Disclose or not? The catch 22 of mental illness stigma

I want to share a recent post of mine from psychinaction because I think it applies to addiction as much as it does to other mental health issues:

A report published by SAMHSA addresses the issue of self-disclosure regarding mental illness.

Research has already shown that the more familiar people are with others who have different form of mental illness, the more their attitudes regarding mental illness will improve.

The problem is that in the process, those who self-disclose fear being ostracized, losing their jobs, and suffering other similar consequences.

Still, the report found that those who do self-disclose often experience relief and find that it improves their relationships. I think this can be especially true for addicts, who often feel shame and therefore hide their drug issues.

Obviously, the process requires careful timing. Also, a progression of self-disclosure, from a small group of trusted friends on, is suggested.

For the full report, go here: “Self-disclosure and its impact on individuals who receive mental health services.”

Pathological Gambling- Is it an addiction? Part II

Michael Campos, Ph.D.

This is part II in Michael’s series on pathological gambling (click the preceding for part I):

The risk factors for pathological gambling

Pathological gambing (or gambling addiction)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. Continue reading “Pathological Gambling- Is it an addiction? Part II”

The genetics of quitting smoking- Bupropion and nicotine metabolism

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

Bupropion helps fast metabolizers increase their quitting chancesFortunately 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.

Citations:

1) Robert A. Schnoll, Freda Patterson, E. Paul Wileyto, Rachel F. Tyndale, Neal Benowitz, & Caryn Lerman. Nicotine metabolic rate predicts successful smoking cessation with transdermal nicotine: A validation study (2009).

2) F Patterson, RA Schnoll, EP Wileyto, A Pinto, LH Epstein, PG Shields, LW Hawk, RF Tyndale, N Benowitz & C Lerman1. Toward Personalized Therapy for Smoking Cessation: A Randomized Placebo-controlled Trial of Bupropion (2008).

Depression and smoking relapse: Anhedonia doesn’t feel good.

A recent study published in the Journal Nicotine & Tobacco research suggests that a particular aspect of depression, namely anhedonia, a.k.a “inability to feel good,” plays an important part in predicting how quickly smokers will relapse after trying to quit smoking. When it comes to addiction research, you can’t get much clearer than these results.

Quitting is smoking is difficult, especially when you're depressed.

The researchers specified a number of factors in depression including: negative affect (feeling down), vegetative state (not moving much), and anhedonia, measuring that last one by making participants rate their expected pleasure to hypothetical pleasurable situations they were asked to imagine. They then split up the participants into three different treatment conditions that included slightly different procedures meant to help them quit smoking. All participants quit smoking immediately after attending the one-day assessment and instruction session. Following that day everyone returned to the lab after 24 hrs, 48 hrs, and then weekly for a total of four weeks to assess their smoking using fancy lab equipment.

When the researchers looked at the results, they saw that when separated into “high-anhedonia” and “low-anhedonia” groups, participants in the “high-anhedonia” group relapsed to smoking much more quickly, even when controlling for depression symptoms before quitting. In fact, 20 days after that initial session, more than half of the “low-anhedonia” participants were still not smoking while essentially none of the “high-anhedonia” participants had managed to quit.

As if it is isn’t hard enough to quit smoking, apparently, feeling like $&%@ just makes it harder… Hey, I never said addiction research would always bring good news!

Citation:

Cook, Spring, McChargue, and Doran (2010). Effects of anhedonia on days to relapse among smokers with a history of depression: A brief report. Nicotine & Tobacco Research.

Addiction Stories: Buzz Aldrin’s Alcoholic Buzz and Recovery

In the whole of human history, only twelve lucky, and brave, men can claim to have walked on the surface of the moon. Buzz Aldrin is not only one of those twelve, but the second ever, a West Point graduate, PhD from MIT and Korean War fighter pilot whose accomplishments place him firmly at the forefront of great Americans.Still, for all his fame, success and vast intelligence, Buzz Aldrin had another title that put him on the same plane as millions of Americans: alcoholic.

At a recent talk at UCLA, Buzz Aldrin reflected on the painful (and all too common) series of personal tragedies and setbacks that put him on the path to addiction, foremost in his mind being the suicide of his mother. Though he now counts himself as a recovering addict and strong supporter of AA, to which he credits his recovery, the fact remains that for even this strong American icon, the lure of the bottle and its ability to temporarily numb the crippling pangs of clinical depression were for a long time too powerful to ignore. When it comes to inspiring addiction stories, it’s hard to find one as inspiring as that of Buzz Aldrin.

Buzz Aldrin is far from the only addict struggling with depression

Depression is amazingly common among addicts, reaching levels as high as 80% in some addict populations (though it more commonly shows a still staggering 30-55% range). As compared to the standard population depression prevalence of about 7%, it becomes impossible to deny what might already be seen as a common sense conclusion: many, many addicts struggle mightily with depression. Because the causes of depression are so numerous, it’s understandably inexact to determine whether the condition precedes or is caused by addiction. Nevertheless, it’s clear that among active users, not using is linked with greater depression rates, but also that successful treatment often resolves both the substance use and depression issues. In fact, when it comes to a number of common antidepressants, their utility in treating addiction problems is often related to whether or not the patient has a separate depression issue – if they do, antidepressants often do a great job on both. But the bottom line is that depression, just as serious an issue as addiction in its own right, can combine with addiction to keep even a great American hero like Buzz Aldrin floating in the void.

As I’ve said numerous times here in relation to the addiction stories we share on All About Addiction, the point of sharing successes, and failures, related to addiction is to humanize, and de-stigmatize the typical vision of an alcoholic, or addict that people have. Addicts are all among us and they’re like every single one of us – They are lawyers, judges, politicians, and store owners. The addiction stories we share try to put a human face on the problem, a face full of hope.

Women, Trauma and HIV Transmission

Co-authored by Jamie Felzer

Just how much can the events of a traumatic childhood affect the likelihood of contracting HIV or other serious diseases in later life? Unfortunately, recent research shows that the effect can be profound, especially for women.The silver lining may be in our ability to reduce later HIV transmission by providing better intervention services post-trauma.

Childhood Trauma, Women and HIV/AIDS

In ways both surprising and predictable, it seems that even very early childhood trauma can be firmly linked to high risk behaviors and a higher risk of contracting HIV. And with AIDS now reported by the US Department of Heath & Human Services as the leading cause of death for African-American women between the ages of 25-34 (and the perhaps even more sobering H&HS assessment that African-American women are a staggering 21 times more likely to die from AIDS compared to non-Hispanic white women), this crisis has a particular impact on women of color.

The obvious conclusion is that those subjected to childhood trauma are more likely to engage in risky behavior in an attempt to relieve some of the chronic stress that often accompanies such experiences. Drug use, unprotected sex, heavy drinking and other accompanying behaviors can all seem like appropriate responses to mental and emotional stress, but that stress can also inhibit one’s ability to make safe choices in this context. This naturally leads to an increased risk for contracting sexually transmitted diseases and blood-borne pathogens. Factor in the simple biological reasons why women may be at an elevated risk of contracting HIV through any one encounter, and it becomes clear that many at-risk young women are not receiving adequate education on how to protect themselves against this threat.

Many young women with a history of trauma and elevated lifetime stress from sexual assault, violence or any of the myriad stressors that accompany low socioeconomic status may be inadvertently putting themselves at greater risk for contracting HIV and AIDS. As mentioned, these risks can commonly come from unsafe sex and the abuse of unknown drugs, potentially with non-sterile needles. Without a strong support system to help them adequately process the short and long-term effects of trauma, many young women end up developing symptoms of chronic anxiety and depression, conditions that can alter behavior and even ultimately lead to demonstrated higher rates of mortality. That these conditions also often co-exist with other health issues linked to lower socioeconomic status such as obesity and heart disease serves to further compound this risk. Stress has even been shown to speed the progression of the AIDS virus, making the disease itself more deadly.

And with a full 1/3 of the female population having reported some form of sexual assault or similar violent trauma, the sad reality is that the risks for contracting HIV among young women are, if anything, growing. It seems that one way to attack the HIV pandemic is by improving prevention, as well as intervention, services, for women affected by such early trauma. It might be a way to kill two, or even more, birds with one stone.

about addiction: smoking, depression, students and treatment

We are back with some great articles that may be of interest to you, so check them out!  There should be new weekly links published every Monday so you are bound to find some relevant articles

From Stop Medicine Abuse:  This article talks about the youth who abuses cough medicine. It states that one in ten youths has intentionally abused cough medicines to get high.

Students and drug addiction

From Vancover Sun:  This article about mental health and addiction discusses the issue of the coexistence of mental health problems and drug addiction.

From Reuters: This text discusses the rising numbers of teen users of smokeless tobacco. According to the article, health experts rised concerns last Wednesday about the growing numbers of teen users.

From Health Day:  This is an article that talks about the link of smoking and depression. People of age twenty and older with depression are twice as likely to smoke than others.