Phish Front Man Backs Drug Courts

Trey tells Congress about his addiction.

Trey Anastasio, lead guitarist and singer with the recently reunited rock band Phish, testified before Congress that drug courts may have saved his life. Without drug courts, he said, there might not have been a Phish reunion tour. Their lead guitarist might have been dead or in jail.

“My name is Trey Anastasio, and I’m a recovering alcoholic and a proud graduate of the Washington drug court program,” the musician testified, according to a Huffington Post report by Ryan Grim. “My life had become a catastrophe. I had no idea how to turn it around. My band had broken up. I had almost lost my family. My whole life had devolved into a disaster. I believe that the police officer who stopped me at three a.m. that morning saved my life.”

Anastasio, on behalf of the National Association of Drug Court Professionals (NADCP), called for drug courts as an alternative to prison for every American in need. Participants in drug courts receive mandated addiction treatment and other services, while submitting to regular drug tests. Those who fail their drug tests spend time in prison. Moreover, participants appear regularly before a specially trained judge to access their progress. A system of rewards and sanctions, plus treatment, replaces a lengthy jail sentence and little hope for effective treatment while imprisoned.

In the past, while supporting the concept, Congress has made only meager sums available for the establishment of drug courts. “I would like every community in America to have the option of sentencing drug offenders to drug court,” Anastasio told members of Congress. “When we imprison people for minor drug offences, we waste money—and we waste lives. Prison will turn a person with a substance abuse problem into a lifetime felon.”

According to NADCP chief executive officer West Huddleston, “The scientific community has put drug courts under the microscope and concluded that drug courts significantly reduce drug abuse and crime and do so at less expense than any other justice strategy.”

Anastasio, who spend more than a year in drug court, told the congressional assembly that he had been sober for two and half years. “In August, my wife and I will celebrate our fifteenth wedding anniversary. My band is back together with a sold-out tour. And in September I’ll play a solo concert at Carnegie Hall with the New York Philharmonic.”

Photo Credit: WPT

addiction drugs

Acupuncture for Addiction: It Doesn't Look Good

Needles fail in latest study of opiate detox.

Acupuncture as a treatment for drug addiction took another punch recently in a study published in the Journal of Substance Abuse Treatment. In “Auricular acupuncture as an adjunct to opiate detoxification treatment,” the study authors investigated whether acupuncture would “add value” to a standard methadone-based detoxification process. For the two-week study, 82 opiate-addicted patients were randomly assigned to either ear acupuncture by qualified acupuncturists, or the attachment of ear clips by non-professionals. Each day, the study participants were tested for withdrawal severity and craving.

"On none of the 14 days,” the authors report, “were there statistically significant differences between patients allocated to ‘real’ acupuncture and the ‘sham’ treatment. Such statistically insignificant difference as there were favored the ‘sham’ treatment....”

The results, say the authors, “are consistent with the findings of other studies which failed to find any effect of acupuncture in the treatment of drug dependence.” Moreover, the authors conclude, this finding is “particularly disappointing as if anything the circumstances favored the acupuncture option,” since in contrast “the alternative may not have been seen as a convincing therapy.” Nevertheless, “like the featured study, previous studies of acupuncture in the treatment of opiate addiction have been unconvincing.... The ‘ineffective’ verdict on acupuncture extends to the treatment of cocaine dependence,” the authors maintain, while an attempt to replicate earlier positive findings on acupuncture for alcohol dependence found no benefits, either.

The authors also reflect on whether such offerings, though of dubious value, attract addicts to treatment centers. “The possibility remains that offering something concrete like acupuncture helps attract people to services, and that doing something both clients and staff believe is worthwhile (even if it is a ‘sham’ procedure) helps retain patients in treatment, and in doing so improves outcomes.”

Of course, this is only one study out of many, and acupuncture enthusiasts remain as optimistic as ever. Proponents of acupuncture treatment continue to petition the National Institute on Drug Abuse (NIDA) for endorsement. Most reports of success remain anecdotal. Nonetheless, the National Acupuncture Detoxification Association estimates that there are currently 200 acupuncture detoxification programs operating in the United States and Europe.


Photo Credit: The 217

addiction drugs

Guest Post: Things Go Better with Meth

The Pepsi Challenge with controlled substances.

[Today’s post comes to us from Neurological Correlates, a blog devoted to the neuroscience of dysfunctional behavior. It was written by Swivelchair, who refers to himself as “an anonymous biopharma worker." It’s an excellent blog, one of the few that focuses on the biological basis of addiction.]
--------

Things go better with meth, as compared to cocaine, if you’re dopamine transporter challenged, anyway.

By Swivelchair

Methamphetamine is taken up more quickly, and lasts longer than cocaine. (Fowler et al, Abstract below).

And here’s something from Microgram Bulletin, October 2008, Published by the Drug Enforcement Administration Office of Forensic Sciences Washington, D.C. 20537: The DEA South Central Laboratory (Dallas, Texas) recently received a submission of approximately 4972 fake “kidney beans” (total net mass 3,210 grams), all containing a fine tan powder, suspected heroin. The “beans” were actually small plastic packets that had been painted to resemble kidney beans... Analysis of the powder... confirmed 90.3% heroin hydrochloride.

The perhaps undeniable point: probably the self-selecting population of people who are first drawn to drugs, and then become irretrievably addicted, are those who lack sufficient dopamine transport to feel fulfilled (or other insufficiency, depending on the choice of drug). They are, in essence, self-medicating, rather than using drugs for recreational use. I mean, you don’t load up kidney beans for recreational drug users.

I’m reminded of a friends’ younger brother, from a locally well-known family, whose arrest was reported as bringing in “the largest amount” of cocaine in those parts. His remark: He was a wholesaler, and the newspaper quoted street (”retail”) values, so the report inflated his inventory value. This was purely about money for him — he made far more money selling coke than any job he was qualified to do (which was, well, probably none, unless being a bon vivant and sparkling raconteur with insufficient money to fund a high rent party lifestyle qualifies as a profession, which it may). If the US were to decriminalize drug use, and fund a program to make an agonist which was not addictive (a la the whole methadone thing), probably we could solve much of the crime problem in the Western Hemisphere.
---------

“Fast uptake and long-lasting binding of methamphetamine in the human brain: comparison with cocaine.” Fowler JS, Volkow ND, Logan J, et. al. Medical Department, Brookhaven National Laboratory, Upton, NY 11973

Abstract from Neuroimage. 2008 Dec; 43(4):756-63.

“Methamphetamine is one of the most addictive and neurotoxic drugs of abuse. It produces large elevations in extracellular dopamine in the striatum through vesicular release and inhibition of the dopamine transporter. In the U.S. abuse prevalence varies by ethnicity with very low abuse among African Americans relative to Caucasians, differentiating it from cocaine where abuse rates are similar for the two groups. Here we report the first comparison of methamphetamine and cocaine pharmacokinetics in brain between Caucasians and African Americans along with the measurement of dopamine transporter availability in striatum.

Methamphetamine’s uptake in brain was fast (peak uptake at 9 min) with accumulation in cortical and subcortical brain regions and in white matter. Its clearance from brain was slow (except for white matter which did not clear over the 90 min) and there was no difference in pharmacokinetics between Caucasians and African Americans. In contrast cocaine’s brain uptake and clearance were both fast, distribution was predominantly in striatum and uptake was higher in African Americans. “Among individuals, those with the highest striatal (but not cerebellar) methamphetamine accumulation also had the highest dopamine transporter availability suggesting a relationship between METH exposure and DAT availability. Methamphetamine’s fast brain uptake is consistent with its highly reinforcing effects, its slow clearance with its long-lasting behavioral effects and its widespread distribution with its neurotoxic effects that affect not only striatal but also cortical and white matter regions. The absence of significant differences between Caucasians and African Americans suggests that variables other than methamphetamine pharmacokinetics and bioavailability account for the lower abuse prevalence in African Americans.”

Related Links

PET studies of d-methamphetamine pharmacokinetics in primates: comparison with l-methamphetamine and ( –)-cocaine. [J Nucl Med. 2007] PMID:17873134

Long-term methamphetamine administration in the vervet monkey models aspects of a human exposure: brain neurotoxicity and behavioral profiles. [Neuropsychopharmacology. 2008] PMID:17625500

Graphics Credit: methamphetaminetx.com

addiction drugs dopamine

NIDA'S Updated Guide Book Emphasizes Science

Drug addiction treatment trends.

Favoring objective medicine over moral exhortation, the National Institute on Drug Abuse (NIDA) has updated one of its primary research guides, continuing the trend toward focusing on the scientific aspects of drug and alcohol addiction.

In the preface to the updated 2nd Edition of Principles of Drug Addiction Treatment, available here, NIDA Director Nora D. Volkow writes:

“Addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior. Some individuals are more vulnerable than others to becoming addicted, depending on genetic makeup, age of exposure to drugs, other environmental influences, and the interplay of all these factors.”

Looking toward the future, Volkow writes that “we will harness new research results on the influence of genetics and environment on gene function and expression (i.e., epigenetics), which are heralding the development of personalized treatment interventions.”

Here are excerpts from a section of the updated guide titled “Principles of Effective Treatment.”

--No single treatment is appropriate for everyone.

“Matching treatment settings, interventions, and services to an individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.”

--Treatment needs to be readily available.

“Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.”

-- Remaining in treatment for an adequate period of time is critical.

“Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a longterm process and frequently requires multiple episodes of treatment.”

-- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

“For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opioid-addicted individuals and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram, and topiramate.”

-- Many drug-addicted individuals also have other mental disorders.

“Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.”

-- Treatment programs should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

“Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling specifically focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors.”

Graphics Credit: NIDA

How Junk Food Works

Ex-FDA chief offers clues to food addiction.

It is a perplexingly common experience: You open a bag of cookies, intending to have one or two. An hour later, the bag is empty, and your self-loathing is at its peak.

But compulsive overeating is not a character flaw, according to David Kessler, former head of the Food and Drug Administration. It is, rather, a “biological challenge.”

Readers may remember Kessler from his anti-cigarette and food product labeling crusades during the Clinton administration. In his forthcoming book, The End of Overeating: Taking Control of the Insatiable American Appetite, Kessler notes that while food took over his brain, the foods in question were not carrots, apples and green leafy vegetables. “Conditioned overeating,” as Kessler dubs it, is driven by a biological drive to eat high-fat, high-sugar foods even when we are not hungry. Moreover, such foods are cheaper than more healthy alternatives.

What Kessler describes in his book is a system of reward-driven eating abetted by a food industry fully aware of the biological attraction exerted by salt, fat, and sugar. Kessler himself is no stranger to this attraction. “I have suits in every size,” Kessler writes, according to a report by Lauren Neergaard for AP. “Once you know what’s driving your behavior, you can put steps in place.”

Kessler has also served as dean of the medical schools at Yale and the University of California at San Francisco. On the book’s Amazon site, Michael Pollan, author of In Defense of Food, calls Kessler’s book “a fascinating account of the science of human appetite, as well as its exploitation by the food industry.”

It is becoming increasingly clear that fat and sugar in combination are capable of producing a dopamine-driven surge of intense pleasure in people with a propensity for addictive behavior. Mice that have been genetic altered so that they lack the ability to taste sweet foods still prefer sugar water to regular water. (See my post on Dopamine and Obesity.) Kessler provides additional evidence that certain forms of overeating qualify as legitimate drug addictions. Just as it is with, say, cocaine addicts, the supersaturated reward pathways of the brain do not have effective mechanisms for signaling: “That’s enough. Stop eating.”

It may seem obvious in retrospect that the same mechanisms that make it so difficult for many drug addicts to “just say no” would also function in the case of addicted overeaters. What happens is similar to the flooding of reward circuitry that occurs in cases of what we might call “compulsive overdrugging,” otherwise known as addiction. The food industry, according to Kessler, has figured out what works, has packaged fat-and-sugar foods in products that scarcely even have to be chewed, and it has priced these products to move.

Yale university conducted studies in which “hypereaters” were given the odor of chocolate during an MRI scan. Normal eaters get used to the odor and habituate rapidly. Hypereaters find that the odor of chocolate becomes more demanding and overpowering with time. And even drinking a complete chocolate milkshake did not quell the craving.

According to Publisher’s Weekly, Kessler’s book, set to be released on April 28, “provides a simple food rehab program to fight back against the [food] industry’s relentless quest for profits while an entire country of people gain weight and get sick.”

Photo Credit: Neurological Correlates

Anti-Craving Drug Eases Pain of Fibromyalgia

Naltrexone being studied for immune-related disorders.

A drug frequently used to treat heroin and alcohol addiction also eased the pain of women suffering the symptoms of fibromyalgia, according to a Stanford study published in the April 17 journal of Pain Medicine.

Fibromyalgia remains a controversial diagnosis. As reported by Coco Ballantyine in Scientific American online, it is a “mysterious ailment whose symptoms include chronic widespread muscle pain, fatigue, sleep problems, anxiety and depression, often appears between the ages of 34 and 53 and is more common in women.”

Jarred Younger and Sean Mackey of the Stanford School of Medicine’s pain management division reported that pain and fatigue ratings for the women dropped by 30% over the 14 weeks of the study. “Patients’ reactions were really quite profound,” said Mackey. “Some people went back to work really improving their quality of life.”

Tara Campbell, one of the patients involved in the study, told the Stanford News Service that she was feeling “really, really good.” She said “my improvement was about 40 percent in the study. When you’re not capable of doing much of anything, that’s a lot... I’m much more back to normal.”

Younger said he became interested in studying naltrexone after he began questioning patients who claimed to be suffering from the disorder. “I was asking patients, ‘Does anything work for you?’ A lot of people in support groups were saying, ‘Yeah, I tried naltrexone and it works for me.’”

Naltrexone is currently used as a treatment for heroin addiction and for alcoholism. (See my post, "Drugs for Alcoholism.") Naltrexone works by locking into central nervous system receptors normally occupied by opiates or by the body’s own endorphins. Researchers like Younger, however, believe that naltrexone also dampens the activity of immune cells known as microglia that are involved in inflammatory responses.

It is not uncommon for scientists to investigate the additional effects of drugs in common use. “From a regulatory point of view,” said Canadian addiction researcher Edward Sellers in my book, The Chemical Carousel, “companies don’t try to develop [new drugs] for forty-three different things. But these drugs still carry with them many other pharmacologic actions. The history of virtually every drug that comes to market is that all these other secondary applications start to manifest themselves.”

Graphics Credit: http://www.aocbv.com/fibromyalgia.html

The Chemical Carousel

What Science Tells Us About Beating Addiction, by Dirk Hanson.


My book on addiction research is now available for purchase online at AMAZON, BOOKSURGE, ABEBOOKS, AND ALIBRIS.

FROM THE PUBLISHER:
The Chemical Carousel is an in-depth look at addiction science and medical treatments for drug dependence and alcoholism. An experienced science and business journalist, author Hanson brings a complex and widely misunderstood subject out of the shadows and into the light of understanding. In this groundbreaking and highly readable examination of addiction science and the biological, emotional, and scientific underpinnings of substance abuse, The Chemical Carousel breaks through the myths, while presenting the surprising and cutting-edge facts about addiction and its medical origins. Hanson leaves no stone unturned in this invaluable examination of why people become addicted.
ISBN-13 978-1439212998
$20.95 Trade Paperback
472 pages
Notes, selected bibliography, index

BOOKSURGE PUBLISHING www.booksurge.com

addiction drugsmedical marijuanaalcoholics anonymoussmokingdopaminenicotine