Monthly Archives: July 2008
Scientists have now described the specifics of how brain cells process antidepressant drugs, cocaine and amphetamines. These novel findings could prove useful in the development of more targeted medication therapies for a host of psychiatric diseases, most notably in the area of addiction. Continue reading
Drug abuse vs. drug dependence.As the neurobiology of addiction has come into clearer focus over time, our ability to separate fact from fiction in the field of drug dependence has grown rapidly. Beliefs that have been common wisdom for years–that anyone who uses cocaine or heroin inevitably becomes addicted to it, for example–can now be confidently replaced with insights gained from a decade or more of intense research on the biological causes and treatment of addiction.Dr. Carlton Erickson, professor of Pharmacology/Toxicology and director of the Addiction Science Research and Education Center at the University of Texas, has assembled an intriguing list of such changes in thinking, based on his book, “The Science of Addiction: From Neurobiology to Treatment.” The complete list can be found on his “Exploding Drug Myths” page at the University of Texas site.With his kind permission, I offer a few of these emerging insights. Many of them, Dr. Erickson told me, are understandable only in the context of DSM-IV criteria for drug abuse and drug dependence as listed in “The Diagnostic and Statistical Manual of Mental Disorders.”The DSM table for drug abuse defines it as “A maladaptive pattern of drug use leading to impairment or distress” including one or more of the following symptoms: recurrent use leading to failure to fulfill major obligations; recurrent use which is physically dangerous; drug-related legal problems; continued use despite social or interpersonal problems.In contrast, the DSM manual defines drug dependence as three or more of the following symptoms: drug tolerance; withdrawal; drug used more often than planned; inability to control drug use; effort expended to obtain the drug; drug use replaces other activities; drug use continues despite knowledge of a persistent problem.With these definitions in mind–which correspond roughly to “problem drinker/user” in the former case, and “addict” in the latter–here are some of the myths:MYTH: Therapeutic pain-killers (such as morphine) produce a high rate of addiction. “Since “addiction” means “dependence,” writes Erickson, “the likelihood of becoming dependent on opioid pain-killers is actually quite low…. Most people given these pain-killers will go through withdrawal but will never want or need the drug again.”MYTH: Crack is more addicting than cocaine powder. “There is no pharmacological reason why the form of a drug or the route of administration should change the ‘addiction’ liability of a drug. In fact, science is beginning to realize that the drug is not the cause of ‘addiction’ rather, the susceptibility of the person to the drug determines how much ‘addiction’ (dependence) develops.”MYTH: “Substance abuse” is a scientifically valid term. “The word is a weak, wimpy, confusing, inaccurate, and misleading term when applied to drug problems.”MYTH: Alcoholics can drink socially. “There are a few scientific studies that suggest this. But most of these studies look at ‘problem drinkers’….’Abusers’ can drink socially (that is, under control), whereas truly dependent individuals cannot.”MYTH: All drugs damage brain cells. “Actually, relatively few have been shown to damage brain cells through a toxic effect. These include alcohol (high doses over a long time), ‘inhalants’… methamphetamine and MDMA (shown in animal studies with high doses, but not yet in humans).”MYTH: Drugs cause “addiction.” “An interesting scientific question is: If drugs cause ‘addiction,’ then why doesn’t everyone who uses drugs too much, too often, become dependent (addicted)? Scientists are looking into genetic and other unknown factors that cause some people to become dependent while sparing others of this brain pathology.”MYTH: It is possible to overdose on LSD. “LSD is a major hallucinogen and can cause people to jump from tall buildings (for example) in their hallucinogenic state. However, there is no known lethal dose in humans.”MYTH: The more a person is educated about drugs, the less likely they are to become “addicted”. “This idea that chemical dependence is preventable is an old one. Strong indirect evident concerning the brain mechanisms involved in dependence tells us that ‘addiction’ cannot be prevented. If the above statement were true, physicians, nurses, and pharmacists would have a low rate of chemical dependence. Sadly, these health professionals have an incidence of dependence that is at least as high as the general population.”MYTH: Anyone who drinks too much, too often, is an alcoholic. “If the ‘too much, too often’ myth were true, then most college students would be alcoholics. In fact, most college students ABUSE alcohol, while only 10-15% show dependence on alcohol at some point in their drinking careers.”MYTH: Everyone “has what it takes” to become “addicted” to drugs. “If ‘addiction’ (dependence) is a chronic medical disease, then why should it be different from other medical diseases? Everyone doesn’t ‘have what it takes’ to get sickle cell anemia, insulin-dependent diabetes, or AIDS.” (Source: Addiction Inbox) Continue reading
SAMHSA’s new Homelessness Resource Center (HRC) Web site launched this week. Targeted toward providers who work with people who are homeless, the Web site shares state-of-the art knowledge, evidence-based practices, and practical resources.
Date Added: 07/25/08
A new report released by three agencies of the U.S. Department of Health and Human Services proposes strategies to overcome barriers associated with the reimbursement of mental health services provided in primary care settings. Key actions recommended focus on a variety of stakeholders, including primary care providers, state Medicaid officials, and others billing for mental health services in the public sector, working together to promote a greater understanding of mental health reimbursement policy.
Date Added: 07/25/08
Every year, towns, counties, and states around the country observe National Alcohol and Drug Addiction Recovery Month in September. This year, the 19th annual Recovery Month recognizes the impact that real people and real stories have on recovery, and celebrates those who have worked to advance the treatment and recovery landscape.
Date Added: 07/22/08
The Substance Abuse and Mental Health Services Administration (SAMHSA) is issuing its latest Treatment Episode Data Set (TEDS) report on Discharges From Substance Treatment Services, which provides a myriad of information on substance abuse treatment episodes at state-licensed treatment facilities across the country.
Date Added: 07/18/08
More than 40 percent of the Nation’s estimated 10.8 million underage current drinkers (persons aged 12 to 20 who drank in the past 30 days) were provided free alcohol by adults 21 or older, according to a nationwide report by the Substance Abuse and Mental Health Services Administration. The study also indicates that 1 in 16 underage drinkers (6.4 percent or 650,000) was given alcoholic beverages by their parents in the past month.
Date Added: 07/17/08
Researchers target GABA, noradrenaline.According to Catalyst Pharmaceutical Partners, a company conducting research on drugs for the treatment of addiction, “The U.S. Food and Drug Administration has recognized that cocaine addiction is a ‘serious, life-threatening condition for which there is no current drug treatment,’ and the National Institute on Drug Abuse (NIDA) has stated that finding a pharmacological treatment for cocaine addiction is their number one research priority.”Other researchers view it differently, however. Allan Parry, a drug counsellor in Liverpool, U.K., told New Scientist that such work was “only likely to be relevant to a tiny minority of people. People often give up cocaine because their lifestyle changes or they just grow up.”Fighting fire with fire–using drugs to treat drug addiction–will likely remain a controversial approach for years to come.What is the rationale for the use of drugs in the treatment of drug addiction? There are two basic approaches. Scientists look for medications that help patients initiate abstinence, and they look for drugs that help prevent relapse once the patient has achieved abstinence. The categories are not hard and fast. For example, a drug that effective reduces the reinforcing effects of cocaine by reducing the intensity of withdrawal can theoretically perform both functions at once. On the other hand, a drug that blunts the euphoric effects of cocaine–a drug that takes away the best of the buzz, no matter how much cocaine is ingested–can also succeed at the twin tasks of abstinence initiation and relapse prevention.The search for medications with which to treat cocaine addiction has been in progress much longer than equivalent efforts aimed at methamphetamine addiction. One research target of long standing is modafinil, an odd-duck drug sold as Provigil for the treatment of narcolepsy. A mild stimulant, modafinil does a little bit of everything, pharmacologically tweaking dopamine, noradrenaline, anandamide and GABA receptor systems. Perhaps for this reason, the drug seemingly has been tried for almost everything, from Alzheimer’s to atypical depression to jet lag. The U.S. military has reportedly shown some interest in it.According to published research by Kyle M. Kampman in the June 2008 Addiction Science and Clinical Practice (PDF), modafinil-treated human subjects used less cocaine than placebo-using counterparts did in several recent small-scale studies. “In a double blind pilot trial with 62 cocaine-dependent patients, those who received modafinil submitted more cocaine-metabolite-free urine samples than placebo-treated patients (42 vs. 22 percent; Dackis et al., 2005).”Propranolol, better known as the beta-blocker Inderal, works primarily by suppressing adrenaline and noradrenaline levels. In human studies to date, propranolol has shown itself most effective with the most severely cocaine-addicted patients. Studies by Kampman have shown that propanolol-treated patients stay in treatment longer than patients in control groups do.Specific research on relapse prevention strategies has focused on GABA-enhancing drugs that inhibit cocaine reinforcement by secondarily blocking the dopamine surge characteristic of cocaine intoxication. In addition to vigabatrin, discussed in the previous post, topiramate is another particularly well-suited candidate for relapse prevention. Known as Topamax, and prescribed for seizures and migraines, the drug has shown early promise: “In a 13-week, double-blind, placebo-controlled pilot trial of topiramate involving 40 cocaine-dependent patients…. more of those on topiramate achieved at least 3 weeks of continuous abstinence (59 vs. 26 percent).”Surprisingly, the granddaddy of all anti-addiction drugs–Antabuse–has made a comeback as a subject of study for cocaine addiction, even though it has never been spectacularly effective in its original application as a relapse prevention drug for alcoholics. Disulfiram, as it is known chemically, causes unpleasant physical sensations, including vomiting, when combined with even small amounts of alcohol. It does so by inhibiting the enzymes responsible for degrading alcohol. Even a little becomes too much. In similar fashion, disulfiram retards the breakdown of cocaine, leading to extremely high levels that induce paranoia and anxiety rather than a pleasurable, if extreme, high. At least four published trials have demonstrated reduced cocaine use in disulfiram-treated patients, according to Kampman’s paper . One important downside to using Antabuse for cocaine addiction is that serious complications might occur if alcohol is added to the mix.Finally, and still well into the future, is the prospect of relapse prevention therapy by means of a vaccine–an entirely different mechanism of approach. Research has shown that it is possible to produce “cocaine-specific antibodies that bind to cocaine molecules and prevent them from crossing the blood-brain barrier, thereby blunting the drug’s euphoric and reinforcing effects,” Kampman’s paper asserts. A vaccine called TA-CD has tested well in preliminary studies.Next Post: Drugs for Alcoholism (Source: Addiction Inbox) Continue reading