Researchers in South Carolina say they’ve found a harmless amino acid that seems able to reverse some of the brain changes that occur during cocaine addiction.

Cocaine causes lasting changes in areas of the brain that regulate reward behavior and decision making. These neural changes seem to limit a person’s ability to fight temptation and so increase the risks of relapse back to drug use.

N-acetylcysteine (NAC) is an amino acid derivative. Researchers at the Medical University of South Carolina found that when they gave cocaine addicted rats NAC, normal function was restored to a glutamate pathway in the brain (a pathway that regulates reward and behavior).

Although rats were cocaine dependent prior to NAC administration, after NAC and neural healing, the rats exhibited no drug seeking behavior, even when presented with cocaine cues.

Khaled Moussawi, lead study author, commented on the findings, saying, "Our finding suggests a promising therapeutic strategy for cocaine addiction, for which there is no approved treatment.

The findings were presented at Neuroscience 2009 in Chicago, the annual conference of the Society for Neuroscience

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Spanish researchers say that using a common antipsychotic medication may help cocaine users manage cravings and quit using.

Researchers in Spain say that cocaine addiction is a big domestic problem, especially among a young clubbing crowd that likes to mix cocaine and alcohol, but the lack of effective pharmacological interventions makes the treatment of these cocaine addicts very difficult.

While much research is currently centered on the development of new drugs and vaccines that may help those with stimulant addictions, scientists at the University of Murcia in Spain wondered if any existing medications might be useful as cocaine treatment medications.

After a review of some possible candidates, they decided to trial the use of a common antipsychotic medication called aripiprazole as a cocaine addiction treatment medication. Cocaine addiction results in disruptions in the functioning of the dopamine systems of the brain. Aripiprazole was chosen as it is known to stabilize dopamine functioning in both the cortical and pre cortical levels of the brain as a way to treat psychosis, which is also very related to dopamine functioning.

The Study

To test the medication, 46 cocaine addicted adults were given between 5 mg and 10 mg of aripiprazole per day. Each study participant also participated in addiction psychotherapy during this period.

• At the end of the 6 month period, study participants displayed significant reductions in measures of impulsivity and cocaine cravings and improvements in overall functioning.
  

The study authors concede that because each participant received both medication and therapy it is impossible to say which intervention caused the improvements and they call for a future double blind controlled study to isolate the aripiprazole effects.

Commenting on the potential significance of the study, Dr. Shaul Lev-Ran of Canada’s Centre for Addiction and Mental Health said, “Some people are looking at completely new pharmacological agents that treat stimulant, cocaine, amphetamine dependence. But others are saying there are a lot of agents that are already around, and maybe we've overlooked some of them.”

The full research findings were presented at the American Academy of Addiction Psychiatry (AAAP) 22nd Annual Meeting & Symposium.

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A 2 drug combo of topirimate and amphetamines worked twice as well as placebo for cocaine addicts looking to quit.

We don’t yet have a single medication to really help people quit cocaine. Maybe that’s the problem, say researchers at Columbia University: no single medication works, but a combination of two different meds might just do the trick.

• Topirimate is an anti seizure medication that has been proven effective against alcohol and nicotine addiction. It has also shown some ability to disrupt cocaine addiction, but it works quite slowly - and on its own, doesn’t work quite well enough.
• There is also some evidence that amphetamines, like modafinil, can ameliorate some of the brain changes caused by cocaine addiction, like reduced executive control and disrupted reward functioning – but amphetamines alone have not proven effective in helping people quit cocaine.

But what if you mixed the 2 drugs together?

The Study

The researchers recruited a group of cocaine addicted people who were looking to get addiction treatment and divided this group in 2 segments:

• For 120 days, half of the study subjects received a combination of topirimate and amphetamines
• For 120 days, the other half of the subjects received a placebo.
• All subjects received addiction treatment psychotherapy

Neither the subjects nor the researchers knew which subjects were receiving the placebo.

The Results

• Subjects getting the medications were twice as likely to achieve three weeks of continuous abstinence (33%, compared to only 17% of the subjects who received the placebo).
• Subjects getting the topirimate and amphetamines also used cocaine on significantly fewer days over the study period than subjects getting only placebo

Commentary

The researchers say the results show the promise of this 2 medication treatment for cocaine addiction and they call for larger clinical studies to continue to test its efficacy.

Read the full study results in the current edition of Biological Psychiatry

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A 2-drug combo of Buprenorphine and Naltrexone may well be the non-addictive cocaine treatment medication the world's been waiting for. 

There aren't many drugs as addictive as cocaine - and unfortunately, once you're addicted, no medications exist to help you kick your habit.

But maybe that's all about to change...

Scripps Institute researchers think they've developed an effective 2-drug treatment for cocaine addiction that makes use of 2 medications already FDA approved as addiction treatment drugs, naltrexone and buprenorphine.

The Cocaine Addicted Brain

Cocaine disrupts the activity of 2 major opioid systems:

The mu opioid system: After ingestion cocaine blocks mu opioid reuptake which results in a huge spike in dopamine activation and resultant euphoria. Over time, a cocaine dependent person needs to take larger and larger doses to experience this euphoria.

The kappa opioid system: Cocaine ingestion causes the kappa opioid system to release dynorphin, which results in feelings of stress and dysphoria (the opposite of euphoria). Dynorphin causes the negative feelings of the come-down. Over time, the kappa opioid system becomes more sensitive to cocaine and smaller quantities produce greater stress and dysphoria.

A cocaine addicted person craves the high and also needs the drug to temporarily eliminate feelings of dysphoria.

The New Drug Combo 

Buprenorphine activates the mu opioid system causing moderate euphoria and a cessation of cocaine cravings. significantly, it also blocks the release of dynorphin, reducing negative effects.

Unfortunately, buprenorphine is an addictive drug, so it has been considered inappropriate for use as a cocaine addiction treatment medication - as users would only substitute a cocaine addiction for an opiate addiction.

But when you add a small amount of naltrexone to the buprenorphine you block the 'high' and addictiveness of the drug without reducing it's ability to reduce the dysphoria and cravings of cocaine withdrawal.

The Experiment

Cocaine addicted rats given the 2 drug combo showed a significant reduction in desire to use cocaine and did not exhibit opiate dependence withdrawal symptoms after cessation of use, as rats treated only with buprenorphine did.

Commentary

Commenting on the significance of the research, study co-author, Leandro Vendruscolo said, “These findings potentially represent a huge bridge from basic research to the establishment of a new and effective medication for cocaine addiction.”

The full research results can be found in last week's edition of Science Translational Medicine.

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Trying to quit cocaine? You might want to consider ditching cigarettes at the same time. New research suggests that nicotine amplifies cocaine’s effects and addictiveness…just remember not to use nicotine replacement products, such as nicotine gum or the patch, as these too increase cocaine’s effects.

The concept of gateway drugs has always been sort of controversial, with many arguing that drugs like alcohol, tobacco and marijuana are used first simply because they are more available and socially accepted than harder drugs, like cocaine.

Researchers at Columbia University, however, say that the nicotine in cigarettes may well act as a true gateway drug by a mechanism in which it amplifies the effects of cocaine and increases the risks of cocaine addiction and that when people want to quit using cocaine, they might want to consider butting out their cigarette habit at the same time.

• The researchers found that rats treated with a nicotine solution for some days before being given access to cocaine developed much stronger addictions than rats given the same access to cocaine, but not pretreated with nicotine.
  
• When the cocaine was intruded before the nicotine, the cocaine did not cause an increased nicotine addiction
  
• When the rats were given the nicotine solution for a period but then denied nicotine for 7 days prior to being given cocaine they showed no increased propensity for cocaine than the rats who had never been treated with nicotine.

Looking closely at what was happening here, the scientists discovered that nicotine caused a change in the way the FosB gene worked in the brain and this change in gene expression amplified the feel-good effects of cocaine and caused an increased addiction risk.

The study authors suggest that people in recovery from cocaine addiction try to quit smoking as a way to reduce their relapse risk. They caution that using nicotine replacement products, such as nicotine gums or the nicotine patch, may not be an effective way to reduce relapse risk, since it is the nicotine and not the smoking that is amplifying the effects of cocaine.

The full research results can be found in the Nov 2 edition of Science Translational Medicine

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Roughly half of American addiction counselors now believe that moderating consumption, rather than abstinence, is an acceptable treatment goal for people with alcohol or drug abuse problems.

Do alcohol abusers always have to strive for complete abstinence as the only acceptable goal?

To find out, Bowling Green State University researchers polled 913 members of the National Association of Alcoholism and Drug Addiction Counselors to learn more about what’s considered acceptable in the treatment of alcohol and drug abuse, and alcohol and drug dependence.

The Findings

Twenty years ago, about 75% of drug and alcohol addiction counselors would have required total abstinence, but today, that number has shrunk to about 50% - with the remaining 50% indicating that occasional alcohol or drug use is an appropriate middle point or even end stage goal to work toward.

When talking about alcohol or drug dependent clients (alcoholics), however, only about a quarter of the therapists polled said that moderation was an acceptable mid or end point goal.

Respondents who did not approve of any alcohol or drug consumption cited a lack of effectiveness, the sending of the wrong message and an incompatibility with treatment philosophy as justifications for refusing to consider moderation as an acceptable mid or end point goal.

Interestingly, although the number of American addiction counselors supporting moderation as a valid option has doubled in the past 20 years, counselors in other countries are still far more likely to endorse moderation as an acceptable choice for some; for example, in the UK, 86% of addiction counselors endorse moderate drinking as an acceptable goal.

Commentary

The study authors argue that contemporary attitudes increase access to treatment for a lot of people who may be unsure about their ability or willingness to give up drinking or drugs completely, writing, “Individuals with alcohol and drug problems who avoid treatment because they are ambivalent about abstinence should know that — depending on the severity of their condition, the finality of their outcome goal, and their drug of choice — their interest in moderating their consumption will be acceptable to many addiction professionals working in outpatient and independent practice settings."

The full study findings are posted online at the APA website.

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Smoking cessation efforts in addiction treatment programs help people quit without compromising overall treatment outcomes.

Here’s a curious fact: almost 3 out of 4 people in treatment for a substance use disorder smoke cigarettes. In fact, people involved in substance abuse treatment are more likely to die from tobacco use than from causes related to alcohol or another drug of abuse. Yet despite this, addiction treatment programs rarely push tobacco cessation as a primary goal. Does this make any sense?

OK, of course straight-up mortality statistics don’t tell the whole story since you almost certainly get a bigger quality of life boost from stopping meth or cocaine or heroin or alcohol. And since dropping two very different addictions at the same time seems a lot harder, it seems to make sense to focus on quitting one at a time – you certainly don’t want a person to quit cocaine treatment just so they can have a cigarette!

That’s the common reasoning anyway, and it makes a lot of sense – unfortunately, like so much else with addiction and addiction treatment, what makes sense isn’t always what’s true.

The counterintuitive truth, according to NIH research published in The Journal of Clinical Psychiatry, is that quitting smoking while in a substance abuse treatment program has no impact on addiction treatment success.

The Study

To come to this conclusion, researchers divided a pool of treatment seeking stimulant abusers (cocaine or methamphetamine) into 2 groups:

1. a group that received standard outpatient addiction treatment.
2. a second group received the same addiction treatment and additional smoking cessation treatment (weekly smoking counseling, buprion medication, a nicotine inhaler and prizes for abstinence).

The Results

After measuring for smoking indicators at 10 weeks, 3 months and 6 months post treatment initiation, the researchers concluded that smoking cessation treatment helped people quit tobacco without affecting stimulant addiction treatment participation.

So if you smoke and you’re changing your life for the better with addiction treatment, why not go all the way and go tobacco free at the same time?

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Because so many young adults use drugs or alcohol young people sometimes have trouble forging sober social support networks after treatment. AA and NA can provide this sober support, but many groups are comprised of middle aged adults. A new research study suggests that this age gap does not matter and that 12 steps meetings do offer younger adults effective social support.

Young adults coming out of treatment often have a tough time finding sober social support due to high rates of drug and alcohol use among people in this age bracket.

So can young adults find effective recovery support from AA and NA groups comprised largely of middle aged and older adults?

That’s what researchers at the Centre for Addiction Medicine at Harvard Medical School wanted to know, and to find out they followed 300 young adult (aged 18 to 24) residential program graduates for a full year post treatment.

The results:

• The average subject attended 3 AA or NA meetings a week at 3 months post treatment and 1 meeting a week at a year post treatment.
• Even after controlling for variables such as motivation etc., subjects who attended the most meetings over the year had the highest numbers of abstinent days
• Subjects who became actively involved, such as by speaking at meetings, were the most likely to stay sober.

Commentary

Lead author John F. Kelly commented on the importance of 12 step resources for young adults, noting, “Our study shows that Twelve Step community resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can provide local, accessible and cost-effective recovery resources for young adults during a stage in life when such support is rare.”

Read the full study results in Drug and Alcohol Dependence

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Teens with substance abuse problems who get involved in AA or NA during the first year of recovery are more likely to maintain abstinence than teens who do not.

In a study which confirms that teens respond like adults to AA or NA participation, researchers found that teens who participated in a mutual self help group like AA after the end of a period of treatment were more likely to stay abstinent than teens who did not.

The Study

Researchers at the Center for Addiction Medicine at Massachusetts General Hospital wanted to know if getting involved with mutual self help groups like AA or NA really helped teens in recovery stay abstinent.

To find out, they followed 127 teen (14 to 19 years) subjects through their first year of addiction treatment, checking in with each subject at intake and at 3, 6 and 12 months after intake, and recorded information on each subject’s use of mutual self help groups and degree of interaction with a personal sponsor.

The Results

• Between a quarter and a third of the subjects participated in AA or NA throughout the first year of treatment
• Subjects who attended AA or NA meetings did better than those who did not and those who attended meetings most frequently (once a week or more) were most likely to maintain abstinence
• Other factors which were associated with a greater probability of maintaining abstinence were finding and working with a sponsor and participating verbally at meetings

Based on the results, the study authors suggest that those working with adolescents during the early recovery period should encourage participation in AA or NA.

The full study results will be available to read in the July 2012 issue of Alcoholism: Clinical & Experimental Research.

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The diabetes medication Exendin-4 may become the first effective medication against cocaine addiction.

Can an existing diabetes drug cure cocaine addiction?

Well, more experiments are needed, but Vanderbilt University researchers say that the diabetes drug Exendin-4, which targets dopamine systems in the brain, may also work against cocaine and meth addiction.

The Experiment

Using animal subjects, the researchers injected Exendin-4 and watched to see how the medication would influence cocaine consumption.

The Results

• The medication, which is simply a synthetic and long lasting version of the peptide hormone GLP-1, blocked the rewarding effects (the high) from cocaine.
• This result occurred regardless of the dose of Exendin-4 given
• There were no noticeable side effects
• Although the drug was only tested against cocaine, the researchers suspect it would also dull the rewarding effects of other psycho-stimulants, like methamphetamine, and that it would work for other disorders which have a dopaminergic component, such as obesity and schizophrenia.

Significance

The researchers say that the findings are significant because:

• The medication is already FDA approved to treat diabetes and so should be easily transferable to addiction medicine.
• There are no existing effective medications for psycho-stimulant addiction

Commentary

Lead researcher Gregg Stanwood, Ph.D noted that since addiction is such a complex disorder in humans it’s unlikely that all people would respond to the medication or that it would ‘cure’ addiction for anyone, stating, "We don't expect this to be a magic bullet where one can simply take this drug and their addiction goes away, but hopefully a medicine like this, in combination with social and behavioral support, will help an addict on the road to recovery." 

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Addiction treatment costs money, but do you ever make that money back? That’s what German researchers wanted to know, and the answer they discovered, was a resounding YES!

Getting addiction treatment invariably costs money and time, but when you consider the expenditure against the benefits of better health and well-being it’s almost always money well spent.

But what if you just looked at things from a financial perspective - forgetting for the moment about health and wellness – does addiction treatment make good financial sense?

That’s what researchers in Germany wanted to know, and to find out they followed 48 families to find out how much money a family member’s alcoholism cost the family before and after 12 months of addiction treatment.

The Results

• The average per family monthly expenditure that was directly attributable to a family member’s alcoholism dropped from $832 per month prior to treatment to $179 per month after 12 months of treatment. This equated to an average expenditure drop from 20.2% to 4.3% of family pre-tax income.
• The average amount of time per family spent caring for an alcoholic family member dropped from 32.2 hours per month pre-treatment to 8.2 hours per month after a year of care. Based on a calculation using the German minimum wage for caregivers, this equates to a wage-loss drop from $338 per month to $86 per month.

Commentary

Lead researcher Dr. Salize of the Central Institute of Mental Health in Mannheim, Germany commented on the significance of the study results, saying, “Addiction studies mainly focus on problems such as domestic violence and depression, not on the financial burden of caring for an alcoholic. But when health services and policymakers study the costs and benefits of treating alcoholism, they need to know that treatment has an immense financial effect not just on the alcoholic but also on his or her spouse, partner, children, and parents. The benefits of treatment reach well beyond the individual patient."

The full study findings were published in the Sept. 24th online edition of Addiction.

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A Canadian Doctor talks about the nearly 200 people he’s treated with an Amazonian hallucinogen called ayahuasca.

Dr Gabor Maté is a family physician in Vancouver Canada and over the past few years he has provided an Amazonian addiction remedy to between 150 and 200 addicts in East Vancouver – and many, he says, have had significant breakthroughs.

Called ayahuasca, this hallucinogenic is taken as a spiritual aid in several religious traditions of the Amazon basin and has been used in ritual for thousands of years. The drug is legal for spiritual use in the US and a Health Canada study on the substance found that it produced no adverse effects and provided spiritual benefits.

Dr. Mate says he first became interested in ayahuasca after learning of addiction treatment clinics in Peru using the herbal medicine which had ‘cure’ rates many times better than that typically seen in North American and Europe.

Working in some ways similarly to the African origin opiate treatment medication Ibogaine, Dr. Mate talked to journalists about  how ayahuasca helps people to break free from addiction, saying, ayahuasca is not a drug in the Western sense, something you take to get rid of something. Properly used, it opens up parts of yourself that you usually have no access to. The parts of the brain that hold emotional memories come together with those parts that modulate insight and awareness, so you see past experiences in a new way. The natural human response to pain is to escape it. That’s the essence of addiction. Ayahuasca allows users to hold pain and not run from it.”

36 year old Megan Hames of Vancouver is one of the almost 200 people who have received ayahuasca treatment from Dr. Mate. Describing her experience, she says, “Ayahuasca saved my life. It enabled me to look at all those dark things I buried long ago … to unleash them and the pain, so that I could move forward.”

*Nov 13th Story Update

In the wake of media reports on Dr Mate’s successes with ayahuasca, Health Canada officials sent him a letter which asked that he immediately cease his use of the drug, which remains a controlled substance within Canada, and threatened prosecution should he fail to comply with the demand.

Based on this, the doctor says he will no longer, for the moment, use ayahuasca in his clinical practice, saying, “I have no intention of breaking the law. But I hope to get permission to use it in therapeutic context. I’m surprised no one thought to talk to me before sending the letter, but I suppose someone in Ottawa is just doing their job.”

Health Canada has previously allowed the use of ayahuasca for spiritual practices, but the director of Ottawa’s Office for Controlled Substances, Johanne Beaulieu, said, “For a controlled substance to be used in Canada, there’s a process that needed to be undergone. We’d welcome scientists like Dr. Maté talking to us before they start their work. Our intent is not to stop research or treatment. It’s to ensure the safety of Canadians.”

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John Hopkins researchers found that people who got treatment and recovery housing after detox were more than 10 times more likely to remain abstinent after a month than people who went through the detox without a treatment follow-up.

Researchers at John Hopkins Medical School wanted to see if providing long-term opiate addicts recovery housing after a stay in a detox center would significantly increase abstinence rates.

The Study

To find out, they recruited 243 opiate dependent men and women. Each study participant underwent medical detoxification for between 3 and 10 days, depending on need, and after detox each was assigned to one of three groups:

1. Participants in one group received referrals to community based aftercare programs. They were responsible for funding their own treatment
2. Participants in a second group received 3 months of free recovery housing, though they could only remain in the sober living home if they remained abstinent
3. Participants in the third group received 3 months of free recovery housing and free access to a day treatment program

The Findings

 After 30 days:

• Only 5% of those who received no recovery housing or treatment remained drug free
• 44% of those living in recovery housing but not attending day treatment remained drug free
• 60% of those living in recovery housing and attending day treatment remained drug free
• 50% of those who remained in recovery housing for more than 60 days stayed remained drug free at 6 months post detox

Commenting on the findings, lead researcher Michelle Tuten said, “providing recovery housing to opioid dependent people, with or without additional formalized treatment, results in much higher abstinence rates than detoxification alone."

She notes that although recovery housing isn’t necessarily cheap, that providing housing for chronically relapsing opiate addicts might actually cost less than paying for the health and social costs associated with recurring opiate addiction.

The full study results can be found in the journal, Addiction.

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Want to get and stay clean? If you’re a man, then you’d better work on minimizing your exposure to drug cues and if you’re a woman it’s stress that you’ve got to watch out for.

Yale University researchers say that when it comes to drug cravings, men and women just aren’t the same.

The Experiment

In an experiment, the research team had 30 cocaine addicted men and women and 36 recreational drinker control subjects submit to MRI scans.

While they were being scanned, each subject was presented with personally relevant stress or drug cues (or alcohol cues for the control subjects).

The Results

• The cocaine dependent subjects showed far greater activation in areas of the brain linked to addiction and motivation after exposure to drug and stress cues than the control subjects.
• Male cocaine dependent subjects showed greater activation in these brain areas upon presentation of drug cues.
• Female cocaine dependent subjects showed greater brain activation in these areas upon presentation of stress cues.

Commentary

The researchers say that based on the findings of the study it looks like men and women have differing addiction treatment needs. They suggest that men might benefit most from cognitive behavioral therapy and 12 steps participation and women might benefit most therapies which reduce stress and help people learn to manage stress related drug cravings.

The full research results can be found in the Jan 31 online edition of American Journal of Psychiatry.

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By testing for your unconscious beliefs about the positive and negative consequences of drug use a newly develop screening test reveals how likely you are to benefit from addiction treatment.

A team of American and Irish researchers have developed an assessment test which seems to reveal which people are most likely to benefit from addiction treatment.

The computer module test, named the Implicit Relational Assessment Procedure (IRAP), requires participants to give very fast and accurate answers to a series of questions regarding attitudes to drug use. Both the answers given and the reaction and answer time for each question are recorded and analyzed in the scoring of the test.

Explaining the test procedure, the researchers say that in traditional questionnaires where participants have a moderate amount of time to formulate answers responses are more likely to be consciously or unconsciously deceptive. When participants must answer very rapidly they are less able to mask the truth and their answers may also reveal unconscious or deeper truths.

The Study

In an experiment, the researchers compared the effectiveness of the IRAP against standard admission treatment questionnaires.  The IRAP test seeks to measure a person’s true feelings about drug use – such as beliefs about positive and negative consequences of drug use.

Twenty five New Yorkers seeking 6 months of outpatient cocaine treatment were asked to complete the IRAP and a standard admission treatment questionnaire prior to treatment onset.

The Results

Standard questionnaires did not reveal which participants would stay in treatment and have success as measured by negative urine tests for cocaine.

On the IRAP test, however, study participants who scored highly on positive feelings for cocaine use were most likely to exit treatment early and most likely to test positive for cocaine use in urine tests.

Commentary

The researchers say that the test may be useful in identifying which people need the most support in the treatment process, such as those at greatest risk of treatment exit and relapse

Study author Professor Dermot Barnes-Holmes commented on the significance of the findings, saying, "Participants' beliefs about their substance abuse and the negative or positive consequences that follow, appear to have an impact on the success of their treatment - and these beliefs aren't currently being identified through standard drug abuse treatment.”

The full study results can be read in the current edition of The American Journal of Drug and Alcohol Abuse.

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