More addiction cures: Early promise for Risperidone in crystal meth addiction

A recent open label study found some support for the effectiveness of a Risperidone injection, given once every 2 weeks, in reducing crystal meth (speed) use.

The 22 patients who participated reduced their weekly crystal meth use from an average of 4 times per week to only 1 time per week. The difference between those who were able to stay completely clean and the others seemed to have to do with the levels of Risperidone in the blood.

The nice thing about using an injection as addiction treatment is that it removes the possibility of patients choosing not to take their medication on any given day. Such non-adherence to treatment is very often found to be the reason for relapse.

This study will need to be followed up by placebo-controlled double-blind studies, but given Risperidone’s action as a Dopamine antagonist, I suspect that those trials will also show a strong treatment effect. The promise of medicines as addiction treatment cures always seems great, but I believe that at best, they can be an additional tool to be used in conjunction with other therapies.

The question will be whether the side-effects common with antipsychotic medication will be well-tolerated by enough people to make the drug useful for addiction treatment.

Addiction research – Who are we studying?

I teach a class on the psychology of addiction (Psych 477 at California State University in Long Beach) and as I have been preparing the lectures something has become very clear to me – textbooks patently gloss over important details about the addiction research they cite. One of the most obvious gaps I’ve noticed this semester concerns the population of research subjects most addiction research is conducted on. An example will clarify:

A student group in my class had to read a study assessing the residual effects of methamphetamine on mood and sleep. They were amazed that no changes in mood were observed and that participants slept a full 6-8 hours the night after being administered meth! Would you have been surprised with these results given that we all have been told that crystal meth improves mood and causes insomnia?

Would it matter at all if I told you that the participants in the study were current meth abusers who use an average of 4 times every week?

For anyone not aware of the tainted history of health research in the U.S. (I’m including psychological research in this group), go ahead and read about the Tuskegee Syphilis Experiment and Stanford Prison Experiment (video here). There are other examples including Stanley Milgram‘s obedience studies, and more but as exciting as the discussion of these studies is, it’s time to get back to my main point.

It is mostly due to the ethically-questionable, psychologically damaging, research above that research institutions are now required to vet proposed research studies using Institutional Review Boards (IRBs) to assure that human participants in studies are consenting to participate of their own free will, are not coerced, and are not suffering undue damage. This is also true of addiction research. Rarely does the public consider this fact however when they are being reported on research relevant to addiction. I know this because the kids in my class never gave it a second thought.

When reading about addiction research, think about the subjects participating in itNearly all addiction research, especially studies utilizing “hard” drugs like cocaine, meth, opiates, etc., are required to make use of a very limited part of society – drug using individuals with a history of use of the specific drug of interest who are specifically not interested in treatment. Individuals who have never tried the drug or who want to be treated for drug abuse or dependence (addiction) are excluded due to ethical concerns. In most studies, participants can not qualify if they are addicted to drugs other than those being studies (except smoking, for which exceptions are usually made since we’d be able left with no participants otherwise) or have any associated mental health disorders, which are very common among addicted individuals. I would further assert that for at least a substantial portion of these research participants, the term “addicts” may not be appropriate since many addicts would not willingly give up using their favorite substance for a week or two to be replaces with a hospital bed and an experimenter controlled dose of drug or placebo. Taken together, our research subjects are pretty obviously not representative of all drug users, or all addicts, or all anything else. They make up a very specific group – less than perfect, but what we have to work with.

In some studies that attempt to make a direct comparison between controls (or drug naive participants) and drug users, this is likely less of an issue. This can happen when researchers try to examine brain structure differences, or performance on a specific psychological or physical test. In such cases researchers can at least statistically identify contributions of length of use, method of use, and other relevant data on differences between people who use and those that don’t. There are probably still some serious differences between “true” addicts, recreational users, and semi-chronic users that would be important to understand here, but we can’t so we don’t. But when it comes to assessing mood effects, or indeed any of a number of subjective effects of drugs, drug cravings, and withdrawal, this limitation in the population to be studied is something that often needs to be made explicitly clear to most public consumers of research. Since we can’t assess changes in mood, absorption rate, anxiety, or any other such measure (some exceptions for very low doses in very specific circumstances) among people who are new to the drug, we end up assessing them among people with a lot of experience, but not enough of a problem to want addiction treatment. Again, this should be considered a pretty specific type of drug user in my opinion.

There are other types of studies – those conducted with abstinent ex-users or addiction treatment intervention studies utilizing addicts who want, or who reported to, treatment on their own or in response to advertisements. While these studies make use of populations that can be considered at least closer to the individuals they are specifically aimed at – assessing the return of  cognitive function after short or long term abstinence or testing a new intervention on those who want treatment – they still bring on limitations that need to be specifically considered.

An important point – most researchers recognize these issues and make them explicitly part of their research publications, in a specific section called “Limitations” but what seems troubling is that the public doesn’t have any awareness of these issues. So when someone tells you that “they just found out meth doesn’t actually make people lose sleep,” take a second to ask “for who?”

Crystal meth addiction and the Miracle of Letting Go

This is a guest post by Cathy Taughinbaugh of Treatment Talk.org.

I am a parent of an addict. I would say looking back, that I was naive and in denial about the drug use in my home. The last two years of high school for my daughter were challenging. One day of her senior year, I found what looked like drugs in her back pack. We were divorced, but I showed them to her father who decided to take them to the police station to find out what they were. When we were told the drugs were crystal meth, we were both shocked and frightened. Two nephews of my daughter’s dad had become addicted to crystal meth. One is now serving a long term sentence in a California prison and the other was killed, so as you can imagine he was concerned about this drug use in particular. We came together, sat our daughter down and she told us she didn’t use drugs, but was carrying them for a friend. She said she knew that it was wrong to be doing that for someone else, burst into tears, and yes, we believed her. Looking back I realize how much in denial we really were.

She went away to college in Colorado. We sent her off, and she went away with the best of intentions. Her grades that freshman year were abysmal. She was on probation her first semester, flunked out the second semester and then went to summer school at the local junior college. She managed to get herself back in for the fall of her sophomore year. Things did not improve, and her grades went from bad to worse. She decided to quit school for the next semester and work. Her dad and I needed to let go of the college dream because we finally realized she was wasting our money, and wasting her life. She did find a part time job at a local pet store, but it seemed her hours were getting less and less. For some reason she had trouble getting to work, and finally could not keep her job. By June we were emotionally exhausted. We agreed to one more month’s rent. We sent it, but both of us felt, that this was the last bit of help we could give her. Yet, I still wasn’t clear what the problem was.

The idea of having my 19 year old daughter living on the streets, was terrorizing. I went back in late June to see what I could do and to find out more. In addition, to not having a job or any obvious means of support, to my surprise, she had bought a Rottweiler puppy, named Bella. We decided one day during my visit to take the dog on a walk in the hills on a hot 80+ degree day. She had on a long sleeve t-shirt which surprised me for such a hot day and during the walk, I made several comments about how hot she must be.

Finally, walking behind her, it became clear to me that she was deliberately covering her arms. I began to panic. I went up to her, touched her arm, and said, “You should at least pull your sleeves up.” She sharply pulled her arm away and I knew.  I was really numb for quite awhile as we continued down the hill, I didn’t know what to say, and prayed that this was some kind of mistake.  Finally, I confronted her in the parking lot. She would not show me her arms, and we both just burst into tears. I began naming off drugs. Of course starting with heroin, but when I mentioned crystal meth, she nodded. I could not believe my daughter who had been a girl scout, and a member of the high school water polo team among other things, was shooting up crystal meth.

I told her I was not going to leave her in Colorado, and she said the only way she would come home was if we brought her dog, Bella. So we did. Luckily, for all of us, she was willing to get into drug treatment.  She went to an outdoor wilderness program in Utah for five weeks and then on to Safe Harbor Residential Drug Treatment Center for Women in Costa Mesa for three months. She lived for about six months in a Safe Harbor Sober Living home. Her dad found a loving home for her dog. Bella.

We have been very lucky with our daughter, because she finally did decide to make some good choices. Her recovery has not been perfect, but I have been forever grateful that she did not have the dramatic relapses that so many addicts and  parents have had to go through.

After six years, she continues to do well, earning her college degree in southern California in June of 2009, and now works at a job in her field that she enjoys. She has moved on with her life, but what she has learned, in treatment is still close to her heart. She is indeed a changed person, and would not be the person she is today, had addiction not entered her life.

What I have learned is this. Addiction comes into your life for a reason. I was most likely living in a fog until drug addiction entered my life, and it was the wake up call I needed to pay attention, look at my life choices and seek inner peace and serenity. There is no finish line for addiction, not for the addict nor for the addict’s parents. We both continue on, the addict hopefully managing their disease and their parents hoping that their child manages their disease.

The greatest gift I have learned from this whole experience is that addiction does not discriminate as well as the importance of letting go. Addiction can enter any family, regardless of their race, economic situation or upbringing. Letting go does not mean I lose interest in my child or their struggles. Letting go means I love and respect my child, but I let them follow their path and find their own way to recovery if that is their choice. I will offer them resources if I am able, but I will let go of trying to control their disease.

For most of us parents, that is the hardest lesson, that lesson of letting go. We want to fix our children’s problems and make everything better. It breaks our hearts, and goes against what the word “parent” stands for. It is however necessary, not only when our child is an addict, but when any of our children reach adulthood and are ready to spread their wings. We need to let go and let our children fly alone.

Addiction stories: How I recovered from my addiction to crystal meth

By the time I was done with my addiction to crystal meth, I had racked up 4 arrests, 9 felonies, a $750,000 bail, a year in jail, and an eight year suspended sentence to go along with my 5 year probation period. Though I think education is important to keep getting the message out about addiction and drug abuse, there is no doubt that addiction stories do a great job of getting the message across, so here goes.

My crystal meth addiction story

The kid my parents knew was going nowhere, and fast. That’s why I was surprised when they came to my rescue after 3 years of barely speaking to them. My lawyer recommended that I check into a rehab facility immediately; treating my drug abuse problem was our only line of legal defense.

cocaine linesI had long known that I had an addiction problem when I first checked myself into rehab. Still, my reason for going in was my legal trouble. Within 3 months, I was using crystal meth again, but the difference was that this time, I felt bad about it. I had changed in those first three months. The daily discussions in the addiction treatment facility, my growing relationship with my parents, and a few sober months (more sobriety than I had in years) were doing their job. I relapsed as soon as I went back to work in my studio, which was a big trigger for me, but using wasn’t any fun this time.

I ended up being kicked out of that facility for providing a meth-positive urine test. My parents were irate. I felt ashamed though I began using daily immediately. My real lesson came when I dragged myself from my friend’s couch to an AA meeting one night. I walked by a homeless man who was clearly high when the realization hit me:

I was one step away from becoming like this man.

You see, when I was in the throes of my crystal meth addiction, I had money because I was selling drugs. I had a great car, a motorcycle, an apartment and my own recording studio. After my arrest though, all of that had been taken away. I just made matters worse by getting myself thrown out of what was serving as my home, leaving myself to sleep on a friend’s couch for the foreseeable future.

Something had to change.

homelessI woke up the next morning, smoked some meth, and drove straight to an outpatient drug program offered by my health insurance. I missed the check-in time for that day, but I was told to come back the next morning, which I did. I talked to a counselor, explained my situation, and was given a list of sober-living homes to check out.

As I did this, I kept going to the program’s outpatient meetings, high on crystal meth, but ready to make a change. I was going to do anything I could so as not to end up homeless, or a lifetime prisoner. I had no idea how to stop doing the one thing that had been constant in my life since the age of 15, but I was determined to find out.

When I showed up at the sober-living facility that was to be the place where I got sober, I was so high I couldn’t face the intake staff. I wore sunglasses indoors at 6 PM. My bags were searched, I was shown to my room, and the rest of my life began.

I wasn’t happy to be sober, but I was happier doing what these people told me than I was fighting the cops, the legal system, and the drugs. I had quite a few missteps, but I took my punishments without a word, knowing they were nothing compared to the suffering I’d experience if I left that place.

Overall, I have one message to those struggling with getting clean:

If you want to get past the hump of knowing you have a problem but not knowing what to do about it, the choice has to be made clear. This can’t be a game of subtle changes. No one wants to stop using if the alternative doesn’t seem a whole lot better. For most of us, that means hitting a bottom so low that I can’t be ignored. You get to make the choice of what the bottom will be for you.

You don’t have to almost die, but you might; losing a job could be enough, but if you miss that sign, the next could be the streets; losing your spouse will sometimes do it, but if not, losing your shared custody will hurt even more.

At each one of these steps, you get to make a choice – Do I want things to get worse or not?

Ask yourself that question while looking at the price you’ve paid up to now. If you’re willing to go even lower for that next hit, I say go for it. If you think you want to stop but can’t seem to really grasp just how far you’ve gone, get a friend you trust, a non-using friend, and have them tell you how they see the path your life has taken.

It’s going to take a fight to get out, but if I beat my addiction, you can beat yours.

By now, I’ve received my Ph.D. from UCLA, one of the top universities in the world. I study addiction research, and publish this addiction blog along with a Psychology Today column and a number of academic journals. I also have my mind set on changing the way our society deals with drug abuse and addiction. Given everything I’ve accomplished by now, the choice should have seemed clear before my arrest – but it wasn’t. I hope that by sharing addiction stories, including mine, we can start that process.

Correlation, causation, and association – What does it all mean???

A comment posted by a reader on a post reprimanded me for suggesting that marijuana caused relationships to go bad.

In this instance the reader was mistaken, as I had specifically used the word “associated”, but the comment made me think that maybe I should explain the differences between correlation, causation, and association. I’m a scientist studying addiction, and in the field, it’s very important to be clear about what each of the words you use means.

Being clear about inferences in research

Correlation – When researchers find a correlation, which can also be called an association, what they are saying is that they found a relationship between two, or more, variables. For instance, in the case of the marijuana post, the researchers found an association between using marijuana as a teen, and having more troublesome relationships in mid, to late, twenties.

Correlations can be positive – so that as one variable (marijuana smoking) goes up, so does the other (relationship trouble); or they can be negative, which would mean that as one variable goes up (methamphetamine smoking) another goes down (grade point average).

The trouble is that, unless they are properly controlled for, there could be other variables affecting this relationship that the researchers don’t know about. For instance, education, gender, and mental health issues could be behind the marijuana-relationship association (these variables were all controlled for by the researchers in that study). Researchers have at their disposal a number of sophisticated statistical tools to control for these, ranging from the relatively simple (like multiple regression) to the highly complex and involved (multi-level modeling and structural equation modeling). These methods allow researchers to separate the effect of one variable from others, thereby leaving them more confident in making assertions about the true nature of the relationships they found. Still, even under the best analysis circumstances, correlation is not the same as causation.

Causation – When an article says that causation was found, this means that the researchers found that changes in one variable they measured directly caused changes in the other. An example would be research showing that jumping of a cliff directly causes great physical damage. In order to do this, researchers would need to assign people to jump off a cliff (versus lets say jumping off of a 12 inch ledge) and measure the amount of physical damage caused. When they find that jumping off the cliff causes more damage, they can assert causality. Good luck recruiting for that study!

Most of the research you read about indicates a correlation between variables, not causation. You can find the key words by carefully reading. If the article says something like “men were found to have,” or “women were more likely to,” they’re talking about associations, not causation.

Why the correlation-causation difference?

The reason is that in order to actually be able to claim causation, the researchers have to split the participants into different groups, and randomly assign some to the behavior or condition they want to study (like taking a new drug), while the rest receive something else. This is in fact what happens in clinical trials of medication because the FDA requires proof that the medication actually makes people better (more so than a placebo). It’s this random assignment to conditions (or randomization) that makes experiments suitable for the discovery of causality. Unlike in association studies, random assignment assures (if everything is designed correctly) that its the behavior being studied, and not some other random effect, that is causing the outcome.

Obviously, it is much more difficult to prove causation than it is to prove an association.

Should we just ignore associations?

No! Not at all!!! Not even close!!! Correlations are crucial for research and still need to be looked at and studied, especially in some areas of research like addiction.

The reason is simple – We can’t randomly give people drugs like methamphetamine as children and study their brain development to see how the stuff affects them, that would be unethical. So what we’re left with is a the study of what meth use (and use of other drugs) is associated with. It’s for this reason that researchers use special statistical methods to assess associations, making certain that they are also considering other things that may be interfering with their results.

In the case of the marijuana article, the researchers ruled out a number of other interfering variables known to affect relationships, like aggression, gender, education, closeness with other family members, etc. By doing so, they did their best to assure that the association found between marijuana and relationship status was real. Obviously other possibilities exist, but as more researchers assess this relationship in different ways, we’ll learn more about its true nature.

This is how research works.

It’s also how we found out that smoking causes cancer. Through endlessly repeated findings showing an association. That turned out pretty well, I think…

About Addiction: Marijuana use, cigarette smoking, and crystal meth

Hey ! After a brief period of inactivity we are back and better as always ready to provide you with your 30 minute tidbit of information about addiction. If you want to learn more about marijuana use, (cigarette) smoking, and addiction stigma then read on!

Marijuana use: Harmless?

Fox News– While many think that Marijuana a harmless drug (read our marijuana driving input), a guy high on weed drove his car into a group of cyclists in Italy. Eight cyclists were killed and an additional four people were injured. This accident can serve as a lesson that marijuana is not as “harmless” as a lot of people make it out to be. Educating the public about the dangers of driving under the influence of marijuana may help in preventing future incidents.

The Dome-Nobody is a stranger to the fact that voters in a number of states have been trying to legalize marijuana. But Illinois legislators just went the other way and struck down a bill which would allow medical marijuana to be legal. The legislators stuck this down with the fear that if this practice were legalized then there would be widespread use of marijuana. Right now fifteen states (and Washington DC) allow the use of medical marijuana but apparently Illinois decided they are not going to be the sixteenth.

Psychology Today– Can recreational pot smokers become addicted to marijuana? A large number of individuals only smoke marijuana recreationally and do not ever become addicted (see here), but about 10% to 30% of regular users will develop marijuana dependence (my vote is actually probably more for the 10%-20% range). About 9% will have a serious addition. Marijuana use in the U.S. has gone through quite an evolution from its early introduction in the 1970’s as an anti war statement to today when it is mostly used by teenagers and those who have been smoking for a long time. Most individuals quit when they are parents or homeowners (which is true of most drugs by the way), and this contributes to the thinking by some that marijuana is not very addictive.

Quitting smokingthrough personal stories

Bloomsburg Buisnessweek– Anti-smoking advertisements have been relying on fear appeals to persuade individuals to avoid or quit smoking smoking. But the commercials that show patients with a hole in their throat or the magazine ads showing a black and diseased lung have not really been very effective. However new research shows that advertisements that target emotions more broadly seem to work best when trying to prevent smoking. Personal testimonies seem to be the most effective because  they allow the individuals who are viewing them to emotionally identify with the person in the ad helping them find reasons why they themselves should quit smoking.

Guardian- Passive tobacco smoking kills more than 600,000 people in the world every year including about 165,000 children.  The most problematic regions in terms of these smoking deaths are third world countries due to the combination of the dangerous effects of second hand smoke and infectious diseases. Second hand smoke is most problematic in the home and although women smoke less they are more likely to be exposed to second hand smoke in the house.

Addiction Inbox– The electronic cigarette is finally here although in the past the FDA wanted to prevent these cigarettes from being marketed in the US. The decision to allow the marketing of these cigarettes was established as long as they are not targeted to minors. In addition marketing individuals cannot make any claims that the products are safe alternatives to tobacco. These products are a battery powered device that allow its users to “smoke” and inhale nicotine vapor without any fire, smoke, ash or carbon monoxide.

Alcoholism stigma and seeking treatment for drug addiction

Med– Individuals who are diagnosed with alcoholism are 60% less likely to seek treatment because they fear the stigma that is attached to alcoholism. To be an alcoholic means belonging to a stigmatized group, and no one likes that. The goal then should be to educate individuals in order to try to alleviate the stigma that is associated with alcoholism in order to allow more people to seek treatment from it. Reducing the stigma of addiction is a goal we at A3 take very seriously.

Recovery Now-If there is one thing that teenagers hate it is snooping parents by far. What is the parent is snooping for a good reason however? Is snooping around with concern that your child is using drugs or alcohol okay? Although a controversial topic this article looks at the implication of snooping and when it is okay to snoop in teenagers stuff. It is a great read, enjoy!

Crystal meth and Suicide-Veterans and Substance abuse

Honolulu advertiser– Hawaii has the worst crystal meth problem in the country and a school in Hawaii held a national crystal meth awareness day assembly. Forty percent of people arrested by police in Honolulu test positive for meth, and about 30,000 Honolulu residents are hard-core users of meth (with as many as three times more being recreational users). Government officials in Hawaii want to increase spending to make more drug treatment programs available to prison inmates. In addition the general public needs to be educated about the dangers of crystal meth.

Breaking the cycles-“Veterans at Higher Risk for Suicide,” is a radio broadcast which talks about the impacts of war on the mental health of all veterans in California. The issues that the radio broadcasts focuses on are anxiety, depression, and PTSD. The radio broadcast reported that veterans are at higher risk of committing suicide than other individuals who are not in the military. This article continues to address the topics of mental illness and how mental illness is a key risk factor to developing a substance abuse problem.

People, places, and things – How important are drug-related triggers for addiction relapse?

In cognitive behavioral therapy they’re a big part of the “Five W’s” = When, Where, Why, With, and What. In the various 12-step programs they’re simply referred to as “People, places, and things.” But no matter how you refer to them, drug-associated cues, or “triggers” as they are more commonly known, obviously play a big role in reminding addicted individuals about their drug-seeking behavior, and they are often enough to restart old behavior, even among those who have been abstinent for a while and especially when unprepared for their effect.

Different triggers to reactivate old behavior

Research on relapse (what researchers call reinstatement) has long shown that there are a number of things that can return a person, or an animal, to drug seeking after they have been abstinent for a while. Stress, small drug doses, and the presentation of triggers are all very capable of doing this, even after months of abstinence and likely even years. It’s probably not surprising that giving drugs to an abstinent person can make them want the drug again. In fact, I would venture to guess that most readers believe that this is the most powerful way to induce a relapse (assuming the initial exposure was out of a person’s control and doesn’t count).

Well, recent research suggests that in actuality, triggers, or those people, places, and things, might be more powerful or at least longer lasting relapse risks than even taking drugs!

Triggers, not drugs, are shown to be longest lasting relapse risk

Researchers in Japan trained mice to press a lever for meth, getting them to poke their nose into a hole 60 times for a total of 30 meth administration per three hour session. Every time they poked their nose in the right hole they got a shot of meth and a little light above their nose-poke hole went on (this will become the trigger in the end). Once they were doing this reliably the researchers took away the meth and the animals learned, within 10-20 days, that pressing the lever no longer got them a drug and reduced their number of presses to less than 15 presses per session.

After all this the researchers gave the mice an injection of meth 30 minutes before putting them back in the box – leading the mice to start pressing again for the drug even though in the previous session they has pretty much stopped pressing knowing that no drug was coming. Obviously, the drug injection caused the mice to relapse back into their drug seeking. But, as you can see from the figure below (on the left side, the right side shows that the mice didn’t poke their nose into a hole that did nothing as a control), this little trick only worked once, and the next time the mice were given a shot of meth before being put in the box (after once again being taken through extinction training teaching them that pressing the lever did nothing), they didn’t press the lever any more and just around not doing much.

For the following part of the study the researchers once again took the animals through extinction training (and once again the mice stopped pressing the lever for meth) and then in a following session reintroduced the little light that used to go on every time the mice originally got meth. Just like they did with the meth the animals immediately went back to pressing the lever like crazy, hoping that now that the light was back, so was their meth. Just like with the drug relapse experiment above, the researchers repeated this whole process over two months later, only this time, the little light managed to re-trigger the lever pressing again, unlike the one-trick-pony meth. Seeing this, the researchers went for broke and tried another run of this with the same animals, now following up five months after the last time the animals received meth when they pressed the lever. Again the little light got the animals to increase their pressing, only this time it was a little less impressive than the first two tries (but still significantly higher). All in all, the little light managed to restart the lever pressing by the mice three times and a full five month after the meth-relapse experiment had failed!!!

Conclusion, thoughts, and implications about triggers, relapse, and addiction

In a completely different article I’d written that researchers found a number of different patterns of relapse among alcoholics who went to rehab and that in fact, the vast majority of those who did relapse never went back to the kind of heavy drinking that characterized their earlier problem (see here for One is too many, a thousand not enough). While this research touches on a different aspect of relapse, it once again challenges our thinking about the crucial factors in relapse prevention among addicts. Everyone knows that triggers are important, but the fact that they are at least as powerful and apparently longer lasting dangers than even being re-exposed to the addictive drug is a novel one. Still, this isn’t very surprising given the very long-lasting impact of drugs of abuse (especially stimulants like crystal meth) on learning mechanisms. In my opinion, and based on my own experience, those changes are essentially permanent and the only thing that makes an ex-user less likely to run back to pressing that drug lever when being re-triggered 10 years later is the life they’ve built, the experience they have, and the training they’ve undergone in reacting to those triggers. As you can see from the graph above, if a person runs back to the drugs and actually starts using again on that first, second, or third exposure to a trigger they are likely to start the whole cycle again, possibly making it ever more difficult to escape the next time.

Obviously preventing trigger-induced relapse should be a major strategy of addiction treatment and indeed, from CBT relapse prevention strategies to groundbreaking medications that have been shown to be effective for relapse rate reduction (like Vivitrol, Buprenorphine, Bupropion, and more), there is quite a bit of effort going exactly that way.

Citation:

Yijin Yan, Kiyofumi Yamada, Atsumi Nitta  and Toshitaka Nabeshima (2007). Transient drug-primed but persistent cue-induced reinstatement of extinguished methamphetamine-seeking behavior in mice. Behavioral Brain Research, 177, 261-268.