"The truth is that most people in this game end up in prison, on drugs or dead. There are very few past the age of 40 who are alive and successful. A lot of pimps meet their maker when a ho's family member finds out about her ho'ing. A big brother who just got out of jail to find his sister out there ho'ing will be looking for that pimp. And when he finds that pimp -- it's his ass. I know so many pimps who have been killed by angry family members who blame the pimp for that ho's life choice. So, do know that my goal is to teach the wisdom of the pimp mentality, not to become a peddler of flesh. The value of this game is in learning how to pimp the same way Uncle Sam, big business and the power brokers in this world pimp. Learn how to pimp on that level, and at the same time, watch out for those who may want to pimp on you."
-Pimpin' Ken, PIMPOLOGY -- THE 48 LAWS OF THE GAME
Last month I invested thousand$ making under-the-counter dope runs for my ATF stripper UTR porn star. Only way to keep her from the stress and risk of working then spending 99.9% of it on pills to inject, while waiting endlessly for detox to let her in or to get free meds from the lawful dope pushers. Even her doctor said self-detox might kill her or the baby, if detox don't. The same OB who never heard of pyroluria, a disease was eventually diagnosed with, with a cheap and simple OTC cure for anxiety disorder and addictions (niacin vitamin B3, B6 and zinc).
An oft-homeless girl who hooked $300,000 getting high before age 21. Hooked on heroin and opiates for 8 years, despite many detox/rehabs/bootcamps/opiate-blockers. At least I helped fix the homeless part with my PT sugarbaby "modeling and cosmetology" contract. Her wealthiest sugardaddy/roommate just checked himself into the loonybin -- after threatening to kill her BF then tried to off himself (thanks to a prescription cocktail of seroquel, ambien and klonopin).
I'm all she's got, without whoring out to stranglers.
"If it weren't for me you wouldn't have bought the drugs. I feel bad about that."
"I would've gotten the money anyway."
"Of course. But I needed access to see what we can do to fix it." The sex marathons were pretty goddamn awesome, too.
The rationalization that she enjoyed sex with me was difficult to maintain while investigating the suburban underworld as an embedded undercover journalist. Orgasms were becoming more and more difficult for her to achieve, and more and more difficult for me to endurance. Got some amazing photos of her shooting up, unlike anything else in publication or on the net. Too early to publish the insane beauty of this rocky horror show. These heroin heads really love their rush, if only for a few minutes.
"Sometimes it lasts longer."
To understand what these girls are up against, its essential to see it f2f. Only then can a successful escape plan be formulated. No social worker or psych pro can do this, which is why many psych pros are required to be former addicts as condition for employment. Few family members have the guts or balls to do it -- they usually just freak out and call the cops, as family did to my little hooker. I certainly didn't have the guts to video the shock and awe for broadcast work -- just too damn close to the inferno.
The same day she was suddenly called to detox, my callgirl nearly ODed on trying to shoot up everything left in her weekly inventory. I fucked up and didn't take possession, due to wimping out and not wanting to take the risk of arrest. I misunderestimated her addiction by a factor of 10. Luckily, her BF and dealer were there to save the day, by using much of the drugs I paid her services for (insert sarcasm here). Watching her procrastinate while emptying her purse of nearly a dozen needles and syringes was sobering for even a sober man like myself, especially when I realized I had been driving around with that shit in my car for 6 months (insert her laughter here). At least I helped jew down her dealers to 20-cents on the dollar (the easier to overdose my dear), teaching her a valuable lesson in finance that her "friendly" dealers had been ripping her off for years.
Then the screaming started. Detox will intentially give no notice as to time of intake, specifically to fuck up an addict who will of course try to score and be as high as possible upon entering detox. Late = no admission. She was unable to find a collapsed vein and started screaming in the bathroom. Intense.
She told me she hated me and wanted to punch me for rushing her to detox. Fair enough. Bring it.
We made it just in time, though they made her wait over an hour to confirm insurance would take her for the second time this year. Rehab not covered for seconds.
Gave her a hug and told her I was proud of her. "It's okay if we never have sex again, so long as you stay clean and sober." (I lied, though it's a very real possibility.)
But that very may well come true. We've never had sex while she was sober. We've never had sex when she wasn't fucking only for drug money. I'm sure I'm more attractive when she wears her opiate goggles. She's been having sex and doing heroin since 13 -- the cancer may be inoperable without killing the patient. She says 90% of hookers only do it for the dope money. How do you get a hooker to stop hooking? Cure her drug addiction...plus free meds, free housing and a disability paycheck.
She's been raped so many times since age 7. What monsters are lurking to explode inside, when the manic genie is no longer corked by opioids?
Got a couple of calls from detox, nothing to discuss besides practical matters. No feelings gushing forth while doped on subutex. (Shit, reminds me of every phone conversation with my alcoholic drug-addicted ex-wife.)
She even saw her doper pimp BF* at an OB appointment in detox. Same BF she was shooting up with 3 days prior, paid for by pimping his GF to me, now going through withdrawal by using up her herbal home detox kit. ("He's off the drugs and he's not my pimp!") Which is why I'm keeping the addiction cure piss test at my place, to be mailed to the lab within 48 hours. [She did later test POSITIVE for pyroluria, the malnutrition cause of addictions and anxiety disorder, cured by OTC niacin vitamin B3, B6 and zinc.] (* "BF" is defined by her as any sucker willing to be monogamous and do dope with her, even if it kills him, one way or another. "Would you ever date a BF in an open relationship?" "Only if he don't sleep around." No wonder he walks like a zombie. More of a sexslave then.)
Forget the mix tape, BF uses my stolen vibrator
Got the call to pick her up from detox. Amazingly, she survived the experience. This is the same girl who got knocked up and ODed in rehab before.
Although still trippin on subutex, the change was already visible upon her release. Still with the opium eyes (or is it undiagnosed hyperthyroidism that mimics her diagnosis of Anxiety Disorder?), since still on opioids, but lookin better already. The glow, intelligence and animation were returning to the face of this beautiful 20-year-old professional model and TV actress (and half-lesbian-porn star). Still dressed like a homeless street urchin, but now that the dope runs are over, we can fix that (a lot cheaper than dope). At least she's not making dope deals on her cell at detox, like she was after the intake interview.
We discuss the pending housing change -- open cohabitation with a drug-addicted hooker sugarbaby -- what a brilliant idea! Has she told the doper BF? Of course not. Everyone agrees, its either him or her baby, she can't have both.
"He's got a job lined up for tomorrow!"
"Your dealer said he skipped job search the day you went to detox. And he's already abandoned 3 kids."
"So what's new with you?"
"Not much. The cops banned me from my home and got fired from my job because my ex-wife didn't enjoy meeting you."
"WTF?!" (long story, much worse than it sounds, though I did get paid $25,000 for the traumatic experience.)
"Welcome back to reality lol."
I took a major hit for being her friend ($25,000 gift notwithstanding). I touch and try to hold hands...no response...I withdraw after a couple seconds. IT HAS BEGUN.
We discuss the risks and contingency plans. "Hey, even if you go back to shooting up with your BF and lose the baby to CPS, I'd have a great pickup tool for the ladies. Better than a puppy!" FRIEND ZONE LEVEL 999,999,999
Why would I risk everything I love for a doped-up hooker I (say I) don't love? She says she only loves her doper pimp.
"But I'm not 'in love', and he's not my pimp!!!"
"I see, you just pimp yourself out to buy him dope and pay his bills."
"He runs pimp game on you -- he doesn't lift you up with Positive Mental Attitude. He beats you down then lifts you up just a little bit to make you think you need him. It's mind control -- Pimpin 101."
"I want to read your Pimp book..."
"The absolute best pimps--business tycoons, power brokers and politicians--don't have girls on the streets working the tracks, but they do make countless dollars living off of other people's intelligence and hard work. Good pimps don't have to steal or take anyone's money by force, because hoes will GIVE the pimps their money willingly. The biggest baddest most powerful pimp of all time is named Uncle Sam. Every April 15th he tells you to 'Break yourself bitch!' Uncle Sam can reach into your pocket at any time and take what he wants, and if you try to stop him, he puts your ass under pimp arrest. Instead of the man in red, white and blue with the top hat, they need to dress Uncle Sam in a fly Versace suit, some gators, and a jewel encrusted cane!'"
-Pimpin' Ken, Pimpology: The 48 Laws of the Game
"You're a loving person. I've never seen you be mean to anyone in the year I've known you. I know you love your daughter. That's so obvious to everyone. It shines through in your modeling photos. You deserve a break and I'm gonna give it to you as best I can." (no response, as expected, feelings still shut down)
Then I drive her back to her doper pimp BF... ("He's off the drugs and he's not my pimp!") She doesn't want to be with me... He don't look happy at her success at cutting off his dope supply, or at me. ("You're having an affair with him, aren't you?!")
She does want to go to a Narcanon meeting later. I offer my taxi service. Woohoo -- a sexless date is more fun than doper sex (I lie). But will she be all fucked up from the leftover shit in her needles? "No, there's no way (my BF) left anything for me." (Don't say much for his self-control "quitting cold turkey while she's in detox.")
I return to the scene of the crimes and pick her up for NA date night. She kisses her BF pimp addict goodbye. ("He quit cold-turkey and he's not my pimp!!")
When we get to the church meeting I realize I've been there before, over 20 years ago for a 12-step group (codependant suckers anon). Syncronicity all over again? I can't recall the name of the red-headed MILF with nice tits I picked up (or picked me up) in that same room, perhaps before my current friend was born...
The rules require no sharing when still high, so she keeps her pretty cum-sucker shut. Needle-tracked hands calmly folded in her preggie lap. Probably terrified the other addicts. At least she suddenly quit dressing for success when off-duty, much less distracting for the fellow addicts. Ironic that detox releases inmates still high on legal dope. Perhaps that explains the 95% fail rate of detox?
The sharing begins. Her eyes water up a couple of times, but she shuts down her feelings quick. Hell, my eyes watered up too, just a little dust in my eye that's all (I lie). I'm proud of her and myself, but we both have a long way to go. Are we saving each other? I wish my ex had done this -- I tried and failed for 20 years. "I'm Bill*, and I'm an addict. I haven't been in this room in 20 years. (Forgot to mention the hookup.) 30 years ago I joined the military and took cocaine to basic training. Somehow I didn't get caught and finally flushed it down the toilet. I haven't looked back since. But I wish I'd gone to these meetings back then." "Thanks for sharing." The healing begins. (*Probably not my real name.)
Daily NA is a substitute for the daily dope runs, with a few hours left over for play (except recovering malnourished addicts hate fun, apparently). I must admit its not as much an adrenalin rush. But its damn nice to not have to plan my entire legal defense and bail arrangements every time I leave the house. The sober dopers are mostly frowns instead of clowns, but after the meeting things pick up as the pickups begin. Very friendly young ladees! Prolly lookin for a sugardaddy, according to their confessions of dire straights. My callgirl is gonna get hammered I'm sure, eventually. She's a Realistic Tester, but perhaps that's why I love her (and will never tell her........probably). Can I flip her to be an Investor Idealist?
Instead of going home to her sickly BF ("HE'S NOT MY PIMP WHY DOES EVERYBODY SAY THAT???!!!), she wants a coffee and donut. Gained 5 pounds after 3 days in detox, perhaps all water gain from flexaril to prevent labor during withdrawal. We sit and talk and plan a marathon of NA dates (sure beats marathon sex I cry to myself).
"I really loved the needle. Even shot up pure water, but I was too stoned to notice. There's something about the needle that attracts me."
"Yes, that's obvious in your photos. Perhaps it's like cutters using razor blades to feel alive?" Lovely thoughts. But lots of cutters go on to live fairly normal lives, if such a thing exists.
Tomorrow she's taking her BF to a local NA, if they survive a dark walk in the Hood (or beg a ride from her other sugardaddy who wants to kill him). We plan our strategy to keep CPS from stealing her baby. Scary to have to take legal advice from preggie inmates in detox with experience losing babies to babysnatchers (usually a fate far worse than a doper parent who actually loves them--one of my relatives was murdered by nuns in an orphanage, but my grandmother escaped).
Her fav TV series is now Secret Diary of a Call Girl.
"You know, actress Billie Piper got paid $2-million a year to do that series, just pretending to have sex. It's the most popular series ever on that network. Sex is a very popular topic, even when it's not porn. We need to get started on your interview project and get rich!"
Yeah, as a real pimp would say, "Im gonna break that bitch and turn her out." (translation: "turn out" means steal a ho from another pimp, "break a ho" means she volunteers to give all her money to you. Juz call me Pimp Daddy lol! "But you can keep all your money, I don't need it." Even though she earns far more than me. PIMP FAIL
I take a shot at her newfound sexless revolution, especially once she gets all the free money she needs without hooking (with my help, and major thanks to the baby).
"Your daughter is saving you, you know."
"Im sorry, my body needs to heal."
"Of course, it's been through hell. I understand completely. I only want what's best for you." (WTF have I done lol?!)
The (Sexless) Friend Zone
Bob, I'll take what's behind Door Number 2 -- THE FUCK BUDDY ZONE.
Funny how women are all or nothing. But then again, you can't have a truly great affair without being friends first... Planting seeds or growing weeds? I'm a pretty bad farmer BTW.
Next Money Date, tomorrow night, LATE. Quick Photoshoot Party. Free pizza. No beer for the preggie.
W&H: "Let's go shopping for you some clothes."
H: "Let's go shopping for baby stuff."
Maternal Instinct: 10
Hooker Instinct: 0
Probably not a sleepover.
I must admit fucking a doped-up highly motivated, highly skilled sex worker is a damn fine date night. Can a clean and sober girl ever compete with that? Would she ever want to? All the fucking games and bullshit and cocktease -- fuck I've created a sexless monster! Which is exactly what I did to my ex-wife... FUCK!!!!!!!!
Or, will she turn into a real-live sex addict after the baby, replacing one dope for another? Gotta get those vitamins in her head before then!
to be cuntinued...
By Linda Hatch, PhD
Even though they have been in 12-step recovery, they may still have problems with intimate relating.
They may have great difficulty following through with relationships and instead go for repeated seductions in which they use the feeling of falling in love as a substitute high. Other recovering chemical dependency people become sexually compulsive with online hook-ups or internet pornography as their new drug of choice. Still others have intense, high drama relationships in which they seek to control the other person out of fear. As they often say, “I don’t have relationships, I take prisoners.”
Recovering alcoholics and drug addicts may use denial mechanisms to avoid seeing their problems with intimacy and sexuality. When we talk about being “in denial” what we mean is that the addict is using one or more habitual ways of thinking about a situation which serve to eliminate the need to take the situation seriously or to do anything about it.
This is the tendency to see anything to do with sex and relationships as relatively minor and harmless. The alcoholic/addict may argue that behaviors like compulsive porn use, preoccupation with online hook-ups, or frequent visits to prostitutes are not nearly as risky or life threatening as chemical dependency. Also they may rely on the argument that sexual acting out is entirely legal and that it is victimless.
Sex addiction can creep into the recovering addict’s life because it is a drug that can substitute for the previous addiction. The addict may “rationalize” this use of sex as a drug on the basis that it makes sense to rely on sex because it is a way to stay away from another addiction. They may argue that “love” is a good thing and that being hooked on sexual behaviors “keeps me out of trouble.”
Recovering alcoholics and addicts can appear to be leading a normal life. As practicing alcoholics and drug addicts, their daily functioning was probably much more compromised in a much more obvious way than that of the practicing sex addict. Sex addicts can keep their sexual behavior compartmentalized and hidden. Out of sight out of mind. Thus the addict can convince himself and everyone else that there is nothing wrong. There may be not obvious consequences and there may be no one in the addict’s life who ever calls him on his behavior.
Recovering addicts often take a superior and derisive attitude toward sex addicts. This grandiosity is a part of a narcissistic defense system that many addicts have and that covers up a sense of inferiority. It can also take the form of machismo and sexism in which recovering alcoholics or addicts may engage in seductive and sexually predatory behavior toward people in their recovery groups. This is sometimes referred to as “13th stepping.” It is a need to feed the ego and to feel better by seeing other people as worse off. Thus recovering alcoholics and addicts may even take the attitude that sex addiction recovery is a kind of joke.
Recovering addicts and alcoholics often attribute their sexually compulsive behavior to something other than sex addiction. They very commonly are aware that they behave in a sexually inappropriate manner prior to chemical dependency recovery and they attribute that to the fact that they were high on drugs or alcohol. Drugs and alcohol allowed them to overcome their inhibitions and behave in overtly excessive ways sexually.
What they fail to see is that the sexually compulsive behavior is a drug in its own right and has the same roots and their chemical dependency. They may also attribute their sexually addictive behavior to another psychological problem such as bipolar disorder. In any case, these are ways of saying that a pattern of sexually addictive behavior doesn’t exist because it is really just a byproduct of something else.
This can take various forms in which the alcoholic uses semi-logical argument as to why they cannot or need not do anything about a problem. One form is to take a victim role, i.e. to feel helpless and hopeless about changing how they relate to intimacy and relationships. They argue that they have already worked a program and that there is nothing more they can do. In other words this is as good as it gets.
Recovering alcoholics and drug addicts often have little or no experience with healthy intimate relationships. Their primary relationship has been with a chemical and they are most often avoidant of true intimacy.
It is important for those of us in the sex addiction field to help educate chemical dependency professionals and people in the recovery community about the next phase in sobriety and about the importance of gaining relationship skills and becoming “intimacy-abled.”
With sex addiction claiming celebrity headlines in recent years, Sex Workers Anonymous addresses the less glamorous topic: addiction to prostitution.
When Konrad Product, a 37-year-old social worker from Los Angeles, first began attending Sex Workers Anonymous meetings in LA in 1996, he was asked to take an inventory of every client he’d had since first becoming a prostitute at the age of 15. The list filled several spiral notebooks. Although he wouldn’t begin attending AA meetings until 2002, Product had always assumed that his problems were drugs and alcohol. But making that list of johns forced him to see that his biggest addiction was not to substances, or even to sex, but to the sex industry itself.
“People will ask if I’m a sex addict, and I’m not,” says Product, who quit sex work in 2005 and has been in and out of sobriety since 2002, but has been clean for the last seven months. “All of my triggers around sex are related to money or some sort of exchange—it wasn’t about the sex itself. And my work in the sex industry manifested in all those ways that they do for addicts: thinking about it obsessively, setting dates to quit and then not quitting. I was literally not able to stop turning tricks.”
But Alexandra Katehakis, the Clinical Director for the Center for Healthy Sex in Los Angeles, says that while there is a distinction between sex addiction and sex industry addiction, she isn't convinced that sex work can truly become addictive. “There’s a neurochemical draw and shutting down of the higher cortical function in sex addiction that you wouldn’t see in an addiction to the sex industry,” she says.
While surely those who believe that sex addiction isn’t real will also doubt the veracity of sex worker addiction, Dr. Paul Hokemeyer, a sober doctor who has appeared repeatedly on Good Morning America and specializes in sex addiction among other topics, says that sex industry work can be classified as a “process” addiction. “You can get addicted to the affirmation of being valued by someone for your body, although it’s a very linear form of validating yourself that’s unhealthy and destructive,” he says. “Money can help assign value to a person in a way that’s not terribly different from someone carrying a Louis Vuitton bag. Being able to say ‘I’m worth $300 for 15 minutes’ can be validating for someone with no self-esteem.”
Whatever the experts say, many with firsthand knowledge believe that what they have experienced is all too real. “We suffer from the disease of addiction, and prostitution can be an addictive behavior,” says Brenda Myers-Powell, a former prostitute for 25 years who now runs SWA meetings in the Chicago area. “It’s the addiction to the money, lifestyle, and instant love. Most people in prostitution seem to be seeking something they can’t find themselves.” A former sex worker who now works as a journalist also agrees with this sentiment. “Addiction to sex work is certainly included under the umbrella of sex addiction. It would be like comparing gin addicts to whiskey addicts: they're both alcoholics,” she says. “For me, sex work is a very powerful piece of my multi-pronged sex addiction, which also includes anonymous and group sex.”
Founded in 1987 by a former prostitute named Jody Williams, Sex Workers Anonymous (formerly known as Prostitutes Anonymous) is a 12-step support program for people either looking to leave the sex industry or simply to recover from its effects. The program—which is in over 100 cities in 49 states and four countries internationally—is similar to other 12-step programs in that it has a main text (in this case, it’s called Sold Out and is only available at SWA meetings), sponsors who take people through the steps and regular weekly meetings. All meetings are run by a leader and include opening statements, a main speaker, readings, and sharing. And like AA or NA, Sex Workers Anonymous holds no formal opinion on outside issues—including the sex industry. “We have people who are still actively involved in the sex industry attending our meetings in some cases,” said Myers-Powell. “They feel like it’s a safe environment for them and sometimes the only safe environment they have.”
While a large number of SWA-ers are drug addicts or alcoholics, not all of them became prostitutes after their substance abuse issues began. Many, in fact, tell tales of turning to drugs and alcohol as a coping mechanism for the lifestyle they were leading. “My issues were around prostitution and not drug abuse in the beginning,” says Myers-Powell, who is also the founder and COO of The Dreamcatcher Foundation—which works to prevent sexual exploitation among women. “But I began taking drugs to cover up the abuse I experienced in prostitution. I went into treatment, but it didn’t work because it was only for the drugs. I still felt bad about myself. I never felt that prostitution was a problem, but it was ultimately the foundation for all of my problems.” (Myers-Powell has now been away from all drugs and the sex industry for the last 15 years.)
For Konrad, the mere act of attempting to solicit clients became an addictive behavior that proved difficult to stop. “You’re organizing your day in the same way that an alcoholic organizes their drinking,” he explains. “You’re logging onto a website to check your messages, wondering who you’re going to hit up that day, figuring out where you’ll meet. You’re doing a version of the needle—it’s just with your phone or your computer. But it’s the same ritual compulsive behavior.”
Katehakis nevertheless doesn’t see this type of compulsive behavior as an addiction. “I don’t think addiction is the right word for the act of doing something like checking your e-mail or thinking about your clients,” she says. “That sounds like the fear and desperation that often just comes with running a business. If it’s to the exclusion of everything else where they are forgoing other activities at the expense or isolating themselves to do it, of course, that might be a different issue.”
Of course, a compulsion to make fast money is one of the primary reasons why people get into the sex industry in the first place. That was certainly the case for Melissa Petro, a sober 32-year-old freelance writer and teacher from NYC who began working as a stripper when she was 19 and studying abroad in Mexico. Once stateside, she continued stripping and it didn’t seem like a terribly long journey from there to advertising herself on the now-defunct erotic services section on Craigslist. But Melissa, who has never been in SWA, says that while she began stripping out of economic desperation, she continued in the sex industry as a means of socio-economic opportunity. “I took pleasure from my work more so than other minimum wage jobs,” she says. “I was making $300-500 an hour as a sex worker and there wasn’t another job I could get which would offer the same freedom and flexibility while still paying that well. That being said, I don’t consider my time as a stripper to have been personally harmful. It wasn’t an act of self harm until I begin soliciting on Craigslist.”
After four months in the sex industry, Melissa felt unwilling to take other work opportunities that paid far less. ”I had lost the value of hard work and felt a sense of entitlement that privileged people often feel,” she says. “I had lost the commitment to the hopes and intentions for my life.” And yet while she readily identifies herself as an alcoholic in AA, she is less willing to view her time in the sex industry in similar terms. “I have trouble labeling my continued participation as an addiction,” she says. “The sex industry worked and kept working for me, but what didn’t work was my alcoholism because I was inebriating myself to do it. I certainly abused sex and craved it when I was out of the industry, but it was a craving to be out of myself. AA was my primary program and it’s the only program I work that deals with the issues I have.” Petro removed herself from the sex industry in 2007 and quit drinking a few months afterward but she says it wasn’t until joining the NYC Teaching Fellows program three months into her sobriety that she realized it was possible to find a well-paying career that she loved.
Of course, not all former sex workers are able to find rewarding careers and lacking a formal resume and simply engaging in traditional jobs can present other issues. “It’s hard to go from getting $1,500 to beat someone to making $10 an hour at Starbucks,” Konrad admits. “And you’re now isolated because you’ve lost all your hooker friends, so you have to build that up. Then you realize your social skills have atrophied because you’ve controlled who comes into your life, always knowing they’re going to be giving your money.
Re-entering the workforce outside of the sex industry—and re-entering the real world in general—is one of the key ways that Sex Workers Anonymous assists its members. While the program provides mentoring and life assistance to those who are prepared to leave the sex industry, Myers-Powell says that many are surprised by how difficult the journey is. “You don’t decide to leave the industry on Monday and it’s done on Tuesday,” she explains. “I had to learn how to work again, date again, interact with people out of that lifestyle—and even go to bed with someone without charging. Our literature addresses all of that.”
Simply being able to talk about these realizations and share sex industry experiences in the supportive environment of SWA is of course another benefit for attendees, some of whom have not felt similar support in other 12-step programs. “There’s a lot of shame around male prostitution in the AA rooms,” Konrad says. “I quickly learned not to share that information because I’d be judged and gossiped about.” And yet Melissa had the opposite experience. “I had no boundaries when I got sober,” she admits. “I’m a provocateur by nature and because being rejected was a fear of mine, I would try to provoke a response to see if that would happen. There was also less of a basis to be judged because I wasn’t going to the AA meetings at NYU, where it’s mainly professionals coming straight from work. I would go to the ones on Perry Street where they would be mentally ill. I felt like those were my people.”
Despite finding an open-minded environment where he could share, Konrad dropped out of SWA. “I went to a total of 10 meetings and apart from the times I brought friends, it was often just me and the woman running the meeting in there. It was literally one addict talking to another and I couldn’t just slip in and listen the way I could at an AA meeting,” he says. “She would literally make home visits and bring me food. And at that time, I wasn’t prepared to make the huge life sacrifices she was asking for. I was making deals with myself and saying I won’t do this, but will do that.”
Still, there are other reasons why a former sex worker—even one who believes that sex work is in itself an addiction—might not be open to SWA. “Most sex workers have a history of sexual trauma, so they became detached with their feelings and push these issues away,” says Hokemeyer. “That makes it less likely they’ll trust strangers and share these experiences with them. Addictions are shrouded in shame, so the meetings, where they’ll have to admit out loud what they did and talk about it, can become a terrifying place to go.”
Yet a number of former sex workers are doing what they can to lift the shame associated with their previous profession of choice. Petro has written openly about having been a sex worker and paid the price while Product is currently producing a play based loosely based on his time in the line of work. And Myers-Powell, of course, continues her efforts to help those who wish to leave the sex industry. But while all have been long removed from the sex industry, only Myers-Powell credits SWA with helping her to escape. According to Hokemeyer, it doesn’t matter what meetings a person attends as long as that goal is achieved. “I don’t see SWA and AA or NA as mutually exclusive,” he says. “I see them as complimentary to one another. Full recovery would be enhanced by doing both if there is a drug or alcohol problem as well, but people need to go with where they are most comfortable so they can get better.”
McCarton Ackerman is a freelance writer currently residing in Portland, Oregon. His work has appeared in Time Out New York, The Huffington Post, abcnews.com and usopen.org, among others. He has also written about Carré Otis and Celebrity Rehab, among many other topics, for The Fix.
Choices always were a problem for you.
What you need is someone strong to guide you.
Deaf and blind and dumb and born to follow,
What you need is someone strong to use you
If you want to get your soul to heaven,
Trust in me.
Don't judge or question.
You are broken now,
But faith can heal you.
Just do everything I tell you to do.
Deaf and blind and dumb and born to follow.
Let me lay my holy hand upon you.
My God's will
When he speaks out,
He speaks through me.
He has needs
Like I do.
We both want
To rape you.
Jesus Christ, why don't you come save my life.
Open my eyes, blind me with your light now
And your lies.
by A. Hoffer, M.D., Ph.D.
The first water soluble vitamins were numbered in sequence according to priority of discovery. But after their chemical structure was determined they were given scientific names. The third one to be discovered was the anti-pellagra vitamin before it was shown to be niacin. But the use of the number B-3 did not stay in the literature very long. It was replaced by nicotinic acid and its amide (also known medically as niacin and its amide). The name was changed to remove the similarity to nicotine, a poison.
The term vitamin B-3 was reintroduced by my friend Bill W., co-founder of Alcoholics Anonymous, (Bill Wilson). We met in New York in 1960. Humphry Osmond and I introduced him to the concept of mega vitamin therapy. We described the results we had seen with our schizophrenic patients, some of whom were also alcoholic. We also told him about its many other properties. It was therapeutic for arthritis, for some cases of senility and it lowered cholesterol levels.
Bill was very curious about it and began to take niacin, 3 g daily. Within a few weeks fatigue and depression which had plagued him for years were gone. He gave it to 30 of his close friends in AA and persuaded them to try it. Within 6 months he was convinced that it would be very helpful to alcoholics. Of the thirty, 10 were free of anxiety, tension and depression in one month. Another 10 were well in two months. He decided that the chemical or medical terms for this vitamin were not appropriate. He wanted to persuade members of AA, especially the doctors in AA, that this would be a useful addition to treatment and he needed a term that could be more readily popularized. He asked me the names that had been used. I told him it was originally known as vitamin B-3. This was the term Bill wanted. In his first report to physicians in AA he called it "The Vitamin B-3 Therapy." Thousands of copies of this extraordinary pamphlet were distributed. Eventually the name came back and today even the most conservative medical journals are using the term vitamin B-3.
Bill became unpopular with the members of the board of AA International. The medical members who had been appointed by Bill, felt that he had no business messing about with treatment using vitamins. They also "knew" vitamin B-3 could not be therapeutic as Bill had found it to be. For this reason Bill provided information to the medical members of AA outside of the National Board, distributing three of his amazing pamphlets. They are now not readily available.
Vitamin B-3 exists as the amide in nature, in nicotinamide adenine dinucleotide (NAD). Pure nicotinamide and niacin are synthetics. Niacin was known as a chemical for about 100 years before it was recognized to be vitamin B-3. It is made from nicotine, a poison produced in the tobacco plant to protect itself against its predators, but in the wonderful economy of nature which does not waste any structures, when the nicotine is simplified by cracking open one of the rings, it becomes the immensely valuable vitamin B-3.
Vitamin B-3 is made in the body from the amino acid tryptophan. On the average 1 mg of vitamin B-3 is made from 60 mg of tryptophan, about 1.5% Since it is made in the body it does not meet the definition of a vitamin; these are defined as substances that can not be made. It should have been classified with the amino acids, but long usage of the term vitamin has given it permanent status as a vitamin. The 1.5% conversion rate is a compromise based upon the conversion of tryptophan to N-methyl nicotinamide and its metabolites in human subjects. I suspect that one day in the far distant future none of the tryptophan will be converted into vitamin B-3 and it then will truly be a vitamin. According to Horwitt , the amount converted is not inflexible but varies with patients and conditions. For example, women pregnant in their last three months convert tryptophan to niacin metabolites three times as efficiently as in non-pregnant females. Also there is evidence that contraceptive steroids, estrogens, stimulate tryptophan oxygenase, the enzyme that converts the tryptophan into niacin.
This observation raises some interesting speculations. Women, on average, live longer then men. It has been shown for men that giving them niacin increases their longevity.  Is the increased longevity in women the result of greater conversion of tryptophan into niacin under the stimulus of their increase in estrogen production? Does the same phenomenon explain the decrease in the incidence of coronary disease in women?
The best-known vitamin deficiency disease is pellagra. More accurately it is a tryptophan deficiency disease since tryptophan alone can cure the early stages. Pellagra was endemic in the southern U.S.A. until the beginning of the last world war. It can be described by the four D's: dermatitis, diarrhea, dementia and death. The dementia is a late stage phenomenon. In the early stages it resembles much more the schizophrenias, and can only with difficulty be distinguished from it. The only certain method used by early pellagrologists was to give their patients in the mental hospitals small amounts of nicotinic acid. If they recovered they diagnosed them pellagra, if they did not they diagnosed them schizophrenia. This was good for some of their patients but was not good for psychiatry since it prevented any continuing interest in working with the vitamin for their patients who did not recover fast, but who might have done so had they given them a lot more for a much longer period of time, the way we started doing this in Saskatchewan. I consider it one of the schizophrenic syndromes.
I have been involved in establishing two of the major uses for vitamin B-3, apart from its role in preventing and treating pellagra. These are its action in lowering high cholesterol levels  and in elevating high density lipoprotein cholesterol levels (HDL), and its therapeutic role in the schizophrenias and other psychiatric conditions. It has been found helpful for many other diseases or conditions. These are psychiatric disorders including children with learning and behavioral disorders, the addictions including alcoholism and drug addiction, the schizophrenias, some of the senile states. Its efficacy for a large number of both mental and physical conditions is an advantage to patients and to their doctors who use the vitamin, but is difficult to accept by the medical profession raised on the belief that there must be one drug for each disease, and that when any substance appears to be too effective for many conditions, it must be due entirely to its placebo effect, something like the old snake oils.
I have thought about this for a long time and have within the past year become convinced that this vitamin is so versatile because it moderates or relieves the body of the pernicious effect of chronic stress. It therefore frees the body to carry on its routine function of repairing itself more efficiently. The current excitement in medicine is the recognition that hyperoxidation, the formation of free radicals, is one of the basic damaging processes in the body. These hyperexcited molecules destroy molecules and damage tissues at the cellular level and at the tissue level.
All living tissue which depends on oxygen for respiration has to protect itself against these free radicals. Plants use one type of antioxidants and animals use another type. Fortunately there is a wide overlap and the same antioxidants such as vitamin C are used by both plants and animals. There is growing recognition that the system adrenaline -> adrenochrome plays a major role in the reactions to stress. I have elaborated this in a further report for this journal. 
The catecholamines, of which adrenalin is the best known example, and the aminochromes, of which adrenochrome is the best known example, are intimately involved in stress reactions. Therefore to moderate the influence of stress or to negate it, one must use compounds which prevent these substances from damaging the body. Vitamin B-3 is a specific antidote to adrenalin, and the antioxidants such as vitamin C, Vitamin E, beta carotene, selenium and others protect the body against the effect of the free radicals by removing them more rapidly from the body. Any disease or condition which is stress related ought therefore to respond to the combined use of vitamin B-3 and these antioxidants provided they are all given in optimum doses, whether small or large as in orthomolecular therapy. I will therefore list briefly the many indications for the use of vitamin B-3.
For each condition I will describe one case to illustrate the therapeutic response. For each condition I can refer to hundreds and thousands of case histories and have already in the literature described many of them in detail. 
1) The Schizophrenias. I have reviewed this for this journal. 
2) Children with Learning and/or Behavioral Disorders.
In 1960 seven year-old Bruce came to see me with his father. Bruce had been diagnosed as mentally retarded. He could not read, could not concentrate, and was developing serious behavioral problems such as cutting school without his parents' knowledge. He was being prepared for special classes for the retarded. He excreted large amounts of kryptopyrrole, the first child to be tested. I started him on nicotinamide, one gram tid. Within four months he was well. He graduated from high school, is now married, has been fully employed and has been paying income tax. He is one case out of about 1500 I have seen since 1960.
Current treatment is more complicated as described in this Journal. 
3) Organic Confusional States, non-Alzheimers forms of dementia, electroconvulsive therapy-induced memory disturbances.
In 1954 I observed how nicotinic acid relieved a severe case of post ECT amnesia in one month. Since then I have routinely given it in conjunction with ECT to markedly decrease the memory disturbance that may occur during and after this treatment. I would never give any patient ECT without the concomitant use of nicotinic acid. It is very helpful, especially in cardiovascular-induced forms of dementia as it reverses sludging of the red blood cell and permits proper oxygenation of the cells of the body. For further information see Niacin Therapy in Psychiatry. 
In September 1992, Mr. C., 76 years-old, requested help with his memory. He was terribly absentminded. If he decided to do something, by the time he arrived where he wanted to do it he had forgotten what it was he wanted to do. His short-term memory was very poor and his long-term memory was beginning to be affected. I started him on a comprehensive vitamin program including niacinamide 1.5 G daily. Within a month he began to improve. I added niacin to his program. By February 1993 he was normal. April 26, 1993, he told me he had been so well he had concluded he no longer needed any niacin and decreased the dose from 3.0 G to 1.5 G daily. He remained on the rest of the program. Soon he noted that his short term memory was failing him again. I advised him to stay on the full dose the rest of his life.
4) An antidote against d-LSD,9,10 and against adrenochrome. 
Bill W. conducted the first clinical trial of the use of nicotinic for treating members of Alcoholics Anonymous.  He found that 20 out of thirty subjects were relieved of their anxiety, tension and fatigue in two months of taking this vitamin, 1 G tid. I found it very useful in treating patients who were both alcoholic and schizophrenic. The first large trial was conducted by David Hawkins who reported a better than 90% recovery rate on about 90 patients. Since then it has been used by many physicians who treat alcoholics. Dr. Russell Smith in Detroit has reported the largest series of patients. 
Of the two major findings made by my research group in Saskatchewan, the nicotinic acid-cholesterol connection is well known and nicotinic acid is used worldwide as an economical, effective and safe compound for lowering cholesterol and elevating high density cholesterol. As a result of my interest in nicotinic acid, Altschul, Hoffer and Stephen  discovered that this vitamin, given in gram doses per day, lowered cholesterol levels. Since then it was found it also elevates high density lipoprotein cholesterol thus bringing the ratio of total over HDL to below 5.
In the National Coronary Study, Canner  showed that nicotinic acid decreased mortality and prolonged life. Between 1966 and 1975, five drugs used to lower cholesterol levels were compared to placebo in 8341 men, ages 30 to 64, who had suffered a myocardial infarction at least three months before entering the study. About 6000 were alive at the end of the study. Nine years later, only niacin had decreased the death rate significantly from all causes. Mortality decreased 11% and longevity increased by two years. The death rate from cancer was also decreased.
This was a very fortunate finding because it led to the approval by the FDA of this vitamin in mega doses for cholesterol problems and opened up the use of this vitamin in large doses for other conditions as well. This occurred at a time when the FDA was doing its best not to recognize the value of megavitamin therapy. Its position has not altered over the past four decades.
Our finding opened up the second major wave of interest in vitamins. The first wave started around 1900 when it was shown that these compounds were very effective in small doses in curing vitamin deficiency diseases and in preventing their occurrence. This was the preventive phase of vitamin use. The second wave recognized that they have therapeutic properties not directly related to vitamin deficiency diseases but may have to be used in large doses. This was the second or present wave wherein vitamins are used in therapy for more than deficiency diseases. Our discovery that nicotinic acid was an hypocholesterolemic compound is credited as the first paper to initiate the second wave and paved the way for orthomolecular medicine which came along several years later.
I first observed the beneficial effects of vitamin B-3 in 1953 and 1954. I was then exploring the potential benefits and side effects from this vitamin. Several of the patients who were given this vitamin would report after several months that their arthritis was better. At first this was a surprise since in the psychiatric history I had taken I had not asked about joint pain. This report of improvement happened so often I could not ignore it. A few years later I discovered that Prof. W. Kaufman had studied the use of this vitamin for the arthritides before 1950 and had published two books describing his remarkable results.  Since that time this vitamin has been a very important component of the orthomolecular regimen for treating arthritis.
The following case illustrates both the response which can occur and the complexity of the orthomolecular regimen. Patients who are early into their arthritis respond much more effectively and are not left with residual disability.
K.V. came to my office April 15, 1982. She was in a wheelchair pushed by her husband. He was exhausted, depressed, and she was one of the sickest patients I have ever seen. She weighed under 90 pounds. She sat in the chair on her ankles which were crossed beneath her body because she was not able to straighten them out. Her arms were held in front of her, close to her body, and her fingers were permanently deformed and claw-like. She told me she had been deeply depressed for many years because of the severe pain and her major impairment. As she was being wheeled into my office I saw how ill she was and immediately concluded there was nothing I could do for her, and had to decide how I could let her know without sending her even deeper into despair. However I changed my mind when she suddenly said, "Dr. Hoffer, I know no one can ever cure me but if you could only help me with my pain. The pain in my back is unbearable. I just want to get rid of the pain in my back." I realized then she had a lot of determination and inner strength and that it was worthwhile to try and help her.
She began to suffer from severe pain in her joints in 1952. In 1957 it was diagnosed as arthritis. Until 1962 her condition fluctuated and then she had to go into a wheelchair some part of the day. She was still able to walk although not for long until 1967. In 1969 she depended on the wheelchair most of the time, and by 1973 she was there permanently. For awhile she was able to propel herself with her feet. After that she was permanently dependent on help. For the three years before she saw me she had gotten some home care but most of the care was provided by her husband. He had retired from his job when I first saw them. He provided the nursing care equivalent to four nurses on 8 hour shifts including holiday time. He had to carry her to the bathroom, bathe her, cook and feed her. He was as exhausted as she was but he was able to carry on. She was severely deformed, especially her hands, suffered continuous pain, worse in her arms, and hips and her back. Her ankles were badly swollen and she had to wear pressure bandages. Her muscles also were very painful most of the day. She was able to feed herself and to crochet with her few useful fingers, but it must have been extremely difficult. She was not able to write nor type which she used to do with a pencil. A few months earlier she had been suicidal. On top of this severe pain and discomfort she had no appetite, was not hungry and a full meal would nauseate her. Her skin was dry, she had patches of eczema, and she had white areas in her nails. I advised her to eliminate sugar, potatoes, tomatoes and peppers, (about 10% of arthritics have allergic reactions to the solanine family of plants). She was to add niacinamide 500 mg four times daily (following the work of W. Kaufman), ascorbic acid 500 mg four times daily (as an anti-stress nutrient and for subclinical scurvy), pyridoxine 250 mg per day (found to have anti-arthritic properties by Dr. J. Ellis), zinc sulfate 220 mg per day (the white areas in her nails indicated she was deficient in zinc), flaxseed oil 2 tablespoons and cod liver oil 1 tablespoon per day (her skin condition indicated she had a deficiency of omega 3 essential fatty acids). The detailed treatment of arthritis and the references are described in my book.  One month later a new couple came into my room. Her husband was smiling, relaxed and cheerful as he pushed his wife in in her chair. She was sitting with her legs dangling down, smiling as well. I immediately knew that she was a lot better. I began to ask her about her various symptoms she had had previously. After a few minutes she impatiently broke in to say, "Dr. Hoffer, the pain in my back is all gone." She no longer bled from her bowel, she no longer bruised all over her body, she was more comfortable, the pain in her back was easily controlled with aspirin and was gone from her hips, (it had not helped before). She was cheerful and laughed in my office. Her heart was regular at last. I added inositol niacinate 500 mg four times daily to her program. She came back June 17, 1982, and had improved even more. She was able to pull herself up from the prone position on her bed for the first time in 15 years, and she was free of depression. I increased her ascorbic acid to 1 gram four times daily and added vitamin E 800 IU. Because she had shown such dramatic improvement I advised her she need no longer come to see me. September 1, 1982, she called me on the telephone. I asked her how she was getting along. She said she was making even more progress. I then asked her how had she been able to get to the phone. She replied she was able to get around alone in her chair. Then she added she had not called for herself but for her husband. He had been suffering from a cold for a few days, she was nursing him, and she wanted some advice for him. After another visit October 28, 1983, I wrote to her doctor "Today Mrs. K.V. reported she had stayed on the whole vitamin program very rigorously for 18 months, but since that time had slacked off somewhat. She is regaining a lot of her muscle strength, can now sit in her wheelchair without difficulty, can also wheel herself around in her wheelchair but, of course, can not do anything useful with her hands because her fingers are so awful. She would like to become more independent and perhaps could do so if something could be done about her fingers and also about her hip. I am delighted she has arranged to see a plastic surgeon to see if something can be done to get her hand mobilized once more. I have asked her to continue with the vitamins but because she had difficulty taking so many pills she will take a preparation called Multijet which is available from Portland and contains all the vitamins and minerals and can be dissolved in juice. She will also take inositol niacinate 3 grams daily." I saw her again March 24, 1988. About 4 of her vertebra had collapsed and she was suffering more pain which was alleviated by Darvon. It had not been possible to treat her hands surgically. She had been able to eat by herself until six months before this last visit. She had been taking small amounts of vitamins. She was able to use a motorized chair. She had been depressed. I wrote to her doctor, "She had gone off the total vitamin program about two or three years ago. It is very difficult for her to swallow and I can understand her reluctance to carry on with this. I have therefore suggested that she take a minimal program which would include inositol niacinate 3 grams daily, ascorbic acid 1 gram three times, linseed oil 2 capsules and cod liver oil 2 capsules. Her spirits are good and I think she is coming along considering the severe deterioration of her body as a result of the arthritis over the past few decades." She was last seen by her doctor in the fall of 1989. Her husband was referred. I saw him May 18, 1982. He complained of headaches and a sense of pressure about his head present for three years. This followed a series of light strokes. I advised him to take niacin 3 grams daily plus other vitamins including vitamin C. By September 1983 he was well and when seen last March 24, 1988 was still normal. 3. Juvenile Diabetes Dr. Robert Elliot, Professor of Child Health Research at University of Auckland Medical School is testing 40,000 five-year old children for the presence of specific antibodies that indicate diabetes will develop. Those who have the antibodies will be given nicotinamide. This will prevent the development of diabetes in most the children who are vulnerable. According to the Rotarian for March 1993 this project began 8 years ago and has 3200 relatives in the study. Of these, 182 had antibodies and 76 were given nicotinamide. Only 5 have become diabetic compared to 37 that would have been expected. Since 1988 over 20,100 school children have been tested. None have become diabetic compared to 47 from the untested comparable group. A similar study is underway in London, Ontario. 4. Cancer Recent findings have shown that vitamin B-3 does have anti-cancer properties. This was discussed at a meeting in Texas in 1987, Jacobson and Jacobson.  The topic of this international conference was "Niacin, Nutrition, ADP-Ribosylation and Cancer," and was the 8th conference of this series. Niacin, niacinamide and nicotinamide adenine dinucleotide (NAD) are interconvertable via a pyridine nucleotide cycle. NAD, the coenzyme, is hydrolyzed or split into niacinamide and adenosine dinucleotide phosphate (ADP-ribose). Niacinamide is converted into niacin, which in turn is once more built into NAD. The enzyme which splits ADP is known as poly (ADP-ribose) polymerase, or poly (ADP) synthetase, or poly (ADP-ribose) transferase. Poly (ADP-ribose) polymerase is activated when strands of deoxyribonucleic acid (DNA) are broken. The enzyme transfers NAD to the ADP-ribose polymer, binding it onto a number of proteins. The poly (ADP-ribose) activated by DNA breaks helps repair the breaks by unwinding the nucleosomal structure of damaged chromatids. It also may increase the activity of DNA ligase. This enzyme cuts damaged ends off strands of DNA and increases the cell's capacity to repair itself. Damage caused by any carcinogenic factor, radiation, chemicals, is thus to a degree neutralized or counteracted. Jacobson and Jacobson, conference organizers, hypothesized that niacin prevents cancer. They treated two groups of human cells with carcinogens. The group given adequate niacin developed tumors at a rate only 10% of the rate in the group deficient in niacin. Dr. M. Jacobson is quoted as saying, "We know that diet is a major risk factor, that diet has both beneficial and detrimental components. What we cannot assess at this point is the optimal amount of niacin in the diet... The fact that we don't have pellagra does not mean we are getting enough niacin to confer resistance to cancer." About 20 mg per day of niacin will prevent pellagra in people who are not chronic pellagrins. The latter may require 25 times as much niacin to remain free of pellagra. Vitamin B-3 may increase the therapeutic efficacy of anti-cancer treatment. In mice, niacinamide increased the toxicity of irradiation against tumors. The combination of normobaric carbogen with nicotinamide could be an effective method of enhancing tumor radiosensitivity in clinical radiotherapy where hypoxia limits the outcome of treatment. Chaplin, Horsman and Aoki16 found that nicotinamide was the best drug for increasing radiosensitivity compared to a series of analogues. The vitamin worked because it enhanced blood flow to the tumor. Nicotinamide also enhanced the effect of chemotherapy. They suggested that niacin may offer some cardioprotection during long-term adriamycin chemotherapy. Further evidence that vitamin B-3 is involved in cancer is the report by Nakagawa, Miyazaki, Okui, Kato, Moriyama and Fujimura  that in animals there is a direct relationship between the activity of nicotinamide methyl transferase and the presence of cancer. Measuring the amount of N-methyl nicotinamide was used to measure the activity of the enzyme. In other words, in animals with cancer there is increased destruction of nicotinamide, thus making less available for the pyridine nucleotide cycle. This finding applied to all tumors except the solid tumors, Lewis lung carcinoma and melanoma B-16. Gerson  treated a series of cancer patients with special diets and with some nutrients including niacin 50 mg 8 to 10 times per day, dicalcium phosphate with vitamin D, vitamins A and D, and liver injections. He found that all the cancer cases were benefited in that they became healthier and in many cases the tumors regressed. In a subsequent report Gerson elaborated on his diet. He now emphasized a high potassium over sodium diet, ascorbic acid, niacin, brewers yeast and lugols iodine. Right after the war there was no ready supply of vitamins as there is today. I would consider the use of these nutrients in combination very original and enterprising. Dr. Gerson was the first physician to emphasize the use of multivitamins and some multiminerals. More details are in Hoffer.  Additional evidence that vitamin B-3 is therapeutic for cancer arises from the National Coronary Study, Canner.  5. Concentration Camp Survivors In 1960 I planned to study the effect of nicotinic acid on a large number of aging people living in a sheltered home. A new one had been built. I approached the director of this home, Mr. George Porteous. I arranged to meet him and told him what I would like to do and why. I gave him an outline of its properties, its side effects and why I thought it might be helpful. Mr. Porteous agreed and we started this investigation. A short while after my first contact Mr. Porteous came to my office at University Hospital. He wanted to take nicotinic acid himself, he told me, so that he could discuss the reaction more intelligently with people living in his institution. He wanted to know if it would be safe to do so. That fall he came again to talk to me and this time he said he wanted to tell me what had happened to him. Then I discovered he had been with the Canadian troops who had sailed to Hong Kong in 1940, had been promptly captured by the Japanese and had survived 44 months in one of their notorious prisoner of war camps. Twenty-five percent of the Canadian soldiers died in these camps. They suffered from severe malnutrition from starvation and nutrient deficiency. They suffered from beri beri, pellagra, scurvy, infectious diseases, and brutality from the guards. Porteous, a physical education instructor, had been fit weighing about 190 pounds when he got there. When he returned home he weighed only 2/3rds of that. On the way home in a hospital ship the soldiers were fed and given extra vitamins in the form of rice polishings. There were few vitamins available then in tablets or capsules. He seemingly recovered but had remained very ill. He suffered from both psychological and physical symptoms. He was anxious, fearful and slightly paranoid. Thus, he could never be comfortable sitting in a room unless he sat facing the door. This must have arisen from the fear of the guards. Physically he had severe arthritis. He could not raise his arms above his shoulders. He suffered from heat and cold sensitivity. In the morning he needed his wife's help in getting out of bed and to get started for the day. He had severe insomina. For this he was given barbiturates in the evening and to help awaken him in the morning, he was given amphetamines. Later I read the growing literature on the Hong Kong veterans and there is no doubt they were severely and permanently damaged. They suffered from a high death rate due to heart disease, crippling arthritis, blindness and a host of other conditions. Having outlined his background he then told me that two weeks after he started to take nicotinic acid, 1 gram after each meal, he was normal. He was able to raise his arms to their full extension, and he was free of all the symptoms which had plagued him for so long. When I began to prepare my report  I obtained his Veterans Administration Chart. It came to me in two cardboard boxes and weighed over ten pounds, but over 95% of it was accumulated before he started on the vitamin. For the ten years after he started on the vitamin there was very little additional material. One could judge the efficacy of the vitamin by weighing the chart paper before and after he started on it. Porteous remained well as long as he stayed on the vitamin until his death when he was Lieutenant Governor of Saskatchewan. In 1962, after having been well for two years, he went on a holiday to the mountains with his son and he forgot to take his nicotinic acid with him. By the time he returned home almost the entire symptomatology had returned. Porteous was enthusiastic about nicotinic acid and began to tell all his friends about it. He told his doctor. His doctor cautioned him that he might damage his liver. Porteous replied that if it meant he could stay as well as he was until he died from a liver ailment he would still not go off it. His doctor became an enthusiast as well and within a few years had started over 300 of his patients on the vitamin. He never saw any examples of liver disease from nicotinic acid. I have treated over 20 prisoners from Japanese camps and from European concentration camps since then with equally good results. I estimated that one year in these camps was equivalent to 4 years of aging, i.e. four years in camp would age a prisoner the equivalent of 16 years of normal living. George Porteous wanted every prisoner of war from the eastern camps treated as he had been. He was not successful in persuading the Government of Canada that nicotinic acid would be very helpful so he turned to fellow prisoners, both in Canada (Hong Kong Veterans) and to American Ex-Prisoners of War. These American veterans suffered just as much as had the Canadian soldiers since they were treated in exactly the same abysmal way. The ones who started on the vitamin showed the same response. Recently one of these soldiers, a retired officer, wrote to me after being on nicotinic acid 20 years that he felt great, owed it to the vitamin and that when his arteries were examined during a simple operation they were completely normal. He wrote, "About two years ago, I was hit, was bleeding down the neck. The MDs took the opportunity to repair me. They said the arteries under the ears look like they had never been used." There is an important lesson from the experiences of these veterans and their response to megadoses of nicotinic acid. This is that every human exposed to severe stress and malnutrition for a long enough period of time will develop a permanent need for large amounts of this vitamin and perhaps for several others. This is happening on a large scale in Africa where the combination of starvation, malnutrition and brutality is reproducing the conditions suffered by the veterans. Those who survive will be permanently damaged biochemically, and will remain a burden to themselves and to the community where they live. Will society have the good sense to help them recover by making this vitamin available to them in optimum doses? Doses The optimum dose range is not as wide as it is for ascorbic acid, but it is wide enough to require different recommendations for different classes of diseases. As is always the case with nutrients, each individual must determine their own optimum level. With nicotinic acid this is done by increasing the dose until the flush (vasodilation) is gone, or is so slight it is not a problem. One can start with as low a dose as 100 mg taken three times each day after meals and gradually increase it. I usually start with 500 mg each dose and often will start with 1 gram per dose especially for cases of arthritis, for schizophrenics, for alcoholics and for a few elderly patients. However, with elderly patients it is better to start small and work it up slowly. No person should be given nicotinic acid without explaining to them that they will have a flush which will vary in intensity from none to very severe. If this is explained carefully, and if they are told that in time the flush will not be a problem, they will not mind. The flush may remain too intense for a few patients and the nicotinic acid may have to be replaced by a slow release preparation or by some of the esters, for example, inositol niacinate. The latter is a very good preparation with very little flush and most find it very acceptable even when they were not able to accept the nicotinic acid itself. It is rather expensive but with quantity production the price might come down. The flush starts in the forehead with a warning tingle. Then it intensifies. The rate of the development of the flush depends upon so many factors it is impossible to predict what course it will follow. The following factors decrease the intensity of the flush: a cold meal, taking it after a meal, taking aspirin before, using an antihistamine in advance. The following factors make the flush more intense: a hot meal, a hot drink, an empty stomach, chewing the tablets and the rate at which the tablets break down in liquid. From the forehead and face the flush travels down the rest of the body, usually stopping somewhere in the chest but may extend to the toes. With continued use the flush gradually recedes and eventually may be only a tingling sensation in the forehead. If the person stops taking the vitamin for a day or more the sequence of flushing will be re-experienced. Some people never do flush and a few only begin to flush after several years of taking the vitamin. With nicotinamide there should be no flushing but I have found that about 2% will flush. This may be due to rapid conversion of the nicotinamide to nicotinic acid in the body. When the dose is too high for both forms of the vitamin the patients will suffer from nausea at first, and then if the dose is not reduced it will lead to vomiting. These side effects may be used to determine what is the optimum dose. When they do occur the dose is reduced until it is just below the nausea level. With children the first indication may be loss of appetite. If this does occur the vitamin must be stopped for a few days and then may be resumed at a lower level. Very few can take more than 6 grams per day of the nicotinamide. With nicotinic acid it is possible to go much higher. Many schizophrenics have taken up to 30 grams per day with no difficulty. The dose will alter over time and if on a dose where there were no problems, they may develop in time. Usually this indicates that the patient is getting better and does not need as much. I have divided all patients who might benefit from vitamin B-3 into the following categories. Category 1. These are people who are well or nearly well, and have no obvious disease. They are interested in maintaining their good health or in improving it. They may be under increased stress. The optimum dose range varies between 0.5 to 3 grams daily. The same doses apply to nicotinamide. Category 2. Everyone under physiological stress, such as pregnancy and lactation, suffering from acute illness such as the common cold or flu, or other diseases that do not threaten death. All the psychiatric syndromes are included in this group including the schizophrenias and the senile states. It also includes the very large group of people with high blood cholesterol levels or low HDL when it is desired to restore these blood values to normal. The dose range is 1 gram to 10 grams daily. For nicotinamide the range is 1 1/2 g to 6 g. Nicotinamide does not affect cholesterol levels. Side Effects Here are Dr. John Marks' conclusions.  "A tingling or flushing sensation in the skin after relatively large doses (in excess of 75 mg) of nicotinic acid is a rather common phenomenon. It is the result of dilation of the blood vessels that is one of the natural actions of nicotinic acid and one for which it is used therapeutically. Whether this should therefore be regarded as a true adverse reaction is a moot point. The reaction clears regularly after about 20 minutes and is not harmful to the individual. It is very rare for this reaction to occur at less than three times the RDA, even in very sensitive individuals. In most people much larger quantities are required. The related substance nicotinamide only very rarely produces this reaction and in consequence this is the form generally used for vitamin supplementation. "Doses of 200 mg to 10 g daily of the acid have been used therapeutically to lower blood cholesterol levels under medical control for periods of up to 10 years or more and though some reactions have occurred at these very high dosages, they have rapidly responded to cessation of therapy, and have often cleared even when therapy has been continued. "In isolated cases, transient liver disorders, rashes, dry skin and excessive pigmentation have been seen. The tolerance to glucose has been reduced in diabetics and patients with peptic ulcers have experienced increased pain. No serious reaction have been reported however even in these high doses. The available evidence suggests that 10 times the RDA is safe (about 100 mg)." Dr. Marks is cautious about recommending that doses of 100 mg are safe. In my opinion, based upon 40 years of experience with this vitamin the dose ranges I have recommended above are safe. However with the higher doses medical supervision is necessary. Jaundice is very rare. Fewer that ten cases have been reported in the medical literature. I have seen none in ten years. When jaundice dose occur it is usually an obstructive type and clears when the vitamin is discontinued. I have been able to get schizophrenic patients back on nicotinic acid after the jaundice cleared and it did not recur. Four serious cases have been reported, all involving a sustained release preparation. Mullin, Greenson & Mitchell (1989)  reported that a 44 year-old man was treated with crystalline nicotinic acid, 6 grams daily, and after 16 months was normal. He then began to take a sustained-release preparation, same dose. Within three days he developed nausea, vomiting, abdominal pain, dark urine. He had severe hepatic failure and required a liver transplant. Henkin, Johnson & Segrest found three patients who developed hepatitis with sustained release nicotinic acid. When this was replaced with crystalline nicotinic acid there was no recurrent liver damage.  Since jaundice in people who have not been taking nicotinic acid is fairly common it is possible there is a random association. The liver function tests may indicate there is a problem when in fact there is not. Nicotinic acid should be stopped for five days before the liver function tests are given. One patient who had no problem with nicotinic acid for lowering cholesterol switched to the slow release preparations and became ill. When he resumed the original nicotinic acid he was well again with no further evidence of liver dysfunction. I have not seen any cases reported anywhere else. I have described much more fully the side effects of this vitamin elsewhere.  Inositol hexaniacinate is an ester of inositol and nicotinic acid. Each inositol molecule contains six nicotinic acid molecules. This ester is broken down slowly in the body. It is as effective as nicotinic acid and is almost free of side effects. There is very little flushing, gastrointestinal distress and other uncommon side effects. Inositol, considered one of the lesser important B vitamins, does have a function in the body as a messenger molecule and may add something to the therapeutic properties of the nicotinic acid. Conclusion Vitamin B-3 is a very effective nutrient in treating a large number of psychiatric and medical diseases but its beneficial effect is enhanced when the rest of the orthomolecular program is included. The combination of vitamin B-3 and the antioxidant nutrients is a great anti-stress program. Reprinted with the permission of the author: Abram Hoffer, M.D., Ph.D. References 1. Horwitt MK: Modern Nutrition in Health and Disease. Fifth Ed. RS Goodhart and ME Shils. Lea & Febiger, Phil. 1974. 2. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ & Freidewald W: Fifteen year mortality Coronary Drug Project; patients long term benefit with niacin. American Coll Cardiology 8:1245-1255, 1986. 3. Altschul R, Hoffer A & Stephen JD: Influence of Nicotinic Acid on Serum Cholesterol in Man. Arch Biochem Biophys 54:558-559, 1955. 4. Hoffer A: The Schizophrenia, Stress and Adrenochrome Hypothesis. In Press, 1995. 5. Hoffer A: Orthomolecular Medicine for Physicians. Keats Pub, New Canaan, CT, 1989. 6. Hoffer A: The treatment of schizophrenia. In Press 1995. 7. Hoffer A: The Development of Orthomolecular Medicine. In Press, 1995. 8. Hoffer A: Niacin Therapy in Psychiatry. C. C. Thomas, Springfield, IL, 1962. Hoffer A & Osmond H: New Hope For Alcoholics, University Books, New York, 1966. Written by Fannie Kahan. Hoffer A & Walker M: Nutrients to Age Without Senility. Keats Pub Inc, New Canaan, CT, 1980. Hoffer A & Walker M: Smart Nutrients. A Guide to Nutrients That Can Prevent and Reverse Senility. Avery Publishing Group, Garden City Park, New York, 1994. 9. Agnew N & Hoffer A: Nicotinic Acid Modified Lysergic Acid Diethylamide Psychosis. 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The Review of Gastroenterology 12:419-425, 1945. Gerson M: Effects of a combined dietary regime on patients with malignant tumors. Experimental Medicine and Surgery 7:299-317, 1949. 19. Hoffer A: Orthomolecular Oncology. In, Adjuvant Nutrition in Cancer Treatment, Ed. P. Quillin & R. M. Williams. 1992 Symposium Proceedings, Sponsored by Cancer Treatment Research Foundation and American College of Nutrition. Cancer Treatment Research Foundation, 3455 Salt Creek Lane, Suite 200, Arlington Heights, IL 60005-1090, 331-362, 1994. 20. Hoffer A: Hong Kong Veterans Study. J Orthomolecular Psychiatry 3:34-36, 1974. 21. Marks J: Vitamin Safety. Vitamin Information Status Paper, F. Hoffman La Roche & Co., Basle, 1989. 22. Mullin GE, Greenson JK & Mitchell MC: Fulminant hepatic failure after ingestion of sustained-release nicotinic acid. Ann Internal Medicine 111:253-255, 1989. 23. 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