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?”
Addicts and others with mental health issues continuously feel as if they need to hide their problems as well as hide from them. But an ongoing west-coast (U.C.L.A. and U.S.C.) study with a group of mental health patients suggests that hiding may be the wrong approach.
The participants in the study, all successful individuals with ongoing mental health problems who seem to be stable and productive are being examined for the specific factors that make them defy the stigma so closely linked with mental health problems. Doctors, lawyers, and CEOs are all part of the group and have all figured out ways to work with their mental health issues and succeed in life.
Mental Health Problems, Addiction, and Stigma
We’ve written before about the dilemma of mental health disclosure and I’ve talked over and over about the notion that stigma is one of the major obstacles to addiction treatment and recovery. This study’s preliminary results suggest that indeed, taking ownership of one’s problems and figuring out how to best function with the characteristics each of the holds has allowed these individuals to succeed where most psychiatrists and psychologists would have expected them to fail – in high-pressure, high-stakes, positions of power.
The relevant metaphor I share often, especially to those who attend our A3 Academy sessions is this:
Imagine that two people you know drive two very different cars. One owns a Toyota Prius, one of the most efficient cars on the market with lots of storage and convenience. The other drives a Lamborghini Gallardo, one of the world’s fastest cars with an engine that makes your whole body shake and a body that reminds everyone of speed and sex. If tasked with giving the two a little guidance on taking the drive between Los Angeles and San Fransisco you would probably give the two very different suggestions…
To your Prius owner-friend you would tell that they should feel free to bring a suitcase and that the entire trip will likely require less than a full tank of gas, making the trip very cheap and economical. However, it’s likely going to take him 7 to 8 hours each way so he should leave early to not waste the day on the road. At least he won’t have to stop for gas. But the Lamborghini driver has a very different trip ahead of him, one that likely includes 2-3 stops for gas but, assuming no speed-traps or traffic, he can still probably make it to San Fran in 4 hours flat. He’s also not likely to be able to bring anything along except for an overnight bag and even that is only true if he’s not bringing anyone on the trip with him.
Unless one comes to the table with judgements about fast versus slow, or gas-efficient versus gas-guzzling, driving I think that few would suggest that I am somehow stigmatizing the cars or their owners in this story. Instead, I am offering a pretty objective description of their most likely and appropriate functioning. But when talking about people, feelings and stereotypes often get in the way.
Overcoming Mental Health Problems
This study from UCLA and USC in collaboration with The Veteran’s Administration shows us that in reality it is likely that, even for those with mental health problems, the real key is to figure out what the requirements of the “machine” you’re driving are and then plan your life accordingly. For Ms. Myrick, one of the participants in the study, that meant a high powered detail oriented job rather than a hiding spot on her favorite couch at home. Still, the researchers have identified a set of common characteristics they’ve written about. Many of the study’s participants do the following:
Adhere to a medication regimen
Often check their thoughts and perceptions with those around them
Actively control their environment, sometimes with the help of a therapist.
Some avoid travel, or crowded, noisy places while others prefer not to be alone.
Stay away from illicit drugs and alcohol.
Overall, it’s obvious that their mental health diagnoses have made them very aware, and thoughtful, about daily activities that most people disregard. Still, with a specific regimen and some help, they’ve all managed to succeed.That regimen might include medication to control attention problems, delusions, or depression; it seems to certainly include some outside perspective when it comes to big decisions; it may also include some regular exercises (physical and mental) to control anxiety and other related emotional responses.
I believe that identifying your own recipe for success is key to success, that believing in your ability to succeed is necessary, and that plotting the course between here and the future is helpful if you’re trying not to get lost. That’s not stigma, it’s practicality.
What influences college students’ decisions about whether to drink and how much?
Do friends peer pressure them?
Do they do it because they are bored?
Do they drink to relieve depression or anxiety?
Researchers recently tried to answer these questions by surveying college students…
65% of the participants reported having at least one drink in the past three months. It was astonishing that the typical number of drinks in a week was 10.5 and on a weekend was 7.3 average drinks. These numbers included drinkers and nondrinkers and was the average (meaning around half the people had more drinks as those had less). This indicates that college drinking is far more extreme than drinking happening outside of the college setting.
3 main influential factors for someone’s decisions in college drinking and to what extent:
You can tell a lot about a person by watching their friends, so watch who you surround yourself with. Those who think favorably of drinking tend to think they can drink more before reaching intoxication and also tend to hang out with others who do the same. However, these people are the ones that need the most intervention yet are the most difficult to change.
Those who socialize with a wide variety of people typically are lighter drinkers and tend to respond better to treatment immediately as well as have fewer problems further down the line. The heavier drinkers benefit more from motivational interventions focusing on their attitudes toward drinking.
Regardless of stereotypes, ethnicity, weight and gender did have an effect on any of these findings. It was peoples’ closest friends that were the most significant factor in influencing all aspects of college drinking.
Examining the Unique Influence of Interpersonal and Intrapersonal Drinking Perceptions on Alcohol Consumption among College Students. Journal of Studies on Alcohol and Drugs. Volume 70, 2, March 2009
Teens raised in affluent homes display the highest rates of depression, anxiety, and drug abuse according to a recent article in Monitor on Psychology, the APA‘s monthly magazine.
One of our recent posts dealt with some of the issues unique to teens and drugs. In addition to the issues we’d already mentioned, the article named a number of reasons for the high prevalence of mental-health issues among affluent teens. Among them were an increasingly narcissistic society, overbearing parents, and an common attitude of perfectionism.
Each of these reasons are likely contributors to the prevalence of mental health and drug abuse issues among upper-middle-class (and above) teens. Still, as far as I’m concerned, the main take home message of the article is this:
Money truly doesn’t buy happiness – Rich teens and drug use.
While drug abuse research often focuses on the lower socioeconomic strata these recent findings indicate that being financially stable offers little in the way of protection from some of the most common psychological difficulties.
Thankfully, the researchers cited in the article gave some simple advice to parents:
Give children clear responsibilities to help around the house.
Take part in community service (to unite the family and reduce narcissism).
Reduce TV watching (especially of reality TV shows that glorify celebrity and excess).
Monitor internet use.
Stop obsessing about perfect grades and focus instead on the joy of learning for its own sake.
I couldn’t agree more with these recommendations. Having taught a number of classes myself, I have witnessed the ridiculous inflation in students’ expectations of top grades. I think it’s time we turned attention back to the family and reintroduce some of the basic skills that many addicts find themselves learning much too late… Often in recovery.
Do you care about addiction? Of course you do, otherwise you probably wouldn’t be reading this right now. Well, you’ve come to the right place A3 will try to address all your questions, but for now, you’ve stumbled onto our weekly links post full of information about addiction from around the world wide web. So enjoy!
Drugs: Bath salts, menthol cigarettes, and Charlie Sheen
PhoenixHouseOC-Geoff Henderson, the senior director for Phoenix House, the country’s largest nonprofit provider of substance use disorder and behavioral health treatment services recently attended the hearing in Los Angeles to ban bath salts. He gave his interpretation on the bath salts issue, emphasizing that in our world today we have an increasing amount of access to a variety of substances and that new things are continuously emerging that individuals might try. For more of Henderson’s thoughts check out his blog.
Star-Telegram– A study has been conducted which found that adding menthol to cigarettes may increase the likelihood of addiction. Menthol cigarettes are considered to be so dangerous because they have a cooling and anesthetic effect which may get more adolescents to smoke. There is a debate to see if menthol cigarettes should be banned. Right now they make up 30 percent of the cigarette market and are favored by 80 percent of African American smokers.
Psychology Today– Charlie Sheen is the latest celebrity that is dealing with drug addiction. He has previously mentioned that he did not want to go to rehab because he thought that he could clean himself up and expressed his disdain for everything 12-steps. A lot of people thought that this was ridiculous but here is an article in which Dr. Stanton Peele agrees with Charlie. Dr. Peele believes that a person can be fixed if they are being forced to do so and that I why he agrees with Charlie Sheen that only he can overcome his addiction on his own. Read this article to get a different opinion on addiction treatment. You can check out this article for Dr. Jaffe’s take on the same issue.
Alcohol-The youth and DUI’s
Medical News Today– A new study by (SAMHSA) found that 5.9 percent of adolescents aged 12 to 14 drank alcohol and about 317,000 of them received this alcohol from their parents or got it at home. This can dangerous because being exposed to alcohol at an early age can expose at-risk children to an increased risk of alcohol abuse and addiction later on in their lives. Parents should be educated about such risk factors and about limiting access and increasing education for at risk youth.
The Daily Beast– Can there be such a thing as anxiety addiction? Some individuals think so. A study was conducted that found that during demanding and stressful circumstances our bodies cultivate and thrive on anxiety. The study found that during a stressful circumstance is was possible that some individuals use anxiety to boost cognitive performance while others are comforted by anxiety. Whether this should be called addiction, I’m not sure, but the idea of anxiety as rewarding is interesting.
There are a number of factors that are important in pathological gambling including types and number of games played, alcohol use, and socio-demographic factors. Some research suggests that casino gambling, pull tabs, card playing outside a casino, bingo, and sports betting are associated with increased risk for gambling problems. In addition, the number of different types of games played is associated with gambling problems such that the more different types of games a person plays, the greater the risk for gambling problems. Alcohol abuse/dependence is associated with increased risk for gambling problems as well. Finally, socio-demographic factors (e.g., low socio-economic status, minority ethnicity) are associated with gambling problems even after controlling for gambling behavior. Read the rest of this entry »
If you’ve been reading A3 for a while, you know that we’re big supporters of scientific progress in addiction treatment. While it may be true that addicts need to want recovery in order to truly turn their lives around, the choice is hardly ever that simple and if we can tip the balance in the favor of treatment, or a better way of life, I say let’s go for it. When it comes to genetics and addiction, I’ve normally talked only about the fact that a person’s genetic code may predispose them to addiction or to other related conditions (like depression, anxiety, and so on). Aside from a single mention of pharmacogenomics, I don’t think I’ve spoke much about the way genetics can help us tailor addiction treatment to individual needs. We’re about to fix that.
Replacement therapies and quitting smoking
You’ve heard of nicotine patches and gums, right? In the research community, those are all known as Nicotine Replacement (NR) therapy and they’ve proven to be some of the most helpful tools for those who are quitting smoking. By allowing smokers to still get the nicotine their body craves (even though there are thousands of other chemicals in cigarettes that likely make them even more satisfying) without having to light up, these NR methods let cigarette addicts get their NIC fix while slowly lowering their dose and getting away from the habit of putting a cigarette in their mouth. Like methadone, buprenorphine, and other replacement therapies, the idea is to move addicts one step away from the actual addictive behavior and allowing them to begin adopting a healthier way of living. Replacement therapies are very successful, even if some people hate the idea of giving drugs to drug addicts, and nicotine replacement works well by itself for some people (though only about 20%).
But when it comes to nicotine, like with many other drugs, different people metabolize the stuff at different rates. The individual variability in the internal processing of nicotine greatly affects how many cigarettes individuals smoke and also the probability that they will become addicted to tobacco (people who metabolize nicotine more quickly smoke more and are more likely to become addicted to smoking). Fast metabolizers are also half as likely to be able to use nicotine replacement alone to quit smoking (1). However, when you put all of the addiction research together, it becomes pretty obvious that the same variability in nicotine metabolism can also help us determine the best course of treatment for tobacco addiction.
Metabolism, treatment, and the best way to quit smoking
Fortunately for smokers, the only research finding in this area hasn’t been that slow metabolizes have a much better chance of quitting smoking with nicotine replacement therapy. The same group of addiction researchers (led by Caryn Lerman of University of Pennsylvania), also found that buporopion, the smoking cessation medication everyone knows as Zyban (and the antidepressant called Wellbutrin), could help those fast metabolizers catch up with the slow metabolizers when it came to quitting (see the figure on the left taken from the actual study – you see that the dark bars, who are the bupropion patients, do as well as the white bars regardless of their metabolism rate, which is on the bottom). The researchers found that while slow matabolizers of nicotine did much better with simple smoking cessation therapy and fast metabolizers did very poorly (30% versus 10% quit respectively in each of the groups), adding bupropion made all groups look essentially the same (2). The moral? While those slow metabolizers don’t really get much of a benefit from using bupropion since they do pretty well with talk therapy or nicotine replacement alone, the fast metabolizers really need it to even their chances of quitting – and once they get bupropion, they do pretty well!
Genetics and addiction treatment – is this just the beginning?
Hopefully you’re now convinced that genetics can really help us determine what treatment course will best suit a specific person over another. There’s little question that this sort of approach is in its infancy, and you certainly can’t go to a doctor right now and get your metabolism rate for a drug analyzed (unless you’re part of a research study), but this sort of work shows great promise in improving the outcomes of addiction treatment. When you look back at that original paragraph, and the quite common thinking that addicts need to WANT to be better – I would argue that those fast metabolizers probably wanted to quit smoking as much as anyone else in the study, and their physical makeup just made it that much more difficult for them. I think that if you look at the science of addiction closely, you’ll find that this supposed lack-of-motivation is sometimes more of a myth than a reality. Many addicts want to get better, they want to stop behaving in ways that specifically mess up their lives but they just find it incredibly difficult. My hope is that this is where science can truly make a difference, by making it just a little bit easier…
Hopefully one day we’ll be able to specifically adjust addiction treatment programs according to individual patients’ needs, including the use of medications, specific behavioral treatments, and more.