A&E’s Intervention – Joey, the middle class, heroin addiction, and hepatitis C

A&E’s Intervention built quite an initial popular following for itself by choosing subjects with disarmingly unique stories and addictions. However, as the show has progressed, it has found strength in an ability to show America the true face of addiction: the so-called normal, everyday people battling their demons in private.

Heroin addiction doesn’t understand “class”

Joey, a 25-year old father from Pennsylvania, stands as a prime example, a young male who grew up with a supportive family in a comfortable suburb and nevertheless found himself in the grip of heroin addiction. By his own account on Intervention, Joey began experimenting with drugs at the age of 13, and by 15 was regularly smoking marijuana. By 17, he was using ecstasy, LSD and had developed a heroin addiction, which several trips through a 12-step rehab program did little to slow. As his tolerance for heroin built, Joey found himself shooting heroin at the rate of up to 7 bags a day to maintain his high. Despite steady work as a tattoo artist, his money was increasingly feeding his heroin addiction, preventing him from even making his child support payments. Sharing dirty needles had also most likely been the cause of his recent contraction of Hepatitis C, an infection that now shows up in a staggering 80% of all regular injection drug users.

A&E’s intervention – A glimpse into the face of addiction

As per the show’s format, this episode revolved around a forthcoming intervention planned by Joey’s family, who were growing more and more desperate as his heroin addiction continued to eat away at his life. In accordance with the Johnson Model, the classic standard of addiction intervention, the family resolved to present Joey with an ultimatum- either he could voluntarily enter rehab treatment, or he faced losing contact with all of his family members, losing any rights to his young daughter, and could even face jail time for violation of his probation.

Even with the gravity of the consequences facing him, Joey’s heroin addiction was such that he still could not come to terms with his situation. Anticipating the intervention, he ran, going into hiding for two days while his family camped outside of his home, his job, and the homes of his friends, waiting for the chance to confront him with reality. Ultimately, they spread the word that they were prepared to have him arrested. With nowhere left to turn, Joey finally resolved himself to rehab, though not without one final fix.

Difficult recovery and relapse

Though the treatment originally seemed to take well, giving Joey 9 months of sobriety, he was depicted on the program suffering a late relapse. This time, he willingly returned to treatment. According to A&E’s Intervention, he has now been sober since April 25, 2010.

Joey’s story resonates because of how tragically common his themes are: the complete loss of personal wealth, the hardship that the addict’s behavior has on family and friends, and the willingness to put oneself in extremely dangerous situations for the chance to use just one more time. Time and again, Joey demonstrated an extreme lack of caution as he shot up heroin with dirty needles, putting himself at risk for Hepatitis, HIV, and any other number of serious diseases. This brings up the issue of so-called “harm reduction” programs designed not to prevent injection drug users from using, but rather to provide them with clean needles and education in order to minimize the threat to public health and guide, not force, the addict towards potential treatment. The long-standing counterargument to such programs has been that they implicitly condone drug abuse, but research has shown that needle exchange programs do not increase drug abuse but merely decrease disease and dirty needle use. In this way, it is increasingly becoming regarded as analogous to sex education and the distribution of birth control, another common-sense public service that has too often fallen victim to the agendas of culture warriors.

Though for some a lurid escape, it has become increasingly clear to us at A3 that A&E’s Intervention, by presenting a straightforward view of the true complexity of modern drug use and addiction, has become an invaluable tool for those attempting to understand the face of this issue. As is usually the case with television content though, it pays to go a little deeper, and hopefully the show motivates people do just that.

Obesity, drug addiction, and dopamine

Eating junk-food can be addictive, and apparently, it causes brain changes that look eerily similar to drug addiction. That’s the message not only from the rapidly fattening waistlines of Americans everywhere, but also from the Johnson and Kenny labs at the Scripps Institute.

Food and drug addiction

The idea that obesity is caused by a compulsive pattern of eating, and that there could be a similarity between such compulsive eating and drug addiction isn’t super new. In fact, Dr. Volkow from NIDA seemed to make research into this association her goal when taking  the helm of the addiction research kingdom.

When you think about it, the notion isn’t far-fetched: Drug addicts continue to take drugs, in increasing amounts, even though they’d often like to stop (at some point) and in the face of negative consequences and the common loss of other important life functions (like family, work, etc.). Obese individuals are quite the same, eating more and more food regardless of their desire to adopt a healthier diet and in-spite of ridicule, low self-esteem, and decreased functioning that often accompanies extreme weight gain.

The research by Johnson and Kenny examined whether exposure to the kind of high-fat, super high-calorie foods that floods the junk-food market are responsible for creating food-addicts in a similar way to drugs that alter the brain in ways that make stopping more difficult.

Dopamine, reward, and junk-food

The study took three groups of rats and gave them either the regular chow diet lab animals are used to or the worse kind of birthday party food: bacon, sausage, cheesecake, pound cake, frosting and chocolate. You can imagine the party going on in the rat cages that got to eat that! Of the two groups that got to eat the crazy-fat food, one had unlimited access while the other got to binge for only one hour a day.

The bottom line: Only the rats that got unlimited access to the fat-party food developed compulsive eating habits that resulted in roughly twice the weight gain of the other two groups and the ability to continue eating even in the face of signals for punishment (a light that they were trained to associate with shocks).

When the researchers looked deeper, they found that the brains of these rats suffered a significant reduction in the density of a specific kind of dopamine receptor (D2) in a brain part known as the striatum, the same kind of reduction common in drug addicted people and obese individuals. This receptor type is often thought to be important for regulation of impulses, both physical and otherwise. It therefore makes sense that losing this type of function would cause uncontrollable eating or drug taking.

Are drug- and food-addictions the same?

While this research isn’t saying that compulsive eating, or obesity, are the same as drug addiction, it does strongly suggest that there are common mechanisms in both. More importantly, it reveals a common process that unfolds when over-exposure to the reward, in this case food, occurs. This tells us that there can likely be common pathways to these different addictive disorders, though whether any specific person ended up a food- or drug-addict because of this kind of process is still an open question. I wonder if we’ll see something like this with sex addiction soon…

Citation:

Johnson and Kenny (2010) Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nature neuroscience, 13, 635-641.

About Addiction: Alcohol, breast cancer & war veterans

Check out our weekly links about addiction!

Health Day: A new study shows that breast cancer survivors who smoke are at increased risk for a second cancer. The time frame to develop second cancer is fifteen years.

Cesar Fax: Drug positives increase consistently with age amongst DC juvenile arrestees. 53% of the juvenile arrestees tested positive for drugs.

Psychology Today: An article from Psychology Today (which Adi has been writing for so check them out!) and discusses the issue of war veterans and drug use as well as PTSD. It relates the discussion to soldiers in Iraq and Afghanistan.

Science Daily: There are some new insights into how alcohol affects brain function. Drinking alcohol over a long period of time does profoundly affect the brain.

Science Daily: More about alcohol! According to Science Daily, genetic differences that make you sleepy when you drink can protect against alcohol dependence.

Salvia, a popular hallucinogen that is much shorter-acting than LSD

Co-authored by Jamie Felzer

If I were a betting person (I’m not really), I’d bet that most of you have been to YouTube before. For some of us the video site provides good information and for others it’s an endless source of comedy.  Either way, YouTube has also become a hallmark of the youngest generation of computer users – they love to post funny videos of their friends for the whole world to see. Some of those young YouTube users have been posting videos of themselves using Salvia.

Salvia, Salvinorin A, and YouTube

For those unaware, Salvinorin-A (note Salvanorin by the way) is the active, hallucinogenic drug in Salvia, a plant that is legal for those above 18 in the United States. Salvinorin A is a very potent hallucinogen that unlike LSD and many other hallucinogens, does not act on serotonin circuits, but instead acts on opioid receptors to produce short term effects.  The range of effects include surfacing of past memories, uncontrollable laughter, sensations with various motor properties and becoming one with an inanimate object.

Salvia’s usage has long been documented among South American Shamans for visions and healing purposes. However, shamans use it only through extraction into tea or through chewing and modern methods of use include smoking or ingestion sublingually. Smoking the drug produces a much faster onset. Chewing Salvia leaves results in a much smaller amount of the drug, allowing the shamans to use the plant therapeutically.  Large doses, such as those that are used now aren’t shown to have therapeutic effects.

Interestingly, the opioid receptor Salvia acts on (the Kappa opioid receptor-type) is not the same one that morphine and heroin act on (called the mu opioid receptor). This can leave Salvia users with a dysphoric effect (like depression) that makes for a miserable experience and a desire for the trip to end.  Good thing it is a quick trip!!  However, Salvia is known to produce different effects in different users, so dysphoria is not always present.

Recently, researchers looked into YouTube videos people posted of themselves or their friends using Salvia. Since Salvia is a fairly short-acting drug, lasting an average of 6 minutes, they were able to see many of the full experiences in their natural environment.  Some of the observed effects of salvia included uncontrollable movements, changes in visual perception, laughter and “separateness” of body.

Salvia, addiction, and long term effects

As far as we know right now, Salvia use doesn’t seem to produce many long-term, severe, consequences and it’s addictive properties are not yet known. Still, the experience during use can be quite harsh. The number of hits, as to be expected, closely correlated with the amount of functionality problems exhibiting themselves in diction and fluency of movements.  As noted earlier, although usage in low doses may be used for holistic healing purposes, smoking of Salvia does not seem to have any sort of healing powers.

Like many other legal drugs, Salvia use should be undertaken with caution, understanding the potency of the drug, its effects, and the possible consequences. Just because a drug is legal doesn’t mean it’s completely safe – Make sure you know what you’re doing before trying it out.

Citation:

Lange, Daniel, Homer, Reed, Clapp. Salvia Divonorum: Effects and Use Among YouTube Users. Drug and Alcohol Addiction. May 4 2009

Brittany Murphy dead at 32 – Anemia, pneumonia, and yes, drugs…

Toxicology update

Well, it seems the toxicology reports are in and Brittany’s death was, at least partially, caused by her taking of multiple prescription drugs. Still, it seems that she was trying to medicate a host of conditions brought on by her underlying anemia and pneumonia. It’s sad to think that this death could have likely been prevented had she simply taken better care of herself and gone to seek emergency care rather than loading her body with those pills. Unfortunately, this seems to be another in a string of medically preventable deaths… Sad.

Original post:

Brittany Murphy, the actress from “Clueless,” and “8 Mile” died last night at Cedars-Sinai in Beverly Hills at the age of 32. Brittany has been rumored to be suffering from severe eating disorders, and recent pictures seem to support that notion. Given that she apparently died from cardiac arrest, I’m wondering if drugs (even prescription drugs) played a role in the death as well… I’ll keep updating the story as more becomes available.

My heart goes out to her family and friends. Certainly a loss suffered far too early.

UPDATE: According to the police report, a number of prescription drugs were discovered in Brittany’s bedroom including (read past the list for my take on this):

  1. Topamax –  While TMZ reported this drug to be used as anti-seizure medication, it is also used to reduce weight-gain associated with the use of many other prescription drugs on this list. Lastly, it is considered to be a mood stabilizer.
  2. Methylprednisolone – An anti-inflammatory that may be used to treat bronchial infections
  3. Prozac – A commonly prescribed SSRI anti-depression med.
  4. Klonopin – A benzodiazepine anti-anxiety prescription medication that is also used to help with insomnia. Like most benzos, the probability of overdose is low if used properly, but overdose would lead to cardiac arrest.
  5. Carbamazepine – Another anti-convulsant mood stabilizer often used to treat bipolar disorder. This prescription drug can be very dangerous when combined with other medications due to its actions on GABA and extensive alteration of Sodium channel activity. It is also a bipolar med.
  6. Ativan – Once again a benzodiazepine that is often used to treat anxiety and insomnia.
  7. Vicoprofen – A pain reliever that includes an opioid (it sounds like vicodin for a reason).
  8. Propranolol – Prescription med used to treat hypertension and as an alternative, less habit-forming anti-anxiety drug.
  9. Biaxin – An antibiotic.
  10. Hydrocodone – Same as Vicoprofen, an analgesic (pain reducing) prescription drug.

What do I think killed Brittany?

With 2 benzodiazepine medications, 2 opiates, and antidepressant, and a drug that is made to lower one’s heart pressure, it’s no wonder that Brittany was found not breathing. I’m going to wait until the final toxicology report to draw a definite conclusion, but from this list, it seems highly likely that a dangerous combination of these prescription drugs was taken, which resulted in Brittany’s heart stopping. Even when taken at their prescribed strengths, these medication, when combined, can form a lethal cocktail.

You should ALWAYS check with your doctor regarding interactions between different prescriptions you’re taking, especially when those medications haven’t all been prescribed by the same physician!

UCLA students speaking out about drug use… kind of.

A recent article in UCLA’s daily newspaper presented the stories of two current students who left behind a life of drug use and petty drug dealing to focus on more long-term priorities, namely school.

The students, who used pseudonyms for obvious reasons, show us once again that it is possible to turn around a lifestyle that many deem inescapable.

I think that one of the biggest obstacles to the advancement of drug addiction treatment in our society is the stigma associated with having taken part in drug use in the first place.

It’s difficult to get the stories of those who’ve made it out while they’re hiding in the shadows.

In the meantime, what we get instead is the story of those who fail in the most spectacular fashion. They don’t care enough about the stigma to shy away from revealing their story and truthfully, no one gives them a choice.

I hope this story reminds people that having a past does not doom one to eternal suffering in oblivion.

There is hope…

Making a difference one post at a time… Helping drug users

Hi everyone,

I’ve been wanting to do something to help drug users for a long time now, so instead of just thinking about it, I’ve decided to go ahead and give this a try.

I’m a doctoral student at UCLA working on my PhD in psychology. I’ve been studying issues related to drug-addiction, sex-addiction, and gambling-addiction for the past 6 years and am continuing on my quest to discover what I call “The pathway to addiction.”

The thing is that on the way I have been, and still am, gaining an amazing amount of knowledge that I think can benefit not only those struggling with drug use and addiction themselves, but also the family members, friends, and loved ones of those being affected by this disease, condition, or whatever each of you feels comfortable calling addiction. As far as I’m concerned, this should all be about somehow actually helping drug users.

I’ve had my own experiences with drug use and addiction, and so I don’t expect my writings to be devoid of subjective input that I feel I can contribute given my experience.

My goal here is to get what we, as scientists, know about addiction to the general public.

I want to do this because I feel that knowledge is a key ingredient not only in curing and fighting conditions (be they medical, academic, psychological, or otherwise), but also in simply being able to handle and accept things as they are more completely.

We tend to be more scared of things when we feel like we don’t understand them.
I’m not going to lie to you on here and I’ll have no problem revealing personal history and experience by they related to my drug use or other aspects of my life.

I want this to be a forum for people to ask honest questions, get honest answers, and be able to look to when they feel like they’re at a loss and need someone who understands. Making a difference takes work. I hope it works…