMA would produce similar toxic effects in humans. This is because there are some difficulties in translating animal MDMA toxicity studies to humans. Firstly, it is difficult to equate rat doses to human doses, because rats metabolize MDMA twice as fast as humans and often larger doses or multiple doses are administered to simulate human plasma levels. Second, if the neurotoxicity of MDMA depends on its metabolites (Jones 2004;[45]), it may be difficult or impossible to translate an MDMA dose between species since different species metabolize MDMA to different extents. Therefore, it is difficult to say what dose in humans would produce the effects seen in animals.
Keeping these limitations in mind, comparisons of MDMA exposures can be made between animal neurotoxicity studies and human clinical studies. One (uncertain) estimate suggests that the neurotoxic dose may be only moderately higher than amounts given in clinical studies (1.5 or 1.7 mg/kg, about 100 or 120 mg).[46] That published comparison was made based on data from rats.
Further comparisons can be made using monkey data. In a recent study by Mechan et al. (2006), the lowest repeated dose regimen that produced serotonergic effects, detectable after 2 weeks, in squirrel monkeys was 2.4 mg/kg given orally three times in a row (every 3 hours). The peak plasma MDMA concentrations seen after that dose was 787 ± 129 ng/ml (mean ± SEM, range: 654 to 1046 ng/ml) and the area-under-the-concentration-vs-time-curve (AUC, a measure of overall drug exposure) was 3451 ± 103 hr*ng/ml. In comparison, 1.6 mg/kg oral (112 mg in a 70 kg / person) in humans produces peak MDMA concentrations of 291.8 ± 76.5 ng/ml (range: 190 – 465 ng/ml) and an AUC of 3485.3 ± 760.1 hr*ng/ml (Kolbrich et al. 2008). Thus, a typical human dose produces peak MDMA concentrations that are about 37% of a known neurotoxic dose and has a very similar AUC. Because MDMA has nonlinear kinetics, it is likely that fewer than three of these doses would be needed to produce an exposure in humans greater than the dose schedule that produced decreased brain serotonin and decreased serotonin transporter binding in monkeys.
[edit] Mechanisms of serotonergic changes
The mechanism proposed for this apparent neurotoxicity involves the induction of oxidative stress. This stress results from an increase in free radicals and a decrease in antioxidants in the brain. (Shankaran, 2001) Oxidation is part of the normal metabolic processes of the body. As the cell goes about its life, by-products called oxidative radicals are formed, also called free radicals. These molecules have an unpaired electron that makes them highly reactive. They pull strongly on the electrons of neighboring molecules and destabilize the electrical balance of those molecules, sometimes causing those molecules to fall apart. This can become a chain reaction.
In normal functioning, there are antioxidants in the system that act as free radical scavengers. These are molecules with an extra electron that they are willing to give up to the free radicals, making both the free radical and the antioxidant more stable. MDMA rapidly increases the levels of free radicals in the system, which is thought to overwhelm the reserves of scavengers. The radicals then damage cell walls, reduce the flexibility of blood vessels, destroy enzymes, and cause other molecular damage in the neurological pathways. (Erowid, 2001) It has been shown that MDMA’s neurotoxic effects in rodents are increased by a hyperthermic environment and decreased by a hypothermic one. (Yeh, 1997)
Studies have suggested that the neurotoxic molecules are not hydroxyl free radicals, but superoxide free radicals. When rats are injected with salicylate, a molecule that scavenges hydroxyl free radicals, the neurotoxic effects of MDMA are not attenuated, but actually potentiated. Further evidence of this superoxide theory comes from the observation that CuZn-superoxide dismutase transgenic mice (mice with excess human antioxidant enzyme) demonstrate neuroprotective mechanisms that protect the mice from MDMA-induced depletion of 5-HT (serotonin) and 5-HIAA and lethal effects. (Baggott, 2001 and Yeh, 1997)
MDMA itself does not seem to be neurotoxic as infusing it into an animal’s brain does not produce long-term serotonergic changes. This suggests that another molecule may be triggering the oxidative stress. Different scientists have suggested that either a dopamine or an MDMA metabolite (such as 3,4-dihydroxy-methamphetamine) might be important for initiating the cascade of oxidative stress. However, no consensus has emerged as of yet.
[edit] Possible neuroprotective strategies
There are a number of factors that have been shown to protect animals from long-term MDMA-induced serotonin changes. These include dose, temperature, antioxidants, and SSRIs. Some MDMA users have attempted to use analogous strategies to decrease their risks of long-term serotonin changes, although there is uncertainty as to how well this works in people[citation needed].
The most obvious strategy is reducing dose. Long-term serotonergic changes are dose dependent in animals. Taking higher or repeated doses of MDMA is therefore likely to increase chances of similar changes in people. Although the threshold dose to cause toxicity is unknown in humans, lower doses are almost certainly less risky[citation needed].
Studies in rats also find that environments or activities that increase the animals’ body temperature increase serotonergic changes. However, this finding has not been replicated in primates, possibly because rodents are less able to regulate body temperature than primates. Nonetheless, it is possible that higher body temperature also increases serotonergic changes in people[citation needed].
Antioxidants may decrease possible MDMA-induced serotonergic changes. Studies in rats have shown that injections of ascorbic acid, alpha lipoic acid, or some other radical scavengers are effective in reducing oxidative stress caused by MDMA. (Erowid, 2001) It has been speculated that humans may be able to similarly achieve protection using a combination of antioxidants, such as Vitamin A, C, and E or multivitamins including selenium, riboflavin, zinc, carotenoids, etc. may help reduce oxidative damage. No published studies have confirmed that this works. In addition, many of these vitamins, though, are water soluble, and are quickly excreted from the body. The typical MDMA user is psychoactive for 4–6 hours and may not have an appetite from the time of taking until the following sleep cycle or many hours later. Damage occurs in the absence of these antioxidants.Selective serotonin reuptake inhibitors (SSRIs) have been shown to decrease or block MDMA neurotoxicity in rodents, even if they are given several hours after MDMA. Because of this, some MDMA users administer an SSRI while, or shortly after taking MDMA, in an attempt to prevent possible neurotoxicity. These SSRIs are typically antidepressants such as fluoxetine or sertraline. The theory of some scientists[who?] is that SSRIs prevent dopamine or a neurotoxic MDMA metabolite from entering through the serotonin reuptake transporter, where it is theorized that it may contribute to formation of reactive oxygen species, including hydrogen peroxide. There are several concerns with taking SSRIs with MDMA. On a practical level, administration of SSRIs will block the desired effects of the drug if taken too early. This blocking effect can last several weeks, depending on the half-life of the SSRI. In addition, MDMA and the SSRI will often mutually reduce each other’s metabolism, causing them to last longer in the body. Theoretically, this might increase risk of overdosing on the SSRI, leading to serotonin syndrome. Although this appears to occur rarely (if ever), it is considered a theoretical possibility.
Evidence for serotonergic changes in humans
Studies have used positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging methods to estimate brain serotonin transporter levels in ecstasy users. These studies have found reduced levels of the transporter in recently abstinent MDMA users as well as evidence of partial or full recovery with prolonged abstinence. However, the sensitivity of these methods is unknown and changes may not have been detected. Three studies of 5-HT2A receptors in human MDMA users have been published by one group of researchers (Reneman and colleagues). Together, these studies find possibly reduced receptor binding during active MDMA use and increased receptor binding in longer-abstinent subjects. The authors argue that long-lasting reductions in 5-HT release may have caused compensatory up-regulation of 5-HT2A receptors. Other studies have measured cerebrospinal fluid concentrations of the serotonin metabolite 5HIAA. Three of four published studies have reported concentrations to be lower in ecstasy users than non-users.
One difficulty in interpreting these studies is that it is difficult to know if serotonergic differences predated MDMA use. In addition, none of these studies can address whether any changes are neurotoxicity proper or neuroadaptation. A recent review concluded that “the current state of neuroimaging in human MDMA users does not permit conclusions regarding the long-term effects of MDMA exposure”.[49]In addition, mood is sometimes found to be worse and impulsivity greater in ecstasy users. At least two meta-analyses of these studies have been completed (Morgan 2000; Sumnall & Cole 2005). Morgan’s analysis of 17 studies showed that ecstasy users had a slight tendency to be more impulsive and have lower mood than controls. Sumnall and Cole’s analysis showed a slight increase in the prevalence of depressive symptoms in ecstasy users over controls. (Mood measured in these studies does not indicate clinical levels of depression, which has not been associated with MDMA use.) Of course, studies like these raise a cause-consequence question: did these impulsive and depressed people use ecstasy to self-medicate or did otherwise normal people become depressed and impulsive after using ecstasy?[52][53][54]A recent important study (the NeXT Netherlands XTC toxicity study) prospectively examined 25 people before and after their first episode of ecstasy use (mean 2.0 ± 1.4 ecstasy pills, on average 11.1 ± 12.9 weeks since last ecstasy use). The study measured working memory, selective attention, and associative memory using fMRI. No significant effects were found of the reportedly modest dose(s) of ecstasy on any of these measures, suggesting that the first few exposures to ecstasy typically do not cause significant residual toxicity.[55] Thus, if ecstasy does cause cognitive-behavioral changes, it would likely require repeated use for these changes to occur (or become detectable). Contrary to this another recent report has shown that a single exposure to MDMA can result in cognitive-behavioral changes.
Addiction and tolerance
The potential of MDMA to produce addiction is controversial. Some studies indicate that many users may be addicted, but this depends on the definition of addiction; while many ecstasy users may take the drug regularly and develop significant tolerance to its effects, relatively few users exhibit cravings or physical symptoms of dependence, or find it difficult to stop using the drug when they decide to do so
PCP & the brain – notes & links
What Are the Effects of PCP?
From National Institute on Drug Abuse
Updated September 07, 2009
PCP, developed in the 1950s as an intravenous surgical anesthetic, is classified as a dissociative anesthetic: Its sedative and anesthetic effects are trance-like, and patients experience a feeling of being “out of body” and detached from their environment.
In powdered form, the drug is sprinkled on marijuana, tobacco, or parsley, then smoked, and the onset of effects is rapid. Users sometimes ingest PCP by snorting the powder or by swallowing it in tablet form. Normally a white crystalline powder, PCP is sometimes colored with water-soluble or alcohol-soluble dyes.
When snorted or smoked, PCP rapidly passes to the brain to disrupt the functioning of sites known as NMDA (N-methyl-D-aspartate) receptor complexes, which are receptors for the neurotransmitter glutamate. Glutamate receptors play a major role in the perception of pain, in cognition – including learning and memory – and in emotion. In the brain, PCP also alters the actions of dopamine, a neurotransmitter responsible for the euphoria and “rush” associated with many abused drugs.
At low PCP doses (5 mg or less), physical effects include shallow, rapid breathing, increased blood pressure and heart rate, and elevated temperature. Doses of 10 mg or more cause dangerous changes in blood pressure, heart rate, and respiration, often accompanied by nausea, blurred vision, dizziness, and decreased awareness of pain.
Muscle contractions may cause uncoordinated movements and bizarre postures. When severe, the muscle contractions can result in bone fracture or in kidney damage or failure as a consequence of muscle cells breaking down. Very high doses of PCP can cause convulsions, coma, hyperthermia, and death.
PCP’s effects are unpredictable. Typically, they are felt within minutes of ingestion and last for several hours. Some users report feeling the drug’s effects for days. One drug-taking episode may produce feelings of detachment from reality, including distortions of space, time, and body image; another may produce hallucinations, panic, and fear. Some users report feelings of invulnerability and exaggerated strength. PCP users may become severely disoriented, violent, or suicidal.
Repeated use of PCP can result in addiction, and recent research suggests that repeated or prolonged use of PCP can cause withdrawal syndrome when drug use is stopped. Symptoms such as memory loss and depression may persist for as long as a year after a chronic user stops taking PCP.
PCP was used in veterinary medicine but was never approved for human use because of problems that arose during clinical studies, including delirium and extreme agitation experienced by patients emerging from anesthesia.
Effects of Long Term Use 26
- “Runs” – Chronic users may binge use PCP, taking it repeatedly for 2 or 3 days at a time without eating or sleeping, followed by a period of sleep. These runs may occur as many as four times in a month.
- Impaired memory
- “Flashbacks” similar to those experienced by chronic LSD users
- Persistent speech problems, such as stuttering, inability to articulate, or the inability to speak at all
- Chronic and severe anxiety and depression, possibly leading to suicide attempts
- Social withdrawal and isolation
- Toxic psychosis may appear in chronic users who do not have a prior history of psychiatric disturbances. The symptoms of toxic psychosis are aggressive or hostile behavior, paranoia, delusional thinking and auditory hallucinations.
PCP and Violence
Despite its reputation in the media as a drug that causes bizarrely violent behavior and gives users superhuman strength, research does not support the idea that PCP itself is the cause of such behavior and strength. Instead, those who experience violent outbursts while under the influence of PCP often have a history of psychosis or antisocial behavior that may or may not be related to their drug abuse.27
potpourri with hummingbird
Its an extremely beautiful day, high 82 low 58. Its dried out some from yesterday’s rain. a hummingbird comes and eats at one of my flowers out front. just magically beautiful and i am still inside. lions and tigers and bears oh my. orioles as well. couple of one point games. i also have pumpkin stuff (my front yard volunteer pumpkin, fresh ground cinnamon, allspice, clove, star anise, and nutmeg, pet milk, bake at 300 for an hour, sprinkle with honey and bake another hour) in the oven plus a mess of hot peppers roasting to be frozen for winter consumption. That with the load of laundry on the line its alright to be inside. after the games and the oven planning on biking my overdue books back to the library. I rode to the market yesterday. I was observant to how it was different then driving. I bought have as much stuff and spent more than twice as long there. I was more thoughtful in how much i wanted something and conscientious not to forget anything. Sarah rode her bike over and we rode together and we walked our bikes til where our paths separated. Rode back along Again Park and it felt good to be riding again. I’m 7 miles towards getting my recumbent. If I can demonstrate I am going to ride a lot it would be better for my back. My most thoughtful physical therapist thought bike riding was how i bulged those two discs. i also don’t want to put out the money and space and then not ride.
I haven’t finished the tale of the detroit trip. On Labor Day the neighborhood came alive, there was a union headquarters near and a lot of folks with signs and t-shirts showed up for a while and we realized we were there on the one day a year trumbul comes back to life. We got the great coffee and i had a pretty authentic ham sandwich at Le Petit Zinc. The bees were back but bothering others. Tre’ and Jeff enjoyed their crepes.
We drove down Trumbul to the Trumbulplex. No one seemed around and the flyer about the political poster exhibit didn’t have times. Trevor flagged down a hipster in black leather pants and matching lipstick who claimed to be a neighbor but said she would get somebody. Somebody turned out to be Ashley who had met Jeff at the bakery (Farmington anarchists is a small pool, I think we had both of them present). The NIRS no nukes bumpersticker caught my eye and took me back to the ’95 fermi protests, I remember picking and dropping off stuff here, might have caught a show but i don’t think so.
The exhibit is cool. An Emma Goldman flier is probably my favorite. Ashley is very friendly, the only resident involved with the theater. she gives us the garden tour: bees, chickens (used to be more til a bunch got heisted), there’s a huge rain catch (500 gallons?), and a great garden plot, orchard, more garden plots. I have an apricot. its yummy but a little early. Ashley’s plot looks great. Awesome cruciferous veggies, better than you can grow in como.
After the tour we drove back grand river to hang out in farmington. met the littler kids and chilled out a bit. learned a friend is an internet meme (note to self: need to check on that). relaxed. walked down and got ice cream. said goodbye.
pleasant flight back and goodbyes to trevor at the airport. some shuttle mishaps but am finally delivered to my truck. on the road home, what a great trip.
The warning lights that had come on in the drive out were on and stayed on. In Wentzville the old truck lost power had it on the floor 65, 60, 55…on the side of the road just in front of a junction to another highway. I tucked my laptop behind the seat (key broke off door at KC airport & can’t lock it anymore) and took my backpack. I walked up the highway and then along a fence until i could squeeze under the fence near a washed out area.
I walked towards a motel not begrudging my lack of a cell phone. adds a little adventure to life. I walk into the lobby the desk is unattended. there is a note to ring bell or call a couple of numbers. I ring the bell. no one comes. I ring again no one comes.
I walk out on the service road weighing my options. I start walking west on the service road it curves away from the highway and i take the first right and walk in the dark country road. I walk 4 miles and get to a gas station. she lets me make a local call on her dieing cordless and gives me the number of a tow company.
He picks me up and takes me to my truck. He grudgingly lets me make a call on his cell and i leave a message for dad asking him to pick me up in Wentzville if he gets the message. He tows me to Dan’s Foreign Auto and I write out a note on what happened and he drives me to the Super 8. He declines me a second call so i don’t tip him. The hotel clerk begrudgingly lets me make a long distance call. Dad is enroute.
We get home late and I am glad I took the next day off work. Slept in and mowed the lawn. was glad to be home where its not so cold and the landscape is not so haunted with sadness and loss. after some days Dan reports he can’t find anything wrong with the truck. Dad runs me out there right after work on Friday and we are rushing to beat the 6 o’ clock close time. We make it and talk to Dan. The warning lights come up and Dan has me show him. Its the alternator brushes. That’s why it comes and goes. i am now rushed to get it home before dark so because the car is questionable with the lights on.
I drive. I am uncomfortable with my rush of thoughts with the abbreviated overwhelming work week. I risk some radio to share the cab with NPR. Until the warning light comes on. then i am left alone with wild thoughts. I note my 20 oz pepsi impulse buy. it was for comfort in a maybe the truck will make it maybe it won’t. I think about neil stephenson’s comments on sugar water in “Anathem’. I decide to write and come up with:
I’m going to drink a bucket of sugar water
And yak into my new jeejah,
And drive my old fetch across the highways of life
Remembering the fuel trees.
And when my journey is finally over
And I am safe at home at last
I’ll think about the present future
What the world will be when it’s past.
Will our numbers keep on growing
While our resources start to where thin
With less and less of god’s creation
And more and more with sin.
I like the start of it and hope i can go further with it. The lions just lost a heart breaker, should’ve been a game winning touchdown. At least the tigers won there’s. win or lose its time to wrap this up and get out and enjoy some perfect day.
sublime detroit part 4
there’s a lot of other stuff i want to write about so i am going to try to knock out the detroit trip so i can move on. its dark so the capitals are off. dad has dinner in preparation so we may not finish in 4.
Sunday we woke and enjoyed some cable and melon from the market. It was pretty good, the melon not the cable. Although on a note the porn was a unique addition to cable tv from my usual hotel stays. i guess that’s what you get with that second star. flipping through channels it would come up every 46th flip and it appeared to be big ass porn. i couldn’t remember if that was what it was yesterday and i wondered if that’s all they played. “popping the trunk” was my expanded horizon but i can’t say i was a better person for knowing that. interesting nonetheless.
We decided to venture out and see the world around us, see what ephemera might be cast about to be noted, collected. Right around the corner was the memorable Cesar Chavez Middle School gone feral. i had never heard that term but Tre’ explained there was a whole culture of folks exploring and documenting feral buildings. “urban spelunking”.
Coincidentally there was an open door on Cesar Chavez Middle School and an exercise bike caught Tre’s eye. We walked in and things were largely intact and empty with a musty smell. A coupe rooms back there was a room full of Alpo cans and there was burned area and a pile of picture encyclopedias. Tre grabbed up the one that included Missouri in spite of the undertones of urine in the room. Huddled up with your dog, i hoped, burning picture encyclopedias for warmth. What a picture for the death of civilization.
We wandered up Trumbul and its environs seeing the grassy lot that was Tiger Stadium. I told Trevor about coming up to see games from when i was a kid to ’95 when I was living in the ‘D’ fighting nuclear power. What decline, closed yuppie restaurants. the old parking signs in yards but no one’s coming to park, free shuttle or not. sad and neglected i have never seen this kind of decline. ghosttownification right before my eyes.
We wander and look and walk-about in wonder at the change. more sardonic than sad seeing some hope in the possibility if we stopped being dumbasses. stranger things have happened. We talk about food deserts in the urban wilderness. in our neighborhood we have a cool looking cafe’ ‘le petit zinc’, french.
We sit on the patio and decide to have coffee. its a crepe and sandwich place with a bar. in france the hole in the wall bars had bars of zinc and hence the name. there are a lot of honey bees pestering the patrons. there’s a bit of garden, so i don’t begrudge the bees. flowers, some ‘maters, and a functioning herb garden. they use a lot of basil, rosemary doing great but they don’t use much.
the coffee is first class. small cups for america ginormous for a french cup but tasting like theirs. nice. friendly and laid back. we head back to the hotel. i pulled the trash out of the ‘mater patch, its doing pretty good. going in the clerk who checked us in gave us a message that Becky had called and let us use his phone so we didn’t pick up a charge. made plans to see Jeff at 7. trevor checked his email on the lobby comuter, as did i. it was quiet on the electronic universe.
We walked down to the festival and caught some jazz. sounded good. i brought my book and Doris Lessing goes good with jazz. its a bit warmer and we never break out our jackets. we get full of jazz and hang out in the park. i tell trevor about hanging out there in ’90 while my buddy chad osborne volunteered at the Focus Gallery. one day they tried to count me as a homeless guy in the census three times, trying to keep their million. didn’t happen. 700k i hear now in a city built for 2 million. we listen to more jazz. a big band. you can do a lot with 17 people. it is the largest jazz group i have seen except for schools. the school band was perfunctory.
we saw jeff who told us his friend Ed would be joining us. they are re-enactor buddies 18th century french explorers. jeff is pretty into it, quite a kit and bakes 18th century. we grab some beers and go back to the hotel and get to know one another. Ed has his partner with him whose name is escaping me. they live up in hamtrammick just bought a house.
we talk and trevor fades and the rest of us go out for more local beers at a barbecue place whose kitchen just closed. so we top it off at a coney island (my third if your counting and far and away the best). i get a first class gyro, man i wish i could get one close to this good anywhere in missouri. its a weird scene out late in the urban coney. a cook gets agitated. he sits down with us and takes our orders right after after a long long wait. the food is excellent and snappy when it happens. its a great evening of great fun. jeff crashes over, what a wonderful day.
sublime detroit part 3 –
We continued to drive down Grand River until a building with mirrors glued all over it caught our eye. Trevor made a quick u-turn and we were back. It was a Heidelbergesque project with the mirror building and in the back a huge installation of found object art. There were a bunch of chairs with chunks of concrete in them (Trevor’s interpretation place holders for when the people come back, my interpretation the deadening effects of school), and most striking a large sort of scare crow made out of slices of vinyl interior topped with an African mask. It was Dabl’s bead museum and we got to meet the propetier who invited us to look around and told us it was a 10 year project. We took the tour and checked out how he had expanded to a nearby abandoned building. There were African language lessons painted on the sidewalks. It was all very cool. A little art in the wreckage, very postapocalyptic and it fit in great with the increasing number of abandoned buildings as we got deeper into Detroit. We also got directions to our hotel as my discount atlas didn’t have Trumbul though I had a fair idea based on the old Tiger Stadium. We drove to the hotel and I was struck on the incredible decline of Trumbul. Michigan and Trumbul is a grass lot, all of the sports bars and restaurants I remembered from my childhood were closed. It was very much a ghost town. We arrived at our hotel and checked in. There was the dank smell of marijuana in the first floor hall and a musty odor on the 4th floor. The room was small but nice and appeared clean.
Then it was off to see some jazz. We decided to walk as it wasn’t much more than a mile to Hart plaza. We caught some pieces of sets and moved from stage to stage. My favorite was an electronic act with the voice all altered and playing loops and it was very fun and the performers looked like they were having a good time. I like jazz a lot when its live and you can feel a part of it but i’m not a fan enough to know bands or probably really appreciate what they are doing.
It was most fun watching the people. It was very diverse 45/45 black and white and 10% everything else. Except for the dearth of children it was pretty age diverse and there were homeless to the bourgeois. Jazz is a uniter not a divider. We left early because it was colder than shit. September in Missouri is far superior. I hadn’t even brought a jacket thinking a long sleeve shirt would be sufficient. I had picked one up at a thrift store and was glad to have it in spite of its unsettling dirty sleeves (they washed up nice you may care to know).
We walked back to the hotel full of jazz. We were debating getting a 6 pack and ordering pizza but we stumbled across a Coney Island instead. I had a fairly good patty melt but trevor’s tuna melt looked tastier.
sublime detroit part 2 –
Woke up Saturday morning at the Burns-Pavlik demesne specifically in the princess room. I had slept hard and needed it going on a few hours of light sleep the night before. The heavy curtains were nice as sleeping well into the morning was a nice change of pace. Trevor was out for a run so i curled up with Doris Lessings “The Golden Notebook” which is just a heavy and brilliant novel. Dense with meaning she has literary talent, a piercing political consciousness, and rare insight into the human condition. its sweet.
After Trevor returned I made coffee and had some of Jeff’s most excellent cinnamon roll I explored the backyard. I remembered what it was like when they first moved in, typical suburban fenced in grass box, the green rectangle endlessly repeated. Now there’s a nice patch of prairie wildflowers looking very Autumnal to my Missouri eyes, looking very sharp in its benign neglect. I was envious that i couldn’t let my plot be and have it still work.
It was a just beautiful morning and I was glad to have lingered. We drove back to Farmington and went to the farmer’s market. Very cool, very lively lots of great stuff. We got cucumbers and a couple of melons a cantaloupe and something similar and some apples. Besides stuff we could eat in detroit i also looked for stuff to take home. I was delighted to see some Michigan maple syrup and I excitedly picked up a big bottle then remembered that i only had a carry on bag to get home and there’s a 3 oz rule for michigan maple syrup (can’t get it at home). I put it down and said “i’m flying and i can’t take it back. the terrorists have won. i conceded, i admit defeat, please now can i fly with michigan maple syrup?”
so i bought nothing, my innocent glee in the beautiful day of seeing all these folks marketing tempered.
but only for a moment. then it was lunch with rosie, jeff was baking and becky was slinging bread but rosie was up for some chicken chili. tre’ and i had the reubens, good but the french dressing kind which i like a bit less, but really good. i can’t remember the name of the place but rosie thought highly of it.
after lunch we said goodbye to becky and rosie and after stopping to look at discount books and by a map we were off. we decided to drive up 8 mile to most appreciate the transition into the city. for some reason we took grand river instead, a cool street that runs across the state. i’d ridden my bike on probably the first 100 miles coming out of grand rapids getting in shape for my trip to Mexico.
This stretch got shoddier and vacant buildings started to increase until we were in full on city. we stopped at a ghetto mart and stocked up on food: bread, mega sized jar of peanut butter, chips, salsa, cheese, plastic ware, perhaps other things. We were in line behind an older african american guy buying a nice stock pot at $5.95 and a mess of greens. I commented quietly to trevor that that was a good buy on the pot and was pleased to see the guy straighten up. everybody likes to get a good deal.
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