Genes Play a Large Role in Opioid Dependence

dna“There is reason to think that opioid dependence is at least 60 percent inherited. Now a genomewide association study appears to have led to the identification of major genes contributing to this risk.

Some major genes that contribute to the risk for opioid dependence appear to have been identified. The genes make proteins that influence calcium signaling or potassium signaling within neurons.

The lead scientist, Joel Gelernter, M.D., a professor of psychiatry, genetics, and neurobiology at Yale University, told Psychiatric News that he was surprised by this finding. He had expected genes that code for opioid receptors to turn out to be major contributors, he said. But that was not the case.

Gelernter and his coworkers conducted a genomewide association study to see whether they could significantly link any gene variants with a risk for opioid dependence. They used a relatively large sample—some 5,700 subjects (over a third with opioid dependence and the rest controls). Afterward they conducted two more studies—one with some 4,000 subjects and the other with some 2,500 ones—to see whether they could replicate their initial findings.

They were able to link variants of a number of genes with a risk for opioid dependence. But the variants that were most strongly associated with opioid dependence risk were those from genes involved in calcium or potassium signaling within neurons.”

http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1820456

Source: Psychiatryonline.org – January 28, 2014

At The White House, Learning How Not To Talk About Addiction

White House“We don’t refer to someone who has anorexia or bulimia as having a “food abuse” problem. We say they have an eating disorder. So why do we refer to someone who is addicted to alcohol or pain pills as having a “substance abuse” problem?

Harvard’s John Kelly, director of the new Recovery Research Institute at Massachusetts General Hospital, made that point this week at what was billed as the first-ever White House summit on drug policy reform. The Obama administration has moved far from the old “war on drugs” model. The current federal drug czar, Gil Kerlikowske, wrote in his email invitation to the summit: “Drug policy reform should be rooted in neuroscience, not political science.” And “it should be a public health issue, not just a criminal justice issue. That’s what a 21st-century approach to drug policy looks like.”

Dr. Kelly, an associate professor of psychiatry, spoke to the summit-goers about the stigma around addiction — so pervasive it can even be seen in language. I asked him to elaborate; our conversation, edited.”

http://commonhealth.wbur.org/2013/12/language-substance-abuse-addiction

Source: CommonHealth.WBUR.org – December 13, 2013

Heroin Addiction Warps Brain’s Ability to Change

brain“In a study of heroin abusers’ post-mortem brains, longer duration of heroin use was associated with changes in the shape and packaging of DNA in the brain in the ventral and dorsal striatum, areas of the brain associated with drug addiction, according to Yasmin Hurd, PhD, of the Icahn School of Medicine at Mount Sinai Hospital in New York, N.Y., and colleagues.

The DNA of these patients’ brains became more “open” to gene expression and overactive, which may mean that a treatment that helps “close” this gap and reduce over activity may help temper addiction, Hurd told MedPage Today during an oral presentation at the Society for Neuroscience meeting.”

http://www.medpagetoday.com/MeetingCoverage/SFN/42901

Source: MedPageToday.com – November 14, 2013

New Resources Available From SAMHSA

Based on TIP 53: Addressing Viral Hepatitis in People with Substance Use Disorders – A Quick Guide for Clinicians and Administrators

Offers clinicians information to address viral hepatitis when working with people with substance use disorders. Covers hepatitis prevention, screening, treatment, and service coordination, and guides administrators on how to add or improve hepatitis services.

http://atforum.com/addiction-resources/documents/TIP53QuickGuide_000.pdf


Based on TIP 54: Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders – A Quick Guide for Clinicians and Administrators

Summarizes guidelines for clinicians treating chronic pain in adults with a history of substance abuse. Covers patient assessment, chronic pain management, managing addiction risk in patients treated with opioids, and patient education.

http://atforum.com/addiction-resources/documents/TIP54QuickGuide.pdf

Source: Substance Abuse Mental Health Services Administration – November 2013

Video from the American Society of Addiction Medicine: Patient Access to Medications (Buprenorphine)

ASAM logoThis six minute video made available from the American Society of Addiction Medicine tells a patient’s story of recovery that shows the difficulty people suffering from the disease of opioid addiction face in gaining access to life-saving medications.

http://www.youtube.com/watch?v=AmqiU_AvG5Y&feature=youtu.be

Source: American Society of Addiction Medicine – July 22, 2013

Many Docs Still Don’t Understand Opioid Dependence

Doctors 613“Misperceptions about opioid dependence, including how to screen for and treat the disorder, continue to persist for the public and for many clinicians, new research suggests.

An online survey of 1,000 adults chosen at random plus 200 primary care physicians who were not addiction certified showed that almost half of the first group and a third of the latter said they believe that opioid dependence “is more of a psychological problem,” such as a lifestyle choice, than a chronic physical illness.

In addition, 35% of the clinicians admitted that they do not know much about opioid dependence; 66% said they feel that a low level of education is a likely cause of the disorder; and 57% said that low income was a likely cause.”

http://www.medscape.com/viewarticle/806303

Source: Medscape.com – June 14, 2013

As DSM-5 Launches, the Drama Ends and the Effects Begin

“The newest edition of psychiatry’s “bible” of diagnosis, the DSM-5, made its long-awaited appearance on May 18 at the opening of the American Psychiatric Association’s (APA) national conference in San Francisco. This revision of the DSM-IV took the APA more than a decade to produce, and unprecedented criticism dogged it most of the way.

Because of the unique role the DSM-5 plays in the diagnosis of addiction—and, as a result, its influence on the allocation of billions of dollars for research, prevention and treatment—The Fix has devoted extensive coverage in recent months to the controversies. Now, with the book launched and the dust settling, we turn our attention to two questions about short- and long-term consequences, and what people with substance use problems stand to gain or lose:

• Will treatment for addiction become more accessible for more people?

• Will research into addiction produce more effective diagnostics and drugs?”

http://www.thefix.com/content/dsm-5-diagnosis-mental-health-addiction-controversy8434

Source: TheFix.com – May 21, 2013

5 Myths about Addiction that Undermine Recovery

“Honest, courageous and insightful aren’t words typically used to describe drug addicts. But if given the chance, many addicts end up developing these qualities and contributing to society in a way they never imagined possible. These successes occur in spite of major obstacles, from the ever-present threat of relapse to the pervasive stereotypes addicts encounter along the way. Even with three decades of myth-busting research behind us, some of the most damaging beliefs about addiction remain.” The five myths include:

  • Addicts are bad people who deserve to be punished.
  • Addiction is a choice.
  • People usually get addicted to one type of substance.
  • People who get addicted to prescription drugs are different from people who get addicted to illegal drugs.
  • Treatment should put addicts in their place.

http://www.psychologytoday.com/blog/where-science-meets-the-steps/201305/5-myths-about-addiction-undermine-recovery

Source: PsychologyToday.com – May 14, 2013

New Book Available – Clean: Overcoming Addiction and Ending America’s Greatest Tragedy

CleanA new book on addiction was released April 2 that has received a lot of press coverage.

Amazon.com describes the book as “Addiction is a preventable, treatable disease, not a moral failing. As with other illnesses, the approaches most likely to work are based on science — not on faith, tradition, contrition, or wishful thinking. These facts are the foundation of Clean, a myth-shattering look at drug abuse by the author of Beautiful Boy. Based on the latest research in psychology, neuroscience, and medicine, Clean is a leap beyond the traditional approaches to prevention and treatment of addiction and the mental illnesses that usually accompany it. The existing treatment system, including Twelve Step programs and rehabs, has helped some, but it has failed to help many more, and David Sheff explains why. He spent time with scores of scientists, doctors, counselors, and addicts and their families to learn how addiction works and what can effectively treat it. Clean offers clear, cogent counsel for parents and others who want to prevent drug problems and for addicts and their loved ones no matter what stage of the illness they’re in. But it is also a book for all of us — a powerful rethinking of the greatest public health challenge of our time.”

The link to the book at Amazon.com is: http://www.amazon.com/Clean-Overcoming-Addiction-Americas-Greatest/dp/054784865X/ref=sr_1_4?s=books&ie=UTF8&qid=1364908254&sr=1-4&keywords=clean

Join Together interviewed David Sheff the book’s author to discuss his exploration into the science, prevention and treatment of addiction. The two part interview is available at:

http://www.drugfree.org/join-together/addiction/david-sheff-author-of-clean-interview-part-1-of-2?utm_source=Join%20Together%20Daily&utm_campaign=a87b199533-JT_Daily_News_David_Sheff_Author_of&utm_medium=email

http://www.drugfree.org/join-together/addiction/david-sheff-author-of-clean-interview-part-2-of-2?utm_source=Join%20Together%20Daily&utm_campaign=35128f3594-JT_Daily_News_David_Sheff_Author_of&utm_medium=email

David Sheff also wrote an opinion article for Time.com that is available at:
http://ideas.time.com/2013/04/03/we-need-to-rethink-rehab/

Sources: Amazon.com, JoinTogether, Time.com – April 2013

Blog – News Outlets Behaving Badly: Appalling Article by Bloomberg

“I don’t know if any of my readers caught that awful article on bloomberg.com, criticizing methadone clinics and their patients. I’m not going to post a link to it because it doesn’t deserve a link. But I did write to the editor, the writer of the story, and a comment to their post:

I read this disjointed and error-ridden article with sadness. I wish you could spend a day with me, talking to the patients I treat with methadone for their opioid addiction. You’d hear how, for many patients, methadone has been a life-saver. Most of my patients are ordinary people who became addicted before they knew what was happening. A very small number are criminals, and those few get media attention, propagating the myth that all methadone patients are irresponsible criminals. This just isn’t true. My patients are housewives, blue collar workers, secretaries, and schoolteachers. Anyone can become addicted.”

The blog can be accessed at: http://janaburson.wordpress.com/2013/02/09/news-outlets-behaving-badly-appalling-article-by-bloomberg/

Source: Janaburson’s Blog – February 9, 2013

Heroin: Small Cities, Even Rural Towns Face Growing Problems

“For years, heroin was considered an affliction mainly of poor urban neighborhoods. But these days, the drug is becoming popular in affluent suburbs, small cities, and even rural towns—especially among young people.

From Arizona to New Jersey, many communities that never imagined they would have a heroin problem now face a rising toll of addiction, overdoses, and even deaths.

“You would have to go pretty remote to find a place that didn’t have this,” says Kathleen Kane-Willis, a researcher at Roosevelt University in Chicago who has tracked heroin use since 2004. “It’s just everywhere”.

http://www.csmonitor.com/USA/Society/2013/0125/Heroin-Small-cities-even-rural-towns-face-growing-problems#.UQPfGQBSZ9g.email

Source: ChristianScienceMonitor.com – January 25, 2013

Buprenorphine vs. Methadone

Buprenorphine and methadone, both being opioids, activate the opioid (mu) receptors on nerve cells. And both drugs have long half-lifes, meaning that they’re long-acting medications. The half-life can vary from 24 to 60 hours for buprenorphine, and from 8 to 59 hours for methadone. (The half-life is the amount of time a drug stays in the body before its concentration in the plasma drops by half. A drug’s half-life can vary from patient to patient.)

The long half-lifes of buprenorphine and methadone account for their usefulness in treating opioid dependence. Simply put, these drugs lack the peaks and troughs that are associated with short-term opioids, like heroin—swings in drug plasma levels that can cause overdose and withdrawal symptoms.

But there are key differences between buprenorphine and methadone.

Full Agonist vs. Partial Agonist

Buprenorphine is a partial agonist; methadone, like heroin, is a full agonist. It is by their actions on opioid receptors that opioids achieve their analgesic (pain-killing) as well as their addictive effects.

Methadone, as a full mu opioid agonist, continues to produce effects on the receptors until either all receptors are fully activated, or the maximum effect is reached.

Buprenorphine, as a partial agonist, does not activate mu receptors to the same extent as methadone. Its effects increase until they reach a plateau. At that level, opioid-addicted patients can discontinue opioid use without experiencing withdrawal. Buprenorphine reaches its ceiling effect at a moderate dose, which means that its effects do not increase after that point, even with increases in dosage.

Like all opioids, buprenorphine can cause respiratory depression and euphoria, but its maximal effects are less than those of full agonists. The benefits of this from an overdose perspective constitute the safety profile of buprenorphine—a lower risk of abuse, addiction, and side effects than with full agonists.

For people who are not addicted to or dependent on opioids, the effects of partial (buprenorphine) and full (methadone) agonists are indistinguishable. However, at a certain point, the increasing effects of partial agonists reach maximum levels. For this reason, people who are dependent on high doses of opioids are better suited to treatment with a full agonist, such as methadone.

Buprenorphine, like methadone, has a serious potential for drug-drug interactions. It must be used cautiously with other medications, in particular benzodiazepines, other sedatives, opioid antagonists like naltrexone, and opioid agonists.

Buprenorphine

Methadone

Heroin

Partial agonist Full agonist Full agonist
Long half-life (24 to 60 hours) Long half-life (8 to 59 hours) Short half-life
Ceiling effect; good safety profile No ceiling effect (useful in patients dependent on high doses of opioids) No ceiling effect

Formulations of Buprenorphine

In October 2002, the Food and Drug Administration (FDA) approved the buprenorphine monotherapy product, Subutex, and a buprenorphine/naloxone combination product, Suboxone, for treating opioid addiction.

Subutex is no longer sold in this country. It has been replaced by generic buprenorphine. Suboxone, a sublingual tablet (designed to dissolve under the tongue), comes in two dosage forms. Suboxone film was approved by the FDA in 2010. The sublingual film dissolves faster than the tablet, and is individually wrapped in unit-dose, child-resistant pouches. According to the manufacturer, Reckitt Benckiser, Suboxone film is clinically interchangeable with the tablet.

Last fall, Reckitt Benckiser voluntarily removed its Suboxone tablets from the market, citing a few pediatric overdoses. But it protected its hold on the Suboxone market by retaining the film formulation. The patent on the tablets had long expired; the patent on the film runs until 2023. Patients, of course, had to be switched to the film, unless their physicians wanted to switch them to generic buprenorphine. At the same time that Reckitt pulled the tablets, it filed a Citizen’s Petition with the FDA, calling on all buprenorphine products to be sold in childproof packaging.

The effect of these moves by Reckitt on the buprenorphine marketplace are not clear, said Nicholas Reuter, MPH, who was senior public health analyst with SAMHSA’s Center for Substance Abuse Treatment (CSAT) when this story was written (he retired on January 31, 2013). “Submitting a Citizen’s Petition doesn’t mean the FDA has to accept it,” he said. In addition, in November 2012 the FDA accepted Orexo’s New Drug Application for Zubsolv, a buprenorphine-naloxone combination. Zubsolv could well be the first generic competition to Suboxone. And on December 17, 2012, Titan licensed Probuphine, its buprenorphine implant, to Braeburn Pharmaceutical for exclusive commercialization in the U.S. and Canada. “The buprenorphine marketplace is looking at different formulations,” noted Mr. Reuter. “There could be a generic competitor [for Suboxone] tomorrow.”

Making the Decision: Methadone vs. Buprenorphine

Aside from the dosage issue, there is no “cookie-cutter” approach for deciding what patient gets buprenorphine and what patient gets methadone. Philip L. Herschman, PhD, chief clinical officer of CRC Health Group, pointed out that different patients react differently to different medications. “Some feel better on buprenorphine, some feel better on methadone,” he said. CRC has been using generic buprenorphine in its OTPs on the same basis as methadone. The extent to which CRC will be able to give buprenorphine take-homes will depend in large part on state regulations—just because the federal government has approved the plan doesn’t mean states will.

“Buprenorphine is great, but it’s not for everybody,” said Walter Ginter, CMA, project director of the Medication Assisted Recovery Support (MARS) project. He doesn’t think the final rule is going to make a big difference for most patients. He noted that few patients go to methadone maintenance as their first course of treatment.

In fact, Mr. Ginter can speak as an expert on subjective effects in a personal way: he has been maintained on both medications—buprenorphine during its development in the 1990s, when he was a study subject, and then methadone. He has been on a high dose of methadone for years, and says “I don’t think I’m clouded out.” Indeed, he is one of the most energetic and articulate advocates in the field. It comes down to a matter of personal preference, he said. “With methadone, you’re never sick and you’re never high, but you do get the serum peaking four hours after the dose,” he said. “I think Suboxone is too much the same, with no ups or downs.”

Still, there are OTPs that do switch patients from methadone to buprenorphine, titrating very carefully downward for patients on doses of 80 milligrams or more of methadone before switching to buprenorphine, said Mark Parrino. MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). In general, if a patient has been using opioids for a longer period, or has a higher tolerance, methadone would be more appropriate. The reason is that buprenorphine’s ceiling limits those higher-dose equivalents.

Publishers Note: Nicholas Reuter, MPH joined Reckitt Benckiser in February 2013 as a Treatment Manager.

Drug Addiction: It’s Different—and Riskier—for Women

When it comes to drug addiction, gender does make a difference.

Women start using substances and become addicted differently from men. Their addiction progresses faster, they find it harder to quit, they recover differently from men, and they relapse for different reasons.

These gender differences have a substantial impact on treatment for substance abuse. But when women’s specific needs are understood and addressed from the outset, better treatment engagement and successful outcomes often follow.

Women and Addiction: The Biopsychosociocultural Framework

The Substance Abuse and Mental Health Administration TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women, proposes approaching substance abuse treatment for women from the perspective of “the biopsychosociocultural framework.”

Differences between women and men in genetics, physiology, anatomy, and sociocultural expectations and experiences lay the foundation for women’s unique health concerns related to substance-use disorders (SUDs). The biopsychosociocultural framework encompasses the impact of gender and culture and the contexts of a woman’s life, including her social and economic environment, and her relationships with family and support systems.

Risk Factors for Substance Use in Women

Some factors are associated more strongly with initiation of illicit drug use in women than with progression to abuse. They include risk-taking (as a personality trait), depression, obsessiveness, anxiety, and difficulty controlling behavior (as indicated by temper tantrums or tearfulness).

Genetics and environment both play a role in some risk factors. Parents who abuse substances may pass along a genetic susceptibility. They may also fail to adequately protect their children from abuse by others, and may be of little help to them emotionally. And they may unintentionally pass along the message that it’s okay to use substances to cope with problems.

Among other risk factors:

  • Divorce, never having been married, and widowhood (the incidence of SUDs in married women is only 4%)
  • Sexual or physical abuse or domestic violence in childhood or adulthood
  • A history of having adult responsibilities as a child: caring for younger children, performing household duties, emotionally supporting their parents
  • Unemployment or underemployment; low income; low education level
  • A partner who abuses alcohol or drugs (some women continue using substances in order to maintain the relationship, a situation that also occurs in some same-sex relationships)
  • Sexual orientation: lesbians have higher rates of SUDs than heterosexual women; younger lesbians and bisexual women are most likely to abuse prescription drugs

Protective Factors

Factors that help protect a woman against substance use, abuse, and dependence include a good marriage, a supportive partner, parental warmth during her childhood, religious affiliation and beliefs, and deep personal devotion.

Research Results: Characteristics of Women with OUDs

Women face a higher risk of co-occurring mental and physical disorders. A UCLA study examined gender differences in 578 men and women with opioid-use disorders (OUDs), drawn from the National Epidemiologic Survey on Alcohol and Related Conditions. The study found that “women were about twice as likely as men to have either a mood or anxiety disorder.” Women were also “more likely to have paranoid disorder, and men, more likely to have antisocial personality disorder.” Another study, the National Survey on Drug Use and Health, found higher rates of “serious psychological distress” and “cigarette use” related to non-medical use of prescription opioids among women, but not among men. In contrast, “serious psychological distress” was a significant predictor of abuse/dependence for both sexes.

Other studies have found that women are much more likely than men to have co-occurring mental disorders, often three or more, including anxiety disorders, major depression, eating disorders, and post-traumatic stress disorder (PTSD). Typically, PTSD follows trauma, sexual abuse, or violence—events that unfortunately are all too common in women with OUD. Physical disorders in women include gynecological infections, high blood pressure, amenorrhea (absence of menstrual periods) and pneumonia.

In a symposium report, Florence Haseltine, PhD, MD, noted that women tend to take illicit drugs to relieve stress; men, to get a high; women, for self-medication; men, as an adventure.

She added that women with OUDs are more likely to

  • Self-medicate, especially using drugs to manage negative moods
  • Need help for emotional problems, and at a younger age
  • Have attempted suicide

Others have observed that, in addition, women with OUDs tend to use more prescription drugs (and use prescription drugs that can be abused), obtain prescription opioids free from family or friends (men are more likely to buy them), and have partners who use illicit drugs.

Relationships and family history are key factors in women’s—but not men’s—initiation and continued illicit use of opioids and other substances. Women are more likely than men to have a family background of dysfunction and alcohol dependency, and to be brought into and maintained in drug use by a partner or family member. It almost seems that when women start to abuse substances, they already have three strikes against them.

Women are more likely to borrow needles and equipment from the person they inject drugs with. They’re also likely to inject immediately after that person—putting themselves at added risk of HIV and hepatitis infections. Intravenous drug use accounts for up to half the cases of HIV infection among women in the U.S., twice as many as sexual transmission.

But, importantly, women can temporarily change their pattern of substance use to meet caregiver responsibilities involving the family, such as pregnancy.

Looking Back When In Methadone Maintenance Treatment

In gender-specific focus groups in a methadone maintenance clinic at UCLA, comments from participants older than 50 years revealed clear differences between men and women in their views of their previous life in addiction. Women talked about the impact on their families, and their regrets about “. . . not being the mother I should have been.” And their remorse: “I almost lost my family.”  Men typically expressed surprise at still being alive, and previous fears about incarceration.

Pregnancy

If a woman’s menstrual periods stop when she is using opioids, she may assume at first that the early signs of pregnancy are symptoms of withdrawal or underdosing. This often delays her pregnancy diagnosis and prenatal care.

But, as TIP 51 points out, “Women are socialized to assume more caregiver roles and to focus attention on others.” Indeed, once a woman is told she is pregnant, she typically casts aside her vulnerability and regains her traditional role of caregiver. She is likely to accept medical care for herself and her unborn child, and to stop or substantially curtail her use of illicit drugs, alcohol, and cigarettes, throughout her pregnancy.

*     *     *

This article is the first in a series on the special challenges that make coping with addiction especially difficult for women. Future topics include the barriers women face in seeking and accepting treatment, and the best approaches to treatment for women in medication-assisted treatment programs. Programs need to address the special needs of women by offering auxiliary or wraparound services, or both—such as child care and prenatal services, and workshops on woman-focused topics.

Resources

Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series 51. HHS Publication No. (SMA) 09-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009.

Becker JB, Hu M. Sex differences in drug use. Frontiers in Endocrinology. 2008;29:36-47.

Haseltine FP. Symposium Report: Gender differences in addiction and recovery. J Womens Health Gend Based Med. 2000;9(6).

Hamilton AB, Grella CE. Gender differences among older heroin users. J Women Aging. 2009;21(2):111-124.

Grella CE, Karno MP, Warda US, et al. Gender and comorbidity among individuals with opioid use disorders in the NESARC study. Addict Behav. 2009;34(6-7):498-504.

Grella CE, Lovinger K. Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence. Addict Behav. 2012;37(3):306-312.

Subramaniam GA. Clinical characteristics of treatment-seeking prescription opioid versus heroin using adolescents with opioid use disorder. Drug Alcohol Depend. 2009;101(1-2):13-19.

Back SE, Payne RL, Simpson AN, Brady KT. Gender and prescription opioids: Findings from the National Survey on Drug Use and Health. Addict Behav. 2010;35(11)1001-1007.

Researchers Say MRI Could Help Predict Success of Drug Addiction Treatment

Scientists at the University of Pennsylvania say MRI scans may be able to predict which patients will succeed with certain addiction treatments, and which ones will relapse, according to the Philadelphia Daily News.

Researchers at the university’s Center for Studies of Addiction are watching how regions of the brain react to drug-related photos, such as pictures of a heroin needle or a crushed pill. They hope to use this research to develop more effective treatments. One day, they hope that treatment could be tailored to a person’s mental strengths and vulnerabilities. These factors are influenced by genetics, life experiences and drug use, they say.

http://www.drugfree.org/join-together/addiction/researchers-say-mri-could-help-predict-success-of-drug-addiction-treatment?utm_source=Join+Together+Weekly&utm_campaign=16753ecc0b-

Source: JoinTogether.org – January 18, 2013

Controversial Surgery for Addiction Burns Away Brain’s Pleasure Center

“How far should doctors go in attempting to cure addiction? In China, some physicians are taking the most extreme measures. By destroying parts of the brain’s “pleasure centers” in heroin addicts and alcoholics, these neurosurgeons hope to stop drug cravings. But damaging the brain region involved in addictive desires risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy.

In 2004, the Ministry of Health in China banned this procedure due to lack of data on long term outcomes and growing outrage in Western media over ethical issues about whether the patients were fully aware of the risks.

However, some doctors were allowed to continue to perform it for research purposes—and recently, a Western medical journal even published a new study of the results. In 2007, The Wall Street Journal detailed the practice of a physician who claimed he performed 1000 such procedures to treat mental illnesses such as depression, schizophrenia and epilepsy, after the ban in 2004; the surgery for addiction has also since been done on at least that many people.”

http://healthland.time.com/2012/12/13/controversial-surgery-for-addiction-burns-away-brains-pleasure-center/http:/healthland.time.com/2012/12/13/controversial-surgery-for-addiction-burns-away-brains-pleasure-center/

Source: Healthland.Time.com – December 13, 2012

Blog: The Deadly Stigma of Addiction – Is it Possible to Separate the Disease of Addiction from the Stigma? Here Are Eight Life-changing Reasons We Should Try

The American Society of Addiction Medicine characterizes addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” The National Institute on Drug Abuse defines addiction as a ‘chronic, relapsing brain disease” that changes the structure and functionality of the brain. So why do so many people still think of addiction as a moral failing? Why do they still refer to victims of substance misuse disorders as meth freaks, alcoholics, junkies, crack heads and garden-variety drunks?

The answer is simple as it is depressing: because that’s the way it’s always been.

http://www.thefix.com/content/professional-voices-addiction-stigma-lethal70023

Source: TheFix.com - December 5, 2012

U.S. Addiction Diagnoses up 70 Percent

“The number of drug and alcohol problems diagnosed by US doctors increased by 70% in the first decade of the 2000s, reveals a new study, just as painkiller abuse in the country reached an all-time high. The number of visits involving a diagnosis of opioid painkiller abuse multiplied nearly sixfold in that time frame: from 772,000 to 4.4 million.

The study has its bright spots, however. Prescriptions aimed at treating drug and alcohol addiction have also increased drastically: from 643,000 between 2001 and 2003 to 3.9 million between 2007 and 2009. And the increase in diagnoses means that more people are seeking treatment for addiction, from medications such as methadone, to talk therapy.”

http://www.thefix.com/news?page=27 (Note: the link is subject to change since it is in the news archives section of the website)

Source: TheFix.com – October 23, 2012

Commentary by Dr. Joseph Shrand: Drug Addiction is Not a Moral Failing

“There is an unfortunate tradition of being angry and disgusted at people who are addicted to heroin. Seeing addiction as a moral failing, these folks become outraged that our government spends their tax dollars on treating people who knew from the start they were using an addictive drug, in essence telling them they were on their own and we should not be spending a dime to help them. Their addiction was their fault and they were stuck with it. If those repelled by the addict had their way, all of these people would be cast aside to rot.”

http://www.patriotledger.com/lifestyle/health_and_beauty/x1671793946/DR-JOSEPH-SHRAND-Drug-addiction-is-not-a-moral-failing

Source: Patriotledger.com – November 17, 2012

Slide Show: The Brain Scans of Addiction, Unscrambled

“These slides are meant as a primer on some of the biggest stories to have emerged in addiction neuroimaging, and the insights they give. Of course, these examples are only a thin sliver of the available science—and scientists are still grappling with addiction’s overwhelming complexity. Without dismissing other relevant brain systems or equally important socio-cultural and environmental influences, our focus here is the striatum: a set of structures heavily involved in reward, motivation, habit formation—and the brain’s dopamine system.”

http://www.thefix.com/content/brain-scans-addiction90916

Source: TheFix.com – November 15, 2012

Blog: Why Addiction is NOT a Brain Disease

“Attempts to define addiction in concrete scientific terms have been highly controversial and are becoming increasingly politicized. What IS addiction? We as scientists need to know what it is, if we are to have any hope of helping to alleviate it.

There are three main definitional categories for addiction: a disease, a matter of choice, and self-medication. There is some overlap among these meta-models, but each has unique implications for treatment, from the level of government policy to that of available options for individual sufferers.”

http://blogs.plos.org/mindthebrain/2012/11/12/why-addiction-is-not-a-brain-disease/

Source: Plos.org – November 12, 2012

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