The not-so-common Reward Pathway?
"The four probable explanations of the null finding are presented by the authors, though not with much guidance as to how to think about them.
1.The heroin shots were passive — the subject knew that he didn’t have to do a thing to get his shot. So maybe DA only gets activated when drug-taking is active, not passive.
2. The PET methodology is simply too insensitive to pick up DA differences at this scale.
3. Despite what looks like sufficient statistical power, ten subjects just weren’t enough to get the effect.
4. Methadone blunts the system enough to quash or even reverse differences in DA."
Does Maintenance Therapy Need Counselling?
I have in previous newsletters questioned the validity of research that claims that maintenance therapy for heroin addicted individuals is sufficient and that further counselling or therapy is not needed. I have, in this article, suggested that perhaps we are measuring the wrong things. There is also a worrying divide that is occurring amongst treatment professionals regarding Maintenance Therapy, and I have discussed this here. A study has just been published: Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings. For a summary and some thoughts around this paper, refer to the ever-reliable findings site.
The conclusions tend to show that there is little significant difference between initiating methadone treatment with or without counselling, either "as usual" or with intensive therapy. This would indicate that there is no reason to delay maintenance therapy because additional services are not available, or, as I would strongly agree, that maintenance should not be terminated because the patient does not attend mandated counselling sessions.
Where the counselling did make a difference was in terms of methadone dose: the dossages of those who received the "expert" counselling were significantly lower than those that didn't, and the ones who received the intensive counselling exited treatment earlier - but these extrapolations are not evidence that this is so as there are other possible explanations as the Findings article points out.
Scottish Review of Methadone Treatment
The recent Review of Methadone in Drug Treatment has highlighted why the general public and many professionals are often so misinformed about addictive disorders. The headlines in the press are diverse and could easily be believed to come from very different sources. While some headlines proclaim "Scottish methadone program should continue" and "Methadone should continue to be central drug addict treatment" others appear to sound dire warnings: "Methadone bigger killer than heroin in Scotland" and "Calls for review of 100k-a-day methadone programme." No wonder the public are confused!
One is too Many?
Piazza and Deroche-Gamonet have published an interesting Multi-step Theory of Transition to Addiction. What I like about this paper is that they regard drug seeking and consumption as within the range of normal behaviours, reserving the term pathological for late stage addictive behaviours. They propose that the transition from substance use to addiction is a three step sequential action between individual vulnerability and the level of drug exposure. They further propose that this transition is determined by two distinct vulnerable phenotypes along the path to addiction. one being those who have a sensitized dopaminergic system and impaired PFC function which leads to intensified, sustained drug use. The second phenotype is characterised by long lasting loss of synaptic plasticity and results in a "form of behavioural crystalization."
In short, the theory attempts to reconcile the drug centered and individual centered theories, and attempts to find a unified model drawn from the research of Koob, Volkow, Robson, Berridge, Nestler and others. One of the problems with this theory, in my opinion, is that it doesn't address behavioural addictions. Talking of behavioural addictions....
Internet Addiction? We Have a Bed for You
Certainly Stanton Peele may argue that the internet is the perfect tool for delivering content that could be addictive, whether it be games, gambling, google or girls. And indeed there may be some people suffering from what appears to be internet addiction, but I doubt if a 10-day harm reduction approach program will solve their problem. Maybe I should start a program for those who are addicted to addiction programs - at US$28 000 it will be cheap as chips (as long as they not casino chips)!
To find out more on gradualism and Integrative Addiction Psychotherapy, visit Scott's website. I was first made aware of his work when I read the paper he wrote with Dr Andrew Tatarsky: Re-envisioning Addiction Treatment: A Six-Point Plan, which, in my opinion, is essential reading for all program directors.
Quote of the Month
Time for some controversy. Recently Richard Wilmot(PhD), author of “American Euphoria: Saying 'Know' to Drugs”, posted a provocative statement on a LinkedIn discussion group. This is a brief extract:
"Today one of the main criteria for a diagnosis of drug addiction/alcoholism is: continuing to consume alcohol or another drug “despite unpleasant or adverse consequences” (DSM). For the Christian martyrs the same criteria would apply. People of that time and place—Rome, 2nd century A.D.—could also say that this new Christianity was like a drug that endangered lives and that being a Christian had all the adverse financial, social, psychological and physical consequences that we now see in the lives of drug addicts and alcoholics. And yet Christians, of all ages, in spite of the consequences, continued to profess their faith… and continued to be eaten by lions.Marc Lewis and I expanded on this idea in our blogs. Dr Wilmott's complete posting can be found here, along with my comments. Marc's blog also has some really interesting insights and reader comments on this same subject.
Obviously there was something to Christianity that prevented the Christian from being abstinent from Christianity..............Like the Christians who suffered and died for their faith, the addict has also made a choice… to lose everything for the “faith” in the euphoria of the drug experience."
Ok, so that's it until next time. Remember, I welcome your comments, ideas, criticisms and input.