A recent open label study found some support for the effectiveness of a Risperidone injection, given once every 2 weeks, in reducing crystal meth (speed) use.
The 22 patients who participated reduced their weekly crystal meth use from an average of 4 times per week to only 1 time per week. The difference between those who were able to stay completely clean and the others seemed to have to do with the levels of Risperidone in the blood.
The nice thing about using an injection as addiction treatment is that it removes the possibility of patients choosing not to take their medication on any given day. Such non-adherence to treatment is very often found to be the reason for relapse.
This study will need to be followed up by placebo-controlled double-blind studies, but given Risperidone’s action as a Dopamine antagonist, I suspect that those trials will also show a strong treatment effect. The promise of medicines as addiction treatment cures always seems great, but I believe that at best, they can be an additional tool to be used in conjunction with other therapies.
The question will be whether the side-effects common with antipsychotic medication will be well-tolerated by enough people to make the drug useful for addiction treatment.
I teach a class on the psychology of addiction (Psych 477 at California State University in Long Beach) and as I have been preparing the lectures something has become very clear to me – textbooks patently gloss over important details about the addiction research they cite. One of the most obvious gaps I’ve noticed this semester concerns the population of research subjects most addiction research is conducted on. An example will clarify:
A student group in my class had to read a study assessing the residual effects of methamphetamine on mood and sleep. They were amazed that no changes in mood were observed and that participants slept a full 6-8 hours the night after being administered meth! Would you have been surprised with these results given that we all have been told that crystal meth improves mood and causes insomnia?
Would it matter at all if I told you that the participants in the study were current meth abusers who use an average of 4 times every week?
For anyone not aware of the tainted history of health research in the U.S. (I’m including psychological research in this group), go ahead and read about the Tuskegee Syphilis Experiment and Stanford Prison Experiment (video here). There are other examples including Stanley Milgram‘s obedience studies, and more but as exciting as the discussion of these studies is, it’s time to get back to my main point.
It is mostly due to the ethically-questionable, psychologically damaging, research above that research institutions are now required to vet proposed research studies using Institutional Review Boards (IRBs) to assure that human participants in studies are consenting to participate of their own free will, are not coerced, and are not suffering undue damage. This is also true of addiction research. Rarely does the public consider this fact however when they are being reported on research relevant to addiction. I know this because the kids in my class never gave it a second thought.
Nearly all addiction research, especially studies utilizing “hard” drugs like cocaine, meth, opiates, etc., are required to make use of a very limited part of society – drug using individuals with a history of use of the specific drug of interest who are specifically not interested in treatment. Individuals who have never tried the drug or who want to be treated for drug abuse or dependence (addiction) are excluded due to ethical concerns. In most studies, participants can not qualify if they are addicted to drugs other than those being studies (except smoking, for which exceptions are usually made since we’d be able left with no participants otherwise) or have any associated mental health disorders, which are very common among addicted individuals. I would further assert that for at least a substantial portion of these research participants, the term “addicts” may not be appropriate since many addicts would not willingly give up using their favorite substance for a week or two to be replaces with a hospital bed and an experimenter controlled dose of drug or placebo. Taken together, our research subjects are pretty obviously not representative of all drug users, or all addicts, or all anything else. They make up a very specific group – less than perfect, but what we have to work with.
In some studies that attempt to make a direct comparison between controls (or drug naive participants) and drug users, this is likely less of an issue. This can happen when researchers try to examine brain structure differences, or performance on a specific psychological or physical test. In such cases researchers can at least statistically identify contributions of length of use, method of use, and other relevant data on differences between people who use and those that don’t. There are probably still some serious differences between “true” addicts, recreational users, and semi-chronic users that would be important to understand here, but we can’t so we don’t. But when it comes to assessing mood effects, or indeed any of a number of subjective effects of drugs, drug cravings, and withdrawal, this limitation in the population to be studied is something that often needs to be made explicitly clear to most public consumers of research. Since we can’t assess changes in mood, absorption rate, anxiety, or any other such measure (some exceptions for very low doses in very specific circumstances) among people who are new to the drug, we end up assessing them among people with a lot of experience, but not enough of a problem to want addiction treatment. Again, this should be considered a pretty specific type of drug user in my opinion.
There are other types of studies – those conducted with abstinent ex-users or addiction treatment intervention studies utilizing addicts who want, or who reported to, treatment on their own or in response to advertisements. While these studies make use of populations that can be considered at least closer to the individuals they are specifically aimed at – assessing the return of cognitive function after short or long term abstinence or testing a new intervention on those who want treatment – they still bring on limitations that need to be specifically considered.
An important point – most researchers recognize these issues and make them explicitly part of their research publications, in a specific section called “Limitations” but what seems troubling is that the public doesn’t have any awareness of these issues. So when someone tells you that “they just found out meth doesn’t actually make people lose sleep,” take a second to ask “for who?”
22.9 million Americans report trying inhalants at least once in their lives.
When it comes to drug use problems, inhalants are often the first drugs that kids decide to experiment with. The habit is often called huffing. While use of alcohol, tobacco, marijuana, cocaine, ecstasy, and other drugs peaks around the 12th grade, inhalant use peaks in the 8th grade. A study conducted by the National Institute on Drug Abuse found that 17.3% of 8th graders have abused inhalants before.
Why does kids’ drug-use start with inhalants so early in life?
Many kids start inhalant drug use by accident; they like the smell of glue, whiteout, or gasoline, take a long inhale, get high, and keep going. For others, inhalant use is introduced through friends.
Also, attaining drugs can be somewhat of a challenge when you are 13 years old. Inhalants solve this problem. Inhalants are found in a variety of household products including: spray paint, nail polish remover, whiteout, marker, gasoline, glue, keyboard cleaner, shoe polish, and aerosol sprays. These products are easy to buy and relatively inexpensive, even for young kids. They can often be found readily in the house, which also makes them easy to hide.
Inhalants, the brain, and organ damage
Inhalants can be breathed in directly or concentrated in a container such as a plastic bag or cloth and then inhaled. Most inhalants work by depressing the central nervous system. The chemicals are absorbed through the lungs and proceed into the bloodstream, where they quickly reach the brain and other organs. Inhalant intoxication looks very similar to being drunk: Slurred speech, bad coordination, euphoria, dizziness, and drowsiness are all common during inhalant drug use.
The inhalant high only lasts a few minutes, so people often use inhalants repeatedly for several hours. This can have some devastating long-term effects. Brain damage, nerve damage, and organ damage are all possible. Inhalant use can impair vision, hearing, and movement. Inhalant drug-use is also linked with a variety of mental disorders, including antisocial personality disorder and depression. In pregnant animals, inhalant use has been linked to low birth weight, skeletal abnormalities, and delayed development.
Most tragically, even a single session of inhalant use can cause heart failure and consequently, death. The National Inhalant Prevention Coalition reports 100 to 125 inhalant-related deaths per year. This is particularly sad considering the fact that many of these individuals are kids and haven’t even left middle school yet.
Dr. Jaffe talking about huffing and inhalant abuse on Fox News
1. Seigial, J.T., Alvaro, E.M., Patel, N., Crano, W.D. (2009) “…you would probably want to do it. Cause that’s what made them popular.” Exploring Perceptions of Inhalant Utility Among Young Adolescent Nonusers and Occasional Users. Substance Use & Misuse. 44(597-615)
2. NIDA. Inhalant Abuse. 2005
Here at A3 we have already armed you with over 400 articles’ worth of knowledge on a wide variety of topics such as sex, gambling, and alcohol addictions. Our articles have in the past been written mostly by the team members at A3 (with a few notable guest pieces) based upon research findings and personal experience. Now we decided to expand our reach and get a different kind of perspective, broadening the knowledge we are able to provide to you and providing you expert opinion on commonly asked questions that the public often has about addiction.
Our first expert is Christopher J. Evans (PhD) who is a professor in the David Geffen School of Medicine at UCLA. In addition to his work at the school of medicine, Evans is also a part of the UCLA Opioid Research Center, and Shirley and Stefan Hatos Center for Neuropharmacology. Evans is particularly interested in opioid drugs and is currently working on discovering the differential signaling at opioid receptors. Some of his past work has touched on withdrawal and on the theory of opponent processes involved in withdrawal, a counter to the theory that a rebound from over-activation is the whole story in the withdrawal process.
11 answers from an addiction expert
1 ) How did you become interested/specialized in addiction research?
Following my PhD studies in protein chemistry where I studied enkephalins and endorphins – opioids in our brains.
2 ) If you had to sum-up your “take” on substance use disorders in a few sentences, what would those be?
A sad disease where an obsession develops for an abused substance that creates fluctuating hedonic states. Increasingly there is decline to a negative hedonic state that can only be relieved by the abused drug.
3 ) What have been the most meaningful advances in the field in your view over the past decade?
The development of genetic models and imaging to begin to tease out circuits involved in liking a drug, withdrawal from a drug and drug craving.
4 ) What are the biggest barriers the field still needs to overcome?
Resolving the interaction of genetics and environment in creating phenotypes such as depression and anxiety leading to susceptibility to substance abuse.
7 ) How do you think the Health Care reform recently passed will affect addiction treatment?
It appears that there will be more attention paid to substance use disorders. With increased access to health services the treatment of substance disorders is likely to become more of a focus.
8 ) What is your view regarding the inclusion of behavior/process addictions in the field?
They should be included. Many of the process addictions have the same co-morbidities with substance use disorders and these are what need to be understood.
9 ) What is your view on the relative importance of Nature Vs. Nurture?
They are intertwined ? the interaction of nature with nurture directs our behaviors so neither should be considered more important than the other. Either nature or nurture can be a disaster for a life.
10 ) In your view, what are some of the biggest misconceptions that the public still holds about addiction?
That addiction is driven solely by the acute rewarding effects of the drug and not by subsequent adaptations induced by the drug including dysphoria or memories of drug action.
11 ) What is the most common question you get from others (public?) when it comes to addiction?
And there you go, a set of untouched, unedited answers about addiction and addiction research diretly from one of the masters. We hope you’ve enjoyed this and that you’ll look forward to more as All About Addiction continues a monthly exposure of what addiction research looks like from within.
This is the ultimate question for many people. In fact, when discussing addiction, it is rare that the addiction potential for marijuana doesn’t come up.
Some basic points about marijuana:
The active ingredient in marijuana, THC, binds to cannabinoid receptors in the brain (CB1 and CB2). Since it is a partial agonist, it activates these receptors, though not to their full capacity. The fact that cannabinoid receptors modulate mood, sleep, and appetite to some extent is the reason behind many of marijuana’s effects.
But how is marijuana addictive? What’s the link to heroin?
What most people don’t know is that there is quite a bit of interaction between the cannabinoid receptor system (especially CB1 receptors) and the opioid receptor system in the brain. In fact, research has shown that without the activation of the µ opioid receptor, THC is no longer rewarding.
If the fact that marijuana activates the same receptor system as opiates (like heroin, morphine, oxycontin, etc.) surprises you, you should read on.
The opioid system in turn activates the dopamine reward pathway I’ve discussed in numerous other posts (look here for a start). This is the mechanisms that is assumed to underlie the rewarding, and many of the addictive, properties of essentially all drugs of abuse.
But we’re not done!
Without the activation of the CB1 receptors, it seems that opiates, alcohol, nicotine, and perhaps stimulants (like methamphetamine) lose their rewarding properties. This would mean that drug reward depends much more heavily on the cannabinoid receptor system than had been previously thought. Since this is the main target for THC, it stands to reason that the same would go for marijuana.
So what?! Why is marijuana addictive?
Since there’s a close connection between the targets of THC and the addictive properties of many other drugs, it seems to me that arguing against an addictive potential for marijuana is silly.
Of course, some will read this as my saying that marijuana is always addictive and very dangerous. They would be wrong. My point is that marijuana can not be considered as having no potential for addiction.
As I’ve pointed out many times before, the proportion of drug users that become addicted, or dependent, on drugs is relatively small (10%-15%). This is true for almost all drugs – What I’m saying is that it is likely also true for marijuana (here is a discussion of physical versus psychological addiction and their bogus distinction).
Ghozland, Matthes, Simonin, Filliol, L. Kieffer, and Maldonado (2002). Motivational Effects of Cannabinoids Are Mediated by μ-Opioid and κ-Opioid Receptors. Journal of Neuroscience, 22, 1146-1154.
My name is Christopher Russell, I am a doctoral student in psychology at the University of Strathclyde in Glasgow, UK. My addiction research interests are wide and varied, but my core interests are in addiction theory (“why people do what they do”), the issue of freedom to control when using drugs, interpretations of addiction research evidence, and the use of licit and illicit drugs in the law.
Respect and rational debate of addiction research
Dr Adi Jaffe has very generously asked me to become a contributor to A3 and after reading about what A3 stood for (the mission and the abbreviation) and what Dr Jaffe is trying to achieve through A3, I am delighted to be a part of A3. Adi noted in a previous post that we do hold some different opinions about the nature and course of addiction. Above our differences, however, I respect that Dr Jaffe and I are able to debate addiction research rationally, respectfully, and vigorously without either of us resorting to ideological proclamations, disrespect for the alternative view, claiming a moral high ground or attacking each other’s moral character, or worst of all, name calling! Such people are hard to find in the academic world! The truth is that I, like Dr Jaffe, am still learning about addiction, and I’m not foolish enough to believe that my way is the way! If addiction research over the past 100 years has shown anything it is that a researcher would be foolish to hang his hat on any interpretation and proclaim it as fact – for example, for the past 200 years, masturbation was considered the most prevalent psychiatric disorder until it was replaced by drug use, and up until 1973, homosexuality was still diagnosed and treated as a form of mental illness! We must be willing to bend with the wind, to accept when addiction research evidence invalidates our beliefs, and to respond to falsifications by constructing models which stand up to our efforts to falsify them.
A3 and the fluid landscape of addiction research
The landscape of addiction research changes by about 50% each decade, as do many scientific ideas, so it is important that we all hold our beliefs about addiction lightly and be willing to consider that some dearly held addiction “truths” may not be as truthful as we had thought, perhaps hoped. Scientists are constantly revising what they thought they knew, changing their approach to measuring and conceptualising the problem, disseminating the latest findings to the public; like any good scientist, those who are involved with addiction, either personally or professionally, should always try to update their model, and sometimes, evidence can arise which causes us to question everything we thought we knew about the nature of a problem. Such evidence may require us to not merely adapt our exisitng models of the problem, but if called for, to abandon them in favour of more potent models which need not necessarily be liked or fully understood.
Hearing what addiction research is telling us, not what we want to hear
However, despite our pledges to be good scientists, our basic ways of thinking tend to get in the way of building better models of a problem. For example, a classic contribution of psychology research has been the finding that people prefer to try to discredit a new piece of evidence about a concept which doesn’t fit with their existing understanding of that concept rather than assimilate the new evidence into our understanding because it is cognitively easier to leave our belief structure as it is. This phenomenon is quite common in the addiction research community; some people just refuse to believe that addiction could be something other than what they had long thought it to be, and no amount of validated, replicable evidence to the contrary will move them to revise their beliefs. It is regrettably common that, for some, beliefs about addiction are based on an unwavering ideology rather than a science-grounded conclusion. Addiction researchers cannot afford to be this pompous, lazy, or inflexible; too many people are counting us to get the right answers to them, no matter who they come from or what form they come in. I know that my contributions to A3 are only useful to the extent to which they help get people from where they are to where they want to be. To achieve this, I must argue my corner but be willing to bend when the wind blows. We all must.
In the hope that I can be both teacher and student of A3, I believe that the value of my arguments will be measured by how well they hold up in the face of your most passionate, insightful criticism. Therefore, I invite all those who read my contributions to criticize, refute or support any of my arguments when you feel it is warranted. I will always try to give an intelligent answer and I swear to never resort to clichéd answers, bumper sticker answers, or the “it just is because it is” answer, which is in effect, no answer. And I will never resort to name calling (except when you really deserve it!).
I look forward to providing you with thought pieces, philosophical contributions, reviews of evidence, and most of all, interacting with you the readers, the lifeblood of A3.