Myths of Addiction

This is a recent talk I presented at the South African College of Applied Psychology Festival of Learning and at the University of Cape Town Department of Psychiatry and Mental Health addictions forum.

In it I dispel the myths that: 

• Addiction is caused by drugs, 
• once an addict always an addict, 
• addiction is progressive 
• abstinence is required to initiate treatment or for remission.

I feel strongly that if we allow these myths to continue, we will not develop practical and helpful treatment modalities or public policies. At the end of the talk I made some suggestions regarding treatment. Comments and criticisms are welcome!

Injecting Drug Use and Harm Reduction

I was recently quoted, along with a colleague and some of our out-reach workers in an article on increased levels of injecting drug use in the Western Cape.

The message is important, and unless substitution therapies are introduced it is likely that there will be a significant increase in overdose deaths and a spread in HIV and other infectious diseases.

This article was originally published on Ground Up and then on allAfrica. The article is by Ian Broughton, and the photo is by Andrea Schneider.

Healthcare workers worry injecting heroin on increase

Sunday 31 August was International Overdose Awareness Day. Health workers in Cape Town have warned of a possible increase in drug overdoses and the spread of infectious diseases, including HIV, if the use of needles to inject drugs increases.

August 2014 Newsletter

The recent death of Robin Williams is incredibly sad. As always, when a celebrity dies, especially when substance use is somehow involved, there is a lot of talk about the dangers of drug use and how addiction so often leads to death. I have a slightly different take on the issue: life long substance use disorders, where there is a constant battle against relapse - are usually the sign of something severe that underlies the SUD.

In this case, it seems, the monster below the surface was unresolved pathological depression. Of course, that mixed with an alcohol use disorder is a recipe for disaster. But the alcohol is an adjunct - it is both the (temporary) solution, and the (long-term) catalyst. It is not the primary disease.

I often see how by focusing on the SUD the real pathology is missed. Each relapse brings around renewed focus on the SUD rather than sparking the question: "Well, we know that SUDs die a natural death in most cases, unless there is a contributing factor, this person is not getting better, so what is the contributing factor, and how do we resolve that?"

It is sad that complex problems get reduced to the simple statement "Oh, he was an alcoholic".

In this newsletter I bring together some information from different types of addiction and drug use. When put together much of the research seems to be stating the obvious and, in my opinion, addiction looks more like a learning disorder or adaptive process and not a primary disease of the brain. It seems that Maia Szalavitz agrees with me.

We look at Marijuana and brain changes and schizophrenia, methamphetamine and brain changes, porn and brain changes, internet addiction (and brain changes), Tom Hovarth and SMART Recovery, the results of the Global Drug Survey. I hope you enjoy, and please feel free to comment! Please click HERE to find out more about the Cape Town Recovery Film Festival 2014.

March 2014 Newsletter

It has been a while since the last newsletter. What with holidays, the start of the new academic year, a revamp of the program I run and various other commitments time has been short. I will try to produce at least one newsletter per quarter for 2014, but can't guarantee it! Please feel free to forward any articles you feel should be included.

It has been a sad time for us in South Africa with the death of Nelson Mandela. Even though this was some months back his presence is very much evident. It is very difficult to explain to those without an intimate knowledge of our history just how much this man has come to symbolise. He is the figurehead that represents the struggle of many other great men, a nation and the political structures he represented. If it was not for the efforts of Mandela and these individuals, the treatment centre I run would not be legal. This is a thought that is truly bizarre,  and a sad indictment on those that allowed the apartheid system to flourish under the old regime. We miss Tata Madiba.

In the last news letter I spoke about the Mind & Life Conference on craving, desire and addiction. Well, that is now past, and it was indeed extremely interesting. I have summarised all the presentations, and they can be accessed through this post here.

Due to time constraints this is a shortened newsletter, but I'm sure you will find these articles and subjects as interesting as I have. These include: Addiction as Relationship, Stress and Addiction, Gabapentin, Buprenorphine, Rat Park, Mindfulness and addiction, Mike Ashton, Logical Fallacies.

Mind & Life XXVII - Craving, Desire and Addiction

The Mind & Life Institute is an initiative that aims to alleviate suffering and promote human flourishing. They aim to bring together scientists, contemplatives and scholars to deepen our understanding of the causes of suffering.

Part of their strategy is to hold dialogues with His Holiness the Dalai Lama. This years dialogue focused on craving, desire and addiction. A group of scholars from the fields of neuroscience, Buddhism, Christianity, psychology, psychiatry and the social sciences gathered at Dharamsala to share their ideas and gain a deeper understanding of addiction.

The speakers were: Marc Lewis, Kent Berridge, Thupten Jinpa, Nora Volkow, Vibeke Asmussen Frank, Matthieu Ricard, Wendy Farley and Sarah Bowen. Brief biographies and their topics, as well as the program, can be downloaded here.

I have watched each of the talks and summarised them. None of this is my original work, but rather was done so that I can have a reference for myself, and I have made this available to you simply to help you choose which talks you may wish to watch in full and for academic purposes. All the videos are available in their entirety here. My summaries can be seen by clicking on the days below:

Day One
Marc Lewis - Craving, Dopamine and the Cycle of Addictive Behaviour 

Day Two
Kent Berridge - Brain Generators of Intense Wanting and Liking

Thupten Jinpa - Psychology of Desire: A Buddhist Perspective

 

Day Three
Nora Volkow -The Role of Dopamine in the Addicted Human Brain  

Vibeke Asmussen Frank - Beyond the Individual: The Role of Society and Culture in Addiction.

Day Four
Matthieu Ricard - From Craving to Freedom and Flourishing: Buddhist Perspectives on Desire 

Wendy Farley  - Contemplative Christianity, Desire and Addiction.  

Day Five
Sarah Bowen - Application of Contemplative Practices in Treatment of Addiction 

Day 5 - Mind and Life XXVII - Craving, Desire and Addiction

You can view the videos here.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full. 

Day Five of Mind and Life XXVII - Sarah Bowen discusses the Application of Contemplative Practices in Treatment of Addiction

Day 3 - Mind and Life XXVII - Craving, Desire and Addiction

Dr Nora Volkow

Dr Vibeke Amussen Frank

You can view the videos here.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full. 

The third day of Mind & Life XXVII - Dr Laura Volkow talks about The Role of Dopamine in the Addicted Human Brain and Dr Vibeke Amussen Frank follows with Beyond the Individual: The Role of Society and Culture in Addiction.

October 2013 Newsletter

It's almost the end of the year. In our setting, because we are moving into summer and festivities, this usually sees a drop in those seeking help for their substance use issues, but often their is a brief spike shortly after new year as resolutions are made and the after-effects of the partying are felt! I recently attended the Dan Siegel Interpersonal Neurobiology workshop that was held in Cape Town, hence the photo. In this month's edition of Addiction Information we hope to spark some thought around some controversial topics, but one topic that should become less controversial is that of opioid substitution therapy, for which their seems to be mounting evidence as a stand-alone treatment modality.

We look at: An opioid addiction switch, Behavioural Interventions and Buprenorphine Maintenance, Chronic Care, Remission Rates, Choice and Will Power, Dr Dan Siegel and the Mind & Life Conference.

A Christian and an addict walk into a meeting...

Recently Richard Wilmot(PhD), author of “American Euphoria: Saying 'Know' to Drugs”, posted this provocative statement on a LinkedIn discussion group:

“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.

Obviously there was something to Christianity that prevented the Christian from being abstinent from Christianity. It was something internal… an internal euphoria. It was something that could not be seen but nevertheless was something that was felt… and felt as something awesomely significant. It was something that made all the pain and suffering worthwhile: it was a religious experience.

June 2013 Newsletter

After a busy two months I have finally managed to produce a newsletter. I recently gave a talk on the emerging divide between those who believe that opioid substitution is a treatment in itself, and those who believe that it is not really recovery. My talk, Opioid Substitution Therapy: Treatment vs. Recovery can be found here. This was prior to me being aware of the DSM qualification of "on maintenance therapy" for those in remission from Substance Use Disorders. I think we will see this argument developing in the States, and opinions will remain polarised. Hopefully we will see a more balanced approach in the South African setting. Comments are most welcome.

In this month's newsletter we talk about: Agonist Therapy for Stimulant Addiction, Is addiction a Disease?, The Anti-Reward System, Stimulant Addiction and Gray Matter, The Most Important Treatment Studies Matrix, Chris Arnade, Mindfulness and Improved RCTs in addiction.

Opioid Substitution Therapy: Treatment vs. Recovery

Introduction

Opioid Substitution Therapy has been a controversial topic. Somehow it is easier for the addiction recovery industry to accept medications such as Disulfiram with its aversive effect or acamprosate which does not carry the risk of approximating the state of alcohol intoxication and because studies have suggested that it is only effective in conjunction with psycho-social interventions. OST, on the other hand, uses opioid agonists or partial agonists that act in similar ways to the drugs of dependence, albeit without the same quality of high, and this, some have suggested, shifts the addiction from opioid dependence to another dependence and may be of more harm than good to the addict.

Human Rights Day Speech

Addicts Are Also Human

By Shaun Shelly
This is a speech I delivered at a public function held to celebrate Human Rights Day in South Africa. Addicts are one of the most marginalised groups in society, not even enjoying the right to freedom or medical care:

The Bill of Rights is a cornerstone of democracy in South Africa. It enshrines the rights of all people in our country and affirms the democratic values of human dignity, equality and freedom.  It places a responsibility on the state to respect, protect, promote and fulfill the rights in the Bill of Rights.

Addiction Information February 2013 Newsletter

This is Newsletter Number 2, which is a little late due to a crashed hard-drive. The only two documents I had not backed up were the talk I was due to present "Sex, Drugs and No Control", and this newsletter, so it was back to the keypad! But we've made it, although in a slightly shorter version. I hope you find this summary of addiction news from around the world useful. Your suggestions are again 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.

Please like us on facebook.

In this issue: 
Inside Rehab, Celebrity Rehab, Recovery or Treatment?, Dr Mark Willenbring, OST, Naloxone, NMDA  Modulators, Epigenetics, Frankenstien Drugs, Local Research, Ibudilast for Meth addiction?, Policy in NZ, Columbia and Africa, Banker or Dealer?

Sex, Drugs, and No Control

Sex as Addiction and the Treatment Thereof

There is much controversy around the use of the term "sex addiction." This article gives a brief overview of the arguments against this term, and then shows some of the aspects as to why sex may indeed be an addiction and how it may be treated. There is certainly a need for further research in this area before anything definitive can be proclaimed, but perhaps the study of behaviours that present as addiction can give us further insight and understanding of exogenous addictions.

PDF Version (Printable)

According to the DSM-V Sex Addiction is not a diagnosable condition. Sexual addiction was mentioned in the DSM-III-R, but disappeared in the DSM-IV, threatened a come-back in the DSM-V but has now been discarded. Sex, however, has long been described as addictive. In the late 1800s Freud described masturbation as the “original addiction.” Rado in the 20’s described addiction as “compulsive” and made the reward/pleasure/sex link. We saw words such as nymphomania (Ellis) and the clumsy “Don Juanism”(Stoller). In the 70’s Mac Dougall spoke of “addictive sexuality”. It was originally proposed that sex be included under the heading of addiction in the DSM-5, and then that was discarded and the idea of hyper-sexuality was introduced as a possibility. Eventually none of these proposals was accepted, and so sexual addiction has ceased to exist, according to the DSM, that is.

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.”