Addiction Treatment Admissions in the United States: Everyone, meet TEDS

January 14th, 2011

Dirk Hanson

What a difference a decade makes.

Between 1998 and 2008, addiction treatment admissions in the U.S. increased markedly for methamphetamine (crystal meth), prescription opiates, and marijuana. Treatment admissions for alcohol and cocaine declined over the same period, while heroin admissions remained roughly the same.

The Treatment Episode Data Set (TEDS), which the Substance Abuse and Mental Health Services Administration (SAMHSA) uses to compile its report, includes only those addiction treatment facilities that receive state alcohol or drug agency funds, and which are represented in state administrative data systems. Despite this caveat, the TEDS study matters, because states use reports of this kind to shift limited resources from one treatment focus to another, based on demand. Read the rest of this entry »

Posted in:  Drugs, Education, Treatment Tags: addiction, addiction treatment admissions, admission, admission rate, admissions, cocaine, crystal meth, heroin, legalization, marijuana, methamphetamine, opiate, prescription drugs, SAMHSA, TEDS, treatment, treatment admission, treatment admission rate, treatment admissions

THC for HIV: Is smoking weed the only way?

December 29th, 2010

The medical marijuana debate is still raging and I have little doubt that it will be around for at least a decade to come. In the mean time, there is little doubt that marijuana, and more specifically its most active ingredient THC, are useful for individuals suffering from a number of medical conditions (see medical uses of marijuana). One of those conditions is HIV, where THC is particularly useful for helping patients fight the anorexia that often goes along with the infection and treatment. While a number of states (15 and the District of Columbia at last count) allow for medical marijuana prescriptions, most others require that patients get their THC in a synthetic form known as dronabinol.

Synthetic THC in a capsule

I’m not getting into the discussion of whether putting THC in a synthetic form is the American government’s way of directing money towards the pharmaceutical industry. The bottom line is that smoking marijuana, like smoking cigarettes, causes pulmonary (as in lung) problems including an increased risk of cancer as well as a host of other diseases like emphysema and such. New(ish) devices like vaporizers may help reduce that risk, but until more data comes in, I doubt those are going to cause any movement in terms of legislation. And since smoking marijuana is still illegal in most states, patients are pretty much left with the dronabinol pill.

The only problem is that something like 30% of HIV patients report smoking marijuana any way for relief of disease-associated symptoms and no one ever assessed the effectiveness of dronabinol on these patients until now. In this recent study, researchers assessed the efficacy of a very high dose of dronabinol (10mg – twice the recommended daily dose and half of the allowed daily maximum dose) on HIV/AIDS patients who smoke marijuana recreationally. Not surprisingly these patients showed a reduced response to the drug and even this high dose was only effective for the first half (eight days – during which they consumed 350 more calories a day and slept better) of the experimental period, after which it was no more effective than placebo at improving caloric intake and sleep.

The researchers’ conclusion in this article is that is seems higher doses are necessary for these patients, although I wonder about the rates of lying about regular marijuana use by patients given its legal status in most states. The patients in this study all smoked marijuana but while some smoked sporadically (2 days a week), others were daily or near daily smokers. I would assume that those two groups reacted differently to the dronabinol, but this paper didn’t address any such differences.

So… Do you have to smoke weed to get the medical benefit of THC?

Overall this study, like a few others before it, shows that synthetic THC is effective in treating a number of the effects of HIV/AIDS infection and treatment. Nevertheless, there is little doubt that HIV patients who use marijuana require different dosing than patients who don’t smoke weed, an effect that was probably predictable. Given the high prevalence of marijuana smoking among HIV/AIDS patients, it seems that more research should be carried out in order to fully develop a recommended dose range for such patients.

For HIV/AIDS patients who live in states where medical marijuana use is legal, it is likely easier and more cost effective to get their THC from marijuana leaves, though given their increased risk of infection and the lung effects of inhaling smoke, they should likely play it safe and use a vaporizer rather using more traditional methods (as in joint, bowl, or bong). The last thing HIV patients need to do is to put their body at any increased risk of any sort of medical complication. However, since dosing can be an issue this way, and since not everyone objects to the notion of taking pills instead of smoking weed, dronabinol might be a good options for those who are simply looking to counteract their infection complications and not to light up.

Citations:

Gillinder Bedi, Richard W. Foltin, Erik W. Gunderson, Judith Rabkin, Carl L. Hart, Sandra D. Comer, Suzanne K. Vosburg & Margaret Haney (2010). Efficacy and tolerability of high-dose dronabinol maintenance in HIV-positive marijuana smokers: a controlled laboratory study. Psychopharmacology, 212, 675-686.

Arno Hazekamp, Renee Ruhaak1, Lineke Zuurman, Joop van Gerven, Rob Verpoorte (2006). Evaluation of a vaporizing device (Volcano®) for the pulmonary administration of tetrahydrocannabinol. Journal of Pharmaceutical Sciences, 95, 1308-1317.

Posted in:  Education Tags: aids patients, dronabinol, high dose, high dose dronabinol, HIV, hiv aids, hiv aids patients, hiv patients, increased rish, marijuana, marijuana smoking, medical, medical marijuana, patients, smoking cigarettes, smoking marijuana, THC, thc synthetic form

About Addiction: Marijuana use, cigarette smoking, and crystal meth

December 27th, 2010

Hey ! After a brief period of inactivity we are back and better as always ready to provide you with your 30 minute tidbit of information about addiction. If you want to learn more about marijuana use, (cigarette) smoking, and addiction stigma then read on!

Marijuana use: Harmless?

Fox News- While many think that Marijuana a harmless drug (read our marijuana driving input), a guy high on weed drove his car into a group of cyclists in Italy. Eight cyclists were killed and an additional four people were injured. This accident can serve as a lesson that marijuana is not as “harmless” as a lot of people make it out to be. Educating the public about the dangers of driving under the influence of marijuana may help in preventing future incidents.

The Dome-Nobody is a stranger to the fact that voters in a number of states have been trying to legalize marijuana. But Illinois legislators just went the other way and struck down a bill which would allow medical marijuana to be legal. The legislators stuck this down with the fear that if this practice were legalized then there would be widespread use of marijuana. Right now fifteen states (and Washington DC) allow the use of medical marijuana but apparently Illinois decided they are not going to be the sixteenth.

Psychology Today- Can recreational pot smokers become addicted to marijuana? A large number of individuals only smoke marijuana recreationally and do not ever become addicted (see here), but about 10% to 30% of regular users will develop marijuana dependence (my vote is actually probably more for the 10%-20% range). About 9% will have a serious addition. Marijuana use in the U.S. has gone through quite an evolution from its early introduction in the 1970’s as an anti war statement to today when it is mostly used by teenagers and those who have been smoking for a long time. Most individuals quit when they are parents or homeowners (which is true of most drugs by the way), and this contributes to the thinking by some that marijuana is not very addictive.

Quitting smokingthrough personal stories

Bloomsburg Buisnessweek- Anti-smoking advertisements have been relying on fear appeals to persuade individuals to avoid or quit smoking smoking. But the commercials that show patients with a hole in their throat or the magazine ads showing a black and diseased lung have not really been very effective. However new research shows that advertisements that target emotions more broadly seem to work best when trying to prevent smoking. Personal testimonies seem to be the most effective because  they allow the individuals who are viewing them to emotionally identify with the person in the ad helping them find reasons why they themselves should quit smoking.

Guardian- Passive tobacco smoking kills more than 600,000 people in the world every year including about 165,000 children.  The most problematic regions in terms of these smoking deaths are third world countries due to the combination of the dangerous effects of second hand smoke and infectious diseases. Second hand smoke is most problematic in the home and although women smoke less they are more likely to be exposed to second hand smoke in the house.

Addiction Inbox- The electronic cigarette is finally here although in the past the FDA wanted to prevent these cigarettes from being marketed in the US. The decision to allow the marketing of these cigarettes was established as long as they are not targeted to minors. In addition marketing individuals cannot make any claims that the products are safe alternatives to tobacco. These products are a battery powered device that allow its users to “smoke” and inhale nicotine vapor without any fire, smoke, ash or carbon monoxide.

Alcoholism stigma and seeking treatment for drug addiction

Med- Individuals who are diagnosed with alcoholism are 60% less likely to seek treatment because they fear the stigma that is attached to alcoholism. To be an alcoholic means belonging to a stigmatized group, and no one likes that. The goal then should be to educate individuals in order to try to alleviate the stigma that is associated with alcoholism in order to allow more people to seek treatment from it. Reducing the stigma of addiction is a goal we at A3 take very seriously.

Recovery Now-If there is one thing that teenagers hate it is snooping parents by far. What is the parent is snooping for a good reason however? Is snooping around with concern that your child is using drugs or alcohol okay? Although a controversial topic this article looks at the implication of snooping and when it is okay to snoop in teenagers stuff. It is a great read, enjoy!

Crystal meth and Suicide-Veterans and Substance abuse

Honolulu advertiser- Hawaii has the worst crystal meth problem in the country and a school in Hawaii held a national crystal meth awareness day assembly. Forty percent of people arrested by police in Honolulu test positive for meth, and about 30,000 Honolulu residents are hard-core users of meth (with as many as three times more being recreational users). Government officials in Hawaii want to increase spending to make more drug treatment programs available to prison inmates. In addition the general public needs to be educated about the dangers of crystal meth.

Breaking the cycles-“Veterans at Higher Risk for Suicide,” is a radio broadcast which talks about the impacts of war on the mental health of all veterans in California. The issues that the radio broadcasts focuses on are anxiety, depression, and PTSD. The radio broadcast reported that veterans are at higher risk of committing suicide than other individuals who are not in the military. This article continues to address the topics of mental illness and how mental illness is a key risk factor to developing a substance abuse problem.

Posted in:  Education, Links Tags: crystal meth, marijuana, marijuana ise, meth, second hand smoke, smoke, smoking

Monitoring the Future by NIDA: Teen alcohol and drug use data from a national survey

December 13th, 2010

One of the perks of being an alcohol, drug use, and addiction researcher, as well as of writing for a website like this and Psychology Today, is that sometimes we get to talk to people that most can’t reach or to receive information that others might not have access to. NIDA‘s Monitoring the Future, a national survey of about 50,000 teens between 8th and 12th grades is a huge annual undertaking the results of which will be released tomorrow for general consumption.

But we got a little sneak peek before everyone else.

If you follow this sort of stuff, you know that teen alcohol and drug use is always shifting as new drugs become more popular and others lose favor with that group of Americans that can’t make up their minds. This year seems to give us more of the same.

Monitoring the future: Early alcohol and drug use results

1. Daily marijuana use, after being on the decline for a short while is apparently rising once again among teens, following last year’s continuing trend of a reduction in teens’ perceptions of marijuana harmfulness – We’ve written on A3 about some of the specific issues relevant to marijuana use including writing about Marijuana’s addictive potential and its medical benefit. There’s no doubt that the national marijuana debate will continue but the idea of 8th graders smoking weed doesn’t seem to be part of anyone’s plan.
2. Among some groups of teens drug use is proving more popular than smoking cigarettes – I guess this could be taken as evidence of the effectiveness of anti-smoking campaigns, though until we see the full numbers I’m not going to comment any further on that.
3. While Vicodin use among high-school seniors (12th graders) is apparently down, non-medical use of prescription medications is still generally high among teens, continuing a recent upward trend – Abuse of prescription stimulants has been on the rise for a number of years as the number of prescriptions for ADHD goes up, increasing access. It is interesting to see Vicodin use go down though the data I’ve received says nothing about abuse of other prescription opiate medications such as oxycontin, so I’m not sure if the trend has to do with a general decrease in prescription opiate abuse among teens.
4. Heroin injection rates up among high-school seniors (12th graders) – I think everyone will agree that this is a troubling trend no matter what your stance on drug use policy. The associated harms that go along with injecting drugs should be enough for us to worry about this, but again, I’ll reserve full judgment until I actually see the relevant numbers. I’m also wondering if this is a regional phenomenon or a more general trend throughout the United States.
5. Binge drinking of alcohol is down – As we’ve written before, the vast majority of problems associated with the over consumption of alcohol (binge drinking) among high-school students has to do with the trouble they get themselves in while drunk (pregnancies, DUI accidents, and the likes), so this is an encouraging trend though hopefully it isn’t simply accounting for the above mentioned increases in marijuana and heroin use.

Some general thoughts on NIDA’s annual Monitoring the Future results

I am generally a fan of broad survey information because it gets at trends that we simply can’t predict any other way and gives us a look at the overall population rather than having to make an educated guess from a very small sample in a lab. NIDA‘s annual MTF survey is no different although until I get to see all of the final numbers (at which point there will probably be a follow-up to this article) it’s hard to make any solid conclusions. Nevertheless, I am happy to see binge drinking rates among teens going down and if it wasn’t for that pesky increase in heroin injection rates I would say that overall the survey makes it look like things are on the right tracks.

I’ve written about it before and will certainly repeat it again – I personally think that alcohol and drug use isn’t the problem we should be focusing on exclusively since it’s chronic alcohol and drug abuse and addiction that produce the most serious health and criminal problems. Unfortunately, drug use is what we get to ask about because people don’t admit to addiction and harmful abuse because of the inherent stigma. Therefore, I think that it’s important for us to continue to monitor alcohol and drug use while observing for changes in reported abuse and addiction patterns. Hopefully by combining these efforts we can get a better idea of what drugs are causing increased harm and which are falling by the wayside or producing improved outcomes in terms of resisting the development of abuse problems.

Posted in:  Education, Opinions Tags: 12th graders, abuse, addiction, ADHD, Alcohol, alcohol drug, alcohol drug use, binge drinking, drug, drug use, heroin injection rates, high school seniors, high-school, marijuana, monitoring the future, NIDA, oxycontin, prescription drug use, prescription opiate, smoking, stimulant, teen, teen drug use, trend, use, vicodin

Is marijuana addictive? You can bet your heroin on that!

November 25th, 2010

This is the ultimate question for many people. In fact, when discussing addiction, it is rare that the addiction potential for marijuana doesn’t come up.

Some basic points about marijuana:

The active ingredient in marijuana, THC, binds to cannabinoid receptors in the brain (CB1 and CB2). Since it is a partial agonist, it activates these receptors, though not to their full capacity. The fact that cannabinoid receptors modulate mood, sleep, and appetite to some extent is the reason behind many of marijuana’s effects.

But how is marijuana addictive? What’s the link to heroin?

What most people don’t know is that there is quite a bit of interaction between the cannabinoid receptor system (especially CB1 receptors) and the opioid receptor system in the brain. In fact, research has shown that without the activation of the µ opioid receptor, THC is no longer rewarding.

If the fact that marijuana activates the same receptor system as opiates (like heroin, morphine, oxycontin, etc.) surprises you, you should read on.

The opioid system in turn activates the dopamine reward pathway I’ve discussed in numerous other posts (look here for a start). This is the mechanisms that is assumed to underlie the rewarding, and many of the addictive, properties of essentially all drugs of abuse.

But we’re not done!

Without the activation of the CB1 receptors, it seems that opiates, alcohol, nicotine, and perhaps stimulants (like methamphetamine) lose their rewarding properties. This would mean that drug reward depends much more heavily on the cannabinoid receptor system than had been previously thought. Since this is the main target for THC, it stands to reason that the same would go for marijuana.

So what?! Why is marijuana addictive?

Since there’s a close connection between the targets of THC and the addictive properties of many other drugs, it seems to me that arguing against an addictive potential for marijuana is silly.

Of course, some will read this as my saying that marijuana is always addictive and very dangerous. They would be wrong. My point is that marijuana can not be considered as having no potential for addiction.

As I’ve pointed out many times before, the proportion of drug users that become addicted, or dependent, on drugs is relatively small (10%-15%). This is true for almost all drugs – What I’m saying is that it is likely also true for marijuana (here is a discussion of physical versus psychological addiction and their bogus distinction).

Citation:

Ghozland, Matthes, Simonin, Filliol, L. Kieffer, and Maldonado (2002). Motivational Effects of Cannabinoids Are Mediated by μ-Opioid and κ-Opioid Receptors. Journal of Neuroscience, 22, 1146-1154.

Posted in:  Drugs, Education, Marijuana, Opiates, Tips Tags: about addiction, addiction, addiction research, addictive, addictive properties, Brain, canabinoid receptors, cannabinoid, cannabinoid receptor, CB1, cb1 receptor, cb1 recpetor, dopamine, drug abuse, Drugs, fact, heroin, is marijuana addictive, marijuana, marijuana addictive, neuroscience, opioid, pot, receptor, receptors, THC, weed

Gambling on marijuana use makes for bad decisions

November 12th, 2010

I just can’t seem to stay away from the marijuana debate, even given the recent defeat of Proposition 19 that aimed to legalize marijuana in California. This article is a short one, but speaks to some of the cognitive issues associated with marijuana use.

A study (see here) conducted by a Wake Forest University team (Including Doctor Linda Porrino) found that habitual marijuana smokers (those who smoked an average of twice a day for seven years) may be bad at detecting negative outcomes.

The experiment used fMRI scanning technology to examine the brain activity of smokers and controls during the Iowa Gambling Task, which uses four decks of cards. Two of the decks yield large, infrequent, rewards as well as losses. The other two decks yield small, more frequent rewards, and less losses. The first two are considered the “bad” decks, and the latter two the “good” decks, because selecting from the small-gain, small-loss, decks will result in more gain overall. The task is considered a pretty good, if complex, measure of risk-taking, decision making, and loss-discounting.

The take-home result from the study: Not only did marijuana smokers take longer to learn how to maximize their rewards, but their decision-making brain regions seemed to show lower overall responding during the task, meaning they were less active while performing the decisions. And as you can see from the graph on the left, while the controls were able to achieve overall gains, the same was not true for the long-term marijuana users even after 100 repetitions. It seems that marijuana smokers’ brains were not as efficient at detecting losses and responding to them. Maybe that’s why marijuana users are the first to claim that marijuana use has no negative outcomes associated with it…

As usual, it is important to note that since the participants in the study were not randomly assigned to long-term marijuana smoking, it’s impossible to know if these deficits are specifically caused by marijuana use or if they were pre-existing. Nevertheless, these results strongly suggest that individuals who engage in long-term use of marijuana are cognitively distinct from those who don’t. I think that plays into the argument that marijuana legalization would not increase use, because if that’s actually true, then there’s something different about individuals who choose to smoke weed and it is not the legal status that matters. I suspect that in actuality, people who currently choose to smoke marijuana long-term are in fact distinct, in some ways, from some of the people who would take up smoking the stuff if it became legal.

Citation:

Christopher T. Whitlowa, Anthony Liguoria, L. Brooke Livengooda, Stephanie L. Harta, Becky J. Mussat-Whitlowb, Corey M. Lamborna, Paul J. Laurientic and Linda J. Porrino (2004). Long-term heavy marijuana users make costly decisions on a gambling task. Drug and Alcohol Dependence, 76, 107-111.

Posted in:  Drugs, Education, Marijuana Tags: Brain, decision, decision making, fMRI, gambling, long term, loss, marijuana, marijuana use, marijuana user, marijuana users, reward, risk taking, smoker, task, weed

About Addiction: Alcohol, drugs, and bipolar disorder

November 11th, 2010

Have any questions about different drugs or alcohol? We bet you do and we’re glad to see you back at All About Addiction ! You should browse our content and check out the information on alcohol, heroin, marijuana.  It is a great source for a quick 30 minute information session.

“Traditional” Drugs

BBC- A man in England was killed after consuming heroin that contained anthrax in it. This was the fifth case of a drug user in England who became ill due to anthrax. It appears that drug users are becoming increasingly vulnerable to having their contraband contaminated with anthrax.

Join Together- Do you think Marijuana should be legalized? That was the question on the minds of many individual’s as they went to the polls on Election Day, yet despite the concerted efforts of some people Proposition 19 was defeated. Some of the arguments for supporting the legalization of marijuana was so that it would be treated like alcohol and tobacco and would not be criminalized along with drugs like heroin, meth, and cocaine. Apparently the majority of voters thought those benefits didn’t outweigh the possibility that legalizing marijuana would increase social problems. By the way, this is not the first time Californians have rejected the legalization of marijuana, it also occurred in 1972, which likely means that some of the people who voted against it this time supported it in the past.

Synthetic Drugs and new drug combinations

KTLA-How does a drink of prescription cough syrup, soda and jolly ranchers sound to you?  Although this may be unappealing to some it is actually a drink bar-goers are getting in to. The drink is also known as Sizzurp (I’m pretty sure I’ve heard Snoop Dog say that in song) and can produce quite a high thanks to the codeine that is found in it. Unfortunately, the combination of alcohol and codeine also increases the chance that the drink will be deadly deadly. Apparently this drink is often promoted by individuals in the music industry and the DEA is worried and wants to crack down on it.

Addiction Inbox- If you would like to learn about a new drug called Mephedrone then this article is for you ! Mephedrone is a new synthetic drug found mostly in England. For more on this topic check out Dirk’s article!

Alcohol: Working Mothers and Energy Drinks

Marin Institute- There has been a growing recognition of the risks of alcoholic energy drinks and officials across the country are starting to take action against them (who hasn’t had a RedBull and Vodka?). Often times these energy drinks are marketed to youth but those individuals do not know the stress that high amounts of alcohol and caffeine can have on the body. Since 2008 major companies such as MillerCoors, Anhueser-Busch, and InBev have removed caffeine from their brands, but smaller companies have begun marketing even more dangerous products that come in larger sizes with higher alcohol content. The news media is attempting to educate the public on the dangers of these products and legal action may even be taken. Check out this article for a great read!

CNN- Working mothers have a lot to balance in their daily lives from running kids to school to doing errands and keeping houses and lives in order – it’s a tough job (just ask my wife). The magazine Working Mother found that 40 percent of working mothers turn to alcohol to try to alleviate stress and 57 percent reported misuse of prescription drugs. Check out this article to find out more and to watch a video which discusses this fuller details and don’t forget to look at some of our content on moderate alcohol intake.

Mental Health and Addiction Treatment

Breaking the cycles- It has often been reported that individuals who have certain mental health problems such as bipolar disorder have a greater chance of developing substance abuse problems (to alcohol or drugs). This article is very helpful in providing the families of individuals with bipolar disorder information to understand the disorder better as well as the alcohol and or drug abuse than may come with. With this understanding the families of these individual can help reduce the stigma of both the bipolar disorder and their addiction.

Addiction Information- Do you remember a couple weeks ago when All About Addiction reported that Michael Lohan wanted to open up his own rehab center? Well the apple does not fall to far from the tree because Lindsay Lohan now wants to open up her own rehab center.  Lindsay has been in and out of rehab five times in the past two years – Is this too early for her to open up a rehab center? I think that’s probably true and that she should focus on getting herself healthy first.

Posted in:  Links Tags: about addiction, addiction, Alcohol, all about addiction, bipolar disorder, drug, Drugs, energy drinks, heroin, legalizing, legalizing marijuana, marijuana, meth, open rehab, open rehab center, proposition 19, rehab center, stigma, working mothers