About Addiction: Smoking, Alcohol, Painkillers, Prescriptions

This are new, interesting articles about addiction. Check out the links to the articles, and give us your feedback.

Smoking and related issues

Health Day: Smoking increases the risk of age-related macular degeneration, a disease that robs people of their sight.

Reuters: When cigarette smokers quit smoking, chronic stress levels may go down. This should give smokers reassurance that quitting will not deprive them of a valuable stress reliever.

Reuters: A nicotine mouth spray may help prevent cigarette cravings three times faster than nicotine lozenges or chewing gum. This might help smokers who are trying to quit smoking.

Cesar Fax: The percentage of national tobacco retailers selling to minors appears to have leveled off. The average national retailer violation rate decreased from 40.1% to 10.8%, and stabilized at 10.8%.

wcstv: Under a proposed deal reached by Governor David Paterson and Albany legislators, cigarette taxes would increase by $1.60 per pack. In New York City, the price of one pack of cigarettes would cost over $10 in many stores. The hope is that this huge price increase will help smokers quit smoking and reduce overall levels of smoking in New York.

About addiction to alcohol, painkillers, and prescription medication

Hazelden: Abuse of alcohol, painkillers, and prescription medication is rising dramatically among older people. Signs of alcohol abuse and drug addiction are different in older adults than in younger people.

Science Daily: Religiosity can moderate genetic effects on alcohol abuse during adolescence but not during early adulthood. The heritability of an alcohol abuse phenotype depends upon the social environment within which it is measured.

Medical News TODAY: Sleep problems can predict the onset of alcohol abuse in healthy adults and relapse in abstinent alcoholics. Puberty is related to sleep problems and later bedtimes, which are associated with alcohol abuse.

Health Day: Exercise may be an effective treatment option for alcoholism. In addition, alcoholism disrupts normal daily circadian rhythms, which can lead to disrupted sleep patterns.

About addiction and mental illness

KansasCity.com:  To study drug addiction and mental illness researchers, at the University of Missouri-Kansas City, have received a $1.8 million federal grant. One of the leading researchers states that conditions such as drug addiction and depression are major problems across the globe.

The brain after cocaine – White matter damage and addiction treatment

The brain damage left behind after long-term cocaine use can apparently tell us quite a bit about how well a cocaine addict will do in addiction treatment – as long as we assess the right kind of damage.

Different kinds of brain matter

I’ve talked before about the fact that use of cocaine, and other drugs, can bring about long-term changes in the brain that sometimes include the actual destruction of neural pathways. What you may not know is that brain matter consists of several different components including the cell bodies of neurons (known as gray matter) and the tracts of axons that transmit messages across the brain (known as white matter). There are other parts as well, but those are the two important ones to know for this article.

Gray matter is important because brain transmission isn’t possible without a cell body, which is its operations center. But white matter is equally important because without it, the messages don’t get anywhere. It’s like having a telephone without a communication network – The phone can work perfectly and no one will ever hear you speak.

Until recently, it’s been pretty hard to measure the structure of white matter because it consists of very thin bands that twist and turn throughout the brain. But recent advancements in fMRI imaging and analysis have allowed us to look at it by measuring the direction in which water molecules flow through white matter. It’s called DTI (Diffusion Tensor Imaging) and it’s pretty complicated, but all you need to know is that it lets us know a lot about the integrity of axons in the brain.

White matter and cocaine

Use of cocaine has already been shown to cause damage to brain white matter. A recent study conducted at Yale examined whether the degree of damage can tell us anything about how well people will do in addiction treatment. Researchers took 16 participants and gave them a host of tests as well as some brain scans before sending them off to an 8 week treatment program. The addiction treatment utilized was outpatient and provided different individuals with different combinations of CBT, medication (antabuse), individual, and group therapy. At the end of treatment, the number of clean urine tests (out of 56 total tests) was used as a measure of treatment success. The more clean urines, the better, something I think we need to adopt overall instead of the all-or-nothing view that abstinence is the only form of improvement.

The bottom line: Using three different measures, the researchers found that individuals with more damaged white matter provided less clean urines throughout the addiction-treatment period. Another important fact – the damages areas that were found to be associated with treatment success were found all over the brain. Interestingly, brain damage wasn’t associated with the length of drug use, but it may have been associated with the extent of use (in terms of years and amount used), something the researchers didn’t report on.

Brain matter and addiction treatment outcomes

One day, we’ll have a battery of tests that will let us tailor treatment more effectively towards specific addicts. Genetics, brains scans, and more, will be able to tell us where an addict is especially weak so that we can focus on those areas first. Some may need specific help with impulsivity and weakened learning systems whereas others may be better off with treatment that addresses past trauma and an oversensitive stress response system.

As this research shows, brain scans can offer us a glimpse into the aspects of an addict’s brain that have been compromised. But we’re not there yet – right now, all we know is that certain genes, brain function patters, and experiences, are associated with a greater risk for addictive behavior or a lower chance of recovery. Getting better at more specifically tailoring treatment is still a little farther than we’d like.

Citation:

Jiansong Xu, Elise E DeVito, Patrick D Worhunsky, Kathleen M Carroll, Bruce J Rounsaville & Marc N Potenza (2010). White Matter Integrity is Associated with Treatment Outcome Measures in Cocaine Dependence, Neuropsychopharmacology 35, 1541–1549.

NIDA and ONDCP – American policy on addiction research

At this year’s College on Problems of Drug Dependence (CPDD) Annual Meeting, I got to hear, and talk to, some of the most influential players in the American addiction research field. Here are a few highlights from their talks and our discussion:

Dr. Nora Volkow of NIDA talked about a shift from Genome Wide Association Studies (GWAS), which have been the most recent popular advance in genetics addiction research and into more Deep Sequencing work. The hope is that this will allow us to begin untangling some of the GWAS findings that have seemed counter-intutitive or puzzling. Deep sequencing should let us see what genes really are associated with addiction specifically, not just as markers.

Dr. Volkow also brought up the numerous issues of medications for addictions including the Nabi Nicotine Vaccine, Vivitrol (a Nalexone depot that helps opiate users who wouldn’t take it otherwise), and a host of new medications that are being developed or considered. An interesting idea here was the use of drug combinations which are showing great promise in providing enhanced treatment results (similar to HIV treatment that benefited greatly from drug cocktails). These include combining vernicline and bupropion for smoking and naltrexone and buprenorphine for cocaine (that’s not a type even though both have been typically thought of for opiate addicts).

Dr. Tom McLellan, who I personally believe is one of the most informed and thoughtful people we have when it comes to addiction research in this country, talked about our need to expand the reach of treatment to the drug abuse earlier in the problem cycle. While about 25 million people are considered drug addicts in this country, more than 65 million are drug abusers. By finding ways to reach those people in primary care (as in doctor offices) settings before they develop the full blown addiction we’re used to talking about we can do better. He also mentioned the idea of anonymity in recovery playing a role in the continued stigmatization of addiction, a topic I’ve written about recently.

Stay on the lookout for more amazing new addiction research knowledge!

Creating a better system of addiction treatment: Matching rehabs to patients

I can’t hide it any longer, I just have to confess: I hate the way addiction treatment is managed nowadays. With over 25 million people meeting criteria for addictions in the U.S., only 10% are seeking treatment on a yearly basis. Sure, part of the problem is that others just don’t want it, at least yet, but there’s something else going on and it’s terrible.

The horrible pain of finding addiction treatment

If you, or someone you know, needs help for an addiction, your options aren’t just limited, they’re hard to find and are simply too stressful to deal with. Where do you even start? Most people wouldn’t dare go to their neighbors or family members with something like “Bobby is really struggling with his cocaine problem, do you have an idea of what we should do?” Instead, everyone is left fending for themselves, scared of going to doctors for fear of later insurance trouble, ashamed to admit their difficulties for fear of being stigmatized, and inundated with conflicting information about their chances for recovery if they do seek help.

So people go online, they seek out information, and they call provider after provider, often getting only partial semi-truths. At the end, most are left confused and the rest simply check in to the first place that will take them given their financial reality. Could you imagine if the same were true when someone broke their leg?

But isn’t addiction treatment really useless?

No, it’s not. Treatment works. It’s just that most people don’t get the treatment they need and end up paying the price (literally and figuratively). Well guess what, help is possible, it’s available, and it shouldn’t be this damn hard to find!

I think it’s about time we create a system that makes it easy for those suffering from addiction to find the right treatment for them. Not everyone needs treatment that costs $50,000 a month, and to be perfectly honest, that treatment is rarely better than much cheaper options. Still, no one would know that given bogus advertisements by rich addiction-industry-players that promise cures and fixes. The truth is that recovery is a difficult road and that different individuals may need different treatment.

Still, we know things that work: CBT works, motivational interviewing works, social-support, contingency-management, exercise, meditation, and specific medications work! So why is it that the addiction treatment industry still looks like something put together by a couple of addicts who suffer from too much self-focus and not enough organizational-capacity? Well, probably because that’s exactly our reality at the moment.

How can we make things better? Matching rehabs to patients

I say it’s time for a new age, especially given the passage of mental-health and addiction parity laws and the slow, but eventual inclusion of our most vulnerable citizens in the American health care system. As addiction-treatment becomes (finally) incorporated with medical care, the increased resources are going to mean an increased need for some standardization. It’s time for us to put people in treatment that works, that everyone can afford, and that is easy to find.

We’re currently testing a system that will use some basic, and some a bit more advanced, criteria to help direct addicts towards the right provider for them. Don’t have much money and working full-time? Then residential treatment should probably not be your first choice? Medicated for schizophrenia? You better stay away from providers that don’t offer serious mental health services (though they’ll sure take you if you walk through their doors)

We’re still figuring out the kinks, trying to improve the system even further than its current state, which I think is nothing short of magical. Eventually, I hope that it will be available for everyone, giving people real, reliable, objective access to addiction-treatment providers that do good work across the united States. It’s that easy to find a condo to buy, why shouldn’t it be that easy to find help?

Yes, I have almost 10 years of research experience into what works, but in truth, most of the issues here probably don’t require that at all. What’s needed is a little big-picture thinking and a little less fine-tooth combing. Hospitals can triage people based on a pretty quick, efficient, assessment. We can too.

Dr. Drew Pinsky – America’s addiction guru in the NY Times

An article in today’s NY Times magazine section discusses the world according to Dr. Drew. Being an addiction specialist myself, I obviously couldn’t resist devouring it, even though I’m in Belgium at the moment.

Dr. Drew the good and bad

The article was a wonderfully written piece that dealt with much of the irony in Dr. Drew‘s fame, which is based on his selling of addiction to the public. Dr. Drew got his start working the Loveline microphone on the radio 20 years ago, so there’s not doubt that he’s put in his time.

For all the flak the man has received , I believe that his work has served Americans in many important ways. By making the patter accessible, Dr. Drew has, to some extent, reduced the enormous stigma associated with addiction. Of course it’d be nice if he could do it without all the excessive drama-centric editing, but such is life, and this is obviously the best he thinks he can deliver. As he points out, one has to work within the confines of what producers will allow, though working with VH1 no doubt restricts his movement greatly.

Addiction as a disease and Dr. Drew’s part

Still, I think that Dr. Drew has prepared America to accept that addiction as a disease. So even though he’s done it by selling his own brand of narcissism, which does little to reduce what seems to be the target of his next therapeutic goal, I think he’s helped us all a bit. He’s certainly cleared the way for therapists who are not concerned with curing celebrity-addicts, riddled with gobs of their own narcissism, to do the work necessary. And that’s what I intend to do.

So thank you Dr. Drew for paving the way through your decades of radio and television work. I’ll be ready to take it from here in September, once this Ph.D. is completed.

How can you offer addiction help?

The question that seems to be on everybody’s mind (except perhaps that of the addict), is:

SO HOW CAN I HELP ?!?!?

– One of the first things you must do if you want to help someone with an addiction is to educate yourself. Obviously, you are already beginning the process by reading blogs like this along with, hopefully, finding other resources online. The National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) have some great information that will no doubt be useful!

– While you’ll learn a lot throughout this process, don’t expect that the addict will be as excited about your learning as you may be. You are learning so that you understand what addiction entails. Remember that addiction is a disease of the brain and that the drugs, or alcohol, have a grip on your loved one that is more than simply moral. There are actual changes in neurological (brain) circuits that are caused by heavy drug use and that affect the user’s ability to quit (look for my educational posts on drug addiction).

Behavior is guided by rewards and punishments. This is something that we’ve learned over and over in psychological research. While it may seem difficult, decide on what you’re willing to accept and what you aren’t, and stick by those rules. I don’t necessarily believe in the punishment idea in this context because it can seriously strain relationships. However, if you go the the mostly-reward-route, make sure that you only reward behavior that is healthy, like decisions not to use. If “using behavior” is sometimes rewarded (like when you feel really bad for the user), the mixed message will make it much harder to change the behavior later.

– I also don’t necessarily believe in the al-anon method of detachment. My own story would have turned out very differently had my family not been there to catch me when I had my last, huge, fall. If you choose to detach though, decide for yourself if this is a temporary solution or if you want to do so permanently. Drug users are great manipulators and if you think that a night of “I’m not talking to you,” may be enough, you are sorely mistaken…

Intervention Hell

– When it comes to interventions, everyone always thinks of the stereotypical kind now immortalized in the A&E television show. That sort of intervention is known as th Johnson Institute method. Nevertheless, it’s far from the only one and has actually been shown to be marginally effective. Remember that any attempt to alter behavior is considered an intervention. The act of rewarding positive decisions I’d mentioned above would alter behavior in ways that are slower, but most likely more long lasting, all while introducing less strain on the relationship, at least in the short run. Another type of technique that I prefer when it comes to getting resistant addicts into treatment is called Motivational Interviewing. Make sure to ask anyone you approach for treatment whether they use this technique. It’s been shown to greatly improve addicts’ own motivation to enter treatment and when they want it themselves they’re more likely to benefit from it.

As always, if you have specific questions, please feel free to contact me.

Be strong, and most importantly, don’t blame yourself for what’s going on, but be aware of your role in the relationship and know what you can change about your part.

Good Luck!

One is too many, a thousand not enough: Does a slip or relapse mean the end?

Breaking news: When alcoholics who have gone through treatment have a drink after a certain length of sobriety, most don’t go off the deep end.

Slip scares and abstinence relapse

RelapsingThe old AA adage: “One drink is too many, and a thousand not enough,” refers to the fact that alcoholics who are sober are assumed to return to their evil ways after even a small slip (known as a relapse). This notion is meant to warn AA members to resist temptation lest they find themselves right back where they started. Or worse.

Most research into sobriety considers a person a success only if they remain sober throughout the study period. The followup periods last anywhere between 6 months to a year (or sometimes more). Have a drink, and you’ve lost. Game over. No one’s ever really looked at what people who have relapsed actually do after the relapse. Which is why the recent findings reported in the journal Psychology of Addictive Behaviors are so intriguing.

Recent relapse research findings

When looking at the behavior of 563 participants, the researchers found that 30% stayed sober for the entire 12 month follow-up period. This leaves a whopping 70% who had at least a drink in the year following treatment. However, the vast majority of those who drank in the first year after treatment (82%) developed moderate, infrequent, drinking habits. In fact, only about 6% started drinking heavily and frequently after their relapse. Even of those who drank, as many as 25% were completely dry for at least an entire month after their relapse.

The bottom line on relapse?

These findings suggest that at least for a year after becoming sober, a relapse is not necessarily the detrimental, destructive, event it has always been feared to be. It is surely possible that these drinking habits change, but according to these findings, if drinking frequency goes anywhere after the initial relapse, it’s down, not up.

I’m not trying to make light of relapse here, and I’m certainly not saying that relapsing is a positive thing. Nevertheless, given the fact that relapse is almost always a part of the recovery process, I’m suggesting that having a relapse shouldn’t scare everyone involved. It doesn’t seem to in any way suggest a necessary demise.

Citation:

Witkiewitz, K. & Masyn, K. E. (2008). Drinking trajectories following an initial lapse. Psychology of Addictive Behaviors, 22, 157-167.