Depression and smoking relapse: Anhedonia doesn’t feel good.

August 17th, 2010

A recent study published in the Journal Nicotine & Tobacco research suggests that a particular aspect of depression, namely anhedonia, a.k.a “inability to feel good,” plays an important part in predicting how quickly smokers will relapse after trying to quit smoking. When it comes to addiction research, you can’t get much clearer than these results.

The researchers specified a number of factors in depression including: negative affect (feeling down), vegetative state (not moving much), and anhedonia, measuring that last one by making participants rate their expected pleasure to hypothetical pleasurable situations they were asked to imagine. They then split up the participants into three different treatment conditions that included slightly different procedures meant to help them quit smoking. All participants quit smoking immediately after attending the one-day assessment and instruction session. Following that day everyone returned to the lab after 24 hrs, 48 hrs, and then weekly for a total of four weeks to assess their smoking using fancy lab equipment.

When the researchers looked at the results, they saw that when separated into “high-anhedonia” and “low-anhedonia” groups, participants in the “high-anhedonia” group relapsed to smoking much more quickly, even when controlling for depression symptoms before quitting. In fact, 20 days after that initial session, more than half of the “low-anhedonia” participants were still not smoking while essentially none of the “high-anhedonia” participants had managed to quit.

As if it is isn’t hard enough to quit smoking, apparently, feeling like $&%@ just makes it harder… Hey, I never said addiction research would always bring good news!

Citation:

Cook, Spring, McChargue, and Doran (2010). Effects of anhedonia on days to relapse among smokers with a history of depression: A brief report. Nicotine & Tobacco Research.

Posted in:  Education, Tobacco Tags: addiction research, anhedonia, depression, quit smoking, smoking

About addiction: DUI, Alcohol Taxes, Underage Drinking, and Addiction treatment

August 16th, 2010

Back again, like so many Mondays before, to tell you all about addiction research, news, and more from around the world wide web.

New York and Texas tough on DUI offenders

Everything Addiction- If you find yourself convicted of a DUI in New York State, you’ll have to install one of those ignition interlocks that verify you’re sober (by showing a BAC of zero) every time you get behind the wheel. So says a new law passed in that state trying to combat the problem of driving under the influence of alcohol. The law will take effect on August 15th and is known as Leandra’s Law. Another part of the law makes it a automatic felony if a person is driving under the influence and has a child under the age of 16 in the car.

ABC News- A man in Texas has been sentenced to life in prison after being caught driving with blood alcohol content (BAC) level of .32. But it wasn’t the high BAC that got him in that endless trouble, it was the fact that is was his NINTH DUI offense. I think there’s little doubt that getting that guy off the road is a good idea, but I’m pretty sure he’s an alcoholic, so hopefully they’ve tried treatment a few times before throwing him in prison forever.

Alcohol Taxes as a mild form of addiction treatment

Los Angeles Times- A study by the National Center for Health Statistics looked at the relationship between taxes on alcohol and the number of deaths that were associated with drinking. It was found that as the taxes increased on alcohol products the number of deaths decreased. As the taxes got lowered the number of alcohol related deaths rose. This study indicates that taxes may not be such a bad thing when it comes to alcohol as alcohol taxes may end up saving lives in the long run.

Underage Drinking can be scary

Drugs Information Online- Read some alarming statistics about underage drinking in the U.S. The article takes the viewpoint that Alcohol is thought to be a symbol of adulthood by teens who want to take on adult role. This seems to jive well with the Moffitt article we’ve cited here before.

Addiction Treatment Hell around the globe

Addiction Inbox- When an individual thinks about addiction treatment they think of people at addiction facilities who are engaging and willing to give their all to help the “addicts” that are in need. While this notion might be true in the U.S. and some other western countries, In China, Cambodia, and Vietnam addiction treatment looks very different. From Chinese labor camps to Cambodian detentions, read Dirk Hanson’s great account of treatment horrors in the rest of the world.

Posted in:  Education, Links Tags: about addiction, addiction, addiction research, Alcohol, BAC, driving under influence, DUI, taxes, treatment

Rehab is easy, Recovery is hard – Making addiction treatment work

August 11th, 2010

Here’s another article from Sarah Henderson, one of our readers who’s recovered from a long battle with eating disorders and is living with bipolar disorder. She’s very candid about her experiences with addiction treatment, which I like a lot, and her unique view on food addictions (or eating disorders) fills a nice gap  in my own knowledge. In this piece, she discusses issues about addiction treatment setting, independence, and the involvement of others in recovery. We’ve all heard that you can’t make someone overcome their addiction, and Sarah’s story shows that sometimes what does the trick is making them confront their own problems. As I’ve talked about in the past, I had a similar experience when I decided to own up  to my problems and asked my father to let me take care of finding treatment myself. It was the first time I’d really internalized that I was the final piece in this puzzle.

Rehab is Easy. Recovery is Hard.

At least, that’s been my experience. Throughout the the years I struggled with anorexia, bulimia, self-harm, drug abuse, and bipolar I had a very distinct pattern: get sick, make people worry, get very sick, go to therapy, get extremely sick, go to residential treatment. Once there, I’d battle the people who were trying to help, then slowly acquiesce, then start to be semi-okay, get my weight up, get my symptoms down, and get discharged. Then, I’d get sick.

And around and around we go.

I did this for about ten years. I went to hospital after hospital, RTC after RTC, therapist after therapist. I was kicked out of treatment in several places for various reasons: not cooperating, hindering other patients’ recovery efforts, refusing therapies or medications. At one point, I was even kicked out of my small private high school because I was so sick I was “disturbing” the other students.

There is a time in my illness when I would have been proud of these things. I would have seen them as showing how tough I was, how strong in my cause, how determined to go down fighting. Now, however, remembering these things only brings a sense of sadness, and heart-wrenching compassion for the pain that this girl was in, how much she had to have been hurting to continue to put herself in that situation.

At a certain point though, the cycle stopped. I had been to this one treatment center twice in one year- and been asked to leave both times. Finally, the person who had been funding my psychiatric revolving door decided that was the last time he was paying for inpatient care. The next time I decided to get super sick, I was on my own.

After getting out of inpatient that very last time, I continued to relapse. However, knowing that no one was going to swoop in and save me, toss me in treatment, and keep up my game, created a shift in my thinking. I didn’t really have the option of continuing to get sick; at least, if I wanted to live. Wanting to live was something I went back and forth on often. I went through two very uncomfortable, joyful, horrible, painful, gratifying, terrifying, and ultimately life-saving years in outpatient therapy stumbling my way towards recovery. That time was like a dance, getting sicker then better, back and forth, until little by little the better days outnumber the sicker ones. I don’t have a “clean date” like many people; I couldn’t tell you the last day I skipped a meal or purged or cut myself. All I know is that I’m recovered.

It took a long time and a lot of work to get here. And all those years that I spent in addiction treatment did NOT go to waste, despite how it may sound. I think for me- for many people- inpatient treatment lays foundation for recovery, plants the seeds of new behaviors, thoughts, and coping strategies. But it’s not until you leave that safe, rarefied environment that those seeds will sprout, and recovery can begin to flower. I always had this idea that RTC was supposed to cure me; that I should be able to walk out all whole and healed, no problems at all. And I was always pissed when it didn’t happen that way. Finally I figured out that’s not how it works. Treatment just gives you the tools and materials for recovery. YOU are responsible for building it.

I wish someone had told me that the very first time I went to inpatient. It’s an important thing to remember throughout the treatment process; the more you understand that you alone are accountable and responsible for your own health and recovery, the more likely you are to achieve it.

Final thoughts from Adi

Like I said in the beginning, I appreciate Sarah’s truthfulness about her experience. Additionally, I share some of her story, especially as it pertains to having to own up to her condition and lose some of the guidance, or maybe crutch, that had been there for so long. However, I think that this story is a great example of why it is true that while addiction stories can offer great inspiration and hope, addiction research looks at patterns in data that can offer insight no given story can give us.

For instance, Sarah says she that outpatient treatment let her truly put the tools that she learned about in residential treatment to use. In fact, she suggests that this is the role of outpatient treatment. In actuality though, addiction research shows that people do better if they’ve been to residential treatment, especially among more difficult cases, and that a structured transition, like moving from a residential treatment facility to sober-living or to outpatient, increases the chances of long-term sobriety.However, I don’t know of any research that shows that past experience at residential treatment predicts greater success at outpatient treatment. Everything I’ve seen shows that past failure at rehab predicts future failure, not success. That’s not to say that Sarah’s story doesn’t repeat, but as a rule, more difficult cases do better in residential, not outpatient.

These sort of research findings can help guide us towards the most probable path to success, after which point individual variability sort of takes over and works its magic. The hope is that as we get better and better at it, our addiction research will guide us towards more customized initial treatment selection. It’s how we make things work in our A3 Rehab-Finder.

Posted in:  Addiction Stories, Drugs, Education, Food, Treatment Tags: addiction research, eating disorders, inpatient, recovery, residential treatment, sick, time, treatment, years

Hold that needle: Acupuncture for holistic addiction treatment?

August 8th, 2010

Acupuncture treatment is supposed to help heal numerous conditions including cancer, depression, and more. Well, when it comes to addiction treatment, poking with needles seems to provide pretty mixed results.

Holistic addiction treatment – Addiction research fact or fiction?

The use of holistic addiction treatment methods, especially ones that originate in disciplines outside of Western medicine, are all the rage nowadays. We’ve written about a number of them on here, including yoga, as they can provide some real help for those struggling with early recovery from addictions. My wife is a big believer in many of these methods, but we both like seeing evidence that treatments work before we recommend them. Apparently, when it comes to acupuncture, it doesn’t really matter where you stick yourself, your probability of quitting won’t go up… or down.

An addiction research study published a little while back used the clinical standards of a double blind, placebo controlled, study to assess the usefulness of acupuncture in treating cocaine addiction. Specialists from Yale, Columbia, UCLA, and other outstanding institutions enrolled over 600 cocaine users who were interested in quitting and gave them one of three treatments: A 4-needle NADA acupuncture condition, a 4 needle-insertion control condition, and a no needle relaxation control condition where patients watched calming videos. The only difference between the experimental and control needle conditions was the location of the insertions – The experimental condition used spots that are supposed to be of clinical utility, the control condition specifically didn’t hit those spots. All clients were offered addiction treatment counseling in addition to their experimental conditions mentioned. Apparently, relatively few of them took advantage of these, not a big surprise to those of us who look at these kinds of studies often.

The clients in each of these conditions were pretty heavy crack-cocaine users, averaging about 11 years of use and something like 30 dime bags a week with over 3.5 days of use per week. These are not your recreational, party, cocaine-users. However, severity of use looked about the same across all three conditions, which is what you want in a study like this.

Acupuncture not most relaxing or best addiction treatment method

Surprisingly (?) watching those videotapes proved more relaxing, as far as the patients themselves reported, than either needle conditions. Still, the level of relaxation wasn’t really what researchers were interested in most – it’s all about quitting cocaine, remember?

The good news? There was a reduction in cocaine use across all of the three conditions throughout the study. The bad news was that there was no difference between the conditions on retention, meaning that patients stayed in treatment as long regardless of whether they received acupuncture, control needle insertions, or watched tapes. Since we know that retention is one of the best predictors of successful outcomes in addiction treatment (CM, or contingency management is a great methods to increase retention), this is already a pretty bad sign for acupuncture. Indeed, when the researchers looked at the percent of cocaine-positive (as in dirty) urine-tests across the 8 weeks of the treatment, or at two follow-up points (3 and 6 months later) they found no differences between acupuncture and the control conditions.

A review of studies assessing the usefulness of acupuncture for the treatment of heroin addicts found that while the treatment offered no reductions in relapse rates, it did help relieve some of the withdrawal symptoms associated with stopping heroin use. There’s no doubt that heroin addicts wouldn’t mind a little help in that department, so it seems that acupuncture isn’t completely useless when it comes to addiction treatment. I’m a little skeptical of a whole string of studies from a single lab, as almost all the studies in this review were, but so it is. In fact, a second review stated exactly my point – that acupuncture treatment for opiate addiction (or cocaine addiction) just doesn’t seem to have scientific support when studies using proper controls are taken into account.

Holistic addiction treatment – Learn before you trust

Overall, it looks like acupuncture didn’t make things better for these more than 200 cocaine addicts, and while may help withdrawal, it doesn’t seem to improve addiction treatment outcomes for heroin addicts either. While this might be disappointing for some, it’s part of the risk of getting involved in alternative treatment. The thing about holistic treatment methods like acupuncture, herbs, equine therapy, and massage is that not being medical, they don’t have to be evaluated by anyone. As this study shows, a method that can be widely accepted as effective may have no real effect when pitted against other, similar treatments. This is why addiction research is so important.

Overall, it’s important to note that this study does not mean that acupuncture does not work for any of the other conditions it is purported to help. However, as far as I’m concerned, it seems that this specific method provided no help for cocaine addiction. But hey, it didn’t hurt things either, so if you like having 4 inch needles inserted into different sections of your body I say go right ahead!!!

Citations:

Margolin, A.,  Kleber, H. D.,  Avants, S. K.,  et al. (2002). Acupuncture for the Treatment of Cocaine Addiction: A Randomized Controlled Trial. JAMA, 287: 55 – 63.

Ting-ting Liu, Jie Shi, David H. Epstein, Yan-ping Bao, Lin Lu (2009). A Meta-Analysis of Acupuncture Combined with Opioid Receptor Agonists for Treatment of Opiate-Withdrawal Symptoms. Cellular Molecular Neurobiology 29:449–454.

Jordan, J. B. (2006). Acupuncture treatment for opiate addiction: A systematic review. Journal of Substance Abuse Treatment, 30(4), Pages 309-314.

Posted in:  Drugs, Education, Treatment Tags: acupuncture, addiction, addiction research, cocaine, cocaine addiction, cocaine users, conditions, control condition, holistic addiction treatment, treatment

Is the drinking age getting lower and lower? Teenage alcoholism

August 6th, 2010

We’ve already mentioned that kids tend to get in quite a bit of trouble during their teen years (see here). Well, adolescence is also a time when the brain is developing and therefore is at a high risk for damage, especially when alcohol abuse enters the picture.

Early use means more alcoholism later

While the risk taking can be playful and harmless, when it involves alcohol and drugs the consequences of use at an early age can be long-lasting. The earlier a person begins drinking the higher the reported rates of alcoholism later in life. During this time, when an adolescent’s brain is changing, they are less likely to be able to inhibit themselves, let alone anticipate the future. Those with hyperactive, disruptive, antisocial personalities are at the greatest risk for alcohol abuse at early ages, putting their already somewhat compromised brains at an even greater risk.

Teens, like adults, report feeling more at ease when under the effects of alcohol, which makes it easy to understand why they would want to continue. Less like (some) adults, teens rarely consider the negative consequences of their actions, a fact that has at least a little to do with their still developing brain structures. But there are consequences to alcohol abuse and they can be dire – over 5000 kids die each year as a result of underage drinking.

Young bodies and early alcohol damage

Before these young adults are truly mature, their intake of alcohol may not be properly resolved by their bodies because their regulatory systems are not fully developed and can be further taxed by the intake of alcohol. Alcohol abuse in a young age can have a lasting effect on brain development resulting in impairments for many years to follow. Reproductive organs and other important maturation factors may also be stunted due to a consumption of alcohol during a vital time (especially when binge drinking). As with most people who drink, regardless of the age, liver enzymes are elevated soon after the heavy drinking begins, meaning the body is less able to ward off other toxins.

Parents and alcoholism

Children of parents who drink more and view drinking with a laid back opinion are more likely to drink more as well. This may not be a problem as long as responsible consumption is discussed, but my guess is that it rarely is. Also, kids who have older friends are more likely to begin drinking at an earlier age. Teens that have become addicted to alcohol need help specifically tailored to their age group that does not remove them from their normal home and school setting. It’s been shown that isolating these kids, or specifically grouping them together, may do more harm than good.

Often, adolescents with alcohol abuse problems are also using other drugs, and they may be suffering from other psychological disorders. All of the issues need to be treated at the same time in order to effectively treat the entire person. No matter what the issue(s), the sooner they are dealt with the more effective the results.

Teenage alcoholism is a problem, and one that we shouldn’t be ignoring.

Co-authored by: Jamie Felzer

Citations:

“Adolescent Brain Development, Decision making, and Alcohol Abuse and Dependence” NIAAA Research. November 2007.

“Why do Adolescents drink, What are the Risks, and How can Underage Drinking be prevented?” Alcohol Alert. January 2006, 67

Posted in:  Alcohol, Drugs, Drugs, Education, For others, Tips Tags: abuse, addiction research, Alcohol, alcohol abuse, alcoholism, binge, Brain, brain development, decisions, drinking, peer pressure, teenage alcoholism

How doctors treat doctors with drug use problems: Addiction treatment that works

July 27th, 2010

Physician Health Programs (PHP) are reporting an astonishing success rate when it comes to providing addiction treatment for addicted doctors:

• Only about 20% of doctors ever test positive after being admitted to the program within a 5 year period.

• More than 70% maintain their license and continue working within the same 5 year period.

These are the kind of addiction treatment results we want!

I’ve been saying for a long time that I believe in the theory promoted by Dr. McLellan, who until recently was the deputy-director of the Office of National Drug Control Policy (ONDCP). Doctor McLellan promotes a long-term view of addiction treatment, more like a chronic disease than anything that can be cured in a few visits (although this view only holds for some addicts).

I’ve also known for a while that the American Medical Association is supposed to be having great success at addiction treatment for addicted doctors. I’ve been meaning to contact someone at the AMA to find out how they did it. Now I don’t need to thanks to this recent bit of addiction research.

Addiction research on treatment for addicted doctors

A recent research article surveyed the vast majority of PHP’s and found that, not surprisingly, the things that we know work in addiction treatment do indeed produce results. The solution may not be easy, but it’s pretty simple:

• Early detection and assessment brings the addicted doctor, their family members, colleagues, and employers together. Getting the problem out in the open early makes it easier to deal with than having to be secretive about it. The doctors get  an option, leave the profession or sign up for a 5 year treatment program to deal with their addiction.
• Formal addiction treatment using the most appropriate and effective treatment centers- In contrast to our criminal justice addiction pipeline, the majority of physicians (69%) receive 90 day residential treatment, while the rest receive intensive outpatient treatment. The PHPs also receive frequent status reports on each physician in treatment to assure adherence. To find treatment that works, use our Rehab-Finder.
• Long-term support and monitoring- After treatment, the physicians continue with aftercare that includes 12-step support, regular counseling meetings, and monitoring that includes random drug testing.

That’s it!  So simple yet so effective.

As addiction research continues to improve, I’m sure we’ll be able to bring these numbers up even higher than the 70% success rate currently reported. Still, you have to admit, 70% is amazing!!!

So if you want to know how to stop drinking and drugging, do like the doctors do and commit to long-term addiction treatment.

There are obvious differences between most addicts and the doctors in these programs (most people don’t have such a clear distinction between losing their livelihood and getting help), but the solution is most likely very similar.

More proof we need more money for addiction treatment:

We need to press our representatives to increase funding for addiction treatment and addiction research so that we can find the most efficient, yet effective, way to offer this kind of addiction treatment to the general population. By reducing the problems, we’d be able to cut into the $500 Billion a year drag addiction is putting on our economy. The effort will pay back for itself in no time.

Citation:

DuPont, R.L., Carr, G., Gendel, M., McLellan, A.T., Skipper, G.E. (2009). How are addicted physicians treated? A national survey of physician health programs. Journal of Substance Abuse Treatment, 37, 1-7.

Posted in:  Drugs, Education, Tips, Treatment Tags: addicted, addicted doctor, addicted doctors, addiction, addiction research, alcohol problems, chronic disease, doctors, drug use, long-term treatment, McLellan, physician health programs, research, treatment, treatment addicted doctors

Addicts’ brains depressed but normal users… normal.

June 30th, 2010

A paper that’s about to be published in the journal Science has found at least part of the difference between the brains of addicted individuals and those that use recreationally.

The question as to why only some people get addicted to drugs has been a difficult one to answer. Still, there’s no doubt that only a relatively small fraction of those exposed to drugs develop the compulsive, often destructive pattern of use we associate with addiction. The pattern holds in animal research too – even though all the animals in an experiment get the same amount of drugs, delivered in the same way, only some of them develop addictive drug taking. It seems there’s something different about addicts’ brains, but what is it?

What’s different about addicts’ brains?

We’ve found quite a few things that differentiate addicts’ brains from those of normal research participants. These include lower density of a certain type of dopamine receptor (D2), reduced activity in specific brain parts like the OFC (orbitofrontal cortex) that are important in decision making and behavioral control. Still, if we start with what is supposed to be a pretty similar group of rats and give them all the same drug, for the same time, in the same amounts, why do only some get addicted?

This recent study found that a specific neuronal process called LTD (Long Term Depression), that is important in learning (or what we call plasticity) is suppressed in addicted animals for far longer than in animals that end up not not displaying addictive behavior. Even though all animals displayed this sort of deficiency in LTD right after learning to take drugs, only the addicted animals showed it when tested two months later.

Since the difference was seen in an area of addicts’ brains called the Nucleus Accumbens, a very important area for learning about rewards, it seems likely that it plays an important role in addicts’ inability to change their behavior after they’ve started using drugs. Past research has already identified this as a problem with something we call “reversal learning” but it seems we may have just found at least part of the mechanism.

Now we have to figure out why some animals show this sort of pattern and others don’t. Genetic variability seems like a good place to start here.

Citation:

F. Kasanetz, V. Deroche-Gamonet, N. Berson, E. Balado, M. Lafourcade, O. Manzoni, P. V. Piazza, Transition to addiction is associated with a persistent impairment in synaptic plasticity. Science 328, 1709–1712 (2010).

Posted in:  Drugs, Education Tags: addict brain, addicted, addiction, addiction research, addicts, addicts' brains, animals, Brain, brains, cocaine, D2, dopamine, drug use, Drugs, important, learning, neuroscience, pattern, science