‚Erasing‘ Drug-Associated Memories May Stop Drug Addiction Relapses

Erasing‘ drug-associated memories may prevent recovering drug abusers from relapsing, researchers at the University of Cambridge have discovered.

 

The team, led by Professor Barry Everitt, was able to reduce drug-seeking behaviours in rats by blocking a brain chemical receptor important to learning and memory during the recall of drug-associated memories. Their research, which was funded by the Medical Research Council, was reported in the 13 August issue of The Journal of Neuroscience.

The Cambridge scientists found that by disrupting or erasing memories associated with drug use during recall, they could prevent the memories from triggering relapses and drug taking.

Memories exist in different states depending on whether they are being recalled or not. When memories are recalled, they become ‚unstable‘ or malleable and can be altered or erased during the process called reconsolidation. Because relapse by drug abusers is often prompted when they recall drug-associated memories, the scientists found that by blocking these memories they could prevent relapse.

In order to undertake the experiments, the researchers trained rats to associate the switching on of a light with cocaine. The researchers then exposed the rats to the light, thereby ‚reactivating‘ the memory, without the cocaine. In an effort to receive more cocaine, the rats would perform tasks that the scientists had created which would turn on the light.

When the animals were given a chemical that interfered with the action of the NMDA-type glutamate receptor (which plays an important role in memory) prior to the ‚reactivation‘ session, the rats showed reduced cocaine-seeking behaviours. A single treatment reduced or even stopped drug-seeking behaviours for up to four weeks.

In contrast, blocking the receptors after or without the reactivation session had no effect on subsequent drug-seeking behaviours, indicating that drug-associated memories can be disrupted during but not after reconsolidation of memories.

Professor Barry Everitt said, „The results suggest that efforts should be made to develop drugs that could be given in a controlled clinical or treatment environment in which addicts would have their most potent drug memories reactivated. Such treatments would be expected to diminish the effects of those memories in the future and help individuals resist relapse and maintain their abstinence.“

Dr Amy Milton, a co-author, said, „This is a new approach to the treatment of drug addiction that has great potential. Additionally, this might also be used to treat other neuropsychiatric disorders characterized by maladaptive memories, including post-traumatic stress and phobic anxiety disorders.“

 

Source: http://www.sciencedaily.com/releases/2008/08/080812213931.htm

Ibogaine: Can it Cure Addiction Without the Hallucinogenic Trip?

Ron Price needs his milkshake. It’s 10 o’clock on a Monday morning and the bald-headed, barrel-chested former bodybuilder is shuffling around the kitchen of a posh rehab clinic in Tijuana, wearing slippers and a blue Gold’s Gym T-shirt. Price had been employed as a stockbroker in New Mexico, until his training regimen left him with debilitating injuries that forced him to undergo 33 surgeries in less than a decade. His doctor prescribed Oxycontin, and Price quickly became dependent on the potent painkiller. More recently, he started snorting cocaine and chugging booze to numb the pain. Now, 53 years old and three weeks into rehab, all he wants is a milkshake and to crawl back into bed.

Clare Wilkins, the vivacious 40-year-old director of Pangea Biomedics, pops the lid of the blender to check the consistency of the concoction Price craves: peanut butter, soy milk, agave syrup, hemp protein powder, and a few scoops of chocolate-flavored Green SuperFood.

Oh, and a half-teaspoon of root bark from the tabernanthe iboga plant.

Taken in sufficient quantity, the substance triggers a psychedelic experience that users say is more intense than LSD or psilocybin mushrooms. Practitioners of the Bwiti religion in the West African nation of Gabon use iboga root bark as a sacrament to induce visions in tribal ceremonies, similar to the way natives of South and Central America use ayahuasca and peyote. Wilkins is one of a few dozen therapists worldwide who specialize in the use of iboga (more specifically, a potent extract called ibogaine) to treat drug addiction.

Now she pours the thick, chocolatey liquid into a mason jar but agrees to hand it over to Price only on the condition that he’ll stay awake and out of bed and interact with his fellow residents and the staff. Price grudgingly agrees and takes a seat at the dining-room table. Sunlight pours in through a sliding-glass door that opens to a terrace with a sweeping view of the Pacific Ocean and the San Diego skyline in the distance.

„Ron, I remember when you called me [three weeks ago], you were crying on the phone. You were so devastated, you couldn’t leave the house,“ Wilkins says gently. „When you use, you end up alone in a bathroom or something. You need a community. As weird and misfits as we are, we need this sense of community. You need to learn to deal with being in your body each day instead of relying on the fucking ibogaine.”

Ibogaine and iboga root bark are illegal in the United States but unregulated in many countries, including Canada and Mexico. Wilkins, though, is hardly alone in her belief that iboga-based substances can be used as a legitimate treatment for drug addiction. Researchers at respected institutions have conducted experiments and ended up with hard evidence that the compound works—as long as you don’t mind the mindfuck.

„All drugs have side effects, but ibogaine is unique for the severity of its side effects,“ says Dorit Ron, a neurology professor at the University of California–San Francisco. „I think ibogaine is a nasty drug. But if you can disassociate the side effects from the good effects, there is a mechanism of action in ibogaine that reduces relapse in humans.“

Now, using chemical variations, scientists have devised ways to make ibogaine non-hallucinogenic. The trouble, say Wilkins and others who have used ibogaine, is that the psychedelic journey carries the secret to the drug’s success.

It was Hunter S. Thompson who introduced ibogaine to a wide audience, in the pages of Rolling Stone. Thompson was covering the 1972 presidential election, reporting what would eventually become Fear and Loathing on the Campaign Trail ’72. When Democratic contender Edmund Muskie acted strangely during a campaign stop in Florida, Thompson suggested that the candidate was taking ibogaine, „an exotic brand of speed“ that „nobody in the press corps had ever heard of.“

„It is entirely conceivable—given the known effects of ibogaine—that Muskie’s brain was almost paralyzed by hallucinations,“ Thompson wrote. „He looked out at that crowd and saw gila monsters instead of people . . . his mind snapped completely when he felt something large and apparently vicious clawing at his legs.“

The notion of Ed Muskie on an ibogaine bender was absurd, and Thompson knew it. Most experienced users say the drug is extremely unpleasant when ingested in large doses, causing severe nausea, vertigo, sleeplessness, and visions that can be nightmarish. The effects last up to 36 hours, and the strain can be so great that some users are bedridden for days after.

„I only took one capsule of extract. It was very weak, but it was still strong enough to make me puke for six hours,“ says Dana Beal, a New York–based activist and longtime lobbyist for ibogaine legalization. „I had my head in a wastebasket or sink or toilet the entire time. It’s aversive. I can tell you from personal experience that I don’t ever want to take it again.“

While Hunter Thompson brought ibogaine into popular parlance, credit for discovering the drug’s medicinal potential is widely attributed to a man named Howard Lotsof. Ten years before the events that gave rise to Fear and Loathing, Lotsof was a junkie living in New York. Having bought some ibogaine for recreational use, Lotsof was astounded to find that when the hallucinogen wore off, he no longer craved heroin. Days passed, and he didn’t experience any of the excruciating symptoms associated with kicking a dope habit.

Lotsof, who died earlier this year of liver cancer at age 66, devoted his life to making ibogaine available as an addiction treatment. He experienced a significant setback in 1967, when the U.S. government banned the drug, along with several other psychedelics. In 1970 officials categorized ibogaine as a Schedule I substance—on par with heroin, marijuana, and other drugs that by definition have „a high potential for abuse“ and „no currently accepted medical use.“

Eventually, Lotsof shifted his focus and began using ibogaine to treat heroin addicts at a rehab clinic in the Netherlands. In 1985, he obtained a U.S. patent for the use of ibogaine to treat substance abuse.

Longtime Yippie activist Dana Beal was charged with money laundering after police caught him carrying $150,000 in cash. He says the money was going to finance a Mexican ibogaine clinic.

Tom Kingsley Brown, a researcher from the University of California–San Diego, is studying whether ibogaine works long-term to quell addiction.

By the late ’80s, doctors and scientists were confirming what Lotsof knew: Ibogaine blocks cravings and withdrawal symptoms for many types of drugs, and opiates in particular.

„Its effects are pretty dramatic,“ says Dr. Kenneth Alper, an associate professor of psychiatry at New York University who specializes in addiction research. „I’ve observed this firsthand, and it’s difficult to account for.“

Dr. Stanley Glick, a pharmacologist and neuroscientist at Albany Medical College, was among the first researchers to test ibogaine on rats. Glick hooked up the rodents to IVs in cages with levers that allowed them to inject themselves with morphine.

“If the rats do it, you can be pretty sure that humans will abuse it if given the opportunity,” Glick explains. “It’s really the time-tested model of any human behavior.”

Strung-out rats dosed with ibogaine stopped pressing the lever that gave them morphine. Glick and other researchers have subsequently replicated the morphine results with other addictive drugs, including alcohol, nicotine, cocaine, and methamphetamine.In the early 1990s, Lotsof teamed with Dr. Deborah Mash, a neurologist and pharmacologist at the University of Miami, to study the effect of ibogaine on people. Mash was granted FDA approval to administer ibogaine in 1993 and was able to test the drug on eight people before the experiment came to an abrupt halt.

„I was unable to get it funded,“ Mash says. „We had the rocket ship on the launch pad, with no fuel.“

A few months after the FDA gave Mash the green light, a committee of academics and pharmaceutical-industry professionals assembled by the National Institute on Drug Abuse (NIDA) concluded that the U.S. government should not fund ibogaine research. Earlier that year, a researcher from Johns Hopkins University had found that rats injected with massive doses of ibogaine suffered irreparable damage to the cerebellum, the part of the brain that controls balance and motor skills. According to Dr. Frank Vocci, former director of treatment research and development at NIDA, the fact that ibogaine increases the risk of seizures for people addicted to alcohol or benzodiazepines such as Valium raised eyebrows as well.

„The question that was posed to them was, ‚Do you think that this could be a project that could result in, essentially, a marketable product?‘ “ Vocci recalls. „There was concern about brain damage, seizures, and heart rate. But it wasn’t so much that the ultimate safety of the drug was being damned, it was just felt that there were an awful lot of warts on this thing.“

Mash and Lotsof soon parted ways, on unfriendly terms. Lotsof sued his former colleague and the University of Miami in federal court in 1996, claiming that her research had infringed on his patent. A judge eventually ruled in favor of Mash and her employer, absolving them of wrongdoing.

Lotsof went his own way, mentoring fellow former addicts who opened ibogaine rehab centers abroad. Mash opened a private clinic on the Caribbean island of St. Kitts and administered ibogaine to nearly 300 addicts. „It really works,“ Mash says now. „If it didn’t work, I would have told the world it doesn’t work. I would have debunked it, and I would have been the most outspoken leader of the pack. That’s my scientific and professional credibility on the line.“

Clare Wilkins is one of Howard Lotsof’s protégés. Born in South Africa and raised in Los Angeles, she got hooked on heroin at the age of 20 while majoring in Latin American studies and psychology at Cornell University. Drug use led to depression and she dropped out her senior year. She’d been trying to get clean using methadone for eight and a half years when her younger sister learned about ibogaine via the Internet. Wilkins, then 30 years old and employed as bookkeeper, read up on the subject, started saving up, and in 2005 shelled out $3,200 for a session at the Ibogaine Association, a clinic in Tijuana.

The trip—in both senses of the word—changed her life.

„I received a direct message that I was washed in love,“ Wilkins says of her first encounter with the hallucinogen. „That the universe in its entirety is full of love and that courses through us and was there for me. There was this soul body, this light body that had no beginning and no end. My fingers had no end, there were atoms coming in and going out.

„It got me off methadone completely,“ she says. „My sense of shame about my addiction was washed away without having to practice with a therapist and talk, talk, talk.“

The experience was so profound that she elected to stay on at the clinic as a volunteer. Confident and chatty, with long brown curls and a disarming smile, Wilkins feels she has a knack for guiding patients through their ibogaine-induced spiritual awakenings.

„On ibogaine, all your walls come down,“ she says. „You can’t lie. You get an opportunity to look at yourself honestly and see how you respond. My role is to be there as a comfort. People compliment me by saying, “You knew exactly when to hold my hand.‘ ”

 

Keegan Hamilton

Clare Wilkins is director of Pangea Biomedics, a rehab clinic in Tijuana’s Playas neighborhood that administers ibogaine to drug addict

Bill Boulanger, CEO of Obiter Research, holds a few grams of 18-MC (18-methoxycoronaridine), a synthetic ibogaine derivative that he believes can cure drug addiction.

In 2006 Ibogaine Association director Martin Polanco offered Wilkins a full-time job. She’d heard rumors that he was considering selling the clinic in the coming year, and on a whim she offered to buy the operation from him outright.

„It was one of those ‚Can I put that back in my mouth?‘ moments,“ Wilkins recounts with a laugh. „I didn’t have the money, I didn’t even have a car.“

Wilkins borrowed $3,000 from her mother for a down payment, changed the clinic’s name to Pangea Biomedics, and made monthly payments to Polanco for the next year and a half.

Having paid off the $65,000 debt, Wilkins’s first order of business was to relocate. Tijuana residents—and rehab clinics in particular—have been terrorized during Mexico’s ongoing drug war. Late last month, gunmen stormed a clinic and murdered 13 people, execution-style. (The mayhem wasn’t random; drug gangs operate such facilities as safe havens for their foot soldiers.) Wilkins’s primary concern, however, was noisy neighbors in the duplex, not narco-violence.

„We’d hear cell phones ring through the wall, and ranchero music—you’d hear everything,“ she recalls. „You’d try to go into a guided meditation and hear someone hammering a nail.“

Wilkins now rents a lavish four-bedroom home on a hill overlooking Tijuana’s upscale Playas neighborhood. Amenities include a hot tub, weight room, fireplace, and veranda with panoramic views. Safety was not overlooked: The subdivision is gated, and security guards inspect every vehicle that enters.

Stays at Pangea aren’t cheap. For the standard 10-day detox, Wilkins charges $7,500, travel not included. She employs a staff of 10, including two Mexican physicians, a paramedic, a masseuse/acupuncturist, and a chef. The chef, Wilkins’s sister, Sarah, is a recovering addict who credits ibogaine for kicking her drug dependence.

Aaron Aurand, a live-in volunteer, feels the same way.

„I did eight months of court-ordered inpatient treatment before I came here,“ says Aurand, a native of Spokane, Washington. „I got more therapy here in five days than I did in that entire time. Lots of junkies don’t want to look inside themselves. With this, you’ll get shown.“

In addition to ibogaine, Clare Wilkins emphasizes nutrition. The clinic’s pantry is mostly organic and gluten-free and boasts a cache of vitamins and supplements that patients gobble by the handful.

“The body has its own framework and can heal itself if you remove harmful substances and balance the systems. We do colon cleanses and liver cleanses even before they get the ibogaine,” Wilkins explains, pointing out that there are practical reasons for the former: “You get people who come in here—especially opiate addicts—who are clogged up.”

To date, Wilkins says, she has treated more than 300 patients. „Sixty-two percent of our clients are chronic-pain patients,“ she says. „You’re not talking IV [heroin] addicts or crack addicts. You’re talking grandmas on Oxycontin.“

Some people come for „psycho-spiritual“ purposes. Ken Wells, an environmental consultant from Santa Rosa, California, with a neatly trimmed gray mustache and wire-frame glasses, says he underwent conventional counseling for depression for 15 years before trying ibogaine as a last-ditch effort to save his crumbling marriage.

Three days after taking ibogaine for the first time, Wells compares the experience to „defragging a computer hard drive.“ He experimented with psychedelics decades ago in college but says ibogaine is like nothing else.

„It was outrageously powerful,“ Wells says. „It was like the inside of my eyeballs was an IMAX screen. It was all-encompassing, just a multitude of images, like 80,000 different TVs, all with a different channel on—just jillions of images, shapes, and colors.“

Did the experience help him find what he was looking for?

„I think I’m different,“ he says. „But I don’t know.“

It’s easier to track ibogaine’s effect on hardcore addicts. Wilkins, who keeps tabs on former clients, estimates that one out of every five stays off his or her „primary substance“ for six months or more.

Tom Kingsley Brown, an anthropologist at the University of California–San Diego who describes his area of study as „religious conversion and altered states of consciousness,“ recently began recruiting Pangea patients for an independent assessment of ibogaine’s long-term efficacy. Brown follows up monthly with opiate addicts during the year regarding their ibogaine treatment, to gauge whether their quality of life has improved.

„People I’ve interviewed at the clinic have had really good results, especially in the first month or so,“ reports Brown, who has enrolled four study subjects to date and hopes for a group of 30. „We know ibogaine interrupts the addiction in the short term, but what we’re really curious about is: Does that translate into long-term relief from drug dependence?“

Participants in Brown’s study fill out questionnaires that ask them to rate the intensity of different aspects of their trips, on a scale of one to five.

„People have been circling a lot of fours and fives,“ Brown says. „One of the things we’re trying to look at is if the intensity of the ibogaine experience correlates with treatment success. I strongly suspect there’s some sort of psychological component. I doubt it’s just a biological phenomenon.“

.

„The hallucinations are just an unfortunate side effect,“ Glick asserts, explaining that ibogaine works on the brain like a „hybrid“ of PCP and LSD. „Part of the problem is that when you go through this thing, it’s so profound you’ve got to believe it’s doing something. In part, it’s an attempt by the person who’s undergoing it to make sense of the whole thing.“

Generally speaking, Glick’s research on rats has shown that ibogaine „dampens“ the brain’s so-called reward pathway, reducing the release of neurotransmitters like dopamine, which cause the highs associated with everything from heroin to sugary foods. The compound has also been proven to increase production of GDNF, a type of protein that quells cravings, and to block the brain’s nicotinic receptors, the same spots that are stimulated by tobacco and other addictive substances. In other words, ibogaine doesn’t work in any one particular way or even on one specific part of the brain, and it’s these multiple „mechanisms of action,“ researchers say, that make it so effective for so many different types of addiction.

People who have taken ibogaine say it can have the unintended consequence of temporarily turning them off a substance other than their drug of choice. Lauren Wertheim traveled from her hometown of Omaha, Nebraska, to a rehab center called Awakening in the Dream House near Puerto Vallarta, Mexico, and used ibogaine to kick her meth habit.

„Ibogaine resets all your [tolerance] levels to zero, like you’ve never done drugs,“ she says. „Even coffee—the first cup set me off like a rocket launcher. That’s when I was like, ‚This stuff is for real.‘ “

Mash, the researcher from Miami, is convinced that ibogaine works long-term because it is stored in fat cells and processed by the liver into a metabolite called noribogaine that possesses powerful detoxifying and antidepressant properties.

„If you gave somebody LSD or psilocybin and they were coming off opiates or meth, they’d go right back out and shoot up,“ Mash says. „There’s evidence that it’s not the visions that get you drug-free; it is the ability of the metabolite to block the craving and block the signs and symptoms of opiate withdrawal and improve mood.“

Though they don’t question its effectiveness, both Mash and Glick believe it’s unlikely that ibogaine will ever be widely accepted in the United States. It’s not just that ibogaine makes people hallucinate. It can be fatal.

Since 1991, at least 19 people have died during or shortly after undergoing ibogaine therapy. Alper, the NYU professor, examined the causes of death in the fatalities, which occurred between 1991 and 2008. His findings suggest that ibogaine itself was not the culprit; the patients died because they had heart problems or combined the hallucinogen with their drug of choice. (By way of comparison, a study published last year by the Centers for Disease Control and Prevention found that between 1999 and 2006 more than 4,600 people in the United States died from overdoses involving methadone.)

„It’s knowing who to treat and who not to treat,“ Alper contends. „None of [the 19 fatalities] appear to have involved a healthy individual without pre-existing disease who didn’t use other drugs during treatment. Two deaths occurred when they took ibogaine in crude alkaloid or root-bark form—they didn’t know what they were taking or how much.“

Three of the deaths occurred at Clare Wilkins’s Tijuana clinic. She says two involved patients who had cocaine in their systems and the third victim had a pre-existing heart condition. Wilkins says she’s now more selective about her clients and requires that they undergo a drug test.

„The learning curve has been difficult at times, but people need to know this can be safe,“ Wilkins says. „We have to show people how far we’ve come.“

Some of the scientists, however, think they’ve found alternatives that will make the risks—and the tripping—associated with ibogaine unnecessary.

Mash has devised two ways to isolate the metabolite noribogaine and administer it: a pill, and a patch similar to the nicotine variety. She hopes to begin testing the products on humans by the end of this year.

„It has all the benefits without the adverse side effects—including no hallucinations,“ Mash says. „I spent a lot of years really pushing ibogaine as far as I could, both in preclinical and clinical studies. But everything that I’ve learned in the course of 18 years of working on ibogaine has convinced me that the active metabolite is the drug to be developed.“

Glick, meanwhile, teamed up with a chemist named Martin Kuehne from the University of Vermont to create and research a chemical called 18-MC (short for 18-methoxycoronaridine) that mimics ibogaine’s effect on a specific nicotinic receptor. Just like ibogaine, 18-MC appears to work wonders on drug-addicted rats.

„Cocaine, meth, nicotine, morphine—we did the same studies with 18-MC, and it worked as well or better than ibogaine,“ Glick says. „We also have data that it will be useful in treating obesity. In animals, it blocks their intake of sweet and fatty foods without affecting their nutrient intake.“

Glick and his cohorts have yet to determine whether their synthetic ibogaine has psychedelic properties. The rats, after all, aren’t talking.

„You look at an animal given ibogaine, and you can’t tell if they’re hallucinating. But they look positively strange,“ Glick says. „You give them 18-MC and you can’t really tell. But we hope when it gets to people, it won’t produce hallucinatory effects.“

The first human testing of 18-MC is scheduled to begin later this month in Brazil. But scientists there won’t be studying its effect on addiction. They’ll be investigating the drug’s potential as a cure for the parasitic infection leishmaniasis, an affliction similar to malaria that is common in tropical climates. Through pure coincidence, 18-MC is chemically similar to other drugs that are used to treat the disease.

The Americans jumped at the chance to test their product in South America. Although 18-MC has shown promise and no observable side effects in animals, not a single pharmaceutical company has shown interest in developing it as an anti-addiction product.

„We’re fortunate we have this other disease apart from addiction where we know it can be tested,“ says Kuehne, a veteran of big pharma who worked for Ciba (a predecessor of Novartis). „Pharmaceutical companies don’t like cures. Really, they don’t—that’s the sad thing. They like treatment. Something for cholesterol or high blood pressure that you [take] for years and years, every day. That’s where the profit is.“

Further complicating matters is the fact that 18-MC has proven difficult to manufacture. Obiter Research, a company based in Champaign, Illinois, that specializes in synthesizing experimental chemicals, spent nearly two years refining the process before successfully creating about 200 grams of the substance—just enough to send to Brazil to be administered to human subjects.

„Imagine a Tinkertoy Ferris wheel,“ says Bill Boulanger, Obiter’s CEO and a former chemistry professor at the University of Illinois. „It’s like taking that apart, then trying to use half of the parts to build a fire engine. Ibogaine is a natural product, and sometimes Mother Nature does a better job than the lab.“

Boulanger is convinced there’s money to be made from 18-MC. With Obiter, he plans to patent the manufacturing process and secure intellectual-property rights. He and two partners also created a separate company, Savant HWP, in hopes of eventually opening addiction clinics across the United States that administer 18-MC in conjunction with conventional rehab techniques such as 12-step programs.

“One part is resetting the trigger that’s saying, ‚Oh, I’ve got to have it,” Boulanger says. “That’s helping the people fight withdrawal, and that would be part of the whole operation. But it’s just one facet. It’s got to be holistic. Just handing out a pill and sending them on their way is a bad idea.”

The notion of hallucination-free ibogaine, however, rubs the drug’s die-hard supporters the wrong way.

„With methadone, they just removed euphoria from opiates,“ says Dimitri „Mobengo“ Mugianis. „This is the same process they’re doing now—removing psychedelic and visionary experience. Ibogaine works. What are they trying to improve or fix? It’s not broken, and they’re spending a great amount of time and money to fix it.“

A former heroin addict, Mugianis is an underground ibogaine-treatment provider. He kicked his habit with the help of ibogaine administered at Lotsof’s clinic in the Netherlands. The experience was so extraordinary that Mugianis was inspired to travel to Gabon to be initiated into the native Bwiti religion and was trained by local shamans. He says he has performed more than 400 ritualistic ceremonies on addicts, most of them in New York City hotel rooms, using ibogaine and iboga root bark.

Despite his strong belief in the power of ibogaine, Mugianis does not see it as a miracle cure for addiction.

„The 12-step approach really helped in combination with ibogaine,“ he says. „I say it interrupts the physical dependency, because that’s what it does. There’s no cure. It’s not a cure. It allows you a window of opportunity, particularly with opiate users.“

Efforts are afoot to legalize—or at least legitimize—ibogaine in the United States. Convincing doctors and elected officials to support a potent, occasionally lethal hallucinogen can be a tough sell. That pitch becomes doubly difficult when some of the ibogaine enthusiasts themselves inspire skepticism.

One of ibogaine’s most outspoken advocates is Dana Beal. An eccentric character who helped found the Youth International Party (more commonly known as the Yippies) in the 1960s, Beal sports a bushy white mustache that inspired a New York Times reporter to liken him to „a Civil War-era cavalry colonel.“ Beal travels the country giving PowerPoint presentations touting the benefits of ibogaine and medical marijuana.

In June 2008, he was arrested by police in Mattoon, Illinois, and charged with money laundering. He was carrying $150,000 in cash in two duffel bags, money he claims was going to finance an ibogaine clinic and research center in Mexico. Beal maintains his innocence and is free on bail as the case heads to trial.

It’s folks like Beal, says pharmacologist Stanley Glick, who keep ibogaine and 18-MC from being embraced by the medical mainstream.

„Some of my colleagues, as well as funding agencies, lump us together without really considering the data,“ Glick says. „There’s a lot of baggage that comes with ibogaine, some of it warranted, some of it unwarranted. It’s really a stigma. Drug abuse itself has a stigma, and unfortunately so does ibogaine. It has really hurt the science

Beal shrugs off the criticism, arguing that grassroots activism is the only way to ensure that politicians will endorse ibogaine. Besides, he adds, the government stopped funding ibogaine research long before he was arrested.

„[The scientists] think if they stay away from us activists, NIDA will bless them,“ says the self-styled rabble-rouser. „NIDA is not blessing them. They’re washed up and on a strange beach. How will they get FDA-approved clinical trials without activists? Explain to me a way that works, and I will do it.“

Beal jokes that the best advertisement for ibogaine might be an episode from the 11th season of Law & Order: Special Victims Unit in which a heroin addict who needs to testify in court is administered ibogaine to make his withdrawal symptoms disappear overnight. “Maybe Congress will watch SVU and say, ‚Maybe we should check this out—wow!—it works for methamphetamine, too?’” he says sarcastically.

In truth, ibogaine’s effectiveness against meth has already helped it gain acceptance abroad. Lawmakers in New Zealand, where methamphetamine use has skyrocketed in recent years, recently tweaked the nation’s laws to allow physicians to prescribe ibogaine. Dr. Gavin Cape, an addiction specialist at New Zealand’s Dunedin School of Medicine, says the nation’s doctors are so far reluctant to wield their new anti-meth weapon.

„[There are] no true controlled studies to give evidence as to its safety and effectiveness,“ Cape says. „There is a strong advocacy group [in New Zealand] for ibogaine, and it may turn out to have a place alongside conventional therapies for the addictions, but I’m afraid we are a few years away from that goal.“

Last month, dozens of ibogaine researchers, activists, and treatment providers gathered for a conference in Barcelona, where topics included safety and sustainable sourcing of ibogaine from Africa. Dr. Kenneth Alper was among the attendees who gave a presentation on the benefits of ibogaine to the Catalan Ministry of Health. The NYU prof believes ibogaine’s most likely path to prominence in the United States will be as a medication for meth addiction, for the simple reason that doctors and treatment providers have found that small daily—and thus drug-company-friendly—doses seem to work better for meth addiction than the mind-blowing „flood doses“ used on opiate addicts.

Alper says no one thought to try non-hallucinogenic quantities of ibogaine until recently. Ibogaine treatment providers tend to have been former ibogaine users, and most assumed that the introspection brought on by tripping was key to overcoming their addictions. „That’s just how it evolved,“ he says, noting that the large doses do seem to work best for opiate detox. „You’re talking about a drug that has been used in less than 10,000 people in the world in terms of treatment. It’s not surprising that’s how it evolved.“

„The visions have some psychological content that is salient and meaningful,“ Alper adds. „On the other hand, there is no successful treatment for addiction that’s not interpreted as a spiritual transformation by the people who use it. It’s the G-word. It’s God. We as physicians don’t venture into that territory, but most people do.“

source: http://www.villagevoice.com/2010-11-17/news/ibogaine-hallucingen-heroin/6/

Potent Jungle Vine Brew Has Potential to Treat Addiction

Researchers say ayahuasca, found in the Peruvian rainforest, could be used for a variety of ailments

New research suggests ayahuasca, a jungle vine found in the Peruvian rainforest, can have a powerful effect on the human central nervous system when brewed with other plants. Researchers say one of ayahuasca’s most promising uses could be in treating drug and alcohol addiction.

According to the World Health Organization, medicines derived from plants play a major role in the health care of 80 percent of the world’s population. Western medicine has synthesized many of these natural drugs, from the painkillers in willow bark to the anti-cancer compounds in the neem tree, and is constantly searching for more pharmaceuticals in the biodiversity of the world’s forests.

Ayahuasca is one traditional plant-based medicine that has drawn the attention of investigators. In the South American jungles, it is used in religious ceremonies to induce visions and also as a remedy to cure ills.

Vine of the dead could help improve life

At the Onanyan Shobo spiritual retreat center in the rainforest near Iquitos, Peru, shaman Alfredo Kayruna Canayo shows off a section of the twisting, leafy vine. „What ayahuasca means is vine of the dead,“ he explains through an interpreter. „Some people call it soul vine.“

Ayahuasca is known as a master plant, a very powerful remedy that treats the whole person: body, mind, and soul. „The ayahuasca [can] cure anything you have,“ the shaman says. „Start with simple things. For example, it’s very simple to cure or repel the bad energies from your insides. What is the bad energy? One of them could be the fears, then some wound or injury you have.“

VOA – E. Celeste

Shaman Alfredo heads for a treatment at Onanyan Shobo.

Whether the plant is being used for religious or medicinal purposes, ayahuasca is taken only in a ceremonial setting under the direction of an experienced shaman. To turn it into a drink, also called ayahuasca, pieces of the vine are pounded into a pulp and combined with several other plants, then brewed down for eight or more hours into a thick orange liquid.

That combination, shaman Alfredo says, is critical. „Only by itself, this plant doesn’t work good, you have to add this with the other plant – the chacruna – which is the help to the ayahuasca. In Shipibo culture, they believe the chacruna is the wife of ayahuasca because they help and work together.“

A sophisticated chemical concoction

An international research team is investigating the pharmaceutical potential of ayahuasca, known scientifically as Banisteriopsis caapi. Principal investigator, Dr. Charles Grob, is a professor of psychiatry and pediatrics at the UCLA School of Medicine. His team has done a chemical analysis of the medicinal drink.

VOA – E. Celeste

Pieces of the vine are pounded into a pulp and combined with several other plants, then brewed down for eight or more hours into a thick orange liquid.

While the shaman’s characterization of the herbal interaction may be whimsical, Grob says science confirms that the ayahuasca brew is a potent medication. „It’s a very sophisticated form of pharmacology, which somehow the native peoples of the Amazon region have figured out. Ayahuasca is generally a decoction of two plants. Each plant if taken separately has no effects on the human central nervous system, but when taken together there’s a very powerful synergy.“

The active ingredients in the brew are DMT, a naturally occurring brain chemical similar to serotonin, and a natural antidepressant. DMT is inactivated in the human gut, but when combined with the antidepressant, it can be absorbed by the body.

Grob says one of ayahuasca’s most promising uses is in treating drug and alcohol addiction. „Number one, it does not appear to be addictive and the individuals do not develop a tolerance, they do not go through withdrawals, and generally speaking, it is very unusual for people to take it on consecutive days over an extended period of time.“

The potion also has anti-parasitic properties, which can help prevent malaria. There is also some evidence that it diminishes the symptoms of Parkinson’s disease.

An illegal brew, for now

The U.S. Food and Drug Administration classifies the principal active ingredient in ayahuasca as a Schedule 1 controlled substance, which is not considered to have any legitimate medical use. As a result, the ayahuasca brew is illegal in the United States, and most of the pharmaceutical studies are being conducted in South America.

Grob says the studies are important. „There’s great potential to learn about the range of ayahuasca and to explore its therapeutic value, but first steps first, and I think first we need to fully understand how it’s utilized in South America and then do trials in the U.S. and Europe.“

VOA – E. Celeste

Retreats like Onanynan Shobo in the Peruvian jungle, have become popular destinations for the medical tourism industry.

Because many Shamans claim ayahuasca cures a variety of cancers, tumors, and other diseases, the Peruvian jungle has become a popular destination for the medical tourism industry.

Most of the visitors at Onanynan Shobo, where Shaman Alfredo practices, are European, with the remainder coming from the United States, Australia and Asia.

As long as its use in western medicine is illegal, anyone wishing to explore ayahuasca’s medical benefits will have to come to the source in South America.

Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment

ABSTRACT
Objectives To examine survival and long term cessation of
injecting in a cohort of drug users and to assess the
influence of opiate substitution treatment on these
outcomes.
Design Prospective open cohort study.
Setting A single primary care facility in Edinburgh.
Participants 794 patients with a history of injecting drug
use presenting between 1980 and 2007; 655 (82%) were
followed up by interview or linkage to primary care records
and mortality register, or both, and contributed 10 390
person years at risk; 557 (85%) had received opiate
substitution treatment.
Main outcome measures Duration of injecting: years from
first injection to long term cessation, defined as last
injection before period of five years of non-injecting;
mortality before cessation; overall survival.
Results In the entire cohort 277 participants achieved
long term cessation of injecting, and 228 died. Half of the
survivors had poor health related quality of life. Median
duration from first injection to death was 24 years for
participants with HIV and 41 years for those without HIV.
For each additional year of opiate substitution treatment
the hazard of death before long term cessation fell 13%
(95% confidence interval 17% to 9%) after adjustment for
HIV, sex, calendar period, age at first injection, and
history of prison and overdose. Conversely exposure to
opiate substitution treatment was inversely related to the
chances of achieving long term cessation.
Conclusions Opiate substitution treatment in injecting
drug users in primary care reduces this risk of mortality,
with survival benefits increasing with cumulative
exposure to treatment. Treatment does not reduce the
overall duration of injecting.
INTRODUCTION
Injection drug use is an important public health problem
with a prevalence of around 1-2% among young
adults in the United Kingdom and a standardised mortality
ratio over 10 times that of the general
population.1 Deaths in those who inject opiates are
mainly a consequence of overdose and bloodborne
infection.2 The principal treatment for dependent
users is opiate substitution therapy, commonly oral
methadone,3 which in the UK is mostly delivered in
primary care settings. Opiate substitution treatment
can reduce opiate use, mortality, and transmission of
bloodborne infections, though most evidence comes
from relatively short term studies.4-8
Short periods of cessation from injecting are relatively
common,9 but few studies have long enough follow-
up to observe long term cessation, and the impact
of opiate substitution treatment on the overall duration
of injecting is unclear.10
We report on a follow-up study of the Edinburgh
addiction cohort.11 This study included injecting drug
users, most of whom were using heroin, recruited
through Muirhouse Medical Group, a single primary
care facility in a deprived area of Edinburgh, during a
rapid local HIV epidemic.12 We describe the duration
of injecting and survival and assess the influence of
opiate substitution treatment and other factors on
these outcomes.
METHODS
Data source
Methods are described in detail elsewhere.11 13 Briefly,
between 1980 and 2006 all patients at a large primary
care facility in Edinburgh who reported a history of
injecting drug use were recruited to the study. Opiate
substitution treatment was publicly funded and accessible
to patients throughout the study period, in keeping
with national guidelines. Cohort members were
flagged with the General Register Office for Scotland
to allow for tracing of deaths and changes of general
practitioner. From October 2005 to November 2007
we attempted to contact all surviving cohort members
to conduct a follow-up interview. Information was also
collected from primary care notes when these were
available.

Read the whole study, it is the longest ever:Methadon, scotland

Western roots feed Afghan poppy scourge

For years, there has been much discussion about the best strategy to rid Afghanistan of its poppies. Eradication, said the George W Bush administration. Interdiction and alternative livelihoods, retorted the Barack Obama administration. Licensing and production for medicinal purposes, suggests the influential Senlis Council.

The issues have been fiercely debated: Would there be enough demand for Afghanistan’s legal morphine? Is the government too corrupt to implement this or that scheme? To what extent will eradication alienate farmers? Which crops should we substitute for poppies?

These questions are not unimportant, but fundamentally, they do not address the primary source of Afghan drug production: the
West’s (and Russia’s) insatiable demand for drugs.

Afghanistan accounts for about 90% of global illicit opium production. Western Europe and Russia are its two largest markets in terms of quantities consumed and market value (the United States is not an important market for Afghan opiates, importing the drugs from Latin America instead). Western Europe (26%) and Russia (21%) together consume almost half (47%) the heroin produced in the world, with four countries accounting for 60% of the European market: the United Kingdom, Italy, France and Germany.

In economic terms, the world’s opiates market is valued at $65 billion, of which heroin accounts for $55 billion. Nearly half of the overall opiate market value is accounted for by Europe (some $20 billion) and Russia ($13 billion). Iran is also a large consumer of opium, with smaller amounts of heroin. The situation is similar for cocaine, for which the US and Europe are the two dominant markets (virtually all coca cultivation takes place in Colombia, Peru and Bolivia).

In short, it is the West that has a drug problem, not producer countries like Afghanistan (or Colombia): demand is king and drives the global industry.

How should we reduce opiate consumption and its negative consequences in the West and Russia? Drug policy research has typically offered four methods. There is a wide consensus among researchers that such methods should be ranked as follows, from most to least effective: 1) treatment of addicts, 2) prevention, 3) enforcement, and 4) overseas operations in producer countries. For example, 12 established analysts reached the following conclusions, published a few months ago:

Efforts by wealthy countries to curtail cultivation of drug-producing plants in poor countries have not reduced aggregate drug supply or use in downstream markets, and probably never will … it will fail even if current efforts are multiplied many times over.

A substantial expansion of [treatment] services, particularly for people dependent on opiates, is likely to produce the broadest range of benefits … yet, most societies invest in these services at a low level.

Also, a widely cited 1994 RAND study concluded that targeting “source countries” is 23 times less cost effective than “treatment” for addicts domestically, the most effective method; “interdiction” was estimated to be 11 times less cost effective and “domestic enforcement” seven times. The problem is that the West’s drug policy strategy has for years emphasized enforcement, combined to overseas adventures, to the detriment of treatment and prevention. Also, Russia has been complaining about the suspension of eradication in Afghanistan, but it has a very poor record of offering treatment to its own addicts, rejecting widely accepted scientific evidence. Moscow has chosen a strategy that “serves the end of social control and enforcement,” just like the US: criminalization is emphasized and the largest share of public resources is directed to arrest, prosecute and incarcerate drug users, instead of offering them treatment. This worsens Russia’s HIV epidemic, the fastest growing in the world – with nearly one million HIV infections, some 80% of which related to the sharing of drug needles – while syringe availability remains very limited. For instance, methadone and buprenorphine remain prohibited by law in Russia, even if they are effective in reducing the drug problem by shifting addicts from illegal opiates to safer, legal alternatives. Accordingly, a just released New York University report states that “Nothing that happens in Afghanistan, for good or ill, would affect the Russian drug problem nearly as much as the adoption of methadone” in Russia – which would also help Afghanistan reduce poppy cultivation. Obama announced last year that the US would have access to seven military bases in Colombia under the pretext of fighting a war on terror and a war on drugs. Likewise, Russia recently announced that it would set up a second military base in Kyrgyzstan, to combat drug trafficking. Victor Ivanov, the Director of the Russian Federal Drug Control Service, explained how he was inspired by US drug war tactics in Latin America:

The United States‘ experience is certainly quite effective. The powerful flow of cocaine from Colombia into the United States prompted Washington to set up seven military bases in the Latin American nation in question. The US then used aircraft to destroy some 230,000 hectares of coca plantations … Russia suggests building its military base in Kyrgyzstan since it is the republic’s Osh region that is a center of sorts whence drugs are channeled throughout Central Asia.

Europe’s record on drug policy has improved over the last two decades, important advances having been made to bring harm reduction into the mainstream of drug policy, and rates of drug usage for each category of drugs are lower in the European Union (EU) than in states with a far more criminalized drug policy, such as the US, Canada and Australia. But there is still room for improvement. For example, although opioid substitution treatment and needle and syringe exchange programs now reach more addicts, “important differences between [European] countries continue to exist in scale and coverage”, a recent review of harm reduction policies in Europe concludes. In particular, “Overall provision of substitution treatment in the Baltic States and the central and south-east European regions, except in Slovenia, remains low despite some recent increases. An estimate from Estonia suggests that only 5% of heroin users in the four major urban centers are covered by substitution programs, and that this rate is as low as 1% at national level.“ Lack of funds is no excuse, as there is plenty of money available, for instance, out of the $300 billion Europeans spend every year on their militaries, to maintain among other things their more than 30,000 troops in Afghanistan. The UK was put in charge of counter-narcotics in Afghanistan. However, domestically, leading specialists Peter Reuter and Alex Stevens report that “Despite rhetorical commitments to the rebalancing of drug policy spending towards treatment… the bulk of public expenditure continues to be devoted to criminal justice measures… this emphasis on enforcement in drug control expenditures also holds for the most explicitly harm reduction-oriented country, the Netherlands.“ In the UK, over 1994-2005, “the number of prison cell years handed out in annual sentences has tripled“ (although significant increases have also been made towards treatment). “The prison population has increased rapidly in the past decade [and] the use of imprisonment has increased even more rapidly for drug offenders than other offenders… These increases have contributed significantly to the current prison overcrowding crisis.“ British enforcement costs taxpayers dearly, but the government does not regularly or publicly calculate those costs. Through a Freedom of Information request a document was released that “calculated the annual cost of enforcing drug laws – including police, probation, prison and court costs – at approximately ฃ2.19 billion, of which about ฃ581 million was spent on imprisoning drug offenders.“ All this said, there is one way in which Afghanistan does have a drug problem, namely, its increasing number of addicts. A recent report from the United Nations Office on Drugs and Crime (UNODC) estimated that drug use had increased dramatically over the last few years and that around one million Afghans now suffer from drug addiction, or 8% of the population – twice the global average. Since 2005, the number of regular opium users in Afghanistan has grown from 150,000 to 230,000 (a 53% increase) and for heroin, from 50,000 to 120,000 (a 140% increase). This spreads HIV/AIDS because most injecting drug users share needles. But treatment resources are very deficient. Only about 10% of addicts have ever received treatment, meaning that about 700,000 are left without it, which prompted UNODC chief Antonio Maria Costa to call for much greater resources for drug prevention and treatment in the country. The problem is that the Obama and Bush administrations could not care less: since 2005, the US has allocated less than $18 million to “demand reduction” activities in Afghanistan – less than 1% of the $2 billion they spent on eradication and interdiction. Clearly, US priorities have nothing to do with fighting a war on drugs.

source: http://www.atimes.com/atimes/South_Asia/LG01Df02.html

Fatty foods may cause cocaine-like addiction

Scientists have finally confirmed what the rest of us have suspected for years: Bacon, cheesecake, and other delicious yet fattening foods may be addictive.

A new study in rats suggests that high-fat, high-calorie foods affect the brain in much the same way as cocaine and heroin. When rats consume these foods in great enough quantities, it leads to compulsive eating habits that resemble drug addiction, the study found.

Doing drugs such as cocaine and eating too much junk food both gradually overload the so-called pleasure centers in the brain, according to Paul J. Kenny, Ph.D., an associate professor of molecular therapeutics at the Scripps Research Institute, in Jupiter, Florida. Eventually the pleasure centers „crash,“ and achieving the same pleasure–or even just feeling normal–requires increasing amounts of the drug or food, says Kenny, the lead author of the study.

„People know intuitively that there’s more to [overeating] than just willpower,“ he says. „There’s a system in the brain that’s been turned on or over-activated, and that’s driving [overeating] at some subconscious level.“

In the study, published in the journal Nature Neuroscience, Kenny and his co-author studied three groups of lab rats for 40 days. One of the groups was fed regular rat food. A second was fed bacon, sausage, cheesecake, frosting, and other fattening, high-calorie foods–but only for one hour each day. The third group was allowed to pig out on the unhealthy foods for up to 23 hours a day.

Not surprisingly, the rats that gorged themselves on the human food quickly became obese. But their brains also changed. By monitoring implanted brain electrodes, the researchers found that the rats in the third group gradually developed a tolerance to the pleasure the food gave them and had to eat more to experience a high.

They began to eat compulsively, to the point where they continued to do so in the face of pain. When the researchers applied an electric shock to the rats‘ feet in the presence of the food, the rats in the first two groups were frightened away from eating. But the obese rats were not. „Their attention was solely focused on consuming food,“ says Kenny.

In previous studies, rats have exhibited similar brain changes when given unlimited access to cocaine or heroin. And rats have similarly ignored punishment to continue consuming cocaine, the researchers note.

The fact that junk food could provoke this response isn’t entirely surprising, says Dr.Gene-Jack Wang, M.D., the chair of the medical department at the U.S. Department of Energy’s Brookhaven National Laboratory, in Upton, New York.

„We make our food very similar to cocaine now,“ he says.

Coca leaves have been used since ancient times, he points out, but people learned to purify or alter cocaine to deliver it more efficiently to their brains (by injecting or smoking it, for instance). This made the drug more addictive!

According to Wang, food has evolved in a similar way. „We purify our food,“ he says. „Our ancestors ate whole grains, but we’re eating white bread. American Indians ate corn; we eat corn syrup.“

The ingredients in purified modern food cause people to „eat unconsciously and unnecessarily,“ and will also prompt an animal to „eat like a drug abuser [uses drugs],“ says Wang.

The neurotransmitter dopamine appears to be responsible for the behavior of the overeating rats, according to the study. Dopamine is involved in the brain’s pleasure (or reward) centers, and it also plays a role in reinforcing behavior. „It tells the brain something has happened and you should learn from what just happened,“ says Kenny.

Overeating caused the levels of a certain dopamine receptor in the brains of the obese rats to drop, the study found. In humans, low levels of the same receptors have been associated with drug addiction and obesity, and may be genetic, Kenny says.

However, that doesn’t mean that everyone born with lower dopamine receptor levels is destined to become an addict or to overeat. As Wang points out, environmental factors, and not just genes, are involved in both behaviors.

Wang also cautions that applying the results of animal studies to humans can be tricky. For instance, he says, in studies of weight-loss drugs, rats have lost as much as 30 percent of their weight, but humans on the same drug have lost less than 5 percent of their weight. „You can’t mimic completely human behavior, but [animal studies] can give you a clue about what can happen in humans,“ Wang says.

Although he acknowledges that his research may not directly translate to humans, Kenny says the findings shed light on the brain mechanisms that drive overeating and could even lead to new treatments for obesity.

„If we could develop therapeutics for drug addiction, those same drugs may be good for obesity as well,“ he says.

Hepatitis C Treatment of Substance Users in Pharmacotherapy for Addiction

Introduction:

Hepatitis C, Substance Use,
and Dependence
Illicit drug and alcohol abuse and dependence are problems
of major medical importance in the United States, leading
to high rates of morbidity and mortality from end-stage
liver disease. The prevalence of illicit drug use in the United
States, as estimated by the National Survey on Drug Use
and Health in 2002, stands at 19.5 million Americans above
the age of 12; half of Americans aged 12 or older (51.0%)
reported being current drinkers of alcohol, an estimated
120 million people [1•].

Salient illicit drug use and practices
are presented in Table 1. The Centers for Disease Control
has estimated that 60% of all new cases of hepatitis C are
related to injection drug use [2]. Injection drug practices
include the use of heroin, cocaine, methamphetamine, and
prescription opioids (Table 1).

It has been estimated that
there are at least 800,000 untreated injection-heroin users
[3]. However, the population of opioid-drug users may be
grossly undercounted, because some surveys have found up
to three times more illicit drug users in particular regions
than commonly estimated [4].
Drug addiction is a chronic, relapsing neurophysiologic
disease resulting from the prolonged neurologic
effects of drugs. The neurochemical abnormalities resulting
from chronic use, such as opioids, underlie many of the
observed physical and behavioral aspects of addiction
(Table 1). The brain abnormalities associated with addiction
are wide ranging, complex, and long lasting [5,6].

They can involve genetically abnormal brain signaling
pathways, social factors, psychological conditioning or
stress, and result in cravings leading to a predisposition to
relapse even months or years after drug use cessation.
Recent studies have identified risk factors for the transition
to injection drug use that include the following: emerging
drug practices, differential characteristics of opiate injectors
versus inhalers, and patient-related factors that predict
entry into substance abuse treatment [7•,8].

The importance
of limiting individuals from progressing to injection
drug use can be vividly seen from data comparing the
hepatitis C incidence between injection and noninjection
drug users [9]. This longitudinal surveillance study in
New York City showed an annual incidence rate of
hepatitis C in young noninjection drug users of 0.4 per 100
person-years compared with 35.9 per 100 person-years in
injection drug users (IDUs).

Thus, delaying or preventing
the transition to injection drug use can have a significant
health benefit by reducing the risk of comorbid conditions
associated with substance abuse and addiction.

read the full file here: 002_HP04-3-1-05

Next Door but invisible!

The WAGER Vol. 9(11) – Attribution, Addiction, and Gambling: Series Conclusion

Series Special Editor: Sarah E. Nelson

Attributions play a role in all aspects of addiction. Attributions for wins and losses can influence the development of gambling problems (see WAGER 9(6)); attributions about peers’ drinking behavior can affect a person’s own drinking behavior (see WAGER 9(7)); being labeled as a heavy smoker can alter people’s attributions about their smoking (see WAGER 9(8)); people’s attributions about their own addictive behavior differ in predictable ways from attributions they make about others’ addictive behaviors (see WAGER 9(9)); and the attributions people make about their addictions can predict their own chances for recovery or likelihood of relapse (see WAGER 9(10)). This week’s WAGER reviews an article that attempts to model the way attributions change across the course of addiction (Davies, 1996).
Davies’ theory of attribution change rests on the idea that the explanations people make for their behaviors are functional: people make different attributions for the same  event in different contexts (i.e., depending on the setting and the goals of the interaction) (Davies, 1996; Schlenker & Weigold, 1992; Tedeschi & Reiss, 1981). For example, in a group of heroin users, Davies found that subjects made different attributions for their own heroin use to an interviewer who substance using habits were unknown than they did to a fellow heroin user (Davies & Baker, 1987). When it comes to explaining our own behavior, the attributions we make often reflect an ego-defensive bias: that is, attributions about the self serve to protect self esteem, meet self-presentational goals, and preserve self-concept (Schlenker, Weigold, & Hallam, 1990). Davies’ model reflects how attributions might serve this self-protective function in relation to an addiction.

In several different studies, Davies and his colleagues conducted interviews in Scotland with drug and alcohol users both in and out of treatment. Based loosely on these interviews, Davies outlined five attributional stages through which a person might progress as an addiction develops. Each stage is marked by a different attribution style for substance-using behavior. In Davies’ model, attributions can vary in terms of purposiveness (i.e., how intentional the behavior is portrayed), hedonism (i.e., how positively the behavior is described), contradictoriness (i.e., whether attributions contradict across the course of the interview), and the inclusion of addicted self-ascription (i.e., whether attributions make use of the concept of addiction as an explanation for behavior). (1)

During the first stage, presumably before the substance using behaviors become a problem, subjects’ attributions for their drug or alcohol use are high on purposiveness and hedonism – people enjoy using the substance and consider it under their control. During stage two, as problems begin to surface, subjects’ discourse becomes contradictory, varying from context to context between the positive and negative aspects of drug use, and the controlled and uncontrolled aspects of their using behavior. These attributions reflect the ambivalence that emerges during the development of addiction (e.g., Shaffer, 1997). During stage three, people refer to themselves as addicted, explain their substance use as out of their control, and view it as negative. At stage four, people begin to reject the usefulness of the concept of addiction in explaining their behavior and their discourse again becomes mixed and contradictory. Finally, people are able to proceed to a fifth stage that is either positive or negative. In either version, their attributions are relatively stable (i.e., the attributions don’t contradict from one context to another) and do not refer to substance using behavior in terms of addiction. In the positive version, people might have given up drugs or alcohol, but return to a view of their past behavior as controllable and a description of their use that highlights both the positive and negative aspects of that behavior. In the negative version, although the concept of addiction has been dropped, people continue to use substances and see themselves as “down and out” – their behavior is uncontrollable and their substance use is negative. Although these stages tend to relate to the progression of an addiction, people can move back and forth between stages. The one exception to this, according to Davies, is an irreversible transition from stage two to stage 3, which often occurs when subjects enter treatment and may persist long after; consider the Alcoholics Anonymous practice of participants introducing themselves, “Hi, my name is X and I’m an alcoholic.” .

To test this model of attributions, interviews with drug and alcohol users were transcribed and coders rated the attributions given in each interview in terms of the dimensions outlined in the model. The investigators assigned each respondent to one of the six stages based upon those ratings. Consensus between four judges rating the same twenty subjects was good: average agreement between the judges was 71% (.’s ranged from .49 to .75). In all cases, the judges never disagreed by more than one stage.
Although Davies demonstrated the reliability of his model (i.e., ability of coders to identify the attribution patterns associated with each stage) and stated that these stages related to the stages of an addiction, he did not provide information about hwo the attributional stages correspond to the actual temporal progression of addiction in his interviewees (e.g., whether the majority of subjects classified as stage 3 were in treatment at the time of the interview). Given his claim that movement between at least two of the stages is irreversible (a claim that contradicts established research on addiction stages — see Prochaska, Norcross, & DiClemente, 1994; Shaffer, 1997), this research is needed to verify the model. Also, although he developed his model based on years of observations and interviews of substance users, in this paper he only tests it on twenty interviewees. Given the theoretical basis of the model (i.e., that attributions vary according to context), it is important to test this model and its stages in different samples of substance users and different settings.

Davies’ model of attribution change needs to be validated, but is important for the questions it raises. How do these attributional stages relate to the stages of change described in more well-studied models (e.g., precontemplation, contemplation, preparation or determination, action, maintenance, and termination; Prochaska, Norcross, & DiClemente, 1994)? If these attributional patterns do reliably correspond to different stages of an addiction, it is important to determine

whether these attributions predict change (e.g., provide explanations that refer to being addicted as precursors of treatment-seeking behavior) or reflect change (e.g., provide explanations that refer to being addicted as an attempt to understand and explain past behavior within the treatment context). Both possibilities (i.e., predictive and reflective) and the research reviewed in this WAGER series stress the importance of people’s subjective understanding and interpretation of behavior in guiding future behavior. This attribution-behavior cycle is a crucial, often neglected piece of the study of addictions.

Is heroin addiction related to a dysfunctional processing of reward and hedonism in the brain? Insights from neuroimaging studies

The functioning of reward in drug addicts is a major issue both in terms of
pathophysiology and in a rehabilitative view. We used a PET imaging device
to assess the hedonic functioning of methadone maintained heroin addicts,
compared to control subjects, by two modalities: 1) the elicitation of interest by
anticipated monetary reward; 2) the neuroimaging correlates of visually elicited
pleasure. In heroin addicts fewer brain regions showed activated during tasks
implying known monetary reward in comparison to tasks without any reward.
On the other hand, the processing of subjectively pleasant videoclips resorted to
different brain pathways in heroin addicts. Heroin addicts seem to show a lower
level of anticipatory sensitivity to monetary reward, whereas the topography of
pleasure-feeling seems to be different from normal subjects’. Such results show
a different reward-seeking and reward-feeling status of methadone maintained
heroin addicts, although it is to be clarified whether such a status was also forerunning
heroin use, or developed as a correlate of addiction

Read more:Martin-Soelch 8(2)2006