October 17th, 2011
Researchers are attacking the issue of drug addiction from multiple angles, and the results seem to be more and more ways to help. Some promising new developments in pharmacological (as in medication) therapies include a new cocaine-vaccine, as well as expanded use of Buprenorphine, for the treatment of opiate (heroin, morphine) addiction.
- These medications are best used along with behavioral treatment in order to increase to probability of treatment success.
- By reducing cravings, as well as reducing the effects of the drugs themselves, these medications can increase the length of time that patients will stay in treatment, which is the most reliable way of producing better treatment outcomes.
What else is new aside from medications?
There are also some exciting developments in the behavioral treatment, including Contingency Management (CM), a treatment method that tries to reteach addicts positive, drug-free behaviors by reinforcing those over the use of drugs. While some people still have problems with programs that use CM because of the notion of rewarding drug addicts for not using drugs, I say use whatever works!
Lastly, as early as 2003, researchers have noted that proper drug treatment may take longer than the 14-30 day programs that are currently being offered (1). In fact, while the article I’m referring too speaks specifically about methamphetamine addiction, we now know that the long use of many drugs, including cocaine, leads to long lasting brain changes that can take up to a year to show significant recovery.
I personally think that proper drug treatment for long time addicts (anyone with more than a year or so of heavy use) should take on the order of 6 months to a year, and should be supplemented by some outpatient post-care for an extended period of time (I’m far from the only one calling for this, see article 2). It’s the only sensible thing to do given the long term changes that such drug use creates in the brain…
I think it’s about time that insurance companies step up the plate and recognize that the huge cost of drug problems for our society (estimated at more than $100 billion annually) can be vastly reduced by providing sound, scientifically based, medical treatment options for those who need it.
(1) Margaret Cretzmeyer M.S.W, Mary Vaughan Sarrazin Ph.D., Diane L. Huber Ph.D., R.N., FAAN, CNAAc, Robert I. Block Ph.D. & James A. Hall Ph.D., LISW( 2003) Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment Volume 24.
(2) A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O’Brien, MD, PhD; Herbert D. Kleber, MD (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of the American Medical Association, Volume 284, pp. 1689-1695.
Question of the day:
Do you know anyone who’s been through residential drug treatment?
How long were they in for?
How many times?
Did it help?
|Posted in: Drugs, Drugs, Education, Medications, Treatment
Tags: Buprenorphine, cocaine, contingency management, drug treatment, Drugs, heroin, medical treatment, medication, residential treatment
September 8th, 2011
You’ll never think of Cashews in the same way after reading the first few pages of this recent report by the Human Rights Watch group that looked into the abuses in Vietnamese “drug treatment” centers.
The detainees in these facilities, whether they checked themselves in voluntarily or were committed after being arrested for using or possessing drugs, describe terrible conditions, hard forced labor, and extensions to sentences that make their experience seem much more like jail than any form of drug treatment. Indeed the report states that “no one who had been detained described any form of scientifically or medically appropriate drug dependency treatment within a center. Psychosocial counseling involved lectures on the evils of drug use and morning exercises while chanting slogans such as ‘Healthy! Healthy! Healthy!’ .”
It should be pretty obvious that relapse rates are extremely high since, as we’ve talked about numerous times here on A3, at least part of addiction involves compulsive behavior affected by biology and early experiences and therefore punishment alone will simply not work for true addicts… And still we put all of our addicts in jails and prisons with little actual drug treatment in our own country – I guess at least we don’t have forced labor.
Read this thing by the Human Rights Watch group – it’ll leave you just a little speechless.
|Posted in: Education, Treatment
Tags: addicts, drug, drug treatment, forced, forced labor, human rights, human rights watch, treatment, treatments, vietnam, vietnamese
July 8th, 2010
As we mentioned in recent posts, giving up addictive behaviors can be difficult.
Research on interventions has long shown that it’s a lot easier to reshape existing behaviors than it is to stop them. Therefore, refocusing, or rechanneling, your energy into something that will improve, not devastate your life should prove easier than simply stopping addictive behavior. Addiction recovery help is often centered on stopping the usage of drugs when instead, they should focus on replacing the use with something else.
Addiction help by active replacement
Exercise has been shown to improve mood, especially in the short term (1,2) and can therefore provide the extra emotional boost many addicts need when they first stop using. An article in the Journal of Sport Psychology reveals that running can create a sense of achievement, fulfill intrinsic and extrinsic needs, and provide a natural high (3).
An activity like running can provide a respite from daily life. It can also offer a means to re-direct most addicts’ need for something to obsess about.
Taking on a long-term running goal and getting involved in some training with appropriate short-term achievement markers can help people in recovery feel as if they’re regaining some measure of control over their seemingly chaotic life. Seeing yourself able to run longer distances, faster times, and feeling the health benefits can be very rewarding.
An inspiring story in Runner’s World magazine tells the story of a father and son who did just this, conquering their drug addiction by taking on the challenge of completing a marathon.
Addiction help, not a new disaster
Importantly, a study has found that animals that are prone to drug addiction are also more likely to develop obsessive running patterns (4). This suggests that a link between these behaviors does indeed exist and underscores the importance of being mindful even when performing these more benign activities; the goal is staying healthy after all.
Keeping this in mind, there are a few simple things that will help reduce the chances of injury as you start running:
Stretching is important for injury prevention. Activities such as yoga are beneficial for runners and can stretch out sore muscles, prevent your next injury, and relieve stress. (Runners World)
Make sure to set realistic running goals and not push yourself too far. Taking on too much too early will only lead to injury and burnout and hurt, not help your enjoyment of running.
So instead of just trying to quit, try changing behaviors that you commonly engage in into ones that are more productive.
Question of the day:
Have you found that running, or a similar form of exercise helped you kick bad habits?
If so, would you mind sharing your story?
1. Plante and Rodin. (1990). Physical fitness and enhanced psychological health. Current Psychology: Research & Reviews, Vol 9, Spr 1990, pp. 3-24.
2. W. De Coverley Veale (1987) Physiological and Psychological Effects of Short-term Exercise Addiction on Habitual Runners, Exercise Dependence Addiction 82 (7) , 735–740.
3. Mark H. Anshel (2005). Applied Exercise Psychology: A Practitioner’s Guide to Improving Client Health and Fitness, Springer Publishing.
4. Werme, M., Thoren, P., Olson, L., Brene, S. (1999). Addiction-Prone Lewis But Not Fischer Rats Develop Compulsive Running that Coincides with Downregulation of Nerve Growth Factor Inducible-B and Neuron-Derived Orphan Receptor 1. The Journal of neuroscience, 19, pp. 6169-6174.
|Posted in: Education, For addicts, Positive addictions, Tips, Treatment
Tags: addiction and recovery, addiction exercise, changing behavior, drug treatment, early recovery, exercise, exercise recovery, recovery addiction, recovery help, running, stretching
February 27th, 2010
I was talking with a friend the other night, and he asked me my opinion about the line between addiction and normal behavior. He was wondering whether I think that everyone who looks at porn is a sex addict.
I don’t. (see some of our posts on sex addiction here)
Still, the conversation made me feel like writing something about my views on addiction causes. So here goes:
For the addicts who are still unaware, the line between normal- and addictive-behavior tends to blur again and again until it seems like more of faded smudge on their life. For those looking at addicts from the outside, the line normally seems so clear and so far away that they rarely believe it can be crossed back again.
I don’t personally believe that addiction per se is where things started for most people. By this I mean that no matter how hard we look, I believe that we will never find the elusive “addiction gene“, genes, or trigger.
Having been in the thick of it, I think that substance abuse is nothing but one possible outcome of set of circumstances, both biological and environmental, that lead some individuals down a particular path.
Impulsivity and other addiction causes
As I mentioned in earlier posts, addiction, at least to drugs (and I believe other addictions as well) is very closely related to a set of psychological conditions that have to do with impulse control problems.
I believe that individuals with increased impulsivity are simply more prone to putting themselves in situations that are inherently dangerous to their well-being. A simple example from non-drug related behavior might be one-night stands.
A typical person with no impulse control issues may hold off on sex if the only option was to have it unprotected. They may think to themselves “I need to stop, this could seriously affect the rest of my life.”
A person who has a reduced ability to control initial impulses may have the exact same thought and yet go through with the action, leaving them feeling remorseful and anxious the next day, but still having put themselves at risk.
This is a very common occurrence among sex-addicts. The thoughts are there, the knowledge is there, the ability to connect those to actions is seriously lacking. While some people make moral judgments about this fact, I’ve seen enough research that connects this problem to biological processes and genetics that I’m now resigned to the fact that at least on some level, the issue is physical and neurochemical.
Addiction help – Cures, treatment, and solutions
Still, I think the battle is far from lost. I strongly believe that education, informed by actual knowledge rather than misguided mythology, can put people in a better position to deal with the issues even if their source is outside of their control.
Even aside from pharmacological treatments (as in medications) that can help, there are endless ways to help people learn to be in better control of their actions once they are aware of their initial deficit. That is how AA and many other support groups function. People within them ask others about decisions they’re making BEFORE they act on them.
We know already that when it comes to drugs, the equation changes once the person starts using regularly and for long periods of time.
Chronic substance abuse further breaks down the brain’s ability to control impulses by reducing functioning specifically in the prefrontal-cortex; the part of the brain right behind your forehead which is thouught to be the center of the brain’s control tower.
The cycle seems too obvious: Impulse control difficulties leading to dangerous behavior which leads to further impulsivity issues and so on…
The treatment, like the progression of the condition itself, needs to be long. I don’t believe that any 30 day treatment program will be able to resolve a condition that took years to develop. Still, the issue of treatment will come up again here. This is enough for now…
Question of the day:
Do you have any insights from your own experiences as to how addiction develops?
|Posted in: Drugs, Education, Food, For others, Opinions, Sex, Tips, Treatment
Tags: addiction causes, addiction gene, Drug addiction, drug treatment, genetics, impulsivity, problem drug use, Sex, substance abuse
January 30th, 2010
The U.S. policy regarding the drug problem is still centered mainly on the enforcement of its drug laws and intervention in the drug supply both within the U.S. and in neighboring countries. There is no question that this “crusade” has had an impact. Importing a kilogram of cocaine into the US costs approx $15000 (an average kilogram sells for $10,000-$15000) while sending a regular package weighing the same costs about $100 (1).
The result of the focus on enforcement
Still, the recent assassination of the Mexican “drug czar”, and the escalation of violence just south of the U.S.-Mexico border point to another fact: Where there’s money, there’s a way. Drug cartels will find a way to deliver their product as long as customers are waiting on the other side of the border. One of the battles in this war has to be fought on the prevention/intervention side. Dr. McLellan’s selection as deputy drug czar brought with it a lot of hope regarding the role of treatment in the big-picture. Still, bureaucracy moves slowly, and there have been few visible changes in policy to date, aside from the well needed symbolic nature of dropping the term “War on Drugs” from our lexicon.
What about treatment?
Unfortunately, health insurance companies in the United States rarely covers any of the cost involved in drug treatment, even though at least 42 states require them to do so by law! Even when they do, insurance companies often limit coverage to 30 days of residential treatment. I’ve made it clear before, but I feel that the notion that 30 day treatment can work needs to be removed from our consciousness (2). I realize this may require hypnosis…
Anyway, without funding, the hope of making drug treatment truly affordable and accessible is small and dwindling as it requires more medical treatment, which is obviously costly. I hope that this aspect of health care coverage finds its way into the ongoing debate, especially given the high, and increasing prevalence of drug abuse in this country.
As it stands, the U.S., with little more than 5% of the world’s population is consuming somewhere between 50%-70% of the world’s drugs. Talk about a problem with our GDP…
I can tell you, without a doubt, that saving someone from ever becoming an addict is the biggest cost saver in this entire equation. It would remove crime costs, treatment costs, and incarceration and court costs right out of this whole thing. The problem, obviously, is that we don’t know with certainty who will, and who won’t, become an addict. There are some recent advances, and I think that as technology (specifically imaging), and our knowledge (specifically about genetics and its interaction with environmental stress), improves we will be able to do a much better job of this.
I work on some projects that assess the cost benefit of treating rather than merely jailing drug users (prop 36 in CA). I can’t wait for us to have the knowledge to allow for the same analyses regarding prevention.
(1) Reuter & Pollack (2005). how much can treatment reduce national drug problems?
(2) McLellan, Lewis, O’Brien, & Kleber (2000). Drug Dependence, a Chronic Medical Illness Implications for Treatment, Insurance, and Outcomes Evaluation.
|Posted in: Opinions, Treatment
Tags: arrest, cocaine, Drug addiction, drug cost, drug treatment, Health insurance, health reform, intervention, McLellan, ONDCP, prevention, smuggling