Healthcare savings and alcohol and drug abuse treatment: Saving lives and money

Alcohol and drug abuse treatment can save health care moneyA recent paper put out by an initiative called Closing the Addiction Treatment Gap (CATG) talks about some of the cost savings benefits that go along with alcohol and drug abuse treatment. The numbers refer to current treatment methods, success rates, etc., so the savings should only go up as we become more successful and introduce longer, more chronic treatment methods (as I discussed here).

  • 2.3 Million hospital stays in 2004 we directly related to substance disorders.
  • Total medical costs were reduced 26 percent among patients that received addiction treatment.
  • Brief counseling alone allowed for a reduction of 20 percent in emergency department visits and 37 percent in days of hospitalization among a group of high-risk alcoholics.
  • Addiction contributes directly to many off our most pressing health issues: heart disease,
    cancer and stroke.
  • In one study, outpatient addiction treatment reduced total medical costs by 26%, inpatient health-care costs by 35%, and emergency room by 36% !!!

You can find the rest of the report on CATG’s website, but I think you’ll agree that alcohol and drug abuse treatment needs to be part of the discussion in our ongoing health-care debate. We can save billions of dollars and millions of life every year by making appropriate, effective, addiction treatment part of the reality of ongoing health care in America.

It’s the responsible thing to do. It’s the right thing to do.

My Friend the sex addict part 2 – The ups and downs of sexaholics

As you may recall from an earlier post, a friend of mine, Brian, has been struggling to get some control over his sex addiction.

I had referred him to a number of clinics that treat sex-addiction specifically, and to Sex Addicts Anonymous (sometimes known as sexaholics anonymous) as a starting point. I’m not at all surprised that he hasn’t followed up with either of these for now, since his addiction has only recently become an issue he recognizes and though the costs are obvious, they’re not staggering, yet.

The concept of addiction to sex is relatively recent (see 1st citation, in 1991). Still, it’s relationship to substance-use and dependence in terms of predictors, determinants, and progression have been mentioned from the very beginning and are still being examined today.

The issue for most people here is the absence of any drug that’s being taken in, which makes them doubt the validity of looking at the two conditions as one.

In my earlier posts on the pharmacological actions of cocaine and meth, I talked about how it is that those drugs activate that neural systems that control rewards in ways that are unnatural. There is little doubt that the “help” provided by these chemicals makes the link between their initial use and later, compulsive use, easy to follow.

ProstitutionStill, repeated exposures to a rewarding stimulus (like sex) can themselves set up behaviors that seem reinforced, but that are maladaptive (as in bad for them). The search for internal reinforcement through repeated sexual encounters, pursuits, and preoccupation would be the pattern common to many sex addicts.

By consistently making them feel better (sexual release results in more dopamine in the brain as well), a pattern develops that may lead certain individuals to seek the reward whenever they need reinforcement. Once such a pattern develops, the road to compulsion, is not too long. This is especially true for those who already have low impulse control, for whatever reason, as I discussed earlier.

Brian’s issue is certainly his need for ego reinforcement, and his brain has learned that the attention of a woman provides that in bulk. The problem is, as I’d pointed earlier, that many areas of his life, including his ego when he ends up not keeping up with other responsibilities, end up being damaged in the process.

This sets up the all too familiar cycle of ups and down common to many addicts. To those who know him, the fact that Brian’s priorities are “screwed-up” is no secret.

Brian at least recognizes his pattern now and perhaps, if the roller-coaster ride become too extreme, he may decide that it really is time to do something about it. One thing is certain, he recognizes that he is likely a sex addict.

In the meantime, the age of the internet has provided immediate access to sexual content, which makes relapse all to easy for sex addicts. I recommend putting a lock on your own computer that is controlled by someone else if that is part of your sexual addiction. Having someone to talk to that you feel comfortable enough to share urges when they do come up can be of great help too. This is where 12-step groups come in handy for most people. It’s hard to talk to most people about things we find shameful unless they too have had the same problems…

Question of the day:
If sex-addiction is your problem, what have you found can help you in best resisting the compulsive urges?

Citation:

Schneider, J. P. (1991). How to recognize the signs of sexual addiction. Asking the right questions may uncover serious problems. Postgraduate Medicine – Sexual Addiction, VOL 90 (6).

Clubs, drugs, and dancing – Crystal meth, and club drug use

Anyone involved with the dance/rave/club culture knows that drugs often go hand in hand with music and dancing. Club drugs, as well as alcohol and drug abuse, are often rampant in the social groups full of excited club goers. Previous academic studies supported this notion but could not distinguish if the drug use took place inside the clubs/venues or whether people consumed before going out.

A recent study seems to support the latter explanation (drugs consumed before the club); at least for all drugs aside from crystal meth.

Club Dancing

In this study experimenters tested patrons as they entered and exited the club. Approximately ¼ of the attendees tested positive for some sort of drug when they entered as well as when they exited the club. There was not a significant difference in percentage of those that entered with drugs already in their system than those who exited with drug use. This supports the conclusion that no significant amount of drug use took place inside the club (excluding alcohol).

But this wasn’t true for all drugs. Cocaine and marijuana usage was the same at entrance and exit but positive crystal meth tests nearly doubled from entrance to exit.

Frighteningly enough 16% of the patrons exited the club with a BAC greater than .08%. Many of the people who were taking drugs also consumed alcohol which poses an even greater threat since the interactions between drugs and alcohol can cause severe reactions as well as a more severely impaired judgment.

Since most patrons entered with drugs already in their system, it seems reasonable to suggest that these clubs do attract drug users. Most people who entered without drug use did not take drugs during the course of their stay at the club. However the usage of methamphetamines while in the club definitely needs to be looked into further, as the effects of taking that inside the club in addition to drinking can cause many problems (legal and health wise) for both the patron and the owners.

Co-authored by: Jamie Felzer

Citation:

Miller, Holden, Johnson, Holder, Voas, Keagy (2009) Biological Markers of Drug Use in the Club Setting. Journal of Studies on Drugs and Alcohol. Vol 70 (9)

More CPDD Addiction research: Addiction, exercise, recovery!

Okay, this is probably the last addiction research update I will give focusing on the Reno conference. The rest of the stuff I learned will be incorporated into future posts.

I’ve written before about the relationship between exercise and recovery (see here) and I will surely write more since for me, it was a big part of the equation.

two separate studies at CPDD reaffirmed my belief that exercise can be a very useful tool in addiction recovery.

The first study, conducted in humans, examined the effect of incorporating an extensive exercise routine into a residential, as well as intensive outpatient, addiction treatment program. Their findings showed improved outcomes for participants in the short, as well as long run. These included length of sobriety, subjective assessment of well being, and more. In talking to the researcher, she seemed to believe that at least part of the effect was due to the relief of cravings achieved by allowing patients to focus on something that took effort, rather than simply sitting around.

The second, and to my mind even more interesting, study examined the effect of exercise on cocaine self-administration in rats. Researchers assigned half of their rats to a cage that had a running wheel while the others were assigned to a regular cage. the rats with the running wheel used the device to run an average of 12 kilometers a day! After a week of simply resting in their cages, when transferred to another cage for 2 hours a day, the rats who had the wheel in their cage took less than half as much cocaine as the rats who didn’t have a wheel. the “wheel-rats” were also found to run less after they began the cocaine portion of the experiment, but their cocaine-taking never got near that of the non-exercising rats. It seems that having the exercise did something to reduce the reinforcing power of cocaine.

I have a feeling that future research will show that these finding hold true for other drugs (like crystal meth, heroin, marijuana, cigarettes, and alcohol) and possibly even for behavioral addictions like food addiction, gambling, and sex addiction.

All in all, research seems to be supporting the notion that exercise can play a significant role in recovery from addiction. Whether it be for boredom relief or an actual internal change in the motivating power of drugs, it looks to me as if Addiction + Exercise = Recovery !

Latest drug addiction research from CPDD: Drug use patterns among adults

I’m currently attending the annual meeting of the College on Problems of Drug Dependence (CPDD) in Reno, NV.

Since there’s so much drug addiction research being presented here, I figured I would post a daily update with some of the things I found most interesting. There’s absolutely no way for me to see all the presentations I’m interested in, so what I get to see is what you get to hear about.

One of the interesting presentations today had to do with a broad study of drug use patterns among adults who are not drug addicts. The study, conducted by researchers at the University of Alabama (who ran the CARDIA study), looked at the drug use patterns of adults enrolled in a Coronary Artery Risk study over many years. It’s important to note that drug use in this case does not include smoking, drinking alcohol, or marijuana use. The researchers also didn’t distinguish between use of different drugs for the purpose of this study.

The researchers found 4 common drug use patterns:

  1. No current use – Over 80% of the participants reported no use within a month of any of the follow-up dates. More than half of those people said they’d used at least one drug at some point in their life, but their use was not common enough to ever fall within a month of their check-ups.
  2. Early use, low frequency – About 12% of people used drugs with some frequency at an early age but then reduced their use throughout the follow-up period.
  3. Persistent use, low – These users continued to use drugs throughout the study period, but their use did not escalate.
  4. Early, persistent, use – These users started early, used a lot, and though their use tapered off, it remained higher than any other group throughout the study.

I personally think that these findings are encouraging. They show that at least within this population, only a small proportion of individuals engage in what we would consider chronic, dangerous, drug use.

I reported similar findings regarding relapse in alcoholics in another post a while back (see here), and I’m glad that statistical techniques are being used to uncover larger patterns of drug use and abuse in a more general population.

More addiction research to come. There’s almost too much to report!

The brain-addiction connection: Cocaine, dopamine, and more

Okay, so we’ve covered how the brain’s neurons communicate with one another normally; now let’s learn about how drugs mess things up to produce their specific effects. Since the brain-addiction relationship is different for different drugs, we’ll do this one by one, starting with cocaine:

Cocaine

One of the most commonly abused drugs, cocaine interrupts a molecule in the brain that’s responsible for clearing away the dopamine that is released during normal functioning (it’s called DAT). Like I’d said before, neurons talk to each other by releasing these neurotransmitter molecules to transmit impulses from one to another.

Imagine for a second that every time you spoke, the sound of your voice would continue on, reverberating endlessly. By the time each of us would be done uttering our first sentence, the world would be a mess of unintelligible sounds, echoing forever. This wouldn’t make for a very effective way of communicating.

Sound loses energy as it travels through air, eventually having so little energy that it no longer moves enough air to be audible. This keeps each word distinct and meaningful. In the brain, the individual messages between neurons are similarly kept distinct up by a number of processes.

These include dissipation, chemical breakdown, and reuptake.

Let’s learn more about these processes

Dissipation is a process similar to the story with air and sound, as the molecules move around, their concentration gets lower, and they become less likely to activate anything.

Chemical breakdown does is exactly what it sounds like, chemicals breaking the neurotransmitters down so they can no longer activate anything.

Reuptake is a more complicated process of recycling. Instead of letting all those precious chemicals go to waste, the brain recycles them so they can be used again later. Cocaine blocks the molecule that makes this reuptake process (for dopamine) possible. It’s a small molecule that carries the cocaine back into the cell that released it. Cocaine wedges itself in place of the dopamine (see picture below) and therefore deactivates it.

Dopamine Transport Molecule

What does cocaine’s action result in?

The result is that since it can’t be as efficiently cleaned up, dopamine ends up hanging around the brain for longer than it’s supposed to. Because dopamine is one of the brain’s main “pleasure”, or “positive” signaling molecules, users of cocaine feel better than they would otherwise as a result of this extra dopamine.

This doesn’t sound like such a bad thing, does it? Reuptake is a small price to pay for feeling a high that is almost “naturally produced” (some of the brain’s own dopamine hanging around for longer than it should). The problem is, that like in anything else, for every action, there’s a reaction…

What happens when cocaine in taken for a long time?

Faced with increasing amounts of dopamine, the brain starts adjusting in these ways:

  • It starts out by producing and releasing less dopamine, because as far as it’s concerned, the balance has been interrupted.
  • The number of receptors available to bind with dopamine is also reduced.
  • Next, it starts turning up brain systems that are supposed to counteract the actions of dopamine in order to once again, adjust for the increased levels.

Overall, these are some of the reasons for the “come down” or, after effects of a heavy night of cocaine use.

Over time, many of these changes become long lasting, resulting in a whole set of undesirable effects for the user, including withdrawal, mood problems, as well as some serious problems with thinking and control over behavior.

Not to be ignored are the effects that cocaine use, and the good feelings it initially brings along, have on motivation and normal reward functioning and learning in the brain; but we’ll get to that in another lesson…

Question of the day:
Does the above explanation of how cocaine works help you make sense of the effects it has? Could you see how these effects would possibly bring about addictive, rather than recreational, use?

About addiction: Animal research, food addiction, policy, and cocaine addiction

Here are this weeks gems when it comes to learning about addiction. As usual, if you click this title’s post, you’ll get a list of our related post as a bonus!

Adventures in Ethics and Science A nice post about the current state of the animal-rights dialog

Addiction InboxMood Foods (and their possible role in food addiction)

Addiction TomorrowAdvocacy and Treatment

PhysOrgAltered reward-based brain-activation in cocaine addiction