…..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.
Last month I unfriended (FB) Huffington Post. The postings were increasingly not only sexual in nature, but outright base. Came across this one via a FB friend, and am grateful. While I believe the jury is still out, it does highlight a factor that probably has been overlooked. Caring compassionate communities do make a difference. Reminds me of a story about an inmate. He was very angry with another inmate, so much so he was contemplating murder. He told this to other members of his prayer group. He also related that he did not murder because he didn’t want to let the prayer group members down.
From the 20 January 2015 Huffington Post article
It is now one hundred years since drugs were first banned — and all through this long century of waging war on drugs, we have been told a story about addiction by our teachers and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my new book, Chasing The Scream: The First And Last Days of the War on Drugs, to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong — and there is a very different story waiting for us, if only we are ready to hear it.
If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves.
The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.
At first, I thought this was merely a quirk of rats, until I discovered that there was — at the same time as the Rat Park experiment — a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported using heroin was “as common as chewing gum” among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers had become addicted to heroin there, according to a study published in the Archives of General Psychiatry. Many people were understandably terrified; they believed a huge number of addicts were about to head home when the war ended.
But in fact some 95 percent of the addicted soldiers — according to the same study — simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so didn’t want the drug any more.
Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.
There just might be something to this. Can only speak for myself. There’s a bottle in the house with about 10 oxycodone pills left over from my husband’s hospital admission. Been there from about a year. I’ve taken three when I thought they were needed. Could be argued I’m not physiologically wired for them. But I think I have a relatively stable life and good support…
Date:November 10, 2014Source:Center for BrainHealthSummary:The effects of chronic marijuana use on the brain may depend on age of first use and duration of use, according to new research. Researchers for the first time comprehensively describe existing abnormalities in brain function and structure of long-term marijuana users with multiple magnetic resonance imaging (MRI) techniques.
Addictive behavior such as drug and alcohol abuse could be associated with poor development of the so-called “love hormone” system in our bodies during early childhood, according to researchers at the University of Adelaide. The groundbreaking idea has resulted from a review of worldwide research into oxytocin, known as the “love hormone” or “bonding drug” because of its important role in enhancing social interactions, maternal behavior and partnership. This month’s special edition of the international journal Pharmacology, Biochemistry and Behavior deals with the current state of research linking oxytocin and addiction, and has been guest edited by Dr Femke Buisman-Pijlman from the University of Adelaide’s School of Medical Sciences. Dr Buisman-Pijlman, who has a background in both addiction studies and family studies, says some people’s lack of resilience to addictive behaviors may be linked to poor development of their oxytocin systems.
“We know that newborn babies already have levels of oxytocin in their bodies, and this helps to create the all-important bond between a mother and her child. But our oxytocin systems aren’t fully developed when we’re born – they don’t finish developing until the age of three, which means our systems are potentially subject to a range of influences both external and internal,” Dr Buisman-Pijlman says. She says the oxytocin system develops mainly based on experiences. “The main factors that affect our oxytocin systems are genetics, gender and environment. You can’t change the genes you’re born with, but environmental factors play a substantial role in the development of the oxytocin system until our systems are fully developed,” Dr Buisman-Pijlman says. IMAGE: This photo shows Dr. Femke Buisman-Pijlman from the University of Adelaide. She is the guest editor of the April 2014 edition of Pharmacology, Biochemistry and Behavior, which is focused on… Click here for more information. “Previous research has shown that there is a high degree of variability in people’s oxytocin levels. We’re interested in how and why people have such differences in oxytocin, and what we can do about it to have a beneficial impact on people’s health and wellbeing,” she says. She says studies show that some risk factors for drug addiction already exist at four years of age. “And because the hardware of the oxytocin system finishes developing in our bodies at around age three, this could be a critical window to study. Oxytocin can reduce the pleasure of drugs and feeling of stress, but only if the system develops well.” Her theory is that adversity in early life is key to the impaired development of the oxytocin system. “This adversity could take the form of a difficult birth, disturbed bonding or abuse, deprivation, or severe infection, to name just a few factors,” Dr Buisman-Pijlman says. “Understanding what occurs with the oxytocin system during the first few years of life could help us to unravel this aspect of addictive behavior and use that knowledge for treatment and prevention.”
Major implications in concepts as free will, sin, justice, mental illness, government/medical “intervention”…..
AUSTIN, Texas — A new study correlating brain activity with how people make decisions suggests that when individuals engage in risky behavior, such as drunk driving or unsafe sex, it’s probably not because their brains’ desire systems are too active, but because their self-control systems are not active enough.
This might have implications for how health experts treat mental illness and addiction or how the legal system assesses a criminal’s likelihood of committing another crime.
Researchers from The University of Texas at Austin, UCLA and elsewhere analyzed data from 108 subjects who sat in a magnetic resonance imaging (MRI) scanner — a machine that allows researchers to pinpoint brain activity in vivid, three-dimensional images — while playing a video game that simulates risk-taking.
The researchers used specialized software to look for patterns of activity across the whole brain that preceded a person’s making a risky choice or a safe choice in one set of subjects. Then they asked the software to predict what other subjects would choose during the game based solely on their brain activity. The software accurately predicted people’s choices 71 percent of the time.
“These patterns are reliable enough that not only can we predict what will happen in an additional test on the same person, but on people we haven’t seen before,” said Russell Poldrack, director of UT Austin’s Imaging Research Center and professor of psychology and neuroscience.
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)
Source: National Center on Addiction and Substance Abuse (Columbia University)
Forty million Americans ages 12 and older have addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer according to a five-year national study released today by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another 80 million people are risky substance users – using tobacco, alcohol and other drugs in ways that threaten health and safety.
The report, Addiction Medicine: Closing the Gap between Science and Practice, reveals that while about 7 in 10 people with diseases like hypertension, major depression and diabetes receive treatment, only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.
The CASA Columbia report finds that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services.
- Well: Effective Addiction Treatment (well.blogs.nytimes.com)
- Young Adults Want to Recover from Addiction but Need Help to Make It Happen (addictionts.com)
- 8 reasons addiction carries a stigma (salon.com)
- Outpatient Rehab in Delray Beach, Florida Follows New Study that… (prweb.com)
- 15 Myths about Addiction (challengingaddiction.wordpress.com)
From the summary at The Nation’s Health [September 2012]
More than 40 million Americans suffer from the disease of addiction, but their treatment needs are largely overlooked by a U.S. medical care system that continues to be influenced by unscientific misperceptions about addiction, a recent report finds.
Released in June by the National Center on Addiction and Substance Abuse at Columbia University, the report found that 16 percent of Americans ages 12 and older have addictions involving nicotine, alcohol or other drugs, and another 80 million people are abusing substances in ways that threaten their health and safety. And while more people suffer from the disease of addiction than heart conditions, diabetes or cancer, only about one in 10 addiction sufferers receives treatment. By comparison, seven out of 10 people with diseases such as high blood pressure, major depression and diabetes receive treatment.
The consequences of the medical system’s inattention to the disease of addiction are profound, the report said. As the nation’s largest preventable and most costly health problems, addictions are responsible for more than 20 percent of deaths in the United States. Moreover, addictions cause or contribute to at least 70 other conditions that require medical care, have a wide range of costly social consequences and account for one-third of all hospital in-patient costs.
Contributing to the medical system’s inattention to addiction treatment is a lack of knowledge about the science of addiction, the report said.
“Right now there are no accepted national standards for providers of addiction treatment,” said Susan Foster, CASA Columbia’s Vice President and Director of Policy Research and Analysis, who was the principal investigator for the report. “There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards. Neglect by the medical profession has resulted in a separate and unrelated system of care that struggles to treat the disease without the resources or knowledge base to keep pace with science and medicine.”
The full report is available at www.casacolumbia.org/templates/NewsRoom.aspx?articleid=678&zoneid=51.
- Complete video of Russell Brand speaking to the Parliamentary Committee today. Video is from the Parliament ArchiveWhy Addiction Treatment Is a Disaster (talesfromthelou.wordpress.com)
As an ex-addict Russell Brand speaks very convincingly of the need for there to be an abstinence based recovery for addicts, and for us to view addiction as a public health problem rather than a criminal offense.
[He says] we need to welcome people back into the community, as this is where they came from before they became addicts.
- In Focus with Martin Sheen to Examine Addiction Treatment Programs (prweb.com)
- Non-medical treatments are essential (addictionandrecoverynews.wordpress.com)
- Broken Treatment: How the Addiction Industry is Failing its Clients (addiction-dirkh.blogspot.com)
- The Great Addiction Divide (psychologytoday.com)
- Yet Another Way to Misunderstand President Obama’s Record on Addiction Treatment (samefacts.com)
- A Collaboration of Behavioral Health Care Plus Addiction Treatment is a Turning Point for Two New Jersey Organizations (paramuspost.com)
- Addiction-Treatment.com Launches Website to Help Millions Struggling With Drug and Alcohol Addiction (prweb.com)
- Rethinking Everything We Thought About Addiction (psychologytoday.com)
- Doctors and dealers battle for addicts (salon.com)
From the 8 January 2012 Addiction and Recovery News blog posting
The new issue of the Lancet focuses on drug policy***. One piece offers key points for formulating policy:
- Drug policy should aim to promote the public good by improving individual and public health, neighbourhood safety, and community and family cohesion, and by reducing crime.
- The effectiveness of most drug supply control policies is unknown because little assessment has been done, and very little evidence exists for the effectiveness of alternative development programmes in source countries.
- Supply controls can result in higher drug prices, which can reduce drug initiation and use but these changes can be difficult to maintain.
- Wide-scale arrests and imprisonments have restricted effectiveness, but drug testing of individuals under criminal justice supervision, accompanied by specific, immediate, and brief sentences (eg, overnight), produce substantial reductions in drug use and offending.
- Prescription regimens minimise but do not eliminate non-medical use of psychoactive prescription drugs. Prescription monitoring systems can reduce inappropriate prescribing.
- Screening and brief intervention programmes have, on average, only small effects, but can be widely applied and are probably cost-effective.
- The collective value of school, family, and community prevention programmes is appraised differently by different stakeholders.
- The provision of opiate substitution therapy for addicted individuals has strong evidence of effectiveness, although poor quality of provision reduces benefit. Peer-based self-help organisations are strongly championed and widely available, but have been poorly researched until the past two decades.
- Health and social services for drug users covering a range of treatments, including needle and syringe exchange programmes, improve drug users’ health and benefit the broader community by reducing transmission of and mortality due to infectious disease.
It’s good stuff. I particularly like its willingness to give credit where credit is due. For example, supply control can help but the benefits are often unstable and have a lot of unintended consequences. I also like the affirmation of the diversity of perspectives on the benefits of policies…..
- An 8 minute video interview featuring one of the authors – Drug policy and the public good: evidence for effective interventions
- An 11 minute MP3 Video where Author Wayne Hall discusses the series with Richard Lane
- Towards a smarter drugs policy | Keith Humphreys and Jonathan Caulkins (guardian.co.uk)
- Overdosing on extremism?? (addictionandrecoverynews.wordpress.com)
- Recent Study Shows Drug Addiction A Hidden Burden for UK Families (uk.prweb.com)
- Interesting global drug use data via new study in The Lancet (sentencing.typepad.com)
- Home Affairs Committee launches new inquiry into Drugs – News from Parliament – UK Parliament (worldwright.wordpress.com)
- Sweden HAS NOT LEGALISED CANNABIS _ Drugs Policy in Sweden (John Yates) (worldwright.wordpress.com)