Virtual World Therapeautic For Addicts: Study Shows Impact Of Environment To Addiction Cravings

ScienceDaily (Apr. 30, 2008) — Patients in therapy to overcome addictions have a new arena to test their coping skills--the virtual world. A new study by University of Houston Associate Professor Patrick Bordnick found that a virtual reality (VR) environment can provide the climate necessary to spark an alcohol craving so that patients can practice how to say "no" in a realistic and safe setting.

"As a therapist, I can tell you to pretend my office is a bar, and I can ask you to close your eyes and imagine the environment, but you'll know that it's not real," Bordnick said. "In this virtual environment you are at a bar or at a party or in a real-life situation. What we found was that participants had real-life responses."

Bordnick, of the UH Graduate College of Social Work, investigates VR as a tool for assessing and treating addictions. He studied 40 alcohol-dependent people who were not receiving treatment (32 men and eight women). Wearing a VR helmet, each was guided through 18 minutes of virtual social environments that included drinking. The participant's drink of choice was included in each scene. Using a game pad, each rated his or her cravings and attention to the alcohol details in each room. Each then was interviewed following the experience.

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In the News: Legislative changes can cut overdose deaths

Chris Farley. Heath Ledger. Anna Nicole Smith and her son, Daniel. Each died of accidental drug overdoses.

But celebrities are not the only ones dying that way. According to the Centers for Disease Control, more than 23,000 people died of accidental drug overdoses in 2005, the last year for which we have comprehensive data. This tops the number of homicides that year (18,000). Overdose deaths have been on the rise. Nearly 1,000 people died of accidental drug overdose in 2006, making it the fourth-leading cause of death among adults in New York City, after heart disease, cancer and AIDS.

The state Legislature can take three immediate steps to reduce accidental overdose deaths.

*Make naloxone more widely available. Naloxone is a short-acting opiate antagonist that reverses the effects of an opiate overdose, including heroin and prescription opiates such as oxycodone. A few years ago, New York legislators made naloxone widely available for prescription and distribution by medical providers to active drug users. Extending medical standing orders to naloxone prescription could further expand access, and FDA approval of intranasal naloxone and over-the-counter sales of the near-harmless drug (which has a low potential for abuse) could assure wider accessibility across the country.

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In the News: Report finds that Connecticut Prisoners have Serious Addictions

STAMFORD - Two-thirds of Connecticut's nearly 20,000 prisoners have serious addictions, and many need to be placed into treatment to avoid an overcrowding crisis, according to a report released Thursday by two non-profit organizations.

The report, commissioned by the Drug Policy Alliance, a non-profit that seeks reform of tough drug laws, urges the state to invest in drug treatment and programs to help former prisoners re-enter society successfully.

It recommends abolishing drug laws that carry mandatory minimum sentences and deal harsher punishments to offenders caught with drugs near a school, public housing project or day care center.

The report, co-sponsored by the A Better Way Foundation, a Connecticut non-profit that has pushed for changes in drug laws, also warns against enacting a three-strikes law in the wake of last year's Cheshire triple-murder.

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Methamphetamine Addiction Mechanism Discovered, Explains Why Cravings Last So Long

ScienceDaily (Apr. 10, 2008) — Repeatedly stimulating the mouse brain with methamphetamine depresses important areas of the brain, and those changes can only be undone by re-introducing the drug, according to research at the University of Washington and other institutions. The study, which appears in the April 10 issue of the journal Neuron, provides one of the most in-depth views of the mechanisms of methamphetamine addiction, and suggests that withdrawal from the drug may not undo the changes the stimulant can cause in the brain.

The researchers set out to determine what sort of changes happen in the brain because of repeated use of the stimulant methamphetamine, and to better understand addiction-related behaviors like drug craving and relapse. Methamphetamine, also known as simply meth, is one of the most popular illegal drugs in the United States, and abuse of the drug can cause severe addiction.

Scientists have believed that abuse of drugs like meth can cause changes to the neurons in the brain and the synapses and terminals that control transmission of information in the brain. In this project, researchers focused on the mouse brain, and how it was affected by methamphetamine over 10 days, which is the mouse equivalent of chronic use in humans.

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New Strategy For Treating Cocaine Addiction, Animal Research Suggests

ScienceDaily (Apr. 8, 2008) — New research in monkeys suggests the feasibility of treating cocaine addiction with a "replacement" drug that mimics the effects of cocaine but has less potential for abuse -- similar to the way nicotine and heroin addictions are treated.

Reporting at the annual meeting of the American Society of Pharmacology and Experimental Therapeutics in San Diego, Calif., scientists from Wake Forest University School of Medicine said treating monkeys with amphetamine significantly reduced their self-administration of cocaine for up to a month.

"This suggests the possibility of developing an amphetamine-like drug for treating cocaine addiction," said Paul Czoty, Ph.D., lead author and assistant professor of physiology and pharmacology. "The research also demonstrates the usefulness for conducting studies in monkeys to test potential treatments."

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Environmental Enrichment Can Reduce Cocaine Use, Researchers Find

ScienceDaily (Apr. 7, 2008) — Simple environmental enrichment and increased social stress can both affect the level of individual drug use, according to new monkey research at Wake Forest University School of Medicine.

Previous research has shown that social rank -- whether animals are dominant or subordinate within their social groups -- can affect the amount of cocaine that monkeys will self-administer. Housed in groups of four, male cynomolgus monkeys will invariably stratify by social rank from the most dominant to the most subordinate.

Once exposed to cocaine and taught to self-administer the drug, the more subordinate animals are far more inclined to engage in the human equivalent of serious drug abuse than are the dominant animals. Research has shown differences in certain neurochemicals in the brains of the animals, both as predictors and results of the social ranking, and therefore as predictors of drug abuse.

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What is Alcohol Harm Reduction?

Excerpt from IHRA.net

Alcohol is no ordinary commodity. It is a legal drug which brings health, personal, cultural and social benefits for many people around the world – yet causes significant mental, physical and social harms for many others. To effectively tackle this dilemma, the alcohol field in general needs to generate and embrace new ideas and more practical approaches.

Alcohol harm reduction can be broadly defined as measures that aim to reduce the negative consequences of drinking.

A comprehensive alcohol policy needs population-level interventions, which focus on the availability and accessibility of alcohol (such as taxation and restricted licensing hours). But it needs more than this - such measures alone will not reduce alcohol related harms. In the last 20 years there has also developed an increasing (but less promoted) interest in alcohol harm reduction interventions. These tend to focus on particular risk behaviours (such as drinking and driving, binge drinking), particular risk groups (such as pregnant women, young people) and particular drinking contexts (such as bars and clubs). These approaches have broadened the sphere of interest in alcohol related harms to include social nuisance and public order problems. Very often (but not exclusively) such interventions operate at the community level.

Examples of this approach in practice are:

• Campaigns against drinking and driving (including designated driver schemes and improved public transport in the evenings)
• Serving alcohol in shatter-proof glass to prevent injuries
• Training bar staff to serve alcohol responsibly
• Promoting the safer design of drinking environments (such as bars)
• Managing the ‘night-time economy’ and the ‘drinking environment’ in order to maximise pleasure and minimise violence and anti-social behaviour
• Brief interventions advising people on moderate or controlled drinking
• Education in schools and universities advising people on moderate or controlled drinking
• Providing shelters for homeless drinkers (known as ‘Wet Centres’)
• Providing shelters for heavily intoxicated individuals (known as ‘Sobering-Up Centres’)
  

The benefits of alcohol harm reduction approaches are as follows:

• They are practical approaches (so much so that many people deliver alcohol harm reduction on a regular basis without realising it)
• They are realistic approaches in that they (often) do not rely upon national consensus, funding, policies or legislation
• They can be designed and delivered by local communities and stakeholders to address specific local needs and contexts
• Their short-term aim is to minimise the impacts of drinking alcohol
• Their longer-term aim is to change drinking cultures – encouraging the benefits of responsible drinking and discouraging harmful drinking

Introduction to Harm Reduction Psychotherapy

Ideas have different meanings at different moments in history. Ideas that once appeared crazy, dangerous, or incomprehensible later become so much a part of accepted truth that society temporarily forgets the time when these ideas were dormant. New ideas arise in response to current conditions as an attempt to make sense of and help guide us in responding to these conditions. Ideas determine our view of reality both expanding and limiting our possibilities. As history marches on and conditions change, ideas that were once progressive and useful can become stale, empty, regressive barriers to change. When the dinosaurs of outmoded ideas die, the ideas that have been hiding in the hinterlands creep back into the mainstream to repopulate the field, New ideas once again arise that attempt to explain the limitations of those that came before. This is as true for individual psychology as it is for scientific paradigms.

Within the drug and alcohol treatment field, there have been a number of great ideas that have represented new paradigms for understanding problematic substance use. The application of these ideas to clinical treatment led to revolutionary changes in practice that resulted in dramatic improvements in the care available to people with substance use problems. The addiction-as-disease concept (Jellinek, 1962) challenged the moral model of drug misuse which blamed the problem on the inappropriate values or immoral character of the user. The disease paradigm opened the way to treatment rather than punishment, for these problems. The self-medication hypothesis (Khantzian, 1985) pointed out that for many, drug use is a form of self-care that reflects an attempt to cope with painful feelings. This idea highlighted the important dimension of the meaningfulness of drug use and the necessity to recognize and address the under- lying issues the user is trying to heal through drug use. Relapse prevention (Marlatt and Gordon, 1985) pointed out that, rather than viewing a return to problematic drug use after a period of abstinence or diminished use as failure, relapse should be seen as a common natural part of the process of changing behavior, which can be an opportunity for learning that might decrease the possibility of future relapses.

Harm reduction is the most recent of these important new ideas in the substance use treatment field. It heralds a paradigm shift in the way we understand and respond to problematic drug and alcohol use. Harm reduction rejects the presumption that abstinence is the best or only acceptable goal for all problem drug and alcohol users. Harm reduction sees substance use varying on a continuum of harmful consequences to the user and the community. In doing so, harm reduction accepts small, incremental steps in the direction of reduced harm with the goal being to facilitate the greatest reduction in harm for a given person at this point in time. Inherent in this change in the treatment focus is a radical redefinition of the relationship between the client and the clinician, a departure from the paternalistic model associated with more traditional substance use treatment. Harm reduction places respect for the client's strengths and capacity to change as the starting point for developing egalitarian relationships in which clients are encouraged to collaborate in setting up the treatment and choosing goals and strategies that they find useful. This shift in basic assumption is actually consistent with psychodynamic and behavioral models of drug misuse and has many beneficial implications for treatment that will be discussed in this book. A growing group of clinicians, researchers, and public policy makers have recognized that the philosophy of harm reduction has a critically important role to play in our efforts as a field and in the larger society to improve the treatment of people struggling with substance use problems.

Brain Stress System Presents Possible Treatment

ScienceDaily (Feb. 28, 2008) — A brain circuit that underlies feelings of stress and anxiety shows promise as a new therapeutic target for alcoholism, according to new studies by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).

In preclinical and clinical studies currently reported online in Science Express, NIAAA Clinical Director Markus Heilig, M.D., Ph.D., and colleagues from the NIH, Lilly Research Laboratories, and University College in London found that a brain molecule known as the neurokinin 1 receptor, or NK1R, appears to be a central actor in stress-related drinking.

The researchers first demonstrated that NK1R plays an integral role in alcohol consumption in animals. Mice that were genetically engineered to lack NK1 receptors consumed much less alcohol than did normal mice with fully functional NK1R. Subsequently, in a small clinical study, the researchers showed that an experimental compound designed to block NK1 receptors reduced alcohol craving and improved overall wellbeing among recently detoxified alcohol-dependent individuals who had high levels of anxiety.

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Common Heart Drug May Reduce Cocaine Cravings

ScienceDaily (Feb. 28, 2008)

Researchers from Boston University School of Medicine and Harvard Medical School have found that diltiazem, a drug used in the treatment of high blood pressure, reduces cocaine cravings in a rat model.

Previous work showed that two brain chemicals, dopamine and glutamate, independently contribute to the development of cocaine addiction. This new research indicates that calcium channels provide critical links between dopamine and glutamate that drives the intense craving associated with cocaine addiction. Diltiazem, one of a class of drugs known as calcium channel blockers, disrupts the connection between dopamine and glutamate formed during chronic cocaine use.

According to the researchers, brain calcium plays an important role in learning and memory in that calcium influences an enzyme known as the "memory molecule." "Our work shows that cocaine increases the levels of this molecule specifically in a brain area that controls motivation. Thus, cocaine use teaches the brain to be addicted, resulting in a dysfunctional form of learning that drives the overwhelming desire to consume more cocaine," said senior author Chris Pierce, a professor of pharmacology and psychiatry at Boston University School of Medicine.

Currently, there are no effective drug therapies for cocaine addiction. Pierce noted that research such as this using animal models could lead to desperately needed medications. "The strength of this work is that it tells us something fundamental about how brain chemistry changes as cocaine addiction takes hold. Importantly, our findings also suggest new strategies for developing cocaine addiction therapies, which thus far remain elusive," he added.

These findings will appear in the March issue of the leading medical journal Nature Neuroscience.

This study was supported by grants from the National Institutes of Health.
Adapted from materials provided by Boston University.

Should Heroin Be Prescribed To Addicts?

ScienceDaily (Jan. 11, 2008) — Experts debate whether heroin should be prescribed to addicts who are difficult to treat in a recent issue of the British Medical Journal.

Maintenance treatment with heroin is appropriate for heroin misusers under certain circumstances, argue Jürgen Rehm from the Centre for Addiction and Mental Health in Toronto and Benedikt Fischer from the University of Victoria, British Columbia.

They point to trials in Switzerland, the Netherlands and Germany, which found heroin assisted maintenance treatment feasible and effective for those resistant to treatment. They also found it to be cost effective compared with methadone maintenance treatment.

In the UK, heroin has also been a treatment option for heroin misusers for several decades, but the practice remains controversial.

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Behavior Therapy Plus Medication May Help Teens With Depression And Substance Use Disorders

ScienceDaily (Nov. 7, 2007) — The antidepressant fluoxetine combined with cognitive behavioral therapy appears as effective for treating depression among teens who also have substance use disorders as among those without substance abuse problems, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine.

"Adolescents with substance use disorders (SUDs) have higher rates of depression (15 percent to 24 percent) than adolescents in the general population," the authors write as background information in the article. "Comorbid [co-occuring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates."

Paula D. Riggs, M.D., and colleagues at the University of Colorado Denver conducted a randomized controlled trial of the antidepressant fluoxetine in 126 teens (average age 17) who met diagnostic criteria for major depressive disorder, lifetime conduct disorder and at least one substance abuse disorder other than tobacco. The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or placebo, along with cognitive behavioral therapy, a type of psychotherapy addressing the way individuals currently think and act rather than past events. The cognitive behavior therapy was focused on substance abuse rather than depression.

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