Cocaine Addiction and Treatment

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Memory may draw addicts back to cocaine

Nostalgia may be a recovering drug addict's worst enemy. A memory center of the brain acts as an ignition switch for relapse into cocaine addiction, scientists suggest in the May 11 SCIENCE.

The researchers electrically stimulated the hippocampus in the brains of formerly drug-addicted rats. The treatment reignited powerful cravings for cocaine.

"It is the first time anyone has ever been able to stimulate relapse by [electrically] stimulating a brain circuit," says coauthor Eliot L. Gardner of the National Institute on Drug Abuse in Baltimore.

The finding suggests that the hippocampus, an area that participates in the recall of memories, and a chemical it releases play important roles in addiction relapses, report Gardner, Stanislav R. Vorel of the Albert Einstein College of Medicine in New York City, and their colleagues. The study could lead in 10 to 15 years to novel drugs to stem the cravings that lead to relapses of addiction, Gardner says.

People grapple with cravings long after escaping chemical dependency. For addicts, even simple reminders of past drug use, such as the sight of a certain street corner, can trigger cravings that lead to renewed abuse and drug dependence. Resuits from laboratory studies indicate that animals return to drug-seeking behavior when they experience stress and other stimuli similar to those that send people back to drugs.

For many years, scientists have associated the hippocampus with drug-experience memories, but research hadn't revealed any physiological pathway leading from memory to relapse, says Vorel. The hippocampus has been linked to the reward pathways of addiction, which lead to the release of the neurotransmitter dopamine and the pleasurable effects of drugs. However, brain imaging of people who say they are experiencing cravings showed no activation in the hippocampus.

In their experiment, Vorel, Gardner, and their colleagues trained rats to press a lever to receive a dose of cocaine directly into the bloodstream. After the researchers cut off the rats' cocaine supply, the lever-pressing behavior gradually ceased. This results from dwindling cravings, the researchers say.

The scientists next applied a specific pattern of electrical pulses to the rat's hippocampus. In response, the animals began pressing the lever again. A drug that blocks glutamate, a signal chemical released by the hippocampus, prevented the behavior. Other types of pulses and the stimulation of other memory regions and the reward pathway did not lead to lever pushing.

The new work points to glutamate as the mediator of the well-known process in which hippocampal activity can cause the release of dopamine by another part of the brain, says Vorel. This neurochemical detail links the relapse and reward pathways, he says, so dopamine must play a role in relapses.

He speculates that dopamine acts as a reminder of past rewards rather than just as a pleasure inducer.

Dopamine's role as stimulus for craving surprises those researchers who thought of the neurotransmitter as satisfying an addict's desire, says Kent Berridge of the University of Michigan in Ann Arbor. "To show that it's the opposite is a major piece of interesting research." -J. Netting
Treatment: Acupuncture helps cocaine addicts

Acupuncture, which has been shown to ease pain, nausea, depression and other ailments in some patients, may also help cocaine addicts quit, researchers said this week.

More than half of the addicts participating in a Yale University study, who were treated with acupuncture needles in their ears five days a week for eight weeks, tested free of cocaine at the end of treatment -- more than double the quitting rate of a control group.

A total of 82 participants who were addicted to both cocaine and heroin were divided into three groups. All had counselling and received methadone for their heroin addictions.

Among those who had needles inserted in their ears in places thought to treat addiction, 55 per cent tested free of cocaine at the close of treatment based on urine screens.

The two control groups included one that had needles inserted in ear points that were not thought to have a treatment effect. Less than one-quarter (24 per cent) stopped using cocaine.

In a third group, which viewed nature scenes and other relaxing images, only nine per cent stopped using the drug.

Those who completed the effective acupuncture treatment also had longer periods of sustained abstinence than the control groups.

"Our study supports the use of acupuncture for cocaine addiction and shows that alternative therapies can be combined with the arsenal of western treatments for fighting addiction," Yale psychiatrist and principal investigator Arthur Margolin said.

"Additional benefits of acupuncture include its low cost, and that it seems to have few, if any, adverse side effects," he said, noting that this was the first study of its kind and that additional research was needed.

A 1997 report by a panel of the National Institutes of Health concluded that acupuncture does work sometimes, specifically for easing the nausea caused by chemotherapy, for morning sickness and as an anesthesia.

The panel also said acupuncture might work either with traditional western medicine or as an adjunct to it in other areas. These included addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia (general muscle pain), low back pain, carpal tunnel syndrome and asthma.

A subsequent study showed acupuncture performed on cats produced endorphins -- sometimes called the body's natural opiate system regulating muscle function and pain -- that could prove effective in lowering blood pressure and treating heart disease in humans. Research on depressed women found some benefited from the needle therapy.
Treatment: Cocaine addiction eased by acupuncture

Acupuncture, which has been shown to ease pain, nausea, depression and other ailments in some patients, may also help cocaine addicts quit, researchers said Sunday.

More than half of the addicts participating in a Yale University study, who were treated with acupuncture needles in their ears five days a week for eight weeks, tested free of cocaine at the end of treatment -- more than double the quitting rate of a control group.

A total of 82 participants who were addicted to both cocaine and heroin were divided into three groups. All underwent counselling and received methadone for their heroin addictions.

Among those who had needles inserted in their ears in places thought to treat addiction, 55 per cent tested free of cocaine at the close of treatment based on urine screens.

The two control groups included one that had needles inserted in ear points that were not thought to have a treatment effect. Less than one-quarter (24 per cent) stopped using cocaine.

In a third group, which viewed nature scenes and other relaxing images, only nine per cent stopped using the drug.

Those who completed the effective acupuncture treatment also had longer periods of sustained abstinence than the control groups.

"Our study supports the use of acupuncture for cocaine addiction and shows that alternative therapies can be combined with the arsenal of Western treatments for fighting addiction," Yale psychiatrist and principal investigator Arthur Margolin said.

"Additional benefits of acupuncture include its low cost, and that it seems to have few, if any, adverse side effects," he said, noting that this was the first study of its kind and that additional research was needed.

A 1997 report by a panel of the National Institutes of Health concluded that acupuncture does work sometimes, specifically for easing the nausea caused by chemotherapy, for morning sickness, and as an anesthesia.

The panel also said acupuncture might work either with traditional Western medicine or as an adjunct to it in other areas. These included addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia (general muscle pain), low back pain, carpal tunnel syndrome and asthma.

A subsequent study showed acupuncture performed on cats produced endorphins -- sometimes called the body's natural opiate system regulating muscle function and pain -- that could prove effective in lowering blood pressure and treating heart disease in humans. Research on depressed women found some benefited from the needle therapy.

The costs of cocaine addiction to this potent narcotic affects many more than just the person ingesting the drug

Deborah James doesn't need to guess how devastating cocaine addiction can be. She knows. James is the former spouse of 31-year- old Gordon Robert Dodds, who was convicted of aggravated assault in September for the March 2004 stabbing of a long-time friend during an argument.

Although James has never done drugs, cocaine has taken a devastating toll on her life. She tells her story in hopes that other people - both those who run the risk of falling prey to the addiction and those who surround them - will be forewarned.

"More has to be done in this town regarding this issue; there are too many good people out there falling into its power," she says. "Believe me, it will take the strongest man or woman down. It not only affects the person addicted to it, it affects everyone around them."

James said the early years of her relationship with Dodds were good. He used to drink beer regularly, but not to the point where it interfered with his work or their lives.

"We hardly ever argued - we had a nice life," she says. "We used to go camping, do lots of things." Then he started staying out late, she says, and the lies started.

"I didn't have any idea for a long time. We were running our business and I'd say, 'Where's all the money going?' He'd make up lies and I'd say, 'Okay, we'll figure it out.'"

Soon Dodds starting staying out later and later and, finally, not coming home at all. When he did come home, he was louder, more demanding. He didn't want the children around him much.

In 2003, James took her four children and left him, in an attempt to wake him up.

"One thing about cocaine, it makes you not care about anything - not yourself - you have no worries, no priorities. All you care about is getting some more. It's a total escape from the world."

She explains that the changes happened slowly so weren't so noticeable but, looking back, it all made sense.

When James left Dodds, she left all their possessions.

"I was so tired of dealing with it all."

Along with losing everything she owned, she also lost their business as well as a supplemental job.

"I was financially destroyed. That's why I'm working so hard now," she says.

Looking back on Dodds' addiction, James says he had been on his own since he was 14. He was a follower, and suffered from low self- esteem - a good target for a drug dealer.

"The dealer would say to him, 'That's okay, you can pay me later or say, 'It's a treat, you don't have to pay.' That's how they get you hooked."

She says she believes cocaine is plentiful in Salmon Arm - and more people should be on guard.

"I've heard that from a lot of people. You can get cocaine easier than you can get pot up here," she says. "People don't talk about it and they need to. People have to stop judging it. A lot of people think I did it because it was in my life. That's not true. They have to stop judging and start helping. I did my judgments too until it happened to me."

James would also like to see people take more time to be together.

"You find a lot now, nobody has time for their family. You have to make time or you can't pick up on these things (symptoms)."

She also believes that six weeks of detox treatment is not enough - addicts need a year. She points out that treatment can be expensive, something that addicts can't afford. James says she continues to be Dodds' friend, but she is glad he was punished for what happened because it has taught her children some valuable lessons about drugs.

"They're really good kids; I'm really proud of them. They've been through a lot. They come first for me."

James would like to see more people talk openly about having someone in their family hooked on cocaine.

"They'll find out there are others in the same situation who aren't doing it themselves. It's helpful knowing you're not alone in the world."
Lawyer thought he had everyone fooled about cocaine addiction

IT WAS TWO years before he realized he was addicted to cocaine - by then he was spending as much as $3,000 a month on the drug, his work had begun to suffer and, surviving on Twinkies and pepperoni sticks, so did his health.

"With the young professional crowd, it was a mark of status to have cocaine around," says Ken, a Vancouver lawyer now recovering from cocaine addiction.

In his 30s and a member of Cocaine Anonymous, Ken says he tried cocaine a few times in the 1970s but didn't begin using cocaine regularly until the early 1980s.

A few lines of cocaine on weekends soon changed to six to eight lines daily. His alcohol consumption also increased.

"I began drinking and doing coke every day - one fuelled the other. Coke sped me up and made me more social, confident. Alcohol slowed me down, kept me from being too speedy."

His life fell into a pattern of hitting the nightclubs after work and staying up to 3 a.m. snorting coke, even though he had to be up for work at 7 a.m.

He started avoiding old friends who weren't aware of his growing cocaine habit. He began missing court dates and appointments with clients. The combined cocaine-alcohol abuse also seriously affected his finances.

"I was spending every spare nickel on coke - $2,000 to $3,000 a month. Rent cheques began to bounce. I totally lost control of my finances at the time."

In his final six months of addiction, he began hitting the bar at noon and doing coke in his office to steady his nerves.

Finally, one of the law firm's partners tapped him on the shoulder.

"He told me to clean up or get out. Up to then, I had the delusion that I had everbody fooled. I was the last one to realize how sick I was. I thought everything was under control."

He now realizes he was a mess mentally and physically.

"My nerves were shot. I had paranoid delusions that family, friends and clients were out to get me, to ruin my life. I was living on Twinkies and pepperoni sticks. I looked like a walking corpse. My skin was pale, my body bloated. I had huge bags under my eyes."

After the warning at work, Ken quit all drugs. He says he was shaky, depressed and disoriented for the first few days and had extreme cravings for cocaine.

Now clean and sober after four years, he still considers himself a recovering cocaine addict and alcoholic.

Since 1981, treatment for stimulant abuse, including cocaine, has grown to about 10 per cent from one per cent, says Dr. Carl Stroh, regional director of Vancouver area alcohol and drug programs.

About 30,000 B.C. residents a year seek treatment for alcohol and drug problems at clinics throughout the province. Cocaine abuse accounts for up to 30 per cent of those seeking treatment at some clinics, Stroh said.

"In the last few years, there has been a fairly significant demand," he said.

Dr. Ray Baker, who treats Vancouver area cocaine addicts as a regional medical adviser for provincial alcohol and drug programs, said addiction to any substance is a gradual process involving compulsive use but cocaine is so addictive that a person can be hooked in two weeks.

"It's one of the most potent stimulants there is - way more addictive than alcohol or heroin," he said.

In the early stages, cocaine users perform well in terms of alertness and stamina, Baker said.

A person usually begins by getting "buzzed" on cocaine during weekends and carries on normally during the week.

Some addicts, however, will stay up for days on end without sleep and "toxic psychosis" sets in, Baker said.

"I've seen it happen very quickly over a number of days. The person becomes paranoid - starts nailing windows shut, that sort of thing - and they can be dangerous."