Monday, October 18, 2010

Do AA and Medications Mix?

Any addiction professional who has worked with program directors of 12 step-based treatment centers, sponsors in Alcoholics Anonymous (AA), and long-term members of AA has experienced the anti-medication bias harbored by some.

However, there is nothing inherent in the 12-step approach that contradicts the use of medication for craving reduction, abstinence enhancement, or for that matter any psychiatric condition or disorder (Brigham 2003). An interesting side note to history occurred during the 1960s and involved a conversation between Dr. Vincent Dole, co-originator of methadone maintenance for heroin addiction, and Bill Wilson, co-founder of AA. Dr. Dole served as a trustee of AA, became friends with Bill Wilson, and recalled a conversation they had (Dole, 1991) where Wilson expressed his concern over alcoholics who could not achieve sobriety despite repeated attempts through AA:

“At the last trustee meeting (of AA) that we (Vincent Dole and Bill Wilson) both attended, he (Bill Wilson) spoke to me of his deep concern for the alcoholics who are not reached by AA, and for those who enter and drop out and never return. Always the good shepherd, he was thinking about the many lost sheep who are lost in the dark world of alcoholism. He suggested that in my future research I should look for an analogue of methadone, a medication that would relieve the alcoholic’s sometimes irresistible craving and enable him to progress in AA toward social and emotional recovery, following the Twelve Steps.”

This highly revealing anecdote reflects the open-mindedness and recognition by the co-founder of AA that some alcoholics require a pharmacotherapeutic intervention to bridge the gap from initial abstinence to stable abstinence and integration in AA. How unfortunate it is that many ardent believers in the 12-step approach have adopted an attitude of rigidity and dogmatism regarding addiction medicine.

Brigham GS. 12-step participation as a pathway to recovery: The Maryhaven experience and implications for treatment and research. Clinical Perspectives-12 Steps and Treatment. 2003;46:43-52.

Dole V. Addiction as a Public Health Problem. Alcoholism: Clinical and Experimental Research. 1991;15:749-752.

Mark Rose

Sunday, October 17, 2010

Agonist Therapy for Stimulant Addiction

Agonist therapy is the use of a (usually) long-acting medication that stimulates the same brain receptors as the drug of addiction. The most obvious example is opioid agonist therapy for opioid addiction using methadone or buprenorphine. Several medications potentially useful for alcohol addiction stimulate GABA receptors as does alcohol. One reason agonist therapy works is that it relieves drug hunger without inducing intoxication. Antagonist therapy, such as using naltrexone to treat opioid addiction can work, but it usually does not relieve drug hunger, so people stop them to seek intoxication. In this new study in Neuropsychopharmacology, a controlled-release form of amphetamine was studied as a treatment for cocaine addiction, with some intriguing results.


Sustained Release d-Amphetamine Reduces Cocaine but not ‘Speedball’-Seeking in Buprenorphine-Maintained Volunteers: A Test of Dual-Agonist Pharmacotherapy for Cocaine/Heroin Polydrug Abusers

Mark K Greenwald1, Leslie H Lundahl1 and Caren L Steinmiller1,2

1. 1Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
2. 2Department of Pharmacology and Toxicology, University of Toledo, Toledo, OH, USA

Correspondence: Dr M Greenwald, Department of Psychiatry and Behavioral Neurosciences, Substance Abuse Research Division, 2761 East Jefferson Ave., Detroit, MI 48207, USA. Tel: +1 313 993 3965; Fax: +1 313 993 1372; E-mail:

Received 18 May 2010; Revised 27 August 2010; Accepted 28 August 2010; Published online 29 September 2010.
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The aim of this study was to determine whether oral sustained release d-amphetamine (SR-AMP) reduces cocaine and opioid/cocaine combination (‘speedball’-like) seeking in volunteers with current opioid dependence and cocaine dependence. Following outpatient buprenorphine (BUP) 8 mg/day stabilization without SR-AMP, eight participants completed a 3-week in-patient study with continued BUP 8 mg/day maintenance and double-blind ascending SR-AMP weekly doses of 0, 30, and 60 mg/day, respectively. After 3 days (Saturday–Monday) stabilization at each SR-AMP weekly dose (0, 15, or 30 mg administered at 0700 and 1225 each day), on Tuesday–Friday mornings (0900–1200 hours), participants sampled four drug combinations in randomized, counterbalanced order under double-blind, double-dummy (intranasal cocaine and intramuscular hydromorphone) conditions: cocaine (COC 100 mg+saline); hydromorphone (COC 4 mg+HYD 24 mg); ‘speedball’ (COC 100 mg+HYD 24 mg); and placebo (COC 4 mg+saline). Subjective and physiological effects of these drug combinations were measured. From 1230 to 1530 hours, participants could respond on a choice, 12-trial progressive ratio schedule to earn drug units (1/12th of total morning dose) or money units (US$2). SR-AMP significantly reduced COC, but not HYD or speedball, choices and breakpoints. SR-AMP also significantly reduced COC subjective (eg, abuse-related) effects and did not potentiate COC-induced cardiovascular responses. This study shows the ability of SR-AMP to attenuate COC self-administration, as well as its selectivity, in cocaine/heroin polydrug abusers. Further research is warranted to ascertain whether SR-AMP combined with BUP could be a useful dual-agonist pharmacotherapy.

Monday, October 4, 2010

Navy Offers On-Line Help for Addictions

Now, if only they'd offer CBT and medications as well... (sigh)


October 3, 2010

Navy Offers Sailors Online Help to Quit Addictions


Filed at 1:13 p.m. ET

RICHMOND, Va. (AP) — The Navy is teaming up with a highly regarded addiction treatment center to provide Web-based support for thousands of sailors, their families and retired personnel struggling with alcohol and drug abuse.

The $3.25 million program is intended to keep sailors with addiction problems on the road to recovery and links them to support programs anywhere in the world, at anytime, even when they're deployed. It is tailored primarily to younger sailors, who are at greater risk and are comfortable navigating the Internet and social programs.

It was developed in collaboration with Hazelden, a nonprofit alcohol and drug addiction treatment center based in Minnesota, and aimed at the 10,000 patients who receive primary treatment annually under the Navy's Substance Abuse and Rehabilitation Services program. While families and retired Navy also receive treatment, the majority of patients are on active duty.

The online program launched in August is called Navy MORE, an acronym for My Ongoing Recovery Experience. An estimated 1,000 patients are expected to use the program in its first year.

"It's patient-centered care," said Master Chief Michael P. Brown, a Navy recovery coach for the Pacific Northwest, the Great Lakes and Hawaii. "We just assist them along the way.

Capt. Richard D. Bergthold, a clinical psychologist with the Navy, said the program is tailored to military use but also provides the continuing, immediately accessible support and resources that anyone overcoming addiction needs.

"We know it's the investment in the continuing care that makes or breaks a successful treatment," said Bergthold, chief of staff for the Navy's Wounded, Ill and Injured directorate. "We recognize more and more the importance of maintaining continuous engagement with an individual's recovery plan."

A 2005 Department of Defense study found that all military personnel between the ages of 18-25 were more likely to drink heavily than their civilian counterparts. Seventeen percent of Navy personnel described themselves as heavy drinkers, defined as someone who consumes five or more alcoholic drinks at one sitting at least once a week. Illicit drug use has trended down over the past few decades, according to the Pentagon.

Hazelden, which has worked with the Navy for 10 years and already trains Navy counselors, developed MORE over several years to help sailors who have struggled with addiction problems to stay clean and sober once they have gone through the Navy's treatment program.

"One of the main reasons for relapse is the loss of that connectivity during early recovery," said Nick Motu, a Hazelden vice president who worked with the Navy on the program. "We believe that if you can maintain a real solid recovery platform for the first 18 months, the chances of your success and long-term recovery are much higher."

Navy MORE extends this connectivity by putting Navy-specific programs online, including 12-step recovery approaches and a suicide hotline as well as treatment programs tailored to sailors or retirees who are suffering from post traumatic stress disorder.

Sailors, their families and retirees also will have access to a virtual "recovery coach" to manage their post-treatment progress; an online library of recovery topics; and online support groups, including real-time connections with counselors.

"They don't have access to the traditional recovery communities that someone on the outside world would have," Motu said of sailors who are deployed around the world.

While a sailor assigned to an aircraft carrier would have access to program counselors, other military personnel including Marines in a carrier group might not have the same access to services, Bergthold said.

The Web program's key benefits are immediacy and the ability to access resources with the click of a mouse.

"It's when they go back to their homes, when they go back to their ships, when they go into the increasingly stressful environments in which they work that they require these continuing care services," he said.

Brown, who is based at Naval Hospital Bremerton in Washington, said it's in the Navy's interest to return "productive sailors to the fleet."

"Everyone in life has their bumps. We're here to assist them and we're here to help them on their path," he said.

The program is free to its users and the Navy has signed a five-year contract. Motu said Hazelden is in discussions with other branches of the military to develop similar programs.



Navy MORE: