Cocaine addiction: Scientists discover ‘back door’ into the brain

Individuals addicted to cocaine may have difficulty in controlling their addiction because of a previously-unknown ‘back door’ into the brain, circumventing their self-control, suggests a new study led by the University of Cambridge.

A second study from the team suggests that a drug used to treat paracetamol overdose may be able to help individuals who want to break their addiction and stop their damaging cocaine seeking habits.

Although both studies were carried out in rats, the researchers believe the findings will be relevant to humans.

Cocaine is a stimulant drug that can lead to addiction when taken repeatedly. Quitting can be extremely difficult for some people: around four in ten individuals who relapse report having experienced a craving for the drug – however, this means that six out of ten people have relapsed for reasons other than ‘needing’ the drug.

“Most people who use cocaine do so initially in search of a hedonic ‘high’,” explains Dr David Belin from the Department of Pharmacology at the University of Cambridge. “In some individuals, though, frequent use leads to addiction, where use of the drug is no longer voluntary, but ultimately becomes a compulsion. We wanted to understand why this should be the case.”

Drug-taking causes a release in the brain of the chemical dopamine, which helps provide the ‘high’ experienced by the user. Initially the drug taking is volitional – in other words, it is the individual’s choice to take the drug – but over time, this becomes habitual, beyond their control.

Previous research by Professor Barry Everitt from the Department of Psychology at Cambridge showed that when rats were allowed to self-administer cocaine, dopamine-related activity occurred initially in an area of the brain known as the nucleus accumbens, which plays a significant role driving ‘goal-directed’ behaviour, as the rats sought out the drug. However, if the rats were given cocaine over an extended period, this activity transferred to the dorsolateral striatum, which plays an important role in habitual behaviour, suggesting that the rats were no longer in control, but rather were responding automatically, having developed a drug-taking habit.

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Heroin Use Spikes Among Those Who Abuse Prescription Painkillers

Researchers at Columbia University’s Mailman School of Public Health looked at the frequency of nonmedical prescription opioid use and the risk of heroin-related behaviors and found that past-year heroin use rose among individuals taking opioids like oxycontin, and these increases varied by race and ethnicity. The most significant rise in heroin use was among Hispanics and non-Hispanic whites, where the rate of heroin use for the latter group increased by 75% in 2008-2011 compared to earlier years.

Findings are published in a sad closed-science way even though funding was provided by National Institute of Drug Abuse, National Institutes of Health (grants K01DA030449, R03DA037770, and R01DA037866) the Eunice Kennedy Shriver National Institute of Child and Human Development (grant HD020667) and Columbia University. I suggest you contact those organizations or Columbia if you want to see what the findings are. They need to learn blocking access to scientific research is wrong and they shouldn’t fund such activity.

Nonmedical prescription opioid use is defined as using a substance that is not prescribed or taking a drug only for the experience or the feeling it caused.

Using data from the National Survey on Drug Use and Health, a large nationally representative household sample of 67,500 people, and self-reported heroin use within the last 12 months, the researchers examined the change in patterns of past-year non-prescription drug and heroin use between 2002-2005 and 2008-2011 across racial and ethnic groups. The study also looked at the association between past year frequency of both, heroin-related risk behaviors, and exposure to heroin availability.

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Drug Addictions Often Disappear Over Time

This article includes links to many research studies, some linked to below, for the rest go to the full article.

Most People With Addiction Simply Grow Out of It by Maia Szalavitz

By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do.

The average cocaine addiction lasts four years, the average marijuana addiction lasts six years, and the average alcohol addiction is resolved within 15 years. Heroin addictions tend to last as long as alcoholism, but prescription opioid problems, on average, last five years. In these large samples, which are drawn from the general population, only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.

If you start drinking or taking drugs with peers before age 18, you have a 25% chance of becoming addicted, but if your use starts later, the odds drop to 4%. Very few people without a prior history of addiction get hooked later in life, even if they are exposed to drugs like opioid painkillers.

These results can give people hope when they, or loved ones, are suffering from an addiction. Treatment helps sometimes but also fails quite often. Even in the case where things are not looking good, there is hope that eventually things may run there course.

Of course, there is a risk, sadly, that before the addiction ends tragedy will strike. So hopefully we can keep researching methods to better treat addiction. But if things are failing (especially for one you love) there may be light at the end of the dark tunnel.

Related: The Success Rate of AA is Only 5-10%How Effective is Drug Addiction Treatment?What Does the Evidence of Treating Alcoholism Show?Combination Strategy to Treat Alcohol Dependence

The Success Rate of AA is Only 5-10%

The treatment of drug addiction continues to be difficult. Even finding data on success rates is hard. And analyzing that data is difficult (the data is not straight forward and leaves open many possible questions or criticisms). This study calls into question the effectiveness of a 12-step recovery method to treat addiction.

With Sobering Science, Doctor Debunks 12-Step Recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.

The reason that the 5 to 10 percent do well in AA actually doesn’t have to do with the 12 steps themselves, it has to do with the camaraderie. It’s a supportive organization with people who are on the whole kind to you and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood, rather than a treatment.

image of the Sober Truth book cover

Dr. Lance Dodes has written a book looking at the data behind the results of AA. The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

Related: Looking at the Evidence of Treating AlcoholismHow Effective is Drug Addiction Treatment?, NIH studyImproving Addiction Treatment with The University of Wisconsin, MadisonMethods Used to Treat Addiction

The Causes of Drug Addiction are Complex

image of comic panels from rat addiction experiment

Comic panels, by Stuart McMillen, of the rat park drug addiction experiment, see the full comic.

The causes of drug addiction are not simple. Like many medical issues they are a complex interaction of factors.

Drug addiction: The complex truth by Tom Stafford

Many studies have shown rats and monkeys will neglect food and drink in favour of pressing levers to obtain morphine (the lab form of heroin). With the right experimental set up, some rats will self-administer drugs until they die. At first glance it looks like a simple case of the laboratory animals losing control of their actions to the drugs they need. It’s easy to see in this a frightening scientific fable about the power of these drugs to rob us of our free will.

But there is more to the real scientific story, even if it isn’t widely talked about. The results of a set of little-known experiments carried out more than 30 years ago paint a very different picture, and illustrate how easy it is for neuroscience to be twisted to pander to popular anxieties. The vital missing evidence is a series of studies carried out in the late 1970s in what has become known as “Rat Park”. Canadian psychologist Bruce Alexander, at the Simon Fraser University in British Columbia, Canada, suspected that the preference of rats to morphine over water in previous experiments might be affected by their housing conditions.

Rats are smart, social creatures. Living in a small cage on their own is a form of sensory deprivation. Rat Park was what neuroscientists would call an enriched environment, or – if you prefer to look at it this way – a non-deprived one. In Alexander’s tests, rats reared in cages drank as much as 20 times more morphine than those brought up in Rat Park.

As the article notes more research is needed, but there should be more research into the importance of social environment on drug abuse and drug abuse treatment.

Related: Methods to treat addictionHow effective is drug addiction treatment in the USA?Prescription drug abuse in the USALooking at the evidence of treating alcoholism

Prescription Drug Abuse in the USA

Some key findings from the Council of State Governments study on Prescription Drug Abuse in America (from 2004). The report is obviously a bit outdated but the problem continues to grow.

  • More than 6.2 million people were current illicit users of prescription drugs in 2002.
  • In 2001, prescription drug abuse and misuse were estimated to impose approximately $100 billion annually in health care costs.
  • In Florida, there were 328 deaths attributed to heroin overdoses in 2001 compared to 957 deaths due to overdoses of the prescription pain medications. The trend continued in 2002, when more Floridians died from prescription drug overdoses than use of illegal drugs.

Prescription Drugs: Abuse and Addiction from the NIH (revised in 2011).

Although most people take prescription medications responsibly, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.

The number of prescriptions for some of these medications has increased dramatically since the early 1990s. Moreover, a consumer culture amenable to “taking a pill for what ails you” and the perception of prescription drugs as less harmful than illicit drugs are other likely contributors to the problem. It is an urgent one: unintentional overdose deaths involving opioid pain relievers have quadrupled since 1999, and by 2007, outnumbered those involving heroin and cocaine.

Years of research have shown that addiction to any drug (illicit or prescribed) is a brain disease that can be treated effectively. Treatment must take into account the type of drug used and the needs of the individual. Successful treatment may need to incorporate several components, including detoxification, counseling, and sometimes the use of addiction medications. Multiple courses of treatment may be needed for the patient to make a full recovery.

Related: How effective is drug addiction treatment?Center for substance abuse treatment (US HHS)Brett Favre overcomes painkiller addiction

Fighting Drugs With Drugs

An Obscure Hallucinogen Gains Legitimacy as a Solution for Addictions

Ibogaine, a brown powder derived from the African Tabernathe iboga plant, has intrigued researchers since 1962, when Howard Lotsof, a student at New York University and an opiate addict, found that a single dose erased his drug cravings without causing any withdrawal symptoms. Unfortunately, the hallucinogen can increase the risk of cardiac arrest, and the U.S. Drug Enforcement Agency lists it as a Schedule 1 substance, a classification for drugs like ecstasy and LSD with “no known medical value” and “high potential for abuse,” making it difficult to get federal funding to run clinical trials.

Animal tests, however, have shown the drug’s medicinal promise. “Rats addicted to morphine will quit for weeks after receiving ibogaine,” says Stanley Glick, the director of the Center for Neuropharmacology and Neuroscience at Albany Medical College. And addicts have reported positive effects in Mexico and Europe, where ibogaine therapy is legal. “Going cold turkey is horrible. There’s vomiting and diarrhea and pain and a constant drug craving,” says Randy Hencken, a drug user who was treated in Mexico. “After ibogaine, I didn’t feel any symptoms or cravings. I’ve been clean for nine years. Heroin and cocaine no longer have any power over me.”

Despite these successes, ibogaine lacks scientific credibility. “As great as ibogaine seems, no one knows exactly how effective it is as a treatment,” says Valerie Mojieko, the director of clinical research for the Multidisciplinary Association for Psychedelic Research (MAPS), a privately funded Massachusetts-based nonprofit. So starting this month, MAPS will enlist Clare Wilkins, the director of Pangea Biomedics, to run the first long-term study to gauge the drug’s lasting effects at her clinic in Mexico (where patients already pay $5,000 for the treatment).

Nearly seven million Americans abuse illicit drugs, costing the nation an estimated $181 billion a year in health care, crime and lost productivity.

We certainly need better ways to treat drug addiction. Current methods are helping people. But current methods fail far too often for too many people. The way to find better treatments is to run medical studies and analyze the results.

Related: Looking at the Evidence of Treating AlcoholismNIH on How Effective Drug Addiction Treatment Is?Principles of Effective Drug Treatment and Rehabilitation

Looking at the Evidence of Treating Alcoholism

AA is Faith-Based, Not Evidence-Based

Alcoholics Anonymous is the most widely used treatment for alcoholism. It is mandated by the courts, accepted by mainstream medicine, and required by insurance companies. AA is generally assumed to be the most effective treatment for alcoholism, or at least “an” effective treatment. That assumption is wrong.

We hear about a few success stories, but not about the many failures. AA’s own statistics show that after 6 months, 93% of new attendees have left the program. The research on AA is handily summarized in a Wikipedia article. A recent Cochrane systematic review found no evidence that AA or other 12 step programs are effective.

The 1992, the National Institute on Alcohol Abuse and Alcoholism’s National Longitudinal Alcohol Epidemiologic Survey studied 42,000 Americans. 4500 had been dependent on alcohol at some time in their lives. Of these, only 27% had had treatment of any kind, and one-third of those who had been treated were still abusing alcohol. Of those who had never had any treatment, only one-quarter were still abusing alcohol. George Bush is a well-known example of someone who stopped drinking on his own without attending AA and without admitting that he was an alcoholic.

To me what matters is finding solutions that work. It is known that the success rates for treating addiction are not great no matter what treatments are used. We certainly should be doing more study of the effectiveness of various treatment methods to improve the success rates people experience. The impact on people’s lives is too large to rely on whoever markets better to end up being the deciding factor.

Related: How Effective is Drug Addiction Treatment? from the NIHCombination Strategy to Treat Alcohol DependenceResults of 4 Year Study of Women in Drug Treatment

Results of 4 Year Study of Women in Drug Treatment

A detailed study of women in treatment for drug addition in England shows a 19 percent fall in the number of adult females under 30 entering heroin programmes over the last five years – 1,000 fewer female addicts than in 2005. The fall is even sharper – 26 percent – for the 18-25 age-group, providing further evidence that the heroin epidemic of previous decades may have peaked.

Although part of the trend was offset by rising numbers of cocaine and crack addicts seeking
treatment over the same period, the numbers of women entering treatment in the under 30 age
group fell by nearly nine per cent in four years.

The study also showed that at the same time the numbers of women problem drug users
successfully leaving treatment having overcome their addiction almost doubled. In addition, the
number of women dropping out of treatment has fallen by well over a third in four years.
The study by the National Treatment Agency for Substance Misuse (NTA) also highlights:

  • While women start using drugs at the same age or slightly older than men, they are more adept at seeking help for themselves and tend to come into treatment earlier
  • Cocaine is the fastest growing treatment need among women drug users, accounting for a 55 per cent increase in new entrants since 2005
  • The number of women entering treatment for crack dependency has increased by 14 percent since 2005
  • Almost two-thirds of women entering treatment are mothers, nearly half of whom have a child living with them. The data indicates that treatment outcomes for mothers are stronger than those who were not parents.

“These findings demonstrate how thousands of women have successfully obtained drug treatment and recovered through it,” said Rosanna O’Connor, NTA director of delivery. “Treatment is the first step on the road to recovery, so it is encouraging that women tend to seek help of their own volition, enter treatment earlier before their drug misuse has become entrenched and frequently achieve better outcomes sooner. Treatment provides the opportunity for individuals to get better, for families to stabilise, and for children to be looked-after at home.”

Related: Research on the Brain and Behavior on AddictionUniversity Research on Improving Addiction TreatmentAlcohol is a Major Cause of Drug Rehab Admissions

Principles of Effective Drug Treatment and Rehabilitation

Principles of Effective Treatment from the United States National Drug and Alcohol Treatment Service

Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.

Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

Too often, addiction goes untreated: According to the National Survey on Drug Use and Health (NSDUH), 23.2 million persons (9.4% of the U.S. population) aged 12 or older needed treatment for an illicit drug or alcohol use problem in 2007. Of these individuals, 2.4 million (10.4%) received treatment at a specialty facility (i.e., hospital, drug or alcohol rehabilitation or mental health center). Thus, 20.8 million persons (8.4 % of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive it.

Scientific research since the mid–1970s shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives. Based on this research, key principles have emerged that should form the basis of any effective treatment programs:

  • Addiction is a complex but treatable disease that affects brain function and behavior.
  • No single treatment is appropriate for everyone.
  • Treatment needs to be readily available.
  • Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
  • Remaining in treatment for an adequate period of time is critical.
  • Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
  • Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
  • An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
  • Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
  • Treatment does not need to be voluntary to be effective.
  • Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

When looking for drug rehab centers it is valuable to keep these facts in mind. Even the best rehab centers have many failed attempts to beat drug addiction. By finding centers that have adopted scientifically tested strategies success rates can be improved.

Related: How Effective is Treatment for Drug Addiction?Methods to Treat Drug and Alcohol AddictionDrug Rehab Centers in Los AngelesUniversity of Wisconsin-Madison Program Aims to Improve Drug Treatment