Addiction Information January Newsletter

Introduction

Welcome to the first Addiction Information Newsletter. The object of this newsletter is to give you a monthly overview of what is happening in the world of addiction across a number of fields. You can subscribe to this newsletter and receive an e-mail version by joining our mailing list. Your suggestions are most welcome, and articles for the website or that you would like to have linked to this newsletter can be directly submitted to me by e-mailing shaun.shelly@yahoo.com.

In this issue:

The Motivated Addict, Dual-process models, CBT Ineffective?, Drug Policy, Brain Structure, Meth Psychosis, Transcriptional Mechanisms, Nepicastat & 18-MC Trials, Neuroscientist Marc Lewis, Dr Frankenstein's Cure and "beating addiction"

CBT Doesn't Work for Heroin Addiction?

Study Suggests Buprenorphine is enough. I Disagree.

In the January 2013 edition of The American Journal of Medicine there is a clinical research study conducted by members of the Yale University of the School of Medicine entitled: A Randomized Trial of Cognitive Behaviour Therapy in Primary Care-based Buprenorphine. (Fiellin, et al., 2013). In the abstract for the study, the stated objective was “To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.” The abstract concludes: “Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioural therapy.”

In the Press.....

   

PRISON NO CURE FOR ADDICTION: EXPERT
By simone.williams
2013-01-15 09:00   
HARSH penalties for drug-related crimes do more harm than good.

This is according to Shaun Shelly, Addictions Programme Manager of Hope House Counselling Centre in Military Road, Retreat. In his opinion, the Drug Watch campaign by LeadSA, and editorial comments and letters in the local press seem to all be praising criminal sanctions for drug addicts encouraging harsher penalties. He complains his letters to the press have been ignored by editors.

Medication in Recovery

IMPORTANT: This article deals with treating post-detoxification addicts who have been weaned from their drug of choice under medical supervision and those who don’t have a co-morbidity that presents an immediate danger to themselves or others. I am also not talking about those who are on a supervised substitution or aversion program. We must also accept that there is a minority amongst us for whom a life free of medication is an unrealistic goal. We should recognise this and not exclude these people from the recovery process.

PDF Version
Many have come to accept addiction as a disease, and one of the down-sides of this belief is that addiction can be easily treated via pharmacological interventions. Accordingly, many recovering addicts are dealing with their symptoms via medical intervention. I think this is a mistake. Here’s why:

The neurobiological underpinnings of addiction.

A brief overview of our current understanding of the neurobiological processes that underlie addiction.

PDF Version Plus Figures 
It is only recently that the idea that addiction is a brain disease has begun to be accepted by the general population. The disease model was at the centre of the AA/NA message long before it became accepted by even the medical field. As we make advances in neuroscience we are finding that many of the conclusions drawn from anecdotal evidence have, in fact, a sound neurobiological basis. There is indeed a strong neurological underpinning for addiction, and in this essay I will summarise the current understanding of this.

The Common Reward Pathway

The common reward pathway for substances of abuse, specifically relating to neuroanatomy and neurophysiology.

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Although substances of abuse have varied and diverse primary targets and acute effects neurochemically, research has shown that almost all substances of abuse lead to an increase in dopamine in the mesocorticolimbic dopaminergic system. The understanding of this common reward pathway is important as it could (i) lead to the development of a single medication that works for various classes of substances of abuse in addiction treatment; and (ii) give a better understanding as to why all those suffering from addiction experience similar psycho-social devastation in spite of the variety of drugs of choice.

Treatment not Time:

Addiction is health issue, not a criminal one.

The recent Drug Watch campaign, editorial comments and letters in the local press seem to all be prescribing harsher criminal sanctions for drug addicts. Even the recent special remissions of sentences, granted by the State President, have excluded those convicted of drug related crimes. Even so, I would like to suggest that this approach is both ill-informed and not helpful if we are to make in-roads in dealing with the drug problem that undoubtedly affects our community. We need to base our approach on sound research and not on popular sentiment.

An Overview of Bipolar Disorders

A brief overview of bipolar disorders for addictions counsellors
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“Compared to bipolar's magic, reality seems a raw deal. It's not just the boredom that makes recovery so difficult, it's the slow dawning pain that comes with sanity - the realization of illnesss, the humiliating scenes, the blown money and friendships and confidence. Depression seems almost inevitable. The pendulum swings back from transcendence in shards, a bloody, dangerous mess. Crazy high is better than crazy low. So we gamble, dump the pills, and stick it to the control freaks and doctors. They don't understand, we say. They just don't get it. They'll never be artists.”

-David Lovelace, Scattershot: My Bipolar Family

Obsessive Compulsive Disorder

A brief overview of Obsessive Compulsive Disorder for addictions counsellors

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When you attempt to eliminate risk from your life, you eliminate along with it, your ability to function.

- Fred Penzel

I once watched a man attempt to cross Belgravia Road. He approached the traffic light, turned away. He approached it again, and again he turned away. He repeated this process at least six times. Eventually he reached out to touch the button that would activate the pedestrian crossing light. Then he withdrew his hand, wiped it vigorously on his shirt and attempted to do it again. Again he withdrew. The next time he covered his figure with his shirt, but still he could not touch the button. The car behind me hooted, and I was forced to pull off. I was not convinced that this man would ever make it across the road. Such is the nature of OCD – obsessive, compulsive and utterly debilitating.