Archive for the ‘treatment’ Category
How to quit pain pills…Methadone or drug rehab?
An addiction to pain pills can so easily sneak up on you.
Whether prescribed the medications for a legitimate reason initially, or whether experimenting with recreational use, the seductive nature of these pills proves too much for a great many of us, and with more than 6 million Americans currently addicted to pain pills, if you do get overwhelmed with abuse and addiction, you are certainly not alone.
Some of these pills are as addictive as heroin, but since they come from the pharmacist, and are legitimately recommended by doctors and other medical staff, we underestimate the warnings, and when the pills fell so good, and take all the pain away, it can be very easy to take just a bit more than recommended, and just a bit more frequently than prescribed.
Once addicted, the way in which it happened is irrelevant, and even if you were prescribed the drugs for a legitimate reason, your situation with dependency is no different from any other drug addict. It doesn’t make you a bad person, and there should be no morality assigned to the use and abuse of drugs anyways, but it does mean that you likely need professional help to get sober.
The most commonly abused pills are opiate type narcotics, and whether vicodin, Demerol, oxycontin or morphine, they all share a commonality of physical addiction, and a very long and painful period of withdrawal. When you make the decision to get off of the drugs, you have three basic options for your cessation of use.
3 ways to get off pain pills
1) You can try a long and gradual tapering of the dosage, until ultimately you are down to none a day.
2) You can try an opiate substitution program, such as methadone maintenance, where intoxicating opiates are switched for non intoxicating methadone, and then the dosage of methadone is gradually reduced.
3) You can enter into a rehab or drug treatment program, and detox quickly yet painfully off of the opiates, and then undergo therapies and counseling to ensure that you stay off of the pills for good.
Try it on your own first, then get help
Obviously, if you can do it on your own, this is preferable, and as such the gradual tapering off is the optimal way to get off of opiates. A gradual tapering of the dosage is safe, does not require a lengthy commitment to treatment, and also saves you the expense of therapy. Unfortunately, a lot of people who try this method find the cravings and pulls back to heavy use overwhelming, and find that they cannot significantly cut their dosage.
Most people with a serious addiction to opiate type pain killers will require some form of professional therapy, and as such there are two general options for consideration; and they both have some advantages and disadvantages.
Methadone maintenance
The largest single advantage of methadone maintenance as a way to get off of opiates is the avoidance of a long and painful cold turkey detox. Methadone, (and now also buprenorphine) is not very intoxicating, and at the doses given addicts will feel no particular high, be able to participate safely and actively in society, and will also avoid the pains of complete detox. Methadone programs are popular with addicts, and not least because they spare people from a very uncomfortable week or so of withdrawal.
The disadvantages to methadone are that it can take a long time, you are still addicted to an opiate, and you still need to invest considerable time and energy into your addiction.
Some doctors argue that methadone addiction is actually more potent and entrenching than for drugs like heroin, and that although we do get people off of intoxicating substances, we do them no favors when substituting for a drug that makes eventual detox, longer and more arduous than the drug originally addicted to.
Because the process is so long, and because methadone must be taken under supervision in a clinic, the continual time and energy investment in your drug habit remains substantial, and many addicts will need to visit methadone clinics several times a week for years, if they can ever even completely wean themselves off of the drug.
Drug rehab
While methadone is relatively painless, but long and slow, the intense period of detox as in a drug rehab can be very uncomfortable, and addicts can expect several days of very painful withdrawal. Medical management can ease the worst of the symptoms and ensure safety during the process, but those days of detox will be tough, and the medications given to ease the pains can only do so much.
The advantage though, is that once those few days of withdrawal are completed, patients are no longer physically addicted to opiates, and they are ready to really benefit from the offered therapies and programming of drug rehab, and ready to learn how to stay drug free for ever. Although they will probably need to retain some participation in aftercare therapies, they do not need to continue taking any other drugs.
Which is right for you?
If you have not yet tried to gradually reduce your dosage on your own, then this is very likely a good place to start your battle with addiction, but if you are like so many of us and find that you just can’t quit without help, you need to consider the relative advantages of either long and painless methadone maintenance, or short, uncomfortable, but effective drug treatment and detox.
Price is always a consideration, and although methadone maintenance is likely cheaper in the short term, the time commitment required for a painless detox can stretch into the years, and some people never mange to get completely off methadone. In some ways, even though rehab will cost more at first, it is the cheaper option over the long term.
Either way is far better than nothing, and either way can help you to get off of the drugs, and get back to a happier and healthier future of sobriety. Speak with your doctor or therapist about the relative advantages of the two types of programming as related to your individual situation, and start the road to recovery soon. Life is far too short to squander ever more time to addiction, especially when the answer to your problems is only as far as the nearest drug treatment center or methadone maintenance clinic.
There is no point wishing an addiction away, and it makes no real difference how that addiction came to be. You need to get serious, get help, and get better.
Recovery is always possible, and no other goal makes much sense.
Study Says Rapid-Detox Method Does Not Work, Dangerous
Health Risk Significant for Heroin Addicts
From JAMA and Archives Journals, for About.com
Created March 23, 2009
The use of general anesthesia for heroin detoxification offers no benefit when compared to two other methods, and is associated with several potentially life-threatening adverse events, according to an article in the August 24/31 issue of JAMA.
Heroin dependence remains a significant public health problem in the United States, according to background information in the article. Most of the approximately 1 million heroin-dependent individuals in the United States are not in treatment. Their main initial contact with the treatment system is often detoxification. Medically supervised heroin withdrawal rehab remains plagued by patient discomfort and high dropout rates. Many patients fear the physical discomfort of withdrawal and either avoid treatment or leave it prematurely.
Even those who complete the detoxification process have high relapse rates, partly due to the absence of continuing treatment. These problems have given rise, in the past 15 years, to ultra-rapid, or anesthesia-assisted opioid detoxification, which involves administering an opioid antagonist drug to neutralize the effects of heroin while the patient is unconscious from general anesthesia.
This has been publicized as a fast, painless way to withdraw from heroin. However, this treatment is expensive (as much as $15,000 in 2005), not covered by insurance, and lacks good evidence to support efficacy. There are also significant concerns about health risks. The detoxification procedure is usually followed by longer term treatment with an antagonist drug such as naltrexone to block the effects of any subsequent heroin use.
Eric D. Collins, M.D., of Columbia University, New York, and colleagues conducted a randomized controlled trial between 2000 and 2003 to evaluate the safety, tolerability, and efficacy of anesthesia-assisted rapid opioid detoxification compared with two other inpatient withdrawal and naltrexone treatment procedures.
The study included 106 treatment-seeking heroin-dependent patients, aged 21 through 50 years, who were randomly assigned to 1 of 3 inpatient withdrawal treatments over 72 hours followed by 12 weeks of outpatient naltrexone maintenance with relapse prevention psychotherapy.
Severe Withdrawals
Patients received either anesthesia-assisted rapid opioid detoxification (for 4 to 6 hours) with naltrexone induction, rapid opioid detoxification with buprenorphine (an opioid substitute) followed by naltrexone induction, or treatment with clonidine (an antihypertensive drug that decreases withdrawal symptoms) followed by delayed naltrexone induction.
The researchers found that average withdrawal severities were comparable across the three treatments. Compared with clonidine-assisted detoxification, the anesthesia- and buprenorphine-assisted detoxification interventions had significantly greater rates of naltrexone induction (94 percent for anesthesia, 97 percent for buprenorphine, and 21 percent for clonidine), but the groups did not differ in rates of completion of inpatient detoxification.
Life-Threatening Events
Treatment retention over 12 weeks was low and not significantly different among the three groups. Overall, only 11 percent of patients continued in treatment for 12 weeks and had less than two opioid-positive urine tests, indicating a high rate of relapse to heroin use.
The anesthesia procedure was associated with three potentially life-threatening adverse events: severe pulmonary edema and aspiration pneumonia; diabetic ketoacidosis, and a bipolar mixed state requiring hospitalization.
No Benefit Over Cheaper Treatments
“In summary, this randomized trial of general anesthesia for opioid withdrawal and naltrexone induction demonstrates no benefit of anesthesia over a safer, cheaper, and potentially outpatient alternative using buprenorphine as a bridge to naltrexone treatment.
“Taken together with the results of earlier studies, our findings suggest that general anesthesia for rapid antagonist induction does not currently have a meaningful role to play in the treatment of opioid dependence,” the authors conclude.
Teen Substance Abuse
Prescription Drug Abuse Rising Among Youth
Illegal drug use is declining among youth, while the abuse of prescription drugs, especially pain relievers, is increasing. Many abuse prescription drugs thinking that they are safe, when in fact they can cause addiction and severe side effects.
Prescription Drug Abuse
Why Do Some People Abuse Prescription Drugs?
Some people experiment with prescription drugs because they think they will help them have more fun, lose weight, fit in, and even study more effectively. Prescription drugs can be easier to get than street drugs: Family members or friends could have a prescription. But prescription drugs are also sometimes sold on the street like other illegal drugs. A 2006 National Survey on Drug Use and Health showed that among all youths aged 12 to 17, 6% had tried prescription drugs for recreational use in the last month.
Why? Some people think that prescription drugs are safer and less addictive than street drugs. After all, these are drugs that moms, dads, and even kid brothers and sisters use. To Angie, taking her brother’s ADHD medicine felt like a good way to keep her appetite in check. She’d heard how bad diet pills can be, and she wrongly thought that the ADHD drugs would be safer.
But prescription drugs are only safe for the individuals who actually have prescriptions for them. That’s because a doctor has examined these people and prescribed the right dose of medication for a specific medical condition. The doctor has also told them exactly how they should take the medicine, including things to avoid while taking the drug — such as drinking alcohol, smoking, or taking other medications. They also are aware of potentially dangerous side effects and can monitor patients closely for these.
Other people who try prescription drugs are like Todd. They think they’re not doing anything illegal because these drugs are prescribed by doctors. But taking drugs without a prescription — or sharing a prescription drug with friends — is actually breaking the law.
opiate treatment, drug treatment, parents and drugs
Ecstasy
XTC, X, Drug Love, Adam & Essence,E
What have you heard?
That it’s the best drug that has hit the Raves and circuit party scenes? That it’s the love pill that makes you want to hug and kiss everybody? That everything becomes bright and clear? That inside you experience joy and happiness? That it’s a great high with the fewest problems? It doesn’t mess up your brain if you only do it once a week? That it’s a much prettier world when you’re on Ecstasy? House music makes more sense when you’re on E? Gives you the energy to dance all night. It helps you be part of the club culture? One E head knows another? You’re open to experiencing more gender blending when you’re on X? It’s so relaxing? It helps you with your depression? It helps you connect better with others when using XTC? That a room filled with strangers all become your new friends? You feel so much better about yourself when high on the love drug?
Have you tried it?
Are you thinking about trying it?
Who do you ask about it?
Who do you trust?
Are you thinking about taking that risk?
Well, here are some facts you need to know about being high and dry on X…
With some drugs like E, the jury is still out. Research is ongoing. But there are a few things we do know about Ecstasy. Generally, you won’t get pure MDMA (methylenedioxymethamphetamine). It’s cut with something, maybe caffeine, amphetamine, ephedrine, MDA (3,4-Methylenedioxyamphetamine), MDE (Amphetamine Derivative), LSD and /or some other unknown ingredient. The half-life of E is about 6 hours. 50% remains in your body after 6 hours. 25% of E remains in your body after 12 hours. After 48 hours only 1% of E remains in your body, because E does not attach itself to fat cells.
How does Ecstasy react in the brain?
The drug interacts with the brain cells called neurons that produce serotonin. Serotonin is a major neurotransmitter, or chemical messenger, in the brain that is thought to influence mood, appetite, sleep, aggressiveness, sensitivity to pain, heightened sexual experience, tranquility, conviviality and other important functions
What does the research show?
Experiments with squirrel monkeys have shown brain damage by MDMA, serotonin-producing nerve fibers regrew abnormally in some brain regions and failed to regrow at all in others. Heavy users of Ecstasy may be risking brain damage that remains long after the high has worn off.
Other Research findings indicate that using ecstasy causes long-lasting damage to brain areas that are critical for thought and memory.
What are the health hazards?
Ecstasy users may encounter problems similar to those experienced by amphetamine and cocaine users, including addiction. Physical effects include muscle tension, eye wiggles, auditory effects, next-day fatigue, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Increases in heart rate and blood pressure are a special risk for people with circulatory or heart disease.
Ecstasy-related fatalities at raves (extended all night parties) have been reported. The stimulant effects of the drug which enable the user to dance for extended periods, combined with the hot, crowded conditions usually found at raves can lead to dehydration, hyperthermia, and heart and kidney failure. An overheated, dehydrated body slowly “bakes” the internal organs and shuts down body functions. Death can result from overheating which causes kidney or cardiovascular failure.
Effects of use.
Ecstasy stimulates the release of the neurotransmitter serotonin from the brain neurons, producing a high that could last for several hours. The drug blocks the natural re-uptake of serotonin and forces the brain to flood itself with serotonin. The drug’s effects vary with the individual taking it, the dose and purity, and the environment in which it is taken. Ecstasy can produce stimulant effects such as an enhanced sense of pleasure and self-confidence and increased energy. Its psychedelic effects include feelings of peacefulness, acceptance, and empathy. Users claim they experience feelings of closeness with others and a desire to touch them. Taking a booster dose to maintain the high could increase the negative side effects of using the drug.
Who uses Ecstasy?
According to the 2001 Monitoring the Future Survey 11.7% of 12th graders and 14.7% of college had tried at least once in their lives.
How is it used?
Ecstasy can be swallowed, snorted, injected smoked, or shefed (insertion of pill into the anus) where it is absorbed.
Dosage
Can be taken orally in tablet form or capsule. On average, a tablet contains about 30 mg. of active ingredients.
Duration
When taken on an empty stomach onset of effects can occur in 30 - 40 seconds. A rush can last from 15 - 30 minutes, 1/2 - 3 hours until effects plateau, and 6 hours until effects are gone.
Cost
$20 - $45 per tablet
Ecstasy’s downside
* Developing a tolerance to amphetamines.
* Dehydration and hyperthermia (high body temperature).
* Anxiety, sleep problems, delusions and paranoia are possible for some users.
* Alcohol is a diuretic (increased urination).
* Mixing alcohol with E may cause increased dehydration.
* Tuesday Blues (depression) can occur when coming down from E.
* For some users, taking E can have an opposite effect called Bubble Bursting.
* Users tend to experience stomach tightness, panic, psychic tension and/or mild nausea instead of the euphoric effects of taking E.
* E may block or cause difficulty with orgasm and may prevent erection in some men.
* Some contraindications include: heart disease, hypertension, pregnancy, diabetes, epilepsy, and others.
What are some of the legal issues associated with Ecstasy?
New Jersey’s laws are getting tougher regarding the distribution and sale of the illegal drug Ecstasy. It’s now in the same category as heroin and cocaine. A person caught with 500+ pills risks 20 years in jail.
What are you willing to risk?
Now that you know a little more about Ecstasy, make a more informed decision regarding using drugs. If you decide to experiment with Ecstasy, here are some tips to reduce your chances of a bad experience by:
* Choose to be in a company of friends who will look out and care for you.
* Ask questions. Know what you’re taking. If possible, get the drug tested by a reliable resource such as Dance Safe
* If you attend a gay circuit party or rave party, be sure to drink plenty of water to keep yourself hydrated.
* Take lots of mini-breaks from dancing. This will give your body a chance to cool down. Try to chill out in a quiet place away from the music for a while before resuming dancing.
* Don’t mix E with other drugs.
* Phony pills are flooding the rave market. Beware.
* Dress in layers so that when you get over heated you can remove some articles of clothing.
* Check out what is being said about E online by both traditional and non-traditional sources.
So, now you know a little more about Ecstasy. It’s your choice. It’s your brain. Who do you trust with it?
help geting off drugs, kids on drugs, how do I stop getting high?
NEW VIOLENCE SEEN IN USERS OF COCAINE
By PETER KERR
In New York and other cities where crack use has become widespread, the police and drug treatment experts say they are being confronted by an increasing number of cases of violent, erratic and paranoid behavior among heavy cocaine users, and the growing appearance of a condition known as cocaine psychosis.
In one dramatic example, a man apparently using cocaine held four people hostage for 30 hours in an East Harlem apartment and demanded baking soda, which the police feared he would use to process powdered cocaine into smokable crack. He surrendered quietly Thursday night. ‘Emotional Roller Coaster’
Although the police say it is too early to say exactly what role cocaine played in the incident, officials point out that as crack has replaced heroin as the drug of choice in the inner city, they are seeing rising numbers of homicides, people resisting arrest and violent, unpredictable behavior among drug abusers.
”Last night was as classic case of an emotional roller coaster,” Deputy Chief Francis Hall, head of the New York City Police Department’s narcotics division, said of the 30-hour siege with the gunman, Ismael Igartua. ”The escalated use of cocaine has truly changed the drug problem. Heroin maintained people on an even keel; it was sort of a tranquilizer. Cocaine causes a very different reaction.”
At a city-operated unit at Interfaith Medical Center in Brooklyn that specializes in crack cases, doctors say more than 20 percent of crack addicts who appear for treatment arrive with symptoms mimicking schizophrenia. Banging Down a Door
”By comparison, heroin addicts were pussycats,” said Dr. Jochanan Weisenfreund, the director of psychiatry at Interfaith. ”In my opinion, the police should approach a crack addict as they would approach someone with acute psychiatric disorder.”
For example, in one case at the hospital now, Dr. Weisenfreund said, a patient entered saying he was capable of jumping from building top to building top. Other experts cited examples of a patient who ran into a liquor store claiming he was followed by a mad dog, or another banging down an apartment door under the belief that he was being chased by a mob.
The condition called cocaine psychosis was first described by Freud in 1884, when a patient given cocaine over weeks described swirling white snakes, the sounds of voices and intense paranoia, according to Dr. Jeffrey S. Rosecan, who heads the cocaine addiction program at Columbia-Presbyterian Medical Center.
Scientists now believe that the psychotic symptoms are caused by the effect of cocaine on dopamine, a chemical that sends messages between nerve cells. Dopamine levels suddenly rise when cocaine enters the body, resulting in a profound sense of euphoria, and drops again as the drug wears off. Psychotic symptoms can develop after dopamine levels rise repeatedly. And even in cases where full-fledged psychosis does not develop, users tend to be highly agitated and prone to violence.
With powdered cocaine taken through the nose, cocaine psychosis can take years to develop, and most users have never experienced the condition. But when powdered cocaine is taken regularly over many years or is smoked, particularly in daylong binges as it is among crack addicts, psychosis becomes much more common. Problem at Crack Houses
Thus during the first years of widespread cocaine use in the United States in the late 1970’s, relatively few people experienced addiction or psychotic symptoms, and some experts even perceived the drug as harmless.
But after many years of widespread use, and particularly with the rise of crack over the past 18 months, reports of crime and psychiatric difficulties associated with cocaine have risen dramatically, experts say.
The problem is particularly acute at crack houses, where groups of people gather to smoke crack. There, a blend of paranoia, weapons and money often leads to dangerous confrontations, said William Hopkins, the supervisor of the street research unit of the New York State Division of Substance Abuse Services. Smokers often search the floor for specks of crack that do not exist, accuse each other of stealing crack they never had and attack each other with knives or with the butane torches used to smoke the drug. Homicide Rate Rises
The police say homicides, which were up 18 percent in New York in the first 11 months of 1986, compared with 1985, had their greatest rise in northern Manhattan and other areas where crack use is extremely heavy.
In Florida, where levels of cocaine use are among the highest in the country, Arthur Nehrbass, the executive officer of the special investigations division of the Metro Dade police, said his officers were increasingly faced with the problem of recognizing a victim of cocaine psychosis before he became extremely violent.
Dr. Charles Watli, the deputy chief medical examiner for Dade County, said his office had discovered a syndrome called cocaine-related delirium, in which the police found people who had used cocaine wildly yelling, screaming or running through the streets. In more than a dozen cases, the victims had to be restrained and then died suddenly, even though the level of cocaine in their blood did not indicate an overdose.
help getting off drugs, drug treatment info, drug rehabilitation
Alcohol Poisoning
ALCOHOL POISONING
A serious consequence of binge drinking
If you suspect that someone has alcohol poisoning,
seek immediate medical care!
Question: What is ALCOHOL POISONING?
How do you know if someone has alcohol poisoning?
Answer: ALCOHOL POISONING is a serious — sometimes deadly — result of drinking excessive amounts of alcohol (ethanol). Binge drinking can lead to alcohol poisoning. The effects of alcohol depend on the concentration of alcohol in your blood (blood alcohol level).
Factors that affect your blood alcohol level include:
How strong the alcohol is
How quickly you drink it
How much food is in your stomach at the time you drink it
Signs and symptoms of alcohol poisoning include:
Confusion
Vomiting
Seizures
Slow or irregular breathing
Blue-tinged skin or pale skin
Unconsciousness (”passing out”)
Alcohol is a stomach irritant and may cause vomiting. It also affects your central nervous system — slowing your breathing, heart rate and gag reflex. This increases the risk of choking on vomit if you’re passed out from excessive drinking. If you suspect that someone has alcohol poisoning, seek immediate medical care.
Blood alcohol content level (BAC) continues to rise even after the person has passed out.
Alcohol can also be harmful in smaller amounts if you use it in combination with any non-prescribed or prescribed drugs.
If you suspect that someone has alcohol poisoning, seek immediate medical care
THE MEDICAL ASPECTS OF ADDICTION
Drugs and alcohol can have serious long-term consequences for those who consume excessively for long periods of time.
SUBSTANCE INDUCED DISORDERS
Introduction
While most information presented in this website focuses on addiction and substance abuse there is another group of disorders associated with drug and alcohol use that does not typically get as much attention.
Disorder Defined
Webster’s New Collegiate Dictionary defines a disorder as an “abnormal physical or mental condition.” For health professionals, the term “disorder” is very common. Examples include growth disorder, bipolar disorder, genetic disorder, bleeding disorder, etc.
Substance Disorders Explained
Substance disorders are those directly related to the taking of any mood-altering drug, including alcohol, over the counter and prescription medications.
Substance disorders are divided into two groups:
* Substance Use Disorders
* Substance Induced Disorders
Substance Use Disorders
A substance use disorder refers to an addiction to drugs or alcohol or the abuse of drugs or alcohol. Abuse and addiction are distinguished by whether an individual continues to use in spite of increasingly negative consequences (refer to the assessment section of this website for tests that help distinguish between addiction and abuse).
Substance Induced Disorders
A substance induced disorder is a change in physical or mental functioning due to the use of a mood-altering drug or alcohol. Substance induced disorders are caused by intoxication or withdrawal from substances.
There are two types of substance disorders: (1) is a technical term for the two types of (intoxication, withdrawal, delirium, persisting dementia, persisting amnesia, persisting psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction and sleep disorder.
i. Substance Intoxication
Drug and alcohol intoxication can mimic mental disorders such as anxiety, mood disorders (depression) and psychosis. Other disorders that result from drug and alcohol intoxication include sexual dysfunction and sleep disorders. Symptoms usually disappear when the substance is no longer present in the person’s system, but the resolution of those symptoms can take weeks or months and may require treatment. Hallucinations and delusions may occur. Impairment in mood and thought processes such as reasoning, retention and recall are the most common symptoms of intoxication. Depending on length of abuse and the substance of choice, these symptoms can become permanent.
Approximately two percent of those experiencing cocaine induced psychosis never recover fully. Anxiety disorders and depressive illness (not present before a psychotic episode) are the most common psychiatric illnesses people may suffer from following a psychotic break. Others are not so fortunate and do not recover from a psychotic state, and may require long term supported care.
Psychiatric symptoms can worsen or suddenly develop during detox and withdrawal and may not abate on physical recovery.
ii. Substance Withdrawal
Alcohol, Benzodiazepines (Valium, Ativan) and Phenobarbital (Tuinal, Seconal) can cause seizures during the detox process. Medically supervised detoxification is essential to monitor health status, and reduce health risks. Withdrawal from chronic substance abuse can be life threatening.
Each subsequent detox and withdrawal tends to be more intense, require more support and longer physical recovery time. Damage to the body is incremental with each detox and withdrawal.
There’s help for drug, alcohol addiction
Hillary Ward
Growing up in Happy Valley, I’ve witnessed my fair share of dangerous drinking and substance abuse. Many personal experiences have helped me to learn about substance abuse, hazardous behavior and eventually addiction.
I do not believe I am an addict, but I do think that educating our community about addiction is essential to the development of those who suffer from this debilitating disease.
Throughout adolescence I experimented with alcohol and drugs at a similar pace with my peers, and my best friend and I had nearly every alcohol-and drug-related experience together.
This friend is an addict. I’ve been with her through her worst addiction, her rehabilitation and her continuing sobriety. These experiences have helped me to understand addiction in a different way.
Addiction is an extremely complex disorder involving a physical, mental and psychological need for a specific drug or combination of drugs.
Merriam Webster’s dictionary describes “disease” as “Any departure from health presenting marked symptoms …” and explains addiction as “compulsive need for and use of a habit-forming substance. …”
Drug addiction is a progressive disease that can never be cured, only treated.
Upon graduating from high school, my good friend and I ended up as freshmen at Penn State. We had extremely similar personalities and experiences, but her mother was an alcoholic and her relationship with her family was often strained. She has had to overcome her mother’s history with addiction, along with several other life factors, to be able to stay sober herself.
Thankfully, my friend realized she was suffering from addiction.
She was extremely lucky to receive wonderful treatment and to be blessed with a powerful, independent spirit that has enabled her to stay sober for 16 months with the help of several programs right here in State College.
Unfortunately, for many victims of addiction, this is not the case.
Sobriety is not easy, especially in a popular college party town such as State College. In this town, it is easy to be unsure whether you are suffering from addiction.
“The Diagnostic and Statistical Manual of Mental Disorders” (fourth edition) has organized the stages of drug and alcohol addiction into three clear stages: preoccupation/anticipation, binge/intoxication and withdrawal/negative effect.
The first stage is characterized by constant cravings and preoccupation with obtaining the substance; the second by using more of the substance than necessary to experience the intoxicating effects; and the third by experiencing tolerance, withdrawal symptoms and decreased motivation for normal life activities.
It is important to evaluate your own personal substance use or abuse, and those of the people you love.
It is imperative that we are educated about addicts and addiction because without education, we are blind to the opportunities and problems in our community. If you think you or a friend may be suffering from addiction, there are several organizations in State College willing to help you.
The first step to treating addiction is admitting you have a problem. The next is finding treatment.
Hillary Ward, a 2006 State College Area High School graduate, is a junior majoring in communications arts and sciences and can be reached at hjw5005@psu.edu.
planning intervention, drugs treatment, alcohol treatment
Cocaine Harms Brain’s “Pleasure Center”
Researchers report first direct evidence that cocaine harms brain’s “pleasure center”
Drug attacks the very cells that allow users to feel its effects
Finding may aid understanding of addiction, depression, normal aging
ANN ARBOR, MI — New research results strongly suggest that cocaine bites the hand that feeds it, in essence, by harming or even killing the very brain cells that trigger the “high” that cocaine users feel.
This first-ever direct finding of cocaine-induced damage to key cells in the human brain’s dopamine “pleasure center” may help explain many aspects of cocaine addiction, and perhaps aid the development of anti-addiction drugs. It also could help scientists understand other disorders involving the same brain cells, including depression.
The results are the latest from research involving postmortem brain tissue samples from cocaine abusers and control subjects, performed at the University of Michigan Health System and the VA Ann Arbor Healthcare System. The paper will appear in the January issue of the American Journal of Psychiatry.
>”This is the clearest evidence to date that the specific neurons cocaine interacts with don’t like it and are disturbed by the drug’s effects,” says Karley Little, M.D., associate professor of psychiatry at the U-M Medical School and chief of the VAHS Affective Neuropharmacology Laboratory. “The questions we now face are: Are the cells dormant or damaged, is the effect reversible or permanent, and is it preventable?”
Little and his colleagues report results from 35 known cocaine abusers and 35 non-drug users of about the same age, sex, race and causes of death. Using brain samples normally removed during autopsy, the researchers measured several indicators of the health of the subjects’ dopamine brain cells, which release a pleasure-signaling chemical called dopamine. The cells interact directly with cocaine.
The team looked at levels of a protein called VMAT2, as well as VMAT2’s binding to a selective radiotracer molecule, and overall dopamine level.
In all three, cocaine users’ levels were significantly lower than control subjects. Levels tended to be lowest in cocaine users with depression.
The paper gives the most conclusive evidence yet that dopamine neurons are harmed by cocaine use, because it uses three molecular measures that provide a trustworthy assessment of dopamine neuron health.
Dopamine, Little explains, triggers the actions required to repeat previous pleasures. It’s not only involved in drug users’ “high” — it helps drive us to eat, work, feel emotions, and reproduce. Normally, when something pleasurable happens, dopamine neurons pump the chemical into the gaps between themselves and related brain cells. Dopamine finds its way to receptors on neighboring cells, triggering signals that help set off pathways to different feelings or sensations.
Then, the dopamine is normally brought back into its home cell, entering through a gateway in the membrane called a transporter. While our brain waits for another pleasurable stimulus — a good meal, a smile from a friend, a kiss — dopamine lies waiting inside the neuron, sequestered in tiny packets called vesicles. VMAT2 acts as a pump to pull returning dopamine into vesicles.
When it comes time for another dopamine release, the vesicles merge with the cell membrane, dumping their contents into the gap, or synapse, and the pleasure signaling process begins again.
Dopamine neurons in the brain’s pleasure center die off at a steady rate over a person’s lifetime. Severe damage is a hallmark of Parkinson’s disease, causing its loss of movement control. “As the words themselves suggest, there’s an intimate connection between motion and emotion,” says Little. “Emotion puts you in motion — they’re pre-activity preparations. It’s not surprising that the basal ganglia, where these dopamine neurons are, is very active in ‘emotional states.’”
When first taken, cocaine has a disruptive effect on the brain’s dopamine system: It blocks the transporters that return dopamine to its home cell once its signaling job is done. With nowhere to go, dopamine builds up in the synapse and keeps binding with other cells’ receptors, sending pleasure signals over and over again. This helps cause the intense “high” cocaine users feel.
Since the dopamine system helps us recognize pleasurable experiences and seek to repeat them, cocaine’s long-term dopamine effects likely contribute to the craving addicts feel, and the decreased motivation, stunted emotion and uncomfortable withdrawal they face.
In recent years, many researchers have come to suspect that chronic cocaine use causes the brain to adapt to the drug’s presence by altering the molecules involved in dopamine release and reuptake, and in the genetic instructions needed to make those molecules. Little and his colleagues are studying the effects of long-term cocaine use on the brain at a molecular level, in an attempt to explain the effects seen in cocaine users and addicts.
In several studies, including the current one, they’ve used postmortem samples of brain tissue from known cocaine users who were using the drug at the time of their deaths, and from well-matched control subjects. They focused in on the striatum, an area of the brain with the highest concentration of dopamine neurons.
With approval from the U-M Institutional Review Board and appropriate consent, they interviewed relatives and friends of the subjects, and asked about the subjects’ alcohol use, mental illness and other characteristics.
The team previously showed that cocaine users have higher numbers of dopamine transporters, suggesting that the cells tried to make more return gateways to compensate for blocked ones. Recently, they showed in cell cultures that cocaine causes more dopamine transporters to travel from the interior of a cell to the membrane, increasing the overall dopamine uptake level.
The data provide support for the idea that chronic cocaine abuse leads to a phenomenon seen in animals, called allostasis of reward. With extended use of cocaine, the brain’s response to the drug is “reset”, and drug-taking once pursued for the pleasure it caused becomes drug-taking to avoid the negative feelings associated with the absence of cocaine.
The new data suggest this same phenomenon occurs in human cocaine users, and is quite pronounced at the neurochemical level. The experiment sheds light on the molecular mechanisms involved as dopamine-producing brain cells try to adapt to a cocaine-drenched environment.
VMAT2 protein levels, measured through the use of specific antibodies that bind to the protein, are not as affected by other factors as dopamine transporters are. VMAT2 binding availability, measured through a unique radioactive tracer developed by U-M nuclear medicine specialists, is another assessment of VMAT2 presence and activity. And the overall dopamine level, measured through liquid chromatography, shows how much of the chemical was available at the time of death.
On the whole, all three were significantly lower in cocaine users than in non-drug users. A history of alcohol abuse in cocaine users or controls did not affect the difference significantly.
Levels of VMAT2 protein were lowest in the seven cocaine users with mood disorders that may have been caused by cocaine use. Researchers have found that depressed cocaine users have more severe addiction and mental health problems than non-depressed users. Little hypothesizes that the decreased dopamine vesicles and increased transporters may contribute to cocaine-induced depression and other depressive disorders. This may explain why depressed cocaine users are less likely to respond to some depression treatments.
In all, Little says, “We could be seeing the result of the brain’s attempt to regulate the dopamine system in response to cocaine use, to try to reduce the amount of dopamine that’s released by reducing the ability to collect it in vesicles. But we could also be seeing real damage or death to dopamine neurons. Either way, this highlights the fragility of these neurons and shows the vicious cycle that cocaine use can create.” New treatments will have to break that cycle, he adds, and the new findings may help steer clinical researchers.
He also emphasizes that the vulnerable nature of dopamine neurons is important in understanding the moods and actions of normal adults as they age and lose dopamine neurons naturally. Considerable evidence suggests that uncontained dopamine may be mildly toxic over time.
In future research, Little and his colleagues hope to look for differences in the number of dopamine neurons in the subjects’ brain samples, and to study gene activity in the cells of cocaine users and control subjects. They also hope their results will help other researchers study living cocaine users and look for signs of decreased VMAT2 levels.
In addition to Little, the study’s authors are David Krolewski, M.S.; Lian Zhang, Ph.D.; and Bader Cassin, M.D. U-M nuclear medicine researcher Kirk Frey, M.D., led the team that developed the radioactive tracer used to measure VMAT2 binding levels. The study was funded by the National Institute on Drug Abuse, Alcohoism and Addiction Articles
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