Showing posts with label addiction medicine. Show all posts
Showing posts with label addiction medicine. Show all posts

Monday, February 17, 2014

Acamprosate For Alcohol: Why the Research Might Be Wrong


Calcium may be curbing the urge to drink.

“Occasionally,” reads the opening sentence of a commentary published online last month in Neuropsychopharmacology, “a paper comes along that fundamentally challenges what we thought we knew about a drug mechanism.” The drug in question is acamprosate, and the mechanism of action under scrutiny is the drug’s ability to promote abstinence in alcoholics. The author of the unusual commentary is Markus Heilig, Chief of the Laboratory of Clinical and Translational Studies at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Acamprosate, in use worldwide and currently the most widely prescribed medication for alcohol dependence in the U.S., may work by an entirely different mechanism than scientists have believed on the basis of hundreds of studies over decades. Rainer Spanagel of the Institute of Psychopharmacology at the University of Heidelberg, Germany, led a large research group in revisiting research that he and others had performed on acamprosate ten years earlier. In their article  for Neuropsychopharmacology, Spanagel and coworkers concluded that a sodium salt version of acamprosate was totally ineffective in animal models of alcohol-preferring rats.

“Surprisingly,” they write, “calcium salts produce acamprosate-like effects in three animal models…. We conclude that N-acetylhomotaurinate is a biologically inactive molecule and that the effects of acamprosate described in more than 450 published original investigations and clinical trials and 1.5 million treated patients can possibly be attributed to calcium.”

At present, the Food and Drug Administration (FDA] has approved three drugs for alcoholism— Antabuse, naltrexone, plus acamprosate in 2004. In addition, there is considerable clinical evidence behind the use of four other drugs—topiramate, baclofen, ondansetron, and varenicline. Acamprosate as marketed is the calcium salt of N-acetyl-homotaurinate, a close relative of the amino acid taurine. It has also been found effective in European studies.

What did scientists think acamprosate was doing? Various lines of research had linked acamprosate to glutamate transmission. Changes in glutamate transmission have been directly implicated in active alcoholism. A decade ago, the Spanagel group had decided that acamprosate normalized overactive glutamate systems, and hypothesized that acamprosate was modulating GABA transmission. So it became known as a “functional glutamate antagonist.”  But specific mechanisms have remained elusive ever since.

Now, as Heilig comments, “the reason it has been difficult to pin down the molecular site of acamprosate action may simply be because it does not exist. Instead, the authors propose that the activity attributed to acamprosate has all along reflected actions of the Ca++ it carries.” As the researcher paper explains it: “N-acetylhomotaurinate by itself is not an active psychotropic molecule…. We have to conclude that the proposed glutamate receptor interactions of acamprosate cannot sufficiently explain the anti-relapse action of this drug.” Further work shows that acamprosate doesn’t interact with glutamate binding sites at all.  In other words, calcium appears to be the major active ingredient in acamprosate. Animal studies using calcium chloride or calcium gluconate reduced alcohol intake in animals at rates similar to those seen in acamprosate, the researchers claim.

Subsequently, the researchers revisited the earlier clinical studies, subjected them to secondary analysis, and concluded that “in acamprosate-treated patients positive outcomes are strongly correlated with plasma Ca++ levels. No such correlation exists in placebo-treated patients.” In addition, calcium salts delivered via different carrier drugs replicated the suppression of drinking in the earlier animal findings. 

Where there cues pointing toward calcium? The researchers conclude that “calcium sensitivity of the synapse is important for alcohol tolerance development, calcium given intraventricularly significantly enhances alcohol intoxication in a dose-dependent manner,” and “activity of calcium-dependent ion channels modulate alcohol drinking.”

Interestingly, in the late 50s and early 60s, there was a brief period of interest in calcium therapy for the treatment of alcoholism. In 1964, the Journal of Psychology ran an article titled “Intensive Calcium Therapy as an Initial Approach to the Psychotherapeutic Relationship in the Rehabilitation of the Compulsive Drinker.” Now it appears possible that a daily dose of acamprosate is effective for some abstinent alcoholics because it raises calcium plasma levels. Calcium supplements may be in for a round of intensive clinical testing if these findings hold up.

The authors now call for “ambitious randomized controlled clinical trials,” to directly compare “other means of the Ca++ delivery as an approach to treat alcohol addiction. Data in support of a therapeutic role of calcium would open fascinating clinical possibilities.”  Indeed it would.

Spanagel R., Vengeliene V., Jandeleit B., Fischer W.N., Grindstaff K., Zhang X., Gallop M.A., Krstew E.V., Lawrence A.J. & Kiefer F.  (2013). Acamprosate Produces Its Anti-Relapse Effects Via Calcium, Neuropsychopharmacology, 39 (4) 783-791. DOI:

Tuesday, August 21, 2012

Addiction Books For the Beach


When 50 Shades of Grey doesn’t cut it.


The Science of Addiction: From Neurobiology to Treatment

Carlton K. Erickson
312 pages
Publisher: W. W. Norton and Company (2007)

Amazon Overview: Neuroscience is clarifying the causes of compulsive alcohol and drug use––while also shedding light on what addiction is, what it is not, and how it can best be treated––in exciting and innovative ways. Current neurobiological research complements and enhances the approaches to addiction traditionally taken in social work and psychology. However, this important research is generally not presented in a forthright, jargon-free way that clearly illustrates its relevance to addiction professionals. In The Science of Addiction, Carlton K. Erickson presents a comprehensive overview of the roles that brain function and genetics play in addiction.


The Addiction Solution: Unraveling the Mysteries of Addiction through Cutting-Edge Brain Science

David Kipper and Steven Whitney
304 pages
Publisher: Rodale Books (2010)

For decades addiction has been viewed and treated as a social and behavioral illness, afflicting people of “weak” character and “bad” moral fiber. However, recent breakthroughs in genetic technology have enabled doctors, for the first time, to correctly diagnose the disease and prove that addiction is an inherited, neuro-chemical disease originating in brain chemistry, determined by genetics, and triggered by stress. In their groundbreaking Addiction Breakthrough, David Kipper, MD, and Steven Whitney distill these exciting findings into a guide for the millions of adults who want to be free from the cycle of addiction, and for their loved ones who want to better understand it and to help.


In the Realm of Hungry Ghosts: Close Encounters with Addiction

Gabor Maté
520 pages
Publisher: North Atlantic Books (2010)

Based on Gabor Maté’s two decades of experience as a medical doctor and his groundbreaking work with the severely addicted on Vancouver’s skid row, In the Realm of Hungry Ghosts radically reenvisions this much misunderstood field by taking a holistic approach. Dr. Maté presents addiction not as a discrete phenomenon confined to an unfortunate or weak-willed few, but as a continuum that runs throughout (and perhaps underpins) our society; not a medical "condition" distinct from the lives it affects, rather the result of a complex interplay among personal history, emotional, and neurological development, brain chemistry, and the drugs (and behaviors) of addiction. Simplifying a wide array of brain and addiction research findings from around the globe, the book avoids glib self-help remedies, instead promoting a thorough and compassionate self-understanding as the first key to healing and wellness.


Memoirs of an Addicted Brain: A Neuroscientist Examines his Former Life on Drugs

Marc Lewis
336 pages
Publisher: PublicAffairs (2012)

Marc Lewis’s relationship with drugs began in a New England boarding school where, as a bullied and homesick fifteen-year-old, he made brief escapes from reality by way of cough medicine, alcohol, and marijuana. In Berkeley, California, in its hippie heyday, he found methamphetamine and LSD and heroin. He sniffed nitrous oxide in Malaysia and frequented Calcutta’s opium dens. Ultimately, though, his journey took him where it takes most addicts: into a life of addiction, desperation, deception, and crime. But unlike most addicts, Lewis recovered and became a developmental psychologist and researcher in neuroscience. In Memoirs of an Addicted Brain, he applies his professional expertise to a study of his former self, using the story of his own journey through addiction to tell the universal story of addictions of every kind.


The Chemical Carousel: What Science Tells Us About Beating Addiction

Dirk Hanson
472 pages
Publisher: BookSurge (2009)

A book for anyone concerned with the care and healing of addiction, substance abuse, and the latest advances in the area of addiction science. In The Chemical Carousel, science writer Hanson takes the reader on a voyage through the heady world of addiction science, from the lab to the clinic to the junky on the street. Hanson explains the workings of common neurotransmitters and documents the direct effect drugs and alcohol produce on the reward pathways of the brain. He shows how scientists and treatment professionals have finally given us an answer to the perennial question about addiction: Why can't those people just say no?


An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug, Cocaine

Howard Markel
336 pages
Publisher: Vintage (2012)

Acclaimed medical historian Howard Markel traces the careers of two brilliant young doctors--Sigmund Freud, neurologist, and William Halsted, surgeon--showing how their powerful addictions to cocaine shaped their enormous contributions to psychology and medicine. When Freud and Halsted began their experiments with cocaine in the 1880s, neither they, nor their colleagues, had any idea of the drug's potential to dominate and endanger their lives. An Anatomy of Addiction tells the tragic and heroic story of each man, accidentally struck down in his prime by an insidious malady: tragic because of the time, relationships, and health cocaine forced each to squander; heroic in the intense battle each man waged to overcome his affliction.


How to Change Your Drinking: a Harm Reduction Guide to Alcohol

Kenneth Anderson
86 pages
Publisher: CreateSpace (2010)

This book is the first comprehensive compilation of harm reduction strategies aimed specifically at people who drink alcohol. Whether your goal is safer drinking, reduced drinking, or quitting alcohol altogether, this is the book for you. It contains a large and detailed selection of harm reduction tools and strategies which you can choose from to build your own individualized alcohol harm reduction program. There are many practical exercises to help people change their behaviors, including risk-ranking worksheets, drinking charts, goal choice worksheets, and many more. There are also innumerable practical tips from folks who "have been there" and have turned their drinking habits around for the better.


Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It

William R. Miller and Kathleen M. Carroll
320 pages
Publisher: Guilford Press (2010)

While knowledge on substance abuse and addictions is expanding rapidly, clinical practice still lags behind. This state-of-the-art book brings together leading experts to describe what treatment and prevention would look like if it were based on the best science available. The volume incorporates developmental, neurobiological, genetic, behavioral, and social–environmental perspectives. Tightly edited chapters summarize current thinking on the nature and causes of alcohol and other drug problems; discuss what works at the individual, family, and societal levels; and offer robust principles for developing more effective treatments and services.

Writers On The Edge: 22 Writers Speak About Addiction and Dependency

Diana Raab and James Brown
204 pages
Publisher: Modern History Press (2012)

Writers On The Edge offers a range of essays, memoirs and poetry written by major contemporary authors who bring fresh insight into the dark world of addiction, from drugs and alcohol, to sex, gambling and food. Editors Diana M. Raab and James Brown have assembled an array of talented and courageous writers who share their stories with heartbreaking honesty as they share their obsessions as well as the awe-inspiring power of hope and redemption. Frederick & Steven Barthelme, Kera Bolonik, Margaret Bullitt-Jonas, Maud Casey, Anna David, Denise Duhamel, B.H. Fairchild, Ruth Fowler, David Huddle Perie Longo, Gregory Orr, Victoria Patterson, Molly Peacock, Scott Russell Sanders, Stephen Jay Schwartz, Linda Gray Sexton, Sue William Silverman, Chase Twichell, and Rachel Yoder

Photo Credit: http://www.readingkingdom.com/

Sunday, April 29, 2012

Addiction Doctors Pick Top Ten Journal Articles


A screen for problem gambling, medications for insomniac alcoholics, and more.

A group of addiction doctors presented a Top Ten List of peer-reviewed articles from 2011 at the American Society of Addiction Medicine’s Annual Medical-Scientific Conference in Richmond, VA. Dr. Michael Weaver presented the findings, noting that the list was “reached by consensus, and articles were selected not only for their quality but also to represent different areas of addiction medicine.” Dr. Weaver stressed that “not all published studies were done really well, and some may not apply to the patients treated by a particular clinician.”

According to Dr. Edward Nunes, with the Department of Psychiatry at Columbia University, the journal articles provide a "nice mixture on epidemiology and clinical outcome or clinical trials research,” which represent “the type of evidence most relevant to patient care."

Thanks to Catharine Zivkovic (@ccziv) for drawing attention to this list. The summaries are my own. Disclaimer: In some cases, these brief summaries are based solely on a reading of the journal abstracts.

1. 

 A Taiwanese study analyzing benzodiazepine prescription records came up with a simple solution: “Prescribers can reduce the risk of long-term use by assessing whether pediatric patients have received benzodiazepines from multiple doctors for various medical conditions.” Huh. Who’d have thought of that one, eh? But for various reasons, such checks, and the open records required to make them possible, are the exception rather than the rule in current health care systems. The study group found that for long-term users under 21, defined as anyone in receipt of a benzodiazepine prescription for 31 or more days in a calendar year, one in four patients fell into the categories of “accelerating or chronic users.” Specifically, “A history of psychosis or epilepsy, prescription by providers from multiple specialties, and receipt of benzodiazepines with a long half-life or mixed indications significantly increased one's risk of becoming a chronic or accelerating user.”

2

This study looked for clinical features of alcohol dependence and socially maladaptive drinking patterns during the first 24 months of alcohol use, based on stats from the 2004-2007 National Surveys on Drug Use and Health (NSDUH). Result: New alcohol users “frequently experienced problems relating to self-reported tolerance, spending a great deal of time recovering from the effects of alcohol and unsuccessful attempts at cutting down on drinking. The likelihood of experiencing the clinical features increased steadily in the first 9 months after use, but appeared to plateau or only gradually increase thereafter.” The researchers suggest there may be a window of opportunity during the 2nd year of drinking.

3.
Volberg, Rachel A., et al. (2011) A Quick and Simple Screening Method for Pathological and Problem Gamblers in Addiction Programs and Practices. The American Journal on Addictions. 20(3): 220-227.

Doctors, as these researchers point out, don’t often screen their patients for pathological gambling. To combat this, the investigators offer health professionals brief computer screenings they have developed for use in identifying problem gambling. “Given the high rates of comorbidity, routine and accurate identification of gambling-related problems among individuals seeking help for substance abuse and related disorders is important.” 

4.
Alford, Daniel. P., et al. (2011). Collaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine: Five-Year Experience. Archives of Internal Medicine 171(5):425-431.

Buprenorphine remains an underused but often effective treatment for opiate addiction, the authors of this study maintain. The cohort being studied was a group of addicted patients under the dual care of general physicians and nurse care managers. “Of patients remaining in treatment at 12 months, 154 of 169 (91.1%) were no longer using illicit opioids or cocaine based on urine drug test results,” the investigators report. However, dropout rates were high. The researchers did find that the nurse-doctor model was workable: “Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.”

5. 
Kolla, B.P., et. al. (2011) Pharmacological Treatment of Insomnia in Alcohol Recovery: A Systematic Review. Alcohol and Alcoholism 46: 578-585.

In this Mayo Clinic review of drugs used for sleep problems in alcohol recovery, the authors combed through more than 1,200 articles and reported that, of all the old and new drugs being used, an old and rarely used medication—trazadone—improved sleep measures as reliably as anything else that was tested. Gabapentin got good but equivocal marks due to questions about testing and inclusion criteria. Topiramate and carbamazepine helped in some cases. Furthermore, “in single, small, mostly open-label studies, quetiapine, triazolam, ritanserin, bright light and magnesium have shown efficacy, while chlormethiazole, scopolamine and melperone showed no difference or worsening. Conclusion: Trazodone has the most data suggesting efficacy.”

6.
Bohnert, A.S., et. al. (2011). Association between opioid prescribing patterns and opioid overdose-related deaths. Journal of the American Medical Association 305: 1315-1321.

Accidental prescription overdose deaths are on the rise, and this group of university researchers in Ann Arbor and Indianapolis thinks it may have something to do with how the dosing instructions are usually worded.  They set out to investigate “the association of maximum prescribed daily opioid dose and dosing schedule (“as needed,” regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders.” They found from VHA hospital records that “the frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%.” The risk for overdose was directly related to the “maximum prescribed daily dose of opioid medication.” And patients who stuck with regular dosages, or took opioids “as needed,” were not at any elevated risk for overdose. Another obvious but frequently overlooked conclusion: “Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.”

7. 
Allsop, D.J. et al. (2011). The Cannabis Withdrawal Scale development: patterns and predictors of cannabis withdrawal and distress. Drug and Alcohol Dependence 19(1-2):123-9.

Rates of treatment for marijuana abuse and addiction are increasing, say these Australian authors, along with relapse rates. They have devised a Cannabis Withdrawal Scale that measures such withdrawal effects as associated distress, strange dreams, trouble sleeping, and angry outbursts—common manifestations of withdrawal from weed. The scientists maintain that their “Cannabis Withdrawal Scale can be used as a diagnostic instrument in clinical and research settings where regular monitoring of withdrawal symptoms is required.”

8.
West, R., et al. (2011) Placebo-Controlled Trial of Cytisine for Smoking Cessation. New England Journal of Medicine 365: 1193-1200.

This important study assessed the effectiveness of the drug cytisine in smoking cessation programs, and a potential star was born. In a single-center, randomized, double-blind, placebo-controlled trial, the journal paper concluded that “cytisine was more effective than placebo for smoking cessation. The lower price of cytisine as compared with that of other pharmacotherapies for smoking cessation may make it an affordable treatment to advance smoking cessation globally.”

9. 

Conducted at eight medical centers across the U.S., this study found that for most of the 140 methamphetamine-dependent adults under scrutiny, use of topiramate produced “abstinence from methamphetamine during weeks 6-12.” That’s the good news. Unfortunately,  “secondary outcomes included use reduction versus baseline, as well as psychosocial variables… topiramate did not increase abstinence from methamphetamine during weeks 6-12.” That’s the bad news. And here’s the silver lining, as far as the investigators are concerned: “Topiramate does not appear to promote abstinence in methamphetamine users but can reduce the amount taken and reduce relapse rates in those who are already abstinent.”

10.

There really is s a gateway drug. In fact, there are two of them in our culture. Almost every potential addict starts out with alcohol or cigarettes or both. Because they are legal and easily available. So is cocaine and marijuana, once you get the hang of it, but in the beginning, and all around us, it’s booze and cigs. The amazing premise of this final study is this: “Pretreatment of mice with nicotine increased the response to cocaine, as assessed by addiction-related behaviors and synaptic plasticity in the striatum, a brain region critical for addiction-related reward.” Nicotine primes subjects for cocaine addiction, in effect. “These results from mice prompted an analysis of epidemiological data, which indicated that most cocaine users initiate cocaine use after the onset of smoking and while actively still smoking, and that initiating cocaine use after smoking increases the risk of becoming dependent on cocaine, consistent with our data from mice. If our findings in mice apply to humans, a decrease in smoking rates in young people would be expected to lead to a decrease in cocaine addiction.”

Photo Credit: www.flickr.com/

Monday, September 5, 2011

Addiction Specialist Kicks Off A3 Academy in L.A.


Filling the void between “doing nothing and formal treatment.”

Good news for recovering addicts and addiction experts in Los Angeles: Dr. Adi Jaffe, a well-known addiction psychologist from UCLA and a longtime friend of Addiction Inbox, is kicking off a new venture: the A3 Academy.

 Dr. Jaffe, who runs the All About Addiction website, and writes a column for Psychology Today, knows whereof he speaks, having spent 8 years as a meth addict and drug dealer in a former lifetime. “The A3 Academy is specifically formulated to fill the void between doing nothing about addiction and formal addiction treatment,” Dr. Jaffe said. The inaugural academy will be held on Tuesday, September 6th, in West Los Angeles (2001 Barrington Ave.) at 6:00 PM, and is intended to become a weekly event. Information, tickets, and details of online participation are available HERE. Or you can email for information at academy@allaboutaddiction.com.

“If it has to do with addiction,” we’ll probably cover it,” Dr. Jaffe said. He plans to integrate “informational sessions, process groups, life planning, mindfulness, nutrition, and expert consultation with leading addiction experts from the Los Angeles area and beyond.”

Dr. Adi told Addiction Inbox that “local LA people can attend the event, and others can stream and watch, and the cost is purposefully low. It's going to be an educational/empowerment sort of thing that will adapt to the needs of the specific group attending.”

Judging by his blog postings at All About Addiction, Dr. Jaffe brings a wealth of information and experience to the task—as well as being an accomplished public speaker. “I’ve learned a lot about the genetic, behavioral, and environmental influences on addiction and drug-abuse,” he says. “Whatever you’re comfortable calling addiction, there’s no doubt that it’s having a great, negative, impact on those it affects. More than 500,000 deaths and a burden of more than $500 million dollars are attributed to substance abuse every year in the United States alone. I think it's time we get real about the problem and stop using stigma and misinformation to hide behind.”

Photo Credit: http://www.findallvideo.com/tag/live-in-fitness

Monday, August 1, 2011

Is Addiction Deductible?


You're free to write off the cost of addiction treatment—if you can afford to.

The cost of addiction treatment is a legitimate medical expense, as long as you are talking about drug and alcohol addiction, which the IRS recognizes as a genuine medical disease. If you go to Betty Ford on the advice of your doctor for alcoholism, it’s deductible. If you go to Passages for cocaine addiction, it’s deductible. If you buy nicotine gum and patches and fill a prescription for Chantix, in a stop-smoking effort, it’s deductible. But if you want to write off the cost of a weight-loss clinic, or a gambling cessation program, or treatment for compulsive sexual activity, you’re a bit ahead of the curve.

According to Dave Hutchison, Planned Giving Officer at the Betty Ford Center Foundation: “Generally, medical expenses, including amounts paid for medical treatment, drugs and medicines, nursing care and certain transportation and travel required for medical care, are deductible as an itemized deduction.  Amounts paid for inpatient treatment of alcoholism or drug addiction at a therapeutic center and for meals and lodging furnished as a necessary incident to the treatment are deductible.”

Officially, IRS Topic 502 says that “payments for acupuncture treatments or inpatient treatment at a center for alcohol or drug addiction are also deductible medical expenses.” So just about any loopy treatment is covered, as long as the official diagnosis is alcoholism or drug addiction, including cigarettes.

And while theoretically the IRS is open to the idea of allowing deductions for the “cost of participating in a weight-loss program for a specific disease or diseases, including obesity, diagnosed by a physician,” the tax people aren’t yet persuaded that obesity, per se, is an addictive disease. They don’t allow most deductions for the cost of health food diet items or health club dues, for example, even if health food and gym workouts are doctor’s orders.

So, in theory, the cost of drug and alcohol rehab is a legitimate medical expense. Or at least those expenses over and above 7.5% of your income that haven’t been paid for by medical insurance. In practice, whether you can deduct the cost of drug rehab depends entirely on your total amount of itemized medical expenses. You can write off the cost of addiction treatment—if you can afford to.
Kelly Phillips Erb, who blogs at Forbes as Tax Girl, explains it all:

As a general rule, the costs of rehabilitation for drug and alcohol abuse and addictions are deductible as medical expenses, assuming that you itemize your deductions on Schedule A. Like other medical and dental expenses, rehab and addiction treatment expenses are only deductible to the extent that they exceed 7.5% of your adjusted gross income (AGI). So, for example, if your AGI was $40,000, you can only deduct expenses which exceed $3,000 (7.5% of $40,000). If the total of your expenses, including treatment costs $5,000, then you can deduct $2,000 ($5,000 expenses less the $3,000 threshold).

And that’s after you’ve parsed the IRS definition of qualifying medical care: “The diagnosis, cure, mitigation, treatment, or prevention of disease.” According to Tax Girl, that’s it. Other than throwing out a few examples—nursing services, x-rays, ambulance expenses—there is precious little help in defining what counts as a disease. Tax Girl says that the “IRS allows deductions for expenses related to the treatment of alcoholism and drug addiction because it agrees that those behaviors are a disease—even if many taxpayers think differently.” But the IRS won’t allow deductions for the cost of treatment with illegal drugs, thereby making the likelihood of write-offs for medical marijuana and marijuana addiction treatment unlikely, as long as marijuana remains illegal at the federal level. Furthermore, certain promising treatment options are not deductible for the same reason. Tax Girl writes that “despite evidence in Europe that “prescription” heroin taken together with methadone might lessen heroin dependence in addicts, the treatment remains illegal in the U.S. and is, therefore, not be deductible for federal income tax purposes. Methadone on its own, however, is a legal treatment for drug addiction in the U.S.” and is therefore deductible for federal income tax purposes.

Furthermore: “The IRS does not necessarily agree that all behaviors considered to be ‘addictions’ qualify as a disease.” Given the broad net cast across the medical waters in the name of addiction—everything from Internet addiction to cornstarch addiction—it’s probably just as well that the IRS is taking a jaundiced view of the so-called behavioral addictions. But they have taken some heat for being hard-nosed about obesity, while at the same time allowing write-offs for medical expenses associated with sex change operations.

Okay. But what if you’re Charlie Sheen, living on the other end of the income scale, until recently pulling down $2 million dollars per TV episode, starring in a mildly amusing sitcom? He’ll make maybe $40 million this year. How much would Charlie have to spend on rehab to make it tax-deductible? As it happens, there are tax geeks like Kay Bell at MSN Money who wonder about such things. Remember, Charlie can only deduct the amount of qualifying medical expenses that exceed 7.5% of his adjusted gross income. Bell says that Sheen “would have to spend lots of time at a pretty swanky rehab center to run up the more than $3 million required for him to claim the medical expenses deduction. He’s in Los Angeles, so it’s possible, but still, that’s a big recovery bill.”

Photo credit: http://potcouture.com/

Tuesday, March 8, 2011

NIDA on Drugs, Brain, and Behavior


How Science Has Revolutionized the Understanding of Drug Addiction.

Addiction to alcohol, nicotine, and other drugs costs Americans as much as half a trillion dollars a year, according to the National Institute on Drug Abuse. Since the 1930s, when the science of addiction got its start, scientists have consistently battled against a prevailing view of addicted individuals as morally flawed and lacking in willpower. In an effort to dispel myths and keep drug arguments on track, NIDA has released an updated 2010 version of its valuable publication, “The Science of Addiction.” The report is available as a PDF for download.

As a disease that affects both brain and behavior, addiction is indeed the “cunning, baffling and powerful” disease described by Bill W., the founder of AA. Dr. Nora Volkow, director of NIDA, said that despite the plethora of scientific advances being made in addiction medicine, “many people today do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. This booklet aims to fill that knowledge gap by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat the disease.”

Dr. Volkow exhorted Americans to “adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation's well-being.”

Today, "thanks to science,” writes Volkow, “our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem.”

Sunday, July 19, 2009

The Changing Face of Addiction Counseling


Most addiction workers are no longer addicts themselves.

For years, addiction therapists and counselors tended to be people who had been addicts themselves. These days, not so much. Drug and alcohol counselors who have experienced addiction firsthand represent a dwindling slice of the addiction therapy community.

But does it matter? A recent study by William L. White for the Great Lakes Addiction Technology Transfer Center and the Philadelphia Department of Behavioral Health and Mental Retardation Services suggests strongly that it does not. The study, “Peer-based Addiction Recovery Support” (PDF), concluded that “Studies of addiction counselors in the United States have not found that addiction counselors in recovery are more or less effective than addiction counselors who are not in recovery....”

This is a good thing, if true, since the report also documents that the percentage of counselors in personal recovery within the “addiction workforce” has fallen from a high of almost 70 % in the early 1970s to about 30% as of 2008. It is unclear what is behind this trend, given that “studies of the personalities of recovering men and women working as addiction counselors reveal few differences from counselors without addiction recovery backgrounds.” White suggests that as the “educational levels of people in recovery have increased,” the perceived differences between counselors in recovery and those not in recovery “diminish or disappear completely.”

The bottom line for counselors: “The key determinants of effectiveness do not include recovery status.”

Nonetheless, White argues, attitudes toward workers in addiction treatment continued to be “plagued by misconceptions and stereotypes that are contradicted by most scientific studies. The prevailing view is that the majority of addiction counselors are in recovery; that most recovering counselors do not have college or advanced degrees; and that recovering counselors differ in their attitudes beliefs, knowledge, skills, and effectiveness” from counselors who have never experienced addiction.

Nowadays, as it turns out, none of these views is correct.

White’s paper also reiterated the sad fact that recovering addicts who work in addiction treatment “are paid less than people not in recovery for comparable work, even when their educational credentials are equal.”


Photo Credit: US No Drugs

Saturday, January 17, 2009

Addiction Research Highlights


Clinical studies in 2008.

Alcohol, Other Drugs, and Health: Current Evidence—a free online newsletter from the Boston Medical Center—offers summaries of relevant clinical research on drugs of abuse and related drug issues.

In the November-December 2008 issue, the editors present “a comprehensive guide to all the clinically relevant research articles published by the newsletter in 2008.”

Herewith, a brief sampling:

Topiramate Reduces Drinking in Adults With Alcohol Dependence

“Topiramate may decrease alcohol consumption among people with alcohol dependence by reducing the release of dopamine.”

Treatment for Alcohol Withdrawal Is Poor Despite Proven Therapies

“Evidence-based practice guidelines are clear that patients at risk for alcohol withdrawal should be monitored and treated with benzodiazepines if the risk is high enough or symptoms are substantial.”

Oral Naltrexone Decreases Use and Extends Time to Relapse in Amphetamine Dependent Patients

“Currently, no medications are FDA-approved to treat amphetamine dependence. Naltrexone, an opioid antagonist, has shown efficacy in reducing relapse among subjects with opioid or alcohol dependence.”

Alcohol Counseling Can Reduce Blood Pressure

“Unhealthy alcohol use is associated with hypertension. Two recent articles examined whether reductions in drinking can decrease blood pressure among hypertensive heavy drinkers.”

Levetiracetam (Keppra) Shows Promise in Treating Alcohol Dependence

“Anticonvulsants have shown promise as pharmacologic agents in the treatment of alcohol dependence, although none are yet approved by the Food and Drug Administration for this indication.”

Are Myocardial Infarction Survivors Who Smoke Marijuana at Higher Risk of Death?

“Although a previous study demonstrated an increased risk of myocardial infarction (MI) within 1hour of smoking marijuana compared with periods of nonuse, the net impact of marijuana use on mortality has not been established.”

American Heart Association Releases Guidelines on Treatment of Cocaine-Associated Chest Pain

“There are approximately 500,000 cocaine-associated emergency department visits annually, and it is estimated that 40% involve chest pain.”

Opioid Maintenance Therapy Saves Lives

“Opioid-dependent patients are 13 times more likely to die than their age- and sex-matched peers in the general population.”

Bupropion Added to Nicotine Replacement for Patients in Alcohol Treatment

“The effectiveness of bupropion, an antidepressant approved for smoking cessation in the general population, has not been studied in people being treated for alcoholism.”


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Thursday, December 11, 2008

Doctors Still Don’t Understand Addiction


Med schools ignore major health problem.

If there is one thing most workers in the field of addiction treatment can agree upon, it is that doctors are inadequately trained to deal with addicted patients.

Researchers at the Boston Medical Center recently reported that “education on addiction is inadequate during medical training, resulting in suboptimal medical care for those at risk.” In a study published in the Journal of General Internal Medicine, the Boston researchers found that a “Chief Resident Immersion Training” program yielded significant benefits. This “train the trainers” approach “effectively transferred evidence-based addiction knowledge and practice to 64 chief residents in generalist disciplines and more importantly, enhanced the addiction curriculum in 47 residency programs,” according to Daniel P. Alford, associate professor of medicine at Boston University School of Medicine.

The problem is not a new one. In 2003, Howard Markel of the New York Times wrote that the failure of primary care physicians to diagnose substance abuse was due to “insufficient training in the treatment of addiction, doctor’s frustration with afflicted patients, the common perception among doctors that treatment for substance abuse does not work, and a poor rate of insurance reimbursement for such services.” Dr. June E. Osborn of the Josiah Macy Jr. Foundation put it bluntly: “In clinical situations where they don’t know exactly what they are doing, doctors tend to walk away and adopt an attitude of blaming the patient.”

The Times article concluded that “scant formal training on addiction and substance abuse is available in American medical schools. Now, most of them offer only a few hours on these complex subjects and even less is offered during most residency or postgraduate programs.”

Moreover, in actual practice, insurance benefits for substance abuse problems present a difficult reimbursement problem in many cases. Hence doctors may be more reluctant to offer a formal diagnosis of addictive disorder.

Joseph Califano Jr. of Columbia University’s National Center on Addiction and Substance Abuse told a conference in October: “Although doctors and nurses have the best opportunity to intervene with alcoholics and substance abusers, our research indicates they are woefully inadequate at even diagnosing someone with this disease." Surveys conducted by the center showed that 90% of primary care doctors fail to offer a diagnosis of addiction even in patients clearly displaying classic hallmarks of the condition.

To redress the current state of affairs, the center recommends formal substance abuse training for med students, residents, and doctors, expanding drug dependency coverage under Medicare, Medicaid and private insurers, and “adding legal accountability” for doctors who fail to diagnose addiction when warranted.

To be fair, however, the plight of doctors in this regard is not to be underestimated. Dr. Catherine D. DeAngelis, editor-in-chief of the Journal of the American Medical Association, told the New York Times that “caring for patients with substance abuse is one of the most difficult things I have ever had to deal with as a doctor.... when the ailment in question carries a substantial behavioral component, like substance abuse, physicians get frustrated and don’t do as well.”

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