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?”

Know before you speak – Why etiquette is important

You know, I try to write this blog from a completely objective point of you, but guess what – I’m a person, so things take on a personal tone once in a while.

There’s nothing I hate more than readers who come to this site, read a single post, and then decide they know who I am, or what I’m about. It’s taken me more than 13 years to get to this point in terms of my knowledge, experience, and viewpoint on drugs, addiction, and policy issues. It all started with 8 years of some personal “experimentation” with the behaviors I’m talking about. I’d love to say I was doing it for science, but the last three years were far from enjoyable for many around me. Since then I’ve studied statistics, neuroscience, public-health, and psychology. And I’m not done. Staying in the academic world, I keep educating myself on issues related to addiction from every field I have access to.

So please, if you have opinions, share them, but if you want to insult me, make sure you know what you’re talking about, because I’ll tell you if you don’t. Personal attacks are easy to make through an internet connection, but being stupid will leave an obvious stain and will cause me to either remove your comment or just reveal how ridiculous it is. I don’t like making personal attacks on people – not in posts, not in comments, and not in real life. Don’t tell me how you do, or don’t, want me to die because I probably don’t care how you go and I certainly don’t want the experience to be bad.

I know blogs are a little loose, but let’s keep this at least somewhat professional, okay?

Am I an addict? A simple new test may help us get the answer!

Originally posted on Psychology Today:

One of the biggest problems with addiction is that we never know who is truly an addict. Yes, we have tests and notions, interviews and criteria, but all of those are simply tools we’ve used to get around the problem of not knowing. Well, a recent study by a couple of researchers at Florida State University may help us get a little closer (before you get too excited, read the limitations at the end). My take-home message from this post is familiar: Addiction is a disease, not a question of morality.

Am I An addict? Testing for addiction

One of the major reasons for the push to find the ‘alcoholic gene’ was the hope that, once found, it would let us say, with certainty, who is (and who isn’t) an addict. All those people who simply use drugs and other addictions as an excuse for their horrible behavior would be revealed and all those who truly need help could be identified. But it didn’t quite work out that way.

There is no alcoholic gene. There are a whole bunch of genes that are associated with, and most likely contribute to, the risk of someone becoming an addict. But they vary for different drugs, require some pretty serious testing, and contribute very little (individually) to our ability to categorize people. The same genes that are linked to addiction are also linked to ADHD, anxiety disorders, depression, and on and on…

But wouldn’t it be great if we had a conclusive test? Something that worked to really help us tell the difference between addicts and the rest?

Skin response testing

Electrodermal response modulation (ERM; a fancy name for measuring skin conductance) is a measure of how skin conductance changes in response to predictable versus unpredictable stress.

The connection between addiction and skin response might seem a stretch, but hey, dilated pupils are a sign for sexual attraction so… The idea is that the more prepared the overall system is to deal with predictable stress, the better equipped a person is to handle life stressors. Bad responsivity would mean that the person’s system is not adjusting well to stressors that are predictable, producing too much arousal and discomfort to events they should be prepared for.

So for this study, high ERM good, low ERM bad, got it?

To make a long story short, this recent research shows that low ERM was more common among individuals with addiction than among controls (people with no major mental health issues) and even among individuals with personality disorders.

The good news is that this finding is promising in terms of possible future identification of people who are likely to develop addiction problems. But of course, there are some issues.

Limitations of the study

Since the study used people who were already addicted, it’s impossible for us to know if low ERM exists before addiction develops. If it does, we may be able to identify potential addicts before they become addicted, but if not, it would still be useful to have a test to distinguish current addicts from non-addicts.

Of course, at the moment the test only works by comparing addicted to non-addicted groups – we don’t have norms or cutoff points to tell us on an individual basis who is or isn’t an addict. A lot more research will be required before that would be possible.

This is not the first test that has shown promise in terms of a quick identification test for addiction. There is quite a bit of research showing a relationship between a specific brain wave (called P300) and addiction. the problem is that P300 turned out to be pretty generally associated with what are known as externalizing disorders (like illegal activity, high risk sexual behavior, aggression, etc.). I personally believe that as behavioral addictions (like sex addiction that involves high risk sexual behavior) become more commonly understood, many of those externalizing disorders may be reclassified, making P300 possibly more popular as an addiction measure.

The Bottom Line: So can we tell?

It’s too early to know if ERM will turn out to be a really good marker for addiction, but I’m sure people are hard at work trying to figure that out, so let’s give them some time. Years ago I heard a presentation about people with low variability in heart rate which seemed to suggest something very similar, so I’m hopeful. But to me, there’s a more important take home message:

Once again, this study shows that there are physiological factors to addiction that are far beyond anyone’s actual control. I don’t personally know anyone who can change their skin conductance, and so I’m pretty comfortable saying that addiction is an actual medical condition in so far as it has physical symptoms and some promising treatments.

But then again, I am a scientist…