About Addiction: School, prescriptions, heroin and morality

It’s Monday and you get another great summary of news and research about addiction that have been making noise this week. If you care about addiction and about recovery, you know you want to stay abreast of what’s important and A3 wants to give you just that! So read on..

Recovery High: A new kind of high school: Across the country, new kinds of high schools are popping up called “recovery high schools”. At these schools kids and teachers aren’t just focused on grades, they are helping the students recover from their drug addiction and alcohol addiction. For teens entering addiction treatment, 75 percent relapse within the first year, often due to the return to the environment that facilitated the use in the first place. While the long-term effectiveness of these schools is still being evaluated, they are showing promise; and with the recent passage of the Affordable Care Act allowing for increased options for recovery, don’t be surprised to see these kind of high schools becoming more and more common. To see the video check out this link.

Prescription Painkillers leading teens to Heroin: According to national data from the Centers for Disease Control and Prevention, the number of deaths from prescription drug overdose tripled between 2000 and 2008. Experts point to the ease of access teens have to prescription pills, such as Percocet’s and Vicodin, from emergency rooms, dentist offices, and especially unfinished prescriptions in household medicine cabinets as one of the main reasons for the increase. These drugs have been found to at times lead teens to heroin, which provides a more intense version of the same high for a fraction of the price. As a result, in the decade from 1999 through 2009, the yearly deaths of people aged 15 to 24 from heroin overdose shot up from 198 to 510.

Heroin abuse becoming a national epidemic: Heroin use and death is still on the rise, exploding in use over the last couple years, fueled by the Baby Boomers. The Boomers increased use of prescription drugs can quickly lead down a road to heroin; once the prescription runs out or the cost gets too high, the more available, cheaper heroin becomes an attractive option. While its use has been increasing nationwide, the statistics from Oregon this past year give an example of the entire nation’s problem. Last year alone, there were 143 heroin-related deaths in Oregon, a 59 percent increase from the year before and almost the entire nation’s total from a decade ago! Marion County, in particular, has already seen more deaths so far this year than in all of 2011. Heroin is on the rebound, no longer a “dormant drug”, and, with its drastic increases recently, should be addressed sooner rather than later.

Addiction: Disease or moral failing? One of the most common questions regarding addiction is the debate on whether it is a disease or a moral failing.  A recent article by Dr. Marc Lewis addresses the question from both sides. He starts by pointing out the common critiques that “you don’t ‘catch’ addiction”, “you don’t treat addiction with medications or expect a cure”, and “you don’t ‘have’ addiction” like you would “have” a cold or other disease, in order to show why addiction should not be considered a disease. However, he then counters with the comparison to type II diabetes, which fits the mold of the earlier critiques, yet is never questioned as being a disease. In fact, having type II diabetes is not seen as a “moral failing” and it seems addiction is following this path and becoming more frequently seen as a disease rather than a moral failing. Truth is, addiction is likely going to continue being seen as straddling these two domains.

A cautionary tale of Fentanyl addiction: Fentanyl, a new painkiller, is becoming the next in a line of destructive and deadly prescription drugs. According to Dr. Michelle Arnot, Fentanyl is 100 times stronger than morphine and 750 more potent than codeine. The article tells the tale of a man who lost his “perfect wife” to Fentanyl addiction. Prescribed as patches to be sucked on, addicts soon learn to smoke them in order to get a greater effect. Shortly after her abuse began, the “perfect wife” was going through a month’s supply in under a week. This led to pawning her children’s and family’s belongings, turning her into someone no one recognized. One day, her husband came home from work to find her dead. Now, her husband wants her story to serve as a warning to anyone else becoming entangled with Fentanyl.

Helping siblings of addicts: When addiction leads to a fatality, almost everyone who knew the victim is affected. However, they are affected and handle it in different ways. Most people know about the grief parents feel when losing a child, and they are given support and programs to help deal with it. Siblings, on the other hand, have often gone overlooked in the coping process, largely because they do not grieve in the same way as parents. The emotional needs, and even physical needs, of addicts’ siblings can often be neglected in favor of the addict while they’re still alive and in favor of the parents needs after an addict’s passing. Now, programs such as GRASP (Grief Recovery After a Substance Passing) are popping up with the goal of helping these siblings cope.

About Addiction: food, treatment, babies and teens

Our weekly About Addiction summaries are back! Make sure to tune in for the latest in research and news coverage of the drug abuse and drug addiction landscape. This time we’re talking about the food and drug addiction connection, drug using baby boomers, accidents, addicted babies, and drug using teens during summer breaks. If you

Food or drugs? A new study suggests a path for choice – A recent study Yale School of Medicine professors has found that neurons associated with overeating are also linked to non-food associated behaviors such as drug addiction. However, their discovery points to a relationship different than the contemporary view; they found an inverse relationship between eating and drug addiction that shows people who lack a desire for food have a higher predisposition towards drug addiction. According to their findings, it seems that the drive for food and the drive for drugs compete with one another!

Obamacare’s effect on addiction treatment – The recent ruling by the Supreme Court to uphold the Affordable Care Act was a huge moment in our country for many reasons. In the world of addiction, it has a great impact as well! By making sure all citizens have health insurance, it gives those seeking treatment a huge advantage: choice. In the past, those seeking addiction treatment could be limited by their insurance situation. Now, those seeking help will be able to get the treatment that is right for them, not just what is available to them. Also, substance abuse treatment will be able to have a more wide-reaching effect as treatment can be provided earlier as well as a preventative measure.

The dangers of driving high – According to a recent study done at Dalhousie University, marijuana use has a severe adverse effect on safe driving. This may not be new information, however this paper was the first to separate driving under the influence of marijuana from the influence of other drugs and alcohol. They looked at nine smaller studies including 49,411 people in order to calculate their results: finding that cannabis use nearly doubles the likelihood of a motor collision as compared to an uninhibited driver. With marijuana being the most widely used illicit substance in the world, with its usage rate still rising, it is important to separate the truths and myths about its effects.

Babies born addicted – This Thursday’s episode of Rock Center With Brian Williams featured a story on babies born with withdrawal symptoms from prescription painkillers. This is an epidemic in America, and the symptoms are heartbreaking to watch: the babies have tremors, digestive problems and cry inconsolably. There’s little doctors and nurses can do to comfort them as they slowly wean them off of the drugs. On this Thursday’s new Rock Center, Kate Snow reports on the shocking increase in the number of babies born addicted.

A Teenagers’ Summer: No school, less supervision, more drugs? – A new study released by SAMHSA (Substance Abuse and Mental Health Services Administration) reports that 671,000 teens aged twelve to seventeen will try alcohol for the first time this June and July alone; 305,000 teens will try cigarettes for the first time during these months, while 274,500 will have their first experience with marijuana. These numbers are an increase from the rest of the year, likely due to an increase in free time and decrease in adult supervision. While a large proportion of these individuals will never end up developing an addiction or substance abuse problems, this study makes it clear that the summertime may be a good time to talk to your kids about the risks and effects of these substances.

Spankings leading to drug abuse? New research reveals it may not be as far-fetched as you may think – The American Academy of Pediatrics (AAP) has released research that reveals strong links between corporal punishment in childhood and mood disorders, personality disorders, and addiction and drug abuse later in life. Specifically, according to the study, spankings raise the risk of alcohol and drug abuse by 59 percent. With a reported 94 percent of three- and four-year-olds receiving a spanking at least once in the last year, this has a widespread effect on the entire population. While one spanking does not lead to abuse, the research points to physical punishment as a regular means of discipline having adverse effects on mental health later in life.

Is grandpa getting high? More and more often the answer is becoming yes! – Drug use and drug abuse are often thought of in connection with young people, however the Baby Boomers are proving it can affect older people just the same. Last year alone an estimated 4.8 million adults aged 50 and above used an illicit drug. The risk is not just with illegal drugs, but also the misuse of prescription drugs. With the average 50-year-old-man using four different prescription drugs per day, the risk of becoming addicted to any one of them is substantial.

Seeing addiction as a disease, not a moral failing – In an interview with MSNBC’s Andrea Mitchell, director of the National Institute of Drug Abuse Nora Volkow explains how addiction and drug use affect the brain and why it should be considered a disease, not a moral failing. Check out this link to see the whole interview.

THC for Huntington’s Disease? Cannabinoid receptors are important for more than drug use

Here at A3, we believe in equal opportunity. We recognize that saying we have an addiction problem is not the same as saying we have a drug use problem and that just because some people abuse substances (or belief systems) doesn’t means that these have no actual value when not abused. Enter this recent paper on CB1 receptors, THC, and Huntington’s Disease.

Those of you who haven’t been reading A3 for too long (shame on you!) may not be familiar with my comparison of the cognitive (or mental) impulsivity associated with substance use disordersand the physical “impulsivity” common to Huntington Disease(HD) patients. To make a long story short – both of these dysfunctions have to do with the striatum, a brain area responsible for inhibiting and controlling unwanted brain output (as in thoughts or actions). When this area starts malfunctioning, everything goes awry. When it comes to HD, “goes awry” doesn’t really do the disorder justice. Patients with a progressive form of the condition end up flailing their limbs in a manner that’s been coined the “Huntington Dance,” a euphemism if I ever heard one. This motor flailing is closely followed by severe cognitive impairments and a premature death. Not a pretty story. Continue reading “THC for Huntington’s Disease? Cannabinoid receptors are important for more than drug use”

Why the addiction-brain connection has to be part of the addiction treatment picture

Dr. Dodes recent article, apparently trying to blow up the myth of addiction as a neurophysiological disorder, sounded persuasive, although its underpinning was oversimplified and it’s understanding of the brain-science involved in addiction, and other associated mental health disorders, was lacking. Hopefully, by presenting a more complete picture of the evidence for a brain-aspect to addiction, I can un-bias the discussion somewhat. I, for one, don’t believe that neuroscience will ever be the only factor important in addiction – an individual’s environment, social influences, and other factors will always end up playing important parts as well – still, I think that to dismiss all of the evidence for biological factors at play in the development of addiction is foolhardy. Especially when there’s so much of it that was glossed over in Dr. Dodes’ introduction.

Pleasure center activation is only part of the picture in addiction

Firstly, supporters of the notion that addiction is, at least partly, an outcome of specific brain function point not only to pleasure center activation, but also to a whole host of findings showing genetic variability that is either protective from, or a risk factor for, dependence on drugs and likely also behavioral addiction like eating disorders, compulsive gambling, and maybe sex addiction as well (you can start out looking up ALDH2-2 variability and alcoholism and cocaine addiction, DRD4 and stimulant addiction, and many more).

While it is true that all those who consume addictive substance activate the brain similarly, there are considerable differences in the specific of that activation in reaction to drugs. Some release more dopamine while others have more “active” versions of specific important receptors; neurotransmitter recycling is quick in some, but not all, and drug metabolism is different in different individuals in ways that have been shown to be important not just for addiction risk, but also for the probability of treatment success. Just look at the nicotine and CPY26 literature for an example. It’s right there.

Additionally an entire body of literature exists that shows differential activation, as well as structural differences, between addicts and non-addicts in regions as varied as the OFC, PFC, Insula, and more. This is not to mention a slew of evidence that shows different behavioral test performance on risk-taking, impulsivity, and delay-discounting, all personality variables highly associated with addiction. If one simply ignore all of this evidence, it may be easy to believe that there is no biological explanation for these phenomena, but that’s just wrong.

To say that mesolimbic activation (what the good doctor called “pleasure centers”) is the only evidence for physiological factors in addiction is dismissive at best.

Drug addiction develops in only some drug users

The notion that not everyone who takes drugs becomes addicted is nothing close to evidence against a brain explanation for addiction. Everyone’s motor–cortex, striatum, and substantia nigra (the areas of the brain responsible for movement) activate in the same way during movement, but only a small group ends up suffering from Parkinson’s or Huntington’s disorders. One fact does not preclude the other but instead may specifically point to the fact the group which develops the disorder has somewhat different neurological functioning. Researchers aren’t concerned with explaining why all individuals can become addicted to drugs, but rather why that small subgroup develops compulsive behavior. A short reading of the literature makes that fact pretty clear. Additionally, while Dr. Dodes’ claims otherwise, imaging technology HAS produced evidence explaining this “mystery”, including differences in the ways addicted smokers respond to smoking-related triggers, and an increased dopamine response in cocaine addicts to cues, and well as to cocaine.

As mentioned in the motor disorder section above, ingestion of chemicals is not at all necessary for brain disorders to occur or indeed develop later in life. Dr. Dodes example of shifting addiction could be used as evidence for an underlying neurological difference just as well as it would serve to make his point… Or even better. If there’s a faulty basic mechanism attached to rewarding behaviors, it doesn’t really matter what the behavior is, does it? Sex addiction, gambling, and more can all be explained using a similar mechanism, though drugs of abuse may just have a more direct impact. I know, I’ve written about them all.

The Vietnam vet heroin story used by Dr. Dodes as evidence that emotional, rather than physiological, factors are responsible for addiction actually fits right in line with the notion of predisposition and underlying differences, and I’m surprised to hear a physician point to group differences as an indicator of no neurobiological basis. Indeed, when it comes to the emotional reactivity associated with drug associated cues, normal learning literature, as well as drug-specific learning research, has revealed over and over that drug-related stimuli activate brain regions associated with drug reward in the same way that natural-reward predictors do for things like food and sex. Once again, these facts are part of the basic understanding of the neuroscience of learning, with or without drug abuse involvement.

My own dissertation work shows that it is very likely that only a subsection of those exposed to nicotine will develop abnormal learning patterns associated with that drug. However, among those, learning about drug-related stimuli (as in “triggers”) continues in an exaggerated manner long after the other “normal” animals have stopped learning. That sort of difference can lead to a seriously problematic behavioral-selection problem whereby drug-related stimuli are attended to, and pursued, more so than other,  non-drug-related ones. If that sounds familiar, it should, since drug users continuously pursue drug-associated activities and exposures in a way that seems irrational to the rest of the world. It just might be due to such a mechanism and others like it.

Some important points about science in Dr. Dodes’ article

One very true fact about mental health pointed out by Dr. Dodes is that diseases like schizophrenia, which used to be explained simply as demon possession and evidence of witchcraft can now be, to a large extent, explained by the study of behavioral neuroscience and cognition. The same is true for bipolar disorder, depression, ADHD, and a host of other such conditions. In fact, the study of psychology has only been able to rely on technological advances that allow us to “see” brain function for a few short decades, leading to incredible advances in the field that I think will continue. The thinking that no such advances have, or will continue to be, made in the study of addiction is, in my opinion short sighted.

As I mentioned above, I don’t for a second think that the entire explanation for drug abuse and addiction will come from neurophysiological evidence. The doctor points out that “If we could take a more accurate image of addiction in the brain, it would encompass much of the history and many of the events that make us who we are.” I agree that we need to advance our technology as well as expand our understanding, but I think that to discount neuroscientific explanations completely is a big mistake.

About Addiction: HIV, smoking, obesity and steroids

We have some wonderful new links about addiction for you to explore and learn through:

Clinical Trials (for anyone interested in participating):  This is the description of a study which is currently recruiting participants to test the neurocognitive effects of buprenorphine among HIV positive and HIV negative opioid-users. The researchers hypothesize that the reasoning abilities of HIV positive participants will be lower than of HIV negative participants.

Science Daily: researchers have developed a technique to visualize the activity of the brain reward circuitry in addicts and non-addicts. This exciting development might help in finding the right treatment strategy for addicts.

Health Day: Three new studies find more evidence that smoking is affected by genes. One study found three genetic regions associated with the amount of cigarettes smoked per day by a person.

UCLA Newsroom: A new study at UCLA found that more than a third of drinkers which are 60 years old and older consume excessive amounts of alcohol. This might be potentially harmful in relation to diseases they may have or medication they may be taking.

Reuters: Obesity and smoking may raise blood clot risk.

Los Angeles Times: An article from the Los Angeles Times about steroid damage. According to the article, long-term use of anabolic steroids damages the heart more than researchers believed.

How can you offer addiction help?

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

SO HOW CAN I HELP ?!?!?

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

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

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

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

Intervention Hell

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

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

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

Good Luck!

Addiction causes – Drug addiction as a chronic disease makes sense

The stigma of addiction is alive and well. Whether you believe in the disease model or not, it seems that people’s judgments regarding what it means to be an addict are well entrenched.

I’d like to work on that a bit.

Why is addiction a disease?

In numerous posts on this site I’ve addressed issues like genetic predisposition and the effects of drugs on the brain that impair addicts’ ability to control their choices. A disease is commonly defined as “A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.” (See Answers.com) I don’t think there’s a question regarding whether or not addiction involves a pathology of a body part, namely the brain.

It would definitely be easier if we could all just say that addiction is the product of bad choices. Nevertheless, all the science I’ve seen points to the fact that addicts have impaired decision making to begin with that is only made worse by the drugs they take in.

A comparison with Diabetes

diabetesFor some reason, this still leaves a lot of people seeing addicts as the only ones to blame. I’d like to try a different approach:

We’ve all heard of type 2 diabetes. It’s the kind people aren’t born with, but rather are develop later in life. Most cases are the result of an over exposure of the body to sugars that breaks down its ability to produce insulin, leading to the disease. There are an estimated 15 million people in the U.S. who have type 2 diabetes. They make up 90% of diagnosed diabetes cases.

I think that type 2 diabetes is a disease that can help many reformulate the way they think about addiction.

Patients with adult onset diabetes likely have genetically reduced insulin receptor functionality and possibly other factors that increase their likelihood of developing the condition. They also likely consume more sugars than people who don’t develop type 2 diabetes, though the exact causes are still uncertain. Nevertheless, with early detection, the disease progress can certainly be slowed and perhaps even halted. As the disease progresses, the body’s response to sugar is altered, eventually resulting in what looks like a severe alergy to sugars. However, once developed, type 2 diabetes patients often require similar treatment courses, including medication, exercise, and dietary changes that patients with type 1 diabetes (the type present early on in life). At this point, simply cutting back will no longer do.

This is not all that different from addiction.

Addicts are often born with a set of genetic and environmental factors that predispose them to impulsively engaging in and seeking out, risky, exciting activities. Moreover, the addict’s reaction to drugs is often different than that of non-addiction-prone individuals. For example, many stimulant abusers report a calming, rather than excitatory, effect of drugs like methamphetamine, cocaine, and the likes. That was certainly my experience back in my crystal meth days.

It is true that here the predisposition is more abstract, since it resides in brain activity patterns, but as I’ve said many times before, the brain is certainly a physical part of the body and should be treated as such. Like diabetic patients, once addicts begin using the drugs in large quantities and for extended periods, the drugs cause alterations in physical systems. Like diabetics, once these changes occur, they are certainly long lasting, if not permanent. Dopamine function in the brain of crystal meth abusers has been shown to take as many as 2 years to return to anything resembling non-user levels and we have no way of telling if the newly formed dopamine activity is at all related to what was previsouly there. Once the disease we know as addiction (or dependence) takes hold, there are specific recommended treatments that need to be followed. Simply cutting back will no longer do.

The bottom line?

Addiction fits the model of a disease as well as many other conditions. I have no doubt that people’s moral judgments get in the way sometimes and make it hard for them not to fully blame an addict for their trouble. I don’t doubt that addiction can only develop with the use of drugs, but if there are pre-existing conditions that make that use more likely, I think it need to be taken into consideration as well.