Producing the “Problem” of Addiction in Drug Treatment.

Producing the “Problem” of Addiction in Drug Treatment.

Qual Health Res. 2013 May 3;
Moore D, Fraser S

In this article, we argue that the “problem” of addiction emerges as an effect of treatment policy and practice as well as a precursor to it. We draw on the work of Marrati to analyze interviews with policy makers and practitioners in Australia. The interviews suggest that the episode-of-care system governing service activity, outcomes, and funding relies on certain notions of addiction and treatment that compel service providers to designate service users as addicts to receive funding. This has a range of effects, not least that in acquiring the label of “addict,” service users enter into bureaucratic and epidemiological systems aimed at quantifying addiction. Rather than treating pre-existing addicts, the system produces “addicts” as an effect of policy imperatives. Because addiction comes to be produced by the very system designed to treat it, the scale of the problem appears to be growing rather than shrinking. HubMed – addiction


Comparison of the Cigarette Dependence Scale with four other measures of nicotine involvement: Correlations with smoking history and smoking treatment outcome in smokers with substance use disorders.

Addict Behav. 2013 Apr 3; 38(8): 2409-2413
Rohsenow DJ, Martin RA, Tidey JW, Monti PM, Colby SM

The Cigarette Dependence Scale (CDS) was developed to assess principal aspects of smoking dependence. In a French longitudinal survey, CDS showed stronger relationships to urge and change in smoking rate than the Fagerström Test for Nicotine Dependence (FTND). Neither measure predicted abstinence at follow-up in that survey but there was no treatment or cessation induction. The present study investigated concurrent and predictive validity of the CDS in a treatment population by comparing the CDS to the FTND and other measures of tobacco involvement as (1) a correlate of smoking and cessation history and (2) a predictor of short-term smoking abstinence among smokers with substance use disorders (SUD) receiving smoking treatment. Methods: Smokers (10+ cigarettes per day) in substance treatment received brief advice and nicotine patch for 8weeks; half also received contingent vouchers for smoking cessation. Assessments were conducted pretreatment and 7, 14 and 30days after treatment initiation, with abstinence verified biochemically. Results: At baseline (n=305), the 12-item and 5-item CDS versions showed excellent and marginal reliability, respectively. FTND shared 43 and 61% of variance with CDS-12 and CDS-5, respectively. FTND and CDS scales correlated positively with cigarettes per day, and negatively with time to first cigarette, motivation to quit and age at first daily smoking. Only CDS correlated with the number of past quit attempts. Neither CDS nor FTND predicted abstinence within treatment, unlike the motivation measure and time to first cigarette. Conclusion: In moderate-heavy smokers with SUD in smoking treatment in the U.S., the CDS is largely equivalent to the FTND as an indicator of tobacco dependence but the CDS-5 is less reliable. Motivation was the most consistent predictor of outcome, and time to first cigarette was the only tobacco dependence measure that predicted smoking abstinence during treatment. HubMed – addiction


Controlled delivery of naltrexone by an intraoral device: In vivo study on human subjects.

Int J Pharm. 2013 May 2;
Paderni C, Campisi G, Schumacher A, Göttsche T, Giannola LI, De Caro V, Wolff A

Naltrexone is widely used in the treatment of opiate addiction but its current peroral administration is characterized by low bioavailability with various side effects. The development of a long-acting transbuccal delivery device (IntelliDrug) for NLX may be useful to improve patient compliance and the therapy effectiveness. The aims of the study are a) to test basic safety and effectiveness of controlled transbuccal drug delivery on human subjects; b) to compare NLX bioavailability following transbuccal delivery vs per os conventional delivery; and c) to test the hypothesis that transbuccal delivery is more efficient than the conventional route. In this randomized cross-over pilot study, 12 healthy subjects received in a different order 2 types of NLX administration, per os or transbuccal delivery, based on which group they were randomized to. For per os administration 50mg NLX tablets were used, while for transbuccal administration, a NLX-loaded prototype of the IntelliDrug device was fixed on patients’ dental arch. Serial blood samples were drawn and analyzed for the NLX concentration. The IntelliDrug prototype functioned properly and it did not exert any adverse side-effect. The transbuccal route resulted in administration efficiency 4-17 times higher than conventional per os route. Transbuccal delivery of NLX appears to be a more efficient drug administration route compared to peroral one. It allows to reach a given therapeutic blood level using a small drug dose. HubMed – addiction


Psychological Stress, Cocaine and Natural Reward Each Induce Endoplasmic Reticulum Stress Genes in Rat Brain.

Neuroscience. 2013 May 2;
Pavlovsky AA, Boehning D, Li D, Zhang Y, Fan X, Green TA

Our prior research has shown that the transcription of endoplasmic reticulum (ER) stress transcription factors Activating Transcription Factor 3 (ATF3) and ATF4 are induced by amphetamine and restraint stress in rat striatum. However, presently it is unknown the full extent of ER stress responses to psychological stress or cocaine, and which of the three ER stress pathways is activated. The current study examines transcriptional responses of key ER stress target genes subsequent to psychological stress or cocaine. Rats were subjected to acute or repeated restraint stress or cocaine treatment and mRNA was isolated from dorsal striatum, medial prefrontal cortex and nucleus accumbens brain tissue. ER stress gene mRNA expression was measured using quantitative PCR and RNA sequencing. Restraint stress and cocaine induced transcription of the classic ER stress-induced genes (BIP, CHOP, ATF3 and GADD34) and of two other ER stress components XBP1 and ATF6. In addition, rats living in an enriched environment (large group cage with novel toys changed daily) exhibited rapid induction of GADD34 and ATF3 after 30 min of exploring novel toys, suggesting these genes are also involved in normal non-pathological signaling. However, environmental enrichment, a paradigm that produces protective addiction and depression phenotypes in rats, attenuated the rapid induction of ATF3 and GADD34 after restraint stress. These experiments provide a sensitive measure of ER stress and, more importantly, these results offer good evidence of the activation of ER stress mechanisms from psychological stress, cocaine and natural reward. Thus, ER stress genes may be targets for novel therapeutic targets for depression and addiction. HubMed – addiction