Twelve steps backward

Say you’ve been diagnosed with a serious, life-altering illness or psychological condition. In lieu of medication, psychotherapy, or a combination thereof, your doctor prescribes nightly meetings with a group of similarly afflicted individuals, and a set of 12 non-medical guidelines for recovery, half of which require direct appeals to God. What would you do?imgres-1

Writing in The Atlantic, Jake Flanagan states that “Especially to nontheists, the concept of “asking God to remove defects of character” can feel anachronistic. But it is the sixth step in the 12 Steps of Alcoholics Anonymous—the prototype of 12-step facilitation (TSF), the almost universally accepted standard for addiction-recovery in America today. “From its origins in the treatment of alcoholism, TSF is now applied to over 300 addictions and psychological disorders: drug-use, of course (Narcotics Anonymous), but also smoking, sex and pornography addictions, social anxiety, kleptomania, overeating, compulsive spending, problem-gambling, even “workaholism.”

“Although AA does not keep membership records—the idea being pretty antithetical to the whole “anonymity” thing—the organization estimates that as of January 2013, more than 1 million Americans regularly attended meetings with one of roughly 60,000 groups. Dr. Lance Dodes, a recently retired professor of psychiatry at Harvard Medical School, estimates about 5 million individuals attend one or more meetings in a given year. Indeed the 12-step empire is vast, but Dodes thinks it’s an empire built on shaky foundations. In his new book, released today, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (co-written with Zachary Dodes), he casts a critical eye on 12-step hegemony; dissecting the history, philosophy, and ultimate efficacy of TSF, lending special scrutiny to its flagship program. “Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent,” writes Dodes.

“About one of every 15 people who enter these programs is able to become and stay sober.” This contrasts with AA’s self-reported figures: A 2007 internal survey found that 33 percent of members said they had been sober for more than a decade. Twelve percent claimed sobriety for five to 10 years, 24 percent were sober for one to five years, and 31 percent were sober for under a year. Of course, those don’t take into account the large number of alcoholics who never make it through their first year of meetings, subsequently never completing the 12 steps (the definition of success, by AA’s standards). Continue reading “Twelve steps backward”

The case for game addiction

First it was Doodle Jump. Then Dots. And now — will it never end? — Flappy Bird.

So many of the games that we download on our smartphones are a waste of time, but we can’t seem to stop playing them. My current high score on the late, lamented Flappy Bird is three. After weeks of tap-tap-tapping to keep that stupid little bird flying.

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Three.Why do we keep falling for these things?

The answer to that question just might be found in, of all places, a medical laboratory at the University of California, San Francisco. Researchers there are trying to figure out what makes games addictive — and how we might use video games to make our minds stronger, faster and healthier.

Using neuroimaging techniques, researchers are peering into gamers’ heads, hoping that the data they collect will help them make video games that change as you play, getting easier or harder, depending on your performance. The idea is to keep people at the addiction point. You know, that infuriating flap-flap-flap zone.

From there, they say, the possibilities seem limitless. One day, we might develop games to treat depression or attention deficit hyperactivity disorder. Or games that rewire our brains to improve memory and cognitive function. The list could go on and on. Continue reading “The case for game addiction”

Overdoses on the rise

imagesBetween 2000 and 2010 the number of people that died from drug overdoses more than doubled from 17,000 to 38,000, according to the most recent figures from the Centers for Disease Control and Prevention.

In 2009, for the first time in US history, more people died from drugs overdoses than from traffic accidents or firearms, although that is partly because the numbers of gun deaths and road deaths are both decreasing, the BBC reports. So what is causing this epidemic?

“The data suggests the number of people overdosing from pharmaceutical – or prescription – drugs has trebled over that decade, just as the quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices has quadrupled over the same period.As a result in 2010, prescription drugs killed more than 22,100 people in the US, more than twice as many as cocaine and heroin combined.

“Explaining the rise, Dr Len Paulozzi of the CDC says: “The use of opioid pain relievers has been increasing since the early 1990s and that increase has been driven by a change in the attitude of health care providers about the effectiveness of those kind of painkillers. Continue reading “Overdoses on the rise”

Stunning findings about addiction treatment

Intensive drug and alcohol treatment may be no more effective than a single appointment, according to a new study reported today in Journal of the American Medical Association.

WebMD reports that “Results of the year-long study are likely to disappoint those who believe treating addiction more like a chronic disease — with a systematic approach and follow-up — is the better way to go.

“We were completely surprised by the result,” said lead researcher Dr. Richard Saitz, a Boston University professor of medicine and epidemiology. “We put everything into this, and we were surprised that even doing that didn’t lead to differences compared to not doing any of it.”

“In the study of nearly 600 adult substance abusers, those receiving chronic care management got intensive medical care at a primary-care clinic plus relapse-prevention counseling and addiction and psychiatric treatment. Others in the study had one medical visit at which they received a list of addiction-treatment resources.

“After 12 months, 44 percent of those in the chronic care management group had stopped drinking or using drugs, as did 42 percent of those not receiving intensive care, the researchers said. Despite these similar findings, Saitz said he still believes chronic care management can be useful for some addictions. However, “we don’t want people to assume that it’s going to be effective when applied everywhere for every person,” he said. More work is needed to determine the best way to use chronic care management and to identify those who will benefit most from the approach, he said.

“We have to recognize that people with drug or alcohol addictions may be different and it’s not one monolithic disorder,” Saitz said. “I do think that integrated chronic care management, in the future, is going to be efficacious for people with addictions.”The report was published in the Sept. 18 issue of the Journal of the American Medical Association. Advocates of chronic care management point out that many substance abusers suffer serious health consequences but receive poor care. By addressing medical, emotional and dependence issues in a coordinated manner, patients would achieve better results, the thinking goes. One expert thinks motivation is the key to any program to treat addiction. People who are motivated are most likely to start and stick with a program or join a clinical trial, said Dr. James Garbutt, a professor of psychiatry at the University of North Carolina at Chapel Hill. “That’s an important point because that’s saying they already wanted to make some changes,” Garbutt said. “That’s a huge step in substance-abuse treatment.” Continue reading “Stunning findings about addiction treatment”

Nations of addicts

Watch out America, a new study suggest that Great Britain is a society of addicts.

The Guardian reports it thus: images-1

“Othello, act 2, scene 3. As part of his evil plan, Iago, you will remember, is trying to get Cassio drunk, singing a song to get him rowdy. “I learned it in England,” he says, “where, indeed, they are most potent in potting: your Dane, your German, and your swag-bellied Hollander – Drink, ho! – are nothing to your English.” Ever the entertainer, Shakespeare knew that you could always get a cheer from a crowd in this country by complimenting them on their drinking.

“But why is it a compliment? The crippling intensity of one’s hangover the morning after, the unwiseness of one’s antics the night before, what makes these things that Britons boast about? The Centre for Social Justice, founded by Iain Duncan Smith, has just released a report that argues for it to be a matter of shame. “Britain is the addicted man of Europe,” the authors say. “Growing sections of society are dependent upon mind-altering substances.”

“The report itself is a muddled, shrill and selective document, determined to bring together issues such as binge drinking, heroin addiction, legal highs, cannabis smoking and alcoholism, which have different levels of seriousness, patterns of use and potential for harm. Yet at the heart of it lies a truth: Britain is a nation addicted, not necessarily to drugs oralcohol per se, but to excess itself.

“Here the facts are not in question. Although rates of drug use are broadly stable or falling, rates of opiate addiction are high in European terms, and in its penchant for party drugs Britain leads the world. Last year’s World Drugs report, which ranked countries on the prevalence of different drugs, put the Isle of Man and Scotland at numbers one and two for cocaine use, with England fourth and Wales sixth. All four figured in the top 10 for ecstasy use as well. Britain also appears to be a hub for the development of new synthetic drugs, often known as “legal highs”, because our laws take a while to ban them. Continue reading “Nations of addicts”

Why writers drink

Olivia Laing’s second book, “A Trip to Echo Springs,” takes its title from a line in Tennessee Williams’s play Cat on a Hot Tin Roof. It’s an apt phrase for a book about writers and alcoholism, with its combined dose of the sublime and the helplessly mortal. But “Echo Spring” is only the liquor cabinet, named after a brand of whiskey, as discussed in a review in the New Statesmanimgres-1

“Laing’s ear was apparently made to catch such notes of melancholia; the book’s subtitle, Why Writers Drink, undersells her achievement. She has produced not an answer to a glib question, but a nuanced portrait – via biography, memoir, analysis –of the urge of the hyperarcticulate to get raving drunk.
“The biographical focus is on the lives of six writers – Williams among them – and Laing visits the places in America where they variously lived, drank and dried out. The journey imposes a stagey narrative that the book could have done without, but Laing’s experiences give line-by-line pleasure and make for bright collisions with the past. A pastrami sandwich from Katz’s Deli in New York in hand, she walks to the Queensboro Bridge and remembers that this is where “John Cheever once saw two hookers playing hopscotch with a hotel room key”. Continue reading “Why writers drink”

Male and female alcohol recovery differences

Alcohol abuse does its neurological damage more quickly in women than in men, new research reported in Scientific American suggests.

“The finding adds to a growing body of evidence that is prompting researchers to consider whether the time is ripe for single-gender treatment programs for alcohol-dependent women and men.

“Over the past few decades scientists have observed a narrowing of the gender gap in alcohol dependence. In the 1980s the ratio of male to female alcohol dependence stood at roughly five males for every female, according to figures compiled by Shelly Greenfield, a professor of psychiatry at Harvard Medical School. By 2002 the “dependence difference” had dropped to about 2.5 men for every woman. But although the gender gap in dependence may be closing, differences in the ways men and women respond to alcohol are emerging. Writing in the January 2012 issue ofAlcoholism: Clinical and Experimental Research, principal investigator Claudia Fahlke from the Department of Psychology at the University of Gothenburg in Sweden and her colleagues found that alcohol’s ability to reduce serotonin neurotransmission, was “telescoped” in alcoholic women compared with their male counterparts. Continue reading “Male and female alcohol recovery differences”

Dopamine and addiction

In a brain that people love to describe as “awash with chemicals,” one chemical always seems to stand out, writes Bethany Brookshire in Slate.com:images-1

“Dopamine: the molecule behind all our most sinful behaviors and secret cravings.Dopamine is love. Dopamine is lust. Dopamine is adultery. Dopamine is motivation. Dopamine is attention. Dopamine is feminism. Dopamine is addiction.

“Dopamine is the one neurotransmitter that everyone seems to know about. Vaughn Bell once called it the Kim Kardashian of molecules, but I don’t think that’s fair to dopamine. Suffice it to say, dopamine’s big. And every week or so, you’ll see a new article come out all about dopamine.

“So is dopamine your cupcake addiction? Your gambling? Your alcoholism? Your sex life? The reality is dopamine has something to do with all of these. But it isnone of them. Dopamine is a chemical in your body. That’s all. But that doesn’t make it simple.

“What is dopamine? Dopamine is one of the chemical signals that pass information from one neuron to the next in the tiny spaces between them. When it is released from the first neuron, it floats into the space (the synapse) between the two neurons, and it bumps against receptors for it on the other side that then send a signal down the receiving neuron. That sounds very simple, but when you scale it up from a single pair of neurons to the vast networks in your brain, it quickly becomes complex. The effects of dopamine release depend on where it’s coming from, where the receiving neurons are going and what type of neurons they are, what receptors are binding the dopamine (there are five known types), and what role both the releasing and receiving neurons are playing.

“And dopamine is busy! It’s involved in many different important pathways. But when most people talk about dopamine, particularly when they talk about motivation, addiction, attention, or lust, they are talking about the dopamine pathway known as the mesolimbic pathway, which starts with cells in the ventral tegmental area, buried deep in the middle of the brain, which send their projections out to places like the nucleus accumbens and the cortex. Increases in dopamine release in the nucleus accumbens occur in response to sex, drugs, androck and roll. And dopamine signaling in this area is changed during the course of drug addiction.  All abused drugs, from alcohol to cocaine to heroin, increase dopamine in this area in one way or another, and many people like to describe a spike in dopamine as “motivation” or “pleasure.” But that’s not quite it. Really, dopamine is signaling feedback for predicted rewards. If you, say, have learned to associate a cue (like a crack pipe) with a hit of crack, you will start getting increases in dopamine in the nucleus accumbens in response to the sight of the pipe, as your brain predicts the reward. But if you then don’t get your hit, well, then dopamine can decrease, and that’s not a good feeling. So you’d think that maybe dopamine predicts reward. But again, it gets more complex. For example, dopamine can increase in the nucleus accumbens in people with post-traumatic stress disorder when they are experiencing heightened vigilance and paranoia. So you might say, in this brain area at least, dopamine isn’t addiction or reward or fear. Instead, it’s what we call salience. Salience is more than attention: It’s a sign of something that needs to be paid attention to, something that stands out. This may be part of the mesolimbic role in attention deficit hyperactivity disorder and also a part of its role in addiction.”

More at: http://www.slate.com/articles/health_and_science/science/2013/07/what_is_dopamine_love_lust_sex_addiction_gambling_motivation_reward.html

And now, carb addiction

Addicted to sugar? Sure, people joke about it all the time.

But then again, what is addiction? images-1

A story on NPR today takes the topic seriously, as excerpted here: “Fresh research adds weight to the notion that certain foods (think empty carbs like bagels and sweet treats) can lead to more intense hunger and overeating. Fast-digesting carbohydrates can stimulate regions of the brain involved in cravings and addiction, according to a study published in the American Journal of Clinical Nutrition.

“Prior studies have shown that highly desirable foods, perhaps a cheesecake or pie, can trigger pleasure centers in the brain. But what’s new about this research is that it shows that even when people are unaware of what they’re eating, the intake of fast-digesting carbs can activate parts of the brain associated with pleasure, reward and addiction.To evaluate this, Dr. David Ludwig, director of the obesity prevention center at Boston Children’s Hospital, and his colleagues conducted brain scans in 12 overweight men after they consumed two different kinds of test milkshakes.Both milkshakes had the same number of calories and similar ingredients, but one contained more fast-digesting carbs and the other was made of slower-digesting carbohydrates. The concept here is that so-called high-glycemic index foods such as sugar and highly processed breads move through the body faster than low-glycemic index foods such as fruit and whole grains.  Continue reading “And now, carb addiction”

The internet addiction diagnosis

“Anything that goes across a boundary becomes as disorder,” says psychologist and counsellor Mohana Narayanan. He is one of several mental health professionals cited in today’s Hindu Times in a story about the newly pathologised phenomenon of excessive time online. At Worlding we are a bit skeptical about these worries.images

“With Internet Addiction Disorder all set to be published in the DSM-5 this year, the need to understand what it actually is and how to combat it is only growing. It is mostly found among kids, who spend most of their time surfing the Net and playing violent games online, or chatting away to glory. Internet addiction is also common among couples, who communicate with each other using social media while, in reality, they would be sitting next to each other!

“Many of the self-confessed addicted teenagers say that the Internet provides a safety blanket for them to escape from the trials and tribulations of real life. Faceless communication, which seems far less intimidating in comparison to face-to-face conversations, helps them to be honest about situations they would otherwise push under the rug. Constant neglect and isolation from real life peers and relatives also push people to seek comfort and an emotional connect with strangers online, which seems very satisfying at first. Continue reading “The internet addiction diagnosis”

A nation of addicts

imagesThe 21st century cupcake is a thing of wonder: a modest base of sponge groaning under an indulgently thick layer of frosted sugar or buttercream.

Now Salon.com asserts that “It’s made to look like a miniature children’s birthday cake – and, indeed, birthdays are the perfect excuse to scurry down to the local boutique bakery for a big box of them. The retro charm of cupcakes helps suppress any anxieties you might have about sugar and fat. Your mother made them! Or so the advertising suggests. Perhaps your own mother didn’t actually bake cupcakes, but the cutesy pastel-colored icing implies that one bite will take you back to your childhood. This can’t possibly be junk food, can it?

“Now let’s consider another ubiquitous presence in modern life: The iPhone, which started out as a self-conscious statement of coolness but which, thanks to Apple’s marketing genius, has now become as commonplace as a set of car keys. Millions of people own iPhones, making use of hundreds of thousands of apps, whose functions range from GPS-assisted mapping to compulsively time-wasting computer games. Your iPhone does everything you could require of a mobile phone and more, so you really don’t need the upgraded model that Apple has just released … do you? Continue reading “A nation of addicts”

Changes in gender and addiction

imgres-1The worse women have it, the better off they are. This is the lesson we might draw from looking at one (and only one) global trend: addiction.Salon.com reports that “Worldwide, women have always had lower rates of drug and alcohol use and dependence than men. Butas women’s access to opportunities grows along with a nation’s affluence, this gender gap begins to close. In fact, just as women often outstrip men in the classroom and office if given the chance, they have already forged ahead in the abuse of certain substances. It may not be the most celebratory way to mark International Women’s Day (March 8), but the fact is, equal rights have their penalties.

Continue reading “Changes in gender and addiction”

Treatment rather than jail for addiction

It’s widely acknowledged that when it come to drug addiction, treatment is more efficient and effective than jail or other punitive measures. Rather than punishing a human being who is already suffering, society should move to more therapeutic and restorative strategies.imgres

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive, reports today’s New York Times. Continue reading “Treatment rather than jail for addiction”

Raising drinking costs saves lives

imgres-3Research published in Canada has linked the introduction of minimum pricing with a significant drop in alcohol-related deaths.

The findings, in the journal Addiction, were welcomed by health campaigners but they have been criticised as “misleading and inaccurate” by the drinks industry, which has questioned the statistical basis of the research, reports the BBC today

“The Scottish government’s plans to introduce a minimum unit price are on hold pending a court challenge. The researchers said a rise in alcohol prices of 10% had led to a 32% reduction in alcohol-related deaths. The Canadian study was carried out between 2002 and 2009 in British Columbia, where alcohol could only be sold directly to the public in government-owned stores. It suggests that, when drink prices rose, there were “immediate, substantial and significant reductions” in deaths wholly attributable to alcohol abuse. The authors suggest increasing the price of cheaper drinks reduces the consumption of heavier drinkers who prefer them.

“Dr Tim Stockwell, director of the University of Victoria’s Centre for Addictions Research of British Columbia, said: ‘This study adds to the scientific evidence that, despite popular opinion to the contrary, even the heaviest drinkers reduce their consumption when minimum alcohol prices increase. “It is hard otherwise to explain the significant changes in alcohol-related deaths observed in British Columbia.’ During the period under study, the law changed in Canada, permitting private liquor stores to open. A 10% growth in the number of such outlets was associated with an increase (2%) in all alcohol-related deaths. This is the first study to highlight the effects on mortality of alcohol minimum pricing, although the Scottish government has used previous research from the University of Sheffield to claim consumption of alcohol would be reduced if prices rose.”

 

Full story at BBC: http://www.bbc.co.uk/news/uk-scotland-21358995

 

 

Addiction and identity

“A leading expert on addictions says there still remains a ‘tremendous misunderstanding’ about the problem in our society,” reports the Chatham Daily News in a story about psychiatrist Gabor Mate.

“People see addictions as some lifestyle choice that somebody makes,” but  “Nobody wakes up and says, ‘My ambition is to become an addict,'” say Mate. A keynote speaker this week at the Chatham-Kent Addictions Awareness Conference, Mate said “addiction is a response to suffering and most people who are severely addicted were traumatized as children. As a result, he said, people in this situation have pain they try to soothe with drugs.”

Continue reading “Addiction and identity”

Addiction, television, and courage

Alcoholism and addiction are two the biggest categories by which people are “othered.”  To many a substance abuser is a celebrity, a skid-row drunk, or maybe your crazy Uncle Bob––but it’s always someone else, not you or the person sitting next to you. Hence, there is shame attached to this illness for the afflicted  and those close to them. The fact is the one in ten people have problems with drugs or alcohol, numbers that tend to be much higher within creative communities. And most of them battle heroically with this problem in the face of a society that views them as derelict, dishonest, or morally bankrupt.

Users don’t fit typical stereotypes, as over 75% are productively employed and many highly successful. Among people who get flashes of brilliance from occasional mania, the numbers go to 85%.  Science has recently shown that genuine addiction (as opposed to occasional binging) results from faulty brain wiring that those afflicted can contain, but never correct (See forthcoming DSM V).

This is why a TV show like Rehab with Dr. Drew should be a good idea––a program that treats addiction as the illness that it is. Continue reading “Addiction, television, and courage”