Showing posts with label brain science articles. Show all posts
Showing posts with label brain science articles. Show all posts

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/

Sunday, May 22, 2011

An Assortment of Drug-Related Articles


Misc. Stuff Etc.

In this post, I offer up an assortment of links to articles, mostly by me, and other related material, so that I can put checkmarks after a few items on the official Addiction Inbox to-do list, here on the official Addiction Inbox plexiglass clipboard. So let’s see….

* Here’s an article I wrote awhile ago for Brain Blogger, called "Why Do Schizophrenics Smoke Cigarettes?" The comments alone are worth a look. Spoiler: Schizophrenics smoke cigarettes because nicotine helps quell both audio and visual hallucinations.

* One of the very early posts here at Addiction Inbox, called "Marijuana Withdrawal," transformed itself into a self-help support board over time, with lengthy and enlightening comments appended to a short original post about the symptoms of marijuana dependency. The post has accumulated more than 1,000 comments at this writing, and is still going strong. Have a look here.

* The title of the Dutch study, published in the journal Alcohol and Alcoholism, is unambiguous: “Alcohol Portrayal on Television Affects Actual Drinking Behaviour.” But the dirt, as always, is in the details. My article at Adi Jaffe’s All About Addiction site.

* This feature of mine about synthetic marijuana products like “Spice” ran last month at The Fix, where I am now serving as senior contributing editor. 

* I contributed a comment or two to this follow-up piece on synthetic cannabis that ran in the New York Daily News.

* Also at The Fix, that irritating fraud James Frey gets his ass totally kicked by Time Healthland’s Maia Szalavitz, who demands that he apologize to addicts for all the harm he has done their cause in this article. Great stuff. 

* Here’s a hard-hitting excerpt from James Brown’s phenomenal addiction memoir, This River, which redeems the entire genre from the likes of James Frey. Read the harrowing “Instructions on the Use of Heroin.”

* Science of Blogging is a great site that regularly features interviews with, you guessed it, science bloggers. Travis Saunders was kind enough to do a Question and Answer session with me recently.

And here are a dozen recent blog posts by yours truly over at the The Fix:

2C-E, a research hallucinogenic best left to the professionals, may have killed two people in Oklahoma.

Almost 30 states now intend to test welfare recipients for drug use.

From the Hold Steady to the Rolling Stones to Nine Inch Nails: best all-time recovery songs.

Lawmakers argue over how to do the right thing for people who do the wrong thing.

As bodies pile up in Mexico's drug war, murdered children account for over 1,000 deaths.

The internet giant may pony up some serious dough for promoting prescription-pill abuse.

Provocative Penn psychologist wonders what would happen if our health care system treated diabetics like it treats most addicts. Nothing good.

Cigarette trafficking is now so lucrative that organized drug and gun smuggling operations want in on the action.

How does alcohol affect memory? New research suggests that students perform much better on tests when their "memory states" match.

For over 30 years, a charismatic Vietnam vet and mercenary named Gordon Baltimore helped hardcore addicts recover with a controversial regimen at a Thai monastery. A former heroin addict, he died last week at the age of 60

An American "charity" is paying thousands of U.S. drug addicts not to have children. Buoyed by its success, the group has moved on to Britain. Now Denmark may be taking up the trend.

An officially-sanctioned injection site for heroin and cocaine addicts in Vancouver prompts a dramatic fall in death rates. So why is the Canadian government so dead-set against it?

Thank you and good night.

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

Tuesday, June 8, 2010

Noteworthy Recent Posts on Drugs and the Brain


A few good articles.

Teasing Out the Effects of Environment on the Brain.
By Moheb Costandi

Antidepressants: Are They Effective or Just a Placebo?
By Maia Szalavitz

SSRIs and Suicide.
By Neuroskeptic

Cannabis and mental health – two new studies give the “wrong” results!

Under the Microscope: How does caffeine work?
By Professor Andrew Smith.

Photo Credit: http://degweb.org/

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