June 20th, 2010
At this year’s College on Problems of Drug Dependence (CPDD) Annual Meeting, I got to hear, and talk to, some of the most influential players in the American addiction research field. Here are a few highlights from their talks and our discussion:
Dr. Nora Volkow of NIDA talked about a shift from Genome Wide Association Studies (GWAS), which have been the most recent popular advance in genetics addiction research and into more Deep Sequencing work. The hope is that this will allow us to begin untangling some of the GWAS findings that have seemed counter-intutitive or puzzling. Deep sequencing should let us see what genes really are associated with addiction specifically, not just as markers.
Dr. Volkow also brought up the numerous issues of medications for addictions including the Nabi Nicotine Vaccine, Vivitrol (a Nalexone depot that helps opiate users who wouldn’t take it otherwise), and a host of new medications that are being developed or considered. An interesting idea here was the use of drug combinations which are showing great promise in providing enhanced treatment results (similar to HIV treatment that benefited greatly from drug cocktails). These include combining vernicline and bupropion for smoking and naltrexone and buprenorphine for cocaine (that’s not a type even though both have been typically thought of for opiate addicts).
Dr. Tom McLellan, who I personally believe is one of the most informed and thoughtful people we have when it comes to addiction research in this country, talked about our need to expand the reach of treatment to the drug abuse earlier in the problem cycle. While about 25 million people are considered drug addicts in this country, more than 65 million are drug abusers. By finding ways to reach those people in primary care (as in doctor offices) settings before they develop the full blown addiction we’re used to talking about we can do better. He also mentioned the idea of anonymity in recovery playing a role in the continued stigmatization of addiction, a topic I’ve written about recently.
Stay on the lookout for more amazing new addiction research knowledge!
|Posted in: Drugs, Education
Tags: about addiction, addiction help, addiction research, addicts, anonymity, Buprenorphine, bupropion, CPDD, GWAS, McLellan, naltrexone, nicotine, NIDA, ONDCP, policy, recovery, vaccine, vivitrol, Volkow
April 28th, 2010
It’s not everyday that I get an invite to speak with NIDA‘s director, Dr. Nora Volkow, and so, even though it required my creative use of some VOIP technology from a living room in Tel-Aviv, I logged onto a conference call led by the leading addiction researcher. When my colleagues, Dirk Hanson and Elizabeth Hartney, were introduced, I knew I was in good company.
Addiction research directions the NIDA way
The call focused on some NIDA interests, including a nicotine vaccine, which Dr. Volkow seemed confident will triumphantly exit phase 3 trials in less than two years and potentially enter the market after FDA approval in three years or less. The vaccine, which seems to significantly and effectively increase the production of nicotine antibodies in approximately 30% of research participants, has shown promise as a tool for smoking cessation in trials showing complete cessation, or significant reduction in smoking among participants that produced sufficient antibodies. Obviously, this leaves a large gap for the 70% of participants for which the vaccine was not effective, but a good treatment for some is much better than no treatment for all. For more on the vaccine, check out Mr. Hanson’s post here.
Aside from the nicotine vaccine (and on a similarly conceived cocaine vaccine), our conversation centered on issues relevant to the suggested new DSM-5 alterations in addiction-related classifications. Dr. Volkow expressed satisfaction at the removal of dependence from the title of addictive disorders, especially as physical dependence is often part of opiate administration for patients (especially pain patients) who are in no way addicted to the drugs. Dr. Volkow also noted that while physical dependence in relatively easy to treat, addiction is not, a matter that was made all the more confusing by the ill-conceived (in her opinion, and in mine) term. Additionally, the inclusion of severity ratings in the new definition, allowing for a more nuanced, spectrum-like, assessment of addiction disorders, seemed to make Dr. Volkow happy in her own, reserved, way.
Treatment matching – rehab search for the 21st century
As most of my readers know, one of my recent interests centers on the application of current technology to the problem of finding appropriate treatment for suffering addicts. I brought the problem up during this talk, and Dr. Volkow seemed to agree with my assessment that the current tools available are nowhere near adequate given our technological advancements. I talked a bit about our upcoming addiction-treatment-matching tool, and I hope that NIDA will join us in testing the utility of the tool once we’re up and running. I truly believe that this tool alone will allow more people to find appropriate treatment increasing the success rate while maximizing our system’s ability to treat addicts.
Involving the greater public in addiction research
It wasn’t until the end of the conversation that I truly understood the reason for the invitation (I’m slow when it comes to promotional issues) – NIDA is looking to move the discussion about it’s goals and directions out of the academic darkness in which they’ve lurked for years, and into the light of online discussion. I’m in no way offended by this, especially since this was exactly my point in starting All About Addiction in the first place. If anything, I’m honored to be included in the select group of people NIDA has chose to carry their message, especially since the conversation was an open, respectful, and data-centered one. I hope more of these will occur in the future.
Resolving confusion about addiction
One of the final points we got to discuss in the too-short hour we had Dr. Volkow on the “phone” had to do with the oft misunderstood concept of physical versus psychological addictions. I’ve written about this misconception in the past, and so I won’t belabor the point here, but it’s time that we gave our brain the respect it deserves by allowing it to join the rank, along with the rest of our body, and the physical realm. We’re no longer ignorant of the fact that our personalities, memories, feelings, and thoughts are driven by nothing more than truly physical, if miniature, happenings in our brains. In the same way that microbe discovery improved our well-being (thank you Pasteur), it’s time the concept of the very physical nature of our psychological-being improves our own conceptualization of our selves.
We are physical, spiritual, and awesome, but only if we recognize what it is that makes “us.”
|Posted in: Education, Medications, Treatment
Tags: About, Addiction Inbox, antibodies, cocaine, confusion, dependence, DSM, FDA, matching, nicotine, NIDA, phase 3, physical, psychological, rehab, rehabilitation, rehabs, smoking, spectrum, vaccine, VOIP, Volkow
September 10th, 2009
Genetics are making their way into every facet of research nowadays, and addiction treatment is no slouch in that area.
What is pharmacogenomics?
If you haven’t heard of pharmacogenomics yet, you are sure to soon. The idea that medications affect individuals differently based on their unique genetic makeup has picked up a lot of steam in the last few years.
Well, the same way of thinking is beginning to emerge in addiction treatment.
What can we expect?
Just as pharmacogenomics is said to greatly increase the usability of certain prescription drugs while reducing the worse side effects, so is the use of genetics in addiction treatment purported to bring more personalized, effective treatment to patients.
For instance, pharmacogenomics could inform us as to who is more likely to respond well to treatment using buprenorphine for craving reductions. It could possibly even tell us who would benefit more from specific behavioral interventions. Eventually, it may allow us to build a customized treatment program for addicts based on their genomic profile.
The importance of genetics!
And no one should underestimate the importance of genetics in addiction. In a recent congressional hearing, Dr. Nora Volkow, the head of the federal agency entrusted with advancing addiction research, NIDA, told congress that about 75% of a person’s inclination to begin smoking, 60% of one’s tendency to become addicted, and about 54% of a person’s ability to quit were genetically determined.
As we learn more about addiction treatment and the importance of specific genetic markers, I’m sure that individual addicts’ genes will play a pretty big role in what course of treatment people are given. Genetics might soon be the newest, most groundbreaking advancement in rehabs and recovery. But we’re not there yet so don’t let anyone fool you that they’ve figured out the formula for this!!!
|Posted in: Drugs, Education, Treatment
Tags: addiction, customized treatment, genetics, groundbreaking, NIDA, pharmacogenomics, recovery, rehabs, smoking, treatment, Volkow