Conversation with an addiction expert – Chris Evans, opiate master

Here at A3 we have already armed you with over 400 articles’ worth of knowledge on a wide variety of topics such as sex, gambling, and alcohol addictions. Our articles have in the past been written mostly by the team members at A3 (with a few notable guest pieces) based upon research findings and personal experience. Now we decided to expand our reach and get a different kind of perspective, broadening the knowledge we are able to provide to you and providing you expert opinion on commonly asked questions that the public often has about addiction.

Chris Evans, Ph.D.Our first expert is Christopher J. Evans (PhD) who is a professor in the David Geffen School of Medicine at UCLA. In addition to his work at the school of medicine, Evans is also a part of the UCLA Opioid Research Center, and Shirley and Stefan Hatos Center for Neuropharmacology. Evans is particularly interested in opioid drugs and is currently working on discovering the differential signaling at opioid receptors. Some of his past work has touched on withdrawal and on the theory of opponent processes involved in withdrawal, a counter to the theory that a rebound from over-activation is the whole story in the withdrawal process.

11 answers from an addiction expert

1 ) How did you become interested/specialized in addiction research?

Following my PhD studies in protein chemistry where I studied enkephalins and endorphins – opioids in our brains.

2 ) If you had to sum-up your “take” on substance use disorders in a few sentences, what would those be?

A sad disease where an obsession develops for an abused substance that creates fluctuating hedonic states. Increasingly there is decline to a negative hedonic state that can only be relieved by the abused drug.

3 ) What have been the most meaningful advances in the field in your view over the past decade?

The development of genetic models and imaging to begin to tease out circuits involved in liking a drug, withdrawal from a drug and drug craving.

4 ) What are the biggest barriers the field still needs to overcome?

Resolving the interaction of genetics and environment in creating phenotypes such as depression and anxiety leading to susceptibility to substance abuse.

5 ) What is your current research focused on?

Opioid drugs and the differential signaling at opioid receptors.

6 ) What do you hope to see get more research attention in the near future?

Inhalants and genetic studies aimed at behavioral phenotypes relevant to obsessive substance use .

7 ) How do you think the Health Care reform recently passed will affect addiction treatment?

It appears that there will be more attention paid to substance use disorders.  With increased access to health services the treatment of substance disorders is likely to become more of a focus.

8 ) What is your view regarding the inclusion of behavior/process addictions in the field?

They should be included.  Many of the process addictions have the same co-morbidities with substance use disorders and these are what need to be understood.

9 ) What is your view on the relative importance of Nature Vs. Nurture?

They are intertwined ? the interaction of nature with nurture directs our behaviors so neither should be considered more important than the other.  Either nature or nurture can be a disaster for a life.

10 ) In your view, what are some of the biggest misconceptions that the public still holds about addiction?

That addiction is driven solely by the acute rewarding effects of the drug and not by subsequent adaptations induced by the drug including dysphoria or memories of drug action.

11 ) What is the most common question you get from others (public?) when it comes to addiction?

Is marijuana harmful for you?

And there you go, a set of untouched, unedited answers about addiction and addiction research diretly from one of the masters. We hope you’ve enjoyed this and that you’ll look forward to more as All About Addiction continues a monthly exposure of what addiction research looks like from within.

Addiction stigma – Making addiction recovery, and addiction treatment entry, even harder

When people think about drug addicts, they often bring-up the negative stereotypical hippie, or homeless, image that movies, television, and much of our daily experience has left us with. Its usually not a successful business man, doctor, or lawyer that comes to mind.

This is an issue because many addicts attempt to disassociate themselves from this negative stigma, often resorting to denial of their drug problem or secrecy coping,  and not seeking the addiction treatment they need.

The truth is that addicts are found in every socioeconomic class and within every ethnic group and gender. On this site we have talked about doctors with addictions, the reality of behavioral addictions, and the science behind the compulsive behavior that addicts are so well known for. We have attempted to destroy myths about addictions, by informing our readers about the neuroscience of addiction, and allowing people “to come out” about their addictions. By doing this we hope to encourage openness about addictions, and not allow stigma to get in in the way of recovery.

Addiction stigma hurts addiction treatment success

The center for Addictions and Substance Abuse Technologies, at The University of Nevada, did a study on the affects of stigmatization on 197 drug users. The findings indicated that there is a direct correlation between the degree to which drug users are perceived negatively (stigmatized) and whether or not they overcome their addiction. The study suggested that addicts become more dependent on the substance they use because of the stigma (actual or perceived).

Researchers looked at six questions regarding stigmatization which were:

  1. To what degree do drug users experience stigma?
  2. Were the metrics of stigmatization conceptually distinct?
  3. Is the perceived stigma related to the number of previous addiction treatment episodes?
  4. How does secrecy as a coping strategy affect drug users?
  5. Do intravenous drug users have higher levels of perceived stigma than non-intravenous users?
  6. Do people with current contact with the legal system report higher levels of stigma?

The study found that there are varying degrees of stigmatization and that the most prevalent stigmas were; drug users felt that people treated them differently after finding out about their drug use (60%), felt that others were afraid of them when finding out about their drug use (46%), felt some of their family gave up on them after finding out about their substance use (45%),  felt that some of their friends rejected them after finding out about their substance use (38%), and felt that employers paid them a lower wages after finding out about their substance use (14%). My own personal experience certainly supports the first three findings – I have encountered people who stopped talking to me after finding out about my drug addiction past, and during my addiction there were long stretches of time during which my family completely gave up on the possibility that I would ever recover. At the time I simply shrugged these things off and pretended like they didn’t matter, but they certainly didn’t give me a good reason to stop using drugs.

The results of the study indicated that the measures of stigma are conceptually unique. These measures included Internalized shame Perceived stigma, and stigma-related rejection, all of which were correlated with one another to some extent.

Users with a higher number of addiction treatment episodes also engendered higher levels of stigma and had a more difficult time succeeding in treatment. These results  support earlier findings (Sirey et al. 2001) that showed that users with higher levels of perceived stigma were more likely to prematurely discontinue treatment, confirming that stigmatized drug users are not likely to seek addiction treatment and are more likely to relapse after starting treatment.

Addicts have a sense of shame associated with seeking treatment for their problem

The current addiction treatment system has produced a seeming paradox within the mind of the struggling addict – By owning up to their addictions, addicts reduce the invisibility of the problem, helping others claim back their lives from the secrecy of substance abuse and behavioral addictions. Unfortunately, that process takes far longer than the stigma the confessing addict has to immediately confront.

The study showed that secrecy coping is associated with lower quality of life because of the drug user’s inability to openly discuss their addiction. Subjects  that dealt with their addiction alone had poorer mental health, decreasing their chances of recover due to the stigma of addiction. Much like with many other chronic mental, and physical, conditions, the stigma attached to addiction, and addiction treatment seeking, can often lead to poorer outcomes in the long run and less successful treatment development due to low participation rates in the kind of groundbreaking research necessary. By reducing the shame associated with confessing to an addiction, society could drive forward the advancement of addiction treatment, helping us treat addiction like we treat cancer, parkinson’s disease, and many other chronic diseases.

Surprisingly the results from the study showed that the legal system does not increase the  level of stigmatization, yet subjects that used intravenous drugs felt a higher level of stigma.

Citations:

Sirey, J. A., Bruce, M. L., Alxopoulos, G. S., Perlick, D., Raue, P., Friedman, S. J., et al. (2001). Perceived stigma as a predictor oftreatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 158, 479−481.

Luoma J.B., Twohig M.P., Waltz T., Hayes S.C., Roget N., Padilla M., Fisher G. (2007) An investigation of stigma in individuals receiving treatment for substance abuse.