[Press release] People with opioid dependence in recovery show ‘re-regulation’ of reward systems — ScienceDaily
Newswise — December 9, 2014 – Within a few months after drug withdrawal, patients in recovery from dependence on prescription pain medications may show signs that the body’s natural reward systems are normalizing, reports a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
The study by Scott C. Bunce, PhD, of Penn State University College of Medicine, Hershey, and colleagues provides evidence of “physiological re-regulation” of disrupted brain and hormonal responses to pleasurable stimuli—both drug- and nondrug-related.
Signs of Reward System Disruption After Drug Withdrawal…
The pilot study included two groups of seven patients in residential treatment for dependence on opioid pain medications. One group had recently gone through medically assisted opioid withdrawal—within the past one to two weeks. The other group was in extended care, and had been drug-free for two to three months. A group of normal controls were studied for comparison.
The researchers performed several tests to assess changes in the “brain reward system” during early recovery. After drug withdrawal, many people with opioid dependence have “persistent changes in the reward and memory circuits”—they may experience heightened “rewards” or “pleasure” in response to drugs and related stimuli, but greatly reduced responses to naturally pleasurable stimuli (such as good food, or friendship).
Dr Bunce explains, “This is thought to occur because opiates are potent stimulators of the brain’s reward system; over time, the brain adapts to the high level of stimulation provided by opiates, and naturally rewarding stimuli can’t measure up.” Such dysregulation of the natural reward system may contribute to the high risk of relapse during recovery.
The test results showed several significant differences in the reward system between groups. A test of startle reflexes showed that patients with recent drug withdrawal had reduced pleasure responses to “natural reward” stimuli—for example, pictures of appetizing foods or people having fun.
In brain activity studies, patients with recent drug withdrawal showed heightened responses to drug-related cues, such as pictures of pills. In the extended-care patients, these increased responses to drug cues—in a region of the brain called the prefrontal cortex, involved in attention and self-control —were significantly reduced.
…May Lead to New Objective Measures of Recovery
Patients who had recently withdrawn from opiates also had high levels of the stress hormone cortisol (adrenaline). In the patients who had been drug-free for a few months, cortisol levels were somewhat reduced, although not quite as low as in healthy controls. The recently withdrawn group also had pronounced sleep disturbances, while sleep in the extended care group was similar to controls.
All of these changes—brain and hormonal responses to drug cues and natural rewards, as well as sleep disturbances—were correlated with abstinence time. The more days since the patient used drugs, the lower the abnormal responses.
The study supports past research showing dysregulation of the reward system during early recovery from opioid dependence. It also provides evidence that these responses may become re-regulated during several weeks in residential treatment—a period of “clinically documented” abstinence from opioids.
That’s a potentially important step forward in addiction medicine research, Dr Bunce believes. “It shows that if the patient remains in treatment and off drugs for several months, the body’s natural reward systems may have the capacity to return toward normal, making it easier for them to remain drug-free outside the treatment setting.” With further study, tests of the natural reward system might provide useful, objective markers of recovery—clinical tests that help to evaluate how the patient’s recovery is proceeding.
Such tests might help in managing the difficult problem of prescription opioid dependence—an ongoing epidemic associated with a high risk of relapse after drug withdrawal. Dr Bunce and colleagues are conducting a follow-up study, funded by the National Institute on Drug Abuse, to determine whether measures of the brain’s reward system, sleep and the stress response system indicate the capacity for re-regulation and the patient’s risk of relapse during recovery.
[Press release] Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence | Full Text Reports…
Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD).
We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression. All patients were treatment-seeking and had moderate-to-severe symptoms.
The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology.
IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression. Our findings suggest that strategies to reduce aggression in patients with IA are necessary and that IA and AD are closely related and should be dealt with as having a close nosological relationship.
Cocaine addicts may become trapped in drug binges — not because of the euphoric highs they are chasing but rather the unbearable emotional lows they desperately want to avoid.
In a study published today online inPsychopharmacology, Rutgers University Behavioral and Systems Neuroscience Professor Mark West, and doctoral student David Barker in the Department of Psychology, in the School of Arts and Sciences, challenge the commonly held view that drug addiction occurs because users are always going after the high. Based on new animal studies, they discovered that the initial positive feelings of intoxication are short lived — quickly replaced by negative emotional responses whenever drug levels begin to fall.
If these animal models are a mirror into human addiction, Rutgers researchers say that addicts who learned to use drugs to either achieve a positive emotional state or to relieve a negative one are vulnerable to situations that trigger either behavior.
“Our results suggest that once the animals started a binge, they may have felt trapped and didn’t like it,” said West. “This showed us that negative emotions play an equal, if not more important role in regulating cocaine abuse.”
- Sticks & Stones: Removing the Stigma of Addiction (aspireindianablog.wordpress.com)
- Addiction and Medication Treatment: Managing Recovery Through Medications (aspireindianablog.wordpress.com)
- Western University make discover that could end opiate addiction (lfpress.com)
- Brain’s ‘Dark Side’ May Be Key To Cocaine Addiction (medicalnewstoday.com)
Pregnant women who abuse drugs, alcohol need compassion, not stigma from doctors and society: experts
My sentiments exactly, real humans do not shame!
Seeing a pregnant women smoking a cigarette, imbibing a glass of wine or using drugs is sure to raise a societal eyebrow.
But a new report says women with substance abuse problems should be treated with compassion by health providers and society at large, especially during pregnancy, because addiction is a brain disorder and not a personal failing.
“It’s harmful for us to look upon pregnant women with addiction issues and assume it’s as simple as saying: ’For the sake of the baby, stop using,”’ said Colleen Dell, research chair in substance abuse at the University of Saskatchewan.
The report says pregnancy offers an opportunity for doctors to help women seek treatment for addiction, while providing comprehensive care aimed at maximizing the health of both mother and baby.
That treatment should involve a wide range of care providers and programs, including addiction counselling, medication-assisted therapy and community resources for parents, the report says.
“When this continuum of care is provided, we see healthier babies and fewer premature births, and overall maternal and infant mortality rates go down,” said Finnegan.
But many women are hesitant to seek treatment because of the stigma around using a substance that’s known to be harmful to their developing fetus, she said.
It’s important to look at the antecedents to drug addiction, said Finnegan, noting that about 98% of the women in her clinic had been sexually or physically abused as children or as adults.
Often women also won’t seek medical help because they’re afraid of losing their children
“This is very much like PTSD (post-traumatic stress disorder). They have had trauma and taking a drug permits them to forget these terrible feelings that they have had. When they take the psychoactive drugs … they become addicted.
“So the first step is that we get them into treatment and help them feel welcome.”
Often women also won’t seek medical help because they’re afraid of losing their children to protective services if they admit to an addiction, she said, suggesting the judicial system has to change.
Dealing with stigma is the greatest challenge in trying to help pregnant women with an addiction, said Franco Vaccarino, a professor of psychiatry and psychology at the University of Toronto and chairman of the CCSA’s scientific advisory council.
“Addiction is a disorder of the brain,” he stressed.
‘Simply put, your brain is different after prolonged substance abuse than it was before’
“Simply put, your brain is different after prolonged substance abuse than it was before. Addiction fundamentally changes neurological functioning and it makes it next to impossible to just quit for the sake of the baby without significant supports.
“The challenge is anchoring the narrative of this discussion in health terms,” Vaccarino said. “If you anchor it in health terms and move it away from justice and moral and will-related issues, you focus the narrative around addiction, which is where it should be.”
- Pregnant women abusing drugs need compassion (cbc.ca)
- Drug use during pregnancy affects baby: report (metronews.ca)
- Case Explores Rights of Fetus Versus Mother (nytimes.com)
- Legal moves to further protect foetuses threaten rights of US mothers (irishtimes.com)
- Fetus ‘Personhood’ Law Results In Arrest And Shackling Of Pregnant Wisconsin Mom (addictinginfo.org)
- Fetus Sues Mother — Case Explores Rights of Fetus (articles.mercola.com)
- Task force targets pregnant drug abusers (kokomotribune.com)
- As Fetuses Gain Personhood, Women Lose It (abortion.ws)
- Sticks & Stones: Removing the Stigma of Addiction (aspireindianablog.wordpress.com)
- Substance abuse linked to troubled children (fijitimes.com)
“You don’t have any idea what you’re dealing with, do you?” asked Mr. Johnson a mere two minutes into my interview. The scene is the Crisis Intervention Unit. The time is 3:00am. I have a feeling my breath is terrible. The hospital pizza I engulfed earlier in the evening has decided to stage a churning acidic protest in my guts. However, far worse than my half-closed eyes, my halitosis or my gastrointestinal distress is the fact that he’s absolutely right. Mr. Johnson is here because he has come to the realization that living sober is about as awful as living as an alcoholic. As a result, he has decided life is simply not worth living.
As a practitioner, patients caught in this double-bind are among the most frustrating to treat. They are living proof that substance dependence treatment can be quite shortsighted. The logic is charmingly simple and irritatingly simplistic: if you’re drinking too much, then you should probably stop. Once you stop, all will be better.
To properly understand the failure of this logic, we need to distinguish the brain from the mind. Although our medications and therapies are effective in removing alcohol from the brain, we are less successful filling the empty space left in the mind. Mr. Johnson’s alcohol use started as a coping strategy and slowly evolved into a way of navigating the world: a drink to take the edge off at a dinner party; a libation or five to take the edge off of a bad day at the office; a quick stop at the corner bar after work to steel himself against a troubled marriage and a wayward teen. Alcohol played prominently in the way his mind functioned for years….
- 5 Ways to Stay Sober After Rehab (24sober.wordpress.com)
- Addiction Recovery – Like Coming Out of a Black Hole (nakunion.wordpress.com)
- What to Do if Your Family Has a History of Addiction (narcononarrowheadreview.wordpress.com)
From the Criminal Injustice Blog item of April 2, 2013
By Louellyn Lambros
It is time that drug use be viewed as a public health issue, rather than a matter for the criminal justice system. Too many drug users are saddled unnecessarily with criminal records, making it extraordinarily difficult to have fulfilling lives including being able to work and to make other kinds of valuable contributions to their families and society.
The skyrocketing incarceration rate in our country has been an outgrowth of the War on Drugs, which began over thirty years ago and had its roots in a political strategy to gain the votes of disaffected whites, in the wake of a successful Civil Rights struggle. Since outright discrimination on the basis of race was no longer acceptable or legal, an alternative route was to label African-Americans as criminals, thereby opening the door to reintroduce all the same forms of discrimination – in employment, housing, voting rights, and so on.
As the number of incarcerated people in the US grew from 300,000 in the last half of the 20th century to over 2.2 million today, racism continues to fuel the revolving door of our fellow citizens into the criminal justice system. In addition, the system has become big business, employing a growing number of judges, lawyers, prosecutors, and all types of ancillary personnel. Prisons themselves are becoming increasingly privatized, run as money-making corporations which sell shares on the NYSE. In thirty-seven states, prison labor is contracted to major corporations who pay 16 to 28 cents an hour, ensuring astronomical profits.
While the majority of Americans, once educated on the issue, may be persuaded by the injustice of the situation as it affects minority communities and may be horrified by how the one percent is capable of turning anything into a lucrative business, it will take more time and effort to address the concerns of those whose loved ones have suffered from addiction and subsequent incarceration.
The truth is that no one, particularly the most vulnerable dealing with drug addiction, is served by the current system. Those who are susceptible to addiction are even more vulnerable and in need of self-soothing in the face of extreme stress. Why do therefore we respond to their difficulties with a system of incarceration which stresses them to the max and saddles them with second-class citizen status as a ‘felon’ upon release back into their home communities?
A policy of decriminalization, as has been in place in Portugal since 2001, would take the whole issue of drug addiction out of the criminal justice system and make it a civil and public health matter. A panel of three– made up of two individuals with a health background and one with a legal background–would make a determination: is this person’s drug use a problem? If not, perhaps a fine or a warning will suffice. If it is deemed a problem, treatment and rehabilitation are in order. Treatment facilities could easily be funded by resources reallocated from the criminal justice system.
- A new day for the ‘war on drugs’ (maddowblog.msnbc.com)
- Jason Silverstein: More Treatment, Less War: The White House Drug Policy Reform (huffingtonpost.com)
- 21st Century Drug Policy (propresobama.org)
- Drug Policy Reform In Action: A 21st Century Approach (whitehouse.gov)
- Focusing On Prevention And Neuroscience, President Ends Reagan’s War On Drugs (newsone.com)
New definition of addiction: Addiction is a chronic brain disease, not just bad behavior or bad choices
The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.
When people see compulsive and damaging behaviors in friends or family members — or public figures such as celebrities or politicians — they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation’s largest professional society of physicians dedicated to treating and preventing addiction…..
Authorities in the field of foodaddiction at the University of Florida say new research indicates that overeating andobesity problems might be effectively tackled if people would limit their food choices.
Editorializing in the August edition of the American Journal of Clinical Nutrition, Nicole M. Avena, Ph.D., a research assistant professor, and Mark S. Gold, M.D., chairman of the UF College of Medicine’s department of psychiatry, suggest modern living presents many delicious possibilities for people at mealtime – too many for people who respond to food as if it were an addictive drug…