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…..The New England Journal of Medicine recently published a review of the “brain science” related to addiction and its management by Dr. Nora Volkow and her colleagues. It is a great review with terrific graphics. I’ve sent it to several of my colleagues.
It would take many blog posts to summarize in detail what goes on in the article (let alone the brain), so I’ll hit the points that are most meaningful to me as a practitioner and citizen — and forgive me if I get a little personal.
A look into the science of addiction
The most depressing course I took in college was an introduction to behaviorism. The low point was when I came to believe that free will did not exist, though I later came to believe that this was a narrow and false conclusion. Humans, with our over-developed frontal cortices, have the power to choose not to respond the way, for example, a pigeon would in an experiment of rewards and punishments. When I became a doctor, I perceived that people suffering with addiction were stripped of their fundamental liberty to choose to live life as they would want (within social and economic constraints). I can honestly say that helping to restore some of that freedom is among the most rewarding things I do as a doctor. That’s the personal stuff.
An addicted person’s impaired ability to stop using drugs or alcohol has to do with deficits in the function of the prefrontal cortex — the part of the brain involved in executive function. The prefrontal cortex has several important jobs: self-monitoring, delaying reward, and integrating whatever the intellect tells you is important with what the libido is telling you. The difficulty also has to do with how the brain, when deprived of the drugs to which it is accustomed, reacts to stress.
What this all means for overcoming an addiction
It is not enough simply to “just say no.”
The person needs to develop alternative sources of joy and reward, and people who have been isolating themselves in order to drink or use drugs without inhibition may need to work in a purposeful way to re-acquire habitual “joy” — social interactions, physical pleasures like a swim or a bike ride, and other healthy, enjoyable rewards.
At the same time, to say that substance use disorders are “all biology” is an over-simplification. Clearly, there are people on the mild end of the spectrum who have the ability to choose to stop or cut back. For these people, when the rewards of not using outweigh those of using, they stop. Some people with a pattern of unhealthy drug or alcohol use that meets criteria for a diagnosis of substance use disorder may also “mature” out of it without formal treatment. However, the more severe the diagnosis (in other words, the more diagnostic criteria that are met), the less likely this is to happen.
There is no specific repellent that works better against the Aedes mosquito
There are many repellents that are effective against all mosquitoes including Aedes mosquitos. Effective repellents contain DEET (diethyltoluamide) or IR 3535 or Icaridin which are the most common biologically active ingredients in insect repellents. Active ingredients are listed on the product label. The following active ingredients repel or kill the mosquito when it rests or approaches the body: DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3- [N-butyl-N-acetyl], aminopropionic acid ethyl-ester) or Icaridin (piperidinecarboxílico acid-1, 2- (2-hydroxyethyl) – 1-metilpropilester).
There is no minimum or maximum percentage of active ingredient required. Insect repellents may be applied to exposed skin to protect against the bites of mosquitoes or on the clothes. WHO recommends covering the skin with clothing as much as possible and using insect repellents as effective measures to protect against bites from mosquitoes that transmit viruses such as chikungunya, dengue, yellow fever and Zika.
Repellents must be used in strict accordance with the label instructions. There is no evidence of any restriction of the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label.
No evidence that vaccines cause microcephaly in babies
There is no evidence linking any vaccine to the increases in microcephaly cases that were observed first in French Polynesia during the 2013-2014 outbreak and more recently in northeastern Brazil.
An extensive review of the literature published in 2014 found no evidence that any vaccine administered during pregnancy resulted in birth defects.
No evidence that pyriproxyfen insecticide causes microcephaly
A team of WHO scientists recently reviewed data on the toxicology of pyriproxyfen, one of 12 larvicides that WHO recommends to reduce mosquito populations. It found no evidence that the larvicide affects the course of pregnancy or the development of a fetus. The US Environmental Protection Agency and EU investigators reached a similar conclusion when they carried out a separate review of the product.
No evidence that the Zika outbreak and unusual increase in microcephaly cases in Brazil is linked to recent releases of genetically modified mosquitoes in Brazil
No evidence that sterilized male mosquitoes contribute to the spread of Zika
Bacteria used to control the male mosquito population are not spreading Zika further
Fish can help stop Zika.
Some countries affected by Zika and dengue are using biological methods as part of an integrated approach to mosquito control. El Salvador, for example, with strong support from fishing communities, is introducing larvae-devouring fish into water storage containers.