Neurobiology and Relapse

The results of a recent study, which will be published in the June issue of Alcoholism: Clinical & Experimental Research, found that MRI-based neuroimaging research holds potential in identifying abnormalities in brain biology that may serve as markers for increased risk of substance abuse relapse. (Medical News Today)

Studies have shown that at least 60 percent of individuals in recovery for alcohol abuse disorders relapse within six months of treatment. Because the reward system of the brain (BRS) has been “implicated in the development and maintenance of all forms of addictive disorders,” researchers of the current study compared thickness, surface area and volume of neocortical components of the reward system of the brain. The study participants included three groups: light drinkers, alcohol-dependent individuals still abstinent after treatment, and those who relapsed. (Medical News Today)

As we’ve discussed before, the reward system of the brain (BRS) includes regions in the frontal and temporal lobes, limbic system, basal ganglia and other subcortical structures. These form a functional network that is involved in how one experiences and responds to pleasure and aversion, mood regulation, higher-level cognitive abilities, such as problem-solving, reasoning, decision-making, planning and judgement, memory, as well as impulse control. It is believed that abnormal biology of the BRS may play a significant role in the development of drug and alcohol dependencies.

For the current study, researchers used magnetic resonance imaging (MRI) to examine the BRS and determine whether there were structural differences in the brain’s cortex for the three groups. The findings support the fact that neurobiological factors influence relapse. Of the two groups who suffered with alcohol dependency (abstainers and relapsers), their brain’s had significantly thinner cortices in the BRS and throughout the brain. Those who had relapsed showed showed the most substantial structural abnormalities in the BRS with lower surface area and volume than the abstainers and the control group. This may mean they have fewer brain cells and neural resources available to assist with recovery. (Medical News Today)

Another significant finding was that of those individuals who relapsed, the ones with the greater volume and surface area in several regions of the BRS had a less severe relapse.

Not only does neuroimaging techniques promote a better understanding of the neurobiological factors associated with relapse, but as this study shows, such methods can be useful in identifying patients with the greatest degree of neurobiological abnormalities and thus the most at risk for relapse at the beginning of treatment. This can help predict which patients will benefit most from certain treatments and aftercare plans.

Can Genes Influence the Severity of Substance Abuse?

A recent study by the Brookhaven National Laboratory found that drug-addicted individuals who have a certain genetic makeup showed lower gray matter density (and therefore fewer neurons) in areas of the brain that are crucial in decision-making, impulse control, learning and memory. As a result, the study demonstrated that genes can influence the severity of addiction for an individual.

Using cocaine-addicted individuals and a control group, scientists took DNA samples and analyzed them for the presence of high or low MAOA to determine each participant’s genotype. MAOA is an enzyme that regulates neurotransmitters in the brain, such as serotonin and dopamine.

The cocaine-addicted individuals with a low MAOA genotype had lower gray matter density in the frontal cortex of the brain than those addicted to cocaine with a high MAOA genotype and the control group (non-addicted individuals). In addition, the study found that patterns of low gray matter correlated with the number of years drugs and alcohol were abused. The longer the substance abuse, the lower gray matter was found the the frontal cortex of the brain.

The research suggests that addicted individuals with a low MAOA genotype may need different methods of treatment than those who carry a high MAOA genotype. The researchers say more studies need to be conducted to further shed light on these neurobiological findings.(Medical News Today)

The study was published in a March issue of  the Archives of General Psychiatry.

Number One, International Killer: Alcohol

This month it was announced by the World Health Organization (WHO) that the number one international killer is alcohol, contributing to 2.5 million deaths worldwide a year. There is also a growing concern over the number of alcohol-related injuries such as car accidents, burns, falls and poisonings, as well as other social and financial tolls such violence, disease, child neglect and job absenteeism.

“Substance abuse disorders profoundly affect our society,” said Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA). In economic terms, alcohol abuse disorders costs the U.S. approximately half a trillion dollars a year. But as Dr. Volkow said, “[Alcohol abuse] is much more insidious, eroding the foundation of human relationships and the established social contract.” (Medical News Today)

A new federal study in the U.S. found that parents are giving their children alcoholic beverages at a much higher rate than most people realize. According to a report from SAMHSA, in the past month alone 200,000 kids were given alcohol by a parent or other adult family member. This is especially dangerous with studies confirming that drinking as a teenager is a potential gateway to alcohol problems in adulthood. In fact, studies show that people who begin drinking before the age of fifteen are six times more likely than those who start at twenty-one to develop an alcohol problem. Parents need to be aware that providing alcohol to children can expose them to an increased risk for alcohol abuse.

The key finding in a recent study regarding the Rutgers Alcohol Problem Index (RAPI), which is widely used to assess adolescent drinking-related problems, found that the more drinking-related problems experienced by an adolescent at the age of eighteen, the greater the likelihood of alcoholism being diagnosed at the age of twenty-five.

Prevention: Are Education and Awareness the Only Tools?

Despite the fact that now more than ever, schools educate students on the risks of substance abuse, the number of cases involving substance abuse disorders continues to climb. This is also true regardless of television regularly displaying the destructive nature of drug abuse, including its negative consequences and social repercussions while intoxicated (often surrounding celebrity hype) and the harsh rigors of trying to get and stay sober (often shown through popular reality shows such as “Intervention”). And while educational exposure to the negative, long-term repercussions of drug and alcohol use maybe prevent some people from developing addictions, others remain vulnerable. Scientists are starting to understand why this is the case.

People who are at risk for developing substance abuse disorders tend to exhibit a trait called “delay discounting,” which is a cognitive function that involves circuits in the frontal cortex of the brain that stores and manages information necessary to guide behavior. This trait causes the tendency to devalue rewards and punishments that occur in the future. It is often paralleled by “reward myopia,” a tendency to choose immediate rewarding stimuli like drugs or alcohol. This may be one reason why education alone cannot prevent substance abuse. Studies have found that people vulnerable to addiction, who know that drugs are harmful in the long-run, devalue such information and are drawn to the instant rewarding effects of drugs or alcohol. (Medical News Today)

This is also evident with those suffering from substance dependencies who face legal, financial, or health problems. Studies have shown they almost consistently choose instant gratification as long as the reward is sooner, despite whether the future reward is greater. Neuroscientists understand that a major challenge in preventing and treating addiction is the reduced value of future reward, especially once the brain is hijacked by drugs or alcohol.

In a new study, published in Biological Psychiatry, faculty members of Virginia Tech Carilion Research Institute present a strategy that increases the value of future rewards in the minds of substance abuses and those at risk. The researches found that by increasing an individual’s ability to remember decreases the level of discounting future events. The head researcher reiterated, an “improved memory resulted in a greater appreciation of future reward.” (Medical News Today)

The idea for this rehabilitation technique was borrowed from methods used on stroke and traumatic brain injury victims. It involves individuals repeatedly performing working memory tasks. Ultimately, the brain “exercises” were found to promote the functioning of underlying cognitive circuits. When used on substance abuses, this cognitive rehabilitation tool improved working memory and reduced the discounting of delayed rewards. Such a tool may also prove to be invaluable in reaching those most at risk for substance abuse.

Prescription Drugs and Binge Drinking: Abuse Trends Shift

The Centers for Disease Control and Prevention recently released a report, the first of its kind, that detailed the socioeconomic and racial disparities in an extensive range of health problems. Although some trends remained the same across the board, and fairly obvious, such as “the poor, the uninsured and the less educated tend to live shorter, sicker lives” (New York Times). Others trends involving prescription drugs and binge drinking came as more of a surprise.

For example, obesity and tobacco use were worse among individuals with low incomes, who lacked education or health insurance. While the opposite was true of binge drinking. Consuming more than four drinks for women and five for men in one sitting constitutes binge drinking. The study not only found that binge drinking was one the rise across the board, but that it was more common among those with higher incomes and better education, including college students. However, those with lower incomes, especially among American Indians, tended to consume more alcohol when they binge drink. (New York Times)

Another trend that has changed is prescription drug overdoses kill more people now than illegal drug overdoses (the opposite from 20 years ago). Prescription drug overdose death rates are now higher among White, non-Hispanics than other groups (a trend that shifted in 2002). One reason given for this: “doctors began prescribing stronger painkillers, antidepressants and antipsychotics, more easily obtained by people with health insurance” (New York Times).

This report comes at the same time as the Food and Drug Administration (FDA) recently issued new, strict limits on the common ingredient acetaminophen found in prescription painkillers. In 2009, an advisory panel recommended that the FDA remove acetaminophen entirely from painkillers. The FDA has decided to allow prescription painkillers to contain 325 milligrams (about half of what they contain today). Companies have three years to adjust their product’s formula or remove it from the market. More than 200 million painkiller prescriptions are written each for Americans.

Heavy Drinking and Increased Risk of Cognitive Impairment

A study with a followup of more than two decades found that midlife alcohol consumption is related to the risk of dementia assessed as much as 20 years later. In particular, individuals who consume large amounts of alcohol are at a greater risk for cognitive impairment later on in life. The study appeared in the December issue of the Journal of Alzheimer’s Disease.

Not only was total alcohol consumption analyzed but also drinking patterns. The findings suggest that drinking large amounts at a single occasion, i.e. binge drinking, at least once a month was an independent factor that doubled the risk of cognitive impairment regardless of whether total alcohol consumption was controlled. The same was found for heavy drinking that resulted in passing out. Therefore, the study reports that not only is the amount of alcohol consumed significant in affecting the risks for cognitive impairment, but also the patterns by which alcohol is consumed.

The findings of the study are important in that changes or early symptoms associated with Alzheimer’s disease (the most common form of dementia) can begin as early as two to three decades prior to clinical manifestation of the disease. This means that identifying early risk factors can be imperative for prevention and treatment.

Risk for Alcoholism and Obesity Linked?

Researchers at Washington University School of Medicine have recently found that those with a higher risk for alcoholism may also be at a higher risk for obesity. The study also found that this correlation between family history of alcoholism and obesity has become more pronounced over the years, which suggested that some of the risks are a function of the environment as well genetics.

The researchers analyzed data from two large alcoholism surveys from the past two decades inclusive of almost 80,000 participants. The study found that individuals with a family history of alcoholism had a greater risk for obesity. This proved even more true for women than men. In 2001 and 2002, women who had a family history of alcoholism were 49 percent more likely to be obese than those without alcoholism in their family history. The risk for obesity also seems to be growing. In the late 1970s in the U.S., 15 percent of the population was obese. By 2004 this percentage had nearly doubled (33 percent).

The research suggests that changes in the food we eat since the 70s and 80s may explain the connection between alcoholism and obesity. Today, many tend to consume higher calories and consist of a sugar, salt, fat combination that appeals to the reward center of the brain, the same brain areas that are effected by alcoholism. The greater availability of these foods may also contribute to the increase.

Alcohol abuse over-stimulates the reward center of the brain until it is unable to support itself with its own chemicals. This leads to anxiety, depression, and greater dependence on the substance. These high-caloric, hyper-palatable foods seem to stimulate the brain in the same way, leading to overconsumption and addiction. However, the researchers noted that not all alcoholics were obese or vice versa. One theory of explanation for obesity in individuals with a family history of alcoholism, is that many may avoid alcohol and turn to food instead, resulting in one addiction instead of another, because of the result the food has on their brain.

The researchers hope that their study will open up a dialogue among addiction therapists, treatment specialists, and those who study obesity. Understanding the correlation between alcoholism and obesity is important in determining methods of prevention and treatment and developing possible advancements in treatment.

Genetic Variant Associated with Increase in Substance Abuse Susceptibility

Researchers at Ohio State University believe they’ve found a genetic variant (characterized by one or both of two identified, tiny gene mutations) that is associated with a more than three times increase in susceptibility to severe cocaine abuse with the risk of fatal overdosing, compared to non-carriers of the genetic variant. (Medical News Today)

This genetic variant was most common among white people with nearly one in five carrying the genetic variant. Among this group of people, one or both of the genetic variants were found in more than 40 percent of the autopsy brain samples from those known to abuse cocaine. This is compared to only 19 percent of those who lived drug-free and contained one or both of the genetic variants.

It was found that this genetic variant, one or both in combination, affect how dopamine functions in the brain. As we’ve discussed before, dopamine is a key neurotransmitter in the reward center of the brain, as well as numerous, regulatory functions of the central nervous system. Previous studies have shown that cocaine blocks dopamine’s reabsorption, leaving the chemical outside the brain cells and thus creates an artificial “feel-good” sensation.

This study found that in people who carry this genetic variant, the “function of a gene responsible for transmitting dopamine signals in the brain is altered” (Medical News Today). This led scientists to believe that this alteration can send neurotransmitters into a vicious cycle, including the development of cravings for an artificial substance, such as cocaine, that can maintain elevated levels of dopamine in the brain.

The study will soon be published in Neuropsychopharmacology. It has further opened the door to more questions about the involvement of the variant in initial use of the drug, level of cravings, and strength of the overall effect of the trait. It also suggests the need to explore how this variant could affect treatment for other psychiatric disorders involving dopamine.

Does Negative Stigma Deter Seeking Help?

Albeit the availability of numerous programs that effectively treat alcohol dependencies, less than 25 percent of people who need help actually seek treatment. Individuals who often perceive a greater negative stigma surrounding substance abuse and dependencies avoid seeking treatment in fear of it confirming their inclusion into a stigmatized group. A recent study conducted by Columbia University found that of the people diagnosed with alcoholism, more than 60% said they would avoid seeking help if they believed they would be stigmatized if people knew.

The study surveyed 34,653 members of the general population (6,309 had been been diagnosed with an alcohol-related disorder). The findings included that individuals diagnosed with an alcohol-related dependency- who perceived a negative stigma surrounding substance abuse – were 0.37 times less likely to seek treatment than those with similar alcohol-related dependencies who did not perceive a negative stigma surrounding substance abuse.  (Medical News Today)

Mike Sanders, founder of ExecuCare ARC, said that as a business professional he was affected by the perceived negative stigma prior to entering recovery for alcohol and prescription drug dependencies. As the owner of a company, he was attracted to the 10-day Neurotransmitter Restoration (NTR) because it was conducive to his circumstances. It was discreet, minimal withdrawal symptoms, eliminated cravings, restored clarity of mind, but most importantly, it broke the cycle of dependency and allowed him an entry point into the recovery process. “I can relate to negative stigma increasing the barrier of that entrance point,” he said. Mike opened ExecuCare in hopes of offering individuals the same opportunity NTR brought him.

In the study, other findings in the general population were: younger individuals perceived a less negative stigma surrounding substance abuse, but were less likely to seek treatment. Men perceived a more negative stigma than women but not by much (38.1% to 37.7%). The study also found that a perceived negative stigma towards alcohol dependency and necessary treatment was higher for those with lower personal income, lower education, and those previously married vs. those who had never been married. The study also showed that individuals with more chronic alcohol dependencies were more likely to seek treatment. (Medical News Today)

This is one of the few studies that focuses on the negative stigma surrounding alcohol dependencies and its relationship to underutilized treatment services. The researchers, who published the study’s findings in the November issue of the American Journal of Epidemiology, hope that it will encourage more effort in reducing the stigma surrounding alcohol-related dependencies, substance abuse, and necessary treatments.

Signs of Risking Relapse in Recovery

The holidays can be a difficult time for those in recovery. Aside from the many parties scheduled this month, there is often the added stressors of money, work, and family that accompany this time of year. With this said, the risk of relapse increases during the holiday season. This can be particularly worrisome for those whose loved ones are in recovery. Though there are many different ways that people relapse, we’ve highlighted some key ones below. Here are some signs to look for if you’re concerned about your loved one in recovery.

Becoming easily irritated or angered. At a high-stress time such as the holidays, a loved one may feel as if his or her sobriety is unstable and lash out for no apparent reason. Anger and irritability can also be masking feelings of fear, embarrassment or shame that may surround their past substance abuse or current lifestyle of sobriety. Anger and irritability can also result from someone being unable or unwilling to seek help in getting a handle on the situation.

Difficulty handling life’s stresses. ‘Tis the season to be merry, right? But we all know what it feels like to be overwhelmed at times during the holidays. However, it becomes a concern for someone in recovery when daily stressors that a healthy person may take in stride, become catastrophic issues for those in recovery, especially those new in recovery. Clear out the calendar some this year, until your loved one has better strengthened their coping strategies and regained their ability to deal with more intense situations.

Believing they will never relapse, no matter what! The holiday season is full of challenges for those in recovery. And often times, especially when someone is new to recovery, situations of temptation need to be avoided all together until someone’s coping strategies have been better developed. For example, someone who is not used to avoiding alcohol at parties may limit how many parties they go to until they are sure that they can still avoid alcohol while at the party. Overconfidence in how one can deal with such situations may be a sign of relapse risk, especially if someone is new to recovery. The truth is many need to avoid situations that involve drugs or alcohol no matter how staunch their initial convictions may be. This may mean missing the office holiday party this year. Think of things you and your loved one can do instead such as rent an old holiday movie and opt for hot coco and popcorn.

Lack or loss of commitment to recovery program. Recovery is not the same for everyone, and different things work for each individual. But a possible risk sign for relapsing is a sudden avoidance or disinterest in one’s recovery program. This could mean leaving a residential or outpatient program early, making excuses to avoid or quit private counseling, group counseling, or AA meetings.

Revisiting past behavior patterns. Similar to the one before, revisiting prior behavior patterns is a sign that a loved one is risking relapse. Undesirable behavior can be quickly relearned. And if a loved one begins hanging out with old drinking buddies or visiting places where her addiction was in full gear, the risk of relapse greatly increases.

If you recognize any of these signs in your loved one, don’t be afraid to speak up and offer support. Remind them of the consequences of relapse and what is at stake if they continue with the destructive behavior. But remember you are not the cause of or responsible for any relapse. Only your loved one can decide to stay in recovery. If you need help, be sure to reach out to an addiction specialists.