Alcoholism , Sniffing Bath Salts, and Prescription Medication Abuse

If you care about addiction you’re going to want to read our weekly update from across the globe. It’ll make you smarter – promise (at least when it comes to alcohol and drug abuse issues)!

Drug Abuse – Vaccines to treat addictions, and Sniffing Bath Salts

Medical News Today-A biochemical breakthrough by researchers at Cornell  produces a unique vaccine that combines bits of the common cold virus with a particle that mimics cocaine. Researchers believe the vaccine could be tailored to treat other addictions, such as to nicotine, heroin, and methamphetamine. While similar to other vaccine discussions we’ve had here, the method and generalizability here are of specific interest.

BBC News-Publicity of scholastic journals back fired on Dr. David E. Nichols as drug makers profit off his research findings. Dr. Nichols says while some drugs can be manufactured in the kitchen the scale to which these “legal high” drugs are produced indicates some small companies are involved.

Fox News.com– A new “drug abuse” trend of sniffing bath salts to try to get high is emerging in Louisiana and is creating a issue for the Louisiana Poison Center. It appears that more kids are attempting this “trend” resulting in of paranoia, hallucinations, delusions, as well as hypertension and chest pain. The problem’s gotten so bad in the state that the Governor had to make the active ingredient in the bath salts illegal. The bath salts contain a chemical called “Mephadrone and Methylenedioxypyrovalerone or MDPV, which is known to be a stimulant that may also cause paranoia and hostility.

Alcoholism – Studies and Personal Stories about alcohol

Science Daily- A new study has been conducted which shows that midlife alcohol consumption may be related to dementia which is often assessed about 20 years later. The study found that both abstainers and heavy drinkers had a greater risk for dementia and cognitive impairment than light drinkers. Again, it seems that drinking no-alcohol is associated with risk factors and outcomes that are not as ideal as moderate consumption and somewhat similar to heavy drinking.

Counselor Magazine Blog- Everyone loves watching a good and inspirational movie from time to time. The new movie “Country Strong” deals with many issues that everyday individuals face such as alcoholism, mental illness, co-dependency, ageism, and grief. These are elements that a person goes through when they are dealing with alcoholism. The movie depicts that alcoholism is a family disease and does not affect just the alcoholic. Another great point that the movie shows is that if there are underlying issues that are often not resolved that relapse is very common.

Prescription Drug abuse and death

Reuters- A new study has found that an increasing amount of individuals are dying from abusing and misusing prescription drugs as well as illegal drugs. In recent times deaths from “accidental poisonings” or overdose are more than ten times higher than they were in the late 1960s. This increase in drug deaths is higher across almost all age groups than it was in previous decades, especially amongst white Americans.

Chicago Sun Times- Prescription drug abuse is a growing problem in our country, and deaths from unintentional drug overdoses in the US have increased five-fold over the last two decades. The drugs that are commonly causing these deaths are particularly painkillers such as OxyContin (oxycodone), Vicodin (hydrocodone) and fentanyl. What many individuals do not realize is prescription drugs can be much more deadly than illegal drugs. In 2007 alone, abuse of prescription painkillers was responsible for more overdose deaths than heroin and cocaine combined. Prescription painkillers, most of which are opioids, are synthetic versions of opium used to relieve moderate to severe chronic pain, however in large and excessive quantities, they can suppress a person’s ability to breathe and are very dangerous when they are mixed with alcohol or other drugs.

Adding environmental factors to pharmacogenomics improves treatment outcome

Hopefully you’ve read our previous discussion of pharmacogenomics but in case you haven’t (and you should), it is the science of personalized medicine (medications and medication-dosing) based on an individual’s genetic code. Well, nothing ever stays simple with genetics and although by now it is pretty clear that aside from considering what is knows as functional variation in genetic code (what everyone was talking about during that whole human genome project thing – changes in human genetic code that directly affect protein function) we also need to consider epigenetics – or that part of the genetic code that we used to think meant nothing (right, that was going to work out) and we now know influences that expression of all those other genes we care about.

Pharmacogenomics – Personalized medicine in treatment for heart disease

Well, it seems that some real advances are being made in the area of heart medication in terms of pharmacogenomics. From aspirin dosing to issues concerning medications that help with clotting after open-heart surgery, the medical field has been working hard on figuring out what drugs and what doses people who vary on specific genes should be prescribed. The article  by Baye and Wikle that drew my attention back to this topic brings up an important consideration that I believe will play a significant role in making sure that medications for substance abuse benefit equally from pharmacogenomics – what they call biogeographical ancestry. Biogeographical ancestry is the politically correct way of asking where on earth people are from, and given the relatively (a few hundred years) recent mixing of African descendants with people from Central and South America, Caucasians with Africans, and a whole other slew of mixes, knowing ones geographical ancestry adds a whole lot of knowledge to our genetic equation because the genetic code hasn’t had the time to mix together fully and so it still clumps together in ways that make analyzing its variability much easier.

Pharmacogenomics and addiction treatment?

What the heck does this have to do with drug abuse you ask? Well even aside from a strong recent push by NIDA director Dr. Nora Volkow, it is becoming clearer and clearer, at least to me, that medication are going to play a bigger and bigger role in treating addictions. Drugs like Vivitrol, Suboxone, and Zyban are making a real difference in the success rates of those seeking help from addictions and I think that as we get better and better at tailoring the drug selection and doses, those medications, and other that haven’t even been discovered yet, will help us get over the initial hump in treatment – the danger zone.

You see, most people who abuse drugs are not what we call addicts. They’re using more than they should and likely need a nudge from their doctor or some real reason, like a likely oncoming heart attack, to tame their use or stop altogether. In fact, the vast majority of drug abusers stop on their own. However, there’s always that group of people who can’t stop on their own and even though right now we only get to treat them once they get in real trouble (cops, hospital, marriage, you name it), as we start incorporating screening for drug abuse into our medical system we will begin finding more of them at an earlier point in their drug troubled life. For them especially, but also for the chronic relapsers, these medication can make a world of difference and give them a chance at a life that may otherwise seem impossible – a life without drug abuse.Our experience with bupropion and quitting smoking proves that knowing a person’s genetic variability can really help determine their effective use of medications.

But for all the people these drugs help, there are always horror stories about individuals who’ve become addicts to the medication or for whom the meds themselves produced such horrible side-effects that staying addicted almost seems better. For them, I believe pharmacogenomics will make all the difference. And once we figure out who will and who won’t benefit from which drugs at what doses I think that the medical field in general, and substance abuse medication therapy in particular, will benefit greatly.

Citation:

Baye, T. M. & Wikle, R. A. (2010) Mapping genes that predict treatment outcome in admixed populations. Pharmacogenomics Journal, 10: 465-477

Here’s a link to an upcoming conference on pharmacogenomics for anyone interested in the topic:

Personalized Medicine: Principles to Practice
March 1, 2011
Dallas, TX, USA

This symposium brings together leaders in the field to address key aspects of the science of therapeutic individualization, the enabling technologies underpinning this biomedical revolution, and the evolution in policies that will advance personalized medicine principles into healthcare management tools for individuals and populations.

www.nature.com/natureconferences/prmd2011

Is marijuana addictive? You can bet your heroin on that!

marijuana“Is marijuana addictive?” seems to be the ultimate question for many people. In fact, when discussing addiction, it is rare that the addiction potential for marijuana doesn’t come up.

Some basic points about marijuana:

The active ingredient in marijuana, THC, binds to cannabinoid receptors in the brain (CB1 and CB2). Since it is a partial agonist, it activates these receptors, though not to their full capacity. The fact that cannabinoid receptors modulate mood, sleep, and appetite is why you get the munchies and feel content and why many people use it to help with sleep.

But how is marijuana addictive? What’s the link to heroin?

What most people don’t know is that there is quite a bit of interaction between the cannabinoid receptor system (especially CB1 receptors) and the opioid receptor system in the brain. In fact, research has shown that without the activation of the µ opioid receptor, THC is no longer rewarding.

If the fact that marijuana activates the same receptor system as opiates (like heroin, morphine, oxycontin, etc.) surprises you, you should read on.

The opioid system in turn activates the dopamine reward pathway I’ve discussed in numerous other posts (look here for a start). This is the mechanisms that is assumed to underlie the rewarding, and many of the addictive, properties of essentially all drugs of abuse.

But we’re not done!

Without the activation of the CB1 receptors, it seems that opiates, alcohol, nicotine, and perhaps stimulants (like methamphetamine) lose their rewarding properties. This would mean that drug reward depends much more heavily on the cannabinoid receptor system than had been previously thought. Since this is the main target for THC, it stands to reason that the same would go for marijuana.

So what?! Why is marijuana addictive?

Since there’s a close connection between the targets of THC and the addictive properties of many other drugs, it seems to me that arguing against an addictive potential for marijuana is silly.

Of course, some will read this as my saying that marijuana is always addictive and very dangerous. They would be wrong. My point is that marijuana can not be considered as having no potential for addiction.

As I’ve pointed out many times before, the proportion of drug users that become addicted, or dependent, on drugs is relatively small (10%-15%). This is true for almost all drugs – What I’m saying is that it is likely also true for marijuana (here is a discussion of physical versus psychological addiction and their bogus distinction).

Citation:

Ghozland, Matthes, Simonin, Filliol, L. Kieffer, and Maldonado (2002). Motivational Effects of Cannabinoids Are Mediated by μ-Opioid and κ-Opioid Receptors. Journal of Neuroscience, 22, 1146-1154.

Harm reduction – Why the bad press for addiction treatment that works?!

condoms can help protect again STDs

How many of you think that giving a crystal meth user condoms will increase their drug use? Probably not many. What if instead the question had to do with giving that same user clean needles rather than having them share a dirty one? Or having him reduce his drug use instead of stopping completely? I bet there would be a little more disagreement there.

Some of you may have heard of the harm-reduction approach to drug abuse counseling and treatment, but many of you likely haven’t because the term itself is essentially taboo in the United States. The idea is to approach the patient (or client) without the shaming or expectations of abstinence that normally come with drug treatment. Instead, the counselors hope to reduce as much of the negative things associated with the drug use.

For example, almost all drug injecting users end up with hepatitis C due to dirty-needle sharing. As in the above example, harm reduction practitioners would seek to provide users with clean needles, thereby reducing needle sharing and the transmission of disease. Risky sexual behavior is often associated with methamphetamine, and crack use; instead of targeting the use itself, often, interventions attempt to reduce unprotected sex, reducing HIV transmission in the process.

hypodermic-needleHarm reduction has many supporters, but unfortunately, there are at least as many people who are against it. The claim is that harm reduction doesn’t stop drug use, and that we shouldn’t be in the business of making drug use easier. In fact, though they have no data to support it, some people argue that giving users clean needles is likely to exacerbate their drug use. My argument is that life as a drug user is pretty difficult as is, and if we can provide a way to show drug addicts that people actually care about their well-being, we might help some of them see the light.

Even more to the point, my thinking is that HIV, Hepatitis C, and other conditions often helped by harm-reduction, have to be considered as additional societal costs of drug abuse. If harm reduction helps us tackle those collateral costs, I’m all for it as an additional tool.

The bottom line is this: If we can use multiple tools to solve a problem, why limit ourselves unnecessarily to only one? If harm reduction helps, why not use it in conjunction with abstinence treatment?

As I’ve mentioned in previous posts, it’s time for us to stop resorting to ridiculous moral judgments and start focusing on solving the problem. If we can help an addict use less, use fewer drugs, or use more responsibly, I say we should go for it!!!

Choice and control in addiction – Genetics and neuroscience of drug abuse

Dr. Jaffe recently gave an online lecture (webinar) for HealthCentral on the processes involved in choice and control of behavior during addiction and drug abuse. We’ve written quite a bit on here about the neuroscience of impulsivity issues and the genetic predisposition to addiction and this talk really covers some of the most important aspects of this topic. I’m also attaching a link to the presentation materials that go along with this talk so that you can follow along (Wellsphere Webinar 1 – Choice Vs. Control). There was definitely quite a bit of material (on both neuroscience and genetics) that we couldn’t get to, so hopefully having the presentation will help you follow along and learn.

We hope you enjoy!

Control Versus Choice in addiction


Watch live video from HealthCentral on Justin.tv

If you need help finding treatment for your own, or a loved one’s addiction, make sure to give our Rehab-Finder a try: It’s the only evidence-based, scientifically created, tool for finding rehab anywhere in the United States!

Trauma and Addiction – The often ignored reality about addiction

In previous post, I’ve talked about some of the links between addiction concepts like cravings and trauma disorders like PTSD (see here). The reality is that there is a closer link between addiction and trauma that is often overlooked.

I spend a lot of time on this site covering some of the neuroscience that explains why the repeated use of addictive substances can lead to the kind of behavior that is so common in addiction. Still, most of that neuroscience ignores the portions of a person’s life that come before the actual drug use. The one exception would have to be all my writing on impulsivity, and some work on the relationship between early life stress (or trauma) and depression, which is known to be associated with drug abuse.

The way I see it, there are at least 3 distinct stages to addiction :

  • What happens before drug use.
  • What happens once chronic drug use begins.
  • What happens once a person stops using.

Though we often like to pretend otherwise, trauma is a common part of the first stage.

How do we define trauma?

In this context, trauma is any event that affects a person in a way that can be seen to have caused a substantial, long term, psychological disturbance. The key to this way of looking at trauma is its subjective nature.

Things like divorce, bullying, rejection, or physical injury can all be considered traumatic if the subjective experience can be thought to conform to this definition. Anything counts as long as it leaves a painful emotional mark.

While we’re all pretty adapt at covering up such trauma, the emotional pain often needs to be soothed and a good way to soothe it is with drugs that make it temporarily go away. The first drink of alcohol, or hit of some other drug, will often take care of that.

The reality of early trauma and addiction

Some call the experience of covering up the pain of trauma with drugs “self-medication” (though the term also applies to other situations), some dislike the term, but I think the fact remains that often, emotional pain can begin a search that often leads to risky behaviors and drugs.

I’m nowhere near calling self-medication the only reason for drug abuse as some others do, but I think it’s an important factor and one that can’t be ignored. As the stigma of emotional pain, or emotional responding in general, is reduced, people’s ability to deal with such pain in a healthy way should lead to a reduction in seemingly helpful, but ultimately self-destructive behaviors.

One of the most useful roles of psychotherapy for addicts is in dealing with the trauma in a healthy, constructive manner. This way the shame, guilt, and other negative emotions associated with it stop guiding the person’s behavior. While this is rarely enough to stop the need for self-medication by itself, it can be a very useful part of a comprehensive treatment plan. It’s important to remember that once someone has entered the realm of chronic drug use, there are brain and body changes that can often trump whatever the reason for beginning drug use was.

The ignored reality about addiction is that it often has an origin in behavior and unfortunately, trauma is often that starting point.

About Addiction: Stress, personal stories, alcohol and drug facts

Stress, PTSD, and a sex doll

Addiction Inbox– After many years of fighting in a war solders often experience post traumatic stress when they return to living their civilian life. There is no known cure for PTSD but there are medications that alleviate the stress experienced by many. Seroquel is prescribed to treat PTSD but  there have been many reported cases of  abuse of the drug. In this story, Dirk covers some of the facts, and consequences of duch drug abuse among PTSD soldiers.

Orange News– Talk about not getting over a breakup ! An Italian man paid  £12,000 to recreate a sex doll of his ex girlfriend. The man wanted the doll to look exactly like his ex though with some enhanced features. Is this sex addiction or simply a case of someone going a little too far after a tough experience? I don’t know but it’s worth a read.

Alcohol abuse facts and fiction 

Irish Times– The Maliebaan centre, has a unique way of  dealing with the care and rehabilitation of alcoholics. They believe that its residents will never stop consuming alcohol and therefore they try to help them end the dangerous binge-drinking by controlling their alcohol intake. Clients are allowed to order up to five liters of beer daily, with an hour between each half liter. The bar opens at 7.30am and closes at 9.30pm, and the only criterion for being served is that the drinker must be able to get up themselves from their chair, walk to the counter and be able to hold their half-liter glass steady. Hey, they are Irish!

Breaking the cycles– Reducing the drinking ages does not stop abuse of alcohol for individuals who are underage. Lisa talks about the reality of underage alcohol abuse in Europe.

Personal addiction stories and Addiction research drug facts

Popeater- Jamie Lee Curtis opens up about her previous drug addiction and tells how recovery was the single greatest accomplishment of her life. She said that without her recovery her life would have fallen apart. She thinks that recovery is an acceptance that your life is in a shambles and you have to change it. Curtis was previously addicted to painkillers but she has been sober for over ten years.   

PsyPost– A protein which is linked to mental retardation may be the controlling factor in drug’s effect in the brain. A study found that a protein known as methyl CpG binding protein 2 (MeCP2) interacts with a type of genetic material known as microRNAto control an individual’s motivation to consume cocaine. It is thought that MeCP2 may regulate vulnerability to addiction in some people through its inhibitory influence on miR-212. Without this influence, the expression of miiR-212 would be far greater in response to cocaine use, and the risk of drug abuse and addiction would likely be far lower.

Everything Addiction– Ezlopitant, a drug that has been shown to decrease preference for alcohol, has been found to decreased appetite in rodents, indicating another link supporting the relationship between alcohol and drug addiction and compulsive eating.