Video for Patients and Families With Questions About MAT

Dr. Hillary Kunins, a PCSS Clinical expert, dispels the notion that treating an addiction patient with medication is simply exchanging one drug with another. Learn how physical dependence is not the same as addiction. A good video to share with patients and their families who have questions about MAT.

Dr. Kunins is an Assistant Commissioner at the New York City Department of Health and Mental Hygiene where she leads the Department’s Bureau of Alcohol and Drug Use – Prevention, Care and Treatment.

Link to original video here.

View more videos at www.pcssNOW.org.

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Medication Assisted Treatment – Debunk the Myths, Get the Facts

A common misconception associated with MAT is that it substitutes one drug for another.

But actually, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body.

Research has proven that this is the case when it comes to addiction to opioids. Medication-assisted treatments substantially improve the odds of successful recovery for people who misuse opioids, including heroin and prescription painkillers.

Addiction to opioids has reached epidemic proportions in the United States. In 2015, accidental drug overdoses surpassed car accidents as the leading cause of accidental death according to the Drug Enforcement Administration (DEA),and the American Society of Addiction Medicine says that more than two million individuals in the US are addicted to opioids.

Opioids and the brain

So what’s unique about opioid addiction? Opioids are so addictive—and so dangerous—because of the way in which they affect the brain’s pleasure center. These drugs work by attaching to the brain’s receptors and sending signals that block pain, slow breathing, and promote a feeling of calmness. They also flood the brain’s circuits with dopamine—that “feel-good” chemical that sends the brain feedback about rewards—creating a feeling of euphoria. For the sake of survival, our brains are naturally wired to repeat behaviors associated with pleasure or reward. So, when that reward system is over-stimulated by the effects of opioids, the brain remembers that behavior and records it as something that should be repeated without even thinking about it.

Due to the way opioids affect the brain, behavioral treatments alone, like therapy and 12-step programs, have been proven to be less effective. However, significant research has shown that the use of medication can be very effective in helping opioid users stay in recovery for years or decades.

MAT options

There are a few drugs that are commonly used in the maintenance of opioid use disorder: methadone, buprenorphine, and naltrexone. Methadone is available as an oral tablet, liquid, or wafer from licensed opioid treatment clinics only—and a person in recovery must visit the facility daily to receive treatment. Buprenorphine, which is usually combined with naloxone, is available as a tablet or film placed under the tongue or against the inside cheek or as an implant inserted in the patient’s arm by a physician. Doctors must be specifically credentialed to use buprenorphine to treat patients.

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MAT as part of recovery

Many doctors and other experts have come out in support of MAT as part of a recovery plan for substance use disorder. The American Medical Association (AMA), the American Academy of Addiction Psychiatry (AAAP) and the American Society of Addiction Medicine (ASAM) all support the use of medication-assisted treatments. Alcoholics Anonymous and Psychiatric Medication have also advocated for the use of MAT.

“The best way to overcome the myths about Medication Assisted Treatment is through information and education.”

Consider the following facts:

  • Science has proven that substance use disorder is a disease
  • Opioid use causes actual changes in the brain
  • Brain chemistry changes can be managed with medication
  • Many people with chronic conditions manage them with medication, including persons with diabetes and asthma
  • MAT is supported by the American Medical Association (AMA), the American Academy of Addiction Psychiatry(AAAP), and the American Society of Addiction Medicine (ASAM)
  • Research has shown MAT for opioids is effective
  • Persons in recovery who incorporate MAT can stay substance-free for decades

MATs have been proven very effective in avoiding relapse and fatal overdose, and staying in recovery.  Of course, every treatment plan should be tailored to the unique needs of the person in recovery, and medication may be used in combination with other therapies. Understanding all of your options and incorporating all of the treatments available will only improve your odds of success. Treatment decisions should be made in consultation with a trained physician.

Link to original article, including references and sources can be found here, originally posted on shatterproof.org.

For more information on Medication-Assisted Treatment please click the image below.

Medication-Assisted Treatment for Opioid Addiction: Facts for Fa

Podcast: Addressing Patient Resistance to Medication Assisted Treatment

Medication-assisted treatment is widely accepted treatment for patients with opioid use disorders. Still, patients have many reasons, spoken and unspoken, to be reluctant to start this potentially life-saving treatment.

On this podcast, Ashley Braun-Gabelman, PhD, discusses the importance of addressing this resistance and why it’s important to explore this barrier to treatment head on. The patient and family materials Dr. Braun-Gabelman mentions during the podcast are available for download here.

Dr. Braun- Gabelman is a clinical psychologist in Addiction Recovery Services at University Hospitals Cleveland Medical Center and an Assistant Professor in the Department of Psychiatry at Case Western Reserve University School of Medicine. She specializes in the treatment of substance use and co-occurring disorders including major depression, anxiety disorders, and PTSD. 

Please click the image below to listen to the podcast. 

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For other PCSS podcasts please click on this link.

Medication-Assisted Treatment Needs Community Support

Communities like Portsmouth, Ohio, regularly make national news for waves of overdoses. On any given day, nearly 100 people across the country die due to opioid overdose. The problem always feels like an uphill battle, and often a losing one for social workers and drug counselors who hope to get clients on the path to sobriety.

Evidence shows that one method, medication assisted treatment (MAT), works; however, for MAT to be truly effective, it takes an entire community.

What Is Medication Assisted Treatment?

Medication assisted treatment is an evidence-based recovery process that combines traditional therapies and detox programs with the use of medication. Medication helps patients manage cravings and provides relief from detoxification symptoms. MAT is useful for people who are addicted to opioids or alcohol.

Addiction Spelled Out in Scrabble Pieces

These are some of the most common medications used to treat in MAT.

  • Buprenorphine: A partial opioid agonist, buprenorphine is used for the treatment of patients who are addicted to prescription painkillers. This medication is the first opioid treatment not required to be administered in a clinic.
  • Probuphine: Approved by the FDA in 2016, the probuphine implant requires four rods to be inserted into the upper arm. The rods provide a continuous dose of buprenorphine for six months to alleviate cravings and withdrawal symptoms.
  • Methadone: Methadone is known as a full opioid agonist, which means that it provides many of the same effects of other opioids. The effects are usually milder and do not impact the patient’s ability to function as much, though.
  • Naloxone: An opioid antagonist, naloxone can reverse or prevent life-threatening overdoses by blocking opioid activity at receptor sites. Police officers and medical workers typically carry these injections and administer as necessary. Sometimes, users also carry them in case of an emergency.
  • Naltrexone: Available as an injectable or in pill form, naltrexone is available as a monthly or daily dose and lacks the potential for abuse.
  • Acamprosate: Sometimes referred to as Campral, acamprosate is used to prevent relapse in alcoholics by lessening the post-acute withdrawal symptoms that often lead to relapse.

Along with medication, patients in an MAT program are required to participate in therapy or counseling.

Healthcare Providers and Community Members Can Erase Stigma

Even though MAT has proven to be an effective form of treatment, there’s still a stigma associated with it, as many believe that it’s about replacing one drug with another. What can be done so that members of behavioral healthcare can recommend this treatment?

Change in Mindset

Addiction is complex. It is a brain disease. Simply viewing addiction as a disease rather than a moral or criminal problem can help make addiction treatment programs, including MAT, more accessible. Despite inclusion in the Diagnostic and Statistical Manual (DSM) and research that states addiction is a disease, many community members and medical professionals do not view addiction in this way. If behavioral healthcare professionals don’t understand addiction as a disease, MAT will continue to be underutilized.

Education

Addiction professionals have a responsibility to educate others on MAT and its effectiveness. There are still misconceptions about what the treatment actually entails.

Social workers, counselors, and others must understand MAT and the evidence that supports this type of program. This also means that healthcare organizations need to mandate ongoing education for staff. Education enables counselors to make appropriate recommendations as to when individuals need abstinence-based treatment or MAT. Both types of treatment can be effective, but which is appropriate for the patients they are treating?

Law enforcement officials should also receive education and training on MAT. This includes promoting MAT as a treatment method for incarcerated addicts. A lack of MAT in prisons means many addicts end up relapsing, and even dying of an overdose because they didn’t receive proper treatment.

Access to Naloxone

Reducing stigma associated with MAT means that access to medication should go beyond the treatment setting. First responders should be trained to carry and administer naloxone. As mentioned earlier in this article, it can be a life-saving step in reducing overdose fatalities. Many states already passed legislation to allow access to naloxone. Healthcare professionals can share research and evidence with community officials to allow access to naloxone or increase supply in cities that already have it.

A holistic solution that involves the whole community is necessary to combat the opioid epidemic, reduce fatalities, and direct people to the appropriate treatment option, whether it’s MAT or not. Community officials and healthcare providers should also look to treatment centers as resources. What can they learn from the individuals who are working with these patients? In order to make MAT effective, it takes community involvement before, during, and after treatment.

Original article here posted on psychcentral.com

8 Care Principles to Improve Substance Use Disorder Treatment

Task force cites medication-assisted treatment, universal screening as key to better outcomes.

More than 20 million Americans struggle with substance use disorder (SUD), and upwards of 33,000 people died from opioid overdose in 2015. Fortunately, effective treatment exists. Medication-assisted treatment (MAT), which pairs U.S. Food and Drug Administration-approved drugs with behavioral therapies, reduces both illicit opioid use and overdose fatalities.

But access to MAT remains elusive for many people largely because treatment providers do not always provide their patients with the evidence-based care shown to be most effective. Public and private payers can play a key role in addressing this problem by encouraging their enrollees to use providers who deliver high-quality, evidence-based care and rewarding those who do.

As a needed step in this direction, the new Substance Use Disorder Treatment Task Force— launched last spring by Shatterproof, a national nonprofit organization dedicated to the implementation of evidence-based solutions to address the SUD epidemic—created a list of national principles of care for SUD treatment to help guide effective care. These eight evidence-based principles have been shown to improve health outcomes and save lives. Sixteen insurance companies have agreed to identify, promote, and reward SUD treatment that aligns with these principles, which are:

  1. Universal screening for SUD across medical care settings.
  2. Personalized diagnosis, assessment, and treatment planning.
  3. Rapid access to appropriate SUD care.
  4. Engagement in continuing long-term outpatient care, with monitoring and adjustments to treatment.
  5. Concurrent, coordinated care for physical and mental illness.
  6. Access to fully trained and accredited behavioral health professionals.
  7. Access to FDA-approved medications.
  8. Access to nonmedical recovery support services.

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The task force brings together public and private payers as well as advocates, policymakers, and other stakeholders. The Pew Charitable Trusts hosted the inaugural meeting of the task force this fall, during which members met to outline and discuss principles of care. Following that meeting, the group refined and reached consensus on the final list, with principles based on research from the past 30 years, including recommendations from the 2016 “Facing Addiction in America: Surgeon General’s Report on Alcohol, Drugs, and Health.”

The task force will continue its work by focusing on implementing the principles, providing a platform to learn and share innovative strategies, and measuring the initiative’s success. In particular, the task force will examine the possibility of establishing a process for certifying providers who have implemented the principles. It will also engage with the broader stakeholder community in the next phases of work.

By joining together, patients, providers, and payers have the opportunity to dramatically increase the quality of substance use treatment in the United States. Incorporating these evidence-based principles of care in insurance programs is a much needed step forward in addressing the opioid epidemic and improving the lives of people with SUD and their families.

Link to original article here: 8 Care Principles to Improve Substance Use Disorder Treatment

How Science Is Unlocking the Secrets of Addiction

We’re learning more about the craving that fuels self-defeating habits—and how new discoveries can help us kick the habit.

Addiction hijacks the brain’s neural pathways. Scientists are challenging the view that it’s a moral failing and researching treatments that could offer an exit from the cycle of desire, bingeing, and withdrawal that traps tens of millions of people.

Patrick Perotti scoffed when his mother told him about a doctor who uses electromagnetic waves to treat drug addiction. “I thought he was a swindler,” Perotti says.

Perotti, who is 38 and lives in Genoa, Italy, began snorting cocaine at 17, a rich kid who loved to party. His indulgence gradually turned into a daily habit and then an all-consuming compulsion. He fell in love, had a son, and opened a restaurant. Under the weight of his addiction, his family and business eventually collapsed.

He did a three-month stint in rehab and relapsed 36 hours after he left. He spent eight months in another program, but the day he returned home, he saw his dealer and got high. “I began to use cocaine with rage,” he says. “I became paranoid, obsessed, crazy. I could not see any way to stop.”

When his mother pressed him to call the doctor, Perotti gave in. He learned he would just have to sit in a chair like a dentist’s and let the doctor, Luigi Gallimberti, hold a device near the left side of his head, on the theory it would suppress his hunger for cocaine. “It was either the cliff or Dr. Gallimberti,” he recalls.

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BREAKING THE CHAIN A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the world.

Gallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says.

In the United States an epidemic of opioid addiction continues to get worse. The Centers for Disease Control and Prevention reported a record 33,091 overdose deaths in 2015 from opioids, including prescription painkillers and heroin—16 percent more than the previous record, set just the year before. In response to the crisis, the first ever U.S. surgeon general’s report on addiction was released in November 2016. It concluded that 21 million Americans have a drug or alcohol addiction, making the disorder more common than cancer.

After spending decades probing the brains of drug-loving lab animals and scanning the brains of human volunteers, scientists have developed a detailed picture of how addiction disrupts pathways and processes that underlie desire, habit formation, pleasure, learning, emotional regulation, and cognition. Addiction causes hundreds of changes in brain anatomy, chemistry, and cell-to-cell signaling, including in the gaps between neurons called synapses, which are the molecular machinery for learning. By taking advantage of the brain’s marvelous plasticity, addiction remolds neural circuits to assign supreme value to cocaine or heroin or gin, at the expense of other interests such as health, work, family, or life itself.

“In a sense, addiction is a pathological form of learning,” says Antonello Bonci, a neurologist at the National Institute on Drug Abuse.

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CREATURE OF COMPULSION This rat, in a simulation of a slot machine, is lured by the same types of flashing lights and throbbing sounds that keep humans playing in casinos. With a choice of openings that pay off in sugar pellets, the rat will consistently poke at the one with the biggest payoff but the smallest chance of winning. Using similar studies, Catharine Winstanley, a neuroscientist at the University of British Columbia, has discovered that a medication that blocks a dopamine receptor can reduce risky decision-making linked to compulsive gambling.

Gallimberti was fascinated when he read a newspaper article about experiments by Bonci and his colleagues at NIDA and the University of California, San Francisco. They had measured electrical activity in neurons in cocaine-seeking rats and discovered that a region of the brain involved in inhibiting behavior was abnormally quiet. Using optogenetics, which combines fiber optics and genetic engineering to manipulate animal brains with once unimaginable speed and precision, the researchers activated these listless cells in the rats. “Their interest in cocaine basically vanished,” Bonci says. The researchers suggested that stimulating the region of the human brain responsible for inhibiting behavior, in the prefrontal cortex, might quell an addict’s insatiable urge to get high.

Gallimberti thought TMS might offer a practical way to do that. Our brains run on electrical impulses that zip among neurons with every thought and movement. Brain stimulation, which has been used for years to treat depression and migraines, taps that circuitry. The device is nothing but a coiled wire inside a wand. When electric current runs through it, the wand creates a magnetic pulse that alters electrical activity in the brain. Gallimberti thought repeated pulses might activate drug-damaged neural pathways, like a reboot on a frozen computer.

He and his partner, neurocognitive psychologist Alberto Terraneo, teamed up with Bonci to test the technique. They recruited a group of cocaine addicts: Sixteen underwent one month of brain stimulation while 13 received standard care, including medication for anxiety and depression. By the end of the trial, 11 people in the stimulation group, but only three in the other group, were drug free.

The investigators published their findings in the January 2016 issue of the journal European Neuropsychopharmacology. That prompted a flurry of publicity, which drew hundreds of cocaine users to the clinic. Perotti came in edgy and agitated. After his first session, he says, he felt calm. Soon he lost the desire for cocaine. It was still gone six months later. “It has been a complete change,” he says. “I feel a vitality and desire to live that I had not felt for a long time.”

It will take large, placebo-controlled trials to prove that the treatment works and the benefits last. The team plans to conduct further studies, and researchers around the world are testing brain stimulation to help people stop smoking, drinking, gambling, binge eating, and misusing opioids. “It’s so promising,” Bonci says. “Patients tell me, ‘Cocaine used to be part of who I am. Now it’s a distant thing that no longer controls me.’”

Not long ago the idea of repairing the brain’s wiring to fight addiction would have seemed far-fetched. But advances in neuroscience have upended conventional notions about addiction—what it is, what can trigger it, and why quitting is so tough. If you’d opened a medical textbook 30 years ago, you would have read that addiction means dependence on a substance with increasing tolerance, requiring more and more to feel the effects and producing a nasty withdrawal when use stops. That explained alcohol, nicotine, and heroin reasonably well. But it did not account for marijuana and cocaine, which typically don’t cause the shakes, nausea, and vomiting of heroin withdrawal.

The old model also didn’t explain perhaps the most insidious aspect of addiction: relapse. Why do people long for the burn of whiskey in the throat or the warm bliss of heroin after the body is no longer physically dependent?

The surgeon general’s report reaffirms what the scientific establishment has been saying for years: Addiction is a disease, not a moral failing. It’s characterized not necessarily by physical dependence or withdrawal but by compulsive repetition of an activity despite life-damaging consequences. This view has led many scientists to accept the once heretical idea that addiction is possible without drugs.

The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders, the handbook of American psychiatry, for the first time recognizes a behavioral addiction: gambling. Some scientists believe that many allures of modern life—junk food, shopping, smartphones—are potentially addictive because of their powerful effects on the brain’s reward system, the circuitry underlying craving.

“We are all exquisite reward detectors,” says Anna Rose Childress, a clinical neuroscientist at the University of Pennsylvania’s Center for Studies of Addiction. “It’s our evolutionary legacy.”

For years Childress and other scientists have tried to unravel the mysteries of addiction by studying the reward system. Much of Childress’s research involves sliding people addicted to drugs into the tube of a magnetic resonance imaging (MRI) machine, which tracks blood flow in the brain as a way to analyze neural activity. Through complex algorithms and color-coding, brain scans are converted into images that pinpoint the circuits that kick into high gear when the brain lusts.

Childress, who has flaming red hair and a big laugh, sits at her computer, scrolling through a picture gallery of brains—gray ovals with bursts of color as vivid as a Disney movie. “It sounds nerdy, but I could look at these images for hours, and I do,” she says. “They are little gifts. To think you can actually visualize a brain state that’s so powerful and at the same time so dangerous. It’s like reading tea leaves. All we see is spots that the computer turns into fuchsia and purple and green. But what are they trying to tell us?”

The reward system, a primitive part of the brain that isn’t much different in rats, exists to ensure we seek what we need, and it alerts us to the sights, sounds, and scents that point us there. It operates in the realm of instinct and reflex, built for when survival depended on the ability to obtain food and sex before the competition got to them. But the system can trip us up in a world with 24/7 opportunities to fulfill our desires.

Desire depends on a complex cascade of brain actions, but scientists believe that the trigger for this is likely to be a spike in the neurotransmitter dopamine. A chemical messenger that carries signals across synapses, dopamine plays wide-ranging roles in the brain. Most relevant to addiction, the flow of dopamine heightens what scientists call salience, or the motivational pull of a stimulus—cocaine, for instance, or reminders of it, such as a glimpse of white powder. Each drug that’s abused affects brain chemistry in a distinct way, but they all send dopamine levels soaring far beyond the natural range. Wolfram Schultz, a University of Cambridge neuroscientist, calls the cells that make dopamine “the little devils in our brain,” so powerfully does the chemical drive desire.

How powerfully? Consider the strange side effect of medications that mimic natural dopamine and are used to treat Parkinson’s. The disease destroys dopamine-producing cells, primarily affecting movement. Dopamine-replacement drugs relieve the symptoms, but about 14 percent of Parkinson’s patients who take these medications develop addictions to gambling, shopping, pornography, eating, or the medication itself. A report in the journal Movement Disorders describes three patients who became consumed by “reckless generosity,” hooked on giving cash to strangers and friends they thought needed it.

Through learning, the signals or reminder cues for rewards come to provoke surges of dopamine. That’s why the aroma of snickerdoodles baking in the oven, the ping of a text alert, or chatter spilling out the open door of a bar can yank a person’s attention and trigger craving. Childress has shown that people who are addicted don’t have to consciously register a cue for it to arouse their reward system. In a study published in PLoS One she scanned the brains of 22 recovering cocaine addicts while photos of crack pipes and other drug paraphernalia flashed before their eyes for 33 milliseconds, one-tenth the time it takes to blink. The men didn’t consciously “see” anything, but the images activated the same parts of the reward circuitry that visible drug cues excite.

In Childress’s view the findings support stories she has heard from cocaine patients who relapsed yet couldn’t explain what prompted it. “They were walking around in environments where most of the time one thing or another had been signals for cocaine,” she says. “They were basically getting primed, having that ancient reward system tingled. By the time they became conscious of it, it was like a snowball rolling downhill.”

The brain, of course, is more than an organ of reward. It houses evolution’s most sophisticated machinery for thinking, considering risks, and controlling runaway desire. Why do craving and habits overpower reason, good intentions, and awareness of the toll of addiction?

“There’s a strong-ass demon that messes you up,” says a burly man with a booming voice who smokes crack regularly.

He sits in a black swivel chair in a small windowless room at the Icahn School of Medicine at Mount Sinai in Manhattan, waiting for his MRI. He’s taking part in a study in the lab of Rita Z. Goldstein, a professor of psychiatry and neuroscience, about the role of the brain’s executive control center, the prefrontal cortex. While the scanner records his brain activity, he’ll view pictures of cocaine with instructions to imagine either the pleasures or the perils that each image evokes. Goldstein and her team are testing whether neurofeedback, which allows people to observe their brains in action, can help addicts take more control over compulsive habits.

“I keep thinking, I can’t believe I’ve wasted all that damn money on the drug,” the man says as he’s led to the MRI machine. “It never balances out, what you gain versus what you lose.”

Goldstein’s neuroimaging studies helped expand understanding of the brain’s reward system by exploring how addiction is associated with the prefrontal cortex and other cortical regions. Changes in this part of the brain affect judgment, self-control, and other cognitive functions tied to addiction. “Reward is important in the beginning of the addiction cycle, but the response to reward is reduced as the disorder continues,” she says. People with addiction often persist in using drugs to relieve the misery they feel when they stop.

In 2002, working with Nora Volkow, now the director of NIDA, Goldstein published what has become an influential model of addiction, called iRISA, or impaired response inhibition and salience attribution. That’s a mouthful of a name for a fairly simple idea. As drug cues gain prominence, the field of attention narrows, like a camera zooming in on one object and pushing everything else out of view. Meanwhile the brain’s ability to control behavior in the face of those cues diminishes.

Goldstein has shown that as a group, cocaine addicts have reduced gray matter volume in the prefrontal cortex, a structural deficiency associated with poorer executive function, and they perform differently from people who aren’t addicted on psychological tests of memory, attention, decision-making, and the processing of nondrug rewards such as money. They generally perform worse, but not always. It depends on the context.

For example, on a standard task that measures fluency—how many farm animals can you name in a minute?—people with addiction may lag. But when Goldstein asks them to list words related to drugs, they tend to outperform everyone else. Chronic drug users are often great at planning and executing tasks that involve using drugs, but this bias may compromise other cognitive processes, including knowing how and when to stop. The behavioral and brain impairments are sometimes more subtle than in other brain disorders, and they’re more heavily influenced by the situation.

“We think that is one of the reasons why addiction has been and still is one of the last disorders to be recognized as a disorder of the brain,” she says.

Goldstein’s studies don’t answer the chicken-and-egg question: Does addiction cause these impairments, or do brain vulnerabilities due to genetics, trauma, stress, or other factors increase the risk of becoming addicted? But Goldstein’s lab has discovered tantalizing evidence that frontal brain regions begin to heal when people stop using drugs. A 2016 study tracked 19 cocaine addicts who had abstained or severely cut back for six months. They showed significant increases in gray matter volume in two regions involved in inhibiting behavior and evaluating rewards.

Marc Potenza strides through the cavernous Venetian casino in Las Vegas. Electronic games—slot machines, roulette, blackjack, poker—beep and clang and trill. Potenza, an affable and energetic psychiatrist at Yale University and director of the school’s Program for Research on Impulsivity and Impulse Control Disorders, hardly seems to notice. “I’m not a gambler,” he says with a slight shrug and a grin. Out of the pleasure palazzo, he heads down an escalator and through a long concourse to a sedate meeting room in the Sands Expo Convention Center, where he will present his research on gambling addiction to about a hundred scientists and clinicians.

The meeting is organized by the National Center for Responsible Gaming, an industry-supported group that has funded gambling research by Potenza and others. It takes place on the eve of the industry’s mega convention, the Global Gaming Expo. Potenza stands at the podium, talking about white matter integrity and cortical blood flow in gamblers. Just beyond the room, expo exhibitors are setting up displays touting innovations engineered to get dopamine flowing in millennials. E-sports betting. Casino games modeled on Xbox. More than 27,000 game manufacturers, designers, and casino operators will attend.

Potenza and other scientists pushed the psychiatric establishment to accept the idea of behavioral addiction. In 2013 the American Psychiatric Association moved problem gambling out of a chapter called “Impulse Control Disorder Not Elsewhere Classified” in the Diagnostic and Statistical Manual and into the chapter called “Substance-Related and Addictive Disorders.” This was no mere technicality. “It breaks the dam for considering other behaviors as addiction,” says Judson Brewer, director of research at the Center for Mindfulness at the University of Massachusetts Medical School.

The association considered the matter for more than a decade while research accumulated on how gambling resembles drug addiction. Insatiable desire, preoccupation, and uncontrollable urges. The fast thrill and the need to keep upping the ante to feel the fireworks. An inability to stop, despite promises and resolve. Potenza did some of the first brain-imaging studies of gamblers and discovered that they looked similar to scans of drug addicts, with sluggish activity in the parts of the brain responsible for impulse control.

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CASUAL DRINKING Sylvie Imbert and Yves Brasey credit baclofen, a medication used to treat muscle spasms, with freeing them from their devotion to the bottle. In studies, baclofen has shown promise for treating alcohol dependency. Brasey, having a beer at the Hotel Luxembourg Parc in Paris, now has just a few drinks at a time. Imbert had six to nine drinks almost daily until she started taking baclofen. Now she drinks only occasionally. Imbert and Brasey have become outspoken advocates for the drug.

Now that the psychiatric establishment accepts the idea that addiction is possible without drugs, researchers are trying to determine what types of behaviors qualify as addictions. Are all pleasurable activities potentially addictive? Or are we medicalizing every habit, from the minute-to-minute glance at email to the late-afternoon candy break?

In the United States the Diagnostic and Statistical Manual now lists Internet gaming disorder as a condition worthy of more study, along with chronic, debilitating grief and caffeine-use disorder. Internet addiction didn’t make it.

But it makes psychiatrist Jon Grant’s list of addictions. So do compulsive shopping and sex, food addiction, and kleptomania. “Anything that’s overly rewarding, anything that induces euphoria or is calming, can be addictive,” says Grant, who runs the Addictive, Compulsive and Impulsive Disorders Clinic at the University of Chicago. Whether it will be addictive depends on a person’s vulnerability, which is affected by genetics, trauma, and depression, among other factors. “We don’t all get addicted,” he says.

Perhaps the most controversial of the “new” addictions are food and sex. Can a primal desire be addictive? The World Health Organization has recommended including compulsive sex as an impulse control disorder in its next edition of the International Classification of Diseases, due out by 2018. But the American Psychiatric Association rejected compulsive sex for its latest diagnostic manual, after serious debate about whether the problem is real. The association didn’t consider food addiction.

Nicole Avena, a neuroscientist at Mount Sinai St. Luke’s Hospital in New York, has shown that rats will keep gobbling sugar if you let them, and they develop tolerance, craving, and withdrawal, just as they do when they get hooked on cocaine. She says high-fat foods and highly processed foods such as refined flour may be as problematic as sugar. Avena and researchers at the University of Michigan recently surveyed 384 adults: Ninety-two percent reported a persistent desire to eat certain foods and repeated unsuccessful attempts to stop, two hallmarks of addiction. The respondents ranked pizza—typically made with a white-flour crust and topped with sugar-laden tomato sauce—as the most addictive food, with chips and chocolate tied for second place. Avena has no doubt food addiction is real. “That’s a major reason why people struggle with obesity.”

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PATIENTS, NOT PRISONERS The law enforcement officers arresting this man on suspicion of smoking heroin in downtown Seattle chose to refer him to a treatment program for certain low-level drug offenders, rather than take him to jail. The innovative program, under way for more than five years, reflects an increasing awareness that habitual drug abuse stems from addiction and can be treated as a disease, not a crime. The program has reduced recidivism among offenders diverted from the criminal justice system.

Science has been more successful in charting what goes awry in the addicted brain than in devising ways to fix it. A few medications can help people overcome certain addictions. For example, naltrexone was developed to treat opioid misuse, but it’s also prescribed to help cut down or stop drinking, binge eating, and gambling.

Buprenorphine activates opioid receptors in the brain but to a much lesser degree than heroin does. The medication suppresses the awful symptoms of craving and withdrawal so people can break addictive patterns. “It’s a miracle,” says Justin Nathanson, a filmmaker and gallery owner in Charleston, South Carolina. He used heroin for years and tried rehab twice but relapsed. Then a doctor prescribed buprenorphine. “In five minutes I felt completely normal,” he says. He hasn’t used heroin for 13 years.

Most medications used to treat addiction have been around for years. The latest advances in neuroscience have yet to produce a breakthrough cure. Researchers have tested dozens of compounds, but while many show promise in the lab, results in clinical trials have been mixed at best. Brain stimulation for addiction treatment, an outgrowth of recent neuroscience discoveries, is still experimental.

Although 12-step programs, cognitive therapy, and other psychotherapeutic approaches are transformative for many people, they don’t work for everyone, and relapse rates are high.

In the world of addiction treatment, there are two camps. One believes that a cure lies in fixing the faulty chemistry or wiring of the addicted brain through medication or techniques like TMS, with psychosocial support as an adjunct. The other sees medication as the adjunct, a way to reduce craving and the agony of withdrawal while allowing people to do the psychological work essential to addiction recovery. Both camps agree on one thing: Current treatment falls short. “Meanwhile my patients are suffering,” says Brewer, the mindfulness researcher in Massachusetts.

Brewer is a student of Buddhist psychology. He’s also a psychiatrist who specializes in addiction. He believes the best hope for treating addiction lies in melding modern science and ancient contemplative practice. He’s an evangelist for mindfulness, which uses meditation and other techniques to bring awareness to what we’re doing and feeling, especially to habits that drive self-defeating behavior.

In Buddhist philosophy, craving is viewed as the root of all suffering. The Buddha wasn’t talking about heroin or ice cream or some of the other compulsions that bring people to Brewer’s groups. But there’s growing evidence that mindfulness can counter the dopamine flood of contemporary life. Researchers at the University of Washington showed that a program based on mindfulness was more effective in preventing drug-addiction relapse than 12-step programs. In a head-to-head comparison, Brewer showed that mindfulness training was twice as effective as the gold-standard behavioral antismoking program.

Mindfulness trains people to pay attention to cravings without reacting to them. The idea is to ride out the wave of intense desire. Mindfulness also encourages people to notice why they feel pulled to indulge. Brewer and others have shown that meditation quiets the posterior cingulate cortex, the neural space involved in the kind of rumination that can lead to a loop of obsession.

Brewer speaks in the soothing tones you’d want in your therapist. His sentences toggle between scientific terms—hippocampus, insula—and Pali, a language of Buddhist texts. On a recent evening he stands in front of 23 stress eaters, who sit in a semicircle in beige molded plastic chairs, red round cushions nestling their stockinged feet.

Donnamarie Larievy, a marketing consultant and executive coach, joined the weekly mindfulness group to break her ice cream and chocolate habit. Four months in, she eats healthier food and enjoys an occasional scoop of double fudge but rarely yearns for it. “It has been a life changer,” she says. “Bottom line, my cravings have decreased.”

Nathan Abels has decided to stop drinking—several times. In July 2016 he ended up in the emergency room at the Medical University of South Carolina in Charleston, hallucinating after a three-day, gin-fueled bender. While undergoing treatment, he volunteered for a TMS study by neuroscientist Colleen A. Hanlon.

For Abels, 28, a craftsman and lighting design technician who understands how circuitry works, the insights of neuroscience provide a sense of relief. He doesn’t feel trapped by biology or stripped of responsibility for his drinking. Instead he feels less shame. “I forever thought of drinking as a weakness,” he says. “There’s so much power in understanding it’s a disease.”

He’s throwing everything that the medical center offers at his recovery—medication, psychotherapy, support groups, and electromagnetic zaps to the head. “The brain can rebuild itself,” he says. “That’s the most amazing thing.”

About the author: Fran Smith is a writer and editor. This is her first article for National Geographic. Max Aguilera-­Hellweg is a photographer who also trained as a medical doctor. His last assignment for the magazine was “Beyond Reasonable Doubt,” in the July 2016 issue.

Link to article here: How Science Is Unlocking the Secrets of Addiction

ASAM Receives Multimillion Dollar Grant from Ohio Mental Health and Addiction Services

by ASAM Staff | August 31, 2017

The American Society of Addiction Medicine (ASAM) is proud to announce the acquisition of a $2.2 million grant from the state of Ohio to help combat the prescription opioid and heroin crisis. Ohio has been awarded over $26 million through the 21st Century Cures Act from the Substance Abuse and Mental Health Services Administration (SAMHSA) to strengthen their healthcare system. ASAM is grateful to be a part of building a strong healthcare system, particularly for patients with addiction, in Ohio. The grant-funded project is beginning immediately and is projected to continue through April 2018.

“ASAM is ready to help Ohio take on this project,” said Ohio State Chapter President Dr. Shawn Ryan, “this will make a difference locally for the physicians who treat addiction and save lives in Ohio.”

The goals of the project include partnering with Ohio Department of Mental Health & Addiction Services to provide the required education needed to increase the number of physicians with a DATA 2000 waiver in Ohio.

The objectives of the project include conducting 42 live 8-hour waiver-qualifying CME trainings, providing access to ASAM’s online waiver-qualifying CME for up to 2,000 physician learners, and providing financial compensation to those physicians who meet training and waiver requirements. All goals and objectives will be completed within the funding period (from July 1, 2017 – April 30, 2018).

For more information about the course click here.

How My Overdose Saved My Life

I’m a mom and a wife. I’m a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio, supporting those struggling with substance use disorder.

And I’ve been in recovery from heroin addiction for five years.

That’s today.

Five years ago, I was sprawled on the pavement getting a dose of naloxone. I had overdosed on heroin. It was a near-death end to a reckless existence that had started without warning.

Naloxone didn’t just bring me back to life, it gave me a second chance at life. But more than that – naloxone was the bridge that got me from the brink of death to treatment and recovery.

When I was young, I had several knee surgeries. I was prescribed pain medication on a regular basis, whether or not I needed it. And at no point was naloxone part of any medical conversation.

If it were, maybe I would have been more aware of the high risks and addictive properties of prescription opioids.

Suddenly, I was hooked. By 15, I was diagnosed as an addict and the cycle of addiction consumed the next decade of my life. I doctor shopped for pills, took opioids, used cocaine, methamphetamine and ecstasy to get my fix. I dropped out of high school, gave up the rights to my first child, and married an abusive man whose drug use was like my own.

What started as a prescription from my doctor spiraled into a deadly mission of finding the next, stronger high – eventually leading me to heroin.

I committed felonies for drug money and couldn’t hold a steady job. My young life was decaying. I became associated with members of a Mexican drug cartel and eventually became a drug mule, buying and selling black tar heroin.

I was so far gone, until thankfully, I overdosed. I say thankfully because had it not happened then, I may not be here to share my story.

Addiction is no joke. It’s not a choice. Yes, I chose heroin, but I didn’t choose to be an addict. Naloxone gave me the chance to correct my wrong choice. It didn’t enable me to keep using, like some may think.

The only thing naloxone enables is breathing.

When I overdosed, my body was pushed out of a car and onto the pavement of a parking lot. I was revived by naloxone, I woke up to strangers around me. I refused treatment and within minutes, I stood up and walked away from where my body laid, moments from death. Six weeks later, I entered into treatment, March 9, 2012.

For ten days, I slowly purged my body of the deadly drugs that brought me to that place. I left clean and with a conviction to stay that way.

Quitting heroin was the easy part, rebuilding my life was hard. But it is possible.

I cleared my criminal record, I mended relationships with my family – my daughter that I had walked away from so long ago. I remarried and gave birth to another beautiful baby girl.

As I rebuilt my life, I decided to focus my energy on helping those that were in the same nightmare I had just escaped. I went through a certification course to become a Chemical Dependency Counselor Assistant. I have worked incredibly hard to build my credibility as someone working in the field to show other addicts that recovery is possible.

So today, on International Overdose Awareness Day, what I want everyone to know is that if it weren’t for naloxone, I’d be one of the mourned, not one of the recovered.

The second chance I got is only possible with the ability to enter treatment. If an addict is still alive, there is still hope.

When a person is revived with naloxone, that is the crucial time when we as a society must offer love and compassion to them. That is the moment to look at the patient and say, “You’ve been through a lot, I want to help you find treatment and change your life.” Because no matter how far a person has gone in their life to support their addiction, as long as they are alive, hope is never gone.

I carry naloxone with me everywhere I go. It is the world we are living in today, that I need to be prepared to reverse an overdose at any time. The only way we are going to change this epidemic is if we as members of society and fellow human beings call upon each other to show compassion and love. Not one person is immune to addiction. Addiction has no prejudice and does not care who you are or how much money you have or what you look like. I am living and breathing proof why naloxone needs to be in everyone’s possession. My life is beautiful today, because of naloxone.

Amy Parker is a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio. She is a member of the WCPO 9 News Heroin Advisory Board and a Motivational Speaker. Amy has been in recovery from heroin addiction for more than five years.

Link to article on Huffingtonpost.com here: How My Overdose Saved My Life

 

 

Imprisoning Drug Offenders Doesn’t Affect Use, Study Says

Sending more people to prison for drug offenses won’t have an effect on drug use and deaths, according to a new analysis released this week.

Researchers from the Pew Charitable Trusts crunched state-by-state data on drug imprisonment, drug use, overdoses and drug arrests and found no evidence that they affected one another.

That lack of a pattern shows the flaw in a central philosophy in the war on drugs: That doling out harsh penalties makes people less inclined to use drugs or join the drug trade, said Adam Gelb, director of Pew’s public safety performance project, which works to reform state-level drug policies.

“There seems to be this assumption that tougher penalties will send a stronger message and deter people from involvement with drugs. This is not borne out by the data,” Gelb said.

He included the entire analysis in a letter Monday to Chris Christie, who is both governor of New Jersey and head of President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis.

The commission held its first public meeting on Friday. It is responsible for coming up with a plan to help the federal government tackle an addiction crisis that killed more than 50,000 people last year. The growing number of overdoses is being driven by runaway rates of addiction to prescription painkillers and heroin, researchers say.

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A line of inmates at the Los Angeles County Sheriff’s Department’s Men’s Central Jail, on October 27, 2011. Reed Saxon / ASSOCIATED PRESS

Meanwhile at the Justice Department, Attorney General Jeff Sessions is carving out his own approach — focused on punishment.  He issued a memo to federal prosecutors in May ordering them to seek the maximum punishment for drug offenses, a return to harsh policies that predate former President Barack Obama.

Pew’s study was relatively simple: gather data from each state in four categories: incarceration of drug offenders, overdose deaths, drug arrests and drug use. The latest year for which all the data was available was 2014.

The theory, Gelb said, was that if deterrence worked, the states with the highest incarceration rates would have lower rates of drug use.

But that’s not what they found.

For example, Louisiana, the state with the highest incarceration rate, was in the middle of the pack on overdoses, drug arrests and drug use. Massachusetts, with the lowest incarceration rate, was toward the bottom in arrests and use, but near the top in overdoses. West Virginia, with the highest overdose rate, was 21st in incarcerations. And Colorado, with the highest rate of drug use, was 37th in incarcerations.

Gelb said he hoped the commission and other policy makers would use it to chart their course forward.

“This is fresh data that should inform the important conversation happening in Washington and around the country about what the most effective strategies are for combatting the rise in opioid addiction and other substance abuse,” Gelb said.

by posted June 20, 2017

Link to original article here: Imprisoning Drug Offenders Doesn’t Affect Use, Study Says

OHSAM president, Dr. Ryan, is the featured speaker in this podcast where they interview experts about addiction and addiction education. Listen at the 1:30 minute mark!

The Cover2 Podcast is an ongoing series of interviews with people who are making a difference in the fight against opioid addiction.  The Cover2 Podcast seeks to raise awareness and to connect users.

Click here for: Podcast – Dr. Shawn Ryan, MD, MBA, ABEM

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