Bath Salts and the College on Problems of Drug Dependence

CPDD holds annual meeting.

I’ll be out of the office for a few days, attending the annual meeting of the College on Problems of Drug Dependence (CPDD), the oldest group in the United States dedicated to addressing problems of drug addiction. The organization functions as an independent body, and is affiliated with other scientific and professional societies involved in the study of drug dependence and abuse. The meeting dovetails with the 2012 NIDA International Forum. A broad selection of the nation’s top drug and addiction researchers will be there, along with Nora Volkow, Director of the National Institute of Drug Abuse (NIDA), and Drug Czar Gil Kerlikowske, director of the Office of National Drug Control Policy.

 I’m pleased to be the recipient of the organization’s 2012 CPDD/NIDA Media Award, which is given each year for “contributions through the media that have enhanced the public understanding of scientific issues concerning drug use disorders.” That’s pretty nice of them, and you can find an interview I did for their CPDD blog HERE.

While in attendance, your faithful correspondent will be attending what looks to be a massively interesting panel discussion called “A Stimulating Soak in “Bath Salts”: Investigating Cathinone Derivative Drugs.” Look for a blog post on that one.

I’m also planning to attend a symposium on “Exercise as a Treatment for Drug Dependence in Humans,” and plan to report back on that topic as well.

Treadmill Rehab

The curious connection between exercise and getting high.

A Vanderbilt study published in the journal PLoS ONE has confirmed what readers of Addiction Inbox have known for some time: Exercise often helps to curb cravings for addictive drugs. The Vanderbilt paper is noteworthy for focusing on heavy marijuana smokers (6 joints per day) who had not expressed any interest in quitting. Yet, at the end of a modest two-week exercise regimen, the participants reported less cannabis use.

Last August, I wrote about a growing body of research suggesting that the runner’s high and the cannabis high were more similar than previously imagined. Investigators wired up college students, put them to work in a gym, and found that “exercise of moderate intensity dramatically increased concentrations of anandamide in blood plasma.”

The British Journal of Sports Medicine ran a research review, “Endocannabinoids and exercise,” which seriously disputed the “endorphin hypothesis” assumed to be behind the runner’s high. The primary problem is that the opioid system is responsible for respiratory depression, pinpoint pupils, and other effects distinctly unhelpful to runners and other strenuous exercisers.

Compared to endorphins, the analgesia produced by the endocannabinoid system is much more consistent with the demands of exercise. Very high doses of marijuana tend to have a sedating effect, but low doses tend to induce activity or hyperactivity. There are cannabinoid receptors in muscles, skin, and the lungs. Moreover, “cannabinoids produce neither the respiratory depression, meiosis, or strong inhibition of gastrointestinal motility associated with opiates and opioids,” according to the research review. "This is because there are few CB1 receptors in the brainstem and, apparently, the large intestine.”

In addition, in my 2008 post entitled “Battling Addiction with Exercise,” I highlighted director Nora Volkow’s remarks at a NIDA-sponsored conference on addiction treatment and research. "Exercise has been shown to be beneficial in so many areas of physical and mental health," Volkow said. "This cross-disciplinary meeting is designed to get scientists thinking creatively about its potential role in substance abuse prevention."

At the same conference, Dr. Bess Marcus of Brown University, working on a NIDA-funded study of exercise for smoking cessation, presented the scientific evidence for the addiction/exercise connection. Similarities in the effects on the reward pathways of the brain's limbic system--dopamine activity in particular--may tie the two behaviors together more directly than previously thought. Among the findings:

--Rats in cages with running wheels show less interest in amphetamine infusions than rats without exercise options.

--Baby monkeys who don't roughhouse with their peers have higher levels of impulse control problems and alcohol use when they get older.

--In humans, exercise is known to reduce stress and tension--and anxiety is a well-known side effect of withdrawal, from alcohol and cigarettes to heroin and speed.

--Physical activity may enhance cellular growth in key areas of the brain involved in addiction, thereby aiding the neural changes that take place during detoxification and withdrawal from addictive drugs.

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

Exercise, Attention, Meditation

Drug treatment alternatives.

A prescription for aerobic exercise might seem trivial in the face of the life-or-death battle people wage against rampant addiction. But with or without anti-craving drugs, both diet and exercise—two non-pharmaceutical methods of altering neurotransmission—will have roles to play in recovery.

Exercise, attention to diet, and nutritional supplements are only three of the complementary avenues being explored as components of addiction treatment. Successes have been claimed for acupuncture as well.  The same can be said for hypnosis. It has its vociferous claimants, but it has not been widely tested and documented as an addiction therapy.

Meditation, in its many Eastern and Western derivations, is used by some recovering addicts as a means of dampening the panic and anxiety that often accompany detoxification. And again, there is a certain amount of good science behind the notion. Sources as disparate as Maharishi Mahesh Yogi and Harvard’s Dr. Herbert Benson have produced evidence that sitting meditation—in which the mind is either purposefully made blank, or else is focused on a mantra (the Maharishi’s mantras are Sanskrit, but Dr. Benson maintains that any soft-sounding set of syllables will do)—produces verifiable changes in blood pressure, heart rate, and oxygen exchange. Years ago, Dr. Benson named this phenomenon the “relaxation response.” Many addiction clinics use variations on this theme in an attempt to ease withdrawal symptoms.

All of these alternative modalities suffer from the same limitations: a lack of large scale clinical testing due to inadequate funding, and a lack of adequate insurance reimbursements. Nonetheless, almost anything goes in the sprawling treatment and recovery industry. There are, for example, numerous clinics and treatment centers based on the principles of naturopathic and homeopathic medicine. The 3HO SuperHealth program that bloomed in Tucson, Arizona, a “holistic substance abuse facility” inspired by the teachings of the Hindu Guru Yogi Bhajan, was accepted by Blue Cross/Blue Shield and other major insurance providers. (Gaining insurance accreditation is a major factor in the success or failure of many treatment providers and large-scale programs.) There are drug recovery programs based on the spiritual wisdom of American Indians, on the teachings of the German mystic Rudolf Steiner, on assorted holistic health practices such as yoga, guided imagery, lucid dreaming, biofeedback, massage, and other forms of “personal growth” work.

Alternative therapists maintain that recovery from addiction is as much a spiritual voyage of discovery as it is a path back to conventional health and sanity. Traditional psychotherapy in isolation is a frequently ineffective method of treatment, while anti-craving pills, congeners, and replacement therapies are still quite new.

 Any treatment that claims to work for all addicts all of the time, under all conditions, should be viewed with extreme skepticism. It is safe to say that any commercial treatment program advertising success rates of 50 per cent or more is very probably engaging in short-term follow-ups, and may be seriously misleading the buying public.

Photo Credit: http://steveroni.blogspot.com/

Battling Addiction with Exercise

It helps you quit. Can it keep you from starting?

We've all heard the claim: Physical exercise helps addicts who are working their way through withdrawal and recovery. It is one of the most common prescriptions given out by doctors and health professionals, whether you are a recovering alcoholic or a chronic binge eater.

And it makes sense. Exercise has verifiable impacts on not just endorphin levels, but also on levels of circulating serotonin and dopamine. All three neurotransmitter systems are heavily implicated in both maintaining addiction and withdrawing from it. Countless drug addicts have extolled the virtues of vigorous exercise, and there seem to be no compelling reason to doubt them.

But is there reason to think that regular exercise can help prevent addiction from blossoming in the first place?

Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), thinks there is. She told the Cincinnati Enquirer: "It's something we could apply right away. Vaccines, we're not going to get those results in one or two years. It will take probably five, six years to results."

"Exercise has been shown to be beneficial in so many areas of physical and mental health," Volkow said recently at a NIDA-sponsored conference on addiction treatment and research in Cincinnati. "This cross-disciplinary meeting is designed to get scientists thinking creatively about its potential role in substance abuse prevention."

Dr. Bess Marcus of Brown University, who is working on a NIDA-funded study of exercise for smoking cessation, presented the scientific evidence for the addiction/exercise connection. Similarities in the effects on the reward pathways of the brain's limbic system--dopamine activity in particular--may tie the two behaviors together more directly than previously thought. Among the findings:

--Rats in cages with running wheels show less interest in amphetamine infusions than rats without exercise options.

--Baby monkeys who don't roughhouse with their peers have higher levels of impulse control problems and alcohol use when they get older.

--In humans, exercise is known to reduce stress and tension--and anxiety is a well-known side effect of withdrawal, from alcohol and cigarettes to heroin and speed.

--Physical activity may enhance cellular growth in key areas of the brain involved in addiction, thereby aiding the neural rewiring that takes place during detoxification and withdrawal from addictive drugs.

No one knows for sure whether this effect, if it exists, works only in the young, and declines with age, or whether it can be of benefit to anyone as a preventative measure to reduce drug craving. "Statistics indicate that teens who exercise daily are the least likely to report using drugs or alcohol," Volkow said.

However, there are numerous exceptions, one being the classic image of the hard-drinking athlete. "Now the kids who exercise the most actually drink the most," Dr. Lloyd Johnston of the University of Michigan told the Associated Press.