Loss, but not absence, of control – How choice and addiction are related

In a recent post the notion that “loss of control” is an addiction myth was raised by our contributing author, Christopher Russell, a thoughtful graduate student studying substance abuse in the U.K. Though I obviously personally believe in control- and choice-relevant neurological mechanisms playing a part in addiction, this conversation is a common one both within and outside of the drug abuse field. Therefore, I welcome the discussion onto our pages. I’d like to start out by reviewing some of the more abstract differences between my view and the one expressed by Christopher and follow those with some evidence to support my view and refute the evidence brought forth by him.

Addiction conceptualization – Philosophical and logical differences and misinterpretations

One of the first issues I take with the argument against control as a major factor in drug addiction is the interpretation of the phrase “loss of control” as meaning absence, rather than a reduction, in control over addiction and addictive behavior. Clearly though, one of the definitions of loss is a “decrease in amount, magnitude, or degree” (from Merriam-Webster.com) and not the destruction of something. Science is an exercise in probabilities so when scientists say “loss”, they mean a decrease and not a complete absence in the same way that findings showing that smoking cigarettes causes cancer do not mean that if an individual smokes cigarettes they will inevitably develop cancerous tumors. Similarly, the word “can’t” colloquially means having a low probability of success and not the complete inability to succeed. Intervention that improve the probability of quitting smoking (like bupropion or quitlines for smoking) success are therefore said to cause improvements in the capacity for quitting.

Next, Christopher wants scientists to identify the source of “will” in the brain but I suggest that “will” itself is simply a term he has given a behavioral outcome – the ability to make a choice that falls in line with expectations. In actuality, “will” is more commonly used as a reference to motivation, which while measurable, isn’t really the aspect of addiction involved in cognitive control. Instead, what we’re talking about is “capacity” to make a choice. The issue is a significant, not semantic one, since the argument most neuroscientists make about drug abuse is that addicts suffer a reduced capacity to make appropriate behavioral choices, especially as they pertain to engaging in the addictive behavior of interest. If someone is attempting to get into a car but repeatedly fails, we say they can’t get in the car (capacity), not that they don’t want to (will). Saying that they simply “don’t” get in the car doesn’t get at either capacity or will but instead is simply descriptive. I don’t believe that science is, or should be, merely descriptive but instead that it allows us to form conclusions based on available information.

That there is a segment of individuals who develop compulsive behavioral patterns tied to alcohol and drug use and who attempt to stop but fail is, to my mind, evidence that those individuals have a difficulty (capacity) in stopping their drug use. Their motivation (will) to quit is an aspect that has been shown to be associated with their probability of success but the two are by no means synonymous. It is important to note, and understand, that the attribution for the performance should not fall squarely on the shoulders of the individuals. We humans are so prone to making that mistake that it has a name, “The fundamental attribution error,” and indeed, individuals who show compulsive, addictive, behavior do so because of neuropharmacological, environmental, and social reasons in addition to the complex interactions between them all. But no one is disputing that and in fact, the article used by Christopher to point out the notion of a “tipping point” in addiction directly points out that fact in the next paragraph (Page 4), which he chose not to reference or acknowledge.

“Of course, addiction is not that simple. Addiction is not just a brain disease. It is a brain disease for which the social contexts in which it has both developed and is expressed are critically important… The implications are obvious. If we understand addiction as a prototypical psychobiological illness, with critical biological, behavioral, and social-context components, our treatment strategies must include biological, behavioral, and social-context elements.” (Lashner, 1997)

Lastly, Christopher’s philosophical musings are interesting, but they seem to stray away from trying to find an explanation for behavior and instead simply deconstruct evidence. In a personal communication I explained that while most addiction researchers understand that addiction, like most other mental health disorders is composed of a continuum of control ranging from absolute control over behavior to no control whatsoever (with most people fitting somewhere in the middle and few if any at the extreme ends), categorization is a necessary evil of clinical treatment. The same is true for every quantitative measure from height (Dwarfism is sometimes defined as adults who are shorter than 4’10”) to weight (BMI greater than 30 kg/m²). I think it’s equally as tough to argue that someone with a BMI of 29.5 is distinctly different from an individual with a BMI of 30 as it is to argue that there is no utility in the classification. Well, the same applies for drug addiction, although some people categorically object to classification and believe it has no utility or justification.

Now for the evidence – “Choice” and “control” are not the same as “will”

Some people quit, even without help – Christopher and a number of the people he cites in support (Peele, Alexander), suggest that because some people do stop using that it can’t be said that there is a problem with any individuals’ capacity to stop. The problem with that argument is that it supposes that everyone is the same, a fact that is simply false. As an example I would like to suggest that we compare cognitive control with physical control and use Huntington’s Disease (HD or Huntington’s Chorea) as an example.

HD patients suffer mental dementia but the physical symptoms of the disease, an inability to control their physical movement resulting in flailing limbs often referred to as the Huntington Dance, are almost always the first noticeable symptoms. Nevertheless, HD sufferers experience a number of debilitating symptoms that originate in brain dysfunction (specifically destruction of striatum neurons, the substantia nigra, and hippocampus) and that alter their ability (capacity) to control their movements and affect their memory and executive function leading to problems in planning and higher order thought processes. So, while it is true that most people can control their arm movements, here is an example of individuals who progressively become worse and worse at doing so due to a neurophramacological disorder. There is currently no cure for HD but some medications that help treat it no doubt restore some of the capacity of these patients to control their movements. If a cure is found it would be difficult to say, as Christopher suggests of addiction, that the cure does not affect the capacity of HD patients to control what they once could not. I chose HD for its physiological set of symptoms but a similar example could easily be constructed for schizophrenia and a number of other mental health disorders (including ADHD and drug addiction). Importantly, cognitive control is a function of brain activity, activity that can become compromised as the set of experiment I will discuss next show.

An experiment conducted at UCLA (1) has shown that cocaine administrations reduced animals’ ability to change their behavior when environmental conditions called for it. Even more meaningful was the finding that once animals are exposed to daily doses of drugs, the way their learning systems function is altered even when the drugs themselves are no longer on board and even when the learning has nothing to do with drugs per se.

In the experiment, conducted by Dr. David Jentsch and colleagues, monkeys were given either a single dose (less than the equivalent of a tenth of a gram for a 150lb human) or repeated doses (1/8 to 1/4 of a gram equivalent once daily for 14 days) of cocaine. The task involved learning an initial association between the location of food in one of three boxes and then learning that the location of the food has changed. We call this task reversal learning since animals have to unlearn an established relationship to learn a new one.

Obviously, the animals want the food, and so the appropriate response once the location is changed is to stop picking the old location and move on to the new one that now holds the coveted food. This sort of thing happens all the time in life and indeed, during addiction it seems that people have trouble adjusting their behavior when taking drugs is no longer rewarding and is, in fact, even troublesome (as in leading to jail, family breakups, etc.).

In the experiment, animals exposed to cocaine had trouble (when compared to control animals that got an injection of saline water) learning to reverse their selection when tested 20 minutes after getting the drug, which is not surprising but still an example of how drug administration can causally affect an individual’s ability to make appropriate choices. As pointed above, the most interesting finding had to do with the animals that got a dose of cocaine every day for 14 days. Even after a full week of being off the drug, these animals showed an interesting effect that persisted for a month – while their ability to learn that initial food-box association, they had significant trouble changing their selection once the conditions changed. Remember, this effect was present with no cocaine in their system and with learning conditions that had nothing whatsoever to do with cocaine.

If that’s not direct evidence that having drugs in your system can alter the way your brain makes choices, I don’t know what is.

Another study conducted by Calu and colleagues with rats found similar (or even more pronounced) reversal learning problems after training the animals to take cocaine for themselves, clarifying that it is the taking of cocaine and not the method that causes the impairments.

Another entire set of studies has shown that stimuli (also known as cues or triggers) that have become associated with drugs can bring back long-forgotten drug-seeking behavior once they are reintroduced. This was shown in that Calu paper I mentioned above and in so many other articles that it would be wasteful to go through all the evidence here. Importantly, this evidence shows that drug associated cues direct behavior towards drug seeking in a way that biases behavior regardless of any underlying will. My own research has shown that animals who respond greatly to drugs (nicotine in our case) likely learn to integrate more of these triggers than animals who show a reduced response, indicating once again that these animals bias  their behavioral selection towards drug-seeking more than usual. While we have more studies to conduct, we believe that genetic differences relevant to dopamine and possibly other neurotransmitters important for learning (like Glutamate) are responsible for this effect.

While we can’t do these kinds of experiments with people (research approval committee’s just won’t let you give drugs to people who haven’t used them before), there is quite a bit of evidence showing an association between trouble in reversal learning and chronic drug use in humans (see citation 3 for example) as well as research showing very different brain activity among addicted individuals to drug-associated versus non-drug cues (like seeing a crack pipe versus a building). All this evidence suggests that drug users are different in the way they learn generally, and more specifically about drugs, than individuals not addicted to drugs. When it comes to genetics, we know quite a bit about the  association between substance abuse and specific genes, especially when it comes to dopamine function. As expected, genetic variation in dopamine receptor subtypes important in learning about rewards (D4 and D2) has been revealed to exist between addicts and non addicts. Without getting into the techniques and analysis methods involved in these genetic studies, their sheer number and the relationship between substance abuse and other impulse disorders points to a direct relationship between drug use disorders (and possibly other addictive disorders) and a reduced capacity to exert behavioral control. Less capacity for control is what researchers have found sets addict apart from non-addicts.

Summary, conclusions, and final thoughts

The toyota Prius is slow but efficientIn closing, there are undoubtedly imperfections about the ways we diagnose addiction (drug addiction and others). It would probably be nice if we could figure out a way to incorporate what we know about the continuous nature of the disorder with the need for clinical delineation of who requires addiction treatment and who doesn’t. Addiction researchers are far from the only ones who wonder about this question though (the same issues are relevant for schizophrenia, depression, and nearly every mental health disorder) and I am certain that better and better solutions will emerge.

However, the discussion of stigma in this context needs to allow us to discuss the reality of addiction without having to resort to blaming and counter-blaming. If I describe the Toyota Prius as being slow but incredibly efficient I am no more stigmatizing than if I describe a Ferrari as being incredibly fact but wasteful in terms of fuel. The same applies, or should apply, to health and mental health diagnoses – Just because an individual is less able to exert cognitive control over impulses should not by definition call into question their standing as a human being. We are complex machines and by improving our understanding of the nuts and bolts that make us function we can only, in my opinion, improve our ability to make the best use of our capabilities while understanding our relative strengths and weaknesses. Any other way of looking at it seems to me to be either wishful (I can do anything if I want it badly enough) or defeatist (I will never be anything because I’m not good at X) and neither seem like good options to me.

Citations:

1) Jentsch, Olausson, De La Garza, and Tylor (2002): Impairments of Reversal Learning and Response Perseveration after Repeated, Intermittent Cocaine Administrations to Monkeys. Neuropsychopharmacology, Volume 26, Issue 2, Pages 183-190

2) Calu et al (2007) Withdrawal from cocaine self-administration produces long-lasting deficits in orbitofrontal-dependent reversal learning in rats. Learning & Memory, 14, 325-328.

3) Some evidence in humans from Trevor Robbins’ group: Reversal deficits in current chronic cocaine users.

Overload, distraction, or inattention? Different factors in a frenzied world

ADHD is one of those clinical diagnoses that caught on and spread wildly, tagging every kid as it rushed by. At least that’s what some people would like you to think. In reality, only about 5% of children have been diagnosed as having ADHD (according to the CDC). Nevertheless, it certainly seems that distraction and inattention are becoming much more common in our society, though most people probably don’t hit clinical levels.

I’ve been losing things my whole life – It’s a running joke in my family (unless I lost your stuff, then it’s not so funny). From keys as a kid, to sneakers after ball-games, to my latest custom-made suit that was left on top of my car as I drove away. I was almost certainly an undiagnosed ADHD case in my childhood – the standards were different back in the early 80s and my Jewish mother was too protective to let anything be wrong with her perfect kid – but I can’t blame everything on my ADHD, and my wife who certainly doesn’t have the condition seems to lose her share of stuff too. So what gives?

Overload, distraction, and inattention

We live in a world full of stimulation where lights, and sounds mark the constant flow of information we’re supposed to process. Overload is a nice concept, but in fact our brains, not adept at processing computer-level bits of information, simply have to screen some stuff out in order to maintain us at below overload levels. In fact, when we hit overload, we normally know it – Headaches, anxiety, increased heart-rate and general stress response are ways our body lets us know that’s we’ve gone too far. The bottom line is that we normally operate well within our body’s functional range.

Nevertheless, if our brain has to screen out information, how controlled is the stuff that gets away? I think this is where the difference between people like me and the rest of you who don’t lose things daily really lies. You see, my brain dumps stuff at the same rate as everyone else but I don’t think it knows what is more, or less, important and therefore performs its cleanup duties indiscriminately.

It’s a bad deal.

The thing is you don’t have to take my word for it – recent research, conducted by some colleagues of mine at UCLA showed that people with ADHD do poorly when it comes to remembering more important words on a list even though they have about the same memory recall overall. When each word on a list of words to be memorized was given a clear point value, controls were able to produce significantly greater total-score word lists from memory than ADHD participants even though the total list length wasn’t different.

You see, it’s not just how much you can remember but also how good you are at screening out the less important stuff. For me, it’s a constant battle that I too often lose. Hopefully you have better luck.

Citation:

Castel, A. D., Lee, S. S., Humphreys, K. L., & Moore, A. N. (2011). Memory capacity, selective control, and value-directed remembering in children with and without attention-deficit/hyperactivity disorder (ADHD). Neuropsychology, 25, 15-24.

About Addiction: Drug Withdrawal in Newborns, Heroin, and Harm Reduction

There’s so much to learn about addiction nowadays – Psychological theories, new stories, neuroscience research, and more. At All About Addiction we try to make the information easy to digest, so when you need to sort of the latest information about addiction, come see us, we’ll help.

Harm reduction – Heroin and Injecting Drugs

Irish Examiner-After four individuals died from heroin overdoses in Ireland drug workers are issuing warnings to heroin users. The heroin that is being used is of better quality so it elevates the risk for overdose. Heroin has been off of the streets of Ireland for the past couple of months due to supplying issues but now heroin is back, and it is so pure that it is killing people. Another issue could be that the short absence of the drug has left people with less tolerance then before.

The Body– The International Harm Reduction Association (IHRA) and HIV rights groups are urging the UN’s to legalize methadone in order to fight HIV/AIDS and heroin addiction In Russia. Russia is home to 1 million HIV-positive people (for comparison, the U.S> has about 500,000) and has one of the fastest growing HIV/AIDS epidemics in the world. In addition to this Russia has 3 million heroin addicts.  Russia is refusing to employ harm reduction programs such as needle exchanges, or to legalize methadone to treat heroin addicts.  Many Russian officials such as Gennady Onishchenko feel that legalizing methadone will not help as it is “just another narcotic.” We’ve hear the same argument here, but perhaps the IHRA can convince Russia to use harm reduction problems in order to help individuals.

Harm Reduction Coalition– This “webinar” allow its viewers to gain cultural competency when it comes to learning about the injecting drug user. It asks questions like:  “Why is there a need for IDU cultural competency?” and “What is IDU Cultural Competency?”. Check out the webinar and see what it has to offer!

Mental Health and Prescription Drug Withdrawal in Newborns

Orlando SentinelPrescription drug abuse is already a problem in our society; in Florida alone prescription abuse is responsible for at least seven deaths a day. Prescription drug abuse is becoming even more problematic as it is now affecting newborns. In 2009 alone 1,000 babies were born and treated for drug-withdrawal syndrome.  In the past babies that were going through drug-withdrawal symptoms were most likely to suffer from crack cocaine addiction but now the babies are more likely to be addicted to prescription drugs.

Science Daily– A study was conducted and found that children with attention-deficit hyperactivity disorder (ADHD) are two to three times more likely than children without the disorder to develop serious substance abuse problems in adolescence and adulthood. Kate Humphreys, a colleague of Dr. Jaffe’s and a graduate student at UCLA was a coauthor of the research.

Addiction Recovery- Peer support

Stop Medicine Abuse-Often times it is best for teens to get information from their peers in order for something to have an effect in their lives. This website approaches substance abuse prevention with that specific mentality. Check out the testimony on this website as well as other resources that can be used by teens to learn about drug abuse.

ADHD and neurocognition – Knowing what to remember

Kate Humphreys

ADHD In children and adults – Symptoms and tests

Children with attention deficit hyperactivity disorder (ADHD, formerly known also as ADD) are classically seen as the kids in class who have trouble staying in their seats and paying attention during long lessons. Underlying these problematic behaviors is a confluence of factors, with evidence pointing to genetics, neural function, and environmental factors (including parenting and lead exposure) that can all affect ADHD behavior. Many children diagnosed with ADHD seem to simply “grow out” of their symptoms. They may learn particularly effective strategies for managing inattention and disorganization (I myself am a notorious list maker), or learn to control some of the fidgeting and restlessness or channel that energy into sports or other activities. Continue reading “ADHD and neurocognition – Knowing what to remember”

About Addiction: Addiction Recovery, Alcohol, and Drug Legalization

Yes, you’ve got it, it’s your 30 seconds of news about addiction from around the world (wide web). Enjoy the reading – you can claim you learned your “new thing of the day.”

Addiction recovery- Inpatient and Outpatient treatment plans

Addiction Recovery-Recovering from addiction is hard, no matter what type of addiction it is. In order to complete a successful recovery from addiction, a positive attitude helps. Holding a positive attitude increases the chances that the recovery attempt will be a successful one. We’ve written often about addiction treatment and tips to increase sucess.

Recovery Now– What are the stages to inpatient addiction treatment? According to Recovery Now, the stages of inpatient treatment include:  intake, detox, stabilization, and long term recovery. Though I don’t necessarily agree with every aspect of this article, it contains some good information about addiction treatment that every reader should know. This additional piece from Recovery Now discusses the appropriateness of inpatient versus outpatient addiction treatment for specific patients.

Alcohol use

Science Daily– We’ve talked about the link that has been found between family history of alcoholism and an individual’s obesity risk.  In this study a family history of alcoholism produced an increased risk for obesity, though the environment also played a large role in this link. Environmental factors include the types of foods that are eaten- foods that are typically high in calories from sugars, salt and fat.

Desert News– Everyone knows at least one person whose life has been affected by alcohol abuse in some form or another. Here is a story of how alcohol negatively affected a woman’s life and how it overtook her life ultimately leading to her death.

The Sydney Morning Herald– Drunk Driving is not just a problem in the United States, driving under the influence of alcohol appears to be a problem in other countries as well.  In Australia almost 1,400 people were arrested for alcohol-related offenses.

AOL Health-There is a multitude of information found on billboards and in TV commercials which explains the risks of drunk and drugged driving. Despite this information 30 million Americans are driving drunk each year and 10 million are driving while they are under the influence of drugs. This problem is very serious and is most problematic among drivers who are aged 16-25. Although there has been a drop in the overall number of individuals who are driving while they are under the influence, one in three car accidents still occur from drunk driving.

Drugs- The dangers of legal drugs, Marijuana, Adderall, and Methadone

Belfast TelegraphAlcohol and legal drugs are okay in small doses and can even be helpful in medical settings and for overall health. However it is important to note that there have been many more alcohol related deaths than deaths from illegal substances such as heroin and crystal meth. By far alcohol is the greatest perpetrator followed by prescription drugs including amphetamines, benzodiazepines and antidepressants. In Ireland in 2009 alone there were 283 alcohol-related deaths were registered in the north and 276 the previous year.

NIH News- There has been a recent increase in marijuana use among 8th graders according to NIDA’s monitoring the future survey. It was reported that the rate of eighth-graders who are using illicit drugs is 16 percent, a 2.5 increase from the previous year’s use of 14.5 percent. Among high school seniors cigarette use has declined but marijuana, ecstasy and prescription drug use has increased. Marijuana use among adolescents is so problematic because it affects the brains development as well as a person’s learning, judgment, and motor skills. Additionally 1 in 6 people who start using it as adolescents become addicted. The spike in the drug use may be attributed to the debate on legalization which may give a false impression that the drug has no negative effects or consequences.

‘WisconsinWatch.org– Use of Adderall, a medication for ADHD, is on the rise and in demand on many college campuses. Adderall is increasing in popularity and is easily accessible on college campuses because it helps individuals study.  The drug is particularly popular in the University of Wisconsin and many students are taking it despite the negative side effects it may bring. School officials are not educating the university population of the ill effects of Adderall so it continues to be used as a study aid. At least part of the worry has to do with the potential for such students to move on to even stronger versions of amphetamines such as crystal meth, so maybe the efforts should focus on teaching students about addiction to amphetamines and the associated risks.

Scotsman NewsMethadone a drug which is used to prevent withdrawal symptoms in individuals who were addicted to opiate drugs (and as a replacement medication in heroin addiction treatment) is going to be in high demand after nearly £2 million worth of the heroin was discovered on a raid in Scotland.  Police hope that by working with healthcare professionals they can help these drug users seek addiction treatment. Anyone who was effected by the drug raid are offered the support and care they need

Victimization and Drug Legalization

Physorg.com– A potential link has been found between victimization (and hence trauma) and the prevalence of substance use disorders. This was most evident for homosexual and bisexual men and women than it was for heterosexual men and women. Both gay men and women reported high prevalence rates of victimization some point in their lifetime with lesbian women twice as likely to report victimization experiences. Men and women who reported two or more victimization experiences were found to have higher odds of alcohol and other drug dependence.

London Evening Standard– Should drugs be legalized? That is the question that is popping up in many states across the United States.  Is marijuana safer if it is regulated by the state?  The argument for legalizing drugs goes a little something like this: Despite drugs being illegal there will always be a demand for them so if drugs are legalized then governments will be able to control drug quality before they are sold on the streets. Tax income from drug sales can then to educate individuals about drugs and to aid individuals who need addiction treatment

North West Evening Mail– Paul Brown, the director of Cumbria Alcohol and Drug Advisory Service spoke out after former drugs policy minister Bob Ainsworth and he called for the decriminalization of all banned substances. Brown informed attendees that only Portugal has decriminalized drugs and since that occurred crime rates have fallen and more individuals are willing to seek treatment for drug problems. Many substances that are legal such as alcohol and tobacco are bigger killers than drugs that are criminalized. Alcohol and tobacco kill an average 40,000 people a year this is 10 times more than any illegal drug.

A new candidate for ADHD medication: Amantadine and the rise of non-stimulants

It is well known that ADHD diagnoses and substance abuse problems are closely associated. It is estimated that substance abuse problems including dependence are up to twice as common among individuals with ADHD, which is not surprising given the impulsivity factor involved in ADHD. The problem is that until recently, most medications for ADHD have belonged to the stimulant category and as many, including us, have written before it is probably not the best idea ever to give drugs that have a relatively large abuse probability to people who are relatively likely to develop substance abuse problems. Right?

We’ve already written about atomoxetine and bupropion, two drugs with relatively low abuse potential (since patients don’t actually feel “high” from them) that are being successfully used in treating ADHD. But there is little doubt that the type of effect seen among patients who are using stimulants (like adderall, ritalin, etc.) isn’t being observed among patients taking non-stimulant medications. All of this means that patients on non-stimulants are getting less bang but with less risk. A dopamine agonist by the name of amantadine might change all of that according to a recent study.

Amantadine versus stimulants for ADHD treatment

Fourty children between the ages of 6 and 14 were enrolled in the study conducted in a psychiatric hospital in Iran. The kids were randomized into two groups a methylphenidate (ritalin) and amantadine group. Over a six week period the kids were assessed four times – at intake and then every two weeks -using an instrument that parents and teachers (who didn’t know what medication the kids were getting) would use to rate the child’s behavior on the 18 ADHD symptoms listed in the DSM-IV.

Amantadine may soon offer a new non-stimulant medication option for ADHD treatmentThe final findings were very encouraging (see picture): The kids in both conditions improved greatly over the 6 weeks of the study and no difference was found between the two medications. the children in the amantadine condition actually suffered less side effects and significantly so when looking at side effects common to stimulant medication such as decrease in appetite and restlessness. While more studies are obviously needed, this randomized trial shows that amantadine is not only safe, but it may be safer than at least some stimulant medications while also providing the same effect on ADHD symptoms. Given that approximately 30% of patients don’t respond well to stimulants and that some families are afraid of giving stimulant medications to their children, at least partially because of the risk of substance abuse issues, non-stimulant medications can be an attractive alternative, and it seems like amantadine can deliver.

Final thoughts from Dr. Jaffe on ADHD medications and amantadine

One of the main reservations I have about the notion of using this medication for ADHD is that NMDA receptors are very important in learning, so it may be that we’re helping to resolve attention problems but making it more difficult to actually create memories that are crucial for learning. More research is necessary to see if these decreases in impulsivity are accompannied by improvements, and not reductions, in learning ability.

So, if you’re considering medicating a child who has been diagnosed with ADHD, I strongly support the notion given the difference that medication has made in my own life. However, I urge you to be educated and to consider non-stimulant options, especially as more are researched and as that treatment option becomes more available, less costly, and less likely to lead to abuse of the drug. With prescription drug abuse one of the fastest growing problems in the U.S., being careful is just sound advice.

Citation:

Mohammad-Reza Mohammadi, Mohammad-Reza Kazemi, Ebtehal Zia, Shams-Ali Rezazadeh, Mina Tabrizi, Shahin Akhondzadeh (2010) Amantadine versus methylphenidate in children and adolescents with attention deficit/hyperactivity disorder: a randomized, double-blind trial. Human Psychopharmacology.

Some parkinson work showing effect of amantadine: http://www.springerlink.com/content/76r5wxux8wn52rq5/fulltext.pdf

Monitoring the Future by NIDA: Teen alcohol and drug use data from a national survey

Teen drug useOne of the perks of being an alcohol, drug use, and addiction researcher, as well as of writing for a website like this and Psychology Today, is that sometimes we get to talk to people that most can’t reach or to receive information that others might not have access to. NIDA‘s Monitoring the Future, a national survey of about 50,000 teens between 8th and 12th grades is a huge annual undertaking the results of which will be released tomorrow for general consumption.

But we got a little sneak peek before everyone else.

If you follow this sort of stuff, you know that teen alcohol and drug use is always shifting as new drugs become more popular and others lose favor with that group of Americans that can’t make up their minds. This year seems to give us more of the same.

Monitoring the future: Early alcohol and drug use results

  1. Daily marijuana use, after being on the decline for a short while is apparently rising once again among teens, following last year’s continuing trend of a reduction in teens’ perceptions of marijuana harmfulness – We’ve written on A3 about some of the specific issues relevant to marijuana use including writing about Marijuana’s addictive potential and its medical benefit. There’s no doubt that the national marijuana debate will continue but the idea of 8th graders smoking weed doesn’t seem to be part of anyone’s plan.
  2. Among some groups of teens drug use is proving more popular than smoking cigarettes – I guess this could be taken as evidence of the effectiveness of anti-smoking campaigns, though until we see the full numbers I’m not going to comment any further on that.
  3. While Vicodin use among high-school seniors (12th graders) is apparently down, non-medical use of prescription medications is still generally high among teens, continuing a recent upward trend – Abuse of prescription stimulants has been on the rise for a number of years as the number of prescriptions for ADHD goes up, increasing access. It is interesting to see Vicodin use go down though the data I’ve received says nothing about abuse of other prescription opiate medications such as oxycontin, so I’m not sure if the trend has to do with a general decrease in prescription opiate abuse among teens.
  4. Heroin injection rates up among high-school seniors (12th graders) – I think everyone will agree that this is a troubling trend no matter what your stance on drug use policy. The associated harms that go along with injecting drugs should be enough for us to worry about this, but again, I’ll reserve full judgment until I actually see the relevant numbers. I’m also wondering if this is a regional phenomenon or a more general trend throughout the United States.
  5. Binge drinking of alcohol is down – As we’ve written before, the vast majority of problems associated with the over consumption of alcohol (binge drinking) among high-school students has to do with the trouble they get themselves in while drunk (pregnancies, DUI accidents, and the likes), so this is an encouraging trend though hopefully it isn’t simply accounting for the above mentioned increases in marijuana and heroin use.

Some general thoughts on NIDA’s annual Monitoring the Future results

I am generally a fan of broad survey information because it gets at trends that we simply can’t predict any other way and gives us a look at the overall population rather than having to make an educated guess from a very small sample in a lab. NIDA‘s annual MTF survey is no different although until I get to see all of the final numbers (at which point there will probably be a follow-up to this article) it’s hard to make any solid conclusions. Nevertheless, I am happy to see binge drinking rates among teens going down and if it wasn’t for that pesky increase in heroin injection rates I would say that overall the survey makes it look like things are on the right tracks.

I’ve written about it before and will certainly repeat it again – I personally think that alcohol and drug use isn’t the problem we should be focusing on exclusively since it’s chronic alcohol and drug abuse and addiction that produce the most serious health and criminal problems. Unfortunately, drug use is what we get to ask about because people don’t admit to addiction and harmful abuse because of the inherent stigma. Therefore, I think that it’s important for us to continue to monitor alcohol and drug use while observing for changes in reported abuse and addiction patterns. Hopefully by combining these efforts we can get a better idea of what drugs are causing increased harm and which are falling by the wayside or producing improved outcomes in terms of resisting the development of abuse problems.