Triggers and relapse, a craving connection for addicts

I’ve already written about one reason why cravings make quitting difficult (find it here). However, cravings and triggers are not just abstract concepts; they are well known, important players in addiction research and I think they deserve some more attention.

What are triggers?

A trigger can be thought of as anything that brings back thoughts, feelings, and memories that have to do with addiction (like a computer reminding a sex addict of porn). In addiction research, these are often simply called cues. The word comes from learning research in which a reward (or punishment) is paired with something (the cue).

For instance, in Pavlov‘s classic experiment, a dog heard a bell ring right before it would get served its daily portion of meat. The dog quickly learned to associate the bell with food, and would begin salivating as soon as the bell would ring, even before the food was presented. In this case, the bell was the cue, and food the reward it was paired with.

The story in drug addiction is similar. I’m sure many of you can relate to the overwhelming memories and emotions that seem to come out of nowhere when you hear music you used to get high to or pass a street where you used to buy drugs (or sex). Each of those examples is a trigger that is simply bringing about a similar reaction to Pavlov’s dog’s salivation. Seeing these things, or hearing them, creates an immediate response to the reward that it was paired with, the drug!

Triggers, cravings, drugs, and relapse

As if matters needed to be made worse, triggers not only bring about responses that make you think about the drug. In fact, over and over in learning and addiction research, it’s been shown that triggers actually bring back drug seeking, and drug wanting, behavior. As soon as a cue (or trigger) is presented, both animals and humans who have been exposed to drugs for an extended period of time, will go right back to the activity that used to bring them drugs even after months of being without it. In fact, their levels of drug seeking will bounce back as if no time has passed. Sound familiar?!

Given these findings, is it any wonder that cravings bring about relapse in so many addicts who are trying to quit? If simply thinking about, or hearing, something that was always tied to drugs can bring about such a strong response, what is an addict to do?

Is there a solution for addicts??

For now, the simplest way to break the trigger-response connection is simply repeated exposure without the reward. As bizarre as this may seem, staying away from the triggers can make their ability to bring back the old drug-behavior stronger. Obviously, this isn’t something that should be undertaken lightly. I’m currently working on putting together a drug treatment system that specifically addresses these issues so that with help, users can eventually release the hold that triggers have over them.

In the meantime, be honest with those around you, and if you’re seeing a therapist, or a good case manager, tell them about your triggers so that you can hopefully start talking about them, and re-triggering them in a safe environment. As always, feel free to email me with any questions you might have.

Ancestry, Addiction, and trauma – Addiction research into genetic differences based on race

We all know that drug use and drug related crimes are a big problem within African American communities. It’s not a secret, but it can be interpreted very differently by different people. Do the differences between African Americans and Americans from European descent mean that Black people are simply meant to have more problems?

A recent study suggests that at least when it comes to addictions, the opposite might be true.

A genetic study of addiction and ancestry

Researchers at the New Jersey VA (Veterans’ Affairs) office collected data from 407 addicted African American patients as well as from 457 comparison participants at a local hospital’s ophthalmology clinic. Like in most studies of this nature, both groups was screened for other psychiatric problems and participants from the control group were excluded from the study if they showed any signs of addiction problems themselves.

The researchers then used 186 different genetic markers that relate to ancestry to determine the proportion of African, European, and Asian descent for each participant. After following this up with some questionnaires about childhood trauma and an estimations of participant socioeconomic status (things like income, education, age, etc.), the researchers ran analyses to see if African ancestry was related to drug problems, childhood trauma, and poverty.

The ancestry of the participants was verified to be mostly (average 80%) African, with European, Middle East, and Central Asia contributing between 5% and 7% more.

What did they find?

Addiction research about race and genetics - The proportion of African ancestry among the different groupsThe first interesting finding was the fact that patients with alcohol, cocaine, or opiate dependence had lower proportion of African ancestry than non addicted individuals. The differences ranged from 5% to 3% but certainly reached significance levels. Since its already known that Europeans are more likely to show alcohol, but not drug, problems, the researchers checked to see if that was the factor responsible for the difference – it wasn’t.

Interestingly, even though childhood abuse or neglect were very much related to addiction in this sample (as we’ve talked about before), there was no relationship between African Ancestry and abuse or neglect.In fact, the two factors that were almost significant (childhood physical and sexual abuse) showed trends similar to those for addiction – African descent was associated with lower problems in those areas.

The final, and not surprising finding, had to do with an association between African ancestry and lower socioeconomic status. The differences in these categories were significant for income and education. This finding can almost serve as a validity check on the whole experiment, since census data has long shown lower SES for African Americans in the united States.

What does this all mean?

Okay, I know this isn’t necessarily the easiest study to understand, so let’s break it down:

Given the known drug problems among African Americans, the researchers wanted to know if African descent could have something to do with underlying genetic factors that make it more likely that Black individuals will end up as drug addicts. There are a host of genetic differences between Europeans, Asians, and Africans, and this was a way to get at a lot of them in one shot. The problem is that African Americans are also poorer than many European Americans, and since poverty is a known risk-factor for addiction, meaning it makes it more likely that someone will end up an addict, the researchers were interested in separating the two. They threw trauma in because it, like poverty, has already been shown to be related to addiction.

The results seemed to indicate that the two factors (poverty and addiction) as indeed separate. While African descent was associated with more poverty, it was actually found to be associated with less drug, and alcohol problems. This suggests that it’s the poverty, and all the factors associated with it, that may be driving the higher addiction rates among African Americans and not some predisposition to drug problems.

The good news is that this suggests that efforts at improving the SES and quality of life for African Americans in the United States will indeed lower their substance abuse rates. In fact, when it comes down to it, this research suggests that European Americans are the ones we need to watch for in terms of genetic risk for addiction.

As always, limitations

As usual, we need to remember that these are associations and don’t prove causality. Also, given the very specific sample used (veteran addicts), the results should be replicated in other populations. Lastly, remember that the ancestry-based differences weren’t huge, but given the fact that this was a strictly African American sample, that’s probably part of the package. Again, more research with  broader populations should help to resolve that.

Citation:

Francesca Ducci, Alec Roy, Pei-Hong Shen,Qiaoping Yuan, Nicole P. Yuan,  Colin A. Hodgkinson, Lynn R. Goldman, and David Goldman (2009). Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort. American Journal of Psychiatry, 166, 1031-1040.

Smoking cigarettes just makes it better… The enhancement effect of nicotine

A recent study by a Kansas state researcher (find it here) reports that part of the power of nicotine may be in its enhancement of other experiences that go hand in hand with it.

While the online source I included suggests that nicotine’s effect may be only in this indirect enhancement, my reading of the article proved that in fact, at high doses, nicotine alone provided the same effects all by itself.

Nicotine as an enhancer

My dissertation is actually going to be based on a nicotine experiment, so this is a topic I know quite a bit about now. As this recent study reports, it seems that animals are rarely willing to work for nicotine alone, something I found surprising at first. I mean, given how many people are addicted to cigarettes, I thought this stuff would be an easy sell. Instead, it’s taken quite a bit of work to figure out how exactly to make nicotine rewarding enough without making its effects almost too much to bare initially. As someone who used to smoke and remembers the nausea I felt the first time I tried, I understand.

Even still, I’ve had to play around quite a bit to make my my nicotine worthy of lever presses and nose-pokes. I now firmly believe that nicotine addiction has quite a bit to do with the context, behaviors, and other factors associated with smoking.

Is nicotine different from alcohol, meth, and cocaine?

So, much like the previous post I put up regarding the finding that drinking enhances people’s enjoyment when they smoke, it seems that not-surprisingly, the same thing happens the other way around – Smoking makes drinking better.

In truth, this isn’t all that surprising, there has been a lot of research showing that many drugs make the animals in research do more of other things they like. This has been shown for crystal meth, cocaine, and a number of other stimulants, and I wouldn’t be surprised if the same is true for other drugs. The thing that makes nicotine a little different is that it is almost never rewarding all by itself. Well, at least in the lab…

Citation:

Nadia Chaudhri, Anthony R. Caggiula, Eric C. Donny, Sheri Booth, Maysa Gharib,Laure Craven, Matthew I. Palmatier, Xiu Liu & Alan F. Sved (2007) Self-administered and noncontingent nicotine enhance reinforced operant responding in rats: impact of nicotine dose and reinforcement schedule.Psychopharmacology, 190, pg. 353–362

Reduce HIV Transmission – Shooting up, clean needles, and addiction treatment

Co-authored by: Jamie Felzer

We’ve talked often on this  site about many of the negative things that often come along with heavy drug use. We’ve not yet talked about any of the factors that make injection drug use even worse. Users inject cocaine, crystal meth, and heroin, or any combination of these.

Shooting up and disease

In addition to all of the other, addiction-relevant, factors we’ve talked about on here, injection drug use brings about the worry of blood borne pathogens, especially HIV and Hepatitis C.  While it may not always be easy to find clean needles or worry about cleaning a needle between uses there are steps that can be taken to reduce the risk of transmission.

1. Get Tested!!  HIV/AIDS testing is available all over the world, often for free.   Having another STD or illness can easily kill someone with AIDS. Know your status!

President Obama just finalized a plan to revoke the 22 year travel ban on those living with HIV/AIDS.  This will significantly reduce the stigma of HIV/AIDS and should bring about more testing centers and education.  See this video to hear Obama.

2. While it may not always be easy, take great care to try to check the needle for visible signs of blood before injecting. If you think the needle may have been used before, clean it with bleach or another disinfectant.

3. Utilize the free clinics around your town that give out free, clean needles.  They are there to help you!!  Use these addiction support centers for clean needles and other equipment (like the bleach I mentioned earlier).

4. Talk about it! Regardless of where you may live, the group of people you hang out, studies have shown that talking about this subject matter increases awareness and can decrease chance of infections.  Being informed is your most important tool. For more info check out AIDS Global Information or AIDS Action.

5. Get help! Treatment options are widely available and they serve as a very effective method for reducing risky behaviors.  We can offer you placement help if you’re in southern California, but even if not SAMHSA has a relatively good addiction treatment locator – Check it out.

Citation:

CAPS Fact Sheet: What are IDU HIV Prevention Needs?

Proteins and cocaine: Addiction is a disease, not a question of morality.

While there are some people who still argue about whether drug addiction is a disease or a condition that results from the moral failing of an individual, most of the scientific community has long agreed that there are at least some influences on it that are far beyond a person’s control.

I’ve mentioned the genetic influences that have been shown to be associated with a risk for addiction before (look here). However, most of the research I’ve been involved in myself recently has more to do with the way that trying drugs changes your brain in ways that make it more likely that you’ll try them again.

Along these lines, a recently published study has shown that very specific molecular targets can have a huge impact on the probability that addicts will keep going after drugs. The molecules studied were common targets of cocaine that are altered after long-term use of coke.

The interesting thing is that the research found that deactivating each of these targets produced completely different effects:

Animals that had the GluR1 receptor subunit turned off were unable to stop themselves from searching for cocaine in a spot where it used to be long after normal mice gave up. I don’t know about you, but that sounds more than a little relevant for addiction given what I know, and have experienced. We’ve been studying this sort of stuff for a while, but the fact that a single molecule can make an animal pursue drugs in a way that is completely irrational is amazing!

Animals that had the NR1 receptor subunit turned off experienced a different effect. While normal mice relapse to drug use when they experience a drug after a long break, the NR1 deficient mice just wouldn’t go back to their addictive behavior when they got a little sample. Again, the implications for relapse preventions are promising to say the least.

In short, while some people may think there’s still a reason to argue whether people with addiction should simply be left to god’s mercy, ongoing work is showing us that we can uncover specific molecular mechanisms that may one day allow us to combat addiction with much more success. I for one welcome that.

California prison problems: Drug use policy gone awry

PrisonOriginally posted on Takepart:

I’ve been aware of the unjust nature of our prison system for a while, but a recent NPR story I heard in the car brought the issue front and center again. This piece is a combination summary and extension of that story.

Did you know that the US makes up 5% of the world’s population but houses 50% of the world’s prisoners? This significantly trumps even China and Russia, those evil countries whose human rights violations we keep hearing about so much.

The California prison system is a perfect example

Though it held steady throughout the ’60s, ’70s, and ’80s, its prison population today is 8 times larger than it was 30 years ago. The reason? California’s passage of a slew of “get tough on crime” laws including:

-Increased parole sanctions
-Minimum sentencing laws
-Tough prison sentences for non-violent drug offenders (now 32% of the prison population)
-The famous “three strikes” law

The push for these laws was strong, and as NPR reports, one of its major contributors was the California Correctional Peace Officers Association (CCPOA). The CCPOA, through its political action committee, has been behind much of the toughening of CA sentencing laws. Even worse, it’s put its muscle to work fighting efforts to divert offenders from prison and reduce the prison population.

And it’s worked. Since the laws went into effect, the union grew from 2,600 officers to 45,000 officers. And the money followed: In 1980, the average officer earned $15,000 a year; today, one in every 10 officers makes more than $100,000 a year. Their average salary? About $50,000, according to Payscale.

Letting the CCPOA affect California’s crime policy is like letting health insurance companies determine what health care you’ll get. What you end up with is too little care that costs too much money.

Prison CellBut aside from giving the officers’ union a full 70% of the state’s correction budget, Californians get little in return for their $10 billion. Cheap inmate programs that have been shown, in study after study, to reduce recidivism (repeat behavior) are now getting cut. In Folsom prison, there is a Braille translation program that in 20 years has kept every inmate who has been involved in it out of prison. This year, that program got chopped in half.

The currently available substance abuse beds can barely handle 5% of the inmates that need them.  To make matters worse, the programs were instituted so poorly that even the available beds are badly managed.

The results are obvious. California has the United States’ worse recidivism rate–70%!

Arnold Schwarzenegger touts his independence from special interest, but what’s happening in California seems to say otherwise . The CCPOA is a special interest of the worst kind–their interest lies in putting us away. The better they do, the more jobs they have, but at what cost to society?

It’s time for us to take back our streets, not by putting away every criminal forever but by fixing a system that’s been broken for nearly 30 years. If we want a fix to the CA budget crisis, let us divert money from officers to teachers, both inside and outside the prison system.

It’s time for California, and indeed America, to start thinking about the end-game. Unless we want to find ourselves building more and more prisons to house a larger and larger proportion of our citizens, it’s time to tip the scale back in favor of rehabilitation, and away from incarceration.

Give me SUGAR!!!! And a little food addiction on the side…

sugarSo while we’re sitting here talking about drug addiction, quite a bit of research in the last few years has looked into food, and specifically high-sugar-content foods, as a possibly addictive substance (food addiction).

The focus started when the new head of NIDA (The National Institute on Drug Abuse), Dr. Nora Volkow, who’s been doing research on obesity, took her seat a few years back. Since then, there have been quite a few papers showing that when given foods (or water) high in sugar content, animals develop behavioral patterns that are very similar to drug addiction.

This makes sense from an evolutionary stand point, since sugar gives our bodies carbs, which supply energy for our daily activities. However, it’s probably no secret that 50,000 (or even 1000) years ago, people weren’t consuming foods with refined sugars crammed into them (refined sugars have only been around for about 250 years). Back then, people needed all the energy they could get their hands on.

Unfortunately for us, evolution doesn’t move as quickly as our industrial and technological advances, which means we now get more of the high energy foods more easily, all while moving less and therefore putting out less energy.

The result? Atkins diets and the likes recommending low carb intake, which in actuality, should probably read “sufficient carb intake.”

A very recent paper has shown that even artificial sweeteners (specifically saccharin, see citation), may be able to induce these types of behaviors. In fact, saccharin sweetened water (and also sugar sweetened water) was chosen over cocaine, even for animals that already liked cocaine, and even when they were offered more and more cocaine!!! How’s that for amazing?!

What does this mean for food addiction?

Well for one thing, it means that if we want to battle the obesity problem in this country, we need to re-examine the availability of these high-sugar, high-calorie foods. But, it may also mean that low calorie foods that are artificially sweetened may soon be shown to be as bad for us…

I’m telling you, by the end of all of this, we’ll learn that growing your own vegetables and fruits is the only way to stay healthy. Come to think of it, even then, I know at least one person who may be addicted to fruits…

Question of the day:
Does your experience with high-sugar foods lead you to agree or disagree with these research findings???

Citation:
Magalie Lenoir., Fuschia Serre., Lauriane Cantin, Serge H. Ahmed (2007). Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698.