Teens and drugs: Drug use statistics and treatment that works

Here are some drug use statistics:

  • Over 80% of teens engage in some form of deviant behavior (1).
  • Over 50% of high-school seniors admit to having used drugs (2).
  • Only 10%-15% of the population develop drug addiction problems related to their drug use (1).

The question is:

If the majority of teens experiment with drug use, and so few eventually develop drug addiction problems, should we be focusing on something other than stopping kids from trying drugs? Continue reading “Teens and drugs: Drug use statistics and treatment that works”

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 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.

Body image and medicalization: Socially relevant behavioral “addictions” beyond drug use

We know that addiction can go beyond drug use, but are we becoming addicted to making our bodies perfect?

I put “addiction” in parentheses here because I think it’s important to distinguish substance-related addictions from behavioral ones. There’s no doubt that people’s behavior can become compulsive in the same way addicts become compulsive about using, but I’ve seen no evidence that behavioral addictions interfere with brain function in the way that cocaine, methamphetamine, and opiates alter actual brain mechanisms.

Still, this recent trend of obsessive plastic surgery is a dual-headed “addiction”, one that is both physical and social.  In many ways, people are now able to change aspects of their being that were once thought unalterable including their own physical appearances. To gain social acceptance, if you have money, you now have new tools!

This may also play a big role for those who are love addicted, at least if they have money… Continue reading “Body image and medicalization: Socially relevant behavioral “addictions” beyond drug use”

The brain after cocaine – White matter damage and addiction treatment

The brain damage left behind after long-term cocaine use can apparently tell us quite a bit about how well a cocaine addict will do in addiction treatment – as long as we assess the right kind of damage.

Different kinds of brain matter

I’ve talked before about the fact that use of cocaine, and other drugs, can bring about long-term changes in the brain that sometimes include the actual destruction of neural pathways. What you may not know is that brain matter consists of several different components including the cell bodies of neurons (known as gray matter) and the tracts of axons that transmit messages across the brain (known as white matter). There are other parts as well, but those are the two important ones to know for this article.

Gray matter is important because brain transmission isn’t possible without a cell body, which is its operations center. But white matter is equally important because without it, the messages don’t get anywhere. It’s like having a telephone without a communication network – The phone can work perfectly and no one will ever hear you speak.

Until recently, it’s been pretty hard to measure the structure of white matter because it consists of very thin bands that twist and turn throughout the brain. But recent advancements in fMRI imaging and analysis have allowed us to look at it by measuring the direction in which water molecules flow through white matter. It’s called DTI (Diffusion Tensor Imaging) and it’s pretty complicated, but all you need to know is that it lets us know a lot about the integrity of axons in the brain.

White matter and cocaine

Use of cocaine has already been shown to cause damage to brain white matter. A recent study conducted at Yale examined whether the degree of damage can tell us anything about how well people will do in addiction treatment. Researchers took 16 participants and gave them a host of tests as well as some brain scans before sending them off to an 8 week treatment program. The addiction treatment utilized was outpatient and provided different individuals with different combinations of CBT, medication (antabuse), individual, and group therapy. At the end of treatment, the number of clean urine tests (out of 56 total tests) was used as a measure of treatment success. The more clean urines, the better, something I think we need to adopt overall instead of the all-or-nothing view that abstinence is the only form of improvement.

The bottom line: Using three different measures, the researchers found that individuals with more damaged white matter provided less clean urines throughout the addiction-treatment period. Another important fact – the damages areas that were found to be associated with treatment success were found all over the brain. Interestingly, brain damage wasn’t associated with the length of drug use, but it may have been associated with the extent of use (in terms of years and amount used), something the researchers didn’t report on.

Brain matter and addiction treatment outcomes

One day, we’ll have a battery of tests that will let us tailor treatment more effectively towards specific addicts. Genetics, brains scans, and more, will be able to tell us where an addict is especially weak so that we can focus on those areas first. Some may need specific help with impulsivity and weakened learning systems whereas others may be better off with treatment that addresses past trauma and an oversensitive stress response system.

As this research shows, brain scans can offer us a glimpse into the aspects of an addict’s brain that have been compromised. But we’re not there yet – right now, all we know is that certain genes, brain function patters, and experiences, are associated with a greater risk for addictive behavior or a lower chance of recovery. Getting better at more specifically tailoring treatment is still a little farther than we’d like.

Citation:

Jiansong Xu, Elise E DeVito, Patrick D Worhunsky, Kathleen M Carroll, Bruce J Rounsaville & Marc N Potenza (2010). White Matter Integrity is Associated with Treatment Outcome Measures in Cocaine Dependence, Neuropsychopharmacology 35, 1541–1549.

Addiction stories – LSD addiction: AN LSD trip down the wrong path

An LSD trip may be fun for a bit, but LSD addiction doesn't sound like any fun at all.**DISCLAIMER: This post has been changed since its original content. Since I Believe the submitted story was fake, I’ve now made this a post about the possibility of developing LSD dependence**

Many of my readers claim that LSD addiction does not exist. Well, They’re simply wrong. LSD dependence (the clinical term for addiction) is certainly out there, though its no doubt rare. To understand why I can make that claim, let’s cover the specifics of what a psychological assessment of dependence requires:

The official definition of addiction

As far as the DSM-IV (the psychological assessment manual) is concerned, dependence on any drug require at least three of the following to occur within a year:

  1. Tolerance, as defined by either of the following:
    • a need for markedly increased amounts of the substance to achieve intoxication or desired effect
    • markedly diminished effect with continued use of the same amount of substance
  2. Withdrawal, as manifested by either of the following:
    • the characteristic withdrawal syndrome for the substance
    • the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
  3. The substance is often taken in larger amounts or over a longer period than was intended
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use
  5. A great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects
  6. Important social, occupational or recreational activities are given up or reduced because of substance use
  7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Now, I’ve taken more than my share of LSD trips before. Actually, I used to sell acid, among many other drugs in my former life. I knew many people who loved acid, mushrooms, and other hallucinogens (including me) but a few cases stand out in particular.

LSD addiction – Hypotheticals and examples

Given the above definition of substance dependence, any number of combinations of symptoms could qualify someone as being dependent on LSD.

  1. Tolerance buildup for the drug is quick and significant. As anyone who’s ever tried to follow one trip with another knows, the second time requires a lot more acid, and any additional trips increase the amount of LSD needed greatly. Tolerance – Check!
  2. Withdrawal from LSD, especially in the wake of repeated exposures (the multiple trips I was talking about before), includes disorientation, difficulty thinking, fatigue, and sometimes perceptual difficulties (problems with hearing, vision). I’ve experienced this myself, but the best example I’ve seen is of a friend who tried to trip continuously for as long as possible – After about a week and a half, she was eating literally a sheet of acid to feel anything (her boyfriend was a dealer, talk about tolerance). When she stopped because her boyfriend cut her off, she had the hardest time finishing sentences, completing thoughts, or following conversations for nearly three months! Withdrawal – Check!
  3. With the above 2 out of the way, any of the other 5 symptoms can serve to complete the LSD dependence picture. Still, though I’ve never met anyone who tried to stop but couldn’t, I have:
    1. Known people who spent a lot of their time and resources (money) chasing down good acid, paying for it, or preparing for and getting involved in activities that involved LSD.
    2. Many of the people I knew began slacking off at work, sometimes being fired, getting far more lax at school, and neglecting any relationships they had with people who were not involved in their LSD use.
    3. Quite a few of the hard-core LSD users I knew told me time and again that they know their LSD use is causing them difficulties (mostly psychological difficulties) but that fact seemed unable to deter them from buying more acid and continuing down the same path.

So does LSD addiction exist?

Obviously, I believe that LSD dependence exists, though it is no doubt rare. As I’ve stated time and again, I am NOT against the use of drugs. However, I think that drug users’ naive approach to many of these issues, including their constant desire to ignore all signs of the negative consequences of drug abuse, is a big part of the problem here. Ingesting drugs is harmful, but knowing that, I believe people should have the choice to harm themselves, though not others. People with drug problems need help, not jails. Still, to make this a reality, we need to do a much better job of educating ourselves about the true effects of drugs.

I’ve seen LSD destroy lives that took years to rebuild. I’m not talking about people locked away in mental institutions thinking they’re an orange (we’ve all heard that story). But I had friends who became completely unable to live and function in society who gave up friends, significant others, and family for a drug that eventually made them crazy. Some of them are back, some aren’t.

All I’m saying is be careful.

Addiction causes – Drug addiction as a chronic disease makes sense

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

I’d like to work on that a bit.

Why is addiction a disease?

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

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

A comparison with Diabetes

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

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

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

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

This is not all that different from addiction.

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

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

The bottom line?

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