Treat Alcoholism by Erasing Memory of Alcohol?

A recent article (see citation at end of this post)* summarized in ScienceDaily for June 26, 2013, reported on a study that suggests that some day it may be possible to block that portion of the brain in alcoholics that has been sensitized to alcohol and is responsible for cravings triggered by cues such as taste or smell of alcohol. The study was of rats who had become exposed to, and dependent on, alcohol, and who developed cravings for alcohol that were triggered by exposure to the taste of alcohol.

The researchers  were "***able to identify and deactivate a brain pathway linked to memories that cause alcohol cravings in rats, a finding that may one day lead to a treatment option for people who suffer from alcohol abuse disorders and other addictions. One of the main causes of relapse is craving, triggered by the memory by certain cues -- like going into a bar, or the smell or taste of alcohol, said lead author Segev Barak, PhD ***." The memories were deactivated by giving the rats a drug that blocked the memory of alcohol for up to two weeks.

The authors also stated: ""One of the main problems in alcohol abuse disorders is relapse, and current treatment options are very limited." Barak said. "Even after detoxification and a period of rehabilitation, 70 to 80 percent of patients will relapse in the first several years. It is really thrilling that we were able to completely erase the memory of alcohol and prevent relapse in these animals. This could be a revolution in treatment approaches for addiction, in terms of erasing unwanted memories and thereby manipulating the brain triggers that are so problematic for people with addictions."

This study is, of course, just a preliminary one in laboratory animals, and raises many questions, including my basic issue that quick fixes for addiction through use of medication are not a treatment of perhaps the more difficult aspects of addiction, namely, the mental and spiritual issues all persons with addictive disorders have that need to be addressed. As always, comments are invited. Jan Edward Williams, 06/26/2013.

*Segev Barak, Feng Liu, Sami Ben Hamida, Quinn V Yowell, Jeremie Neasta, Viktor Kharazia, Patricia H Janak, Dorit Ron. Disruption of alcohol-related memories by mTORC1 inhibition prevents relapse. Nature Neuroscience, 2013; DOI: 10.1038/nn.3439

Children in the Womb Exposed to Cigarette Smoke More at Risk for Addiction?

In a recent study (Müller, K.U., et al. (2013). Altered Reward Processing in Adolescents With Prenatal Exposure to Maternal Cigarette Smoking. JAMA Psychiatry, online, 06/19/13, summarized by The Partnership at Drugfree.org), researchers found that children exposed to cigarette smoke while still in the womb (prenatally) may be predisposed to be attracted to nicotine because of brain chemistry changes in how the brain's reward processing system functioned due to the prenatal exposure to cigarette smoke. Brain imaging studies (MRI) showed that teens exposed prenatally to cigarette smoke had reactions to stimuli that were slower in anticipation of a reward than the reactions of teens not exposed to prenatal smoke. These slowed reactions were interpreted by the researchers to perhaps " *** represent a risk factor for substance use and development of addiction later in life. They explained the reduced activity of brain chemicals that signal satisfaction may lead people to continue to seek a high, and become addicted to particular substances or behaviors." So, it seems we have here yet another reason for pregnant, or about to be pregnant, women to not only not smoke themselves but also to avoid exposure of themselves and their infants in the womb to cigarette smoke or any other source of nicotine regardless of who is doing the smoking. As always, comments are invited. Jan Edward Williams, 06/25/2013.

A Comic Book from the Feds about Recovery from Addiction and Mental Health Disorders

The federal government, specifically the Substance Abuse and Mental Health Services Administration, has developed an educational comic book entitled People Recover, that "uses a comic book format to tell the story of people who are dealing with co-occurring disorders. [It ...] presents a hopeful message of recovery for people with a substance use disorder and mental illness, and provides resources for more information." The publication is free and can be downloaded as a pdf here. As always, comments are welcomed. Jan Edward Williams, 06/25/2013.

Why Mental Health Professionals Often Misdiagnose Addiction

The Fix, an online alcoholism and addiction website with daily news and articles, presented an interesting story in its June 21, 2013 edition, entitled Five Ways Therapists Are Clueless About Addiction, written by Marilyn Freimuth, PhD. Dr. Freimuth states at the outset of her article:
"One of the sad truths about addiction treatment is that many of the most talented clinicians—the licensed psychologists and social workers that most people seek out when they have mental health concerns—don’t treat addictions. And, worse, this state of affairs exists because many of these clinicians fail to identify addictive disorders in their clients, even when fairly obvious signs and symptoms confront them."
Dr. Freimuth goes on to list five reasons that therapists often fail to identify, and, therefore treat or refer for appropriate treatment, patients with drug and alcohol use disorders, including gambling disorders:

"1. "Behaviors are not addictions." Many clinicians only inquire about, and consider, substance use when they think about addiction. They do a quick check about alcohol and other drugs but don’t delve deeply enough into a client’s behavioral history to uncover non-substance-related addictive patterns, such as gambling, shopping, Internet use, etc.

"2. "Real addiction stares you in the face." In addiction treatment settings, addictions are indeed obvious because they are the presenting problem. But in other setting—perhaps due to the way that addiction is portrayed in media and entertainment—many mental health professionals believe that the signs and symptoms of addiction are blatant, like the disheveled appearance and outrageous behavior of Lindsey Lohan. But in fact addictions often are not obvious—even to the client. SAMHSA research has shown that only 1 in 10 people whose alcohol use qualifies as problematic self-identify it as such. One reason is that addiction can often masquerade as a mental health problem ***

"3. "Alcoholics are men, shoppers are women…" Even clinicians with a more nuanced view of addiction can overlook the problem because of mistaken preconceptions. For example, more men than women have alcohol use disorders, so therapists may be more attuned to alcohol addiction in men. A woman’s drinking problem may be further enhanced because it may not create the kinds of apparent adverse effects (e.g., DUIs, arrests) typical for men. Gender is only one impediment to identifying alcohol use problems. Within healthcare settings, alcohol use disorders tend to go underdiagnosed in people who are insured, employed and Caucasian. Stereotypes also block identification of behavioral addictions.

"4. “I don’t treat addictions.” Many mental health clinicians think of their patient population as generally not including addictions, and they don’t actively seek out evidence to the contrary. In fact, addictive disorders are so common that it’s nearly impossible not to work with people who have them. A recent review of the prevalence of substance and A recent review of the prevalence of substance and behavioral addictions found that the annual rate of emerging or diagnosable addictions among adults is 47%. Some of these people will take their distress to therapy. In other cases, an addiction develops over the course of treatment as a person who has poor emotional regulation or limited means of coping turns to a substance or behavior as a way to manage the discomfort of issues addressed in treatment.

5. " 'My patients aren't 'addicts.' Despite the fact that addiction is widely viewed as a treatable disorder, the perception of “addicts” as unsavory, immoral, antisocial and unmotivated for treatment may still hold sway. Given that we often come to like the patients we treat, it may never cross our minds that our patient could have an addiction. Also, many therapists may believe that they are unqualified to help a patient with addictive behaviors; that addiction treatment cannot be seamlessly integrated into psychotherapy; that such patients need to be referred to a specialist; or that “you have to be an addict to treat an addict.” Clinicians who are subtly influenced by these mistaken beliefs may overlook signs of addiction in order to continue working with a patient.

As always, comments are invited. Jan Edward Williams, 06/21/2013.

Can an Alcoholic or Addict Learn to Drink Moderately?

Alternatives in Beverly Hills, California (Los Angeles area), offers abstinence and moderation based treatment for alcoholism and drug use disorders. This program opposes the 12 Step based approach that complete abstinence from all drugs of abuse, including alcohol, is required for sobriety. Not only may alcoholic drinkers, under this Program, be taught to drink moderately (without consequences), but the drug addict whose primary drug is cocaine, heroin, sedatives, or other drug, will have abstinence from use of those drugs as their recovery goal, but may be helped to learn to use alcohol moderately. The standard position of probably 95% of drug and alcohol treatment programs in the U.S. is that once an individual has crossed the line into loss of control over one class of drugs (for example, sedatives, alcohol, or opiates), he/she can no longer safely use any class of substances of abuse, regardless of his/her positive or negative experience with the drug class. Thus, according to this model, a heroin addict in an abstinence recovery from heroin addiction cannot safely use alcohol or marijuana, even if he/she has no history of problematic use with these substances. Under this abstinence, usually 12 Step, based model, sobriety means complete abstinence from any substance of abuse.

The model just described is considered by the Alternatives Program to be inappropriate for many persons with drug or alcohol use disorders: 

Per Alternatives, sobriety does not mean abstinence. "Traditional addiction treatment programs often confuse these two terms. Abstinence is the avoidance of consumption, whereas sobriety is a condition of control. Most addiction treatment programs would have you believe that abstinence is the only road to sobriety, and for some it is, but Alternatives can offer many another choice… moderation."

According to the Alternatives website, the term sobriety has been erroneously defined to require abstinence. Thus the site states:

"The word ‘sobriety’ is actually a very old English term that has been resurrected and has gained a modern meaning due to its usage within 12-step programs. Sobriety in Alcoholics Anonymous and the 12-step community imples [sic] the requirement of 100% total Abstinence from all mind-altering substances – to call oneself ‘sober’. According to the dictionary, “abstinence is the avoidance of consumption” whereas “sobriety is the condition of control”. The traditional 12-step based treatment programs for addiction define these two terms inaccurately – using them interchangeably and synonymously. Because of this error, most people unintentionally get confused, which often results in them falling easy prey to a type of ‘psychological recovery gridlock’.

"If you look up the word ‘sobriety’ in the dictionary today, you will find that most definitions actually do not even include references to ‘abstinence’. *** By honestly understanding the distinct definitions of these two different words, a new more realistic mindset is possible. This difference explains why when I [the Alternatives representative] speak of ‘sobriety’, I am not necessarily talking about ‘total abstinence’, but rather only the ‘trait of avoiding excesses’. *** Sobriety is really a psychological or emotional state of self-management – not really having anything to do with abstinence. Sobriety is available to drinkers and non-drinkers alike, and is seen when people relate to their world in a rational, calm and mature manner.

" 'The goal is to stop the consequences, right?' The approach Alternatives offers is to help you learn to acquire feelings of joy or satisfaction from the more typical activities of life. Our goal is NOT necessarily to have you stop your drug or addictive behavior as would be required from most addiction treatment programs. We focus on trying to teach control and moderate use.

"Recovery can be observed…

-When the individual is not utilizing their addictive substance or displaying their addictive behavior   to a point that it interferes with their life and future.
-Where there is an internal emotional resilience to the typical ‘ups and down’ of life – without immediately defaulting to their addiction.
-When they can foresee the typical upcoming triggers, and adjust their behavior and thinking to act appropriately without relying on the drugs.
-When an individual is able to tolerate uncomfortable feelings without ‘tipping over’ and reverting back to their compulsive addictive behavior.compulsive addictive behavior."

I do not object to a harm reduction approach whereby the treatment provider helps the individual with an alcohol or drug use disorder to see if he/she can in fact use without negative consequences, with an abstinence goal should the individual discover he/she cannot use successfully. That is a sensible, practical approach to counseling the the addict or alcoholic in denial. I do, however, have concerns that under the Alternatives approach a true addict or alcoholic may be seduced into moderation management and waste a lot of time and cause a lot of pain (even death) to him/herself and those in his/her path while seeking to use moderately. As is stated in the AA basic text (Big Book): "The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The
persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death (Alcoholics Anonymous, page 30)." As always, comments are invited. Jan Edward Williams, 06/20/2013.

Medical Marijuana May Not Be a Good Option for Treatment of Chronic Pain in Teens

With the approval in 18 states in the U.S. of smoked marijuana for treatment of medical conditions including pain, I have often wondered about the negative effects of marijuana use on those being prescribed the drug, knowing, as I do, that marijuana is not a benign drug, has serious side effects, and that individuals who use marijuana over time may develop physical dependence on, and, in some cases, addiction (or "cannabis use disorder" per the new DSM-5) to the drug. Although not a scientific research study, ScienceDaily, on June 17, 2013, reported on a case study included in a Commentary in the July issue of the medical journal Mayo Clinic Proceedings that "While medical marijuana may help some specific conditions, its adverse effects, even with short-term use, can include fatigue, impaired concentration and slower reaction times." The report stated:

"The researchers describe the cases of three high school-age patients at Mayo Clinic's pediatric chronic pain clinic who said they used marijuana regularly. Pain worsened for all three despite their marijuana use. None attended school full time; they reported impaired functioning and difficulty becoming more socially active. [Continuing the quote] *** excessive doses of marijuana may induce symptoms that many chronic pain patients already experience, including dizziness, anxiety, sedation, fatigue, decreased reflexes, confusion, difficulty concentrating and a lack of motivation *** Marijuana use before age 16 has been linked to earlier development of psychosis in susceptible patients; smoking marijuana more than once a week has been connected to persistent cognitive damage in adolescents, the authors say. An estimated 1 in 10 marijuana users becomes addicted, and people under 25 are more susceptible to that." ***

"If you will not work on your life until your pain is gone, then you're probably going to be stuck for a very long time, because the kinds of chronic pain that show up in pain clinics tend to not ever completely go away," *** "They tend to be managed. People have to learn to get on with their lives even despite the pain."

In other words, a quick fix using a drug such as marijuana for relief of chronic pain, may not be possible, and, indeed, the marijuana use may perpetuate dysfunction in those who use it. As always, comments are welcomed. Jan Edward Williams, 06/18/2013.

Smoking Cessation for Teens Using an App and Text Messages

PoliticoPro, in a June 10, 2013 article, describes an eight week smoking cessation program designed by the National Cancer Institute specifically for teenagers that is now available as an app. The program consists of text messages whose content is determined by texts from the teenagers describing their moods, cravings and the like. The article reports that "Teen smoking remains a huge problem: A Surgeon General report released in 2012 found more than 3.6 million high schoolers and middle schoolers smoke, and nearly 9 out of 10 of all U.S. smokers start by age 18. The report found that the rates of teen smoking had hit a discouraging plateau, after several years of decline." Erik Augustson, a behavioral scientist in the National Cancer Institute's Tobacco Control Research Branch was quoted:
"Teens don’t respond as well to tradition cessation efforts, Augustson says. They don’t really see themselves as smokers, they underestimate how hard it is to quit, they don’t think they’ll need help quitting, and they don’t know about cessation resources out there. ***That’s why the cancer institute is using smartphones, as part of the smokefree.gov initiative, to try to connect with them and other hard-to-reach groups, including women, Latinos and veterans. We’re trying to leverage the function of emerging technologies to do two things: One is to more effectively engage smokers in health behavior change … as a means to really engage these people in an intervention, and then the other thing is we’re trying to use these tools as a way to greatly expand our reach. NCI’s smoking cessation mobile apps let users track their mood, cravings and days gone without smoking or get data on a treatment plan."

As always, comments are invited. Jan Edward Williams, 06/17/2013.

Negative Feelings, Not the Urge to Get High, May Drive Addiction:

Scientific studies have shown that chronic use of a drug such as cocaine results in release of large amounts of the feel good chemical dopamine in the reward pathway in the brain producing intense pleasure, a high, that is chemically imprinted in the brain and reinforced over time, driving the individual to chase the high repeatedly. It has been known, anecdotally (meaning based on experience with addicts and not scientific studies) in the addiction field for some time that an individual with advanced addiction no longer uses his/her drug to get high but merely uses just to not get sick, that is, to avoid withdrawal. Recent research, reported in ScienceDaily of June 12, 2013, has demonstrated that drug induced changes in “... an emotion-related brain region called the central amygdala -- whose activity promotes feelings of malaise and unhappiness – play ... a major role in sustaining cocaine addiction.” The researchers in experiments with rats, found signs that cocaine-induced changes in this brain system contribute to anxiety-like behavior and other unpleasant symptoms of drug withdrawal -- symptoms that typically drive an addict to keep using. The report continues: “While changes in these pleasure-seeking brain networks may dominate the early period of drug use, scientists have been finding evidence of changes in the "negative" motivational circuitry as well -- changes that move a person to take a drug not for its euphoric effects but for its (temporary) alleviation of the anxiety-ridden dysphoria of drug withdrawal.”

So science is catching up with what has been common knowledge in addiction-recovery circles, namely, that an alcoholic or drug addict continues to use just to try to feel “normal”, that is, not sick or in withdrawal. As always, comments are invited. Jan Edward Williams, 06/13/2013.

Internet Addictions: Do You Have a Problem?

Individuals in recovery from drug and alcohol addiction tend to be vulnerable to developing other compulsive behaviors that might become problematic.  Gambling, for example, is now included as an addictive disorder (it used to be called pathological gambling and was not included as an addiction) in the new American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, DSM-5, along with alcohol and other drug use disorders. Addiction to activities on the internet such as games, porn, and social media, has not been recognized by the DSM-5 as a true addiction. However, regardless of whether there exists sufficient hard scientific evidence to support creation of a formal addictive disorder, individuals can, and do, develop problematic behaviors around use of the internet that can interfere with their lives in significant ways. My favorite rule of thumb for figuring out if a behavior needs to be addressed (treated) is this: does your use (for ex.., of the internet) cause a pattern of adverse consequences in significant life areas (relationships, job, legally, health) and do you continue to do the behavior anyway? In other words, use in the face of adverse consequences is a sound measure of whether a behavior is problematic or not. In any event, there seems to be enough of a problem to support a residential treatment program for internet addiction, called ReStart. Here is a sample of the program's literature:

"ReSTART has taken an innovative whole person approach to treatment, combining the best of research-based techniques (like CBT and ACT), animal-facilitated therapy, wilderness adventure, traditional 12-steps, and the intimacy of a family-style, cooperative living environment. The 45-day period allows for staff to carefully assess and begin addressing underlying issues, co-morbid conditions, and skill deficits. By limiting access to digital technology for 45 days, the brain begins the process of “detoxing” which stimulates a return to healthier functioning. During this time, participants develop a recovery plan designed to allow the person to engage in moderate, healthy computer use after the program. Many who come to ReSTART have stayed longer than 45 days to solidify their new habits, increasing their chances of remaining addiction-free once they leave."

Research shows that gambling highs result in activation of the same areas of the brain and production of dopamine, a feel good chemical, as occurs when using drugs such as cocaine; the same process undoubtedly occurs with highs from any behavior with a reward attached to it. So, to all you recovering individuals out there, bear in mind that we tend to be attracted to any behavior that feels good, and exercise caution by using the adverse consequences measure specified in this post to see if you are getting into trouble. As always, comments are invited. Jan Edward Williams, 06/11/2013.

a website for agnostics in AA

In the interests of offering a way out of addictive disorders for those leery of the 12 Step programs' focus on seeking a Higher Power or God as you understand Him, I suggest the following website called AA Agnostica. This site seems to suggest a way to access the well known curative factors of the 12 Step programs, namely, the support and caring of one alcoholic/addict for another, honest sharing of experience, strength, and hope, and all that the fellowship of these programs embraces. Here is a summary of what this website says that it is about:

"The AA Agnostica website does not endorse or oppose any form of religion or atheism. Our only wish is to ensure suffering alcoholics that they can find sobriety in AA without having to accept anyone else’s beliefs or having to deny their own. The word “Agnostica” in the name of this website is derived from Chapter Four, “We Agnostics,” of Alcoholics Anonymous, otherwise known as the Big Book. When we use the word “agnostic” in relation to AA – or similar words like “atheist” or “freethinker” – we are simply referring to the specific wisdom of groups and individuals within the fellowship who understand that a belief in “God” is not necessary for recovery from alcoholism.The experience strength and hope of these women and men form the basis for the pages and posts on this website and are often a comfort and an inspiration for others in AA. If you have something similar that you would like to share then this is a place where your contributions will be warmly received."

In my own early recovery journey, I had serious reservations, even anger, about the language used in AA, such as God and Higher Power, but experienced my first connection with the spiritual strength present in meetings when I heard and felt real people honestly sharing real feelings. So, I present the AA Agnostica site as a good place for the agnostic or atheist to start his/her, dare I say, "spiritual" recovery journey. As always, comments are invited. Jan Edward Williams, 06/07/2013.

Helping Alcoholics Hit Bottom per Bill W. AA's Co-founder

I have been reflecting lately about how it is that an alcoholic or addict can be helped to become willing to seek recovery whether through 12 Step meetings or other path to recovery. I recently read an article written by Bill Wilson, AA's co-founder, in 1944, that describes, at least in part, what helps the process of being willing to recover using 12 Step principles. I will first summarize what Bill Wilson said and then give some quotations from the text of the article he wrote. Bill Wilson says in effect that the alcoholic or addict must be convinced that the choice facing him/her is to continue drinking or drugging or go insane or die. In other words, the user needs to develop a state of mind that his/her drinking or drugging predicament is hopeless, that he/she has no way out; that he/she has hit bottom. Here is some of Bill's own language in which he states in the 1944 article that:

"...alcoholism is a complex malady; that abnormal drinking is but a symptom of personal maladjustment to life; that, as a class, we, alcoholics are apt to be sensitive, emotionally immature, grandiose in our demands upon ourselves and others; that we have usually 'gone broke' on some dream ideal of perfection; that, failing to realize the dream, we sensitive folk escape cold reality by taking to the bottle; that this habit of escape finally turns into an obsession, or ***a compulsion to drink so subtly powerful that no disaster, however great, even near death or insanity, can, in most cases, seem to break it; that we are the victims of the age-old alcoholic dilemma; our obsession guarantees that we shall go on drinking, but our increasing physical sensitivity guarantees that we shall go insane or die if we do."

He further said: "When these facts are poured by an AA member into the person of another alcoholic they strike deep - the effect is shattering. That inflated ego, those elaborate rationalizations by which our neurotic friend has been trying to erect self-sufficiency on a foundation of inferiority, begin to ooze out of him. Sometimes his deflation is like the collapse of a toy balloon at the approach of a hot poker. But deflation is just what we AA’s are looking for. It is our universal experience that unless we can start deflation, as a self-realization, we get nowhere at all. The more utterly we can smash the delusion that the alcoholic can get over alcoholism 'on his own', or that someday he may be able to drink like a gentleman, the more successful we are bound to be. In fact, we aim to produce a crisis, to cause him to 'hit bottom' as AA’s say. ***...[O]nce he has accepted the fact that he is an alcoholic and the further fact that he is powerless to recover unaided, the battle is half won. As the AA’s have it, 'he is hooked.' "

That language seems to me to capture the state of mind needed for some alcoholics or addicts to be open to recovery. Unfortunately, there are some who seem to understand their hopeless state but are unwilling or unable, probably the latter, to accept help. As always comments are invited. Jan Edward Williams, 06/05/2013.